Fecal transplant (fecal microbiota transplantation or FMT)
What is a fecal transplant?
How to do a fecal transplant
Results of using faecal/fecal transplantation
References
This procedure is also known as faecal/fecal microbiota transplantation (FMT), faecal/fecal bacteriotherapy or faecal/fecal flora reconstitution.
What is a fecal transplant?
A single course of antibiotics can destroy the good bacteria in your intestines. If you have ever had a course of antibiotics, there is a good chance that the microorganisms in your digestive tract are out-of-balance or even ruined. This can also apply to your eyes, nose, throat, skin, vagina, bladder and other parts of your body where a bacterial balance is essential for good health. Health professionals usually recommend that you use of probiotics in this situation, and sometimes probiotic capsules and pills help.
The bacteria, yeasts, protozoa and other microorganisms in a healthy person are built up over a lifetime. Mother's milk contains important flora, and during the first few years of life while infants crawl around and put virtually every available object in their mouths, they are building up an essential balance of gut flora that will protect and provide good health for the rest of their lives.
Most store-bought probiotics contain one or at the most a dozen different bacteria and yeasts. What you really need is hundreds of different microorganisms to re-establish your digestive ecosystem. In Grow Youthful I recommend the use of natural probiotic foods such as home-made water kefir, milk kefir, rejuvelac and sauerkraut. There is plenty of evidence that these natural home remedies are very successful in re-establishing your microflora ecology.
However, in a few intractable cases, even water kefir and other natural probiotic foods are not enough. Clostridium difficile is a notoriously difficult infection to control. Typically, most doctors prescribe powerful antibiotics with limited success. Typically, those infected with c. difficile experience chronic diarrhea, a variety of serious IBS type symptoms, and the bacteria may even eat away the lining of the gut. C. diff has become drug resistant, with many of those infected being hospitalised, occasionally having their colons removed, and even dying.
Other infections such as blastocystis hominis and dientamoeba fragilis are notoriously difficult to control, and in some people cause the symbiotic balance of bacteria in the gut to go out of kilter.
FMT is a first line treatment for patients with pseudomembranous colitis, ulcerative colitis, some other forms of colitis, chronic constipation or diarrhea, Irritable Bowel Syndrome, SIBO and inflammatory bowel disease. It can have great success with a variety of other conditions such as various autoimmune disorders, obesity and some neurological conditions including anxiety and depression.
One of the essential bacteria in the gut is helicobacter pylori. A century ago, this was the dominant bacterium in the stomachs of most people. Today, fewer than 5% of children in the USA and rich countries have it. However, in poor countries that use traditional medicine rather than modern pharmaceutical medicines (ie antibiotics), most people still have it. H. pylori is associated with stomach ulcers and several other ailments, but this is not the full story. New research shows that the loss of this bacterium (and probably others not yet identified) may cause many modern diseases like asthma, diabetes, IBS, stomach cancer and much more. Details on helicobacter pylori.
How to do a fecal transplant
A sample of stool from someone with good intestinal health is inserted in the small intestine, or high in the large intestine. The effect is that the good bacteria in the donated stool establish themselves and crowd out the pathogenic microorganisms that are out of control.
Patients often find their own donor, such as a spouse or family member. The best donors are usually those who have never had an antibiotic in their entire lives, and who enjoy good health and particularly, good digestion. There is an "ick" factor about using someone else's poop. If the donor is not someone known to the patient, the doctors need to put them through the same level of screening as for a blood donation for example. There should always be some testing to ensure that the donor does not have c. difficule or other infections.
Most doctors prepare the fecal sample by putting it in water and filtering out the solid matter. In future as this therapy becomes widely used, further refining and preparation of the donated faeces is likely, with widespread use of refined faeces in enteric coated capsules.
Currently, three different methods of fecal transplantation are being used to get the fecal donation into the patient.
- Most doctors use a bowel cleansing routine, followed by a colonoscopy to squirt a solution made from the donated faeces through the anus and high up into the large intestine as an enema
- A few doctors have used a tube down the throat (nasogastric or nasoduodenal tube) and through the stomach to reach the small intestine
- Others use an enteric-coated capsule - this is a capsule that does not dissolve until it has passed through the stomach.
Some patients perform the procedure themselves, emptying their bowels as much as possible, and then using a simple enema or colonic tube to insert the donated faeces as high as possible up into their own colon. An enema syringe or Higginson syringe, available at most pharmacies, is also suitable for the job.
Results of using faecal/fecal transplantation
Sometimes the first attempt will "take", but often multiple attempts are necessary, particularly by those who are doing it themselves. I heard of a case where someone self-applied a friend's donation for several weeks before enjoying complete remission of their ulcerative colitis / Crohn's disease.
The results have been dramatically successful. About a dozen doctors in the USA, Australia and Europe have described using fecal transplants to treat c. difficule patients, with complete recovery in more than 90% of their patients. This is an unheard-of success rate. It has had up to a 95% success rate with some IBS type conditions, and small intestinal bacterial overgrowth (SIBO).
In the US, the FDA is stonewalling the use of fecal transplants, rather than encouraging further research. It seems that fecal transplants are too successful, too simple, and too cheap. Various medical bodies are not keen to see the incomes of some of their members lost so easily.
I find it appalling that some so-called expert doctors will consider removing a patient's colon and condemning them to a shortened and unpleasant life, without at least first trying a fecal transplant.
References
1. Borody T.J., Leis S., Campbell J. et al.
Fecal Microbiota Transplantation (FMT)in multiple sclerosis (MS).
Am J Gastroenterol 2011; 106: S352
2. Scientific American.
Swapping Germs.
December 2011
3. Borody T.J., Campbell J., Torres M. et al.
Reversal of idiopathic thrombocytopenic purpura (ITP) with Fecal Microbiota Transplantation (FMT)
Am J Gastroenterol 2011; 106: S352
4. Journal of Clinical Gastroenterology, September 2010. Editor-in-chief Dr Martin Floch:
"It is clear from all these reports that fecal bacteriotherapy has arrived as a successful therapy."
5. Borody T.J., Khoruts A.
Fecal Microbiota Transplantation and emerging applications.
Nat Rev Gastroenterol & Hepatol Published online 20 December 2011
6. Kelly C.R., De Leon L., Jasutkar N.
Fecal Microbiota Transplantation for relapsing Clostridium difficile infection in 26 patients: methodology and results.
J Clin Gastroenterol 2012; 46(2): 145-149.
7. Bakken J.S., Borody T.J., Brandt L.J. et al.
Treating Clostridium difficile infection with Fecal Microbiota Transplantation.
Clin Gastroenterol & Hepatol 2011; 9(12): 1044-1049
8. Lawrence Brandt of the Albert Einstein College of Medicine has been performing fecal transplants since 1999, and says fecal
donations should be the first option for c. difficile infection, rather than a last resort.
9. Borody T.J., Campbell J.
Fecal Microbiota Transplantation: current status and future directions.
Expert Rev. Gastroenterol & Hepatol 2011; 5(6): 653-655.
10. Borody T.J., Torres M., Campbell J. et al
Reversal of inflammatory bowel disease (IBD) with recurrent fecal microbiota transplants (FMT).
Am J Gastroenterol 2011; 106: S352