The brave new world of DIY faecal transplant(bbc.co.uk)
bbc.co.uk
The brave new world of DIY faecal transplant
http://www.bbc.co.uk/news/magazine-27503660
62 comments
I was diagnosed with crohn's disease in 2008. Thankfully mine is under control with 2.5mg naltrexone every second night - I have mildy active disease now but am asymptomatic and have no ulceration visible on a 'scope. Before I started LDN, I'd have happily done this, and my symptoms were pretty mild compared to many.
Everything that can be done to make this easier, safer and a more wildly offered option should be done ASAP.
I am a fecal donor for FMT (in addition to a microbiologist and epidemiologist) and am willing to answer any questions you might have, an AMA if you will.
I have some problems that I don't have any particular diagnosis for. Is there any way I can find out whether it's worth trying this? Is it a problem for someone to get a transplant when they don't actually need it? (The article writer seemed to think it was a bad thing, but if it really is "as dangerous as changing a baby's diaper", then it doesn't sound any worse than taking unnecessary vitamins.)
(Problems are food intolerances, some cause unusually painful gas, others affect my mind. My doctor has no idea what causes it, and some of them are to really common foods, so staying on my diet is difficult.)
(Problems are food intolerances, some cause unusually painful gas, others affect my mind. My doctor has no idea what causes it, and some of them are to really common foods, so staying on my diet is difficult.)
I'd speak with your physician about the possibility of FMT. Your MD can get in touch with these guys http://www.openbiome.org/ that provide low cost samples for transplant ($250).
Has this procedure been investigated to ensure proper gut colonization in new borns after labor that involves antibiotics? Either via a transplant to the mother or child?
Not that I know of.
An interesting aside - as you may have read, FMT is being investigated as a treatment for autism. The thinking here is as follows. Babies are born with a certain level of Clostridium species (not necessarily C. diff). Clostridium are very good at producing toxins (botulism and the toxins involved in C.diff). Normally the level of clostridium in babies drops on its own. It's believed that in some babies, this drop never happens. These babies are then therefore continually exposed to toxins from these clostridium bugs, some of which may have neurotoxic properties and can result in autism. The goal of FMT is to alter the gut flora enough to get rid of these Clostridium species and stop the toxin from reaching the brain. There has been success in young children. What we need to keep in mind though is that autism is a spectrum of not only symptoms, but also a spectrum of causes as well, so FMT won't necessarily work for everyone.
An interesting aside - as you may have read, FMT is being investigated as a treatment for autism. The thinking here is as follows. Babies are born with a certain level of Clostridium species (not necessarily C. diff). Clostridium are very good at producing toxins (botulism and the toxins involved in C.diff). Normally the level of clostridium in babies drops on its own. It's believed that in some babies, this drop never happens. These babies are then therefore continually exposed to toxins from these clostridium bugs, some of which may have neurotoxic properties and can result in autism. The goal of FMT is to alter the gut flora enough to get rid of these Clostridium species and stop the toxin from reaching the brain. There has been success in young children. What we need to keep in mind though is that autism is a spectrum of not only symptoms, but also a spectrum of causes as well, so FMT won't necessarily work for everyone.
Fascinating. What are the symptoms or diagnostic tests that would lead a doctor to consider this?
It would mostly be a parent investigating it on their own I would say.
It's well known that children with autism have frequent GI issues (diarrhea etc). You'll find that many parents have their autistic children on special diets (gluten free, dairy free etc) all of which attempt to alleviate the GI symptoms. They may work, but it's likely because they are changing the gut flora, rather than removing the gluten protein for example.
It's well known that children with autism have frequent GI issues (diarrhea etc). You'll find that many parents have their autistic children on special diets (gluten free, dairy free etc) all of which attempt to alleviate the GI symptoms. They may work, but it's likely because they are changing the gut flora, rather than removing the gluten protein for example.
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>ensure proper gut colonization in new borns after labor that involves antibiotics
Babies get their intestinal bacteria during the birthing process from the vagina, their mother, the mother's feces, etc. That's why C-section infants have vastly different gut flora initially. They never made that trip down the vagina to be exposed to vaginal bacteria and are exposed to different types of bacteria during the first few weeks of life. I'm not sure the effect of antibiotics are the same or similar to that of a c-section baby. I'm not sure we know the long term effects of c-section babies and gut flora especially later in life. I would think c-section would be much more disturbing to gut flora than antibiotics.
http://en.wikipedia.org/wiki/Gut_flora#Acquisition_of_gut_fl...
Babies get their intestinal bacteria during the birthing process from the vagina, their mother, the mother's feces, etc. That's why C-section infants have vastly different gut flora initially. They never made that trip down the vagina to be exposed to vaginal bacteria and are exposed to different types of bacteria during the first few weeks of life. I'm not sure the effect of antibiotics are the same or similar to that of a c-section baby. I'm not sure we know the long term effects of c-section babies and gut flora especially later in life. I would think c-section would be much more disturbing to gut flora than antibiotics.
http://en.wikipedia.org/wiki/Gut_flora#Acquisition_of_gut_fl...
As a potentially interesting correlation: difficult pregnancies/cesareans tend to produce more autism:
http://www.autismtoday.com/library-back/Autism_More_Likely_i...
http://www.autismtoday.com/library-back/Autism_More_Likely_i...
I'm sure your right but my wife and I just had a kid through lengthy vaginal birth with antibiotics which is why I asked. (FWIW I'm a computational biologists working on medical studies and have the seen some of the research in this area before, not just one to randomly self medicate.)
There seems to be a growing interest in this field, but there is a lot we don't know yet.
Human feces hasn't been an area with much prestige (and money to be made), so few used to care about it. But, if I remember correctly, the growing interest has partly been caused by geneticists who were initially studying the genome of e.g. humans, but who switched target as the original work was done much quicker than anybody though was possible.
From what I know about the research so far, it seems like our bacterial flora, especially in the gut, is tightly connected to quite a few diseases. However, for many of them, it is still unclear what is cause and effect: Does the altered flora cause the disease, or does the disease cause the altered flora? External factors like stress is known to alter gut flora. On the other hand, bacteria in your gut may affect your mood and personality. Figuring out what is what is tricky, and I suppose there can be feedback loops here as well.
There is much more research to be done. You should be careful with experimenting, as there is risk involved: You may get bacteria that you don't want, and you don't know what the changed flora will do to you. An acquaintance of mine is a researcher in this field, and he does not recommend taking probiotics for e.g. IBS, as he think we still know too little about what types of bacteria to take, dosage, and potential negative long term effects. "Good" strains can do bad things in some contexts, and interaction/symbiosis between different strains (and us) may complicate things. That being said, afaik, probiotics is generally thought to be safe (although I am not sure all manufacturers are trustworthy).
Personally, I think this field has the potential to really change the way we think about health, disease, and medicine. Another field, which I think is related, is diet and fasting: food, and lack of food, alters our gut flora too.
Human feces hasn't been an area with much prestige (and money to be made), so few used to care about it. But, if I remember correctly, the growing interest has partly been caused by geneticists who were initially studying the genome of e.g. humans, but who switched target as the original work was done much quicker than anybody though was possible.
From what I know about the research so far, it seems like our bacterial flora, especially in the gut, is tightly connected to quite a few diseases. However, for many of them, it is still unclear what is cause and effect: Does the altered flora cause the disease, or does the disease cause the altered flora? External factors like stress is known to alter gut flora. On the other hand, bacteria in your gut may affect your mood and personality. Figuring out what is what is tricky, and I suppose there can be feedback loops here as well.
There is much more research to be done. You should be careful with experimenting, as there is risk involved: You may get bacteria that you don't want, and you don't know what the changed flora will do to you. An acquaintance of mine is a researcher in this field, and he does not recommend taking probiotics for e.g. IBS, as he think we still know too little about what types of bacteria to take, dosage, and potential negative long term effects. "Good" strains can do bad things in some contexts, and interaction/symbiosis between different strains (and us) may complicate things. That being said, afaik, probiotics is generally thought to be safe (although I am not sure all manufacturers are trustworthy).
Personally, I think this field has the potential to really change the way we think about health, disease, and medicine. Another field, which I think is related, is diet and fasting: food, and lack of food, alters our gut flora too.
I agree. We have only started to explore the interaction between our microbes and our health and I am sure there will be some amazing discovery made over the next few years.
An example of this is the report by Borody that three Parkinson's patients who had C. difficile infections treated using faecal transplant. The transplants cured the C difficile infection, but he noticed that their Parkinson's symptoms were significantly reduced. Changing the bacterial in the guts somehow had an effect on neurotransmitters in the brain.
An example of this is the report by Borody that three Parkinson's patients who had C. difficile infections treated using faecal transplant. The transplants cured the C difficile infection, but he noticed that their Parkinson's symptoms were significantly reduced. Changing the bacterial in the guts somehow had an effect on neurotransmitters in the brain.
Also, it's fairly well known by this point that there's an altered microbiome in Autism. Would be fascinating to see a transplant study done if the risk is so low.
Not for the faint of heart... the picture of the blender was a little too much for my taste!
It is an interesting approach. One thing I don't understand is why they are blending the faecal matter. Most of the organisms in the gut are strict anaerobes which are killed on contact with oxygen. Blending is going to introduce an enormous amount of oxygen.
If I was doing this I would put the faecal matter in a ziploc bag containing saline, expel all the air, close the bag and gently massage it to get the nice "soup". This would stay anaerobic and save my blender too :)
If I was doing this I would put the faecal matter in a ziploc bag containing saline, expel all the air, close the bag and gently massage it to get the nice "soup". This would stay anaerobic and save my blender too :)
Microbiologist here - the name anaerobe is a pretty broad term. Within the gut there is going to be obligate anaerobes (killed by atmospheric O2) and facultative anaerobes (can survive in both oxygen rich and oxygen deplete environments).
In a blender, the obligates will likely die but the facultative will remain.
In a blender, the obligates will likely die but the facultative will remain.
I am also a microbiologist (my Ph.D was in molecular microbiology). I didn't work on obligate anerobes, but the lab next door did. They had to go to a lot of trouble to keep oxygen out of all their experiments by using aneroboic chambers and the like (a total pain).
The problem is that most of the organisms in the gut are obligate (strict) anerobes. Sure the faculatative anaerobes will survive, but this is going to create an imbalance in the populations being transplanted. If the aim is to restore tha balance present in a healthy individual why introduce oxygen when it is easy to avoid.
The problem is that most of the organisms in the gut are obligate (strict) anerobes. Sure the faculatative anaerobes will survive, but this is going to create an imbalance in the populations being transplanted. If the aim is to restore tha balance present in a healthy individual why introduce oxygen when it is easy to avoid.
Two things, you aren't necessarily trying to achieve the identical balance. Most of the research in this area is finding the particular bacteria that are important to repopulate the ill gut. The aim is to eventually transplant only the important bugs or just grow the important ones and skip the fecal donors all together.
The other issue is that it would be very hard to get a fecal sample that hasn't been exposed to O2.
The other issue is that it would be very hard to get a fecal sample that hasn't been exposed to O2.
I think I remember reading that the rough-and-ready procedure being used by doctors performing the study also involved the laboratory equivalent of a blender. Not sure if I'm misremembering, or if there are laboratory blenders that don't introduce oxygen, or if the researchers don't think it matters, or what.
I am a donor at a large center performing these procedures and work with the physician and lab staff. The purpose of the blender is to make the fecal material into a slurry, after that it is filter through paper to remove food particles. The filter paper allows the bacteria to pass through. The resultant liquid is given to the patient (enema, NG tube, pill).
Can you address danieltillett's question regarding anaerobes?
For sure.... quoted below.
Microbiologist here - the name anaerobe is a pretty broad term. Within the gut there is going to be obligate anaerobes (killed by atmospheric O2) and facultative anaerobes (can survive in both oxygen rich and oxygen deplete environments).
In a blender, the obligates will likely die but the facultative will remain.
Microbiologist here - the name anaerobe is a pretty broad term. Within the gut there is going to be obligate anaerobes (killed by atmospheric O2) and facultative anaerobes (can survive in both oxygen rich and oxygen deplete environments).
In a blender, the obligates will likely die but the facultative will remain.
You sir, have just ruined... everything.
Reddit and having children desensitized me to that sort of stuff.
Interesting idea though. What happens if it goes wrong?
Interesting idea though. What happens if it goes wrong?
From my reading of the scientific literature in this area the worst you can expect is mild gastro - compared to a C. difficile infection this is not really a concern.
I was thinking more that the cultures in the donor poop are unknown. There are numerous horrible things that you don't want stuffed up your bum from more c.diff to worms to ulcerative bleeding carrying HIV for example.
Yes this is a risk, but in general pretty low if you know the person well. If you are taking the sample from your husband or wife you would hope you would know if they have HIV or not.
Actually the risk of getting worms is an interesting potential positive. There is a lot of data suggesting that the lack of intestinal worms in western countries is one of the reason for the rise of autoimmune diseases like Crohns. The theory is that the immune system in the gut is designed up to keep worms under control and in their absence starts attacking things like the gut tissue instead. There are a couple of stage three trial currently running that are giving people pig wipworms (they can infect but not reproduce in the human gut) to treat Crohns. The earlier trials were really encouraging so it will be interesting to see how they turn out.
Actually the risk of getting worms is an interesting potential positive. There is a lot of data suggesting that the lack of intestinal worms in western countries is one of the reason for the rise of autoimmune diseases like Crohns. The theory is that the immune system in the gut is designed up to keep worms under control and in their absence starts attacking things like the gut tissue instead. There are a couple of stage three trial currently running that are giving people pig wipworms (they can infect but not reproduce in the human gut) to treat Crohns. The earlier trials were really encouraging so it will be interesting to see how they turn out.
This is why the doctors/scientists in the article recommended that donors be screened first.
But the more I discover about medicine and biology, the more I realize how much we still don't know. Hundreds of types of bacteria in a typical stool sample? This is amazing! Whole biomes await study... from internal gut bacteria (very small scale), to microbial colonies (regional or national scale) that we use for fermentation. Exciting!
But the more I discover about medicine and biology, the more I realize how much we still don't know. Hundreds of types of bacteria in a typical stool sample? This is amazing! Whole biomes await study... from internal gut bacteria (very small scale), to microbial colonies (regional or national scale) that we use for fermentation. Exciting!
We actually don't know how many bacteria live in the human gut, but may be as many as 100,000 different species although around 1000 dominate. One of the difficulties with estimating how many species are present is that it is hard to know if a particular species is a member of the "native" gut microflora or just passing through.
No one knows - that's the biggest issue. It is very complex.
Based on studies it seems pretty low risk, as long as the donor is tested for disease.
Thanks for the warning, unfortunately I took no heed. Gonna wait it out a little longer before breakfast!
What do you mean, "taste"?
My company published a guide to C Diff last year. The author, a GI doc and C diff researcher, had this to say about hospital-initiated transplants:
Stool transplant, also known as a fecal transplant, is a unique therapy. At our hospital, we recommend stool transplants only if all else has failed. Specifically, if a patient has had recurrence of C. diff, even after pulse-tapered Vanco treatment, or multiple bouts of Vanco, Dificid or Flagyl, it’s time to consider a stool transplant.
The idea behind a stool transplant is to “reseed the lawn,” so to speak. After exposure to weeks or months of antibiotics (including Vanco) the normal bowel flora — the organisms in your colon that help prevent infection — is weakened. They simply can’t keep C. diff out. In other words, the normal barrier function of the colonic flora is gone, and C. diff gets right back in. So putting in some normal flora from a healthy donor is like reseeding the lawn — it restores the barrier.
The author was aware of the DIY movement, as well as the rise of holistic medical practitioners who are offering transplant treatments.
He also noted that transplants are still relatively rare. Not many PCPs know much about C diff and recommended treatments; patients usually are referred to specialists in gastrointestinal and infectious disease.
Stool transplant, also known as a fecal transplant, is a unique therapy. At our hospital, we recommend stool transplants only if all else has failed. Specifically, if a patient has had recurrence of C. diff, even after pulse-tapered Vanco treatment, or multiple bouts of Vanco, Dificid or Flagyl, it’s time to consider a stool transplant.
The idea behind a stool transplant is to “reseed the lawn,” so to speak. After exposure to weeks or months of antibiotics (including Vanco) the normal bowel flora — the organisms in your colon that help prevent infection — is weakened. They simply can’t keep C. diff out. In other words, the normal barrier function of the colonic flora is gone, and C. diff gets right back in. So putting in some normal flora from a healthy donor is like reseeding the lawn — it restores the barrier.
The author was aware of the DIY movement, as well as the rise of holistic medical practitioners who are offering transplant treatments.
He also noted that transplants are still relatively rare. Not many PCPs know much about C diff and recommended treatments; patients usually are referred to specialists in gastrointestinal and infectious disease.
One thing that I'm curious about: the GI tract is long and wiggly. Stuffing a transplant in one end only gets flora so far. Probiotics in the other end may help too. So what happens about the rest?
Is anyone making coated capsules to deliver flora further down the gut?
Is anyone making coated capsules to deliver flora further down the gut?
To your first question: In the hospital, they use a device similar to that used for a normal colonoscopy. Then:
When the scope reaches the top part of the colon, the doctor injects through the scope a feces suspension prepared from a healthy donor, usually a family member or close friend. … The scope is slowly withdrawn. As it is withdrawn, and more fecal suspension is put in from the top to bottom of the colon.
Not sure of the answer to the second question.
When the scope reaches the top part of the colon, the doctor injects through the scope a feces suspension prepared from a healthy donor, usually a family member or close friend. … The scope is slowly withdrawn. As it is withdrawn, and more fecal suspension is put in from the top to bottom of the colon.
Not sure of the answer to the second question.
The book is C Diff In 30 Minutes. If anyone is interested in learning more: http://cdiff.in30minutes.com
As I was glancing down the front page, I read the title as "DIY facial transplant".
For me, the most interesting part of this article was recognizing that you can actually indirectly die from taking antibiotics. Of course sometimes you need to take it, but it shouldn't be the default thing to do when you just have a cold.
Many C. diff patients have recent history of dental procedures or surgeries. Dentist's often prescribe an inappropriate amount of ciprofloxacin to the patient. The cipro is pretty broadspectrum and knocks out majority of the gut flora but leaves the C.diff in tact (~10% of population have c.diff in their gut but it doesn't case harm). When they finish their 2 doses of cipro (inappropriate dosing by the dentist) the C.diff is left with this nice clean gut, free of competition. The c.diff flourishes and causes CDI(CDAD) C.diff Infection (C.diff associated diarrhea).
A cold is typically a viral infection, so taking antibiotics has absolutely no effect whatsoever on the evolution of the disease.
You can directly die from taking antibiotics too if you have a bad reaction to them. Given the rise of antibiotic resistant bacterial and the lack of new antibiotics being developed, death directly or indirectly caused by antibiotics may soon be a problem of the past.
It shouldn't ever be the thing to do when you just have a cold, seeing as a cold is a viral infection. If you have an illness caused by a bacterial infection, then antibiotics are an option.
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"90% of cells in our body are bacteria - organically, our bodies are only 10% human" That would be amazing, but of course those ~3 X 10^12 cells only weigh about a kilo, so yes, 'organically' (whatever that means in this context) bacterial cells outnumber ours by a large ratio, but in terms of mass or volume, they are only a few percent. Not to say they aren't extremely important.
Take it the other way around: if you think a 50 kg human is just as much "a human" as a 250 kg one and extrapolate from there to counting "living things", it is 3E12 bacteria vs one human. Makes the 'human' part negligible.
But of course, a drop of water on your skin would be over 1E20 molecules of H2O, so it would be dead things:living things > 1E7 (give or take a few orders of magnitude)
But of course, a drop of water on your skin would be over 1E20 molecules of H2O, so it would be dead things:living things > 1E7 (give or take a few orders of magnitude)
Well, if we use your approach, we're mostly water then.
The Freakonomics Podcast has an episode on faecal transplants:
http://freakonomics.com/2011/03/04/freakonomics-radio-the-po...
http://freakonomics.com/2011/03/04/freakonomics-radio-the-po...
HN being the one website that I can normally read while having breakfast this left an - for want of a better term - bad taste in my mouth. I misread 'faecal' for 'facial' (serves me right for not having my reading glasses on...).
How hard would it be to extract the useful stuff and throw the gross stuff away? I'm sure that would make the procedure a lot more attractive to patients and doctors.
I think the useful stuff +is+ gross. Bacteria is stinky!
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Followed by the brave new world of DIY hepatitis.
As someone who's father died from rapid, late-onset Ulcerative Colitis, this is really fantastic and makes me wonder what could have been.
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