
Why DIY fecal transplants are a thing - ca98am79
http://blogs.plos.org/publichealth/2013/05/29/why-diy-fecal-transplants-are-a-thing-and-the-fda-is-only-part-of-the-reason/
======
ca98am79
My wife has ulcerative colitis and it always surprises/annoys me when I ask
the doctor about fecal transplants and they bring up the "ick" factor - how
they think it is disgusting. They usually say something like "you really want
someone else's poop in you?" At this point our only other option is for my
wife to be cut open and have her intestines removed - which I find much more
horrifying and risky, but they mention it as if it is just the normal thing to
do.

~~~
jpdoctor
> _but they mention it as if it is just the normal thing to do._

As usual, you need to evaluate your doctors' incentives. Do they make more
money from

1\. Cutting your wife open, with all the associated hospital care or

2\. Fecal transplant, for which their competition is free DIY?

As Upton Sinclair said a long time ago: It is difficult to get a man to
understand something, when his salary depends upon his not understanding it.

Edit: BTW, I wish you luck with your situation. I gained familiarity because
my wife had recurrent c-diff. During this episode, I saw such non-scientific
quack-like behavior that I pretty much lost faith in most of the modern
Medical Industrial Complex. And this was for a _bacterial_ infection, for
which the literature is accessible to anyone with a high-degree of education
and a decent biology background.

The takeaway lessons from our episode was: Take matters into your own hands as
much as possible. You have 24 hours a day to work on your problems, the doctor
has about 20 minutes. So if you're not an expert on your particular situation,
then you're pretty well screwed.

~~~
lukeschlather
Seems like it's a branding problem. "Fecal transplants" might get a lot more
traction if we called them something a little more benign-sounding like "stool
infusion." Transplant makes it sound like you're moving an organ around rather
than just some fungible bodily excretion. A transplant also doesn't sound like
something anyone ought to do daily...

~~~
dlhavema
Repoop?

~~~
Fomite
You laugh, but there's a study out there called RePoopulate. My preferred term
was "Intestinal Recolonization".

------
DanBC
Intestinal flora are complex. Here's a story about _Akkermansia muciniphila_
(<http://www.bbc.co.uk/news/health-22458428>) which appears to make it harder
for people to become obese.

Here's an article from Nature that shows mice can become more easily obese if
you infect them with some, er, stuff, and that this is transmissible
([http://www.nature.com/nature/journal/v444/n7122/abs/nature05...](http://www.nature.com/nature/journal/v444/n7122/abs/nature05414.html))

So you could be giving yourself stuff that would make it easier for you to
become obese, or you could be giving yourself stuff that would make it easier
for you to stay not-obese.

And that's just these few bugs. There are a whole range of really quite
unpleasant things you could be getting.

Regulations are important. They're not to protect well informed people from
making calm rational choices, although they do have that unfortunate effect
sometimes. Regulations are to prevent cynical, or stupid, people from offering
dangerous untested unproven "treatments" at great cost to desperate and ill
people.

It'd be great if there was a safe way to decouple these, allowing people to
gamble with their own health if that's what they want to do, but protecting
people from evil con-merchants.

~~~
jere
One of my favorite quotes on this subject from Kurt Harris:

>This is why I am very hesitant to offer ANY specific prescriptions for what
to do about your gut biome. The advice to eat dirty vegetables or even start
walking around barefoot in the dirt or drinking pond water or whatever
"natural" activity you can think of is VERY DANGEROUS.

>The reason is not all parasites are "old friends", only some of the ones that
are commensals that we co-evolved with. Getting toxoplasmosis from a cat, or a
zoonotic helminth from dog shit or a dead raccoon or a pig tapeworm will do
your immune system no favors and could even kill you.

>DO NOT PLAY AROUND WITH THIS CONCEPT UNLESS YOU ARE ABSOLUTELY CERTAIN WHAT
YOU ARE DOING.

~~~
pyre

      | walking around barefoot in the dirt [...] is
      | VERY DANGEROUS
    

Really?

~~~
gte910h
In many parts of the country, yes, you get worms this way.

Hookworms directly or some other worms via eggs into small cuts.

~~~
ef4
Not in the US. They're very rare in the US, and everywhere with indoor
plumbing.

People who are deliberately trying to get infected as a treatment for their
Crohn's or arthritis have literally resorted to travelling to the third world.

~~~
philwelch
This whole concept sounds like a South Park episode waiting to happen.

~~~
claudius
You mean eating with your bum?

------
rdl
Speaking of DIY and feces, ubiome.com is essentially 23andme for your
intestinal flora. It's kind of interesting, although I haven't done it yet
(they had a kickstarter that I missed out on).

~~~
gwillen
They are now taking orders through their website.

~~~
ableal
Clicky: <http://ubiome.com/shop/>

------
chuckcode
Your microbiome is essentially another organ in your body. You have 10 times
the number of bacteria cells as you do human cells (they are a lot smaller)
and they weigh over 2 pounds. Problems with this microbiome have been
associated with very important diseases including autism, malnutrition and
heart attacks. The economist had a good semi-science summary back in August
last year [1]. I would recommend being just as careful getting a fecal
transplant as any other organ, it would be terrible to catch something you
didn't want like hepatitis.

It will likely be a while still until we understand the microbiome as the
current sequencing methods only can sequence about ~1000 nucleotides at a time
[2]. The strategy is to shred all the DNA into smaller pieces, sequence them
and then try to assemble them back into the full genome. This is difficult to
do in just single organisms and becomes very difficult when you're dealing
with a soup of many different organisms in something like your gut. Hopefully
we can make some good progress associating smaller chunks of sequence with
phenotypes until we can sequence full chromosome lengths of dna.

[1] <http://www.economist.com/node/21560523> [2]
<http://en.wikipedia.org/wiki/DNA_sequencing>

------
nicholassmith
I understand medical regulations are in general a good thing, but if a
treatment works why not let people push it as much as possible? If doctors
(note, preferably doctors who don't stand to make money from it being a
roaring success) are confident that there's an inherent level of safety, and a
patient is willing to accept there's an inherent level of risk, why not just
let them get on with it? Like the article says, it'll just go underground and
there's less to be gleaned through studying.

~~~
roc
I'm guessing because doctors _aren't_ confident that there's an inherent level
of safety. [1] Some are optimistic, some less so. But the way they and the FDA
generally come to conclusions on these things, is through trials. Trials which
have to be properly constructed and conducted to gather meaningful data.

Throwing the doors open isn't going to give you very good data. So we wouldn't
be gaining anything we could rely on for study. We'd just be enabling DIY-ers
to get (for-profit) professional assistance. Which is its own cause for
concern.

These trials can certainly be better constructed, or made larger or more
inclusive in such circumstances (many people facing very major surgeries that
might be unnecessary should this approach pan out for their particular
affliction; and shockingly-high success rates in early trials).

But I don't think there's a better alternative; most of the proposals would
just open the doors to all sorts of chicanery that we've spent generations
weeding _out_ of the health care industry.

[1] It's taken us this long to figure out the importance of gut flora in the
first place. And we still have little-to-no idea how it works. So how in the
world could someone feel objectively confident they know what is or is not a
'safe' treatment for it? Particularly when you consider the research that this
flora impacts brain function as well. A transplant might treat a gut
affliction but inflict an equally (or more) serious mood disorder.

------
marcosscriven
This was the process I just went through:

1) Is this actually safe to click on in a public place?

2) What the heck is 'fecal transplant'?

3) Clicked it - oh my goodness, that's gross

4) Read it - wow, this is actually real, and it's amazing

5) Who thought of this, and who tried it first?

6) I'm never going to get a story on the front page of HN, if this is what I
have to contend with...

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crohn1
Have fecal transplants worked on anybody suffering from Crohn's disease?

I have both Crohn's and UC and am running out of options and would really like
to explore options for a fecal transplant. My doctor only does FT on patients
who have C. Diff but not any others.

------
EvanAnderson
The Scientific American podcast Science Talk had a very informative show on
fecal transplants:
[http://www.scientificamerican.com/podcast/episode.cfm?id=fec...](http://www.scientificamerican.com/podcast/episode.cfm?id=fecal-
transplants-the-straight-poop-12-01-31)

------
swombat
I have to do this. It's a once-in-a-lifetime opportunity.

))<>((

(<http://www.youtube.com/watch?v=KQoJo81lujk>)

------
strebler
What about probiotics for ulcerative colitis? A brief scholar search shows
some tentative promise:

[http://www.nature.com/ajg/journal/v104/n2/abs/ajg2008118a.ht...](http://www.nature.com/ajg/journal/v104/n2/abs/ajg2008118a.html)
[http://www.nature.com/ajg/journal/v100/n7/abs/ajg2005272a.ht...](http://www.nature.com/ajg/journal/v100/n7/abs/ajg2005272a.html)

May only help for the more mild cases, but I know a number of people who speak
very highly of probiotics for various digestive tract issues.

~~~
ca98am79
Thanks - I've looked into this and my wife has tried it, but it doesn't work
for her, at least. I haven't heard much success from others with UC, either.

~~~
jpmc
As one with UC I can say that this helped me:
[http://shop.vsl3.com/vsl3-ds-20-pack---prescription-
only-p17...](http://shop.vsl3.com/vsl3-ds-20-pack---prescription-
only-p17.aspx)

It is magnitudes more powerful than anything else you will find. Taking it
stopped my flare and anytime I feel a flare coming on I take it. I had to push
my DR into getting the script after fistfulls of Asacol HD and prednisone a
day only slowed my flare down.

~~~
ca98am79
thanks!

------
Fomite
The "ick factor" - which is pretty much reduced to a minimum if the donor
stool is processed appropriately anyway - may not be long for the world. There
has been at least one small scale study using synthetically derived donor
samples - essentially taking someone's stool, figuring out what the hell is in
it, and culturing accordingly.

That may also solve one of the big burdens behind using fecal transplant as a
common technique - while the procedure itself isn't too expensive (though its
not trivial, getting microbes past your stomach acid in quantity is no small
thing), _testing_ donor stool is, because of the amount of things we could
accidentally give you. Synthetic donor culture would have less of a problem
with that.

------
zwieback
Less gross but also interesting is the earwax transplant anecdote contained in
this article:

[http://www.newyorker.com/reporting/2012/10/22/121022fa_fact_...](http://www.newyorker.com/reporting/2012/10/22/121022fa_fact_specter?currentPage=all)

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swah
Someone tell me in plain english: is the procedure to take fresh healthy poo
and stick it in your anus?

~~~
btilly
Yes, in the hope that the bacteria from that poo will spread and start doing
the job that you need done from poo.

------
s_baby
Same reason why you should suck your kids pacifier if you have a healthy
digestive system.

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anonymous
If anyone wants to view the site without js, you can just right-click the
overlay->inspect element and then right-click the noscript element->delete
node.

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lisper
Gives new meaning to the phrase, "Are you shittin' me?"

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crusso
I prefer the name "transpoosion".

~~~
marcosscriven
Gave me a puerile giggle, thanks!

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X4
Sounds like there is a lot of Pootential in there!

Which illnesses does it cure?

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Zigurd
FTA: "Fecal matter occupied a gray area..."

~~~
fencepost
Clearly a plumbing misconnection. Gray water is sinks, tubs, etc.

------
j1mmyb0b
This is why we need 💩

