

The brave new world of DIY faecal transplant - outrightfree
http://www.bbc.co.uk/news/magazine-27503660

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rollthehard6
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.

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giarc
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.

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micro_cam
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?

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giarc
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.

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micro_cam
Fascinating. What are the symptoms or diagnostic tests that would lead a
doctor to consider this?

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giarc
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.

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oyvindeh
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.

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baha_man
"...the growing interest has partly been caused by genealogist who were
initially studying the genome of e.g. humans..."

Do you mean geneticist rather than genealogist?

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oyvindeh
Indeed, I do. I've corrected the text. (I blame too little coffee, and I've
corrected that as well.)

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bambax
Not for the faint of heart... the picture of the blender was a little too much
for my taste!

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danieltillett
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 :)

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giarc
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.

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danieltillett
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.

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giarc
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.

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ilamont
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.

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DanBC
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?

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ilamont
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.

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ilamont
The book is _C Diff In 30 Minutes_. If anyone is interested in learning more:
[http://cdiff.in30minutes.com](http://cdiff.in30minutes.com)

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blueskin_
As I was glancing down the front page, I read the title as "DIY facial
transplant".

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izzydata
I did the same thing. I was rather disappointed even though I knew in my mind
it was far-fetched to begin with.

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erikb
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.

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giarc
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).

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blacksmith_tb
"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.

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Someone
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)

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rmorlok
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-power-of-
poop/)

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jacquesm
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...).

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seren
This is what I also read initially, but a DIY facial transplant would probably
look even worse..

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dlhavema
it's the British variant of "fecal".. i thought it was odd at first and it
made me do a double take too...

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zwieback
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.

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erikpukinskis
I think the useful stuff +is+ gross. Bacteria is stinky!

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jmount
Followed by the brave new world of DIY hepatitis.

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sscalia
As someone who's father died from rapid, late-onset Ulcerative Colitis, this
is really fantastic and makes me wonder what could have been.

