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Scientists are transplanting faeces into obese people with type 2 diabetes (walesonline.co.uk)
55 points by prostoalex 52 days ago | hide | past | web | favorite | 50 comments



For those who just read the beginning of the article

“It’s in liquid form and injected through a tube in the patient’s nose. There is no smell or taste associated with it – it’s all very purified.”


FMT transplants have a very high success rate for treating C Diff infections that don't respond to antibiotics. Something like 70-80% success.


The numbers I've seen are higher than that.

The Mayo Clinic has posted numbers for a couple of different clinic locations that have seen a a 90% success rate.

https://www.mayoclinic.org/medical-professionals/digestive-d...


Source?


Fecal Transplantation for Recurrent Clostridium difficile Infection in Older Adults: A Review - https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.12378

Fecal Microbiota Transplantation for Clostridium difficile Infection: A Systematic Review - https://annals.org/aim/article-abstract/2288521/fecal-microb...

I just cribbed these from the Wikipedia article at https://en.wikipedia.org/wiki/Clostridioides_difficile_infec... so I don't know if there's better or more recent studies.


Here is a comparison of capsule-based FMT versus colonoscopy-based FMT, in which either approach had a (very) high success rate.

https://www.ncbi.nlm.nih.gov/pubmed?term=29183074


This is interesting. I was wondering if anyone is working on something similar meant for nasal area? Chronic sinus infections, thick mucus and various other annoying nasal afflictions could possibly be solved by something like this?


I wondered the same thing, and came across this guy who has been documenting his experimentation and purported success with self-administered bacteria from kimchi... https://lactobacto.com/2019/01/17/what-else-can-lactobacillu... :)


I have no idea if people are doing this yet, but I would love to find out more. Doing a nasal rinse with Xylitol can break down thick and lodged mucus to get things moving again. Also lactobacillus sakei seems to fight off sinus infections according to some.


No shit, this has been going on for a while I thought? The idea being the gut microbiome is partly to blame for obesity.


The main source of obesity is to high calorie intake.


Thats like saying the main source of famine is to low calorie intake. It may be technically true but it misses almost every part of the problem.


If you want go down that road I will say that reason of high calorie intake is not gut bacteria. In majority of cases it’s bad eating habits. Too much sugars, too much fats. Education is the greatest weapon against obesity that we have.


>Education is the greatest weapon against obesity that we have.

Yet the most educated societies have the worst problems with obesity. A fair statistical case could be made that Education causes obesity, albeit it too would miss most of the problem.

>reason of high calorie intake is not gut bacteria [majority of cases]

Most research I've read, especially around epigenetics, the thrifty metabolism and the Dutch hunger winter studies, all show a strikingly different biome of gut bacteria in [an overwhelming majority] of obese individuals compared to average bmi non-thrifty metabolic people.


There is some evidence that your gut flora and fauna influences your appetite and calorie intake [https://www.nature.com/articles/nutd201121]


>Education is the greatest weapon

It doesn't seem to be working.


I don't have the study at hand, but there's evidence that healthy, lean people excrete unused calories whereas obese people don't. In other words, the body adapts to calorie intake, and it's not just a simple formula of "calories in/out".


Still looking for donors..


Never go ATM


It was my understanding that T2D is due to Insulin Resistance and the reason most folks gain weight is that an excess of Insulin will do that. Doing a Fecal Transplant seems more like a band aid solution for T2D since unhealthy eating habits will just kill off the good bacteria over time.

I'm curious if these folks tried to lower sugar intake in all forms and reduce their eating window to 8 hours and whether that would have lowered Insulin Production and caused an increase in Insulin sensitivity.

How difficult it is for people to change lifestyle habits to fix their hormonal unbalance when it comes to obesity.


"How difficult it is for people to change lifestyle habits to fix their hormonal unbalance when it comes to obesity."

Sadly, evidently, very.

Annecdotally, most ppl don't seem to connect what they consume with their health. There's no sense of garbage in...feel like garbage.

I'm not sure what they're tbinking but when I look at their bodies and then at their shopping cart (at the super market) disconnect wins 9 of 10 times.

Furthermore, abnormal has been normalized. Humans are naturally wired to assume the norm. They see what's around them and naturally presume it's okay. Obesity is the new black. Soda, cookies, etc. (and the advertisement there of) is ubiquitous. Honesty is now called "fat shaming."

I understand there are people who have health issue the cause them to be obese. The rest a simply negligent. Sadly, it's not PC to say such truths.

p.s. Editorial: How is it, in the face of the obesity crisis (which directly contributes to increased healthcare costs), that the adults who lead the Girl Scouts are still pushing cookies. The hypocrisy and absurdity boggles my mind.


> Honesty is now called "fat shaming."

Yeah, that's more about the fact that if you're telling someone who's fat that they're fat, guess what - they already know, and they're probably already very conscious about it.

"shaming" people for it will either make it worse for them or inspire change; but if they're in that situation it trends towards worse.

It's no help at all, and a bit of a dick move at best.


I never said it was the thing to do. I also never said it was helpful. That said, there is direct correlation between the PC'ing of such language and the __increase__ in the crisis.

If people choose to let themselves go, I'm not so sure another pat on the back is the answer.


Obligatory reminder that correlation is not causation - even if you provide data demonstrating a correlation, which you haven't.

To me it looks like the rise in obesity could roughly map to the rise in depression and anxiety, though I have no data on that and I make no assertions on the causality, should they turn out to be correlated.

I comment every time I see the obesity/calories topic come up because it's something I've been deeply researching and experimenting with for years and I can't let misconceptions and falsehoods go without a response.

To avoid letting this get into a lengthy back-and-forth, I'll just state what I understand and move on.

Yes, food/calorie intake and expenditure is partly a choice, but it is a choice that is profoundly complicated by many factors, including but not limited to: diagnosed or undiagnosed illness, pre-exisiting nutritional levels, genetics/epigenetic expression, emotions/hormones/neurological issues, social influence, culture, financial constraints, time constraints and more.

Obviously, letting one's self go is not something that most people freely choose to do or enjoy doing.

Some work harder than others to avoid it. Some succeed, and some fail even if they work hard at it.

Usually when I get into a back-and-forth discussion about this topic, the co-debater will resort to something like "I don't have all the answers but everyone can try harder to cut calories".

We'd all be better off if people simply stuck to the shorter, humbler version: "I don't have the answers."

Anyone who does have answers could contact their nearest metabolic research institution.


TL;DR I know what I should be doing, do mostly the right things, but still am obese.

Speaking as an obese person that knows the dangers and generally does the right thing re: diet and excercise- it’s crazy hard.

I entered freshman year of HS 6’2” 275lb, graduated Senior year 6’3” 290lb. I’m 36 now and my weight has pretty much been in that same window my entire life.

I played very high level high school athletics (4 sport varsity, all star teams, etc.), still play competitive “A” league rec sports all year every year, and still do cardio and weight lifting 3-5 days a week. I hike at least 6 miles a week rain or shine with my bow and hunting pack in the woods outside my house for practice. I’m very strong and shockingly flexible- but I still have the physique of a beer league bowler (of which I also am).

I don’t drink soda or eat fast food for the most part, and my diet throughout the week is mostly veggies and proteins. My diet is definitely not perfect and I must be consistently eating more than I output, but...

The weight will melt away until I get to 275 and then my body turns into an always hungry eating machine. Or If I have pizza (or something carby) for lunch I’ll be craving carb food the rest of the day.

My will power is strong, but there is no such thing as just one bite. It’s zero bites or all the bites and it’s a crazy pull. It’s also infuriating because this is the one part in my life where I’ve never been able to just will it so. Sports, work, kids, outdoor adventuring: I have never faced a situation that I couldn’t just grit my teeth and make it through.

Not the weight though. There are too many little unconscious failures that stack up through a day or week that will hinder progress. The conscious ones take a toll even more because now you get to think about “I shouldn’t have...” the rest of the day.

It’s a weird deal, luckily it doesn’t take an emotional toll on me like I’ve heard it takes others. It’s a thing, it’s my thing I try and work on (that and being generally nicer), I just keep plugging and monitor the hell out of my health. BP, glucose, A1C, cholesterols, etc. all paint a picture of a man healthier than I look on a BMI chart.


I was in a similar situation. What I found is very slow diets work well. Eat more or less the same thing every day for a while to so you get a feel for what a matence level is then cut just enough calories so your losing ~2 pound a month.

I still got stuck at my old normal, but it’s now easy to maintain. Maintain that for a year or so and you can start cutting things again without awakening that ravenous hunger.

So what if you only lose 40 lb in 4 years that’s still real and sustainable progress. At 38 it’s the end of January and even with plenty of indulgence I weigh what I did before thanksgiving, that’s huge IMO.

PS: I am still heavy, but dropping your BMI by 5+ and keeping it off while also bulking up just feels so much better. Remember, a net gain or loss of even 1 pound per year adds up.


>My will power is strong, but there is no such thing as just one bite. It’s zero bites or all the bites and it’s a crazy pull. It’s also infuriating because this is the one part in my life where I’ve never been able to just will it so.

somewhat familiar. Finding oneself deep at night in the kitchen eating donuts/cake/pastries/cookies/pizza/waffles/etc. and not able to stop... I'm 6' and topped at 230 soon after coming to the US (that supermarket quick-rise white bread is easily half of US medical problems). By starting to exercise regularly i took it under some control and had been keeping it between 180-200 since then. A year ago a GE using breath test diagnosed me with pretty severe SIBO. Once i was able to take SIBO under control (separate story as typical antibiotic treatment didn't work (happens in 30-70% cases according to various sources)) those sugary&fat cravings got much easier - that is inline with the growing body of research about chemical signaling, including neurochemicals, these gut bacteria do (and they love sugars and high blood glucose level). Resisting such a direct injection of neurochemicals is a pretty uphill battle, and it is no surprise that a lot, if not majority, of people aren't able to.


> "Speaking as an obese person that knows the dangers and generally does the right thing re: diet and excercise- it’s crazy hard."

Personal will-power aide, it's hard because so much of the things that are designed to work against you have been normalized. Sadly, no one wants to hear - because of the way humans are wired - that their personal decisions have (literally) bigger and broader social implications.

Big might be beautiful. Thanks Oprah! But it's also unhealthy. Funny how that's never mentioned. It's madness how a parent can get arrested for leaving their child home alone (or similar) but it's perfectly fine to raise a 10 y/o to be obese, bordering on T2D.

p.s. Kudos to you for making the effort. I know it's not easy, as mentioned. What kills me is the denial of how normalized abnormal has become. And saying so in any form is not PC.


It’s normal because most people’s lives and normal obligations are difficult enough relative to their abilities that they have issue proactively managing these things. It’s actually a matter of life and death what you eat in many cases and should be prioritized, but this is frankly not a viewpoint that people are going to respond well to you taking in most cultural milieus


Which health issues cause people to be obese?


There are some more recent findings that need further study.

For instance, surgery that removes the upper portion of the small intestine has a large observed effect.

>gastrointestinal surgery can improve blood-sugar levels more effectively than any lifestyle or pharmaceutical intervention, and even lead to long-term remission of the disease.

https://www.scientificamerican.com/article/why-doctors-for-d...

We know it works, but don't know why.

Very recently, doctors released a study showing that just destroying the inner mucous membrane in that region of the small intestine had a similar effect.

>By destroying the mucous membrane in the small intestine and causing a new one to develop, scientists stabilised the blood sugar levels of people with type 2 diabetes. The results have been described as “spectacular” – albeit unexpected – by the chief researchers involved.

Even a year after the treatment, the disease was found to be stable in 90% of those treated.

https://www.theguardian.com/society/2018/oct/24/spectacular-...

This early study of a much less invasive treatment certainly deserves further study.


I think this article describes a new understanding emerging.


Who's going to give you the money to buy foods that have not been engineered to addict you, mess with your mental state, or otherwise screw with your health?

Who's going to tell you where the good foods are at, that have not been tampered with, and that are compatible with your body, vs the bad foods?

Who's going to train you to cook?

Who'se going to help you with your mental health? As far back as the 1800's Mormons running insane asylums knew fixing diet resolved mental health issues 50% of the time. Most obesity, especially people hundreds of pounds overweight, are due to mental health problems.

And finally, if you're over the tipping point of these problems, how do you overcome them? A Diet for a 500ib person losing weight has to be engineered very differently than someone who's 200ibs looking to lose 10 pounds of belly fat.

This is a complex subject, with an obecity epidemic, you should be asking the questions of "Who poisoned these people?" and also "Do we have a mental health crisis?". Follow those questions to their root and you'll find most of the answer.


No. If you always look to external sources you'll never be free. The most important facet in the whole story is that each individual is responsible for what they put in their mouth. Everything else is an excuse. No one is being forced to eat a Big Mac. Or two. Or three.


But, there is a massive industry, employing carefully honed psychological tactics in order to get you to want their unhealthy food (and other unnecessary, unhelpful products). I'd warrant far more is spent tricking people to eat unhealthy food items than is spent on helping them to eat healthily. Companies know that once you push that button, and strongly associate their brand with the fuzzy-feel-good hormone hit, that they're on to major profits - a capitalist dream.

"Oh, but an occasional bottle of pop [soda, sugar-y fizzy drink] is fine", for sure, but $BRAND aren't advertising to get you to have one of their drinks each month; they want you to reach for 3-a-day. [Mind you the major pop brands have modified their behaviour, removing regular sugars and pushing sweetener; I think they're worming their way out of being sued like the tobacco companies were. And there's good and bad in that.]


Fecal microbiota transplants are more pseudoscience than science. Research should be done to identify the most relevant microbes within fecal transplants, which could then be isolated and manufactured via industrial fermentation; such standardized products would be more scalable, would reduce the risk of infections from unwanted microbes, and would improve the scientific study of the approach, since the same substance would be administered each time. https://en.wikipedia.org/wiki/Fecal_microbiota_transplant#Re... This would remove many unnecessary and correlated variables associated with feces transfer, especially when it is being transferred "with the liquid injected through people's noses"! This could benefit from either a medical ethics review or an editorial review of the article.


Why not send them a note? I'm sure they'll be grateful for your input - sounds like it could save them a lot of time.


This made me laugh.


I do not appreciate the sarcasm.


So, let me make sure I have this right:

1. Fecal transplants are pseudoscience, because we don't know if they work.

2. We should assume they work, and identify specific microbes within them that are relevant or dangerous.

That's contradictory. Further, without data from examining #1, #2 is almost impossible - there are at least 1,000 species in our gut at all times. The only identification process I know of that could be reasonably affordable is 16S RNA sequencing, which is still expensive and would be nearly impossible to do properly on the 0.5 - 1.0 kg sample of gut bacteria (yes, that's the weight of just bacteria) from the average human. Not to mention that evidence suggests that gut bacteria act in concert, that is, we'd have to examine combinatorially many combinations of these 1,000+ species to get any real data.

This is just nonsense.


Your comment is hardly understandable, but feces transplant are not pseudoscience and a hope for many autoimmune disease sufferers. I don t know anything about this specific trial though.



> into the nose

It's not going into the nose, it's going into the jejunum (the intestines) via a nasojejunal tube, which is placed up your nose.


They still have to withdraw the tube though...


Ha. I wonder if they flush it with a little water before withdrawing?


Ho do you flush the outside?


I think they're putting it in through a tube that's inserted through the nose, not actually into the nose.


Nasojejunal intubation would make more sense than how the article describes the clinic trial. Unfortunately, I am not able to find any documentation regarding the study, which appears to be named "Faecal microbiota transplantation in the management of obesity and type two diabetes mellitus"


The trial is ongoing [1], so it's not surprising you can't find any information on it.

[1] http://www.isrctn.com/ISRCTN30359027


I get the issue with standardization of your independent variables, but do consider that trying to identify the "most relevant microbes" might not be as fruitful as you think. A lot of the factors may relate to community level effects, emerging from interaction between a multitude of species.




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