The brave new world of DIY faecal transplant

http://www.bbc.co.uk/news/magazine-27503660

by outrightfree • 12 years ago

122 58 12 years ago

bbc.co.uk

bambax• 12 years ago

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

jm547ster• 12 years ago

Thanks for the warning, unfortunately I took no heed. Gonna wait it out a little longer before breakfast!

danieltillett7• 12 years ago

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 :)

mathgladiator• 12 years ago

You sir, have just ruined... everything.

jessriedel• 12 years ago

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.

giarc9• 12 years ago

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.

pling2• 12 years ago

Reddit and having children desensitized me to that sort of stuff.

Interesting idea though. What happens if it goes wrong?

danieltillett7• 12 years ago

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.

ca98am79• 12 years ago

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.

JetSpiegel• 12 years ago

What do you mean, "taste"?

rollthehard6• 12 years ago

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.

blueskin_• 12 years ago

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

jacquesm2• 12 years ago

That's exactly what happened to me. From now on: don glasses, then open HN. Call it a learning moment.

izzydata• 12 years ago

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

jacquesm2• 12 years ago

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...).

seren2• 12 years ago

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

dlhavema• 12 years ago

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

oyvindeh2• 12 years ago

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.

baha_man• 12 years ago

"...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?

oyvindeh2• 12 years ago

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

danieltillett7• 12 years ago

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.

olva22• 12 years ago

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.

erikb• 12 years ago

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.

danieltillett7• 12 years ago

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.

seren2• 12 years ago

A cold is typically a viral infection, so taking antibiotics has absolutely no effect whatsoever on the evolution of the disease.

ultrafez• 12 years ago

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.

giarc9• 12 years ago

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).

rmorlok• 12 years ago

The Freakonomics Podcast has an episode on faecal transplants:

http://freakonomics.com/2011/03/04/freakonomics-radio-the-po...

giarc9• 12 years ago

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.

micro_cam3• 12 years ago

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?

giarc9• 12 years ago

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.

aestra• 12 years ago

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...

mareofnight• 12 years ago

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.)

giarc9• 12 years ago

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).

ilamont3• 12 years ago

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.

DanBC• 12 years ago

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?

ilamont3• 12 years ago

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.

sscalia• 12 years ago

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

jmount• 12 years ago

Followed by the brave new world of DIY hepatitis.

blacksmith_tb• 12 years ago

"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.

kolev• 12 years ago

Well, if we use your approach, we're mostly water then.

Someone• 12 years ago

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)

zwieback• 12 years ago

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.

erikpukinskis• 12 years ago

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

The brave new world of DIY faecal transplant

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