Woman becomes obese after fecal transplant from overweight donor

http://www.upi.com/Health_News/2015/02/04/Woman-becomes-obese-after-fecal-transplant-from-overweight-donor/1581423067944/

by edward • 11 years ago

45 84 11 years ago

upi.com

e402• 11 years ago

It has been posited before that bacteria or viruses might play a role in obesity. This is an interesting development, for sure.

sarciszewski2• 11 years ago

https://xkcd.com/605/

Please be careful not to read too much into one data point.

delecti• 11 years ago

Alternatively, the alt text from: http://xkcd.com/552/

Correlation doesn't imply causation, but it does waggle its eyebrows suggestively and gesture furtively while mouthing 'look over there'.

There seems to be enough evidence that it's not unreasonable to believe your weight is strongly influenced by your gut bacteria.

sarciszewski2• 11 years ago

I wasn't talking about the relationship between the two, I was talking about "it happened to her, therefore it must be true".

gambiting• 11 years ago

>Her weight gain continued despite a medically supervised liquid protein diet and exercise regimen.

How is this possible? If they were supplying her with a certain amount of calories per day, she absolutely HAD to lose weight. Unless she was snacking, in which case the whole mystery is solved.

jdminhbg• 11 years ago

If they were supplying her with a certain amount of calories per day, she absolute HAD to lose weight.

It's weird how people talk about calories in/calories out as if they have a way to measure the second half of the equation.

brohee• 11 years ago

Actually there are ways. A pretty efficient one is being hooked up to a machine measuring the amount of carbon dioxide you are generating, this is not practical outside of a lab tho.

But more practically, monitoring heart rate is a decent proxy, after calibrating...

task_queue• 11 years ago

Not burning as many calories through exercise over time as previously thought?

Altered metabolism that allowed her to pull more nutrients from her food or store them easier?

Symmetry2• 11 years ago

The number of calories that go into your mouth can be very different from the number of calories absorbed by your body. To give a simple example you'll absorb way more calories by eating a piece of bread with olive oil than if you eat the two pieces of food a couple of hours apart. And someone with intestinal parasites will receive notably less nutrition from their food than someone without. It would would actually be very surprising if intestinal flora didn't effect the ratio of calories consumed to calories absorbed.

elmin• 11 years ago

Can you cite your source on this please?

panzagl• 11 years ago

I wonder what the reaction will be if it turns out obesity isn't just about 'fatty has no self-control'

api• 11 years ago

It would be the death of yet another piece of Calvinist moralist BS -- along the same lines as "the poor are just lazy," etc.

chez172• 11 years ago

To treat ongoing CDI-related diarrhea problems, the woman received a fecal transplant from her overweight but healthy daughter, via colonoscopy.

One possible situation is that she was eating poorly but didn't gain weight due to diarrhea and when she had healthy stool she gained the weight. Also, 'fatty has no-self control' is a way to stifle opposition to your opinion. Ther is no need for that. The laws of physics apply to all people. Burn more calories than you take in, you lose weight. Clearly there will be factors that determine how many calories you burn (perhaps someone burns them much slower than the average person), but as far as I've read magic isn't real yet. The laws of the universe still apply to everyone. I've yet to see anyone eat well and exercise and not maintain a healthy weight. Ever. Not once.

CaveTech2• 11 years ago

And it's important to note that while she wasn't considered obese previously, her BMI was 26, which is considered overweight.

maratd3• 11 years ago

The laws of physics apply to all people.

Yes they do. Ever consider this possibility?

Your body is immensely complex, can rid itself of toxins, pathogens, and other invaders ... but is not able to discard excess calories it doesn't need? To the point of making you sick and immobile?

That makes sense to you? That our body doesn't have a regulation mechanism?

Or perhaps it's more likely that it works in some people and is broken in others. Yes, starving yourself will always work. So will increasing exertion. But so will fixing that regulation mechanism. Just because we don't know how is hardly enough reason to discard the possibility.

freyr2• 11 years ago

I've yet to see anyone eat well and exercise and not maintain a healthy weight. Ever. Not once.

I too had never, ever met an overweight person who ate well and exercised. Not even once! Until I did meet one. Your anecdotal absence of proof is not proof of absence. The vast majority of overweight people may eat poorly and not exercise, but that doesn't exclude other possibilities.

In my case, I eat junk food and lead a sedentary lifestyle, and yet I'm lean and muscular. Care to explain?

dragonwriter7• 11 years ago

Burn more calories than you take in, you lose weight.

Wrong. Exercise burns calories, but also promotes muscle formation. Forming muscle, pound per pound, takes less calories than burning fat produces. So you can have a calorie deficit while gaining more weight in muscle than is lost in fat.

Depending on exercise patterns, precise nutrition, and other factors, a calorie deficit can result in:

Weight loss and decrease in body fat % (net weight loss disproportionately from fat), Weight loss with no change in body fat %, Weight loss and increase in body fat % (weight loss from disproportionately from muscle), Weight gain and decrease in body fat % (weight loss from fat offset by greater weight gain in muscle.)

(I don't think there is any way for a calorie deficit to result in weight gain and increase in body fat % simultaneously, but I may be overlooking something.)

Additionally, changes in absorption, metabolic efficiency, and other factors can make what is assumed to be a calorie surplus based on food/exercise logs into a deficit or vice versa; both the "in" and "out" side of calories in vs. calories out are, absent a lot of detailed measurement most people aren't undergoing even in inpatient medical settings, a lot more approximate and have a lot more bundled assumptions than people tend to think.

rhino369• 11 years ago

You are just vastly oversimplifying a complex issue. It's like telling a drug addict to stop after 2 beers. Or teliing black kids to study more for school. How about telling people to stop having kids out of wedlock. Simple, just don't to it! SOLVED!Debt issues? Just make more than you spend.

Just eat less, conservation of energy man. Science YO! argument is essentially the abstinence solution for STDs.

Normal people aren't a healthy weight because they sit there and resist hunger all day. Their body keeps it in check.

Finding out why obese people don't keep their diet in check would be a huge help in fighting obesity.

Don't get me wrong, I'm sure for a lot people poor impulse control is part of it, but it clearly isn't the whole story.

radicaledward2• 11 years ago

I believe in many cases it is well documented that obesity isn't caused by a lack of self-control. However that knowledge is simply not accepted by the general population. I would guess that it is difficult for people to accept this for the same reason that rich people have difficulty accepting that poverty is commonly not the fault of the poor. We may even be able to generalize these problems to all forms of victim blaming.

Zergy4• 11 years ago

I believe in many cases it is well documented that obesity isn't caused by a lack of self-control.

Please show me the documentation because nearly everything I have read is to the contrary. More specifically I am interested if there are cases where someone eats less than their TDEE and doesn't lose weight or a case where eating at TDEE is unhealthy for some reason.

buckbova2• 11 years ago

Everyone I have ever known or seen that goes on one of those bootcamp style exercise programs loses dramatic weight. Every single person.

There's something about working your ass off everyday for an hour with resistance and cardio that works.

Everyone I have ever known or seen that went to actual bootcamp loses dramatic weight too, whether be army or marines.

Yes there might be exceptions for some with rare illnesses, but let's not throw out good common sense because of a small percentage of people.

dragonwriter7• 11 years ago

I wonder what the reaction will be if it turns out obesity isn't just about 'fatty has no self-control'

Since the scientific evidence for a variety of metabolic conditions, etc., contributing to obesity has been overwhelming for a long time without dispelling the popularity of this attitude, I'm going to say the correct answer is "people who are emotionally attached to the idea of 'fatty has no self-control' will continue to ignore the scientific evidence."

UnoriginalGuy8• 11 years ago

There won't be one. Bigotry cannot be fought with facts.

While some forms of obesity have been linked to physical health and or genetic factors, even if you discount that the remaining research has suggested it is a mental health disorder not that dissimilar from e.g. alcoholism, exercise addiction, sex addiction, drug addiction, smoking, and so on.

Essentially food causes pleasure centres in the brain to fire, these make people feel less depressed, tired, or just happier in general. So food is often used to treat depression, which unfortunately as the person gains weight can cause both tiredness, lethargy, and depression to grow, so they need even more food to fight it (rinse, repeat).

But all this won't change perception, because perception isn't about facts. For example, homophobes don't hate gay people for any logical reason that you can fight with facts and evidence, it is deeper than that. You have to deal with the core of their hate, which is often self-hate, or fear.

Ultimately these are people picking on others with a mental health issue. It only makes the depression worse. But they rationalise their bullying as "helping" (even if there is evidence that it hurts, not helps), but really this all comes from a core of self-hate or fear, rather than any logical part.

morganvachon3• 11 years ago

I'm curious what your opinion of diabetes is then; is that simply a "food addiction" too?

dragonwriter7• 11 years ago

While some forms of obesity have been linked to physical health and or genetic factors, even if you discount that the remaining research has suggested it is a mental health disorder not that dissimilar from e.g. alcoholism, exercise addiction, sex addiction, drug addiction, smoking, and so on.

The research on alcohol, drug, and other addictions seems to indicate that they are physical health disorders -- often with substantial genetic contributions -- and, in fact, the entire idea of separate "mental health disorders" and "physical health disorders" relies on mind being somehow not a product of the physical state of the body, which, while it certainly connects to beliefs of many popular religions (e.g., concerning the soul), doesn't appear to have any scientific basis at all.

bloaf3• 11 years ago

The core of the issue is

1. Obesity is unhealthy (i.e. persisting in obesity is self-destructive)

2. Obesity is obvious (i.e. ignorance of your obesity is not an excuse)

3. Obesity is treatable (whether from a mental-health angle or otherwise)

I'm honestly not sure what the mental-health roots of obesity has to do with anything. It may be hard to quit smoking, that doesn't stop me from correctly judging that people who smoke are engaging in a self-destructive behavior. It may take professional help for some people to stop gambling, but I'm still going to judge harshly the parent who gambles away money that should be spent on their children. I would not humor the excuses of an obese person who fails to get help anymore than I would humor the excuses of someone who broke their arm but refuses to get it fixed.

Red_Tarsius3• 11 years ago

There may be special factors we haven't discovered yet, but a lot of people are overweight simply because they don't have the money or will to consume decent food.

imho the article is awful. There was 1 case study and it happened by accident. The title is just giving another excuse to people who are struggling with self-discipline.

emodendroket3• 11 years ago

I don't get this attitude. Like, is the problem with obesity really that people don't feel bad enough about it? I don't think that's it.

emodendroket3• 11 years ago

It doesn't matter if that idea is disproven; moral shaming has seemingly unlimited appeal.

hipcactus• 11 years ago

Dr. R. Kelly

jimrandomh2• 11 years ago

So, a bit of background on fecal transplants. The idea is that you take the gut bacteria from a healthy donor, and put it in an unhealthy person's gut. This will make the recipient's metabolism/digestion more like the donor's. This has been found to work for weight loss; you give a normal-weight donor's microbiome to an overweight person, and they lose weight a significant fraction of the time.

So, when I read:

the woman received a fecal transplant from her overweight but healthy daughter, via colonoscopy

I cringed. There are three things wrong with that. First: you don't need to use a relative, because fecal transplants don't have risk of rejection. Second, you wouldn't use a donor who's overweight. And third, it's normally done with a swallowed capsule, not with a colonoscopy, which adds risk and unpleasantness for no reason.

(Edit: The primary source says "With the occurrence of weight gain after FMT in this case, it is now our policy to use nonobese donors for FMT. The untoward consequences of using nonideal FMT donors are important, because patients may prefer to use a family member rather than an unrelated or unknown stool donor due to the perception that these sources are safer.")

frandroid• 11 years ago

Second, you wouldn't use a donor who's overweight.

Why did that make you cringe in particular?

jimrandomh2• 11 years ago

Because they're used as a treatment for obesity, based on a model of "they'll become more like the donor".

UnoriginalGuy8• 11 years ago

Second, you wouldn't use a donor who's overweight.

Why? These transplants are so new and cutting edge that we don't know if taking from an obese person will be a bad or good thing, anecdotes like this might help us form an educated opinion, but it is too early to say for sure.

You certainly cannot say for sure if that was a mistake because few know that really...

DanBC2• 11 years ago

We know that some people have gut flora that help keep them slim; we know that some people have gut flora that help keep them overweight.

Taking fecal matter from someone who is overweight stacking the probabilities away from your favour.

toomuchtodo• 11 years ago

If we're able to cure obesity using probiotics designed to wipe out existing gut bacteria and replace it with something designed to reduce the absorption of calories/carbohydrates/sugars, that would be a huge breakthrough.

As always, science doesn't happen via "Eureka!" but by "Well that's strange...".

jessriedel2• 11 years ago

This donation occurred back in 2011, when it was still very unclear whether familial relations were important. We now know that there don't appear to be any additional risks for unrelated donations.

This has been found to work for weight loss; you give a normal-weight donor's microbiome to an overweight person, and they lose weight a significant fraction of the time.

Do you have cite for this? I think there is some circumstantial evidence on this, but it's far from settled.

DontBeADick• 11 years ago

Almost nothing you said is correct aside from your basic description of the procedure.

Weight loss is rarely the primary goal of FMT and its efficacy in that realm remains unproven. Nowhere did the article imply that any of the things that made you "cringe" are necessary. And oral administration isn't objectively better than the alternatives, nor is it always an option since many people understandably find the idea of swallowing a "poop pill" rather repulsive.

fit2rule• 11 years ago

>Weight loss is rarely the primary goal of FMT and its efficacy in that realm remains unproven.

Well, doesn't this case demonstrate that FMT can be used to have an effect on weight, albeit in the negative sense? So something is going on here, and while the science is unproven, it sure seems like this incident demonstrates that it has promise.

e402• 11 years ago

Weight loss is rarely the primary goal of FMT and its efficacy

He didn't say it was the primary goal. In fact, the way I read it it was a side effect.

jnevill2• 11 years ago

This woman was being treated for recurrent Clostridium difficile, not obesity. The weight gain was a side affect of the treatment, not the reason for it. Yes, people recently have started experimenting with fecal transplants to help with weight loss, but that's not what was happening here. The woman also picked her daughter because who wants a stranger's poop injected into their colon? No one... is pretty much the correct answer there. No one. Lastly, this was done in 2011, so... up the butt it went.

xtrumanx• 11 years ago

it's normally done with a swallowed capsule, not with a colonoscopy, which adds risk and unpleasantness for no reason.

Perhaps the patient opted for the colonoscopy the avoid the "unpleasantness" of swallowing a capsule of fecal matter. It may not taste like shit, but you know it is.

Balgair• 11 years ago

Fecal transplants.... what a world we live in....

That said, the study of gut flora is just starting. Here's a summary of <Nature Article I read a while ago but can't seem to find> : When raising sterile mice (no bacterial whatsoever) they tend to do pretty badly. Low body mass, overactive immune system, etc. Taking these mice and then doing fecal transplants (method is for sure 'icky') from obese PEOPLE and thing PEOPLE (totally strange), the mice tend to be obese or thin. Now, they then just cage sterile mice NEAR transplanted mice, and see the same thing, the flora just waft over and find a home. Then they cage sterile mice near thin and obese mice at the same time. The sterile mice get obese, rarely thin, and NOT in-between, it's all or nothing. Flora, this one article I once read states, come in flavors (real icky ones) that like to be in certain relations to each other. Why the mice tended to get obese is strange, and needs more funding.

Real cool stuff, I guess, but then you get to be known as the 'rat poop eating' labs. So there is a detriment to the research.

eof• 11 years ago

In high school we did an experiment where we caught different types of food on fire, and using them as fuel burning under a beaker, measured the temperature change of the water in the beaker.

Later I learned that cow-dung was used for fuel in some of the poorer places on earth.

I always assumed there must be some calories left in stool; and that this seeming-dogma about 'calories in calories out' was completely ignoring what could be a huge amount of calories getting shat out (or not).

jnevill2• 11 years ago

She didn't gain weight because of the calories in the fecal transplant. She gained weight, it's suspected, because of the new gut flora from the overweight donor. Different flora may mean a different metabolism.

sparkman55• 11 years ago

There is an excellent New Yorker article on fecal transplants and gut flora.

The article spends considerable time talking about the donors, and the rigorous screening process to make sure the donated bacteria are good ones. Obviously, that procedure wasn't followed in this particular incident.

Worth a read!

http://www.newyorker.com/magazine/2014/12/01/excrement-exper...

Woman becomes obese after fecal transplant from overweight donor

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