Can You Cure Your IBD with a Poop Transplant?
Animal poop is a good thing
Since time immemorial we’ve used it to nourish the ground and grow our food.
But human poop?
We’d just as soon not talk about it, but these days, doctors can’t seem to talk about it enough.
Not because it might be a good alternative for growing food (that’s an entirely different discussion), but because it’s been found to be a miracle for some patients suffering from stubborn and life-threatening infectious diseases in the gastrointestinal tract.
That’s right. Patients who have been near death’s door suffering from recurrent C. difficile colitis have been able to recover by receiving a special donation—the transfer of human stool from a healthy donor.
The Rise of Antibiotic-Resistant Infections Requires New Treatment Approaches
The idea of transplanting poop from one person to another—officially called “fecal microbiota transplant (FMT)”—is actually not as radical and new as it may sound.
The Fecal Transplant Foundation notes that the practice was first documented in fourth century China, that it’s been used for over a century in veterinary medicine, and that it’s actually been used to treat C. diff infections for decades in many countries.
It’s become popular in recent years in the U.S. because of stubborn C. diff infections that resist treatment with antibiotics. In this country, we’re used to treating infections with the medications we’ve come to rely on, but because of overuse and misuse, some infectious bugs have gained the ability to survive an antibiotic attack.
According to the Centers for Disease Control and Prevention (CDC), at least 2 million people now become infected with bacteria that are resistant to antibiotics each year, and at least 23,000 die because of those infections.
“[T]hese drugs have been used so widely and for so long,” the CDC states, “that the infectious organisms the antibiotics are designed to kill have adapted to them, making the drugs less effective.”
Imagine being diagnosed with a bacterial infection in your gastrointestinal tract. We’re used to thinking of infections as being completely curable in today’s age, but that’s no longer true. Your doctor tries this drug and that drug and still the infection won’t go away.
Pretty soon, things can look awfully desperate.
Desperate enough to talk about accepting someone else’s poop into your system.
How the Bacteria in Your Body Affects Your Health
To fully understand FMT, it helps to understand the main infection it’s been most used to treat.
Clostridium difficile (C. diff) is a type of bacteria that causes symptoms like diarrhea and life-threatening inflammation in the colon. It most commonly occurs in individuals who are hospitalized long-term, or in those who used antibiotic medications for a long period of time. Recent reports, however, show that it can also occur in younger, healthy people, too.
The Mayo Clinic states that every year, about half a million people in the U.S. get sick from this bacteria, and that in recent years—most likely because of the rise of antibiotic resistant strains of bacteria—that these infections have gotten more severe and difficult to treat.
Now the key to understanding how FMT helps beat this stubborn infection is to understand why it often takes hold after a person is treated with antibiotics. Antibiotics, by their very nature, kill bacteria. Unfortunately, they are not able to differentiate between good and bad bacteria, and the human body is filled with both.
That’s right—you’re walking around right now with about the same number of bacteria in your body as you have human cells. According to a 2016 study, the average person is composed of about 30 trillion human cells and about 40 trillion bacteria. Since women tend to have smaller blood volume than men, estimates are that their bacteria-to-human cell ratio may be about 30 percent higher than that of men.
This bacterial community, which includes both beneficial and potentially harmful bacteria, is often called the body’s “microbiome,” and has been linked to many aspects of human health. You’ve seen those commercials urging you to eat more yogurt to experience digestive benefits. That’s because yogurt has beneficial bacteria to help boost the number of helpful bugs in your digestive tract, tipping the balance toward the good guys.
Studies have linked the health of the microbiome not only with digestive issues, but with obesity, skin reactions (like acne and rosacea), food allergies, mental health, and even cancer.
In other words, having a good balance of helpful bacteria, particularly in the digestive tract, is good for you.
So imagine what happens while you’re taking those antibiotics. All that bacteria is wiped out—much of the good with the bad. That’s what allows that nasty C diff. bacteria, which is already in our bodies and is also known to exist in hospitals and health care facilities, to reproduce and grow. Without the good bacteria to keep it in check, and having adapted to resist the antibiotics, the C diff. gang hangs around while the other bacteria are killed off, and eventually starts to take over.
In people with weakened immune systems—such as those in the hospital or older people—it’s even easier for C. diff to get around our defenses and start causing real problems.
And the problems are serious. Once established, C. diff is very difficult to treat. Meanwhile, it produces toxins that attack the lining of the intestine, destroy cells, and produce patches of inflammatory cells decaying cellular debris inside your colon.
Symptoms include diarrhea 10 to 15 times a day, abdominal cramping, fever, blood or pus in the stool, loss of appetite, weight loss, and eventually, dehydration, kidney failure, “toxic megacolon” (a condition in which the colon becomes greatly swollen or enlarged), and often fairly quickly, death.
FMT to the Rescue for Patients with C. Diff Infections
Doctors typically try one antibiotic after another in an attempt to treat C. diff, but recent studies have shown that FMT is a much more successful and tolerable therapy.
Why would it help to transplant poop from a healthy person to a sick person?
Because that healthy poop is full of good bacteria that can go to work on the C. diff and show it who’s boss.
It works. So far, studies have shown that FMT has a 90 percent success rate for patients who have failed to respond to typical antibiotic therapy. Most all of the cases were resolved with just one treatment, and adverse side effects were very rare.
In a 2012 study review, for example, researchers noted that FMT “is becoming increasingly accepted as an effective and safe intervention in patients with recurrent disease, likely due to the restoration of a disrupted microbiome.” They added that cure rates of over 90 percent were “consistently reported from multiple centers,” and that FMT for recurrent C. diff infections (CDIs) had a primary cure rate of 91 percent.
In a 2015 study, researchers reported that FMT not only cured CDIs, but made long-term healthy changes to the gut bacteria of infected patients, lasting for at least 21 weeks after the procedure. And in a 2015 case study, researchers found that FMT not only cured C diff. in a 66-year-old man, but it also eliminated other drug-resistant organisms in the man’s gastrointestinal tract and several other body sites.
FMT May Help Treat Ulcerative Colitis and Crohn’s Disease
But it’s not only life-threatening infections that may benefit from FMT.
More recent studies have also shown that FMT has promise in treating a number of other health issues, including inflammatory bowel diseases (IBDs) like ulcerative colitis and Crohn’s disease.
In a 2016 study, for example, researchers reported that FMT helped 44 percent of patients with treatment-resistant ulcerative colitis to go into remission at eight weeks, compared to only 20 percent in the placebo group.
Two other studies the year before found similar results, with FMT creating significantly greater levels of remission over placebo.
So with all this good news, we have just one question—exactly how is FMT performed?
Scientists Working on an FMT Pill
The good news is that the standard FMT procedure saves you from the “ick” factor.
The most common approach involves gathering a fecal sample from a healthy donor—often a family member— who must pass screening tests to be sure he or she is free of any infections or viruses that could prove unsafe for the recipient.
Once a healthy donor is found and approved, he or she donates a cup of stool, which is then put through a process to prepare it. Clinicians mix it with a preservative-free saline and strain it through a filter to create a solution that they can then infuse into the sick patient via a colonoscopy.
The patient must “hold” the stool as long as possible—at least two hours—and that’s it.
Some doctors have also used a nasogastic tube (inserted through the nose into the stomach) or an enema to deliver the solution into the gastrointestinal tract, but so far, the colonoscopic delivery remains the gold standard.
If this still sounds a bit too yucky for you, consider how you might feel if you were suffering a life-threatening diarrhea. You probably wouldn’t mind so much.
But meanwhile, researchers are looking at other, less nauseating and more efficient ways to provide the treatment. A 2016 study found that frozen stool samples worked just as well as fresh—meaning that the samples could be stored longer and used more quickly, potentially eliminating the need to find a donor.
Even more exciting is a possible fecal transplant pill.
The capsule degrades within minutes, and was found in a pilot trial to have an initial efficacy rate of 70 percent, and a higher rate of 94 percent when used at a higher dosage in those who didn’t respond the first time.
Once you get past the squeamishness, you realize that the future of this treatment is extremely exciting. We’re learning more every day about how the bacteria in our bodies affects our health, and we may find that FMT has a lot more applications the more we learn.
Meanwhile, if you want to prevent these types of infections, take care of your microbiome by regularly consuming foods with health probiotics, including yogurt, kefir, miso soup, kombucha, and sauerkraut.
“What is FMT?” The Fecal Transplant Foundation, http://thefecaltransplantfoundation.org/what-is-fecal-transplant/.
“Antibiotic/Antimicrobial Resistance,” CDC, https://www.cdc.gov/drugresistance/.
“FAQs about Clostridium Difficile,” CDC, http://www.cdc.gov/HAI/pdfs/cdiff/Cdiff_tagged.pdf.
“C difficile infection,” Mayo Clinic, http://www.mayoclinic.org/diseases-conditions/c-difficile/home/ovc-20202264.
Tina Hesman Saey, “Body’s bacteria don’t outnumber human cells so much after all,” Science News, January 8, 2016, https://www.sciencenews.org/article/body%E2%80%99s-bacteria-don%E2%80%99t-outnumber-human-cells-so-much-after-all.
The Human Microbiome, Diet, and Health: Workshop Summary, Institute of Medicine Food Forum, Washington D.C: National Academies Press (US): 2013, http://www.ncbi.nlm.nih.gov/books/NBK154098/.
Honor Whiteman, “The gut microbiome: how does it affect our health?” Medical News Today, March 11, 2015, http://www.medicalnewstoday.com/articles/290747.php.
Lawrence J. Brandt, “Fecal Transplantation for the Treatment of Clostridium difficile Infection,” Gastroenterol Hepatol, March 2012; 8(3):191-194, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3365524/.
Christina M. Surawicz, “C. Difficile Infection,” American College of Gastroenterology, December 2012, http://patients.gi.org/topics/c-difficile-infection/.
Faith Rohlke and Neil Stollman, “Fecal microbiota transplantation in relapsing Clostridium difficile infection,” Therap Adv Gastroenterol., November 2012; 5(6):403-420, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491681/.
Honor Whiteman, “Fecal transplantation ‘more effective than previously thought’ for C. Diff infection,” Medical News Today, March 30, 2015, http://www.medicalnewstoday.com/articles/291532.php.
Nancy F. Crum-Cianflone, et al., “Fecal Microbiota Transplantation and Successful Resolution and Multidrug-Resistant-Organism Colonization,” J Clin Microbiol., June 2015; 53(6):1986-1989, http://jcm.asm.org/content/53/6/1986.
Damian McNamara, “Colitis Improves in Multidonor Fecal Transplant Trial,” MedScape, March 21, 2016, http://www.medscape.com/viewarticle/860690.
“Two new studies show that fecal transplantation may help fight against ulcerative colitis,” McMaster University, July 3, 2015, http://www.news-medical.net/news/20150703/Two-new-studies-show-that-fecal-transplantation-may-help-fight-against-ulcerative-colitis.aspx.
David A. Johnson, “Fecal Transplantation for C difficile: A How-To Guide,” Medscape, February 15, 2013, http://www.medscape.com/viewarticle/779307_3.
Dennis Thompson, “Frozen as Good as Fresh for Fecal Transplant: Study,” HealthDay, January 12, 2016, https://consumer.healthday.com/infectious-disease-information-21/misc-infections-news-411/frozen-as-good-as-fresh-for-fecal-transplant-706928.html.
“Fecal transplant pills: Large-scale production begins following successful dosing study,” Open Biome, October 28, 2015, http://www.openbiome.org/press-releases/2015/10/28/fecal-transplant-pills-large-scale-production-begins-following-successful-dosing-study.