The balance of microorganisms in your gut — known as your gut microbiome — is one key to health. Because our feces contains those microorganisms, the feces of someone in good gastrointestinal health can be valuable, even life-changing, to another person with intestinal problems. This insight has led to the “fecal microbiota transplant,” when doctors introduce feces into to some part of the gastrointestinal system.
One man’s waste can be another man’s medicine.
The results can be dramatic. In a procedure like a colonoscopy, when doctors insert a tube in the colon, a team at the Mayo Clinic in Arizona performed a fecal transplant in 2011 on a patient with a severe gastrointestinal infection who wasn’t responding to medication, using donated stool from his brother. "Unbelievably, the patient left the hospital 24 hours after the procedure, after having been bedridden for weeks," said Robert Orenstein, DO, of Mayo Clinic in Arizona.
Fecal transplants are best-established in patients infected with clostridium difficile (CDI), a sometimes lethal microorganism that causes contagious diarrhea. The problem has increased sharply over the last two decades, especially among hospital patients. Relapses are increasingly common, too; some 20 to 30 percent of patients experience at least one recurrence two to four weeks after completing the standard antibiotic, and others get no relief at all. Some patients undergo emergency colectomies and still have problems afterwards. CDI is especially vexing among the elderly, who are harder to treat. So doctors got imaginative when looking for answers.
In a 2015 research review that included two randomized controlled trails, researchers found that fecal transplants resolved symptoms for 85 percent of the people with recurrent bouts of CDI and 55 percent of those who weren’t responding at all.
Scientists are studying the idea to treat a range of conditions that involve a disordered microbiome. Besides entering through the colon, doctors can introduce the fecal matter in the upper parts of the gastrointestinal system in an endoscopy, where the tube is inserted through the throat; or with other kinds of tubes depending on the location of the problem. Swallowing capsules of frozen fecal matter is also effective. Transplants may subdue other pathogens resistant to many drugs, particularly vancomycin-resistant enterococci, or help treat inflammatory bowel syndrome, a common term for auto-immune conditions such as ulcerative colitis and Crohn's disease.
“Some physicians claim to have great success treating ulcerative colitis and celiac disease,” said Orenstein, “And it's been looked at for obesity, diabetes and rheumatoid arthritis,” all possibly related to the gut, although he does point out that it’s difficult at this early stage for researchers to compile good data. Some evidence does suggest that introducing feces from lean donors to obese recipients made them more sensitive to insulin — a much-desired result to manage diabetes.
No, we’re absolutely not advising that you eat your sister’s doo-doo even if you get diarrhea a lot and she doesn’t, or you’re obese and she’s skinny. You don’t want feces in your mouth. You can keep your own microbiome healthy by taking antibiotics only when necessary, and eating lots of vegetables containing fibers considered “prebiotics,” foods that fuel healthy bacteria in your body. Prebiotics include asparagus, bananas, onions, garlic, cabbage, beans, legumes like peas and lentils, artichokes, apples, root vegetables, apples, and various kinds of bran. You might also try “probiotics” fermented with good-guy bacteria: yogurt, sauerkraut (fermented cabbage), kimchi (the spicy Asian cabbage), kombucha (fermented tea), or tempeh (fermented soybeans).
July 24, 2015
Christopher Nystuen, MD, MBA