The role of the gut microbiome
Microbiota refers to the entirety of microorganisms (bacteria, archaea, microeukayotes, viruses) that inhabit the human body. Of all of these microbial cells, the intestinal microbiota contains the largest and most diverse population, and is being referred to as the microbiome. The human microbiome project has shown huge variation in the composition of the gut microbiota between race, ethnicity, sex and age. In addition to these factors, it has also come to light that diet plays an integral role in the health of the gut microbiome. For example, the gut microbiome of children who consume plant carbohydrate-based diets varies exponentially from children consuming a typical western diet (1).
Interest in the gut microbiome is increasing. This is because of its affect on the overall wellness of the human body. There is strong research to suggest that the presence, quantity, richness, and diversity of certain bacteria in the gut may be an indicator of health. In fact, specific microbes are thought to aid in cancer resistance, improve brain function, support a healthy heart, and enhance metabolism and the immune system. Put simply, a healthy, happy gut microbiome equals a healthy, happy body, and mind.
What is Fecal Microbial Transplant (FMT)?
Fecal Microbial Transplantation (FMT) is the transplantation of donor fecal matter into a recipient’s intestinal tract. This may seem strange, but its purpose serves to have a direct effect on the health of the recipient, and the treatment has actually been around for a lot longer than you may think. The first recorded use of FMT dates back to 4th century China, where sufferers of gastro-intestinal illnesses, such as diarrhea or food poisoning, were treated with fecal suspension or orally prescribed infant feces (2). By 1958 it was introduced into mainstream medicine when doctors prescribed the use of fecal enemas as treatment to 4 patients with pseudomembranous enterocolitis, 3 of which were in critical condition. Hours after receiving an FMT, all 4 patient’s symptoms were completely resolved (3).
FMT and the treatment of Clostridium difficile (CDI)
Clostridium difficile (CDI), a specific kind of gut bacteria, can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. It is often caused by prolonged periods of antibiotic use. In a healthy gut, CDI is vastly out-numbered by many different species of beneficial bacteria, but the use of antibiotics can completely disrupt this delicate ecosystem by killing the protective bacteria. As crazy as it may sound, the mainstream treatment of this disease caused by too many antibiotics, is to give more antibiotics. Not surprisingly, CDI has become resistant to the antibiotics used to treat it, leading to a more serious infection, and the release of toxins into the body. Sufferers may have severe diarrhea, abdominal pain, and a fever. In 2010, 500,000 people were treated for CDI, with a morality rate of 1500-2000, and the cost of managing the illness is estimated at $1 billion in the U.S. (3). The rise of cases, relapses, and reoccurrences, are due to the abusive overuse of antibiotics, and the increasing resistance of CDI to antibiotic treatment.
Currently, researchers are testing the role of FMT and its potential for treating CDI, and it is proving to be a highly effective alternative therapy. In theory, it’s simple. Antibiotic use doesn’t rebalance the gut microbiome (actually, it does the opposite), whereas FMT reintroduces protective flora through donor feces, thus restoring balance to the delicate ecosystem. FMT has been shown to be 87-90% effective at curing CDI in more than 500 cases that have been reported in the literature to date. It has also shown to be a relatively safe, well-tolerated, and effective treatment with very few adverse side effects (3).
The use of FMT for other chronic diseases
Inflammatory Bowel Disease (IBD)
IBD is technically a term for 2 conditions, Crohn’s disease and ulcerative colitis (UC). Both of these illnesses are characterized by chronic inflammation of the gastrointestinal tract. Crohn’s disease can affect almost any part of the digestive tract (which goes from mouth to anus) and shows up as patchy, damaged areas. UC on the other hand occurs only in the colon and rectum, the damaged areas are continuous, and the condition usually spreads. Symptoms of both of these conditions include; diarrhea, abdominal pain, blood in the stool, weight loss, and fatigue. The exact cause of IBD is unknown, but is thought to be the result of a defective immune system, which is why they are classified as autoimmune diseases.
Studies have explored the microbiota present in IBD, and found that overall people with IBD have reduced diversity. In addition, the population of bacteria present in people with IBD has been shown to be inflammatory in nature and produce a greater number of toxins. This has led to an exploration of FMT as therapy for the disease. Studies show that through FMT treatment there is a 30-50% reduction in the symptoms of IBD (1,2).
Irritable Bowel Syndrome (IBS)
IBS is the most prevalent functional gastrointestinal disorder (FGID), and affects 20% of Americans (1). It is characterized by a group of intestinal symptoms that occur together, varying from person to person. Symptoms often include; cramping, abdominal pain, gas and bloating, constipation, and/or diarrhea. These symptoms are not usually persistent, but tend to come and go each month. Consistent with the gut-brain connection, with IBS there seems to be a mental-emotional component as well.
For many people, managing stress and changing their diet can help significantly in reducing symptoms of IBS. However, currently there is no cure for IBS, and most treatments are focused on relieving the symptoms. What we do know, is that microbial diversity and the gut-brain axis in sufferers of IBS is altered. One study used FMT to treat 45 patients suffering from chronic IBS, and found 89% of patients to have immediate symptom relief, and 60% of them maintained this relief for 9-19 months. Another study used FMT with 13 patients, which resulted in 70% of them having symptom relief for 6-18 months (1).
Multiple Sclerosis (MS) & Chronic Fatigue Syndrome
It is not new information that a complex relationship exists between the brain and the gut. An example of this is multiple sclerosis, an autoimmune chronic inflammatory disorder, in which the immune system attacks the healthy tissue in the central nervous system (CNS). Symptoms of MS include, fatigue, numbness and tingling, weakness, vision problems, dizziness, pain, issues with digestion, and depression.
Recent studies have shown that the bacteria in the gut play a crucial role in the development of MS. We now know that certain species of bacteria are able to trigger the demyelination process that occurs in MS. In addition to this, MS patients have increased intestinal permeability (leaky gut), leading to bacteria inside the gut making its way into the bloodstream. Studies using FMT therapy have resulted in patients showing no constipation or neurological disabilities for 2-15 years post treatment (2).
Similarly, patients with chronic fatigue syndrome also present with increased intestinal permeability in direct correlation with the severity of the disease. Studies have shown a 70% success rate in clinical improvements after treatment with FMT (2).
Obesity & Metabolic Syndrome
According to a recent National Health and Nutrition examination survey, 18.5% of children and almost 40% of adults were obese in 2015-2016 (4). These rates are alarmingly high, and many populations, regardless of race or ethnicity, have continued to see a rise in obesity. Along with obesity, there has been a dramatic increase in the prevalence of type 2 diabetes and hypercholesterolemia (high cholesterol).
Studies comparing the gut microbiome between lean and obese people show significant differences. It is believed that the specific bacteria found in obese individuals may be increasing their risk of obesity, potentially via direct influencing to the brain. Research where an FMT is transferred from lean individuals to obese individuals has shown improved sensitivity to insulin, and an increase in the diversity of the gut microbiome (1).
Metabolic syndrome was first defined in 1998. It is not a disease in itself, but rather a group of risk factors (high blood pressure, high blood sugar, unhealthy cholesterol levels, and abdominal fat). The combination of these factors is highly damaging to overall health. They can double the risk of heart disease and increase the risk of diabetes five fold. The gut microbiome is quickly being recognized as being a key player between metabolic health and disease.
Research has already discovered that certain species of bacteria play a role in obesity by either increasing appetite, decreasing satiety, or increasing the calorie extraction from food. Alterations of this bacterial population through FMT have shown to positively affect individuals with metabolic syndrome. After FMT, patients show improved insulin sensitivity, increased bacterial diversity, and an increase in butyrate production (1,5).
Regulations and Policy
In 2013, the F.D.A (Food and Drug Administration) announced a decision to regulate FMT therapy as a drug, stating that it would continue to study its effects before making a decision. For many advocates of the treatment, there is concern that corporate greed will get in the way of patient access, and for many patients, FMT is a balance between life and death. Many leading gastroenterologists fear the needs of the investors will be prioritized above those of the patients (6).
On the other end of the spectrum, pharmaceutical executives claim that the drug model will ensure the efficiency and safety of the still largely under-researched therapy (6). In my opinion, this is political mumble jumble that basically means they want to profit from the therapy. Big pharma is looking to create synthetic poop that is consistent, reproducible, and patentable. The huge downfall to this is that it completely negates the benefit and purpose of FMT therapy. The reason that FMT treatments work so well is because of its unique, complex, and unpredictable nature. There is still so much we don’t know about the intricate interplay between the bacteria in our gut and the immune system. This interaction is crucial for the success of this therapy, and would likely be lost if it was synthetically produced.
Currently, the administration of FMT is only allowed for patients with CDI that are not responding to standard antibiotic treatments. Patients must be explained the risks and benefits, and be made aware of the fact that FMT is still an investigational therapy. The donor of the feces must also be properly screened for various pathogens and diseases. This is an extremely important fact for anyone considering FMT therapy. If a donor isn’t properly screened, it is possible for the therapy to cause more harm than good.
My FMT Experience
If you haven’t read my personal health story, you can find it here. The quick and dirty version is that I have suffered from a variety of digestive issues since I was born. I was delivered via c-section, had a difficult time breastfeeding, and was colicky for the first 6 months of life. Through adolescence and early adulthood I was frequently bloated, always fatigued, struggled with my weight, and battled with chronic Candida overgrowth. I saw many Naturopathic Doctors, Medical Doctors, Chinese Doctors, and other holistic practitioners. Everything I tried offered moderate relief of my symptoms, but the benefits were never long lasting.
In medical school I started learning about the microbiome, and quickly became addicted. It was like I had found the missing piece to my health puzzle. It made so much sense to me that the microbes living inside of us were an important part of our health, and that an imbalance to this ecosystem could lead to a variety of ailments. I started taking advanced gut health courses, and this is when I learned about FMT. From that moment on, I was determined to experience this icky yet fascinating therapy for myself. I didn’t want just any donor however. I wanted a donor whose microbiome would be far superior to an American microbiome. So I researched endlessly until I found a clinic in Mexico that was providing FMTs from an indigenous Indian tribe living in central Mexico.
So in the beginning of 2017 I dragged my very patient husband down to Mexico with me. While there, I received an FMT enema along with an FMT capsule. Over the next 60 days I continued swallowing FMT capsules weekly, and received my 2nd enema. So what was the result? For 6 months following the start of treatment I experienced about 50% less bloating, my cravings for carbohydrates almost disappeared, my chronic heartburn was 75% better, and I had a profound improvement in my emotional well being. Unfortunately, my funds for the treatment ran out, and it didn’t take long for my symptoms to return.
The truth of the matter is that the microbiome we possess is the result of our environment, our lifestyle, and our overall stress load. Research shows that the microbiome can be dramatically altered in as little as 48 hours with simply a change in diet. At the time, the overwhelming stress from school, my unhealthy relationship with food, and my love for winding down with wine left my gut unable to support the healthy microbiome of my donor. I have zero regrets about this experience, because I learned a lot from it. I am now on a mission to change my life and my health through the alteration of my microbiome. If you have any questions about FMT therapy, feel free to contact me.
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