By Laura Shin
Posting in Environment
Fecal transplants sound gross, but they are one of the most promising cures for a growing and serious health problem.
One of the most refreshing things about science is that it doesn't care whether it offends you. It presents the data, and whether you take it or leave it is your business. Science doesn't care.
Take, for example, fecal transplants.
Yes, it is what it sounds like -- taking a healthy person's stool and transplanting it into a patient's large intestine.
If you're already turning up your nose at the idea, ready to click to a more civilized section of the Internet, you are not alone. Doctors, scientists and whole hospital staffs can't get over the ick factor, causing them and their patients to miss out on one of the most promising cures for a growing problem.
If you think fecal transplants are old news (because, well, they are old, if not widely known, news), then you should know that they are on our radar again because Scientific American is publishing in its December 2011 issue an essay, "Swapping Germs," by science journalist Maryn McKenna describing the health benefits of fecal transplants and the regulatory hurdles the treatment faces.
How it works
What a fecal transplant seems to do is allow the bacteria from the healthy stool to repopulate the gut of the patient who has lost healthy bacteria in their gut or who has a preponderance of bad bacteria there.
And it's an especially enticing procedure because of a really nasty bacteria called Clostridium difficile that grows in people's intestines and causes health problems ranging from persistent diarrhea to life-threatening inflammation of the colon to death.
One University of Minnesota doctor, Alex Khorutus, who has performed two dozen fecal transplants explains what led him to conclude that the bacteria from the healthy stool was repopulating the intestines of the patients. McKenna writes:
In 2010 he analyzed the genetic makeup of the gut flora of a 61-year-old woman so disabled by recurrent C. diff that she was wearing diapers and was confined to a wheelchair. His results showed that before the procedure, in which the woman received a fecal sample from her husband, she harbored none of the bacteria whose presence would signal a healthy intestinal environment. After the transplant -- and her complete recovery -- the bacterial contents of her gut were not only normal but were identical to that of her husband.
What there is to like about fecal transplants
C. difficile has become more and more common in recent years as a result of antibiotic treatments. An especially virulent new strain emerged in 2000, and now the deadly bacterial infection has been seen not only in elderly patients but also in children, pregnant women and otherwise healthy people.
As McKenna writes:
One study estimated that the number of hospitalized adults with C. diff more than doubled from about 134,000 patients in 2000 to 291,000 patients in 2005. A second study showed that the overall death rate from C. diff had jumped fourfold, from 5.7 deaths per million in the general population in 1999 to 23.7 deaths per million in 2004.
The second part of the two-part punch is that C. diff is also now harder to cure. It has become more resistant to antibiotics, and so the new standard treatment is to employ two antibiotics. The only problem is that these two antibiotics kill off the friendly bacteria in the gut, too, and so any C. diff organisms that survive end up having a lot more room to repopulate.
And repopulate, they often do: One in five people who have C. diff once get it again, and 40% of that group will get it a second time, and 60% of the people that have it twice will get it a few more times. It sometimes even gets to the point where a patient has to have their colon removed.
So, when you've got something this annoying, you want a treatment that will work. And that's where the fecal transplant comes in: Medical journals show that in about 300 such transplants, more than 90% of the patients recovered completely from C. diff.
Before fecal transplants become a technique widely adopted by hospitals and reimbursed by insurers, the treatments needs to be studied in a randomized clinical trial of two groups: those receiving the treatment and those who are not.
But a few bureaucratic hurdles must be overcome. First, the National Institutes of Health will only study substances deemed "investigational" by the Food and Drug Administration.
And what are those substances normally? Drugs, as you would expect. Devices, yet another obvious choice. And lastly biological products such as vaccines and tissues. But feces? They don't really fit anywhere.
Aside from that, protocols need to be established. In the experiments so far, most patients have received transplants from their relatives or spouses, but if this became a widespread treatment, it might be cumbersome to deal with new "donors" for every transplant, because each one has to be screened as rigorously as a blood donor does. That could get time-consuming and costly very quickly.
One proposed solution is having a pool of "universal donors" (read: healthcare workers). Another idea is to manufacture drugstore enema kits that patients can take home to perform the transplant on themselves.
But in the meantime, many other obstacles need to be cleared, and some data needs to be gathered before this can could be turned into a widespread cure. Canada has already begun three trials, and some U.S. doctors are submitting a proposal for a trial here in the U.S.
But until doctors can put fecal transplants through the paces and get good data, don't poo-poo the idea.
via: Scientific American
photo: Un naturaliste du Midi/Wikimedia Commons
Nov 14, 2011
A friend did the procedure at home for severe U.C. that was no longer responding to other natural remedies, extreme drugs, etc. She was facing colon removal. Major surgery & talk about a life-changer! Within days, she became symptom-free & remains so for the past year. Say what you will, but if you or your child were suffering, you might change your mind. Don't poo-poo the idea just because you don't understand it. The naysayers are the ones full of crap. When the pharmaceutical companies discover how to make a profit from this process, you will see ads on TV. So get used to the idea, it's some great sh**.
It is so childish the vein in which this article is presented. It is simply transplanting the intestinal flora of a healthy person into a sick one. Childish sensationalism is all this is.
I had c. diff, 3 trips to the ER with critically low potassium. 3 rounds of treatment, during which I discovered that Vancomycin had been bought by a different company & a course of treatment went from about $200 to $1200. Even with probiotics & yoghurt it cam back. Dr. finally did another round of Flagyl, & halfway through did a colon cleanse similar to colonoscopy prep. Reasoning was that 'let's clean it all out & see what grows back'. It worked. By that time a fecal transplant would have been OK with me. If you've never been that sick you can't know what you'd do to get better.
Will all the Americans be trooping up to Canada for the cure? Canada has a Universal Health Care system, much like what Obama touts. Too bad the selfish 'I'm not paying for someone else' won't get the cure, if they have their way. Most of them must be stupid Republicans, or HMO employees. Don't they understand how Wal-Mart works...the more people that buy, the less you pay.
Whatever happened to probiotics? Shouldn't they be tried before resorting to something as revolting and expensive as this? If probiotics don't work, why not? It would seem that finding the answers to these questions would be a useful follow-up to this article.
The biggest hurdle to this treatment is the Big Pharma that created the need for it in the first place!
In college in the early 90's I heard a lecture from a doctor who had discovered a new antibiotic after an extremely persistent case of giardiasis. In an effort to cure himself he searched the world over and found a new antibiotic by examining bacteria from the catacombs of Rome, Delhi or another large city. He mentioned offhandedly that a mother had cured her son of the same type of infection by using a fecal enema, which the doctor dismissed with a shudder. Considering all the doctor's suffering and that the infection brought him near death I thought that he was prideful and foolish to not at least try the low tech method.
... the day sh*t is worth money, the poor will be born without ars*holes? That day may have arrived!
If this is turns out to be a viable treatment I would be concerned about using healthcare workers as donors. Massive and at times indiscriminate use of antibiotics has been the cause of these "superbugs" many of which seem to be bred out of hospitals. The last place I would look for donors would be in this sort of environment.
The original premise that science only presents facts is a bunch of crap too. Scientists and researches will present the "facts" that will get them published and garner more grant money. Just ask any climate scientist that tries to publish articles against anthropomorphic climate change and see how many there are. Those who allocate grant money for research want to see research that supports their agenda. YES scientists do care who their facts offend. Especially when they offend the people who dole out government grant money.
when the medical establishment figures out a way to charge lots of money for it. Because, right now, anyone can do it at home. You just need a healthy donor, a blender, an enema bag, and the courage to do what needs to be done.
While this procedure may be direct and effective, there are less invasive and not so disgusting options available to repopulate good bacteria in a persons intestinal tract.
Have you ever had Ulcerative Colitis or C. Diff or Crohn's? Now that is really gross! It's gross every day, multiple times per day & bloody gross.
I think it is the opposite - it presents the information in a way that gets past the unpleasant connotations
I would think and hope that before they start giving a lot of antibiotics that they would already have tried probiotics. Unless the doctors skip it knowing that it is mostly a marketing product.
From personal experience, I would say that you are right & probiotics are the FIRST thing people try. However, when the disease/disorder gets to a certain level of severity, probiotics simply are not enough.
Part of the problem???at least here in the U.S.???is that there is no meaningful legal definition of "probiotic," so there are products on the market using/containing strains of bacteria that are irrelevant at best (and potentially harmful at worst) in terms of healthy gut bacteria. There are certainly reputable companies as well. For example, I recently learned that the cultures Renew Life uses in their Ultimate Flora: Critical Care product are descended from cultures obtained from healthy human donors???in other words, a cleaner & less invasive way of introducing these bacteria than the method presented in this article.
A lot of the problems are caused by patients failing to complete their course of treatment: the bacteria are not quite all disposed of, and those that survive, mutate, and become resistant. A bit Darwinish. Survival of the fittest.
What other options are you talking about? The usual response is a course of antibiotics but the complications is that we are breeding antibiotic resistant bugs. The article pointed out that the species of bacteria has developed immunity and can cause problems from diarrhea to death. The problem is that the results are clinical experiments and not the full research to confirm if this treatment is effective. I think that the super bugs are only dangerous because they developed immunity to antibacterial drugs that kill off their competition. The super bugs may be easily killed by other bacteria that are beneficial to health.