We’ve learnt a lot about our microbiome, the bacteria that live everywhere, in us and on us. They do much more for our digestion than we ever guessed. They digest the fibre we eat and make some of the nutrients that are essential to us. Little bacterial critters also form the bulk of our poo. Think logically, it would be a complete waste of food to excrete that much in our faeces, so it makes sense that it is mostly not food that we excrete.
But what happens when things go wrong? We all have good and bad bacteria, and they keep each other in balance in a healthy system. If one of the two goes out of balance, the results can be bad. An out-of-balance digestive biome (set of bacteria) will cause symptoms like gas, cramping, nausea, fever, diarrhea and vomiting. These symptoms can be severe, even life-threatening.
The trigger for upsetting your microbiome could be something like food poisoning or taking an extended course of antibiotics. The result is long-term digestive problems that don’t respond well to treatment. Conditions like IBS and SIBO and eventually even autoimmune conditions result from this imbalance. These are the people who are prepared to look outside the box and maybe even inside the potty for their answers.
First steps to reversing digestive problems
Some bacteria can be eradicated and rebalanced. Often, eating a healthy diet with enough fibre as food for the bacteria, and eating whole and fermented foods or taking good probiotics, can rebalance your digestive biome over time. Obviously that and more common IBS interventions like a FODMAP diet are where you start if your digestive system needs help.
But what do you do when nothing works? This is especially likely with bacterial invasions like C. difficile which are notoriously difficult to eradicate and can be life-threatening. People infected like that, or with severe IBS or Crohn’s Disease are turning to recycling excreted bacteria into their gut to rebalance their microbiota. In short, they’re using other people’s poo, so they’re getting faeces from poo pals and inserting those into their own colon. Faecal transplants (FMT) are performed either by getting a doctor to transfer it into their bowel or by doing a DIY transfer.
There are doctors who offer faecal transplants as a treatment option, but it’s new and frankly not well studied, so they are rightly cautious. In some cases faecal transplants have literally saved lives of people with severe problems. Other cases have seen a reversal of symptoms and then, after months or even years, the problems have reasserted themselves despite continued faecal transplants. The behaviour of the microbiome is not properly understood yet, so we don’t know why these treatment outcomes are different or what the long term side effects of faecal transplants could be. Some people are too sick to wait, so they accept the unknown risk versus their immediate pain.
New studies in weight loss suggest that one of the causes of yo-yo dieting is because your microbiome changes as your diet and exercise patterns change, but over time your microbiome reasserts itself, so your weight does as well. That would also explain why faecal transplants might initially be successful, but then the improvement regresses.
Choosing your donor
If you’re going to do it, partner with a doctor. If your own doctor doesn’t support FMT, find one who will. You’ll have to find a donor – a poo pal (I should patent that name). There are banks in the USA that offer screened faeces, but not in South Africa.
Some say you should choose someone with a healthy lifestyle of your own sex and age as a poo pal. If I were doing it, I would choose a toddler who’s had minimal exposure to antibiotics or parasites etc. Either way, before you start popping their poo, it’s really, really important to have it tested for hidden infections. That’s one of the reasons why you need a doctor.
Faecal transplants and your weight
There are currently a lot of studies being conducted about the interaction between the gut microbiome and weight. They know that there are certain bacteria that, if injected from obese mice into thin mice will cause the thin mice to become obese. These trials are not complete in humans and not all studies are clear on outcomes. (The fact that one of them was tampered with by fraudulent scientists and recalled doesn’t help make anything clearer for us either.) Bottom line is don’t pop someone else’s poo just yet to lose weight, we need to learn more. The reverse is also true: don’t choose poo from an obese donor. You don’t want to gain weight on top of your other problems.
That’s not a reason to find an obese donor if you’re struggling to gain weight. it’s still a very good reason to find a healthy weight donor with healthy lifestyle habits.
How does a faecal microbiota transplant (FMT) help?
So your poo pal – either an anonymous donor medically arranged for you, or someone known that you have chosen for a healthy lifestyle, and whose poo your doctor has had screen for unwanted viruses and parasites – has donated their bacteria-rich excrement. You now need to get that delivered to the right place in your colon so that the diverse bacteria there can take up home in your colon. As they do so they will battle your overgrown bacteria for space and hopefully come out victorious in a new diversity in your gut.
Swallowing a capsule is the least gross of the options, but it MUST be a medically prepared capsule. Gelatin capsules which are available for home use will dissolve faster; the medically prepared one will only release the bacteria into your large intestine which is where you need it. Your stomach is supposed to be clear of bacteria. Releasing faeces into it could start an overgrowth there that could be disastrous for your health.
The other transplant option is doing a rectal transfer. That involves mixing the faeces with saline and inserting it as high into your colon as you can enema-style. This is the preferred method for a DIY and many medical transplants. A word of warning though, your gut is extremely thin and easily damaged. Even having a doctor do this procedure under medical conditions is not without dangers.
A final option is a feeding tube. It’s the most invasive and it needs to reach the large colon past the stomach and small intestine.
After the transplant
Is there anything you can do to retain a richer, more diverse gut bacteria to avoid swapping poo again? Definitely. Exercise shifts the microbiome, so does eating fibre rich whole foods. Eating live-culture fermented foods adds to the diversity. These are all changes that have to be maintained in order to maintain the biome shift.
Adopting a healthy lifestyle can make a difference.