fecal transplant

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Question What You Read Everywhere!

If you follow my blog and keep up with the news, you’ve heard about a pair of recent studies published in the medical journal, Cell, that found probiotics may have very limited value.

Unfortunately, the mainstream media — seemingly everyone from CBS News to Forbes — jumped on the bandwagon to dispute the value of probiotics without looking at their considerable and proven benefits over time, many of which we’ve discussed here.

Since you have some questions and concerns about these reports, we have some answers.

What do the studies say?

Study one examined how well a generic probiotic with 11 strains of bacteria could colonize the intestinal lining when given to 25 healthy adults, as determined with a colonoscope taking specimens from the mucosa, versus a placebo.

This approach differs from most previous studies in which probiotics were measured in stools. Their justification was to determine if the generic probiotics you find at most supermarkets “colonize the gastrointestinal tract like they’re supposed to, and then whether these probiotics are having any impact on the human host.”

Study two investigated whether patients should be taking a probiotic when they were prescribed an antibiotic to prevent antibiotic-associated diarrhea.

Twenty-one healthy patients were divided into three groups: Seven took an antibiotic, six more were given an antibiotic and the same generic probiotic from the first study and the rest received an antibiotic and pills containing fecal samples from their own microbiome.

What were the results?

In study one, the generic probiotic bacteria were found in the stools of each patient, and only in the lining of the colon of a few patients. This finding led scientists to conclude that, if probiotic bacteria weren’t found in the colon, they’re not beneficial. It also explains why many stories reported probiotics were ‘’useless.”

The results of study two were a bit more complicated:

  • The microbiomes of patients who received just an antibiotic returned to their healthy composition after 21 days.
  • Patients given fecal transplants experienced a normal intestinal microbiome within days after stopping the antibiotic.
  • Among patients treated with a generic probiotic, their microbiomes did not return to their original composition even five months later.

Problems with both studies

Now that you’ve had a chance to review both studies, it’s easier to see why taking these results at face value is tricky.

The problem with study one that examined the use of a generic probiotic was pretty straight-forward. These generic probiotics were given to healthy people with normal microbiomes, so the beneficial bacteria wouldn’t find a place in the lining of the colon to colonize.

In fact, the immune system of the intestines and existing microbiome would prevent it!

Studies have shown when patients struggle with gut health problems like irritable bowel syndrome (IBS), taking a good probiotic can treat their symptoms and rebalance their microbiomes. So, probiotics aren’t “useless!”

In study two, because patients treated with a generic probiotic after receiving an antibiotic didn’t return to normal right away, researchers assumed the probiotic might cause ”harm” by increasing their risk of intestinal disorders. Moreover, researchers suggested patients “personalized probiotics” in the form of fecal transplants might lessen any risks.

Unfortunately, this phase of the study set up patients for more health problems like diarrhea down the road, merely by giving them antibiotics.

Plus, antibiotics change the composition and balance of bacteria in the gut, which may increase the activity of enzymes that trigger a faster absorption of carbohydrates, leaving you more vulnerable to obesity and diabetes.

Remember those extra carbs and fats feed poor dietary habits that disrupt your gut-brain axis, the biological connection that links your intestines, brain and emotions.

One more variable this research team didn’t consider in either study: The contribution of prebiotics, the non-digestible starches that feed the bacteria in your gut contained in a lot of probiotics, including EndoMune Advanced ProbioticEndoMune Junior Probiotic and EndoMune Metabolic Rescue.

Prebiotics have been shown to offer a number of health benefits connected with probiotics, like improving your sleep and giving your body some extra protection from type 2 diabetes.

Also, I have to take issue with the use of fecal transplants to engineer the results of this study. Fecal transplants may have performed better among three options in this second study, but going this route isn’t without its risks, especially if you’re receiving fecal matter from another donor.

In one 2015 report, a patient was successfully treated for a recurring C. diff infection with a fecal transplant from an overweight donor (her daughter) only to gain 34 pounds in just 16 months.

In other cases, people who have tried “do-it-yourself” fecal transplants from donors have suffered brand new health problems they never expected from people who seemed to be very healthy, but were carriers of germs they could pass on to others.

I cannot stress enough that using these results from both studies to imply that probiotics in many cases are “useless” or “harmful” just isn’t accurate.

As a physician specializing in gastroenterology, I’ve seen firsthand how the use of probiotics has changed the lives of patients suffering from simple problems like constipation and hard-to-treat ones like IBS. Also, patients who are on a strong course of antibiotics may avoid the risks of experiencing life-threating infections just by taking a probiotic too.

One more reason why you don’t need a fecal transplant

As medical science looks for new ways to conquer tough-to-treat health problems like Clostridium difficile (C. diff), fecal transplants — the transferal of gut flora from healthy donors to sick patients via tubes or pills — are attracting more attention than ever.

Due to the growing amounts of successful research, the FDA has been pushed to regulate fecal transplants as experimental drugs, yet continues to struggle on how to do so.

A recent case study published in Open Forum Infectious Diseases illustrates the conundrum the FDA and patients face when deciding if the “cure” is really worth the true price.

Unintended Consequences

This study could be defined as a case of unintended consequences, a term coined by American sociologist Robert K. Merton. Unintended consequences defines unexpected outcomes — benefits, drawbacks or perverse results — that occur from a purposeful action.

One such case was a 32-year-old woman who was successfully treated for a recurring C. diff infection with a fecal transplant from an overweight donor (her teenage daughter) in 2011. She then gained 20 percent of her body weight (34 pounds) over the following 16 months, jumping to 170 pounds.

Unfortunately, despite a medically supervised exercise program and liquid protein diet, the woman, who had never been overweight before the fecal transplant, has gained 7 more pounds since then and remains obese today.

“We’re questioning whether there was something in the fecal transplant, and whether some of those ‘good’ bacteria we transferred may have had an impact on her metabolism in a negative way,” said Dr. Colleen R. Kelly of the Warren Alpert Medical School of Brown University via a press release. The case report was a joint effort with Dr. Neha Alang, of Newport Hospital in Rhode Island.

The unintended consequences of sharing bad traits thanks to fecal transplants is supported in other published studies, in which fecal samples transferred from obese mice to those of a normal weight may lead to a marked increase in fat. This explains why scientists urge patients to find fecal transplant donors who aren’t obese.

What’s more, scientists speculate the fecal transplant may not be the sole reason why the woman became obese, citing several antibiotics prescribed to treat H. pylori, illness-related stress, aging, genetic factors and the resolution of her C. diff infection as other contributing factors.

One way to have counteracted those side effects: Her doctor should have prescribed a probiotic, such as EndoMune Advanced Probiotic, that would have helped her treat the H. Pylori to protect her overall gut health.

Do you really need an oral fecal transplant for a C. diff infection?

There’s no denying fecal transplants — the transferring of gut flora from a healthy donor to sick patients — can be helpful in treating Clostridium difficile (C. diff) infections that contribute to diseases from colitis to diarrhea.

Transfers of healthy gut bacteria have been delivered via a variety of uncomfortable methods, ranging from tubes through the nose to the intestines (nasojejunal) and stomach (nasogastric) to endoscopies, colonoscopies and enemas.

However, the promising findings of a recent Journal of the American Medical Association report may be changing the delivery of fecal transplants for good.

After successfully testing the delivery of frozen fecal transplants to patients via nasogastric tubes and colonoscopy to treat patients earlier in the year, researchers at Massachusetts General Hospital designed a study to test the efficiency of fecal transplant capsules.

To produce those capsules, stool samples were taken from healthy volunteers who had been screened for infectious diseases and avoided consuming common food allergens. Then, the samples were processed, placed into capsules and frozen for four weeks.

Feeling squeamish yet?

Scientists tested their frozen transplant on 20 patients between ages 11-84 who were suffering from a persistent or recurring C. diff infection. Over two consecutive days, each patient took 15 capsules per day. After an initial two-day treatment, the symptoms from 14 patients were completely resolved.

Then, after a second treatment with the remaining six patients (who were generally in poorer health) a week later, all but one were successfully treated. Over the eight-week trial, all but two patients responded successfully to the frozen fecal transplant capsules.

Despite the success of the study, Dr. Ilan Youngster (co-author of the study) warned patients, literally, not to experiment with fecal transplants at home. “While we are striving to make this treatment more accessible to patients, it’s important to remind people of the potential dangers of attempting ‘home brew’ FMT [fecal microbiota transplants] using fecal material from family members or friends.

“Many people can be carriers of bacteria, viruses, and parasites that are shed in their stools but have no symptoms. It’s not enough to know your donor and just ask how he or she feels, as some websites suggest. In any form, this procedure should only be performed under strict medical supervision with material from thoroughly screened donors.”

The lesson to be learned from this study is pretty simple: If doctors encouraged their patients to take a probiotic when prescribing them antibiotics, doing that one thing would reduce the number of C. diff cases significantly.

Taking a probiotic about two hours after a prescribed antibiotic will reduce the risk of antibiotics depleting the live, beneficial bacteria that protect and improve your gut health naturally.

Taking a multi-species probiotic like EndoMune Advanced Probiotic and EndoMune Advanced Junior (for kids) can give your immune system a much needed boost by improving the diversity of beneficial bacteria in your gut, and eliminate the need for a fecal transplant.

What you need to know about fecal transplants

You’ve probably seen an increasing number of stories about the “wonders” of fecal microbiota transplants, the process of transplanting gut flora from a healthy donor to a patient suffering from Clostridium difficile infection (C. diff) that contributes to diseases ranging from diarrhea to colitis.

Fecal transplants may not be the perfect cure-all many patients are expecting, however. In fact, taking a multi-strain probiotic every day can go a long way toward preventing C. diff infections without the need for one.

Some background about C. diff

  1. Symptoms of this infection can range from inconvenient and mild (loose stools punctuated by abdominal pain or tenderness for a few days) to life-threatening and possibly fatal (loss of appetite, fever, weight loss, severe abdominal pain and even a hole in the intestines).
  2. Some 14,000 Americans die each year due to the effects of C. diff., out of 23,000 who perish due to antibiotic-resistant infections. Medical experts estimate 25 percent of patients who are treated for C. diff suffer recurrences, and half of them occur in stages.
  3. C. diff is a bacterium that resides in our intestines and, generally, will not cause harm because the normal, healthy bacteria in our gut will suppress its growth. The main reason C. diff becomes a problem: The overuse of antibiotics eliminate the good bacteria that fight infections.

 

After the success reported in a recent New England Journal of Medicine study conducted in the Netherlands, some medical experts believe fecal transplants have created “a lot of buzz for lots of illnesses” may show some potential for treating Parkinson’s disease, ulcerative colitis and celiac disease.

Simply put, the success of fecal transplants underscores the importance of good gut health that contributes to the total scope of health. But, do you really need one?

What follows are answers to common questions about fecal transplants.

Why have fecal transplants become so popular in treating gut health problems?

Fecal transplants have been shown to be safe and effective for C. diff-related diarrhea and colitis. It is known that ulcerative colitis and many other health disorders are related to an unhealthy balance of intestinal bacteria.  By giving a fecal transplant — which is really a “super probiotic” — it is possible to infuse healthy bacteria that can rebalance the intestinal flora and stop the immune mediated inflammation.

There are ongoing trials of fecal transplant for ulcerative colitis, irritable bowel syndrome (IBS), pre-diabetes, autism, obesity and other conditions. Some of the results have been very promising.

What are the primary causes of C. diff that have pushed gastroenterologists to prescribe fecal transplants?

C. diff is a bacteria that has become a common hospital-acquired infection, especially when a patient is given an antibiotic that disrupts the normal intestinal bacteria.

C. diff produces severe diarrhea and colitis which will respond to specific antibiotic therapy. Unfortunately, there is a significant risk of relapse of the colitis. Some patients have become critically ill, especially after their third or fourth relapse. Drastic situations require drastic care.

There were case reports of patients responding to fecal transplant dating back to 1958. The medical community knew that it might work, but the “ick” factor had made it an unattractive therapy.

In 2010, there were reports that greater than 90 percent of patients were cured after a fecal transplant. Given the serious nature of a C. diff infection and the safe and rapid recovery after fecal transplants, physicians are now embracing its use.

Are fecal transplants FDA-approved procedures?

No, they are not. It is a real problem in that controlled clinical trails need to be done with sick patients who have C. diff, giving half a real fecal transplant and the other half a placebo to prove there is a statistical improvement, and that there are no serious side effects. Studies are now underway.

Because of the severity of the illness and the noted benefits, the FDA has issued a statement that “fecal transplants be used only on patients with C. diff who have not responded to any other therapy, and only after doctors make sure the patient understands the approach is ‘investigational’ and has ‘potential risks’.”

How much do fecal transplants cost?

The current standard treatment for C. diff is costly since expensive courses of medications may need to be given a number of times and, even then, the patient may need to be hospitalized.

The cost for a fecal transplant depends on how the transplant is delivered. It can be given as a retention enema or through a colonoscope or nasogastric tube. I would think depending on the route given, the total cost would be less than $3,000.

Can probiotics help in ways that fecal transplants cannot?

Probiotics have been shown in clinical trials to lessen the risk of developing a C. diff infection if given during the course of the antibiotic. Probiotics can lessen the risk of C. diff multiplying and causing colitis. It wouldn’t make sense to give a transplant to a healthy patient taking a prescribed antibiotic.

How can probiotics help by preventing C. diff and avoiding fecal transplants?

Probiotic bacteria produce antibacterial proteins that kill C. diff bacteria and also inhibit it from adhering to the intestinal lining cells. These properties of probiotic bacteria prevent C. diff from multiplying and producing toxic substances that cause diarrhea and colitis.

Just a reminder, it’s important to know when to take probiotics and antibiotics to get the maximum benefits from both. Taking antibiotics and probiotics two hours apart lowers the risk of the former, eliminating the live and beneficial probiotic bacteria that preserve and protect your gut health.

Photo source: CDC’s Public Health Image Library

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