February 10, 2017 by Amy Hollenkamp
From December 5th through the 16th, I was in the Bahamas receiving fecal microbiota transplantations to help rebalance my imbalanced gut. It was a unique experience and I think it could be a promising treatment strategy for many diseases in the future.
So, why did I decide to undergo FMT treatment? The primary reason was that after years of trying to rebalance my gut, it remained full of overgrowths with little diversity. Both recent stool and organic acid testing revealed overgrowths of bacteria and yeast in my body. According to SIBO breath tests, the SIBO was gone, but many of my symptoms remained. I had definitely made improvements and had become an expert at managing my symptoms, but I still had thyroid issues (not autoimmune), GI discomfort, bloating and low white blood cell count. I felt like FMT could be the nudge that my body needed to reach my health goals. All my strategies were approaching the problem from the top down and I was hoping a bottoms up approach would be more effective.
I also felt like some of the antimicrobial and diet treatments I naively completed early in my treatment might have been helpful at eliminating the SIBO, but had a steep price. That’s why in past posts I have warned against long periods on low FODMAP diets and cyclical antibiotic treatments. I, like so many within the SIBO community, was very narrowly focused on killing and starving the small intestine bugs that I failed to see the collateral damage these treatments had on my large intestine, hormones and overall health. By the time I did see the light, the damage was already done.
What is FMT?
Fecal microbiota transplantation involves taking bacteria from a healthy donor (from their stool) and putting it into a person with an unhealthy colonic bacterial population. I always think of FMT like probiotics on steroids. FMT can introduce a more robust and diverse bacterial population to your GI tract than any probiotic food source or supplement. Typically, the bacteria is administered via enema, colonoscopy or endoscopy. More recently, FMT pills have become available and seems to be the most convenient way to deliver the gut bugs to patients. While convenient, I find the idea of swallowing someone’s poop rather disconcerting. But, if it helps people, I guess I can get used to the idea.
So, you might be wondering, if FMT is like probiotics on steroids why isn’t it a more popular treatment for gut problems like SIBO and IBS? The main problem is that the law prohibits FMT as a treatment for these conditions. In the US, FMT is only FDA approved to treat recurrent C. Diff infections.
But in other countries, FMT is used as a treatment for a variety of conditions like MS, Crohns, IBS, UC, neurological conditions and even autism. In fact, according to the nurses at the clinic I went to, they had recently treated a number of autistic children in their facility with positive results (not curing, but greatly improving their social behaviors).
I remember first reading about FMT in Dr. David Perlmutter’s book Brain Maker. He describes in his book how he has great success utilizing FMT as a treatment for his patients with severe neurological conditions like MS. While these are diseases of the nervous system, Dr. Perlmutter astutely understood that the root cause of these diseases is usually disturbances in the gut microbiota. One patient Perlmutter highlights even went from wheelchair bound to walking after his miraculous treatment of FMT overseas.
With my own gut problems in full swing, I investigated further. I stumbled on a Chris Kresser podcast that featured Dr. Glenn Taylor, a microbiologist and co-founder of the Taymount Clinic in the U.K. that specializes in performing FMT treatment. This podcast was extremely informative and I highly recommend any one interested in FMT to check it out. But in case you don’t want to listen to a whole podcast, I am going to lay out some of the highlights from various interviews with Dr. Taylor about FMTs.
DIY FMTs are not recommended by Dr. Taylor
With FDA only approving FMT for C. Diff, many desperate sufferers take matters into their own hands and perform the transplant themselves. This process involves finding a donor, which is usually a friend or family member with good gut bacteria. It always makes me laugh thinking about asking a loved one for their poop. I would assume it might be hard to slip that casually into a conversation. “Oh by the way….can I borrow some of your poop?” I would do anything to be a fly on the wall when that convo went down! Once they nab a donor, the more responsible DIYers test their donor’s stool to make sure it has a healthy bacterial population and doesn’t have any pathogenic bacteria. If the poop passes the test, you throw it in a blender with some saline and whip up a nice bacterial cocktail that is later injected into the colon. I can only hope that they have a special “poop” blender for this endeavor. Wouldn’t want my smoothies to be sharing the same blender as poop. But, I digress haha 🙂
While intimidating, the messiness of preparing the implant is not what turned me away from DIY methods, but rather the flaws in the extraction process. In the interview, Dr. Taylor points out that 90% of the bacteria in the large intestine are anaerobes, meaning that they can’t survive in oxygen rich environments. He states:
“…all these poor people who don’t really quite understand that particular aspect are taking stool from a friend or a loved one, putting it into an ordinary kitchen blender, blending it up in the presence of oxygen and perhaps not quite the right liquid medium, and almost instantly they’re killing 90% of the bacteria that would have been available. When you don’t know precisely which one you’re missing, I cannot understand why you’d take the risk of killing 90% and hoping that the one you need is in the remainder. Then subsequent mishandling of the rest of the process means that people are getting exposed to a very, very small amount of what they need.”
So, while I admire the gung hoe spirit of DIYers, the extraction process doesn’t preserve the robust diversity in the donors stool. The only real way to solve this problem is to extract the bacteria in an anaerobic environment that mimics the conditions inside the colon. Luckily, Dr. Taylor and his team have perfected an anaerobic extraction method that preserves nearly 100% of the bacteria.
After extracting the poop, the Taymount team also filters out everything other than the bacteria. This isolation of the bacteria greatly reduces the risk that the recipient will react negatively to the transplant, because it removes all the excess gunk (hormones, food particles, fibers,etc.) from the donor’s stool. The end product is a small pellet of bacteria that can be implanted into donor. At home fecal transplanters don’t have the equipment or know how to separate the bacteria from the other poop components, so they run a higher risk of reacting to their transplants.
Screening a donor is complicated.
Dr. Taylor also has concerns about donor screening methods with at home FMTs. First, many DIYers fail to thoroughly screen their donors for any auto-immune or communicable diseases. While a donor may appear perfectly healthy, great precaution needs to be taken to ensure that they are not a hidden carrier of disease. Second, DIYers usually fail to have their donors stool properly screened. Dr. Taylor doesn’t think a one time stool analysis is enough to rule out potential pathogens in the donors stool. Instead, he believes that donor stool should be frozen and retested over a period of time to make sure that no dormant infections remain.
Picking a family member is also not the best idea since living in the same environment usually produces similar bacterial profiles among family members. Taymont focuses on finding “super donors” who are healthy lean individuals with great gut bacteria! The vetting process to become a super donor is like something out of a CIA investigation. It requires multiple interviews and tons of testing.
They also help their donors foster a vast microbiome by challenging them to consume a diverse paleo diet. They challenge their donors to eat 100 different foods per month to feed as many different bacterial species as possible. An infusion of bacteria from these super donors is going to expose the recipient to a robust variety of bacteria that is hard to match. And to further enhance the diversity of bacteria to patients, Taymount uses different donors implants in each of their patients.
I am very curious to know exactly how they recruit their donors….I am just imagining a person dressed up as the poop emoji wandering around London twirling a “Poop Wanted” sign. That must be how they do it!
Who is a good candidate for FMT? And what about for SIBO?
At Taymount, they treat a wide-variety of conditions that are rooted in dysbiosis. Some conditions do respond better than others. For C. Diff, they have a 100% success rate. You literally can’t get any better than that! Dr. Taylor also says they have a lot of success with post antibiotic infections and IBS. Taylor states:
“We’re having a great time with IBS at the moment. Really, a good time…. And I think perhaps it won’t take too long before FMT becomes the treatment of choice, the first treatment of choice for all IBS.”
With the leading researchers at the most recent SIBO symposium concluding that 60% of those diagnosed with IBS have SIBO, it leads me to believe that most cases of SIBO would benefit from FMT as a part of a comprehensive plan treatment plan. But, I definitely think the etiology of each individual SIBO case needs to be understood before considering FMT. For instance, experts agree that SIBO cases in which the ileocecal valve is compromised should probably refrain from FMT.
Timing of FMT treatment is also a very important factor to consider. Because FMT is focusing on balancing colonic bacteria, it won’t directly eliminate active overgrowths in the small intestine. That’s why I think it is important to treat the small intestine with pharmaceutical or herbal antibiotics before undergoing FMT treatment. I would love to see a controlled study that looked at the long term success/remission rate of antibiotics followed by FMT treatment for patients with SIBO.
The reason I think FMT could be a powerful tool to help treat SIBO is because by rebalancing the colonic bacteria it could potentially reboot motility. SIBO is often rooted in dysfunctional migrating motor complex (MMC). The MMC stimulates the peristaltic waves that move food through the digestive tract at an appropriate pace. You can think of the MMC as a broom that sweeps the small intestine clean after in between meals. SIBO sufferers MMC activates much fewer sweeps than a healthy person. This MMC deficiency leads to bacterial fermentation of foods that are sitting in the GI tract for long periods of time
As my former probiotics post describes, having a healthy colonic bacterial population is essential for having a healthy MMC. Without a healthy MMC, SIBO will persist. No matter how many times you clear the small intestine with antibiotics, bacteria will continue to overgrow unless you rebalance colonic bacteria. And this is why FMT could be such a game changer for SIBO patients (when timed correctly)!
While FMT is very powerful at correcting colonic dysbiosis with SIBO, people struggling with IBD need to take extra precautions when undergoing FMT treatment. Because FMT ramps up the immune system, in some cases this can exacerbate the immune attack in the intestines of these conditions if the FMT (especially if FMT is completed during a flair). Dr. Taylor says that they have been having greater success with colitis, but it usually takes a more long treatment plan. Crohn’s seems to be the trickiest of the bunch when it comes to FMT and Taymount is seeing about a 50% success rate with Crohn’s patients.
In my case, my Bahamian doctor considered me a prime candidate for FMT, because my GI issues are rooted in dysbiosis without any autoimmune disease of the GI tract like IBD.
My Experience with FMT at the Bahamas Medical Center
So, now that I have given you a little background on what FMT is, I would like to share my experience in the Caribbean. After being very impressed with Dr. Taylor, I decided to have my treatment at the Bahama’s Medical Center, which is associated with the Taymount clinic. I first have to say that the team at the BMC was top notch. Shout out to Sakina and Kemala and the nursing staff there! Basically, the treatment involved going into the clinic every day of the week where I would receive the implants via enema. The enemas sound a little bit intimidating, but while not very glamorous it was easy.
Once the implant was placed in the colon, measures were taken to insure that the bacteria traveled the whole length of the colon. This process usually involved a quick manual massage by a nurse and then laying in different positions to move the bacteria to different parts of my colon. I was usually in and out of the clinic everyday in about an hour. Then, I was free to lounge around on the beach.
During treatment, I definitely had some ups and downs, which is pretty normal. After my first implant, I felt like my gut had been woken up from a deep slumber. It felt like my gut was like Snow White and the new gut bacteria was the prince’s kiss I needed to bring my gut back to life. It was a strange sensation!
Around Wednesday after my 3rd implant, I definitely started having pretty severe die-off reactions. And I continued to have die-off on and off for the remainder of treatment and even in the weeks post-treatment. My die-off symptoms usually involved pretty severe fatigue and flu-like symptoms right after treatment. I would usually feel better after I laid down for a couple hours after treatment.
A dip in energy (detox reaction) at around the three to four day mark is usually quite common according to my nurses and Dr. Taylor who calls it “dip-day Thursday.” I think my detox reaction was stronger than they typically see, because I theorize that I had an allusive fungal issue that amplified the die-off reaction.
The nurses also explained that many people respond to treatment at different rates. Some people notice drastic positive results right away, while it takes others longer to see results. According to my nurses, it takes about 3 months for the bacteria to mature and form a cohesive community, so many see improvements 3-6 months after treatment.
It was interesting because a woman who was receiving FMT treatment while I was there had incredible results during her second week. For years, she had basically only been able to consume white refined grain products. She would have severe reactions if she veered away from a strictly white carb diet. After venturing all over the US to consult with all the top GI experts in the country with little relief, she decided to give FMT a try! By the end of her second week, she ate an arugula salad without reacting! I haven’t kept in touch with her, but I bet she is slamming all kinds of veggies and fruits by now!
At two months post treatment, I am still waiting it out to assess the full impact of the treatment on my health. I have seen some positive indicators such as an increase in my white blood cell count, a couple regular menstrual cycles (which are rare for me) and much healthier looking stool (lots of 4s on the Bristol stool chart). I am looking forward to see what additional improvements I might have in the next couple months! (and I will keep you all posted)
With stool banks starting to open in the US for C. diff, I hope to a see a push to loosen FDA regulations on transplants and an increase in availability of FMT for other disease states. Its a shame that I had to go overseas to undergo this type of treatment, but I am hopeful the FDA loosens the requirements in the next 5 years or so.
If anyone has any questions about FMT or my experience, please leave a comment or reach out to me in some way and I would be happy to answers them! And if you anyone reading has had experience with FMT please comment about your experience!
Also, I know I have been sort of quiet the last few months, but I am hoping to start posting at least once a month, so be on the look out for new material soon. And if you don’t want to miss a post please like the Facebook page (click here to go to FB page). My next post on SIBO and the brain will be hitting the presses next month. That’s all for now!