Just when you thought things couldn’t get an weirder:
After Antibiotics, the Feces Pill Remains
“Some people with potentially lethal gut infections find that the only effective treatment is an orally-administered fecal transplant. The treatment is gaining acceptance among physicians.”
Olga Khazan pens a pretty interesting piece and in parts, resorts to what one has to do, I guess, and that’s just toss your hands up and laugh. First, some of the serious.
By the time patients arrive at the office of Bruce Hirsch, an infectious disease specialist at North Shore University Hospital in Long Island, they’re desperate. Many have diarrhea that strikes up to 20 times a day. They eagerly pay $1,200 out of pocket for the only thing that might make their lives normal again.
Hirsch offers them an orange pill, which they swallow. Underneath the pill’s outer shell are several smaller gel capsules. Inside the smallest capsule is a glycerin-suspended clump of bacteria that’s been extracted from human feces.
“It’s like a Russian doll,” Hirsch told me. “With a surprise in the middle.”
Hirsch is one of just a few dozen specialists in the country who perform fecal transplants—procedures used primarily to treat people who have severe gut infections caused by an overgrowth of a bacteria called Clostridium difficile.
C. diff is a big problem. According to the article, 250,000 Americans are hospitalized each ear and a whopping 14,000 die. Often, these infections are brought on by a round of antibiotics but often enough, just from contact with the bacteria itself. Even the most potent administration of antibodies don’t stop it and in fact can just make things worse, as those antibiotics will kill off the good bugs.
So here’s the kicker:
Increasingly, doctors are finding that their last remaining weapon is the bacteria from a healthy person’s bowels.
So, it it that C. is so difficult, or is it that the quality of the human gut biome has been so degraded over decades by bad diets, antibiotics as candy, and over sterilization? Recall the magnitudes greater gut health Tim “Tatertot” Steele developed with a clean diet heavy in prebiotic resistant starch, such that his biome was in better shape than anyone’s they had ever tested.
So basically, rather than try to kill it with complex, fancy, expensive, high-tech drugs, they just switch out a person’s shit with that of a healthy person.
In January, a study in the New England Journal of Medicine found that a far higher percentage of patients infected with C. diff recovered among a group being given an enema containing the stool of a healthy donor than did among those who were treated with antibiotics. Fecal transplants have been shown in that and other studies to cure 90 percent of C. diff infections within a few days.
Very low-tech, inexpensive cure, wouldn’t you say? Now, this part cracks me up.
Despite his years in medicine, Hirsch seems perpetually shocked by how poop—the archetypal odious substance—can be so curative. Shit’s inherent nastiness is, it seems, partly what’s been holding it back from curing countless C. diff patients by now.
“I mean, it’s really impressive how disgusting shit is,” he said. “Our experience of stool is this brief, six-inch flight time from rectum to water. But really, it’s not that it smells bad, it’s that the bad smell is deep. There’s a profundity. If you were describing a wine, it would be ‘woody notes, with a depth of pestilence underneath it.’”
At the same time, though, “Shit is a great drug.”
And by contrast:
Antibiotics, on the other hand, are “like a blitzkrieg on the gut,” explained Gerard Honig, a neuroscientist and the director of operations at Symbiotic Health, the startup working with Hirsch to take his poop pills to a broader market. Antibiotics usually kill what ails the patient, but they also sweep away much of the beneficial flora that keeps C. diff at bay. Meanwhile, C. diff hides out until the antibiotics have run their course, and then takes over the digestive system.
It’s well known that the microbiome—the bacterial makeup—of each person varies, but that of healthy people appears to be able to successfully settle and grow in the gut of a sick person.
First, the transplanted fecal material joins the stream that courses through the intestines. Once in the colon, the bacteria divide and propagate.
“The C. diff gets crowded out,” Hirsch said. “It’s basically lost its ecologic niche.”
Within a few days, most of Hirsch’s patients have a normal bowel movement, sometimes for the first time in years.
There you go. What could be simpler than a relatively clean diet, adequate probiotic fermentable fiber and of course, our old friend Resistant Starch. You still won’t be able to claim that your shit doesn’t stink, but you might be able to sell it anyway.
Fecal transplants are amazing. There is a fair amount of resistance from the drug companies, push to have the FDA regulate the shit out of it. That right there tells you there is something good to it. So have Tim or you sent any info on to this or other docs doing fecal transplants? Seems like info that would blow their mind and maybe help save a few thousand lives a year. Great work to both of you, this may be the most important thing you ever do, the implications for a healthy gut biome seem to be astounding. Time will tell, I suppose. Thanks again.
Hey Richard, I figured this is a good time to throw my experience with RS into the ring. I came home from South America with a nasty case of the shits (got lax and drank some tap water) and had diarrhea 5+ times per day for almost two months straight. I started taking 4T of potato starch per day and within 2 or 3 days, it was completely gone. I didn’t even make the connection until afterwards, but it’s astounding how quickly my unfriendly Amazonian bugs were defeated by the ‘RS protocol.’
I’m extremely cautious, test everything I can myself and even then I’m not given to unequivocal statements, but there’s just no ifs or buts here:
Antibiotics on an 8-hour dosage cycle should carry the directions “to be taken 4 hours before a serving of yogurt”.
At a Minimum they should carry such directions. Ideally, doctors would co-prescribe probiotics and prebiotics with antibiotics.
Exactly 18 years ago, I was in the ICU for a week and hospitalized through 2 relapses for a total of 5 weeks due to C.diff. I was then put on Vancomycin, the “antibiotic of last resort”, for six months.
Today, even Vancomycin doesn’t work for half the cases. Of course it wouldn’t, because with the rise of resistant strains of several bacteria, Vancomycin has been used more and more in hospitals in a ‘chicken-and-egg’ scenario where more and more strains of different bacteria are getting resistant, like those strains of Clostridium difficile.
So today it’s even more “difficile” and deadlier.
Yet, C.diff. infection is avoidable.
Very avoidable.
I was a grad student still feeling invincible back then and I didn’t listen to sane advice : my (canadian) doctor had told me to eat yogurt half-way between antibiotic doses and to make sure I’m eating garlic and onions (RS wasn’t much known yet, I imagine, but apparently they knew about inulin).
It was a second course of amoxycillin that created the environment for C.diff to flourish, an environment I foolishly had not protected with probiotics and prebiotics.
No doctor will argue with the probiotic advice for antibiotics, yet so many people hear it for the first time from a friend or on some internet forum.
Why?
I can’t see Cui bono in this case, so it’s a mystery to me why this advice isn’t given with every prescription.
A note of optimism though : the pharmacist here when I last had to get antibiotics for a child actually advised me to get a kiddie yogurt ‘to avoid diarrhea’. She even advised unsweetened (brilliant, since sugar can increase diarrhea in such cases). Small steps.
No shit?
When do the celebrity shit pills start hitting the market? Finally, an honest product. :-)
Best post title ever Richard!! :D :D
When I read the title post, I just knew Richard meant it literally.
Great information. I’m going to check out this doctor with his shit pills. Send it on to someone in Brooklyn who possibly might actually have a problem solvable with this therapy.
So, “Holy shit,” is not just an exclamatory, but an honest description.
A few months a go I read somewhere about a man approaching his best bud. Hesitantly, asking for a big favor. “Well, sure!” “Uh, can I have some of your shit?”
I’m laughing as I recall reading that. But like the above post, it worked.
A simple test would be to survey the gut health of promiscuous sexual adventurers that experience exposure to feces and compare it to those who don’t.
@bornagain
I was considering linking up this Wikipedia on analingus, but stopped short.
http://en.wikipedia.org/wiki/Anilingus
I’m losing my edge.
A thought- is it possible that one reason we are so disgusted by our own feces is that, on some level, we know it harbors some nasty pathogens (like C. diff), possibly in huge quantities, and we want to minimize contact and possible re-exposure?
On another note, thanks to these posts and taters comments, I will be taking part in the American Gut Project early next year. Tater’s description that the collection process was easy and not gross at all is what sealed it for me.
Between this and the increasing legality of medical marijuana we have some good shit to look forward to.
Tim, stop flushing and open up the shop.
Bionic Shit fortified with resistant starch. Curing AIDS, enlarging breasts and dicks.
30% off until monday!
>> “such that his biome was in better shape than anyone’s they had ever tested.”
I am kinda missed that part. Did someone from AMGut stated so?
John, I think people are more grossed out by other people’s shit than their own. If not, then why is it that so many people don’t wash their hands after wiping? Shit bacteria get through 5 thicknesses of toilet paper in 1 second. So there’s no ‘safe’ wipe.
SteveRN said “Fecal transplants are amazing….push to have the FDA regulate the shit out of it”
So true, literally and figuratively. I’m a child, I know.
Laughter is the hand of God on the shoulder of a troubled world.
Man, cubicle folks are in a world of hurt. I’m grateful to have bonded with the land so many years ago, digging in the dirt, eating real food, performing real physical labor (not exercise) daily. I can’t help leaping to suspicion(s) that these eccentric bio-system fractures are manifest from “civilized” living. I haven’t “dieted” in decades and stay within 10 pounds of my ideal weight of 177 pounds. Neither have I any medical issues or take prescription medications. I’ve seen so many of my 1977 high school alumni drop dead that I should feel like I have ghosts in my head. If I had to live any differently than I do now, I’d just as soon jump in the sea and drown. Honestly, shit pills? Well that oughta be the nail in the coffin for the folks believing that a God made Man in His image. I mean write another verse for Zappa’s “Dumb all over” song, cause it ain’t enough that God is dumb and maybe a little ugly on the side, but now he’s takin’ shit pills?
I might be moving to Montana soon…
Woodchuck Pirate
aka Raymond J Raupers Jr USA
http://www.woodchuckpirate.com
Hi Marie…it’s me.
Wow, just thought I’d check in on Richard, and low and behold I find what killed my aunt. Wow. She went thru dental surgery, had massive doses of antibiotics…and then was never the same again. She had explosive…literally….diarrhea for a year. In and out of the hospital and no one could find a cause or cure. When just a little poop would have done it. How sad.
This is hilarious yet amazing. I had no idea that so many people died from gut infections. GO POOP!
I guess dogs know what they are doing…
One of my dogs eats the goat’s poop, like candy.
I’m so fed up with the FDA that I am going to use Medstartr to start a clinical trial in the SF Bay Area to use FMT to treat Post infectious IBS and IBS. Resistant starch helps but I’m too far down the road and don’t want to pay $10K going to another country when our insurance companies should be covering this. Anyone interested? fecalmicrobiotatransplant.blogspot.com
Debbie, good luck with that. The moratorium on fecal transplants allegedly circles and circles around the ‘other stuff’ like viruses and parasites that may inadvertently be introduced with the fecal transplant. I’ve read most of the transcript from the workshop in May 2013. My take on it is the FDA is waiting on some big pharma to produce a capsule which would contain, presumably, the bacteria a person requires. Except, it seems big pharma isn’t all that interested. FDA is taking an immovable position on this. For some reason, in other countries, the possibility of introducing viruses doesn’t seem all that important. Parasites are easy to screen for.
Perhaps this will be useful to you:
“Supporting formal clinical trials is a core component of our mission.” – from OpenBiome, the Cambridge, MA, stool bank, which was started by a grad student and author of the Nature paper.
They have a Biologics Master file lodged with the FDA, so doctors don’t have to develop their own for each clinical trial or indicated use (the FDA does not regulate fecal transplants as a drug if they are for C.difficile treatment).
Hey, Marie! Good to see you back around.
Also, a current update on the progress using FMT : http://www.boston.com/news/science/blogs/science-in-mind/2014/02/19/cambridge-stool-bank-helps-meet-growing-need-for-fecal-transplants/X9R8Acj5cDBsuimWYIjJoJ/blog.html
marie luv:
Posted that link on FB, Twitter and G+ with the following intro:
“‘regulators have been wrestling’
“I’d hoped to read: ‘regulators are being kidnapped, stripped naked, beaten to death and dumped on the street.’
“But that’s just me.”
“Researchers are concerned because YouTube videos now offer guidance on DIY fecal transplants for at-home use, and misinformation is abundant. The team that wrote the study has received questions from people suffering from gastrointestinal infections who wonder whether their pets could be used as donors. (They cannot.)’
That’s blanket non scientific. I’d guess that feral pigs would be an excellent experiment.
“I have pretty serious concerns about this,” said Mark Smith, a graduate student in microbiology at the Massachusetts Institute of Technology who co-wrote the paper published in Nature. “It’s an exciting area of research, but it’s not ready for every patient to get their hands on.”
Light, stream of consciousness rant draft for eventual post, maybe next week.
How about you go fuck yourself with a healthy shit enema, Mark Smith, a graduate student in microbiology at the Massachusetts Institute of Technology who co-wrote [a] paper? Now, I know you want everyone to suffer and wait years while you complete your graduate degree, get on with some folks with grants and patents so you can cash in and look such the hero, but unless you can stop people from taking shit and sew up all rectums, the cat’s out of the butt.
….
Perfect, chéri. You read my mind, comme d’habitude ;)
When I read the article, I thought “regulators don’t stand a chance’. This is spreading like wildfire in every hospital and clinic and it’s just a matter of time before people start doing it themselves at home. Someone might think squeamishness would be a factor, but they’d think wrong because when you’ve had incessant diarrhea for days on end, you’re no longer squeamish.
In point of fact, it’s likely the most compatible ‘transplant’ is from an intimate family member.
I dont’ think the kid is so far off base though, there’s good poop and really nasty poop, so if you do this in a clinical setting with stool from strangers, you’d need to check for parasites and other nasties. That’s all.
The kid is the one who started the non-profit stool bank and started supplying hospitals etc.