RHR: All About Fecal Microbiota Transplants

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In this show we have Glenn Taylor of the Taymount Clinic, one of the few places doing fecal microbiota transplants, otherwise known as FMTs. He’s doing some great work, and I know a lot of people are interested in this. It’s a revolutionary treatment, and so I’m looking forward to getting the lowdown.

In this episode, we cover:

3:10 The history of Fecal Transplants
10:50 How the Taymount Clinic approaches FMT
16:40 How to screen for the right donor
24:15 What conditions can FMT treat?
30:50 The future of FMT technology
32:45 The side effects of Fecal Transplants
39:50 Why FMT is approved in the UK

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Full Text Transcript:

Steve Wright:  Hi, everyone.  Welcome to another episode of the Revolution Health Radio Show.  This show is brought to you by ChrisKresser.com, and I’m your host, Steve Wright from SCDlifestyle.com.  With me is integrative medical practitioner, New York Times bestseller, and healthy skeptic Chris Kresser.  Chris, are you ready for today’s show?

Chris Kresser:  I’m ready, Steve.  I’m really looking forward to it.

Steve Wright:  It’s my favorite topic, man.

Chris Kresser:  I know it.  Who doesn’t like to talk about poop?

Steve Wright:  It just puts a smile on your face.  You can’t say it without smiling.

Chris Kresser:  Yeah, we have Glenn Taylor of the Taymount Clinic in the UK, one of the few places doing fecal microbiota transplants, otherwise known as FMTs, and we’re really excited to have him come on the show.  He’s doing some great work, and I know a lot of people are interested in this.  It’s a pretty revolutionary treatment, and so I’m looking forward to getting the lowdown.

Steve Wright:  All right, so before we bring him on, I just want to let the listeners know that as of today over 76,511 people have already signed up for Chris’ free membership.  Yes, I just looked that number up.  It is true.  Chris has just recently redone his site at ChrisKresser.com, and what he’s done is he has reorganized his content and created a lot of in-depth eBooks on weight loss, gut health, and thyroid health that you get access to when you sign up for his free membership, not to mention you’ll get some in-depth audio seminars that have never been released to the public before as well as a free 30-part email series on Chris’ most essential topics for anyone serious about feeling great.  If this isn’t something that you have access to yet, you’re going to want to take advantage of it.  Go over to ChrisKresser.com and sign up for the free membership.

OK, Chris, our guest today is Glenn Taylor from the Taymount Clinic, and as you were saying before, he specializes in fecal microbiota transplants.  Glenn is not conventionally medically trained.  He’s a qualified engineer and a microbiologist, so we kind of have something going on there.  For some years, he was running a training center for health professionals, but he was unhappy with the colon lavage not appearing to bring about any long-term improvements.  He took a phone call one day, and a young man was asking about fecal transplants.  That got him thinking.  After two years’ worth of research and experimentation, that gave rise to the new FMT clinic.  He has been doing FMT treatments now for nearly two years, and he has carried out over 800 of them to date.  Over the last few months, he has been invited to give talks at several top London hospitals and primary care trust hospitals.  In other words, this guy knows poop.  I’m excited.

Chris Kresser:  Let’s bring him on.

Glenn, welcome to the show.  Pleasure to have you on.  Pleasure to speak with you again.

Glenn Taylor:  Well, thank you very much for inviting me on.  It’s good to talk to you again.  It’s good to get to talk to everybody out there.

The history of Fecal Transplants

Chris Kresser:  Great.  Let’s take a step back a little bit for those who aren’t that familiar with fecal microbiota transplants, and maybe you could just tell everyone what they are and a little bit of the history, how they were discovered and initially used therapeutically.

Glenn Taylor:  OK, well, it’s a process of basically bringing the human gut back to as close as normal as we can hope to get it in the attempt to bring all the other processes that it impinges upon back to normal as well.  The first cases of manipulation of gut flora were, I guess, back in about 1908.  A Russian physician, Ilya Mechnikov, working in Paris had noticed the changes in human health and behavior when people were exposed to different types of bacteria in terms of probiotics.  He wrote a few papers on it that disappeared from view but ended up in just a couple of hospitals.

Then in 1958 in a fit of desperation, one of your countrymen, Ben Eiseman, a doctor working out of Denver, was faced with four patients with a really advanced case of toxic megacolon, which is an infection of Clostridium difficile, and the four patients were completely refractory to all kinds of treatments and their prospects were very grim.  Eiseman went to the hospital library and looked up some papers that might help him and came across the original Mechnikov papers, and he thought, well, we have some evidence here that borrowed microflora from another human being may be the answer to the problem.  Back in ’58, this was very radical.  I mean, the idea of swapping poop really wasn’t taken quite as easily as it is now, but he went to the four families and told them what he had found.  Obviously faced with the prospect of losing their loved ones, they just said, please, go ahead.

The astonishing thing was that all four patients made a very rapid recovery.  He wrote his own paper, and this was all before the Internet, so it meant people had to keep this stuff in a library.  And I guess most people now are aware that those papers ended up in Sydney, Australia, where a young professor of gastroenterology, Tom Borody, read them when he was faced with a similar situation, and I think from then on people have become more and more aware of its potential.

The astonishing thing is that farmers have been passing this down by word of mouth from generation to generation, that the beasts on their farm can benefit from getting the bacteria from healthy beasts and cattle and birds transferring them to sick creatures, and they’ve been doing this for literally hundreds of years.  I have a couple of veterinarian friends who swap stories like this and then throw their hands up in horror and say, well, surely you’re not now talking about doing this in humans!  And I’m always tempted to say, what [indiscernible]!

Chris Kresser:  Right!  Well, it’s amazing how much more open minded we become if our life is threatened, and certainly as you pointed out with C. diff, it’s a potentially life-threatening infection.  There are antibiotic-resistant forms that don’t respond well even to some of the most potent broad-spectrum antibiotics, and people in the year 2014 are still dying from it.  In a way, it’s sort of a blessing in disguise that we’ve had this testing ground for this remarkable new treatment because I don’t think it would have achieved such rapid acceptance in the scientific community if it hadn’t demonstrated such an incredible ability to be effective in a situation where nothing else is.  I think that really opened the door for people to be amenable to it in a way that they wouldn’t have been otherwise.

Glenn Taylor:  Yeah, I partially agree with you, but don’t you find it actually extraordinary that despite the amount of coverage, I mean, scientific papers, academic papers being available now that discuss this in fine detail, so many papers saying that this is an effective treatment for, in particular, Clostridium difficile, and articles being written in all the world’s top gastroenterological journals and mouthpieces, and yet when you talk to the average gastroenterologist, they’re still wide mouthed and amazed about it?  It makes you wonder, don’t they read their own professional journals?

Chris Kresser:  Well, Glenn, I wish that did surprise me.  Unfortunately it doesn’t surprise me in the least because I come across that every day in my practice, where I refer a patient to a specialist, like a gastroenterologist.  Or another case where this often happens for me is I discover that someone has iron overload and I refer them to a hematologist only for them to be told that there’s nothing to be concerned about, and I just want to pull my hair out because I’ve read numerous papers published in the scientific literature about the risks of even somewhat mildly elevated iron levels, but seemingly these hematologists who are the top specialists in the field are not staying current with the literature in their very field.  Unfortunately I was prepared for that to some extent, but there’s this frustrating gap between what’s in the scientific literature and then what even specialists in that field, much less primary care physicians and the general public, have accepted, but it seems to me – and maybe you disagree – but it seems to me that the acceptance of this procedure sort of skipped over the gastroenterologists and the medical community and we’ve seen a lot of articles about it in the public media that are more friendly to it than you find just talking to the average gastroenterologist.

Glenn Taylor:  Oh, yeah.  I had a phone call from New Scientist.  They really just wanted to know the background and to talk about it and see if they could have access to one of my patients.  Scientists are now beginning to really want to know more about the biological value, and that’s why I say it is good old fashioned biology, which if you’ve been brought up on an entire menu of pharmacology and chemistry, it’s perhaps a step too far.  It depends on how you’re trained, I guess, Chris.  If your professor at college fed you pure pharmacology, then you’re going to carry that [indiscernible].

Chris Kresser:  Yeah.

Glenn Taylor:  I think we have to look further back to why people have these ideas that only one type of medicine is effective and when you run out of pharmacological solutions, you should then actually deem something to be incurable.  I think it’s a little unfair.  The term ‘incurable’ means you haven’t found a cure.

Chris Kresser:  Exactly!

Glenn Taylor:  It’s doesn’t mean to say that it doesn’t exist.

How the Taymount Clinic approaches FMT

Chris Kresser:  Yes.  I think also that the increase in interest – and this, of course, is not coincidental – but there is a lot of attention being paid now to the microbiome.  We’ve had front page stories on The New York Times Magazine, Michael Pollan, and I know that there are some books in the pipeline that are coming out about the microbiome and its connection between health and disease.  That’s, of course, the theoretical underpinnings of why a fecal microbiota transplant would work in the first place and why it’s something we might want to investigate, and then we have these research projects, like, we had Jeff Leach on to talk about the American Gut Project and all of these ongoing research projects looking at the microbiome.  So, I’m cautiously optimistic.  I think there are definitely some hurdles, especially regulatory hurdles in the US, and I’ll be curious to hear what’s happening in the UK with that, but before we get into that, why don’t you tell us a little bit about how you and your team over at Taymount approach FMT, because I think what you’re doing, from our previous conversations, is somewhat unique in the world, really.

Glenn Taylor:  OK, so maybe I’m a little bit too much of a scientist, in that I really wanted to know how to make the very best of the procedure.  And that led me to many, many long hours in the lab, a lot of research along with some of the leading people in the world, particularly some of the best food microbiologists in the world – and I take my hat off to the amazing team at Reading University in the UK who are trying very, very hard to understand all gut functions in relation to the microbiome – but what I needed to do was to understand why the process did and didn’t work in certain cases and why was it that home treatments – and I can understand why people do it; it’s out of complete desperation because it’s not available to them or the cost is prohibitive – why home treatments had relatively poor outcomes.  I guess the answer lies in a very simple feature.  It’s a simple biological fact that 90% of the gut microbiome is of a group called obligate anaerobes.  Now, that quite simply means that they cannot survive in oxygen.  If you expose them to an oxygen-rich environment, they die.

So, 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.

What we did at the clinic was we addressed that fact, and we work in an almost completely anaerobic environment.  The collection process is anaerobic, without oxygen.  The homogenization, breaking up, the separation, filtration – everything is done in an anaerobic environment, which means that when we collect bacteria, at the end of the two-hour process, we have a pellet of bacteria that’s pretty much intact.  Now, that’s what everybody’s after.  When you’re trying to take a microbiome out of one human being to put it another, what you’re hoping for is to get as close to 100% of that bacteria as you possibly can because at this moment we don’t know exactly which of the, oh, it could be a thousand, it could be 1150 species at this moment.  There are new methods of assay, new methods of measuring which are kind of suggesting at this moment that there may be many more thousands of species in the gut than we actually realize, and because of the way the morphology goes on, it could be literally a never-ending number of species because they’re constantly mutating.  And there’s no catalog for this.  We just don’t know where we’re going to end up, so we try and gather safely together as many as we possibly can and store them in the correct way.  That’s the process.

Also we want them to go back in and be effective, so we’ve spent some time working on the implant method, and we’re feeling quite comfortable that we’ve found the most benign and most comfortable, in itself with the patient, the most comfortable method, the most effective method of complete dissemination around the whole of the colon, and we had to work hard on this to come up with a gentle, effective method of delivery.  I also have a method I’m working on in the background, and I’ll probably bring it to a much wider audience and make it much more acceptable to the public at large, but I have some pegs to put in place before I can talk about it.

How to screen for the right donor

Chris Kresser:  All right, that’s exciting.  We’ll have you back on the show when you’re ready to release the goods, so to speak!

Glenn, another potential concern that I have in terms of DIY, at-home FMTs is improper screening of donors.  I know when people really get desperate because I’ve been there myself in my past and with my pretty severe chronic illness that judgment can be impaired, let’s just say.  And when there’s a treatment that promises some potentially miraculous benefits, it can be relatively easy to minimize the risk, at least in our own mind.  Why don’t you talk a little bit about how you’re screening donors and making sure that the donations are of the highest quality, which, of course, will lead to the best results?

Glenn Taylor:  Well, first of all, I have huge sympathy for all those people who because of the lack of interest of their own physician or the lack of a facility wherever they live they’re being driven to do this themselves.  And on top of that, they simply don’t have the finances in many instances to be able to take all the precautions they should, but we really have to urge people that if they’re already immunocompromised with a condition, they could make things very, very much worse for themselves.  The donor they choose may not display the symptoms of a severe disease, but they could simply be a carrier, and you never know what you’re going to get, so you owe it to yourself and your loved ones around you to be absolutely sure that your donor is safe.  You have to do your best to make sure there are no communicable diseases.  I know it means having to go through some medical professional to see if you can get the testing done, but when the alternative is so horrendous, you really should just take that extra bit of effort to make sure that your donor is good.

Also this idea that the donor should be somebody from the family and who shares the same environment in biological terms is actually erroneous because people living together over a period of time gradually share their bacteria.  This is a simple biological fact.  They share their bacteria, and their microbiomes become very similar.  There will be some minor changes in them, but despite the fact that everybody has this unique microbiome, almost a fingerprint style, it’s quite unique to them, in general terms, we all have little wavy lines on our fingers, same thing as we all have x number of bacteria.  People living in the same environment generally have the same type of bacteria.  Now, if your condition has been brought about because you’re missing certain bacteria, what on earth makes you think that your partner, spouse, friend, or cousin is going to have that bacteria if they share the same environment, share the same food, etc.?  It doesn’t actually make good biological sense.  What you actually really need is somebody outside your environment who has a completely different profile of gut flora.  That’s the person you’re after.  And then if you get them tested and they’re good, that’s the person you should go for.

But equally, I’ve heard talk saying, I want the microbiome from somebody’s who has never had antibiotics, so let’s go for an infant, a child.  Please, don’t forget for a second that a child only gets the microbiome that it got from its mother during the birth.  If the mother didn’t have a good microbiome, the child’s not going to have a very good one.  And then it takes up to two years for a child to develop an adult-like microbiome.  Despite the fact the child may not have been exposed to antibiotics, they’ll have an immature microbiome as well, and that might not suit your purpose.

Chris Kresser:  Mm-hmm.  So, give us an idea a little more specifically of what kind of tests that you’re doing to screen donors just so people have a sense of what the spectrum of these tests are that need to be done.

Glenn Taylor:  Obviously, all the sexually transmitted diseases and HIV.  I think most of it’s sitting on our website where you can see precisely what we’re doing, but in essence, we really are trying to protect people from the serious life-taking diseases and the other diseases that would affect you if you’re immunocompromised, even down to sort of rheumatoid factor, arthritic – there’s a whole group of things that you really don’t want to pick up just because you want a good microbiome.

Chris Kresser:  Right.

Glenn Taylor:  You just have to use common sense, and actually what I noticed this afternoon when I was just cruising through some websites is that there’s a lot of information out there that people can go and look for when looking for the testing.  Tom Borody did a paper that has a home protocol that’s pretty comprehensive.  Alex Khoruts has, as well, so there’s stuff out there from people who have been doing this for a very long time that’s very valuable information to make sure that you can protect yourself.

Chris Kresser:  Yeah, and it’s worth saying that as our understanding of the microbiome expands, the kinds of testing that we’re doing to screen donors expands as well.  I was in contact with the Center for Digestive Diseases and Dr. Borody’s clinic probably 10 years ago, and I’m pretty sure – and they may still not be doing this, I’m not sure – but they weren’t at that time doing tests for autoimmunity because it wasn’t as clearly understood as it is today that autoimmunity is linked to the microbiome, so it’s really great to know that you’re thinking more broadly in terms of what an optimal donor might be and which markers that we can currently test for might exclude them from being donors based on that connection between the gut microbiome and not just digestive conditions, of course, but now many other conditions including immune dysregulation and mental and behavioral problems, the whole gamut.  It’s really actually difficult to find a modern chronic inflammatory disease that the gut microbiome is not linked to at this point.

Glenn Taylor:  Isn’t it astonishing?  I get inquiries all the time with obscure diseases, saying, what do you think?  And my only response can be, well, we haven’t found anybody or we haven’t treated anybody with that particular condition, but hey, I’ve learned enough by now not to discount it, and do you want to be the first?

Chris Kresser:  Yeah, worth a try.

Glenn Taylor:  Shall we give it a try?  I’m not discounting anything, really.  The likelihood is that we could be going on for years and years, bumping in more and more conditions that respond favorably once we’ve normalized the gut microbiome.

What conditions can FMT treat?

Chris Kresser:  Mm-hmm.  I don’t doubt it at all.  Along those lines, though, tell us some of the conditions that you’ve seen respond particularly well.  Now you’ve done about 800 of these, it sounds like, so you’ve had a broad spectrum of patients or people that have come and have had experiences.  Tell us a little bit about what you’ve learned.

Glenn Taylor:  Everybody knows that the whole thing started off with Clostridium difficile, so we’ve done our fair share of C. diff.  We’re actually really, really lucky at this moment in that in every case of C. diff we’ve managed to get full remission.  It’s completely clear.  We’re doing testing before and after, and everybody so far is absolutely clear.  I have a young lady who started this week, who I can’t name, but she is a midwife and she picked it up at her place of work.  And after two years of them trying to get rid of the Clostridium difficile recurring every three months, they’d given up, and basically they were trying to railroad her out of a job.  They gave her the thing in the first place, and now they’re trying to get her out of a job.  She came to me, and on day one I just completed the implant, and I sat her up and said, right, in about a half an hour’s time, that’s it.  It’s over and done with.  You’re back to work.  And she just broke down.  She couldn’t quite take it all in.

Chris Kresser:  Yeah.

Glenn Taylor:  On the second morning, she came back.  I had her come into the clinic.  She was taking the stairs five at a time, and she just threw herself through the door and said, I feel just extraordinary, absolutely amazing!  She got her life back again.  C. diff is easy.  What I’m finding really, really interesting is I’m working quite a bit with that very, very nebulous of conditions that’s called IBS.

Chris Kresser:  Yes.

Glenn Taylor:  You can probably hear in my voice that I’m smiling at the moment.

Chris Kresser:  Mm-hmm.

Glenn Taylor:  The lengthy protocol, you get a list of 10 symptoms, and if you sit with your physician and he can tick three of them, then great.  He’s happy because he has a diagnosis and he has a stamp that he can put on your forehead and say, you have IBS.  There’s probably not much we can do about it.  You’ll have to just get used to living with it.

Chris Kresser:  And more importantly, drugs they can prescribe that have been created for that condition that was created for the purpose of making drugs for it!

Glenn Taylor:  Chris, you are turning into an old cynic, you are.

Chris Kresser:  I can’t help it.  I can’t help it.

Glenn Taylor:  So, I look down the list of their own three of I think, yes, dysbiosis.  Yeah, that’s bacteria.  Yeah, that’s bacteria.  That’s bacteria.  Basically change the gut flora with people with IBS.  Stop.  Take a step back.  Watch their symptoms.  Send them back to their physician again who did the diagnosis, and say, now what do you think they have?  It’s a real eye opener.  We’re having a great time with IBS at the moment.  Really, a good time.  People are coming in for post-antibiotic, post-infectious IBS, for a combination of constipation and diarrhea or one or the other, and we have some very, very happy [indiscernible] walking home at the moment.  And I think it’s perhaps it won’t take too long before FMT becomes the treatment of choice, the first treatment of choice for all IBS.

I was talking to two major gastroenterologists in London a couple months ago.  These guys are professors of gastroenterology at the top of their field, and they were saying, we really are looking forward to the day when it’s available as a first choice, not a last resort, because patients come to us with this whole mass of white noise that’s going on with the various symptoms they’ve got.

Chris Kresser:  Yeah.

Glenn Taylor:  And it’s so very confusing trying to work your way through all these various symptoms to work out precisely what the problem is.  If only we had a method where we could normalize them and get rid of this effective white noise, and we believe that FMT might be the answer because normalization of the gut normalizes other processes.  Then we send the patients back to their doctor much quieter, and the doctors go, oh, crikey, yeah.  Now I can see what you’ve got.  Oh, that’s really much clearer.  It was cloudy before.  I couldn’t quite work it out, but yeah, I can diagnose, and here’s the remedy for it.

Chris Kresser:  Glenn, this is so similar to a paleo challenge or intervention, which you’ve probably heard of.  When I see a patient who comes in to me with all of these varying symptoms that are seemingly disconnected and all over the place and they’re on a kind of Standard American Diet, the first thing I do is put them on a paleo type of diet for 30 days, and I use the exact same language that you just used.  It’s like a cloud settling or silt in a pond going to the bottom, and at the end of that 30 days, it doesn’t mean that they won’t have any issues, but it’ll be much clearer what those issues are because all of the triggers that were causing all that chaos in their body have been removed and the dust has settled and the things that are remaining are much more easier to go after, after that.  Imagine if we combine a nutrient-dense, whole-foods dietary intervention like paleo for 30 days with an FMT.  The potential for that is just mind blowing.

Glenn Taylor:  Exactly.  As anybody that works in a hospital will tell you, patients turn up with a whole range of comorbid conditions, and it makes it very difficult for them to be quite precise.  And if there was a standardized procedure that they could employ that would help them sort the wheat from the chaff, it would be hugely helpful.  Now, you know that doctors of functional medicine have this fixation on the gut, if you can fix the gut first and then look at the rest of the patient.  They only know that it’s a good idea, but perhaps they don’t quite understand the microbiology of why.  But when you say to them, yeah, the reason why you’re going to sort the gut is to normalize the gut flora because of all the other things that impinge upon it.  Then you stand more of a chance of actually highlighting precisely what the problem is.  Yeah, it will be a treatment of the future, I’m sure, but it’s all come down to the method of delivery, and that’s the bit.

Chris Kresser:  Yeah.

Glenn Taylor:  I think Tom and I are on a bit of a race at this moment to come up with that.

The future of FMT technology

Chris Kresser:  Well, I’m rooting for everyone in this race because we’re all going to be the beneficiaries of your passion and investigation, so I’m excited.  I was going to ask you a question about the oral form of delivery, which has gotten some press recently.  I believe it was a Canadian physician who was written up about that.  I’m not sure if you want to go into that or leave that for the next time when you come on the show.

Glenn Taylor:  No, that’s OK.  You’re talking about Robogut, are you now?

Chris Kresser:  Yeah.

Glenn Taylor:  Or you’re talking about Hamilton’s project.  On Robogut, yeah.  It’s a good attempt.  At the moment, the best that they’re coming up with is about 10% of the microflora, but it’s a controlled, standardized system, and it’s quite effective, yet it’s 10% of what’s actually needed.  But it might to the 10% that works, Chris.  It may be, but we’ve still got to see how that goes.

Chris Kresser:  Sure.

Glenn Taylor:  The oral route – you see, now you’re trying to get me to tell you what I’m doing!

Chris Kresser:  No, no, no, I’m really not!  I shared an article a while back about the Hamilton, the oral delivery system for this, and of course, it generated a lot of attention and interest.  I’m not going to force you to talk about it at all.  You can just say whatever you want to say, and as long as you promise to come back on the show when you’re ready to say more, we’ll leave it at that.  We’ve got plenty more to talk about.

Glenn Taylor:  OK, well, how about this?  If I’m right about the method of delivery and if I get it right and if I can put all the factors together to make it effective and it becomes scalable and deliverable, we hope to be able to slash the price of the treatment by 10.

Chris Kresser:  That’s tremendously exciting, and I’m sure that a lot of my listeners are jubilant hearing that!

The side effects of Fecal Transplants

Let’s get back to some of the nittier, grittier details.  We were talking about the importance of screening donors, we’ve talked about how – really, there’s no other word – miraculous some of the transformations can be with this procedure.  I’m sure a lot of people are wondering, well, is there is a downside?  What are the side effects of FMT, and what are the risks when it’s done properly?  Since we’ve already discussed the importance of doing it properly, let’s just assume that it’s done properly.  Are there side effects and are there risks?

Glenn Taylor:  OK, in the clinical environment, side effects.  Well, in terms of the biology, you ask the question, if you take perfectly functioning bacteria out of a healthy person and you put them into a person who has dysbiosis, what reason would there be to be a side effect or a negative effect?  And the reality is, no, there isn’t.  However, that’s not totally true because we have had a couple of occasions where people have been teetering on the very edge of an IBD flare and just interfering with their microbiome sets them off, so we’ve had to stop treatment, send them home, and get their physicians to bring their flare back under control before they can come back in.  So, it has happened where a flare tips over simply because we’re working in that area.  It may well be that they were scheduled to have a flare and it was the last straw that broke that particular camel’s back.  But in all other cases, I don’t believe there are any recorded cases of a clinic application that have had any kind of negative side effects.

Chris Kresser:  Which makes this, of course, all the more remarkable.  I want to actually move backwards because there’s a question I forgot to ask you that I wanted to.  Have you had any people coming over with chronic infections that have had any success?  I’m thinking of things, you know, intracellular infections, Chlamydia pneumoniae, some of the stealth infections, like Lyme and Bartonella, Mycoplasma, stuff like that.

Glenn Taylor:  No, I haven’t.  Please, where are these people?

Chris Kresser:  Careful what you ask for because I’m sure a lot of them are listening right now!

Glenn Taylor:  Well, that’s the kind of stuff that we need to be able to do sufficient numbers of.  I know the medical community wants big n numbers, big numbers in a sample, a large sample, before they’ll even listen to the result.

Chris Kresser:  Yeah.

Glenn Taylor:  But remember the world’s first medical trials took place on a British warship in the 1700s when the surgeon on board the vessel chose six crewmen, all suffering with scurvy, and gave three of them lemons and three a placebo effect, and the n number, the total sample, was 6.  Now, the first trial went down as a huge, huge success with such a low number and we applaud what went on.  You try and do a trial today with 6, and they’ll laugh you out of the room.

Chris Kresser:  Yeah.

Glenn Taylor:  They only want hundreds or thousands.  But if it works and it works again and again and again, don’t we owe it to take it seriously and see if we can try and get more interest, get people to listen to us?  There’s such a fixation on high n numbers as being the only credibility in terms of treatments.

Chris Kresser:  Yeah.  It’s a real obstacle.  There are even n=1 experiments in the history of science, like, was it Warren and Marshall and the discovery of H. pylori?

Glenn Taylor:  Yeah.  Tom, by the way, Borody was involved in that.

Chris Kresser:  Yeah.  He was a grad student for them or something?  Yeah.  For people who don’t know that story – and correct me if I’m wrong; I’m a little hazy on it.  At that time, everyone thought ulcers were caused by stress, and they presented the idea that they were actually caused by a bacterium called H. pylori, and they were literally laughed off the stage at the conference that they presented at and then proceeded to labor in obscurity for several years and be completely ignored by their professional colleagues.  And it wasn’t until he infected himself with H. pylori, developed an ulcer, and then cured it with antibiotics that he was taken seriously.

Glenn Taylor:  Absolutely.  I remember watching Barry and Robin sitting together. – That’s not the Gibb brothers, by the way! – They were sitting at a restaurant, and this was 10 years after their first discovery.  And I remember looking at Barry’s face, and he was so jaded about his.  He said, look, it’s been 10 years since we discovered Helicobacter pylori and we’ve now got 10% of the doctors accepting and treating for it.  Maybe in a hundred years’ time we’ll have everybody doing it.

Chris Kresser:  Wow.

Glenn Taylor:  Yeah, he wasn’t impressed with his peers.  That was a typical case.  They had to peddle that all over the world for people to listen, and the established structure, the old guard, were really not ready for this young upstart to stand there and tell them how things worked.  And yes, Marshall had to infect himself and then cure himself in an effort to make people sit up and take notice.  You know, that’s not uncommon in history, where the only chance you get to do the research is on yourself!

Chris Kresser:  That’s right!  And it’s ludicrous to discard that result, in particular, simply because it was only one person.  That’s a rather compelling result, which actually in one experiment shows a causal relationship and not just an association and makes it certainly worthy for further exploration, so I completely agree with you on the recent trend of the over-focus on sample size and even on RCTs as if we can’t still use our common sense to reach conclusions, as if common sense is not part of the scientific process or even the basis of it.

Glenn Taylor:  I agree.  What I’m seeing is a lot of physicians being interviewed and dismissing the procedure on the basis that they’ve yet to see large-scale trials.

Chris Kresser:  Right.

Glenn Taylor:  And I think we’ve worked that one to death.

Why FMT is approved in the UK

Chris Kresser:  Yeah, exactly!  Tell us a little bit about the regulatory system in the UK.  I’ve posted several articles on what has happened in the US.  The FDA has only approved the use of FMT for antibiotic-resistant C. diff.  That means it’s not technically approved to do for any other uses, and I know there was a clinic in Portland that was doing some FMTs that was doing them for other conditions but is now only doing them for antibiotic-resistant C. diff.  I imagine the environment must be a little bit different in the UK, given your presence and operation, so tell us about that.

Glenn Taylor:  OK, yeah, that’s because of Europe and the UK having a completely different medical structure than the United States.  Our structure is based on a state system, a state kind of insurance system.  It’s very different from the health industry.  Oops.  Did I say ‘industry’ instead of ‘profession’?  Very, very different from the way that it’s financially structured over in the United States, this triangle of insurance company, physician, and drug company that you guys have yourselves stuck in and don’t seem to be able to extricate yourselves from, which has allowed – boy, I’m going to have to choose my words carefully here!  I am not making any accusations, not making any suggestions, but I would really like to see the structure of the ethics committee that came up with the decision that FMT or human feces should be regarded as an investigational new drug.  I’d like, honestly, to see the structure of that committee and see who is a genuine physician and who is in medicine and who is in pharmacology.

Chris Kresser:  Yeah.

Glenn Taylor:  But then you never forget there’s a big issue of safety, and I think also – and this is genuine – that they needed to see a standardized system of reporting in this particular respect.  Clearly it was a health thing, and it appeared to be effective, and no health authority in the world can afford to let this just run amok, so some form of regulation was needed, as will be needed in the UK, and I look forward to it.  I’m sure that at some point the lack of regulation could equally lead to many, many problems, but in the UK at the moment, this is research work, and scientists are permitted to go on with research without being over-encumbered with too many restrictions by medicine itself.  Medicine in Europe tends to respond to what scientists discover.

Chris Kresser:  Imagine that!

Glenn Taylor:  And then what we find out we hand over to physicians who then make use of it.  I think that we’re getting a lot of interest.  There are journals, there’s the media, there are doctors and hospitals who are sitting on the sidelines watching with great eagerness as to what we’re going to be able to do with this, and I’m regularly asked, what kind of response are you getting with this condition or with that condition?  They’re all hopping from one foot to the other, hoping that something will happen soon, and I think we really are – actually, Chris, would you say that we’re reaching tipping point?  I think the exposure of this is such that we’re getting to the point where no matter what interested parties might be out there that wouldn’t want to see this progress, when the public know enough about it, you can’t put this back in the tube.

Chris Kresser:  Yeah.

Glenn Taylor:  We’re going to reach a point where everybody will want to know.

Chris Kresser:  I would definitely agree with that, and I do think we’re nearing that point, if not right on the cusp of it, so it’s an exciting time to be involved in this, to be, I imagine, in your shoes, to be a functional medicine practitioner, someone who works with patients and may be able to administer this kind of treatment or at least refer them to it, so I’m really looking forward to seeing what unfolds, and I really appreciate you taking the time to come on the show.  Stay in touch, and we’ll definitely have you back when you’re ready to talk about the new delivery system.

Glenn Taylor:  Absolutely, I’d love to.  No problem at all, Chris.  Big thanks to you guys.

Chris Kresser:  Take care.

Glenn Taylor:  Thank you.  Bye-bye.

Chris Kresser:  Bye-bye.

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Comments Join the Conversation

  1. J says

    What is the timeframe for the development of an oral form of treatment? Dr. Thomas Louie at the U of Calgary has used triple capsuled pills for his treatments, although I imagine it’s probably very time consuming.

  2. Eddie says

    It seems reasonable to put down a deposit for an FMT treatment. However, with the deposit being $1,675 US and wait times of 5-6 months, is it possible for the deposit to be refunded if a comparable treatment becomes available during the 6 month wait?

  3. Debbie says

    This is on-topic but not exactly: my chronic constipation -severe constipation, I should say, meaning I went on average once a week and with a lot of straining and not much evacuated – has become what seems to be a normal bm almost daily with no straining at all. This is a result of eating a good amount of sweet potato and/or butternut squash every day plus a probiotic drink consisting of homemade kefir, green powder, psyllium, SBO probiotic and Vitamin C. I’ve also been supplementing with magnesium daily and eating brazil nuts.

    I’m grateful and still amazed every day. I feel wonderful about it – clearly I’m doing something right diet-wise. Here’s my question: the stool is a #3 on that Bristol scale and doesn’t happen – usually – without my morning coffee. I have the kefir drink, then about half and hour later, the coffee. Then about half an hour later – go to the bathroom. So, it seems the #3 is still constipated, but – why is it considered constipation? Am I healed or still in the borderline zone?

    • says

      Debbie, as it is particularly relevant to your question, can I please ask what form your daily supplementation of Magnesium is in? i.e. what specific Magnesium compound is it; Magnesium Glycinate? Citrate? Oxide? Dioxide? Sulphate?

        • says

          Thank you, just checking that the Magnesium compound you were taking was not responsible for the looser stool. It isn’t. In that case well done on your choices. Professor Tom Borody says that constipation is EITHER structural OR bacterial – Period. When it is structural, you will might surgery. When it is bacterial, then you are either 1. lacking the essential diversity of species and proportional distribution or 2. you are not feeding them properly (which will lead back to 1. again) so in the absence of an FMT, feed your commensal bacteria properly and they will reward you with good motility.
          P.S. commercial probiotic bacteria will not do what you expect they should do.

  4. ANNE says

    interesting as I am currently participating in a double blinded 8 weeks FMT clinical trail. my first FMT infusion was in hospital and now I do home infusions the enemas are frozen and I thaw them 1-4 hours before giving me my own infusion. being double blinded I have no idea if I am getting placebo or the real FMT. 4 weeks now and sadly no sign of improvement. curious to know if I should I do any particular diet?

    • says

      Can I clarify that? You are part of a double-blind placebo-controlled ramdomised trial….. that you are conducting at home…? Where on earth are the clinical controls in that procedure?

        • says

          I have been working with and handling active microbiota implants for over three years and I have experienced every characteristic of live and active microbiome. I am mystified as to how the designers of the trial could intoduce a home treatment and still keep you in the dark as to whether you are getting a pacebo or a live and active microbiome. If it is not too personal for these pages, you you enlighten me with the method of the containment of the “sample” and the method of delivery.

  5. John Es says

    Oral administration of probiotics seems a thousand times more difficult than anal. I don’t understand why more effort isn’t put into a suppository with a wide variety of beneficial bacteria to more closely emulate a fecal transplant. I can’t keep my cynicism from creeping in, here. Maybe I should shut up and be grateful for all that *is* available to me. I’m probably in a more fortunate position than 95% of all humans. It just seems like I am stuck in dysbiosis, with no clear solution.

    • says

      Hi John, you are right in that oral delivery IS a thousand time more difficult, but in time might turn out to be the most effective. Lyophilising (freeze-drying) is currently the common method as you can buy a Chinese desk top Lyophilising machine relatively cheaply and low volume encapsulating is extremely cheap. The problem is in the high level of attrition of the species when exposed to the lyophilising process.

      There are a number of us specialists working on significantly improved oral techniques, but with all the testing required for public safety, they are still a few years off being introduced.

      As far as a suppository is concerned you have to decide whether the implant will be live or lyophilised. If lyophilised the bacteria need time to rehydrate and recover before they can become actively undergoing binary fission and growth and that is before they can even start their 150cm (5ft) journey against the flow of traffic. This can take over 24-48 hours hours and with normal bowel motility that is too long as the patient will probably evacuate the implant via normal bowel movement before the implant even becomes active. If however you are chosing to use live and active bacteria, then there are already far more efficient methods currently employed than a suppository.

      I have spent four years on this problem of accurate, safe and complete dispersal so far, but any suggestions would be gratefully appreciated.

  6. Dr Silvio Najt says

    Hi, great interview. I agree 100% with the concepts that were expressed here. I am a physician and I have been applying FMTs for some time now until I decided to build a clinic devoted to do FMTs in Buenos Aires, on the daily increasing number of patients aware of the benefits of the method.
    I have one comment about some of the posts posted there. I think this method does not “cure” IBD patients, as it seems to do with Clostridium difficile cases. It repairs the microbiota and patients improve a great deal, but when they do not get maintenance implants, the inflammation symptoms recur. These are chronic diseases and we ignore why bacteria get disrupted, what is provoking this, so what we do is “repair” the glitch, we do not know why this takes place, and it seems there are way too many theories and very few answers, but at least we can change the natural course of the disease with practically no side effects.

  7. Kate says

    Wonder if Glenn needs any test subjects for solving multiple, long term health problems for this? My mother has had virtually every test under the sun over the past several years to try and solve her ill health, so far conventional medicine comes up with nothing. I’m trying to help her make dietary, supplemental changes, but slow progress in the face of longterm ill health (at least 30 years of autoimmune issues etc)

    • says

      Dear Kate,
      We are using FMT for an increasing number of conditions now, so it is worth trying if you think everything else has failed. It is a shame that FMT should be used as the last resort and some eminent gastroenterologists have expressed their wish that FMT should be used in the first instance in many situations, that would be giving it a much greater chance of bringing about resolution in many conditions. But if you want to try, just book a consultation and we can discuss her condition in more detail.

  8. Shannon Lister says

    Great podcast. loved it.. there is so much to learn.. i just hope the Sick system (health system) opens their eyes.. thanks Chris

  9. Kristi says

    The goals that Glenn speaks of cannot come soon enough. I would consider traveling to his clinic to address my white noise of symptoms. Until then, a paleo diet as described by Chris has been the only real help that I have found.

  10. Allison says

    I had 10 faecal transplants here in Australia at the CDD in December – I no longer have panic disorder. I am incredibly grateful to have access to this much needed treatment that is so heavily restricted in the US.

  11. says

    Chris, Glenn,

    Great interview, thanks for spreading the word.

    A few of us who are part of the large DIY movement find your DIY is only 10% effective due to 90% bacteria killed in the kitchen. There are many who have much success, at home, with blenders(search on You Tube) some with one treatment, some with many – varies by individual as you know.

    Can you elaborate on your 90/10 comment, do you have data to back up your claim? You can read many success stories from those who chose to FMT at home here:
    http://thepowerofpoop.com/

    Thanks again for the informative interview, look forward to your response

    • says

      Sorry John, I missed your comment (we are suffering from e-flood at the moment).

      Aerobic damage is 1st Year Microbiology. 90% of your gut microbiota BY SPECIES are in a group called Obligate Anaerobes – they are obligated to live in an oxygen-free (anaereobic) environment. When exposed to the oxygen in air (for example; frothing it until it is completely homogenised in a food blender) these species do not survive the oxygen shock. When biologists isolate species in the lab for investigation they do so under carefully controlled anerobic conditions. When we store the extracted bacteria, we do so anerobically.

      When FMT is employed to improve the diversity of the microflora, it makes no sense to me to process the stool in a way that reduces the diversity.

      Finally, whilst I do accept that there are reported cases of home treatment achieving a degree of remission, I would also offer that it is human nature to celebrate instances of sucess whilst sweeping failure under the carpet. It is because of this that home treatment does not allow us to gather meaningful data.

  12. Donal says

    I don’t often find myself commenting on forums but this is a really important topic. I had the pleasure of bringing my son to the Taymount clinic for treatment of UC after much research. Not only is Glenn at the cutting edge of the science, he and his wife Enid are the most thoughtful and caring people I have encountered in the 10+ years of helping our son deal with his illness. Both of them deserve tremendous accolades for breaking through the barriers, the setbacks and the personal sacrifices they have made to bring this treatment to the people who desperately need it. I was delighted to see Chris highlight the great and exciting work being done at Taymount.

    • Gerry says

      I could not agree with you more Donal, well said. This treatment, pioneered by these kind and caring people, is helping lots of people get their lives back on track and they deserve tremendous credit.

  13. Neal says

    Glenn. Thank you for such an amazing presentation. Gerry, it’s great to hear the FMT was successful for you. At the hospital where I work as a nurse clinician there has been interest in FMT. One of our gastroenterologists has done a case study of using FMT on a patient with Crohn’s disease with some success. He is submitting it for publication but will send me a copy of his write up.
    Most of the discussion at our hospital has focused on the use of FMT as a treatment for C. diff. It is cheaper in comparison to a 10 day course of Vancomycin and more effective in preventing recurrence when looking at the research.

  14. marcus volke says

    Chris do you know if the Australian FMT clinic uses the same procedure to ensure that the ‘sample’ is not exposed to oxygen so as to preserve the anaerobic bacteria? I am interested in getting FMT done in Australia because it is cheaper.

    • Allison says

      Hey Marcus
      Did you ask over on the FMT group? I had the transplants at the CDD myself but I don’t recall what method was used. But I am fairly certain they do try to minimise exposure to oxygen.

  15. Wenchypoo says

    Sounds like another “cure” searching for a disease to me. Instead of expensive procedures to fix the problem, why not just change the diet, and save the insurance company tons of money? Problems resulting from an off-balance menu of probiotic bacteria can easily be cured by changing the diet–definitely a D-I-Y solution.

    This is akin to statins, COPD, and erectile dysfunction–a wealth transfer scheme from you to the doctor.

    • Gerry says

      How can you possibly make such ill informed comments? C-Diff is not down to diet and neither is Crohns or UC…unless you know different??

      • says

        Wenchypoo’s comment is ignorant. Microbiota Transplants have been around since 4 century BC in China. This isn’t an industry created procedure looking to make money.

        But, broadly speaking, most health conditions are down to diet. Gerry, believe that an imbalance in microbiota was the problem with your UC. Diet is one of the best ways to cultivate a healthy gut microbiota. Human microbiota transplants are a way to transplant a healthy gut microbiome into a patient.

        I was diagnosed w/ Crohn’s in 1997. Since 2004 I’ve been rebuilding my gut microbiota through diet (SCD/GAPS/Paleo). It’s worked amazingly well for me. No meds since 2007. Most days I forget I was even diagnosed w Crohn’s.

        Glerry, glad you are feeling well. Keep it up.

    • Sunny says

      Wenchypoo, it is frightening to see someone write such an ill-informed opinion when they have no experience or knowledge to back up the statements. Cdiff is the #1 infectious disease on the CDC list.perhaps you might do some research before you say anything more.
      I almost died from it, the foods I ate were Paleo, and included homemade bone broth, plus multiple daily doses of probiotics that I had been on for 5 years ever since my first case of Cdiff, but it did not help due to the rapid transit time…. And to the nature of the bacteria itself . And my body was quickly overwhelmed by both the bacteria and the spores that hatched. None of the antibiotics worked because the medical protocol had to be followed.
      I heard about FMT , had 3 transplants done in a 3 day period in Portland, Oregon and the nightmare was over.,

    • prioris says

      The cost to do the procedure I think is over $4000+. I think if you have a donor, it can be done much cheaper. Anyone know this cost. I read $100+. What are the costs of certifying a donor as good.

      Most conventional medicine is designed to transfer the wealth of the population to the global power structures. The economy on this planet is designed as a “company store”.

      Most conventional medical care is designed to be harmful to people’s health. Most medical education is designed for this purpose also but also helps put anyone who wants to become a doctor in great debt from tuition. It also limits the number. The requirement to spend long years in medical school is unnecessary. Most medical care can be done by foot doctors with minimal education. If that weren’t enough, medical licenses are designed to force doctors to dispense toxic medications.

      The cost of medical care could be dirt cheap but this goes against the idea of the “company store” that removes most wealth from the population with artificially created product costs. High costs are intentionally built into the system but few people ever are willing to confront this.

  16. Gerry says

    Hi, I have recently been treated by Glenn and his team (March 2014) after suffering with Ulcerative Colitis for 15 years. I had been on all kinds of pills, including steroids and other suppressant drugs but nothing worked. Post treatment at Taymount I have been clear of all drugs for almost four weeks. This treatment really works and has changed my life already!

    • Tom says

      First, congratulations. Second, four weeks is hardly proof that this treatment will work long term. I sincerely hope so but I’ve seen statements like “This treatment really works and has changed my life already!” plastered all over the Internet only to find that the authors of these words relapsed. UC is super tricky and I’ve yet to see something that works well long-term without adverse side effects. Best of luck and I hope you are one of the very few lucky ones to have found something that works!

      • John says

        John,
        While Gerry may only have had relief for 4 weeks, there are many others who have remission, from FMT, for a year and more. It’s not 100% of those who try, every case is different, but the results are rather miraculous. Just read some of the success stories:
        http://thepowerofpoop.com/fecal-transplant-success-stories/

        Is that enough proof? maybe, maybe not. I just know it’s helped me, and many others immensely. Yes, I have UC.

        Hope you find your long term without adverse side effect treatment.

        • Gerry says

          6 weeks and counting now.; no blood and no pills either..! I don’t think I will even attempt to consider the condition dealt with for at least a couple of years but, frankly, even if I all get are periods of genuine remission and further top up treatments are required, that’s a lot better than a life on medication right!

          • Georgianna Henry says

            Hi Gerry! How are things still holding up for you? Are you still getting better? I sure hope so! Which treatment schedule did you do with Glenn? Was it the 10 day FMT, or longer? Sorry so many questions, but I’m considering going to him as well…

            • Gerry says

              Hi Georgianna,

              Thanks for asking; I’m still in really good shape! I checked my CRP levels (inflammatory markers) last week and when I was dealing with UC they were +10 etc but last week I was 0.62!

              I take daily pre/pro biotics and other supplements and I have changed my diet, avoiding gluten and focusing more on healthy choices; something I was unable to do with UC. I’ve lost 30lbs and feel better than I have in a long time…no more fatigue!

              I must confess that I have also joined Taymount as CEO now. I’ve been in business a long time and I wanted to help Glenn and the team build the clinic into a world centre for FMT and Glenn asked me to join the board at the end of May and it’s a privilege to be involved.

              We have purchased a new building and will be moving there at the end of this year. The new Taymount Clinic will allow us to treat 5X the number of patients we treat now, which means we can bring the waiting tines down dramatically and treat a lot more patients.

              • Georgianna Henry says

                That’s such great news! And wow, congrats on becoming the CEO! It must feel great to be part of something that truly helps people get better.
                Btw, how many fmt treatments did you get for your UC? So many things I read have conflicting info as to how often it has to be done, just want to know what worked for you.

                Sincerely,
                Georgie

                • Gerry says

                  Thanks Georgie, it’s an amazing journey and I look at it as Payback for all the years I struggled with this awful disease!

                  I had 10 treatments initially and have had about 5 top ups. I’ll keep having the top ups up to two years because that’s the length of time we think it takes to nail it. I’m very lucky to be in such good hands.

                  Hope you manage to find relief. Let me know if you do decide to have treatment, it would be nice to meet you.

              • Georgianna Henry says

                Haha! Payback is right :). Thanks Gerry! I will definitely let you know as soon after I get my phone consult (which I could only get scheduled at the earliest by Oct 21st. — you guys must be soo busy!). I’m suffering with a second c-diff reinfection and the UC has been so disabling, I have no doubt in my mind that I will go through with one of the treatments.
                I was thinking of doing the 10 FMTs and then I’ll do the 5 re-ups like you– now that you mention it takes 2 years to get the flora rebuilt in there for good. Do you get the 5 re ups all at once or spread out? I ask simply because I live in the US and traveling back and forth to the UK could prove somewhat challenging, but I will do whatever it takes!
                Thanks again!

                Georgie

                • Gerry says

                  I had my top ups in the clinic as I work here but we do send out home kits, in fact we encourage patients to have home kits so that we can keep the clinic free for new patients. We need to do the initial treatment in the clinic so that we get to know you and understand your condition and your response to FMT but after that you can buy home kits on the website as often as you need to. The home kits cost £300 each + shipping.

                  I am sorry to hear that you are struggling so badly and I wish we could fit you in sooner. The new clinic will clear the backlog very quickly and then we will be able to treat patients much faster.

    • Gerry says

      I was sceptical too but my only remaining option was surgery so I had nothing to lose. This treatment works and the fact that it is based something other than modern medicine actually encouraged me to try it! Don’t expect your doctor to embrace it though!

  17. says

    Thank you Chris for this awesome interview. In amour nutritional practice we are only too aware of the importance of human microbiota. I was wondering if lacking access to FMT, would probiotic theaphy be helpful and is there any other nutritional strategy you would indicate?

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