Poop: The Cure of the Future? | Chris Kresser
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Poop: The Cure of the Future?

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Poop has been all over the news lately. (And no, I’m not talking about the recent election.) I’m referring to fecal transplant, the process of transferring a healthy person’s stool into a sick person’s colon in order to restore the bacterial balance. It sounds bizarre, and even a little crazy, but doctors and scientists all over the country are discovering just how effective fecal transplants can be.

Just last week, the Chicago Tribune wrote a story predicting that stool banks may one day be just as common as blood banks. Human stool transplants have been found to consistently cure up to 90 percent of patients who have had multiple episodes of C. difficile, an infection which causes serious diarrhea and affects about 3 million people per year. Typically, these infections are treated with antibiotics such as vancomycin, which can actually make the infection worse by killing off beneficial bacteria and allowing the resistant C diff. to survive. This recurring infection can be fatal, killing an average of 14,000 Americans every year. It’s especially dangerous for young children and the elderly who are more susceptible to the bacteria that causes the colonic inflammation and diarrhea.

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Use of the procedure is simple and shockingly effective for patients with serious bowel infections. CNN recently reported on a young girl who nearly died from the infection, and was cured immediately by a fecal transplant using stool donated from her mother. This recovery was after nine rounds of antibiotics failed to eliminate her life-threatening infection. While the idea of receiving a fecal transplant may disgust some, the sickest patients aren’t fazed by the “ick factor” of the procedure. If it helps them recover from their serious illness, they’re willing to try it.

Several studies have demonstrated the effectiveness of the procedure on treating not only C. difficile, but other conditions as well. (1) Various studies have shown fecal bacteriotherapy, to be effective in colitis, constipation, irritable bowel syndrome, and some neurological conditions like multiple sclerosis or Parkinson’s Disease. (2, 3, 4, 5) Researchers in Amsterdam are even running a clinical trial to see if fecal transplants can help treat obesity. (6) I’ve written before that the composition of the gut flora is one of many factors that affects weight regulation, and fecal transplant could very well be a future obesity treatment. (7) There may be countless other conditions that could be helped by this simple, effective, and safe procedure.

I’m fascinated by fecal bacteriotherapy and have read all the studies on it. It’s a miraculous treatment in certain conditions, and we have yet to tap into its full potential in treating a number of gut-related illnesses. I’m excited to see how this therapy develops, and wouldn’t be surprised to see the creation of stool banks in a few years. Fecal transplant may be a disgusting concept to some, but who knows – one day it could save your life!

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  1. I was at the point where I needed a fecal transplant. I was taking VSL#3 which is the strongest probiotic you can get in this country that I’m aware of. The VSL#3 helped so much but it was never quite enough. Eventually after eating a high fat diet and incorporating fermented foods, bone broths, basically a mixture of GAPS diet/Weston Price/ high fat (lots and lots of good butter) my gut finally healed. I no longer need to take VSL#3 or any store bought probiotics. I eat kimchi, fermented pickles, sauerkraut, kombucha, kefir, raw milk… bone broths and lots of fat.

  2. Chris,
    Can you please review the process for how the transplant happens? I had heard of this a few months ago, and have had severe IBS-d for decades (started in my teens with Giardia) and was diagnosed with Celiac recently (3 decades later!). I eat really clean (a la Nourishing Traditions) and would want my donor’s poop to be, well what to say? high quality/clean — all sounds ridiculous, but I think you get the jist. So, I prefer for my donor to be someone I know and know their diet. Also, are there other things that need to be considered? Can anything be transmitted or cause a reaction in the immune compromised person? So, for Celiac, would it matter that the donor eats gluten/corn?
    Many thanks for all you do!!
    Happy holidays,
    Devona

  3. I had a C. Diff infection as a complication from the antibiotics I took to treat Lyme Disease and I diagnosed myself. I was really surprised that my self diagnosis was actually correct though because really, when does that ever happen? I am glad my doctor listened and confirmed the diagnosis with a lab test. Fortunately the Vancomycin did cure my C. Diff but at the time I wanted the fecal transplant because I have such a compromised gut due to Celiac disease and long term candida infestation. My question and also my naturopath’s question is where can healthy donors be found? I don’t know anyone who hasn’t taken antibiotics, steroids or OCP. Will there be people who can actually become suitable donors? I would still like to do a transplant for healing of my gut from the years of abuse it has suffered.

    • I did a little research on this subject. My information could be wrong, of course. A healthy infant over 6 months of age who is currently being breast-fed. That would be a good donor.

      • Actually I have heard that infants have different gut profile to adults and so they are not ideal donors for adults.

        • Really? When I did the research, I wasn’t looking at real peer-reviewed research. I was merely browsing through some of the experiences shared by some who have chronic ulcerative colitis. Of course, there is nothing to stop anyone from trying this if they had a family member who fit the profile.

          • That’s the info I’ve been given be someone who has had the transplant both by a clinic that has a donor bank and also has sourced her own donor stool using strict screening. I haven’t delved into this aspect any further though. I had asked her whether a child was suitable as you would assume they have a better gut profile but she said that the species are somewhat different between infant and adult. Since she has the personal experience, I trust what she is saying….though it restricts the possibilities!

      • Allison is correct. The Center for Digestive Disease in Australia that developed this procedure recommends that donors be >18 years old. The gut flora is not fully developed until then, according to them.

        • I keep reading that mothers pass their gut flora to their children at birth. Does that mean my 18-year-old son who has good digestion would not be a good donor? He has never taken antibiotics and has been low sugar all of his life. All because of my anti-candida and later paleo diet.

    • Alicia, I was hoping you could expand upon your experience with Lyme/co-infections and Candida. I tested positive for bartonella, and have tested positive for Candida, and finally positive for Crohn’s. So I am very interested in what you or others have done to deal with these issues

  4. As a person who ten years ago contracted C. Diff was in the hospital for two weeks, had to have my appendix removed because of the infection and was ultimately given vacomyacin as treatment….I would to this day have a fecal transplant without a second thought. After being released I had symptoms and suffered angonizing intestinal issues for years before everything eventually leveled out. But it didnt level out before I had tried everything out there to alleviate my symptoms. It interfered with my work, and my life. Not fun for a person from years 19-21. To this day I am speptical of antibiotic use unless I am on the verge of death, and I feel like that part of my life has impacted my health in ways I will never fully understand. That is why a fecal transplant is still appealing to me…perhaps it could help with the past trauma. It might be gross to some, but Chris you make a stellar point at the end of your post when you mention seriously ill people being willing to look at other angles. Pain and suffering like what comes along with c diff is enough to make you do whatever it takes. Thanks for the awesome posts and continued info Chris!!!!

  5. Wow! I had heard about this but didn’t realize it was this big of a deal! It sure is making waves! I’m so glad so many people are having good results with this. I’ve been sick with stomach issues literally since I was born. I cant’ remember a day in my life where my stomach didn’t hurt. I don’t have a diagnosis at all, which isn’t surprising, since I quit going to doctors after years and years of needle stabbing did nothing but stress me out. This has me wanting to go get a diagnosis so I can possibly join in a test group! I’ve been trying to follow an auto-immune protocol diet, while eating fermented foods and taking probiotic supplements but it’s SO HARD! I keep failing, I feel hopeless.
    Are there any studies out there on fecal transplants and celiacs?! I don’t have a diagnosis of this but I’m almost positive this is what I’m dealing with.

    • Hi Staci, So sorry you feel hopeless. It is terrible.
      If you are Celiac, which I am, then I highly recommend that you do not eat any grains whatsoever. I imagine that you’ve done a lot of research and know to never eat gluten: wheat, oats, barley, and rye, but a recent study confirmed that for some Celiacs (like me) corn triggers it too. You likely have a very damaged digestive system if you have been sick for many many years, and then of course have to be more strict until you heal — which will come if you are dedicated. There is so much I couldn’t/can’t tolerate: whey, dairy, eggs, grains, sauerkraut. I eat meat/veges (Weston A Price pastured/organic) and am really healing, normal BMs for the first time in so many years I can’t remember. I also do take a clinical grade probiotic: VSL#3 capsules (not the powder as one of them has cornstarch!) and Vit D3 supplements. As I can tolerate it, I take a little fermented cod liver oil, but I often can’t tolerate it. That plus a glass of homemade kombucha (I use organic decaf black tea) has me healthy. Good luck to you!!!

  6. I’m a vet, it’s something that’s commonly done in horses to restore the flora after colics and/or antibiotics… just take some stool of a normal horse, dilute it un water and give it through a stomac tube, cheap and easy.

  7. Nice post. I never thought that medical science would “get” the importance of beneficial gut flora but they can’t ignore the avalanche of studies showing just how important they are to health. But as I’m highlighting in my current blog series on gut flora and heart disease, it’s not just about diarrhea and colon disease. The medical community needs to understand what disturbances in our gut flora mean for a whole host of health disorders.

  8. i’ve sat in on lectures from one of the pioneers in this field here in Minneapolis. his clinic and lab have devised a way to “purify” the stool from donors into a refrigerated “nugget” that is transplanted during colonoscopies. this eliminates the need to coordinate donations and processing. they’ve moved away from using related donors and now recruit and screen donors that can be used for anyone. the success rates with the refrigerated “processed” stool are equal to fresh donors (for treatment resistant c diff). may be coming to a clinic near you some time soon…

    • Hi Steve — I live in Minneapolis and I have been looking for a functional medicine doctor comparable to Chris Kresser. Do you know of anyone here? Thank you! Annie

  9. To look at this another way, can you speak to how much people should perhaps be concerned about potential negative effects from this treatment?

    For example, let’s say one spouse has IBS and the other spouse is healthy and a willing donor. Is there any risk of somehow picking up bad or worse bacteria, given a healthy donor?

    (I imagine you can pick up STIs, hepatitis, or somesuch… but that seems irrelevant if the people are already sex partners…)

  10. Chris can you explain as to why the transplant would be better than using hi doses of probiotics?
    This is extremely interesting, however I was just curious about why if it is the healthy flora that is curing the C Diff why they could not just use probiotics? In my opinion as a previous nurse, it’s a shame to me that they do not give probiotics to every patient that is on antibiotics. I am sure soon we will see a prescription for probiotics. It’s a shame that it has taken this long to realize that probiotics are key to many ailments. I have seem my share of death and near death from C-diff….I am happy they are figuring it out.

    • The highest dose probiotic would not come remotely close to the diversity and quantity of microbiota present in a stool transplant. There are over 1,000 species of bacteria in the gut, and maybe 14-16 species in the most potent combo probiotics.

  11. Very interesting! I’m glad you are staying on top of this and keeping us informed. I love your blog and podcast. Keep up the great work! 🙂

  12. We’re in a crazy world: on one end, surrounded by hand sanitizers everywhere we turn (grocery stores, banks, schools,….) , and news of fecal transplants or the miracles of sh*t shakes on the other.

  13. Are Doctors doing this procedure in the US? Specifically in the California Bay Area? I googled this with no luck.

  14. I’ve been taking tons of probiotics over the last few years, ones in the refrigerated section at our local health food store – spending $50-$80 monthly. I just recently had a stool profile done with Genova labs to find out that I have no good bacteria in my gut!!! Do you feel Kefir and fermented veggies are the way to go? Not sure a stool transplant would be available for me? Have lots of cyclic diarrhea and it showed no parasites either? Do lower carb paleo to keep Candida at bay? Thoughts please!!

    • Loretta,
      Real food is always the way to go. Chris has a few articles with recent studies showing that re-population on gut bacteria is a long, slow slog. Store-bought probiotics are probably going right thru you (at one point they were giving me *more* diarrhea), so start fermenting some kraut, yogurt, and kombucha! Start with just the kraut juice a la GAPS protocol.

    • Hi Loretta,

      Your experience is all too common. The reason I went with the non-refrigerated process for my probiotics was because there is no possible way to ensure organisms remain viable once in the distribution chain. I explained why in this post http://syontix.com/everything-you-wanted-to-know-about-probiotics-but-were-afraid-to-ask/

      I would also strongly recommend a prebiotic to build up populations of bifidobacteria in the colon. I wrote about that here: http://syontix.com/what-are-prebiotics-and-why-you-should-care/

    • That’s really bad news. I also spend a fortune on probiotics as well as have IBS-d.
      I should probably have all of the tests on the IBS page of Genova labs. Which one did you have?
      I am assuming you are not still taking the probiotics from the health food store.

    • Hey Loretta, you should make your own kefir, you can buy the grains for a few dollars on Amazon, and then make it with milk for a life time, the grains just keep reproducing, soon you can sell your own, and help others like you. Just a thought instead of spending all that money on it and other products like it at expensive health food stores.

    • I recently had a similar test with Nordic Laboratories. They found no growth of Lactobacillus spp. or Enterococcus spp. But being on a dairy and grain free diet I presume the Lactobacillus wouldn’t have anything to feed on?

    • The wonder of fermented dairy and veggies is that they are so easy to do. Sally Fallon’s cookbook Nourishing Traditions has lots of tasty fermented vegetable recipes, it also contains kefir and kombucha recipes. Another great drink is water kefir – especially for the summer. The quantity and the quality of the bacteria available from these traditional means are much better than the supplements. And they aren’t expensive. And they taste delicious!

      Problem is, if you are eating sugars and grains then you are feeding the candida that is creating the gut dysbiosis and diarrhea. That’s where I would suggest you need to start! Cut them out completely and enjoy a paleo diet of real food.

    • Loretta what sort of testing have you had done? Perhaps you have c. difficile overgrowth.

      Probiotics are not a viable option for many people because the bacteria just do not take hold – human bacteria are far superior to probiotics because they are able to latch on.

      There are people who now do DIY fecal transplants because they cannot access the transplant through official channels – there are protocols available to ensure harm minimisation, coming from the Centre for Digestive Diseases in Sydney, considered a world leader in this treatment.

    • Fermented foods are valuable for the nutrient improvement that fermentation causes;eg,sourdough fermentation of wheat bread makes wheat more digestible,but obviously the bacteria doesn’t survive baking; similarly,the bacteria in yoghurt,fermented veges,etc.,won’t survive stomach acids to augment a colon lacking beneficial bacteria.
      If your colon has had bacteria kill-off from antibiotics,etc.(eg,I had bacteria kill-off from a bowel clean prep,prior to a colonoscopy),then stool transplants may be the only way to resolve the problem.

  15. Exciting news. Thanks for sharing this article Chris. I ruined my immune system after contracting a rare parasite when I was 23 and now have the gut flora of an obese person. I have IBS-D but would never qualify for help because I am not obese and don’t suffer with the IBS-D as much due to rigid dietary compliance. I do have insulin resistance and test that way even after a year without sugar and starches This help can’t come soon enough. Most people really can’t understand why I can’t have sugar and starches and preach exercise and eating everything in moderation. They think it’s calories in and calories out. It’s not.

    • Absolutely – your gut bacteria and what communities are in the highest concentration.can actually determine WHERE your body holds weight. Calories in/Calories out just doesn’t work for most people. It’s about eating lots of healthy, nourishing food and leaving behind the empty calories that leave you weighed down with depression, heaviness and physical weight.

      • Debbie and Rebecca – which bacteria do you refer to as being linked to metabolism and weight issues? I am very low in bacteroides which I’ve heard may be linked to obesity (at least in rats). Interested to know what the other species are that are known about.
        thanks

        • I wish I knew more. I have always thought my issue is with Candida. It causes, bloating, food intolerances, and eventually weight gain. But now with all this new research on the gut biome, I think it’s a lot more complicated than that.

    • Actually, calories are misunderstood. I took a sports nutrition class that opened my eyes. The typical calories in/out doesn’t work because people don’t understand calories and the body’s requirement. For the body to work optimately it requires 2,000 calories min. You add calories when you are exercising. When you cut calories or don’t eat enough or create too great a deficite in calories from exercie you then gain weight not lose weight. Or end up with a yo yo effect. There is a fine line for the body to work optimately. We have been brain washed for low calorie diets. Most people should be at 2300cal depending on height and muscle mass. Calorie increases with height, muscle mass, and activity level.

      If you have insulin resistance one thing that has been proven to work is anaerobic exercise as well as strength training for the legs.

  16. It certainly speaks to how far away we have gotten as a society from eating proper foods with proper bacteria. The majority of patients and folks I talk to have no Idea that they need to be eating fermented foods to get the probiotic bacteria in their gut, or supplement with them. It is also vital to be eating appropriately. Thanks for the article. It always amazes me how emergency medicine comes about because we simply aren’t living as we should.

    • Although, many years ago I heard a doctor on the radio say to eat sauerkraut for acid reflux nothing was mentioned about the gut flora in that conversation. I have hypothyroidism so can’t eat cabbage on a regular basis, but thanks to the Balanced Bites podcasts, I have recently been made aware of the many other types of fermented foods as well as kombucha.

    • Scott – you are correct, however many people require a transplant because they have contracted c. difficile in hospital having a procedure, not because of their diet.

    • I read about fecal transplants three years ago and was completely fascinated. When I broached the subject with my physician colleagues they laughed it off like arrogant close-minded school yard bullies. It is so encouraging to see this slowly garnering the serious attention it deserves.

      Like Scott I am also amazed at the both the paucity of people aware of the beneifts to fermented foods and a healthy gastro-intestinal tract. I actually am an Emergency Medicine physician and have come full circle on the approach to medicine to the point that I am seriously conflicted about my role in just treating people when they have a problem rather than adopting a more proactive approach to preventing problems in the first place. I am deeply troubled about the lack of attention, interest and value from my physician colleagues about the need to transition our healthcare system into a more prevention-minded approach begining especialy with nutrition. What a struggle we face.

      • We need MORE doctors (MDs) that think like you do now. Spread the word!! Hopefully MDs will take it seriously coming from one of their own. Sadly though, I have found many MDs lacking in their open-mindedness to even consider the relationship between diet/nutrition and health. Definitely keep it up — shout it out every chance you get! And, thank you for that!!

      • Hello Dr. Sean,
        You are exactly right about the direction of Prevention with Patients you should take. Only Doctors like yourself who become proactive and step out of the old systems can make the difference. I would like to share with you a Physician in Tulsa who is doing just that! Over the course of time, she will change the face of medicine in Tulsa!!!
        Her website is http://www.fmidr.com
        Her office is The Functional Medical Institute.
        Her name is Michele Neil, DO. She is an Internal and Sports Medicine Dr. She is having marvelous success in teaching and lecturing Physicians and patients about Nutrition and health through whole foods, supplementation and integrative exercise. I am in the process of becoming certified to be her Health Educator for her patients, right now and am on the same path…:)
        Lori Lange
        Exercise Physiologist
        Tulsa, OK

      • Hello Sean!!
        I am so excited to read your post! To many Dr’s have no interest in preventive measures as you know. I am so excited about your future. Have you checked out mercola.com? Dr Mercola is a preventive dr with a very informative website. I wish you all the best. Your patients are so lucky to have you and be there for your transition.
        Kat in CO

      • Sean – if we became a prevention minded society where in the world would the money come from? What would the pharmaceutical companies do if they had no drugs to sell for the sick people? Cure cancer – oh my?!? That would never be acceptable for corporate big wigs of these same companies because then how many people would be out of work? It’s all just one HUGE monopoly and a way to keep our population in check. Sounds very cold and conspiracy theory like, but just think about it….how can we send men to the moon but we can’t cure cancer? Really? We are much smarter than that people!

      • Sean, I understsand how you feel regarding the attitudes of your physician colleagues. Wait until you are an FMT practitioner, you will need a tin hat!!

        We at the Taymount Clinic continually face criticism from trained physicians that demonstrate a complete absence of the understanding of fundamental microbiology and are more about their personal dogma and less about researched and trialled science.

        If you want to see the sparks fly, try casually dropping into the conversation at coffee time that you were considering treating a patient with FMT – then duck!

      • Hi Sean.
        If nutrition isn’t your field then I suggest you do what my MD collegues do. Find a reputable nutritional therapist who is experierienced in changing people’s health using therapeutic foods and natural diet plans in the area you work. I don’t try to be a doctor and they don’t try to be a nutritional therapist.

      • This is a really thoughtful reply, thank you. As someone researching a cause and cure for dyshidrotic eczema, I am amazed at the lack of information out there that includes looking inside the body, not just to outside triggers.

        • Steph
          I am curious about your research on dyshidrotic eczema. I went on a paleo diet 3 years ago to treat join pain, chronic fatigue and FM. It has been very effective, but a year and a half ago I developed d. eczema and there’s nothing I can do to stop it. I would consider a fecal transplant if I thought it would help, but I am not sure if that would be effective.

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