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Fecal Transplant: Can It Help Colitis, Candida, IBS and More?
January 17, 2018
According to a study published in the journal of Gastroenterology Hepatology, fecal transplants, also known as microbiota transplants, have a 91 percent cure rate (!) in treating clostridium difficile and may also help treat IBS, colitis and autoimmune disease. (1) There are several instances where someone with a life-threatening infection had fecal transplant actually save their life.
A fecal transplant is a procedure in which fecal matter, or stool, is collected from a pre-qualified healthy donor, mixed with a saline or another solution, strained and then placed into the colon of another patient using a colonoscopy, endoscopy or an enema.
Why do such a thing? Well, the intent is to repopulate the receiver’s gut with normal, healthy bacteria and microbes that are living in the donor’s gut. You can repopulate the gut with good microbes by consuming probiotics-rich foods and taking quality probiotic supplements, but this can take much longer to repopulate the gut. Your average probiotic food or supplement may contain between 1–30 strains of probiotics at billions of units while healthy poop contains 1,000+ strains of microbes (bacteria, yeast, bacteriophages, etc.) at hundreds of trillions of units.
Before you judge and dismiss (don’t!) this procedure, please realize that Fecal Microbiota Transplants (FMTs) are actually backed up by some very compelling early clinical research. While FMTs haven’t exactly become “mainstream” medicine just yet, fecal transplants are providing huge relief to people with a range of painful, even deadly, digestive disorders and symptoms.
They are especially useful for people who have reoccurring intestinal infections caused by the type of intestinal bacteria known as C. difficile or Clostridium difficile, but in the future they may also provide help for those with leaky gut syndrome, IBS, ulcerative colitis, autoimmune disease, chronic fatigue syndrome, celiac disease, obesity, food allergies, rheumatoid arthritis, and diabetes. Recently, findings from new studies have even suggested that fecal transplants may be able to play a role in treatment of cancer and Parkinson’s disease.
Why Would Someone Need a Fecal Transplant?
Why would it be beneficial, or even safe, to transplant stool from one person to another, you might be wondering? It turns out there are trillions of live, beneficial strains of bacteria that live inside of our colons. Poop itself contains over 500 forms of bacteria and potentially 4,000 unique microbes that are found in our gut “microbiome.”
Your microbiome is like a little world, or ecosystem, inside your gut that contains all of the good and bad bacteria that control how your body digests and processes nutrients. It is as unique as a fingerprint and reflects all the damage that your gut has experienced such as antibiotics, medications, processed foods and parasites, according to what your body has interacted with over the course of you lifetime.
So what if you could take all the wear-and-tear bacteria that developed from misuse and substitute a whole new “world” for your body to process nutrition and grow new healthy cells from? Essentially this is what FMT is — a whole system reboot from the inside-out!
According to the Centre for Digestive Diseases in Sydney Australia, “to understand the utility of FMT, it is first necessary to appreciate the compositional complexity of the GI microbiota, along with its associated functional implications. There are over 10 trillion bacterial cells in our body — 10 times more than the amount of human cells — and most of these bacterial cells reside in the GI tract.” (2)
People who suffer from digestive infections and disorders — such as irritable bowel syndrome, Crohn’s disease and ulcerative colitis — typically have a high amount of harmful “bad” bacteria living inside of their gut and, unfortunately, a low amount of healthy “good” bacteria.
Either due to a disorder or certain lifestyle factors, like a poor diet and long-term antibiotic use, the good bacteria that are normally present have been killed or suppressed. So, for those people with such a compromised gut, a fecal transplant is worth considering. They essentially benefit from having another person’s good bacteria inhabit their own gut and getting their digestive system rebalanced.
The best way to take advantage of living bacteria is to transplant them directly from a donor to a receiver while the bacteria is still living — this way the healthy microbes take hold in the receiver’s gut and reside and repopulate there. You can think of the process almost like someone receiving an organ transplant, or even like an entire immune system transplant!
Are Fecal Transplants Safe, and Do They Really Work?
By donating healthy stool to another person, the donor is able to give the receiver the ability to replace good bacteria in the gut over time and reduce harsh and dangerous symptoms that have previously been untreatable.
According to the latest research, fecal transplants are up to 98 percent effective. So while it may sound completely strange to transplant poop from one person to another, fecal transplants actually have an extremely high success rate and provide an affordable and natural solution to people who have tried other treatments but still not found relief.
Fecal transplants delivered via capsules have also been proven to be an effective approach according to a 2017 clinical trial. The clinical trial found a 96.2 percent prevention rate of C. difficile infections in both participating groups: capsule recipients and colonoscopy recipients. Additionally, only 5.4 percent of capsule recipients experienced adverse events versus 12.5 percent of the colonoscopy group. Sixty-six percent of the capsule recipients rated that their experience with the treatment was not unpleasant (compared to the 44 percent of recipients who received their treatment by colonoscopy). (3) Furthermore, treatment cost per patient for capsules equaled $308 compared to $874 for the colonoscopy recipients, according to NEJM. (4)
Best of all? To date, no serious side effects of fecal transplants have been reported. This makes FMTs a low-cost, low-risk, highly effective treatment for those willing to try it out.
Health Benefits of Fecal Transplants
While the research on fecal transplants is somewhat limited, early studies show very high success rates and impressive results in patients who have been suffering for months, or even years.
In particular, a 2013 study done by the New England Journal of Medicine (NEJM) compared the effects of traditional antibiotics to fecal transplant procedures.
The researchers found such positive improvements in patients receiving FMTs during the study that they actually stopped the study short in order to give all patients receiving the antibiotics fecal transplants instead! The researchers felt that in light of the positive research showing the dramatic improvements in patients’ symptoms from fecal transplants, it would be unethical to continue giving a group of patients antibiotics alone and withholding FMTs. (5)
“Those of us who do fecal transplants know how effective they are. The tricky part has been convincing everybody else.” Those words came from Dr. Colleen R. Kelly, a gastroenterologist with the Women’s Medicine Collaborative in Providence, R.I., in a New York Times article. Speaking about the NEJM study, Dr. Kelly said, “This is an important paper, and hopefully it will encourage people to change their practice patterns and offer this treatment more.”
1. Can Cure Infections, Including C. Difficile and Possibly Candida
Clostridium difficile colitis, or C. diff, is a very serious infection inside the gut that causes severe cases of diarrhea, vomiting and fever. Sometimes C. diff can be so serious that it can even lead to death.
Unfortunately, its incidence has grown over the past decade. The Centers of Disease Control report that about 500,000 people in the U.S alone were diagnosed with C. diff in 2012 and 14,000 sadly died. Some other sources show that these numbers are likely even higher but that the causes of death are sometimes undiagnosed. (6)
The frequent use of antibiotics is most likely the cause of C. diff. bacteria over-populating the colon. The NEJM reports that roughly 24 percent of C diff. cases occurred in hospitals and 40 percent began in nursing homes or community health care settings. (7)
Antibiotic use can lead to C. diff infection because antibiotics have the ability to kill normal gut bacteria that fight infection. If patients are then exposed to C. difficile, which is common in many hospitals (especially among the elderly), a dangerous infection can take hold.
The 2013 NEJM study results show overwhelming positive effects of fecal transplants when compared to antibiotics for curing C. diff. In the study, patients were treated with either antibiotics alone, antibiotics in combination with fecal transplants, or antibiotics in combination with “bowel lavage” (a method for flushing out the intestinal tract with liquids). Fifteen out of 16 patients were cured of C. diff after receiving one or two fecal transplant procedures. In comparison, only four of 13 were cured using antibiotics alone, and three of 13 using antibiotics and bowel lavage.
The researchers concluded that the infusion of donor feces during the fecal transplants was significantly more effective for the treatment of C. difficile infection than the use of antibiotics. Also important? No serious side effects were reported in the group receiving fecal transplants. This shows serious promise for treating other infections and viruses with FMT, such as Candida, a fungal yeast infection that populates the digestive tract and feeds off of a poor diet high in sugar.
Even better, a 2017 study performed by The University of Texas Health Science Center at Houston offers a potential new treatment — more convenient than traditional FMT. Researchers observed 72 patients with a minimum of three instances of recurrent C. diff in a clinical trial and treated them via colonoscopy with either fresh, frozen or freeze-dried fecal matter.
The fresh product showed a 100 percent cure rate, while frozen product had an 83 percent cure rate; Freeze-dried product produced a 69 percent cure rate. Frozen and fresh FMT product restored the microbiota diversity within seven days after treatment was received. With the freeze-dried product, researchers saw some improvement after seven days and full restoration of healthy bacteria within 30 days.
“Freeze-dried product can be put into a pill that can be given orally, which is much more convenient for patients and physicians,” said DuPont, who is currently testing a pill version of the product. (8) Using fresh fecal matter presents obvious limitations and obstacles, and although freeze-dried fecal matter was slightly less effective and took longer, this new research presents a potential new option to make this treatment more readily available for patients.
2. Helps Heal Ulcerative Colitis
After conducting an experiment on children and adults with ulcerative colitis (UC), researchers from the Helen DeVos Children’s Hospital in Michigan found that fecal enemas were effective and well-tolerated at controlling UC symptoms. (9)
Those who suffer from an overgrowth of unhealthy microorganisms in the bowels are often diagnosed with “intestinal dysbiosis” or “colonic dysbiosis,” which can develop from intestinal parasites that are hard to completely remove — and many sufferers find that they keep on recurring. Colonic dysbiosis contributes to the development of inflammation in the colon of people with UC.
Fecal transplants can help eliminate intestinal dysbiosis and, therefore, lessen UC symptoms. In the DeVos Children’s Hospital study, when nine children with UC received freshly prepared fecal enemas daily for five days, seven of the nine patients (78 percent) showed positive clinical response within one week! One month later, six of the nine (67 percent) maintained clinically responsive.
Since no serious reactions or side effects were reported, researchers concluded that FMTs can be an effective and low-risk way to help heal UC in children and adults in the future. Other similar studies have showed positive results for those with UC, although researchers still want to see more clinical evidence in order to know how many treatments would be needed to actually cure the disease instead of just improving symptoms like inflammation and diarrhea. (10)
3. Can Treat Chronic Fatigue Syndrome
There’s now strong evidence showing that in people with chronic fatigue syndrome (CFS), the health of the patient’s gut microbiota (flora) is actually very connected to their psychological state of mind. Several studies show that there is a presence of abnormal bacterial gut flora in CFS patients and that this is linked with their cognitive dysfunction and symptoms of exhaustion, stress, sadness, low motivation and trouble sleeping. (11)
A 2012 study published in the Journal of the Australasian College of Nutritional and Environmental Medicine reported findings that 70 percent of patients with CSF who had gut bacteria therapy treatments showed significant improvements in symptoms. When 60 patients with CFS underwent either one or two bacterial infusions to introduce healthy bacteria into the rectum and colon, 42 out of 60 patients (or 70 percent) responded positively. (12)
Maybe even more impressive is that the patients were contacted years after the experiment was done and 58 percent reported that they still had a significant resolution of symptoms, even after so much time had gone by. Complete resolution of symptoms was maintained in seven of the 12 patients and five of 12 didn’t experience recurrence for approximately 1.5–3 years after the treatment.
4. Helps to Control Irritable Bowel Syndrome
As you’ve probably heard me say plenty of times, our gut microbiota has an enormous impact on our health in general. So we shouldn’t be surprised that clinical evidence suggests roles for our microbiome in everything from obesity to autism.
Unfortunately, many adults experience poor macrobiotic health because of antibiotic use, a conventional gluten-and-GMO-packed diet, nutrient deficiencies, allergies and toxin exposure, all of which can lead to the formation of common digestive disorders like irritable bowel syndrome (IBS).
IBS is usually a chronic problem that is hard to really detect or solve, and it’s marked by unpleasant periods of diarrhea and/or constipation. IBS is partially caused by intestinal dysbiosis, an imbalance of normal intestinal flora, certain dietary components, and by such factors as antibiotics, psychological and physical stress. Intestinal dysbiosis can be eliminated or at least reduced by FMT treatment, or when the microflora is treated and repopulated with healthy bacteria from a donor.
In a 2012 study undertaken by the Diabetes and Nutritional Sciences Division of King’s College London, when 15 patients with IBS were treated with FMT, 86 percent demonstrated improvements and had better response to their current medications afterwards. (13)
A 2017 study of 90 patients with moderate-to-severe IBS highlighted that active transplantation over placebo transplantations by colonoscopy were favorable by 65 percent (versus 43 percent). There were no serious adverse events attributed to the FMT performed. (14)
5. May Address Food Allergies and Sensitivities
According to a report published by the U.S National Library of Medicine, “Bacteria which naturally live inside our digestive system can help prevent allergies and may become a new source of treatment … Bacteria may have a particular role in altering the immune defenses of the gut lining and preventing some of the food allergen entering the bloodstream.” (15)
One 2014 animal study run by the University of Chicago looked at how alterations in gut bacteria are associated with food allergies. The study results showed that mice lacking normal gut bacteria had increased allergic responses when they were given peanut extracts, but when the mice had specific groups of healthy bacteria inserted into their guts, they then had reduced allergic responses. (16)
The same positive effects are believed to work in humans regarding food allergic reactions, too. While a fecal transplant may not be able to eliminate a food allergy or sensitivity all together, it can help reduce inflammation in the gut and that will indirectly help food intolerances.
6. Can Assist in Healing Autoimmune Diseases
Those with autoimmune diseases suffer from abnormal gut bacterial health that makes their own immune system “attack itself.” In an autoimmune reaction, antibodies and immune cells target the body’s own healthy tissues by mistake, signaling the body to attack and causing ongoing inflammation. (17)
Because fecal transplants can help repopulate an unhealthy gut with bacteria that are able to re-establish microbiota homeostasis, autoimmune disease patients can experience improvements in inflammatory responses as their body learns to properly distinguish real “threats” from normal cells.
In January 2015, the Department of Gastroenterology and Hepatology at Tianjin Medical University in China reported, “It is an exciting time in the burgeoning science of FMT application in previously unexpected areas, including metabolic diseases, neuropsychiatric disorders, autoimmune diseases, allergic disorders, and tumors.”
A trial was conducted by the researchers in patients with metabolic syndrome by using FMT to infuse microbiota from healthy donors into the patients. The results showed that patients had increased insulin sensitivity along with increased levels of healthy intestinal microbiota. (18)
7. May Help Maintain Brain Health and Slow Cognitive Decline
At this time, more clinical evidence is still needed to prove that FMT treatments can help improve symptoms of cognitive disorders such as multiple sclerosis, Parkinson’s disease and autism. However, researchers are hopeful that fecal transplants will help prevent or treat brain disorders due to the strong relationship between gut health and brain health.
The gut and brain have a steady ability to communicate via the nervous system, hormones and the immune system. Some of the gut microbiome can even release neurotransmitters, just like our own neurons do, speaking to the brain in its own language via the “vagus nerve.”
Scientists know that patients with these brain conditions suffer from abnormal GI microbiota, and so it’s believed that improved gut health will work to signal messages to the brain that may turn off causes of cognitive decline, memory loss associated with getting older, mood disorders such as depression, or learning disabilities like ADHD. (19, 20)
Can Fecal Transplants Help Fight Cancer?
As of April, 2019, early results from two clinical trials described at the annual American Association for Cancer Research (AACR) meeting show promise that some patients who initially do not benefit from immunotherapy drugs alone may benefit from fecal transplants prior to using these drugs. Some saw their tumors stop growing or shrink after they received fecal transplants from patients for whom the drugs worked before receiving immunotherapy drugs.
Researchers have recently uncovered that there’s a connection between response levels to immunotherapy drugs (called PD-1 blockers) and the bacteria, viruses, and other microbes in a patient’s gut/microbiome.Recipients who received donated microbes appeared to have a boost in their cancers’ responses to PD-1 drugs because their gut microbiomes changed to more closely match the genetic makeup of the stool donors’ gut microbiomes. And according to coverage of the trials by Science Magazine “patients who take antibiotics (which temporarily wipe out gut microbiota) prior to or soon after receiving PD-1 blockers tend to see less success.”
These are among the first clinical trials to test fecal transplants as part of cancer therapy. While the results are still only preliminary and the number of patients in the trials were small, there’s evidence that transplants can make a positive impact on antitumor immunity and responses to other cancer treatments.
How a Fecal Transplant Works
As of 2013, the FDA allows only qualified physicians who have been trained in this procedure to perform fecal transplants. It’s not recommended to try doing one on your own at home (although some people still do!). Currently physicians can perform FMT procedures for recurrent C. difficile infections only, with signed consents from patients and carefully tested donor stool. But in the near future this may be changing.
Fecal transplants are performed in clinics, which is the recommended approach at this time, or in someone’s own home. The process involves diluting the donor’s stool with a liquid, usually saline, and then pumping it into the intestinal tract of the receiver via an enema, a colonoscope or a tube that is run through the patient’s nose into their stomach or small intestine.
For curing C. diff infection, usually one or two treatments is enough to show significant results. However, for chronic digestive disorders, treatments over several months are usually needed, or at least for two weeks. Most people experience positive relief from disorders after two to three months of doing FMTs almost daily, for this is at least how long it takes for the healthy bacteria to repopulate in the gut.
The most common way of doing a FMT is to collect stool from a donor in a cup at a medical clinic, then for a doctor to put the stool into a french catheter and easily inject it into the colon of the receiver. The living microbes within the stool then take hold in the gut of the receiver and populate the microbiome with beneficial bacteria that can kill infection. While its best to do the procedure right away in order to ensure all the healthy bacteria are still living, it can also be done with a stool solution that has been frozen and thawed.
As of now, bowel lavage, or “gut flush,” is not always included as part of a FMT protocol. The reasoning behind first doing a bowel lavage is to enhance FMT success by flushing out residual feces, antibiotics, harmful bacteria, toxins and spores from the gut prior to the administration of the donated flora. Bowel lavage can help enhance the potential for FMT to provide a ‘fresh start’ in repopulating the colonic habitat of the recipient’s gut, but it isn’t always necessary.
Where Do Fecal Transplant Donations Come From?
The benefits of a fecal transplant will depend on the health of the bacteria present within the donor’s stool. A donor should always be in good health and should have no medical history of digestive disorders or intestinal infections. One benefit of having a FMT done at a clinic is that the clinic will always tests the donor’s stool to make sure healthy bacteria are present in high levels. They will usually also tests the donor’s blood in order to reveal any unknown diseases or infections, such as sexually transmitted diseases or hepatitis.
As of now, most people use stool from donors that are family members. However, in the future, we may see larger projects that will involve collecting and banking or freezing donor stool samples for further studies and anonymous transplants.
For example, the University of Minnesota Fairview Medical Center has a small standardized laboratory process of banking frozen fecal material. When patients treated for C. diff infection with fresh donor material were compared to patients treated with the standardized frozen material, there were no significant differences in infection clearance for fresh versus frozen samples. The Centre for Digestive Diseases in Sydney, Australia, also performs the majority of their FMT procedures with standardized frozen and fresh donor fecal samples that are anonymous. (21)
Are Fecal Transplants New?
While it’s only become an accepted practice recently in the U.S., the idea of performing a fecal transplant is actually not new at all. Similar practices have been done for hundreds of years, going back to 4th century China where these techniques were known as “yellow soup.”
In many areas around the world, it’s also been a customary practice to give newborn babies a small amount of their mother’s fecal matter in order to boost the baby’s immune system by populating its gut with healthy living bacteria. FMTs have also been used with animals for many years as part of veterinary medicine.
Few people are aware that fecal transplants have actually been performed either by doctors or by patients themselves in the U.S since the 1950s. FMTs have increased in popularity over the past decade or so, especially with more research coming out that shows their proven benefits, but they still have a small following. That’s beginning to change now.
Read Next: Poop — What’s Normal and What’s Not?