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Fecal Transplants and the Promise of Therapeutic Poo

Be a hero by giving a crap!

This is the strange story of poop, pot-bellies and parkinson's. Where crazy ideas and random luck meet to give us something wonderful.

It started several hundred years ago in China. Healers gave people with diarrhea a "yellow soup." It was essentially a mixture of fecal matter and water. There are no records of its effectiveness, but the concept of swapping out a person's poop to cure them was intriguing enough for a team of surgeons to look into.

In 1958, Eisemann and his colleagues gave four critically ill patients fecal enemas. Those patients were diagnosed with fulminant pseudomembranous colitis. Doctors didn't know that C. difficile was what caused the problem, but after getting the procedure, the patients quickly recovered. It was a miraculous cure. Unfortunately it involved transplanting something polite society doesn't like to talk about. So doctors, hospitals and insurance companies focused their attention on antibiotics to treat the problem and fecal transplants were ignored.

Fast forward 40 years. America has seen a dramatic increase in the number of deaths related to C. difficile. In 1999 it was 5.7 deaths per million people in the United States, or approximately 1,556 lives cut short. That number continued to grow at a staggering rate of over 34% a year, until 2004 when it killed an estimated 6,958 people. At the same time, a stronger, more antibiotic resistant form of C. difficile began to emerge, so doctors started looking into alternatives.

Fecal transplants were the answer. In several studies, patients who got stool transplants saw a 90% cure rate. Incredibly, those studies were conducted on people who had severe cases of C. difficile colonization where antibiotics didn't work!

Fecal Transplants Work for C.Difficile

A study published in the New England Journal of Medicine in 2013, showed patients who received fecal transplants had a 94% cure rate from pseudomembranous colitis caused by C. difficile. The unfortunate subjects who were treated with the antibiotic vancomycin had only a 31% cure rate. The differences were so vast, the study was stopped early so that all patients could be offered the fecal transplant option.

But things have only gotten stranger.

In May of 2008, Dr. Thomas Borody was experimenting with fecal transplantation, and some of his patients also happened to have Parkinson's. After the transplants, his Parkinson's patients experienced a significant reduction in symptoms, with some decreasing so much that their Parkinson's could no longer be detected by other neurologists.

 

Doctors have now started looking into fecal transplants for autoimmune disorders, diabetes, multiple sclerosis, metabolic syndrome and obesity. We know the gut microbiome plays a significant role in keeping us healthy, now we have to learn how to separate the good stuff from the bad.

As much of a health problem as C. difficile is, it pales in comparison to obesity. It's hard to pin down an exact number because it's growing so fast, but in 2003 the United States Surgeon General said, "This year, more than 300,000 Americans will die from illnesses related to overweight and obesity." Since then, our nation has gotten fatter.

To try and combat the problem, some of the research in fecal transplantation has been focused on taking stool samples from normal weight people and giving it to obese patients. Early results on mice are encouraging, but human trials haven't been panning out. Significant weight loss just doesn't seem to happen without some fundamental change in the quality, and quantity, of the food people eat.

What Works

So what do we know? Fecal transplants have proven to be an EXTREMELY effective treatment for people with C. difficile. If that's what you have, it can be a lifesaver.

What's Unknown - Be Warned

The success rate for fecal transplantation and other medical problems, like parkinson's, diabetes or obesity is extremely limited and in some cases, shows no benefit. You can seek out clinical trials, but you'll be a guinea pig.

If obesity is your problem, tackle it the old-fashioned way. Eat a healthy diet, move some weights and do cardio. It's the only long-term sustainable plan.

UPDATE:

In the October 22, 2014 issue of Nature, researchers reported that a friendly bacterium called C. scindens fought the harmful bacterium C. difficile. Just having C. scindens in your gut seems to be able to protect one from C. difficile infection. Researchers will have to spend time confirming that it works and clinical trials, but it's a promising bit of information for sufferers of the C. difficile infection and may point to a treatment in the future.

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6/29/2014
Update: 12/17/2014