Gut Check

It doesn’t sound pretty — or even very sanitary — but transplanted fecal microbes are gaining popularity as a way to treat digestive tract bugs


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Illustration by James Yang

After years of being largely ignored, the microbes in our gut are receiving lots of attention. That’s largely due to the bacterium Clostridium difficile, antibiotics that can unleash that mighty bug, and a startling remedy that puts a donor’s digestive-track bugs to work.

“There are more bacteria in the intestines than there are human cells in the body,” says Dr. Mitchell S. Cappell, chief of gastroenterology and hepatology at Beaumont Hospital, Royal Oak. “But until recently, we thought they were just there hanging around.”

Doctors now know that many antibiotics can kill the good bacteria normally present in the gut and allow harmful bacteria such as C. difficile to flourish. The harmful bacteria can then cause inflammation in the intestines and lead to severe diarrhea or occasionally even death, Cappell says. 

Now, a way to stop C. difficile that avoids using more antibiotics is gaining popularity: The technical term is “fecal microbiota transplant” (FMT), but are more commonly known as poop transplants. Even though these transplants sound unclinical, if not downright unsanitary, they’re used because they work so well.

The procedure involves taking stool from a healthy person with a good amount of healthy bacteria that keep bad bugs in check and transplanting it into the colon of someone with C. difficile-related diarrhea.

Dr. Mayur Ramesh, infectious diseases specialist at Henry Ford Hospital, has done almost 500 poop transplants — his words to a reporter, although he probably says FMT to other doctors. 

Ramesh says he’s achieved a 90-percent cure rate for C. difficile using the procedure. The transplants have become used across the country.

The treatment isn’t new or unprecedented, Ramesh says. The first FMT was done in the United States in 1958, and it occurs naturally among animals.

“If you just look at nature, if animals don’t feel well, they eat poop,” says Ramesh. Rats, mice, and horses that eat feces get a dose of healthy bacteria as a result, he says.

There are many instances when such a transplant is unnecessary. For example, Dr. Teena Chopra, infectious diseases specialist at Wayne State University, says it’s been proven that people can treat mild cases of diarrhea from antibiotics — not the C. difficile kind — with over-the-counter probiotics, the pills that contain good bacteria. 

But for severe diarrhea, FMT may be the right route. The technique has changed; doctors like Ramesh still do the transplants during a colonoscopy or through a tube. But, recently, most docs have switched to lower-tech enemas. 

Not surprisingly, enemas are the method of choice for DIYers, too.

Physicians are split on people doing the transplants at home, however. It’s a simple enough procedure, but the donor supplying feces should be checked before transplantation by blood or stool tests for blood-borne infections like human immunodeficiency virus, syphilis, and viral hepatitis; bacterial infections that can cause infectious diarrhea such as salmonellosis, cholera, and typhoid fever; and parasites, Cappell says.

Researchers are studying the use of FMTs for other gut ailments, like inflammatory bowel conditions, including ulcerative colitis and Crohn’s disease. Meanwhile, more speculative thinkers say they may be useful for autoimmune diseases such as psoriasis, allergies, and multiple sclerosis, the idea being that their conditions stem at least in part from an out-of-balance gut microbiome, the word for the entire population of bacteria.

“The science is not quite there yet,” says Beaumont’s Cappell. “But it’s an intriguing area.”

Ramesh is intrigued, too: “It’s a newer way of thinking about medicine.”

Scientists are using germ-free mice to investigate. They’ve done transplants on them, using feces from lean and obese humans. The mice that got feces from the obese person gained weight, even though they ate the same amount of food as their counterparts, who stayed svelte. 

That principle might apply between humans, too. In February, doctors reported on a normal-weight woman whose stubborn C. difficile infection was treated in 2011 by an FMT from her overweight daughter. The mother rapidly gained weight and became obese, and she stayed that way despite medically supervised weight loss efforts. 

While it’s possible the daughter’s donor feces led to her mother’s obesity, there are other things that may have contributed, including treatment for another infection. 

Dr. Amer Alame, a colorectal surgeon at St. John Hospital and Oakwood Hospital in Dearborn, says there are things everyone should always do to make sure good bacteria not only keep bad bacteria like C. difficile in line, but also help us get the nutrients out of our food as it’s digested. To avoid gut disorders, he advises, decrease consumption of red meat and don’t smoke or drink alcohol. 

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