Oct 282011
 

One of my favorite topics at the moment is the human microbiome. That’s the part of us that’s not human. Back in May, I wrote a post about it:

A human body has about 10 trillion cells in it. And that very same human body (yours, for example), is also home to 100 trillion bacteria. Your mouth, your nose, your armpits, your navel, your skin and especially your gut are teeming with thousands of different species of bacteria. If you could separate out all those bacteria from the rest of you, they’d weigh 2 kilos.”

I was suggesting (only partially in jest) that we’re actually being crowdsourced by a superior form of collective intelligence. Just last month, I wrote another post about how the gut microbiome plays an important role in mental health.

I was wrong on one count. I mentioned a study that had found that excessive use of antibiotics can permanently damage your gut flora. It turns out there’s hope after all. Here’s the story:

Antibiotic overuse can allow a particularly nasty (and appropriately named) microbe, Clostridium difficile, to set up shop in the gut. This critter makes you really miserable – recurrent bouts of  severe diarrhea, abdominal pain, nausea and vomiting. It stubbornly resists treatment – well, most treatments. There is one that works.

A fecal transplant.

It turns out that the gut flora from a healthy human donor can outcompete C. difficile, restoring gut health in no time flat. (Ce n’est pas si difficile…)

And where can this gut flora be found? Right. Someone else’s poop. Wait. Don’t go away. Bear with me for a minute, this is really interesting stuff (this is a picture of some E. coli, magnified 10,000 times, originally from the USDA).

 

gut bacteria

Dave brought it up this morning in our regular chat.

Dave: Apparently it works.

Me: works for what?

Dave: (sends a link) It cures gut infections caused by antibiotic therapy.  Gives new life to the phrase “eat shit”

Me: I see. repopulating the gut microbiome. I can write about that.

Dave: That’s why I instantly thought of you when I read about it. (That’s my story and I’m sticking to it)

Yes, indeed. The article he sent me describes the case of 75-year-old Pat Shoop, who had a nasty C. difficile  infection. Her husband valiantly offered to provide a batch of bacteria from his own, healthy gut.

… Bob was under pressure to produce a usable stool sample within 15 minutes of her scheduled appointment. [...] He complied and the pair rushed to the clinic, where Dr. Rubin snaked a tube through Shoop’s nose and into her stomach. “It was 20 minutes,” she said. “He told me, ‘You’re not going to taste it, you’re not going to smell it.’”

Apart from the obvious question of what constitutes “usable” – consistency? size? – one wonders why Bob had to be under so much pressure. Couldn’t he just refrigerate his offering? Another thing not mentioned in the article was exactly how the sample was prepared. I had to go elsewhere to find that information:

An article in the Scientist describes how Australian gastroenterologist Thomas Borody did his first transplant (in the mid-1980s) :

…He collected stool from the woman’s brother, and after screening it for known pathogens, he stuck it in a blender, added some brine, and filtered it to get rid of any undigested material. The stool, now turned into slush, was administered to the patient — who had her gastrointestinal tract previously flushed — via two enemas over the course of two days.

In only days, the patient was cured. Her colitis never returned.

In fact, a recent study shows that fecal transplants (which often go under the more palatable monikers of fecal bacteriotherapy, intestinal microbiota transplantation or human probiotic infusion) successfully cure more than 90% of intractable C. difficile cases and many other cases of irritable bowel disease (IBD) and ulcerative colitis. The transplant is administered either via enema, or, as in Pat Shoop’s case, via a nasogastric tube.

Borody oversees 5-6 fecal transplants a week, mostly for patients with IBD. It’s catching on in the US, as well:

Currently, while most fecal transplants in the U.S. are performed exclusively to treat C. difficile, a growing list of doctors, [...] are beginning to expand to other gut disorders such as inflammatory bowel diseases. Because stool is not yet a marketable biologic product, the procedure is not federally regulated.”

Note the use of the word “yet” in that last sentence. I sense an entrepreneurial opportunity here. If I weren’t so damn busy translating…

It’s considered a treatment of “last resort,” which is also a bit odd, seeing as it has been used in veterinary practice for ages to calm the bellies of ruminants. In fact, come to think of it, don’t animals regularly partake? Could it be they know something we don’t?

Lest you be tempted to get out the blender and take matters into your own hands, be aware that this is a job for professionals only. The wikipedia page on fecal bacteriotherapy says that “The best choice for donor is a close relative who has been tested for a wide array of bacterial and parasitic agents.The enemas are prepared and administered in a hospital environment to ensure all necessary precautions.” 

The page goes on to describe a new “safer, more effective, and easier to administer” form of fecal bacteriotherapy that’s being developed, which requires the patient to keep a refrigerated sample on hand. In the event that he/she develops a C difficile infection, the sample is extracted with saline, filtered, freeze dried and put into capsules. The patient can then repopulate her gut with her own microbiome just by popping a pill! Now that’s a win-win.

One obvious question arises, however: How many of us are paranoid enough to prepare ahead for a C. difficile infection?  

And another, given the current lack of federal regulation:  What’s the refrigerator shelf-life of a shit sample? 

You might be wondering what all this has to do with mental health.

In January 2011, an article appeared in NewScientist magazine, which you can’t read unless you have a subscription :( , telling the story of an elderly Parkinson’s patient who came to her doctor with a horrible case of constipation and an infected colon. I think the doctor treated her with a fecal transplant from her son, but I don’t know for sure, since I’m not a subscriber. Anyhow, rumor has it her Parkinson’s symptoms miraculously disappeared along with her gut infection.

What I do know is that Borody is currently doing a clinical trial on 18 Parkinson’s patients using C. difficile antibiotics. It will be very interesting to see what happens. Could it really be as straightforward as swapping out our shit? Like I said in my earlier post, maybe it’s time we paid more attention to all those freeloaders in our bellies.

  3 Responses to “What’s the poop?”

  1. C’est difficile, C. difficile!
    Sh– + Poop = Shoop
    Shoop made into pills to pop is music to my ears (Shoo-pop shoo-pop!) but I think the other methods would be hard to swallow.

  2. Awesome, Mary. You have the best taste in topics. Who fed you this one? HAHA!

  3. I wonder how many time’s it’ll happen that I spend an afternoon studying a boring subject, and in the evening I’ll read your blog, and say “oh, wait a sec, if you put it the right way, microbiology is really interesting!”

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