Fecal microbiota transplants (FMTs) have become increasingly popular to cure diarrheal infections, including Clostridium difficile (C-diff). Unfortunately, after the media carried encouraging research results, many began following advice given on YouTube channels to do their own fecal transplants.
Although a fairly common medical practice, performing your own transplant exposes you to a range of bacteria that may do more harm than good. Donor feces obtained from medical facilities are first screened and tested for microbes having previously been associated with health conditions such as Parkinson's and multiple sclerosis, before being used in transplant procedures. 1
Physicians have reported patients experiencing sudden weight gain or new bowel diseases after fecal transplants. Even those who appear to be in robust health may silently carry harmful bacteria they can pass to others.
Fecal transplants have become a standard of care for those suffering repeated infections with C-diff and physicians can now prescribe freeze-dried donor stool in capsule form that their patients can swallow. 2
A new study published in Frontiers in Cellular and Infection Microbiology 3 supports the theory that some fecal donors have gut bacteria that increases the success rate in treating disease over the average donor. Called "super donors," the study finds results of clinical remission may double with super donor stool compared to stool from the average donor.
Fecal Transplants From Super Donors Increase Success Rates
Since Alzheimer's, multiple sclerosis , asthma, heart disease and certain cancers are associated with changes to gut bacteria, researchers were interested in understanding what makes a fecal super donor. Senior study author Justin O'Sullivan, Ph.D., from the University of Auckland, says: 4
"The last two decades have seen a growing list of medical conditions associated with changes in the microbiome — bacteria, viruses and fungi, especially in the gut.
In fact, we know already that changes to the gut microbiome can contribute to disease, based on studies in germ-free mice as well as clinical improvement in human patients following restoration of the gut microbiome by transplanting stool from a healthy donor."
The efficacy of FMT in treating chronic diseases has been modest, with scientists and doctors finding high variability in patient responses. Some studies have pointed to the microbial diversity and composition of the donor, believing this increases the potential of a super donor.
In this new study, the researchers reviewed evidence and explored the idea that keystone bacterial species may be predictors of FMT success. O'Sullivan and the team analyzed more than 100 fecal transplant trials, finding evidence that not only do super donors exist, but data that could potentially explain why. 5
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In the small percentage who outperformed others, the donors had a high diversity of microbiota. These results may be significant in helping to identify how human gut microbiology influences disease to develop screening for FMT donors.
Today, the overall cure rate for recurrent diarrhea infections exceeds 90 percent. However, FMT for other conditions has an average success rate of only 20 percent. 6 O'Sullivan believes the pattern of success actually demonstrates the existence of super donors, where clinical remission rates may double over those of the average donor.
One Stool Doesn't Fit All Conditions
Researchers have also found the balance of other bacteria present in the stool sample, and the interactions between them, influence the retention of species needed to treat specific conditions. 7 By digging deeper, researchers discovered not only do the species of bacteria matter, but also what's present around the bacteria, such as viruses and other debris.
Ultimately, the team acknowledges the bacterial diversity of super donors may not fully account for successful transplantation, as some failures could be attributed to the recipient's immune response to the transplanted microbes, potentially stemming from underlying genetic differences. 8
Compatibility between the donor and recipient, in which bacterial species and strains are present in the recipients' gut before transplant, are also important in predicting success.
O'Sullivan believes supporting the transplanted microbiome through diet is important to improving the success rate, as it has been shown a rapid change in diet can alter the composition of your gut microbiota within 24 hours. 9 The researchers concluded that while super donors may be identified as those whose donations have a higher potential for success, there is no "one stool fits all."
The authors believe FMT will require a personalized approach with better matching between recipients and donors to improve transplant success. Through improved matching, the procedure may also have a higher rate of success for other diseases, such as asthma. Robert Knight, Ph.D., expert on human microbiome from UC San Diego, who was not involved in the study, commented: 10
"Strategies to find super-donors whose stool is especially effective as a curative are still in their infancy, although progress on this topic — or making synthetic super-donors from the stool of many people — could greatly improve application of [fecal transplants]."
FMT Helps Re-Establish Bacteria Wiped Out by Chemotherapy
Your gut microbiome exists in a dynamic balance between external and internal stimuli. Anything impacting the balance, such as chemotherapy and antibiotics, can severely change your gut microbiota. Chemotherapy-induced cognitive impairment and mucositis are common side effects of chemotherapy treatment for cancer. 11
Two studies from Memorial Sloan-Kettering investigated how gut microbiome influences the outcome for patients undergoing stem cell transplants. The data revealed changes in the balance of bacteria affect the patient receiving a treatment for blood cancers, such as leukemia and lymphoma, making them temporarily more susceptible to infection.
Antibiotics used to prevent or treat some infections following the transplant also create an opportunity for harmful antibiotic-resistant bacteria to grow abundantly in the gastrointestinal tract. Researchers found a diversity of bacteria can substantially drop with the administration of chemotherapy and antibiotics, increasing the likelihood infections in the bloodstream. 12
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A second study demonstrated graft-versus-host disease is also affected by the balance of microbiota and the gut. 13 The goal of a recent study published in Scientific Reports 14 was to assess the efficacy of FMT to reverse antibiotic and chemotherapy-induced dysbiosis in an animal model.
Ampicillin was administered to mice causing a significant and immediate decrease in bacterial species richness and diversity, persisting for one week. However, in the mice receiving FMT, the disruption was reversed immediately.
The mice who received FMT demonstrated significant increase in bacterial species known to have anti-inflammatory properties. While chemotherapy led to a critical decrease in beneficial bacteria, FMT appeared to mitigate these effects.
Stool Donation Not as Simple as It Sounds
If you're considering donating stool, it may not be as simple as it sounds. OpenBiome is a Boston-based company aimed at expanding the safety and access to FMT. They actively recruit stool donors and pay up to $40 per donation, but carefully screen applicants.
The company claims an 85 percent success rate for treatment for C-diff using their FMT. In order to donate, individuals must be from the Boston area and pass a series of rigorous screenings. 15 Applicants must be between 18 and 50 years old during their donation period, go through a clinical in-person health assessment and two rounds of blood and stool testing.
After this rigorous screening, only 3 percent of applicants are accepted. The nonprofit's clinical program director states this is because most of the chosen stool will eventually end up treating a recipient and if not carefully screened the recipient could wind up with a number of medical conditions. 16
Donors who have taken antibiotics , traveled anywhere deemed risky, or if their body mass index or alcohol intake is too high, are not accepted. Once they pass the initial questionnaire, a clinician asks up to 200 more questions on other topics such as a history of depression, anxiety, allergies and asthma, some of the other common reasons a donor may be ruled out. 17
Once accepted, donors can provide samples three times a week for a period of 60 days, earning approximately $40 for each donation. At the end of 60 days, if they wish to continue providing donations, they must go through the screening process again. 18
Protect and Improve Your Gut Microbiome Using These Simple Steps
Hippocrates once said "all disease begins in the gut," and the more we learn, the more accurate that statement becomes. With research and study, scientists now understand your gut plays a crucial role in many health and disease processes, and actually acts as your body's second brain.
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The diversity of your gut is established as an infant and affected by genetics, whether you're breast or bottle-fed and your immediate environment. As you age, it is continually affected by your food choices and medications. Diets high in sugar and processed foods reduce the variety and have a negative impact on your overall health.
Taking care of your gut not only may help prevent disease, but also may help you achieve your goals in weight loss, fitness and overall health and wellness. The consequences of a poorly developed microbiome may affect your mood, emotions, allergies and anxiety. 19
Consider these strategies to improve your gut microbiome and affect recovery should you have to take antibiotics.
• Eat more fermented foods — This is one of the easiest, most effective and least expensive ways to make a significant impact on your gut microbiome. Fermentation, especially when using a starter culture, ensures you end up with a high-quality product with high levels of healthy bacteria and beneficial enzymes, including short-chain fatty acids that support healthy immune function.
Get enough sleep. Make a special effort to get enough sleep and to sleep well on a regular basis. Sleep impacts energy levels, ability to make good decisions and to put your best face forward — all of which can impact self-confidence and more.
• Take probiotics and prebiotics — Probiotics increase the diversity of your microbiome, while prebiotics feed beneficial bacteria, helping them to grow and thrive. Beneficial bacteria require high levels of fiber found in a variety of fruits and vegetables. 20
If you starve your gut microbiome of fiber, some die off and others switch their source of nutrients to the mucus lining your gut. 21 High-fiber diets help reduce your risk of premature death from all causes, 22 but in order to work the fiber must be unprocessed. 23 Processed supplement fiber such as inulin powder does not provide your gut bacteria what they need.
It's far better to use a supplement processed from Jerusalem artichokes where inulin is extracted. Organic whole husk psyllium is another great source, as are sunflower sprouts and fermented vegetables, the latter of which also supply beneficial bacteria.
• Avoid antibiotics — Before antibiotics, the average life expectancy was 47 years and most died from communicable diseases. Today the leading causes of death are noncommunicable, but antibiotics are triggering other health conditions. Although useful in severe infections, they also damage bacterial colonies in your gut, which may increase your risk for a number of different ailments and diseases.
If it is essential to take antibiotics, sporebiotics may be able to re-establish your gut microbiome more effectively than regular probiotics when taken in conjunction with antibiotics, as they do not contain any live strains, only spores.
• Avoid processed foods — Processed foods are high in sugar and grains and low in fiber. I believe you need 50 grams of fiber for every 1,000 calories consumed each day, as fiber feeds your good bacteria and strengthens your gut health.
Sugar is the preferred fuel for harmful bacteria, so it's important to reduce your net carbohydrate intake and eliminate processed foods and white sugar.
• Optimize your vitamin D — Optimizing your vitamin D level to 60 to 80 ng/mL is another simple yet effective means of improving your gut microbiome and reducing metabolic syndrome. Vitamin D deficiency is associated with the development of certain cancers, infections, cardiovascular disease and dysbiosis. 24 In one study, researchers discovered metabolic syndrome in mice improved when supplemented with vitamin D. 25
An insufficient amount of vitamin D aggravated the imbalance in the gut microbiota. This finding confirms vitamin D deficiency hinders the production of antimicrobial molecules your body uses to maintain the integrity of gut bacteria. 26