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Medicine’s Dirty Secret: Would you have a faecal transplant?

I first heard about faecal transplant and my initial reaction, probably like everybody else, was of disgust. It completely goes against everything we think of as healthcare and treatment, when the more surgically clean something is the better. This is especially with my already existing disgust with users of public restrooms who don’t wash their hands and then use the same door handle I’m meant to touch in order to escape the environment; or the sneezers and coughers out there who don’t use tissues (or at least their elbow – a much better place to cough into than your hand or sleeve).

Faecal transplant (either as an enema, through a colonoscopy or in capsule form) wasn’t particularly appetising. And to top it all off, it would be someone’s else’s poop (not that your own would be any better).

However there are lots of emerging research and old, long-obscured evidence (this was even first recorded in fourth-century China) that faecal transplant is a viable therapy for those suffering from debilitating autoimmune diseases or infections that are winning against antibiotics.

In his recent fascinating article about the therapy, Bryn Nelson writes:

With the last lines of antibiotic defence beginning to crumble, however, getting past the cognitive dissonance of healthy poo as powerful curative could be a matter of life or death for tens of thousands of patients.

The main reason is due to the amazing gut flora, an ecosystem that has been linked to a varied number of conditions from obesity to mental health. Consisting of an ecosystem of good and bad bacteria, it is constantly changing due to influences from your diet, antibiotics and other environmental factors. Your gut health is a huge market: think of all the prebiotics and probiotics.

Antibiotics by nature are very indiscriminating in its total wipe-out of bacteria, good or bad. The idea behind faecal transplant is that by using faeces from a healthy, pre-screened volunteer, specialists can “repopulate” the gut flora. Anecdotal results have seen patients recover from serious illness within hours.

The article explains:

Poo is a decidedly imperfect delivery vehicle for a medical therapy. It’s messy. It stinks. It’s inconsistent, not to mention a regulatory nightmare. But it can be incredibly potent. A classic study of nine healthy British volunteers found that bacteria accounted for more than half of the mass of their faecal solids. That astonishing concentration of microorganisms, both living and dead, makes sense when you consider that the microbial colonists inhabiting our gastrointestinal tract outnumber our own cells roughly three to one, on recent estimates.

In the ideal conditions of the human gut, a thriving ecosystem of 1,000 or more bacterial species that rivals the complexity of a rainforest has co-evolved with us. This microscopic jungle is constantly adapting in response to our diet, antibiotic use and other environmental influences. As the science has progressed, researchers are now comparing the entire collection of microbial inhabitants of the human gut, our microbiome, to a “hidden metabolic organ”. Scientists have linked disruptions to this organ, a condition known as dysbiosis, to everything from inflammatory bowel disease and high blood pressure to diabetes and obesity.

Viewed in this light, a faecal microbiota transplant is nothing more than an attempt to reseed an intestinal tract, often after antibiotics have killed off the native flora that might have kept invasive species at bay. No other medical therapy can claim such a high cure rate for the infection widely known as C. diff.[Clostridium difficile]


Image: Flickr, QThomas Bower

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