After some standard blood work and testing nine samples of his stool, my fiancee was dubbed safe–HIV and parasite free, that is–to be a donor.
With a smile on his face, he blended up his beet-tinted bowel movement in our now retired blender, filtered out the solids through a strainer, and left the liquid on the counter for me to insert into my rectum.
My doctor thought I’d be capable of retaining 16, 32, or even up to 64 ounces of fecal slurry for four hours; I luckily had ample practice with water enemas, but lacked the confidence that I could realistically retain 64 ounces of my partner’s feces.
This was the first of three at-home fecal matter transplants, also known as FMT, or officially as Fecal Microbiota Transplants.
What the heck is a Fecal Matter Transplant?
Back in 2012, the FDA classified poop as a drug, approving its medically supervised use in transplants for those with C. difficile (C. diff), a nasty infection characterized by bloody diarrhea, severe cramping, and sometimes resulting in removal of the colon or death due to digestive complications.
The standard approach is to attack C. diff with antibiotics. Often times, treatments are ineffective, leaving the patient with even less microbial diversity and even more severe symptoms. By introducing the full range of bacteria from a healthy donor’s colon in a FMT, the desirable strains can start to recolonize the injured gut following antibiotics, or even in place of antibiotics. Some patients swallow capsules made from the donor’s stool, which are designed to survive beyond the acidic environment of the intestines. Others are sedated as they receive implants all along their colon. With time, and sometimes requiring up to 10 implants, the donated microbiome can crowd out the bad bacteria and restore diversity to the antibiotic-ravaged terrain.
Several studies show that FMTs might even be more effective than antibiotics, with an 87-90% cure rate, contrasting starkly to the 31% cure rate of traditional approaches.
Beyond digestive distress, the growing research continues to demonstrate remarkable links between the microbiome and the brain, especially in terms of mood regulation and behavior. For instance, if you hold a mouse by its tail, a healthy critter wriggles and squirms as it attempts to escape the unfortunate situation.
Not the case when these mice are given a fecal transplant from a donor with major depressive disorder: the mice give up, hanging motionless.
Similarly, researchers studied mice with a genetic mutation that caused them to eat a lot and put on weight. They introduced the stool of these curvy mice into the colons of mice that had been raised germ-free–or, entirely without gut microbiomes–since birth.
After receiving their transplant, the previously germ-free mice got hungry and put on extra weight, as well.
In both human and mouse studies, mounting evidence indicates that FMT can improve conditions as diverse as chrohns, ulcerative colitis, IBD, obesity, mood disorders, and even alopecia, autism and alzheimers. These wide ranging effects emphasize the profound ability of the microbiome to impact the body far beyond the gut: a healthy gut is necessary for a healthy you.
We still don’t fully grasp how our microbiomes impact us, but it is clear that diversity and specific strains of bacteria are conducive to health, while a lack of diversity (such as is the case following antibiotics) and an overgrowth of undesirable strains can contribute to disease and dysfunction. We are finding that not only do gut microbes help with digestion and absorption, they regulate our moods via the production of neurotransmitters that interact with receptors and nerves in our guts, as well as through our bloodstream to send direct signals and commands to our brain. These neurotransmitters even influence gut motility, as serotonin helps dictate the sweeping action of the intestines responsible for moving waste out of our system.
Why We Did it at Home
Unfortunately, without the diagnosis of C.diff and therefore lacking FDA approval, patients with tricky gut disorders are flying across oceans to FMT clinics in Mexico, Vancouver and Australia. In my case, we chose to do it hill-billy style right at home, with directions and full support from my GI doc.
I was hopeful that my partner’s poop–and therefore, his balanced profile of bacterial strains–could restore the significant damage I had unknowingly afflicted to my microbiota.
After years of medications, inflammatory diets, several rounds of long-term antibiotics, and two recent infusions of antibiotics during hyperthermia-based Lyme treatments, I crossed my fingers that a fecal transplant could repopulate my gut. I imagined the good guys swarming in like a miniature army and battling the bad bugs on my behalf, later building bustling cities within the folds of my intestines, rich with activity and aliveness. I dreamed about these cities restoring my digestive ability, motility, and even balancing my moods, as the research suggested could be possible.
My doctor noted that with idiopathic constipation and SIBO (small intestinal bacterial overgrowth), FMTs had about a 1 in 4 chance of working. While nothing else seemed to work, a 25% chance of success seemed pretty darn wonderful to my weary spirit.
Everything I’d learned about the microbiome’s impact on health confirmed the possibility that with the right poop, my health could and likely would turn around. My family agreed, my mom and aunts eager to help out in any way. My mom even considered becoming a donor, but we didn’t know how to realistically ship her stool from Massachusetts to California. Even a good friend offered to help out, donating her child’s feces. She raised her child with ample opportunity to play, love, experiment, on an organic diet, eagerly offering to Uber (after testing, of course) her potentially perfect 9 year-old son’s poop across town when I was ready.
We opted to try David’s stool first. (It felt a little cruel to put the little one through the pain of blood tests. It also took the burden off of us of having to figure out the logistics of sending a child’s poop across town in an Uber)
As we prepped for the procedure, I noticed how the whole idea of my partners poop saving my life felt borderline romantic: an atypical act of love. I liked the idea of having the microbiome of the man I love potentially fixing my most nagging health concerns.
Leading up to the first FMT, we started curating my partners biome and starving out my own. I made sure to feed my partner the most diverse range of fibers, prebiotics, and probiotics I could procure, everything from purple sweet potatoes, cauliflower, jicama, sauerkraut, and goat kefir. He even gave up beer, gluten, and sugar, with the hope of nourishing the good guys to the utmost of our ability. To increase the likelihood of his microbiome setting their roots in my colon, I stuck to a low-fiber diet, intending to starve out some of my own critters. I’m not certain this approach had an effect, as research shows that gut bacteria go into dormancy when their food source is removed. Or, they start feeding off of the mucosal lining. But, I also trust that everything amounts to something, and we never know exactly what makes the difference in hindsight.
After inserting the first FMT, I felt a little queasy. I wasn’t sure if the smell triggered the nausea, which to my dismay, was not blocked by the burning of pinon or the lavender in my diffuser. I managed to hold it in the rest of the day, and even went to bed without any urge to release, which is likely the one and only benefit of gut paralysis.
Each week, we repeated the procedure, planning to hit the magic number of 10 that my doctor recommended. I felt determined and hopeful. With each blending, filtering, and transplant, I kept wondering what it would feel like to wake up and not instantly have my awareness scan to the pain in my gut. To wake up, and get on with the day, to digest, to process food, to assimilate some nutrients, and to finally break free from a mode of living characterized by pure survival, panic, and a deep sense of doom.
By FMT number three, we decided to postpone.
I was growing too weak and the simple procedure exhausted the emotional and physical reserves I clung so dearly to. I thought that by holding off and focusing on more joyful things throughout my day, my gusto and determination to fire up the blender would return.
The blender, strainer, and disinfectant still stare at me from the shelf every time I use the bathroom. We haven’t attempted a transplant since April, and haven’t needed to, as the terrain of my gut drastically improved by jumping on the meat bandwagon. We keep the tools ready to go, just in case, letting the bacterial journey unfold as it will.
Disclaimer: The information contained in this blog should not be used to treat or diagnose disease or health problems and is provided for your edification and delight only.