YOU ARE WHAT YOU HOST: ARE FECAL TRANSPLANTS THE WAY OF THE FUTURE FOR GUT HEALTH?
According to a new study presented by Dr. El-Salhy at the United European Gastroenterology week in Spain, fecal microbial transplants (FMT) may significantly improve the pain and distress caused by irritable bowel syndrome, if transplants come from what has been termed a 'super-donor'. The double-blind, randomized control trial study found that 75-89% of recruits aged 18-75 receiving 30-60 g of endoscope-administered feces into the duodenum donated the same day from a human 'super donor' reported significant benefits in their overall IBS symptoms after 3 months, with no long term adverse effects (1). Slightly greater benefits were observed in the patients receiving higher dose transplants and/or repeat transplants (2). Furthermore, Dr. El-Salhy suggested that preliminary results show 90-95% of the patient who responded are still well 1 year later, and 50% are 'cured' (3).
While the cause of IBS remains unknown, many researchers suggest a correlation to the plethora of bugs that exist in our gut, also known as our microbiome. Fecal transplants have become of interest since research shows little sustained benefits to the use of oral probiotics for gut repopulation (as confirmed by microbiome testing) (4). Our guts are like fingerprints, and research suggests our digestive tracts are resistant to recolonization with probiotics for this very reason (4). In fact, some research suggests the recovery of our microbiome following antibiotics may actually be impaired by probiotic use, whereas FMTs produce a rapid and complete recovery within a matter of days (5). There's even some research showing FMTs may reduce the occurrence of SIBO in mice (6). Fecal transplants have been so successful in the management of infectious diarrhea, that the Infectious Disease Society of America has updated its guidelines to include fecal microbial transplants as a primary treatment method for the management and prevention of multiple-reoccurrence C. Difficile infections (the most common health-care-associated infection seen in hospitals)(7). What's even more promising is that medium size clinical trials are also demonstrating oral encapsulated fecal transplants do not show inferior outcomes to those delivered by colonoscopy, suggesting oral transplants may be an equally effective and less invasive intervention for treatment-resistant C. Difficle (8,9). The key to success, according to El-Salhy, is the use of donated feces from a 'super host'. The donor in the trial was young, healthy, and active, had been breastfed, had a nutritious diet, took no regular medications, was a nonsmoker and had taken antibiotics only a few times. This naturally poses issues with sourcing donors for a larger-scale therapeutic application of this research, as well as the reproducibility of the study results, knowing no two microbiomes look the same. At this point, fecal microbial transplants are not FDA or Health Canada-approved and are therefore not available to the public as a therapeutic intervention. Furthermore, El-Salhy's evidence is contradictory to numerous other studies conducted on FMTs. A recent meta-analysis (comparing data across multiple trials) shows there was no statistically significant difference in IBS outcomes between patients receiving FMTs and controls (10), concluding further research must be done on the efficacy of fecal transplants before it can be recommended as a therapeutic intervention for microbiome-related gut disorders. To learn more about microbiome testing, supportive diets, and recovery, schedule a consult with Toronto Naturopathic Doctor, Dr. Courtney Holmberg, ND today at 647 351 7828, or by booking online here. References:
https://www.ncbi.nlm.nih.gov/pubmed/29100842
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628324/
https://www.nbcnews.com/health/health-news/fecal-transplants-could-ease-ibs-symptoms-if-they-come-super-n1068646
https://linkinghub.elsevier.com/retrieve/pii/S0092867418311024
https://linkinghub.elsevier.com/retrieve/pii/S0092867418311085
https://www.frontiersin.org/articles/10.3389/fcimb.2019.00348/full
http://www.cidrap.umn.edu/news-perspective/2018/02/new-c-diff-guidelines-incorporate-fecal-transplant
https://jamanetwork.com/journals/jama/fullarticle/2664458
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6081131/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794695/
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