Ready for Your Fecal Transplant?

The fairest thing in nature, a flower, still has its roots in earth and manure. —D. H. Lawrence

Yes, fecal transplants are a thing. And they are just as cringeworthy as you might imagine. But to someone dying of a miserable Clostridia difficile (C. diff) infection, there is rarely any flinching. That’s because fecal transplants are over 95% effective against C. diff, which is a pretty remarkable success rate for a portion of poop. Anyone looking at that cure rate is bound to marvel, What the heck is in feces that can so easily kill us or save us?

Your colon is host to trillions of microbes.

Source: ChrisChrisW/iStock

The answer: microbes, or more precisely, the collection of microbes called the microbiota. These creatures include bacteria, viruses, fungi, and protozoans. Before we realized that some of them were on our side, we called them germs and proceeded to kill them any way we could. Actually, we still do.

But they are mostly good guys, little bugs that were recruited by our ancestors and – incredibly – passed down to their children. Through the millennia, they have proven their mettle and are on the front lines when pathogens attack. They will starve, maim and kill invaders before your immune system is even aware of them. These beneficial microbes are not a luxury. We literally could not live without them.

A birthday gift

Amazingly, we typically inherit our microbiota from our mother. There are several points of engagement for this handoff, starting at birth where we pick up motherly microbes in the birth canal. If you were born by c-section, you likely missed this early opportunity. But later, mother’s milk provides beneficial bacteria to digest milk and to kill bad guys. Your mom goes to a lot of trouble to pass on her own set of gut bacteria, because if you get your microbiota off-the-rack it may never really fit you.

When you are around a thousand days old, your microbiota gets locked-in and it can be hard to dislodge. Your microbiota is a baroque, interrelated ecosystem with each microbe enjoying a cozy relationship with everyone else in its neighborhood. It can be quite stable, and interlopers are dealt with severely. That means that no matter how many probiotics you eat, they are unlikely to take up permanent residence – which explains why you need to take probiotics on a regular basis. They can do much good, but mostly in passing.

Your microbiota acts like an organ

If we’re talking about simply putting someone’s poop into your colon, what’s the big deal? Can’t you do it yourself at home? The short answer is no. That three-pound pulsating bolus of microbes in your gut acts as a kind of endocrine organ, ready at a moment’s notice to produce a raft of hormones, neurotransmitters, and immune signals. In that sense, a fecal transplant is a type of organ transplant, only with less dignity. You would not do an organ transplant in your bathroom, nor should you attempt a DIY fecal transplant.

In order to make a fecal transplant work, you need to decimate the existing microbiota with laxatives. Then the microbes of the carefully vetted donor doo can settle into their freshly scoured digs with little resistance. The researchers call it repoopulation. Patients suffering from C. diff infections typically get relief in days or even hours.

But something else can happen as well. The patients sometimes take on attributes of the donor. Some patients have reportedly been cured of long-term depression. There are anecdotes of people becoming fat or thin, mirroring their donor. And now that we know that, where can we sign up?

Who came up with this idea?

Surprisingly, fecal transplants are not a new phenomenon. Ge Hong, a 4th-century Chinese doctor, prescribed fermented feces to treat diarrhea. Yes, fermented; apparently the fresh stuff didn’t have enough piquancy. He called his concoction yellow soup and as enticing as that sounds, it didn’t really catch on. Today we are a little more sophisticated and use an enema or colonoscope to inject the soup from the other end, which is better targeting.

Of course, you may not like the idea of receiving a yellow-soup enema. No worries. There is an alternative oral formulation popularly called crapsules. Not everyone agrees that the oral route is a big improvement, ick-wise, but at least you have a choice.

Why would you get a transplant?

As noted at the top of this article, people with C. diff infections are only too glad to get a fecal transplant. After all, their life is in the balance. But as the hype spreads, many have suggested that a poop transplant is just the ticket for a wide range of ailments. One study suggests that the success rate and safety for treating C. diff could open the door to treating Parkinson’s disease, fibromyalgia, chronic fatigue syndrome, multiple sclerosis, obesity, insulin resistance, metabolic syndrome, depression, and autism.

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Not everyone is so enthused. In 2019, there was a death recorded after a transplant, blamed on an unnoticed pathogen in the sample. Given the hundreds of thousands of fecal transplants that have been performed, that is not statistically worrisome, but it points to the real problem of proving that donor droppings are safe. Given that feces are generally not pristine, that creates a headache for companies that manage poop banks. Yes, that’s also a thing.

Not only do you have to show that the sample is pathogen-free, you have to hope that the mix is appropriate for the patient. There are so many variables, it makes the head spin. Genetics, environment, diet, and antibiotic use all play a role in the success of a transplant. Still, the stunning success of transplants for C. diff patients across the board indicates that some amount of flexibility is built in.

As we hinted earlier, research has turned up another use: controlling depression and anxiety. Studies by John Cryan and Ted Dinan, two prolific researchers from University College Cork in Ireland, have found that transplanting poop from a depressed person to a rat makes the rat depressed as well. They call it transferring the blues. That represents an astonishing breakthrough in psychiatry: a reliable method of inducing depression, simply via microbes. The important takeaway here is that we should probably vet poop donors for mental health, not just physical health.

Also of interest, research by Pierre-Marie Lledo has shown that fecal transplants of poop from old mice to young mice makes them act old, with reduced neuron growth and impaired memory. The same results occur with poop from old humans, too. Conversely, in a mouse model of premature aging, fecal transplants from young mice helped the aging recipients to live longer.

If all this is true (clinical trials are ongoing) then happy young lean people will become prime poop producers, the maestros of manure – and command a pretty penny for their productions. They will be pursued by the pooparazzi. It should be obvious that your author has enjoyed the squirminess of this topic. In my defense, my microbiota made me do it; I may need a transplant.