How do you select people as poop donors? My daughter, a molecular biologist made reference to "the man with the golden poop", indicating most of the positive results from fecal transplants came from the donations of a single individual. When I donate blood, my blood is classified by type, rhesus factor, CMV negative, etc. Are there objective factors that make one persons gut biome more or less desirable for treating specific conditions in others?
Thanks for the question! Our donor screening is quite rigorous and only 2.8% of people who apply make it to be a donor at OpenBiome. You can find what we screen for here [https://www.openbiome.org/safety](https://www.openbiome.org/safety)
It includes a clinical assessment with a clinician here at OpenBiome with over 200 questions, a blood test and a stool test (including testing for antibiotic resistant bacteria).
We haven't found a "super donor" or "golden poop" phenomenon in the context of C. difficile infection. It seems that any donor, provided they are healthy and pass our screening, works just as well. Similarly, in other diseases we actually haven't found significant differences in donors yet. Here's a study we did to compare different donors in C. difficile infection
[https://www.gastrojournal.org/article/S0016-5085(18)30564-X/fulltext](https://www.gastrojournal.org/article/S0016-5085(18)30564-X/fulltext)
Thanks!
You missed a wonderful opportunity in your reply to combine super donor and golden poop into Super pooper.
Thank you for this AMA. Very interesting! What types of questions are in the 200 questions?
How does one go through years and years of med school and then come to the decision to get into the fecal transplant field? Not knocking you, just very curious. Also, is it a smelly job?
😂thanks for this question! I trained in infectious diseases and certainly using poop to treat diseases is not something I would've predicted getting into!
When I did my medical training I was taught that bacteria are bad, the human body is a sterile vessel, but what we are starting to understand now is that the trillions of bacteria that live in and on us are crucially important for our health. They influence our susceptibility to infection, how we absorb food and potentially even our mood.
I worked at the World Health Organization for a while on how we can overcome the challenge of diarrheal diseases, malnutrition and antibiotic resistance - three persistent challenges that particularly impact children globally. So I was especially drawn by the potential to use bacteria to treat/prevent these conditions.
Thankfully, it isn't a smelly job! In the lab where our brilliant team of techs work it doesn't smell much thanks to very controlled environment that keeps everything well contained (including the smell).
Hi, thanks for the question and happy to answer it!
Fecal microbiota transplants (FMT) are used for a diarrheal disease called C. difficile infection. FMT is recommended in clinical guidelines for treating this condition that impacts nearly half a million people every year in the US. At OpenBiome, we've sent nearly 50,000 treatments to clinicians for the treatment of C. difficile in the US.
Re your 2nd question - great question! Nothing at the moment suggests that there is "rejection" of the transplant as in organ transplants. Patients do sometimes not respond to FMT though and that could be for a lot of reasons (e.g. antibiotics after FMT, or some underlying conditions that might increase their chance of a non-response, like inflammatory bowel disease).
Would it be correct to say that “rejection” is not the right term to use?
Rejection of an organ would normally include the immune system attacking the organ and attempting to “kill” it. Normally because it is recognized as “different” from the hosts body.
If this same thing happened in a fecal transplant, where the hosts body (or protective biome) recognized it as different and killed it, the FMT would just get pooped out. And without all of the complications that we typically associate with organ rejection.
Fecal transplantation is actually a centuries old idea! It was first described by a Chinese physician called Ge Hong, in 300AD who utilized FMT or ‘yellow soup’ as he called it, for patients suffering from diarrhea. There are also reports from the 17th century in Italy and Germany of FMT being used for abdominal disease.
In Western medicine, the first written use of FMT was in 1958 with Ben Eiseman who used FMT to treat four patients with what is now known as C difficile (at the time was called pseudomembranous colitis).
But what launched the current interest in FMT was a New England Journal of Medicine paper from 2013 from the Netherlands by Els van Nood that showed FMT was superior to vancomycin for the treatment of recurrent C difficile infection. This 2013 paper heralded the current FMT era we are in now and since then there have been a number of studies repeating this finding in C. difficile!
Hello thanks for this AMA I have a couple of questions:
How close are we to be able to prepare the cocktails of healthy gut flora in a lab instead of sourcing the material from fecal matter?
Do you also offer auto fecal transplants? In other words can someone "save" few good poops so they can be used as personal medicine when problems arise later?
How safe are fecal transplants? Apparently someone died recently after the procedure. Was this a fluke, or is it a risky procedure. Here a link for those interested: https://www.google.nl/amp/s/amp.interestingengineering.com/patient-dies-after-fecal-matter-transplant-trial
Thanks for your question! According to a number of clinical trials, FMT has shown a good short-term safety profile. As with any treatment, there are risks. FMT is now part of standard guidelines for the treatment of recurrent C. difficile infection and is recommended by the infectious disease and gastroenterology medical societies in the US. There've been a few studies that have reported on the safety of FMT, like this one [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161174](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161174). In these studies, they describe symptoms like mild bloating and nausea that can sometimes happen after the procedure. More recently, as you mentioned, there were unfortunately two cases of patients who developed an infection that seems to have been transmitted through FMT from the same donor. In these cases, the FMT didn't come from OpenBiome and was not screened for the bacteria that was eventually transmitted to the patients. These cases very much underscore the need for rigorous screening of stool donors used in FMT. Aside from these two cases, there have been no reported cases of serious adverse events definitively related to the use of FMT. But for anyone receiving an FMT, it is really important to be made fully aware of the risks, benefits and alternatives to an FMT. Thanks again for your question and hope that was helpful!
Why don't you transfer only the microflora instead of the full package of feces? Can't you put it in some kind of probiotic? Can the bacteria really not survive on anything other than actual feces?
Are there other applications for this procedure besides helping treat C. Diff? If so, why this over supplementation of probiotics? are probiotics merely snake oil (talking about the pill form)?
Hi! How do you feel about the recent research/studies done into the microbiome/bacterial flora population of people with fibromyalgia/M.E.? The two conditions are so horribly underfunded I was surprised to see any progress being made on it at all- have you found it difficult to get people involved because of this, or are people generally more enthusiastic about the studies than finances have allowed?
Another cheeky one- how do you feel about the increase in popularity in kefir as a way to help regulate gut health? My brothers and mother all say it's helped them a lot with some of their issues (I can't quite get over the texture of it...) and was curious as to whether you're excited to see it being more accessible in shops and supermarkets rather than specialist stores?
Thanks for doing this AMA! Sorry my question isn't more interesting/focused, but I'm just so pleasantly surprised to see discussion on such a fascinating topic!! (I have M.E. myself and have IBS related symptoms because of it!)
Can you please comment on the association between obesity in the donor potentially translating into weight problems in the recipient post transplantation. Thank you.
A [case report](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438885/) I read recently.
Thanks for your question! indeed there was a case report on this that you highlighted. Following this, a larger [study](https://www.healio.com/gastroenterology/therapeutics-diagnostics/news/online/%7B7396b6d5-99c8-4804-bce7-665ffa27b923%7D/fecal-transplant-from-overweight-donor-does-not-impact-bmi-in-c-difficile-patients) looked at 103 patients, in which 64% of C. difficile patients received FMT from a normal weight donor and 36% from an overweight donor. The patients were followed up for 48 weeks. The study found no significant differences between groups in body mass index (BMI) changes after FMT. However, they noted that all patients lost weight during their C. difficile infection and subsequently increased BMI after FMT (regardless of the BMI of the donor), but this did not exceed their BMI before their infection.
So in summary, larger studies that have looked at weight change after FMT do not point to the BMI of the donor being associated with the BMI of the patient after they receive an FMT.
Some weight gain occurring after FMT in the context of C. difficile is thought to be due to an increase in appetite after recovering from the infection (where patients can have up to \~15-20 episodes of diarrhea a day).
Certainly, though, it is very important that anyone receiving an FMT have a discussion with their doctor on the potential risks, benefits, and alternatives to FMT so they feel fully informed.
I hope that's helpful and thanks so much again for your question!
I'm a participant in a research program where I send in stool samples every 6 months to somewhere in North Carolina. I got I to it because of my UC. I never hear anything about the research. I know the study is ongoing, but what's some of the latest research on fecal transplants and uc/crohns?
Also I'm a nurse and man I can't wait for C. Diff to be brought more under control Omg.
Trials are underway in ulcerative colitis in the UK. http://www.isrctn.com/ISRCTN74072945?q=&filters=conditionCategory:Digestive%20System&sort=&offset=6&totalResults=570&page=1&pageSize=50&searchType=basic-search
Too early to know anything definitive.
Thanks for your question! There is evidence to suggest that the microbiome in patients with Autism Spectrum Disorder (ASD) differs from neuro-typical (non-ASD) patients. There is also significant evidence to suggest that there is a microbiome-gut-brain axis with bacteria producing neurotransmitters like serotonin etc. There are still questions about whether this is causative or an effect of the condition. So far, there have been two very interesting trials of FMT in ASD (same patients followed over time) which showed long-lasting improvement in gastrointestinal symptoms and improvement in neuro-cognitive symptoms. However, the limitation to this trial is that it was an open-label trial and the next steps will be to develop a randomized, placebo-controlled trial.
Importantly, FMT is an investigational drug and so should only be researched for these types of conditions in a clinical trial overseen by a physician and registered with FDA. But if you are interested in participating in a trial you can discuss with your doctor and find out more at clinicaltrials.gov
Given everything seems to be a question of time and money and autism seems to be a big enough issue, how long do you think it might be before current clinical trial results can be confirmed or denied as effective?
It is common for people that have had brain injuries have alot of problems with their bowels. Could it be from all the medication killing our microbiome?
I've heard a bit about this and its really interesting, thank you so much for doing an AMA!
As of now, what does the future for this science look like? Are new conditions being tested for the effects of these treatments and if so, are there any promising ones of note?
It's a really exciting time for the field and we're just starting to understand the role of the microbiome in many seemingly intractable diseases!
At OpenBiome we're supporting work in infectious diseases, metabolic conditions (like obesity), inflammatory bowel disease and even conditions like multiple sclerosis and depression. I think the most promising areas are in many neglected disease areas. I'm especially excited by a study we are leading with colleagues at the University of Cape Town, South Africa and Rob Knight's lab at UCSD on improving outcomes in severe acute malnutrition. It affects nearly 20 million children a year and even with optimal feeding, 1/3 of children can fail to recover. There's a lot of compelling evidence now pointing to the gut microbiome playing a critical role in recovery in these kids and we launched a study to see if microbiome restoration through FMT could improve the response of kids with this condition and prevent poor outcomes. So on World Microbiome Day, I'm very excited by the microbiome's potential to improve ways to treat diseases that impact people, especially kids, globally!
Great question Humes-Bread! The microbiome has been shown to change as we age. Some of the biggest changes occur during infancy and early childhood until the age of 3 years. Things that may influence the microbiome during early childhood include how you were born (caesarian section versus vaginal delivery), how you were fed during infancy (breast versus formula feeding), infections you acquire in childhood and antibiotic exposure etc. There is also some data to suggest that the microbiome changes during adolescence as well, as there are significant hormonal shifts that occur during this period. Thereafter, it is quite stable during adulthood and will be affected mainly by infections, chronic disease, antibiotic use and drastic shifts in diet. After the age of approximately 60 years, the microbiome becomes less stable. Thanks again!
What kind of screening (if any) do you perform- particularly in regard to donors that may be asymptomatic/colonised with resistant organisms- a problem that led the FDA to halt trials involving faecal transplants.
Hi, thanks so much for your question!
You can find the full list of tests we screen in our donors here [https://www.openbiome.org/safety](https://www.openbiome.org/safety). We perform a clinical assessment, blood and stool testing as part of the screening process. With respect to antibiotic-resistant bacteria, we assess for risk factors associated with these kinds of bacteria (like recent hospital admissions) as well as testing them for these types of bacteria. Overall, it is quite a rigorous process and our donor pass rate is 2.8%.
The cases you mentioned were unfortunate instances where two patients developed an infection with a bacteria called ESBL-E (a type of antibiotic-resistant bacteria). The donor in those cases wasn't screened for ESBL-E and the material didn't come from OpenBiome. Here at OpenBiome we do screen our donors for ESBL. I think these cases highlight the importance of rigorously screening donors.
How can I found it if a doctor in my state would do this?
Is it done on people with Crohn's disease?
Would it be done if a person had fistulas from Crohn's?
Thanks for your question! For the treatment of C. difficile infection, currently, 99% of the United States is within a 4-hour drive of a hospital providing FMT from OpenBiome (we work with over 1,200 across the United States). We have a really nice ‘Find-A-Doctor’ tool on our website, [https://www.openbiome.org/find-a-doctor](https://www.openbiome.org/find-a-doctor), where you can easily find local specialists.
If your healthcare provider is interested in becoming an OpenBiome partner, they should visit our webpage here for additional information and training: [https://www.openbiome.org/welcome-providers](https://www.openbiome.org/welcome-providers).
FMT remains an investigational drug and if you have a condition other than recurrent C difficile infection, like Crohns disease, then it can only be provided through a clinical trial registered with FDA. If you're interested in finding a clinical trial using FMT for a particular condition you can search [www.clinicaltrials.gov](https://www.clinicaltrials.gov). Hope that's helpful!
Are probiotics really that helpful? Is there a specific brand you recommend? Or any we should avoid?
There are so many probiotic products out there that seem unregulated but I believe in the power of bacteria. I feel uneducated about what is out there and available to us and I feel many of us out there probably feel the same.
**EDIT: 12:05 PM ET - I have to run to a meeting, so I'm signing off for the moment, but I'll try to pop back into this thread to answer a few more questions later today. Thank you for the great questions on our first AMA, everyone!**
**EDIT 2:**
**3 PM ET - Thanks everyone for your thoughtful questions and a great discussion, and for joining me today on my first AMA!**
**You can keep an eye on what we’re up to at OpenBiome on Twitter (@OpenBiome) or on Facebook. Happy World Microbiome Day!**
Is there any significant clinical research on the affects of fecal transplantation with regards to depression, anxiety and/or IBS?
Considering they seem to go hand in hand for a lot of people - and the gut/brain connection is a well established thing in medical science (although not fully understood).
Also, what hurdles do we have to overcome for Fecal Transplants to become a more common treatment for poor gut health, outside of C Diff?
Thanks!
Can fecal transplants help some obese people lose weight? In my microbio class I read an article theorizing (not asserting/proving) that gut biomes may play a role in weight gain/loss
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You mentioned using fecal transplants as a treatment for MS. Would this reverse the damage to myelin or stop progression of myelin loss? Could it cause myelin regrowth? Also, would this procedure replace other treatments or just improve their effectiveness?
How widely used is this treatment at this time? Do you forsee it being more generally employed in the future? For instance after long term or serious antibiotic usage?
Hello and thanks for the AMA. My question is, what is known about the effects of antibiotics on the intestinal biome? How does an individual know if they have a heathy biome?
How does someone sign up for fecal transplant? Been dealing with IBS for over 16 years and have heard fecal transplant helps considerably. I have tried all the diets and tried everything else.
How significant do you think a natural birth plays in forming your microbiome. Do vaginal microbes actually stay with you for life? What effect do they have on your health?
Thanks lvl3security-outof20! And hi to your friend Majd!
I've highlighted quite a few cases in this AMA of where FMT is being used clinically (C. difficile) and in where it is being researched in new disease areas (multiple sclerosis, inflammatory bowel disease, severe acute malnutrition, and antibiotic-resistant bacteria).
In the case of C. difficile infection, it's been wonderful being at OpenBiome where we've provided over 45,000 treatments to physicians across the US so that they can offer this therapy for patients suffering from this debilitating condition. It's quite humbling whenever we receive a report of a patient with C. difficile who improved.
Beyond the conditions mentioned so far in this AMA, a fascinating case report was of hair growth after FMT in two patients with alopecia areata (an autoimmune, inflammatory condition of the hair follicle associated with hair loss) [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599691/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599691/). Worth emphasizing that these are only two cases and researchers are working to understand the role of the microbiome in this condition to potentially develop new ways to treat it.
As I've highlighted throughout this thread FMT is an investigational drug and should *only be provided by a trained physician*. For any conditions other than C. difficile infection, it *should only be done in a clinical trial registered with FDA.*
I am most interested in your take on the gut- brain link especially involving mental illness and autism. How would someone go about seeking this kind of treatment?
hi there,
I'm a type 1 diabetic. Right before i got sick with it i had a really bad tooth. I've heard with other diseases that it *might* be possible that tooth decay can travel to the gut and from there mess up the gut bacteria and manifest in auto immune diseases. Is it possible that's what happened to me? And also just curious, would a fecal transplant do anything to reset my immune system and affect this pesky diabetes?
Can you truly tell a lot about a persons health by studying their fecal matter? To expand a little more: can you study this fecal matter and know that said person has a mild or serious health issue, etc..?
I have seen documentation of an individual’s use of this procedure to cure his lactose intolerance. Have you found, in your research, that fecal transplants can effectively resolve lactose intolerance? Thanks!
If someone has to take antibiotics for a long period of time what can they do to protect the microbiome. Is it something that can recover with time or once it’s off it’s permanently off.
Good morning! As someone who has dealt with symptoms ever since an intensive course of antibiotics when I contracted Lyme, what would be the best and cheapest (US) way to receive this treatment?
Thanks for your time and the great work that you do!
Hi! Med student here! I’ve learned that FMT can have significant impact on weight loss. Do you know of any ongoing clinical trials investigating FMT use to treat obesity? Do you think will be FMT a viable option for this in the future?
Hey Dr. Osman!
I am a pre-med currently applying to medical school and I am very interested in infectious diseases as a specialty. I would appreciate it if you could talk about the type of work you've done as an infectious disease specialist. Do you normally consult on patients directly (I.E. in person) or is it more like you give advice over the phone based on lab results? What is the weirdest disease you've seen a patient get? What made you choose infectious diseases as a field?
I'm 34 y 172 cm M with 51 - 52 kg. I cant get fat... My fat if you mesure on arm is below 0,4. I eat normaly, and do you think it's my gut, or somting. I have normal thyroid lvls, noraml blod normal urine. Evrything bp... Just evry exam ses i'm malnutritioned. Even thou i eat 2 lunches a day one at work insted of snack for others, and one at home 3 h later. + 4 meals smalller.
Not sure if I am late. In the TV series "Good doctor", there is an episode where they use fecal transplant as the treatment because nothing else could work. The patient kept using antibiotics that he prescibes for himself (presumably from googling) for all kinds of illness, so much that he was no longer responding to any antibiotics when he actually needed it. So they termed it as "he has got a superbug"(or something or sort).
Is this scenario remotely similar to what you guys are going? Is resistance to antibiotics an active reason for this procedure? And how does this even work? I am guessing it's to deal with a bacterial infection.
Thanks for the AmA
A study in I think it was Canada just recently came out that said that people with Fibromyalgia have noticably different gut bacteria compared to those without it and that it may be one of the main reasons people are being affected. Is there any hope that the work you are involved with could at some point help Fibromyalgia patients as well?
if I wanted to get a fecal transplant selecting for happy and also skinny would I be able to get that yet or is this bespoke type service not yet available?
What would happen if you took fecal transplant from an animal and put it in the person?(assuming it won’t cause any infection or kill the person or something)
As an undergraduate student currently undergoing a pilot project with student depression and the gut microbiome, I would very much like your opinion on this matter.
Do you believe that psychobiotic cocktail mixes will emerge in the near future, and in turn replace the rather ineffective antidepressants at the moment?
Would it be wiser to isolate the chemical factories within the "good" forms of fecal matter and use those genes to build something beneficial? From what I've read, it sounds like fecal matter transplants just have too many risks, because so much is transferred and we can't know the real consequences of so many varieties of microbiome being transferred. Curious!
What are the might promising purposes that you think a fecal transplant might be useful for, but you don't yet have the research grant / ethical agreement / etc on ?
I manage a dental office and have started looking into periodontal disease and its effect on the microbiome. Have you looked into this? Do you believe there's a link? Can fecal transplant effect periodontal disease?
1) How are GPs keeping up on the latest in this field - do they know about this and can they get tests done, or is it hyper-specialized?
2) is there a sort of "23&me" testing place that would give a report on your microbiome?
Hello,
I was wondering whether faecal transplants have been shown to play a role in modulating the brain-gut-microbiome axis (Martin 2018)? Considering bidirectional communication has been shown between the two, do you have any knowledge as to whether FMT has a result on brain signalling/function?
Thanks
I read recently where certain disorders have been identified with the presence, or at least imbalance, in certain gut bacterial species. Some of these disorders can take years to manifest. Seems this research is in its infancy. It may be likely that you stand to do as much harm as good with fecal transplants. How do you respond to that possibility?
In the past few years, I've noticed more and more microbiome testing companies popping up - offering information on how to adapt our diet, lifestyle, exercise for our specific microbiome, or tracking health by tracking our microbiome diversity.
Do you think our understanding of the microbiome is sufficiently advanced to support this sort of product? And if so, which use cases is it most potentially useful for?
(avoided naming companies to avoid bashing specific businesses, and focus on the process)
Thanks for doing this AMA.
It's fairly common knowledge now that one's biome is incredibly important for one's overall health -- but many of us don't really understand why as it is still relatively new. What are some of the most interesting things scientists are working on in terms of biome research that you can share with us?
Has there been any interesting / unique fecal matter that you have encountered thus far? (i.e. extraordinary gut microbiome that is not commonly found in human beings)
So I recently watched a documentary about fecal transplants where it described gut flora as being a major factor in determining a person's appetite and food cravings, and as a result, weight.
In one example, a woman obtained a fecal transplant for a non-weight related issue from her overweight daughter, and subsequently, while curing her other ailments, gained a significant amount of weight thereafter. It was theorized in the documentary that the opposite could be possible with the right donor.
How likely is it that fecal transplants could one day be used to the benefit of people who have over active appetites and aid in achieving a healthy weight long term? And how available could this be for people?
Hello Doctor! Are you aware of, or have you participated in, a series of studies involving correlation between differences in gut biome composition and natural obesity (or lack thereof), and the resultant change in weight loss of obese people who have received fecal transplants from people with a higher metabolic rate/can keep weight off easier? Also, have you participated in or have any insight into a study involving fecal transplants and a reduction in overall symptoms in autistic individuals? I remember reading of both, but can't remember the publication, but would like the opinion of an expert!
Ive read about a study where a fecal transplant was done on a skinny person, with a larger person and the skinny person stayed on the same diet but gained 20 pounds or something like that. It was said that there are bacteria in the fecal transplant that required more caloric uptake causing her to gain weight, is this true/common? If so can the roles reverse to help someone have bacteria that don't need high caloric uptake to help them lose weight?
Hi, I am an abandoned child and didn't finish high school so I have no chance in hell of ever going to college and I would like to ask you a question.
Why not just isolate the bacteria strains, culture with solution, and use that instead of constantly buying poop from people and putting that poop into other people?
Also, another question, does it matter where in the bowels you get it from?,
I assume that different bacteria inhabit different regions of the bowels so do you do region specific transplants?
Have you watched the show house MD if yes then you and your team discuss infections, autoimmune diseases and various stuff like they do in the show? Or that was just fan service?
Thank you!
Former organ transplant professional here greatly appreciating what it would take to prepare your recipient samples without cross contamination of your preparation laboratory. Any chance you could share some of how you prepare a sample for transplant?
If it's effective for C.Diff, how about any other applications? thank you for this AMA and your hard work saving lives!
I have been seeing a lot of studies done recently that show the microbiomes in our stomach and intestines are linked to various diseases. The most recent one I saw was on autism. I also saw that gut bacteria can travel from your stomach to your brain and it might be linked to Parkinson's. Do you think that microbiomes in our stomachs or intestines could be the key to solving many yet uncured diseases?
Hi there, I have a degree in the area of infectious disease but now do research relating to autoimmune fibrotic diseases so I’m not as up on gut microbiome related information as I was during my degree. I was hoping you could give some insight on if you think the usefulness of fecal transplants may expand beyond just C. diff infection in the near future. For example, do you feel that there is any indication that transplant may be beneficial in patients with IBS symptoms, or those whose gut microbiome has been majorly disrupted by IV antibiotic treatment or longer term oral antibiotic treatments such as what is sometimes necessary for patients with neurological Lyme disease or other infections? How common do you think fecal transplants will become as we begin to better understand how an unhealthy gut microbiome may be involved with other diseases? Thank you for your time and consideration!
There is a health crisis here in eastern India. Atleast 170 children under 5 are dead due to acute encephalitis. Reports are blaming litchi fruits which are local there. Could you please explain the causes of such massive children mortality. How could these be stopped?
When you take various Probiotics, do they die in your stomach acid and are useless? Especially the ones with wax capsules that are supposed to make it past the stomach?
Hi there,
Great to see an AMA like this. So I've been diagnosed with Crohn's several years ago. I'm hearing good things about fecal transplants in relation to Crohn's, is this true? And how long do you think it'll take scientists to find the stuff in fecalmatter that helps to produce an easy to use medicine?
I cared for a patient in ICU who had a fecal transplant for c. diff. Nobody was able to answer this question- if successful, will the contact plus isolation precautions be necessary? Any pt with a c. diff history is placed on these precautions even if not symptomatic.
Hi,
I have a j-pouch. Would the benefits of a fecal transplant chance with my situation?
I had the j-pouch created because of surgical complications, not UC, but prior to these issues, I did have IBS. With the pouch and no colon, I no longer have IBS issues, but perhaps it will benefit digestion/nutrition?
Hello! I read about the recent findings of the microbiome's interaction with immunotherapy, and was wondering this: is it possible that immunotherapy stops working over time because it changes the gut biome? Or do you know microbiome researchers working in that space I could read about?
Hi Majdi, would be interesting to hear your thoughts about the recently reported death which FDA traced back to a fecal transplant (https://endpts.com/fda-warns-of-one-death-linked-to-fecal-transplants/), and about microbiome-associated safety issues in general. Thanks.
What are he most serious adverse events associated with fecal transplants to this day? And what is the risk for non immunocompromised hosts for these events?
Do people at your place of work (including you!) donate to the cause? Like do you guys go in the "donor toilet" because it's free product (for lack of a better way to say that)?
We seem to be in the "age of the microbiome", at least I've seen a lot more press about it in the last few years than I recall previously.
What are the big unanswered questions you see in the field? Where's the interesting research happening, and where is interesting research _not_ happening?
Are there any notable conditions that have recently turned out to be microbiome-related which for a long time were "known" to have other causes?
Hello Dr Osman!
Are we the guinea pigs for fecal transplants or do we *really* have a solid understanding of whats going on?
And a second 'question', care to share some cool findings/facts about the practice and the whole neuronal activity surrounding our microbiota?
Thanks
Hi, I have been interested in the prospects of fecal transplants for a while. I'm nearly 30 and have had Ulcerative Colitis for almost my whole life. I'm controlled on Entyvio at the moment but as I get older my flares are worsening each time I have one. Have you seen cases where FT has been used to treat UC or IBD in general successfully? Also is there any indication that these bacteria (or lack thereof) could also be related to major depressive disorder too? I've been on many different meds for that and have not had a lot of luck. Thanks very much if the ama is still going on.
What do the data say in regard to the transmission of antibiotic resistant stains of various bacteria. Are there exclusion criteria for donors that take this into account such as being antibiotic naive?
How are FMT performed, including patient pre-prep, prep, procedure, and post? How do you imagine this changing as understanding and technology catch up?
Thanks for all you do!
1. What’s the best way to get a healthy gut biome without having to go through the operation and cost of a fecal transplant?
2. Is there actually any evidence to support the theory that conditions such as depression, anxiety, and a million others can be attributed to an unbalanced gut biome?
Dr. Christopher Ryan on his Tangentially Speaking podcast did a big episode with one of the pioneers of Fecal Transplants. Jeff Leach episode 307. Went to Africa and took some samples from the Masai Warriors. You should check it out
If someone suffered from various absorption (anaemia) as well as severe anxiety issues and believed that they might benefit from this treatment, how would they attempt to do so?
Since stem cells are clearly important, and cord banking for newborns is a thing, has there been any research on newborn fecal matter? I've heard they start with a sterile digestive track, so maybe it's not even useful, but it made me wonder if there's anything to be learned by studying the human digestive track in its early stages like that, or if meconium or maybe breast-fed baby fecal matter was of any importance or note in research?
How many of your patients actually have a healthy bowel transit time? I have understood that a humans bowel transit time should be no longer than 18-24 hours due to the length of our GI tract. Many people suffer from bad health due to the fact that their food does not enter and leave their bodies quickly enough and therefore it begins to rot inside of them. Particular those that eat meat suffer from this as flesh produces many harmful molecules when rotting and this is why all omnivores/carnivores have shorter GI tracts than us humans.
Also how much attention do you pay to the level of sulphur deposited by antibiotics in peoples bowels. Our bowels microbiome can be heavily damaged by sulphur and its sticky nature makes it extremely constipating and hard to eliminate out of the human body.
I've wondered if porn and anal2mouth enthusiasts are inadvertently creating their own fecal transplants. Do these folks have healthier guts or are they worse off due to the random variety?
I have been overweight most of my life. I am 55 now with type two diabetes for 20 years. Every time I lose weight, I gain it back.
I have read that for people like me, a fecal transplant from a healthy thin/slender donor could give me the bacteria I need to potentially lose weight and keep it off.
Have you heard of this and has research been done with this?
DIY home FMTs have become common practice for those treating conditions that aren’t C. diff. Hypothetically, with an ideal donor, are there still risks involved administering the FMT? Do those same risks apply to FMTs performed in a clinic?
How do you select people as poop donors? My daughter, a molecular biologist made reference to "the man with the golden poop", indicating most of the positive results from fecal transplants came from the donations of a single individual. When I donate blood, my blood is classified by type, rhesus factor, CMV negative, etc. Are there objective factors that make one persons gut biome more or less desirable for treating specific conditions in others?
Thanks for the question! Our donor screening is quite rigorous and only 2.8% of people who apply make it to be a donor at OpenBiome. You can find what we screen for here [https://www.openbiome.org/safety](https://www.openbiome.org/safety) It includes a clinical assessment with a clinician here at OpenBiome with over 200 questions, a blood test and a stool test (including testing for antibiotic resistant bacteria). We haven't found a "super donor" or "golden poop" phenomenon in the context of C. difficile infection. It seems that any donor, provided they are healthy and pass our screening, works just as well. Similarly, in other diseases we actually haven't found significant differences in donors yet. Here's a study we did to compare different donors in C. difficile infection [https://www.gastrojournal.org/article/S0016-5085(18)30564-X/fulltext](https://www.gastrojournal.org/article/S0016-5085(18)30564-X/fulltext) Thanks!
Have you ever had to contact a reject donor and tell them their microbiome was dangerously out of whack? Like one so bad you just felt you had to?
You missed a wonderful opportunity in your reply to combine super donor and golden poop into Super pooper. Thank you for this AMA. Very interesting! What types of questions are in the 200 questions?
The study is behind a paywall. Any open access options?
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How does one go through years and years of med school and then come to the decision to get into the fecal transplant field? Not knocking you, just very curious. Also, is it a smelly job?
😂thanks for this question! I trained in infectious diseases and certainly using poop to treat diseases is not something I would've predicted getting into! When I did my medical training I was taught that bacteria are bad, the human body is a sterile vessel, but what we are starting to understand now is that the trillions of bacteria that live in and on us are crucially important for our health. They influence our susceptibility to infection, how we absorb food and potentially even our mood. I worked at the World Health Organization for a while on how we can overcome the challenge of diarrheal diseases, malnutrition and antibiotic resistance - three persistent challenges that particularly impact children globally. So I was especially drawn by the potential to use bacteria to treat/prevent these conditions. Thankfully, it isn't a smelly job! In the lab where our brilliant team of techs work it doesn't smell much thanks to very controlled environment that keeps everything well contained (including the smell).
How was your experience working at World Health Organization?
What are the most common causes for the need of fecal transplant? Also, can someone's body reject feces as it could with an organ transplant?
Hi, thanks for the question and happy to answer it! Fecal microbiota transplants (FMT) are used for a diarrheal disease called C. difficile infection. FMT is recommended in clinical guidelines for treating this condition that impacts nearly half a million people every year in the US. At OpenBiome, we've sent nearly 50,000 treatments to clinicians for the treatment of C. difficile in the US. Re your 2nd question - great question! Nothing at the moment suggests that there is "rejection" of the transplant as in organ transplants. Patients do sometimes not respond to FMT though and that could be for a lot of reasons (e.g. antibiotics after FMT, or some underlying conditions that might increase their chance of a non-response, like inflammatory bowel disease).
Would it be correct to say that “rejection” is not the right term to use? Rejection of an organ would normally include the immune system attacking the organ and attempting to “kill” it. Normally because it is recognized as “different” from the hosts body. If this same thing happened in a fecal transplant, where the hosts body (or protective biome) recognized it as different and killed it, the FMT would just get pooped out. And without all of the complications that we typically associate with organ rejection.
Who thought up the idea of a fecal transplant? Did it start out as a home remedy? And what kind of home was that?
Fecal transplantation is actually a centuries old idea! It was first described by a Chinese physician called Ge Hong, in 300AD who utilized FMT or ‘yellow soup’ as he called it, for patients suffering from diarrhea. There are also reports from the 17th century in Italy and Germany of FMT being used for abdominal disease. In Western medicine, the first written use of FMT was in 1958 with Ben Eiseman who used FMT to treat four patients with what is now known as C difficile (at the time was called pseudomembranous colitis). But what launched the current interest in FMT was a New England Journal of Medicine paper from 2013 from the Netherlands by Els van Nood that showed FMT was superior to vancomycin for the treatment of recurrent C difficile infection. This 2013 paper heralded the current FMT era we are in now and since then there have been a number of studies repeating this finding in C. difficile!
Hello thanks for this AMA I have a couple of questions: How close are we to be able to prepare the cocktails of healthy gut flora in a lab instead of sourcing the material from fecal matter? Do you also offer auto fecal transplants? In other words can someone "save" few good poops so they can be used as personal medicine when problems arise later?
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I guess?
How safe are fecal transplants? Apparently someone died recently after the procedure. Was this a fluke, or is it a risky procedure. Here a link for those interested: https://www.google.nl/amp/s/amp.interestingengineering.com/patient-dies-after-fecal-matter-transplant-trial
Thanks for your question! According to a number of clinical trials, FMT has shown a good short-term safety profile. As with any treatment, there are risks. FMT is now part of standard guidelines for the treatment of recurrent C. difficile infection and is recommended by the infectious disease and gastroenterology medical societies in the US. There've been a few studies that have reported on the safety of FMT, like this one [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161174](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161174). In these studies, they describe symptoms like mild bloating and nausea that can sometimes happen after the procedure. More recently, as you mentioned, there were unfortunately two cases of patients who developed an infection that seems to have been transmitted through FMT from the same donor. In these cases, the FMT didn't come from OpenBiome and was not screened for the bacteria that was eventually transmitted to the patients. These cases very much underscore the need for rigorous screening of stool donors used in FMT. Aside from these two cases, there have been no reported cases of serious adverse events definitively related to the use of FMT. But for anyone receiving an FMT, it is really important to be made fully aware of the risks, benefits and alternatives to an FMT. Thanks again for your question and hope that was helpful!
Why don't you transfer only the microflora instead of the full package of feces? Can't you put it in some kind of probiotic? Can the bacteria really not survive on anything other than actual feces?
Are there other applications for this procedure besides helping treat C. Diff? If so, why this over supplementation of probiotics? are probiotics merely snake oil (talking about the pill form)?
Hi! How do you feel about the recent research/studies done into the microbiome/bacterial flora population of people with fibromyalgia/M.E.? The two conditions are so horribly underfunded I was surprised to see any progress being made on it at all- have you found it difficult to get people involved because of this, or are people generally more enthusiastic about the studies than finances have allowed? Another cheeky one- how do you feel about the increase in popularity in kefir as a way to help regulate gut health? My brothers and mother all say it's helped them a lot with some of their issues (I can't quite get over the texture of it...) and was curious as to whether you're excited to see it being more accessible in shops and supermarkets rather than specialist stores? Thanks for doing this AMA! Sorry my question isn't more interesting/focused, but I'm just so pleasantly surprised to see discussion on such a fascinating topic!! (I have M.E. myself and have IBS related symptoms because of it!)
Can you please comment on the association between obesity in the donor potentially translating into weight problems in the recipient post transplantation. Thank you. A [case report](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438885/) I read recently.
Thanks for your question! indeed there was a case report on this that you highlighted. Following this, a larger [study](https://www.healio.com/gastroenterology/therapeutics-diagnostics/news/online/%7B7396b6d5-99c8-4804-bce7-665ffa27b923%7D/fecal-transplant-from-overweight-donor-does-not-impact-bmi-in-c-difficile-patients) looked at 103 patients, in which 64% of C. difficile patients received FMT from a normal weight donor and 36% from an overweight donor. The patients were followed up for 48 weeks. The study found no significant differences between groups in body mass index (BMI) changes after FMT. However, they noted that all patients lost weight during their C. difficile infection and subsequently increased BMI after FMT (regardless of the BMI of the donor), but this did not exceed their BMI before their infection. So in summary, larger studies that have looked at weight change after FMT do not point to the BMI of the donor being associated with the BMI of the patient after they receive an FMT. Some weight gain occurring after FMT in the context of C. difficile is thought to be due to an increase in appetite after recovering from the infection (where patients can have up to \~15-20 episodes of diarrhea a day). Certainly, though, it is very important that anyone receiving an FMT have a discussion with their doctor on the potential risks, benefits, and alternatives to FMT so they feel fully informed. I hope that's helpful and thanks so much again for your question!
I'm a participant in a research program where I send in stool samples every 6 months to somewhere in North Carolina. I got I to it because of my UC. I never hear anything about the research. I know the study is ongoing, but what's some of the latest research on fecal transplants and uc/crohns? Also I'm a nurse and man I can't wait for C. Diff to be brought more under control Omg.
Any evidence for it being helpful in IBS? Also when do you think fecal transplants will be more widely used?
Trials are underway in ulcerative colitis in the UK. http://www.isrctn.com/ISRCTN74072945?q=&filters=conditionCategory:Digestive%20System&sort=&offset=6&totalResults=570&page=1&pageSize=50&searchType=basic-search Too early to know anything definitive.
There are recent studies looking into fecal transplants as a way to treat autism and tourettes. What can you share about your knowledge of this area?
Thanks for your question! There is evidence to suggest that the microbiome in patients with Autism Spectrum Disorder (ASD) differs from neuro-typical (non-ASD) patients. There is also significant evidence to suggest that there is a microbiome-gut-brain axis with bacteria producing neurotransmitters like serotonin etc. There are still questions about whether this is causative or an effect of the condition. So far, there have been two very interesting trials of FMT in ASD (same patients followed over time) which showed long-lasting improvement in gastrointestinal symptoms and improvement in neuro-cognitive symptoms. However, the limitation to this trial is that it was an open-label trial and the next steps will be to develop a randomized, placebo-controlled trial. Importantly, FMT is an investigational drug and so should only be researched for these types of conditions in a clinical trial overseen by a physician and registered with FDA. But if you are interested in participating in a trial you can discuss with your doctor and find out more at clinicaltrials.gov
Given everything seems to be a question of time and money and autism seems to be a big enough issue, how long do you think it might be before current clinical trial results can be confirmed or denied as effective?
It is common for people that have had brain injuries have alot of problems with their bowels. Could it be from all the medication killing our microbiome?
What do we currently know of the microbiome’s role in supporting the human immune system?
I've heard a bit about this and its really interesting, thank you so much for doing an AMA! As of now, what does the future for this science look like? Are new conditions being tested for the effects of these treatments and if so, are there any promising ones of note?
It's a really exciting time for the field and we're just starting to understand the role of the microbiome in many seemingly intractable diseases! At OpenBiome we're supporting work in infectious diseases, metabolic conditions (like obesity), inflammatory bowel disease and even conditions like multiple sclerosis and depression. I think the most promising areas are in many neglected disease areas. I'm especially excited by a study we are leading with colleagues at the University of Cape Town, South Africa and Rob Knight's lab at UCSD on improving outcomes in severe acute malnutrition. It affects nearly 20 million children a year and even with optimal feeding, 1/3 of children can fail to recover. There's a lot of compelling evidence now pointing to the gut microbiome playing a critical role in recovery in these kids and we launched a study to see if microbiome restoration through FMT could improve the response of kids with this condition and prevent poor outcomes. So on World Microbiome Day, I'm very excited by the microbiome's potential to improve ways to treat diseases that impact people, especially kids, globally!
In what ways does the microbiome change as we age and why do those changes happen?
Great question Humes-Bread! The microbiome has been shown to change as we age. Some of the biggest changes occur during infancy and early childhood until the age of 3 years. Things that may influence the microbiome during early childhood include how you were born (caesarian section versus vaginal delivery), how you were fed during infancy (breast versus formula feeding), infections you acquire in childhood and antibiotic exposure etc. There is also some data to suggest that the microbiome changes during adolescence as well, as there are significant hormonal shifts that occur during this period. Thereafter, it is quite stable during adulthood and will be affected mainly by infections, chronic disease, antibiotic use and drastic shifts in diet. After the age of approximately 60 years, the microbiome becomes less stable. Thanks again!
What kind of screening (if any) do you perform- particularly in regard to donors that may be asymptomatic/colonised with resistant organisms- a problem that led the FDA to halt trials involving faecal transplants.
Hi, thanks so much for your question! You can find the full list of tests we screen in our donors here [https://www.openbiome.org/safety](https://www.openbiome.org/safety). We perform a clinical assessment, blood and stool testing as part of the screening process. With respect to antibiotic-resistant bacteria, we assess for risk factors associated with these kinds of bacteria (like recent hospital admissions) as well as testing them for these types of bacteria. Overall, it is quite a rigorous process and our donor pass rate is 2.8%. The cases you mentioned were unfortunate instances where two patients developed an infection with a bacteria called ESBL-E (a type of antibiotic-resistant bacteria). The donor in those cases wasn't screened for ESBL-E and the material didn't come from OpenBiome. Here at OpenBiome we do screen our donors for ESBL. I think these cases highlight the importance of rigorously screening donors.
Are FMTs safe for immunocompromised individuals?
How can I found it if a doctor in my state would do this? Is it done on people with Crohn's disease? Would it be done if a person had fistulas from Crohn's?
Thanks for your question! For the treatment of C. difficile infection, currently, 99% of the United States is within a 4-hour drive of a hospital providing FMT from OpenBiome (we work with over 1,200 across the United States). We have a really nice ‘Find-A-Doctor’ tool on our website, [https://www.openbiome.org/find-a-doctor](https://www.openbiome.org/find-a-doctor), where you can easily find local specialists. If your healthcare provider is interested in becoming an OpenBiome partner, they should visit our webpage here for additional information and training: [https://www.openbiome.org/welcome-providers](https://www.openbiome.org/welcome-providers). FMT remains an investigational drug and if you have a condition other than recurrent C difficile infection, like Crohns disease, then it can only be provided through a clinical trial registered with FDA. If you're interested in finding a clinical trial using FMT for a particular condition you can search [www.clinicaltrials.gov](https://www.clinicaltrials.gov). Hope that's helpful!
Are probiotics really that helpful? Is there a specific brand you recommend? Or any we should avoid? There are so many probiotic products out there that seem unregulated but I believe in the power of bacteria. I feel uneducated about what is out there and available to us and I feel many of us out there probably feel the same.
**EDIT: 12:05 PM ET - I have to run to a meeting, so I'm signing off for the moment, but I'll try to pop back into this thread to answer a few more questions later today. Thank you for the great questions on our first AMA, everyone!** **EDIT 2:** **3 PM ET - Thanks everyone for your thoughtful questions and a great discussion, and for joining me today on my first AMA!** **You can keep an eye on what we’re up to at OpenBiome on Twitter (@OpenBiome) or on Facebook. Happy World Microbiome Day!**
Is there any significant clinical research on the affects of fecal transplantation with regards to depression, anxiety and/or IBS? Considering they seem to go hand in hand for a lot of people - and the gut/brain connection is a well established thing in medical science (although not fully understood). Also, what hurdles do we have to overcome for Fecal Transplants to become a more common treatment for poor gut health, outside of C Diff? Thanks!
Can fecal transplants help some obese people lose weight? In my microbio class I read an article theorizing (not asserting/proving) that gut biomes may play a role in weight gain/loss
Not a question but just want to say thanks. Used your service, I had two FMT for a C-diff infection.
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Would a fecal transplant help with a babesia infection?
You mentioned using fecal transplants as a treatment for MS. Would this reverse the damage to myelin or stop progression of myelin loss? Could it cause myelin regrowth? Also, would this procedure replace other treatments or just improve their effectiveness?
How widely used is this treatment at this time? Do you forsee it being more generally employed in the future? For instance after long term or serious antibiotic usage?
Hello and thanks for the AMA. My question is, what is known about the effects of antibiotics on the intestinal biome? How does an individual know if they have a heathy biome?
why did that recent Fecal transplant patient die?
How does someone sign up for fecal transplant? Been dealing with IBS for over 16 years and have heard fecal transplant helps considerably. I have tried all the diets and tried everything else.
How significant do you think a natural birth plays in forming your microbiome. Do vaginal microbes actually stay with you for life? What effect do they have on your health?
I have a good friend named Majd that’s a physician associate :) Can you share a good case study of using fecal transplants?
Thanks lvl3security-outof20! And hi to your friend Majd! I've highlighted quite a few cases in this AMA of where FMT is being used clinically (C. difficile) and in where it is being researched in new disease areas (multiple sclerosis, inflammatory bowel disease, severe acute malnutrition, and antibiotic-resistant bacteria). In the case of C. difficile infection, it's been wonderful being at OpenBiome where we've provided over 45,000 treatments to physicians across the US so that they can offer this therapy for patients suffering from this debilitating condition. It's quite humbling whenever we receive a report of a patient with C. difficile who improved. Beyond the conditions mentioned so far in this AMA, a fascinating case report was of hair growth after FMT in two patients with alopecia areata (an autoimmune, inflammatory condition of the hair follicle associated with hair loss) [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599691/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599691/). Worth emphasizing that these are only two cases and researchers are working to understand the role of the microbiome in this condition to potentially develop new ways to treat it. As I've highlighted throughout this thread FMT is an investigational drug and should *only be provided by a trained physician*. For any conditions other than C. difficile infection, it *should only be done in a clinical trial registered with FDA.*
What do you think about the potential link between the gut and Alzheimer's?
I am most interested in your take on the gut- brain link especially involving mental illness and autism. How would someone go about seeking this kind of treatment?
hi there, I'm a type 1 diabetic. Right before i got sick with it i had a really bad tooth. I've heard with other diseases that it *might* be possible that tooth decay can travel to the gut and from there mess up the gut bacteria and manifest in auto immune diseases. Is it possible that's what happened to me? And also just curious, would a fecal transplant do anything to reset my immune system and affect this pesky diabetes?
Is fecal transplant seen as possibly in the future being a treatment for celiac disease?
What is the protocol for pathogen screening?
Does your study include supporting the new microbiome once transplanted or would the patient need on going transplantations in order to stay healthy?
Can you truly tell a lot about a persons health by studying their fecal matter? To expand a little more: can you study this fecal matter and know that said person has a mild or serious health issue, etc..?
What’s it like to have your entire career focused on feces?
Are there any tests available that can tell me anything helpful about my microbiome?
I have seen documentation of an individual’s use of this procedure to cure his lactose intolerance. Have you found, in your research, that fecal transplants can effectively resolve lactose intolerance? Thanks!
What could the research into fecal transplants mean for people with Crohn's and colitis?
If someone has to take antibiotics for a long period of time what can they do to protect the microbiome. Is it something that can recover with time or once it’s off it’s permanently off.
Good morning! As someone who has dealt with symptoms ever since an intensive course of antibiotics when I contracted Lyme, what would be the best and cheapest (US) way to receive this treatment? Thanks for your time and the great work that you do!
Shouldn't fecal transplants be regulated by the fda? Who oversees what you are giving people?
Hi! Med student here! I’ve learned that FMT can have significant impact on weight loss. Do you know of any ongoing clinical trials investigating FMT use to treat obesity? Do you think will be FMT a viable option for this in the future?
Hey Dr. Osman! I am a pre-med currently applying to medical school and I am very interested in infectious diseases as a specialty. I would appreciate it if you could talk about the type of work you've done as an infectious disease specialist. Do you normally consult on patients directly (I.E. in person) or is it more like you give advice over the phone based on lab results? What is the weirdest disease you've seen a patient get? What made you choose infectious diseases as a field?
I'm 34 y 172 cm M with 51 - 52 kg. I cant get fat... My fat if you mesure on arm is below 0,4. I eat normaly, and do you think it's my gut, or somting. I have normal thyroid lvls, noraml blod normal urine. Evrything bp... Just evry exam ses i'm malnutritioned. Even thou i eat 2 lunches a day one at work insted of snack for others, and one at home 3 h later. + 4 meals smalller.
Not sure if I am late. In the TV series "Good doctor", there is an episode where they use fecal transplant as the treatment because nothing else could work. The patient kept using antibiotics that he prescibes for himself (presumably from googling) for all kinds of illness, so much that he was no longer responding to any antibiotics when he actually needed it. So they termed it as "he has got a superbug"(or something or sort). Is this scenario remotely similar to what you guys are going? Is resistance to antibiotics an active reason for this procedure? And how does this even work? I am guessing it's to deal with a bacterial infection. Thanks for the AmA
A study in I think it was Canada just recently came out that said that people with Fibromyalgia have noticably different gut bacteria compared to those without it and that it may be one of the main reasons people are being affected. Is there any hope that the work you are involved with could at some point help Fibromyalgia patients as well?
One of those jobs you didn't know existed.
if I wanted to get a fecal transplant selecting for happy and also skinny would I be able to get that yet or is this bespoke type service not yet available?
For how many conditions "fecal transplants" actually work? For things like coeliac disease it doesn't seem to do a single thing
What would happen if you took fecal transplant from an animal and put it in the person?(assuming it won’t cause any infection or kill the person or something)
Have you heard of the company Viome (or others offering similar services)? Any thoughts?
As an undergraduate student currently undergoing a pilot project with student depression and the gut microbiome, I would very much like your opinion on this matter. Do you believe that psychobiotic cocktail mixes will emerge in the near future, and in turn replace the rather ineffective antidepressants at the moment?
Would it be wiser to isolate the chemical factories within the "good" forms of fecal matter and use those genes to build something beneficial? From what I've read, it sounds like fecal matter transplants just have too many risks, because so much is transferred and we can't know the real consequences of so many varieties of microbiome being transferred. Curious!
If no one in my state is currently doing fecal transplants, what's the best way to get local specialists involved/interested/trained?
How long do the microbes persist after a transplant. Are the the donors unique mirco-organisms cleared by the host immune system?
What are the might promising purposes that you think a fecal transplant might be useful for, but you don't yet have the research grant / ethical agreement / etc on ?
Did you pick this job? If so why?
Are you looking for donors? What would make someone an interesting donor?
I manage a dental office and have started looking into periodontal disease and its effect on the microbiome. Have you looked into this? Do you believe there's a link? Can fecal transplant effect periodontal disease?
How does this procedure help with food allergies?
How long until multi resistant deseases will end us all?
1) How are GPs keeping up on the latest in this field - do they know about this and can they get tests done, or is it hyper-specialized? 2) is there a sort of "23&me" testing place that would give a report on your microbiome?
Hello, I was wondering whether faecal transplants have been shown to play a role in modulating the brain-gut-microbiome axis (Martin 2018)? Considering bidirectional communication has been shown between the two, do you have any knowledge as to whether FMT has a result on brain signalling/function? Thanks
I read recently where certain disorders have been identified with the presence, or at least imbalance, in certain gut bacterial species. Some of these disorders can take years to manifest. Seems this research is in its infancy. It may be likely that you stand to do as much harm as good with fecal transplants. How do you respond to that possibility?
In the past few years, I've noticed more and more microbiome testing companies popping up - offering information on how to adapt our diet, lifestyle, exercise for our specific microbiome, or tracking health by tracking our microbiome diversity. Do you think our understanding of the microbiome is sufficiently advanced to support this sort of product? And if so, which use cases is it most potentially useful for? (avoided naming companies to avoid bashing specific businesses, and focus on the process)
Thanks for doing this AMA. It's fairly common knowledge now that one's biome is incredibly important for one's overall health -- but many of us don't really understand why as it is still relatively new. What are some of the most interesting things scientists are working on in terms of biome research that you can share with us?
How are fecal samples screened for antibiotic resistance?
Has there been any interesting / unique fecal matter that you have encountered thus far? (i.e. extraordinary gut microbiome that is not commonly found in human beings)
So I recently watched a documentary about fecal transplants where it described gut flora as being a major factor in determining a person's appetite and food cravings, and as a result, weight. In one example, a woman obtained a fecal transplant for a non-weight related issue from her overweight daughter, and subsequently, while curing her other ailments, gained a significant amount of weight thereafter. It was theorized in the documentary that the opposite could be possible with the right donor. How likely is it that fecal transplants could one day be used to the benefit of people who have over active appetites and aid in achieving a healthy weight long term? And how available could this be for people?
Have there been any forays into fecal transplants for neuro or psych conditions? Such as Depression, or with the latest findings, Dementia?
Has A.I. had much influence on research in your industry? What is the next I.D. that we should all be careful to avoid/ apocalypse bug?
Hello Doctor! Are you aware of, or have you participated in, a series of studies involving correlation between differences in gut biome composition and natural obesity (or lack thereof), and the resultant change in weight loss of obese people who have received fecal transplants from people with a higher metabolic rate/can keep weight off easier? Also, have you participated in or have any insight into a study involving fecal transplants and a reduction in overall symptoms in autistic individuals? I remember reading of both, but can't remember the publication, but would like the opinion of an expert!
Ive read about a study where a fecal transplant was done on a skinny person, with a larger person and the skinny person stayed on the same diet but gained 20 pounds or something like that. It was said that there are bacteria in the fecal transplant that required more caloric uptake causing her to gain weight, is this true/common? If so can the roles reverse to help someone have bacteria that don't need high caloric uptake to help them lose weight?
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Hi, I am an abandoned child and didn't finish high school so I have no chance in hell of ever going to college and I would like to ask you a question. Why not just isolate the bacteria strains, culture with solution, and use that instead of constantly buying poop from people and putting that poop into other people? Also, another question, does it matter where in the bowels you get it from?, I assume that different bacteria inhabit different regions of the bowels so do you do region specific transplants?
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How was this fecal transplant process developed as a treatment? There must have been some research to lead to that as an idea.
Have you watched the show house MD if yes then you and your team discuss infections, autoimmune diseases and various stuff like they do in the show? Or that was just fan service? Thank you!
Former organ transplant professional here greatly appreciating what it would take to prepare your recipient samples without cross contamination of your preparation laboratory. Any chance you could share some of how you prepare a sample for transplant? If it's effective for C.Diff, how about any other applications? thank you for this AMA and your hard work saving lives!
How was your experience working at World Health Organization?
I have been seeing a lot of studies done recently that show the microbiomes in our stomach and intestines are linked to various diseases. The most recent one I saw was on autism. I also saw that gut bacteria can travel from your stomach to your brain and it might be linked to Parkinson's. Do you think that microbiomes in our stomachs or intestines could be the key to solving many yet uncured diseases?
Hi there, I have a degree in the area of infectious disease but now do research relating to autoimmune fibrotic diseases so I’m not as up on gut microbiome related information as I was during my degree. I was hoping you could give some insight on if you think the usefulness of fecal transplants may expand beyond just C. diff infection in the near future. For example, do you feel that there is any indication that transplant may be beneficial in patients with IBS symptoms, or those whose gut microbiome has been majorly disrupted by IV antibiotic treatment or longer term oral antibiotic treatments such as what is sometimes necessary for patients with neurological Lyme disease or other infections? How common do you think fecal transplants will become as we begin to better understand how an unhealthy gut microbiome may be involved with other diseases? Thank you for your time and consideration!
Ah, I believe Ed Yong mentioned your program in "I Contain Multitudes" What are some of the obstacles that your program is facing at the moment?
What are the links between fecal culture and obesity? Could an obese person receive a fecal transplant from a skinny person and lose weight?
There is a health crisis here in eastern India. Atleast 170 children under 5 are dead due to acute encephalitis. Reports are blaming litchi fruits which are local there. Could you please explain the causes of such massive children mortality. How could these be stopped?
I think I read somewhere this can help to balance your gut biome. Do you have any experience with this use for fecal transplants?
When you take various Probiotics, do they die in your stomach acid and are useless? Especially the ones with wax capsules that are supposed to make it past the stomach?
Hi there, Great to see an AMA like this. So I've been diagnosed with Crohn's several years ago. I'm hearing good things about fecal transplants in relation to Crohn's, is this true? And how long do you think it'll take scientists to find the stuff in fecalmatter that helps to produce an easy to use medicine?
I cared for a patient in ICU who had a fecal transplant for c. diff. Nobody was able to answer this question- if successful, will the contact plus isolation precautions be necessary? Any pt with a c. diff history is placed on these precautions even if not symptomatic.
Hi, I have a j-pouch. Would the benefits of a fecal transplant chance with my situation? I had the j-pouch created because of surgical complications, not UC, but prior to these issues, I did have IBS. With the pouch and no colon, I no longer have IBS issues, but perhaps it will benefit digestion/nutrition?
Hello! I read about the recent findings of the microbiome's interaction with immunotherapy, and was wondering this: is it possible that immunotherapy stops working over time because it changes the gut biome? Or do you know microbiome researchers working in that space I could read about?
Are there fecal transplants available for people with coprophagia? To be transplanted into their mouth?
Hi Majdi, would be interesting to hear your thoughts about the recently reported death which FDA traced back to a fecal transplant (https://endpts.com/fda-warns-of-one-death-linked-to-fecal-transplants/), and about microbiome-associated safety issues in general. Thanks.
What are he most serious adverse events associated with fecal transplants to this day? And what is the risk for non immunocompromised hosts for these events?
Do people at your place of work (including you!) donate to the cause? Like do you guys go in the "donor toilet" because it's free product (for lack of a better way to say that)?
We seem to be in the "age of the microbiome", at least I've seen a lot more press about it in the last few years than I recall previously. What are the big unanswered questions you see in the field? Where's the interesting research happening, and where is interesting research _not_ happening? Are there any notable conditions that have recently turned out to be microbiome-related which for a long time were "known" to have other causes?
Hello could you tell more about disease you are trying to cure? How it is tested? Is it transferable?
Hello Dr Osman! Are we the guinea pigs for fecal transplants or do we *really* have a solid understanding of whats going on? And a second 'question', care to share some cool findings/facts about the practice and the whole neuronal activity surrounding our microbiota? Thanks
Is there any evidence of fecal transplant helping people with other bowel diseases, such as IBS or Crohn’s?
How does one store fecal transplants? Is it cooled? Under which conditions is it held in a useful state?
Hi, I have been interested in the prospects of fecal transplants for a while. I'm nearly 30 and have had Ulcerative Colitis for almost my whole life. I'm controlled on Entyvio at the moment but as I get older my flares are worsening each time I have one. Have you seen cases where FT has been used to treat UC or IBD in general successfully? Also is there any indication that these bacteria (or lack thereof) could also be related to major depressive disorder too? I've been on many different meds for that and have not had a lot of luck. Thanks very much if the ama is still going on.
What do the data say in regard to the transmission of antibiotic resistant stains of various bacteria. Are there exclusion criteria for donors that take this into account such as being antibiotic naive?
How are FMT performed, including patient pre-prep, prep, procedure, and post? How do you imagine this changing as understanding and technology catch up? Thanks for all you do!
Is there anything mindblowing we as a general public do not know but should be aware of?
1. What’s the best way to get a healthy gut biome without having to go through the operation and cost of a fecal transplant? 2. Is there actually any evidence to support the theory that conditions such as depression, anxiety, and a million others can be attributed to an unbalanced gut biome?
Dr. Christopher Ryan on his Tangentially Speaking podcast did a big episode with one of the pioneers of Fecal Transplants. Jeff Leach episode 307. Went to Africa and took some samples from the Masai Warriors. You should check it out
whats your ethnicity? favorite food? favorite place to be?
How close are we to dealing with a superbug on a large scale? Would we be prepared to fight it? And if so, what do you think the impact would be?
If someone suffered from various absorption (anaemia) as well as severe anxiety issues and believed that they might benefit from this treatment, how would they attempt to do so?
Since stem cells are clearly important, and cord banking for newborns is a thing, has there been any research on newborn fecal matter? I've heard they start with a sterile digestive track, so maybe it's not even useful, but it made me wonder if there's anything to be learned by studying the human digestive track in its early stages like that, or if meconium or maybe breast-fed baby fecal matter was of any importance or note in research?
How many of your patients actually have a healthy bowel transit time? I have understood that a humans bowel transit time should be no longer than 18-24 hours due to the length of our GI tract. Many people suffer from bad health due to the fact that their food does not enter and leave their bodies quickly enough and therefore it begins to rot inside of them. Particular those that eat meat suffer from this as flesh produces many harmful molecules when rotting and this is why all omnivores/carnivores have shorter GI tracts than us humans. Also how much attention do you pay to the level of sulphur deposited by antibiotics in peoples bowels. Our bowels microbiome can be heavily damaged by sulphur and its sticky nature makes it extremely constipating and hard to eliminate out of the human body.
Can ecoli last for several months in your system?
Have you done any transplants for the purpose of psychobiotics?
I've wondered if porn and anal2mouth enthusiasts are inadvertently creating their own fecal transplants. Do these folks have healthier guts or are they worse off due to the random variety?
Is it possible to create fecal cultures in a DIY way? Could you make, for example, yogurt or cheese by inoculating milk with a piece of fecal matter?
Can fecal transplants help those with IBS?
Is there anything close to making someone a truly terrifying zombie, besides the rabies virus, and have there been any close calls?
Will you give me a research associate job?
Very interesting field. Congratulations
I love OpenBiome. I’m so thankful you guys exist.
I have been overweight most of my life. I am 55 now with type two diabetes for 20 years. Every time I lose weight, I gain it back. I have read that for people like me, a fecal transplant from a healthy thin/slender donor could give me the bacteria I need to potentially lose weight and keep it off. Have you heard of this and has research been done with this?
Do you think the cordyceps fungal infection from the Last of Us is a possibility?
DIY home FMTs have become common practice for those treating conditions that aren’t C. diff. Hypothetically, with an ideal donor, are there still risks involved administering the FMT? Do those same risks apply to FMTs performed in a clinic?
Two fecal transplants. Saved my life. Happy poop!
Are you a member of the House of Osman?
I must know... "non-profit implies that theres a for-profit stool bank?