Differences between Probiotics and FMT

Tomorrow, I will receive my first of 10 transplants of fecal microbes (fecal microbiota transplant, or FMT) harvested from a healthy donor. For the following two weeks, I will get 9 more transplants from 9 different donors. What prompted me to take this extraordinary -- and some would say extreme -- step?

My lifelong history of antibiotic use is the likely culprit for why I suffer from chronic constipation. I've taken approximately 275 courses of antibiotics in my 56 years. To date, I tried to fix my gut issues with probiotics and fermented foods. By the way, only one doctor ever advised me to "double, or even quadruple" my dose of probiotics during and after my use of antibiotics. That was Dr. Bill Code, who is coincidently accompanying me on this journey to receive FMT treatment himself. No other doctor even mentioned probiotics, other than a British doctor who told us to eat "as much natural yogurt" we could handle to get over a stomach bug many years ago.

For the past 10+ years, I regularly took probiotic supplements, including (for the past 3 years) the highly regarded VSL#3. When I started considering FMT, the whole notion of probiotics got me thinking: Why can't we just swallow the microbes we need? Why aren't oral probiotics enough?

My training as a Biology teacher told me the stomach was a veritable fortress to keep bacteria from entering our bodies. Sure, this system sometimes fails (food poisoning is a painful example), but what about all the probiotics I swallowed -- in pill and food form? Do the microbes in these sources get killed by the strongly acidic stomach (in which case, I've wasted a lot of money...)?

Even if a few bacteria from a probiotic make it through alive, is it a drop in the bucket? In the face of probably +/-1000 different species of trillions of individual microbes, what difference can a 5-strain probiotic with a few million total bacteria possibly make to repopulate the bowel with beneficial bacteria?

In a very Darwinian sense, it appears some bacteria do survive the scathing pH of the stomach as they travel through the gut. Not all, but enough. What do these lone survivors do? Probiotics don't necessarily have to stick around and repopulate your microbiome in order to do good things. As they transit your system, they can modulate our immune system and effectively set the table so the bacteria that are already there are supported (the "good bacteria"). See also this study. According to Dr. Terry Wahls, the preferred way to bolster your microbiome is through fermented foods. I heard her favourably compare 1 tablespoon of sauerkraut to multiple doses of the best probiotic. Dr. Wahls recommends some type of fermented food at every meal. Research supports this approach -- fermented foods or probiotics are part of our transient microbiome and must be ingested regularly to do any good, which seems to support the "setting the table" hypothesis.

By the way, it turns out you CAN swallow microbes for a FMT treatment, just not at the clinic we are going to use. Some clinics put the microbes in triple encased capsules with the idea that these pills make it all the way to the colon before spilling their contents. Interesting concept (especially if you can get over the swallowing poop bacteria concept). Much research has been done on this method and it appears to work. See this link for a description of how its done (but also a caution that oral pills are being commercialized).

The clinic we are going to uses the "bottoms up" approach. The harvested microbes will be put in a slurry of solution and squirted directly into their new neighbourhood -- about 16 inches up my colon. There they can use their furry hair-like structures to stick to the mucosal lining and burrow themselves towards the endothelium. Once there, they will be in contact with my vagus nerve and my immune system. Amazing! This can all happen very, very quickly. Its lie the best probiotic you can take, except these microbes WILL stick around!

Obviously, I needed to prepare my colon to receive my new microbes. This is one disadvantage about doing the direct fecal microbe transplant instead of the pills. Because of my history with constipation, the clinic wanted me to do 2 months of preparation. Basically, I had to clean the pipe. First, I had to take Oxyklenz capsules -- a magnesium compound that hydrates the colon -- for 4 weeks. Then I had to have my first colonic irrigation. The colonic cannot possibly remove the bacteria in your microbiome, but it does remove toxins and other sluggish material. I had visions of a fire hose blasting away, but it was surprisingly low pressure. Both these preparatory steps showed me my colon reacts very aggressively to interventions, however. I must say I got about 3 days of improved energy following my colonic, which bodes well for potential changes following my transplant. I had to repeat this 4-week prep a second time. Tonight I need to take an extra large dose of Oxyklenz (sigh -- I'm so glad there's a toilet close to my bedroom here in England!).

Big day tomorrow as I will receive another colonic irrigation and my first transplant! I'll let you know how it goes.

~Sandra

Resources:

Mind-altering microbes: how the microbiome affects brain and behavior: Elaine Hsiao
https://www.youtube.com/watch?v=FWT_BLVOASI

Can microbes from someone else's poop help me?

Well...I'm about to find out.

On Monday, February 29, I will receive the first of 10 transplants of microbes from a healthy, screened donor. The next day, and for the next 9 days, I will receive another healthy, screened transplant, each a different donor. So, why am I doing this? Let me begin by telling you a little bit about myself and what I understand to be the science behind this promising field of research and discovery.

I'm a 56 (almost 57) year-old female, with a lifelong history of chronic gastrointestinal and bladder issues. Long before I knew I had multiple sclerosis, I knew I had problems with chronic constipation and infections, particularly urinary tract infections. Fast forward to my actual MS diagnosis in 1991, my neurologist traced the first symptoms of my MS to my bladder problems when I was 19 or 20 years old. When I finally got the courage to go see a gastroenterologist in 2001 about my constipation (not a subject I could easily talk about, even with a doctor!), he performed a colonoscopy and told me "Good news! It's only MS."

Unfortunately, this diagnosis of "irritable bowel syndrome from MS" did not bring relief. Between my frequent UTIs and bowel issues, I tried every folk and holistic remedy on the market. On top of that, I took antibiotics for a UTI numerous times a year. Eventually, I succumbed and also started taking prescription drugs to treat my bowel in 2005 when spasms started accompanying my ever-present constipation. I never went anywhere without my "blue pills" – an antispasmodic. Between them and massive doses of magnesium, I could manage. But there were days! I remember spending many hours trapped in bathrooms unable to get relief. It didn't matter if I was home, in a hotel, or in a restaurant – each of which happened many, many times.

Back to those darn antibiotics. I had the good fortune to sit with Dr. Terry Wahls through a dinner at the Canadian Neurovascular Health Society conference last October. She was interested in my progress following her adapted Paleo diet. When I recounted a 14 month long battle with bouts of physical fatigue interspersed with improved energy and function, she gently inquired whether I had a history of using antibiotics. I told her I had and, in the following weeks, I completed an extensive tally of the number of antibiotic prescriptions I had taken in my life. Tonsillitis as an infant and child/teenager, strep throat, sinus and other infections, post-op infections (after every type of surgery), and numerous bladder infections all quickly added up over my 56 years. Some of these prescriptions were for multiple months as doctors tried to prophylactically treat my bladder infections. The number of prescriptions for antibiotics over my lifetime, to date, is an astonishing 275.

Each prescription was accompanied by lab tests confirming its necessity. I would get very, very ill with a bladder infection to the extent that I could not move my arms or legs or even sit up. Within two days of taking antibiotics, I noted a marked improvement in neurological symptoms and physical abilities. My walking was BETTER than before I started taking antibiotics. However, by the fifth or sixth day of a seven-day course of pills, my MS symptoms regressed to my "normal." And then the cycle would repeat, sometimes twice a month.

Through this, I had an intuitive sense that I was either battling some hidden infectious agent or certainly an imbalance in my gut. I was lucky enough to be part of a study of nutrition and MS in 2013 conducted by Dr. William Shaw and Dr. Bill Code that showed that I had gut bacteria that weren't exactly welcome visitors. Although I didn't have C. difficile, I had 6-7 strains of bacteria that were not normally found in a human microbiome. Their effects on my health were unknown.

My husband and I continue to follow the diet recommendations of Dr. Terry Wahls. Despite eating the healthiest of foods, I don't feel I get the full benefit in terms of nutrition and improvements to my gut. In fact, I would describe my gut as a war zone. This history prompted us to seek fecal microbiota transplant (FMT) to reboot our systems and introduce a much wider diversity of microbes to their new homes. At the minimum, I expect it to resolve my lifelong battle with chronic constipation.

Yes, Landon is doing FMT beginning Monday too! As a couple, we share many common characteristics in our microbiomes (especially since we have a pet). Landon did not want to continue to harbour any of the more deleterious bacteria he picked up from me in case they found their way back or even affected his health.

One more person is coming with us to receive FMT: Dr. Bill Code. Like so many of us with a chronic illness, Bill is experiencing increased sensitivities to a variety of foods and other symptoms that may respond well to this treatment. I am thrilled to have him along as a good friend and physician!

My hope with this blog is to introduce the conversation to a wider audience of people who may be facing similar challenges. This may seem like something a person would keep private – my mom, if she was still alive, would agree! However, I feel strongly that sharing this experience will help me come to terms with the changes that may happen over the next months and years as I adapt to my new microbes (and they adapt to me!). I hope this may help others with a similar medical history or, like me, who have a feeling that something isn't quite right in their gut.

Here are some resources that helped me explore FMT as an option for my gut dysbiosis (a gut whose microbiota is severely affected and dysfunctional as a result of inflammation or antibiotics). Many of them mention taking pre- and probiotics – both of which I tried for many years and still ingest. However, for me, that just wasn't going to be enough to reverse the damage from a lifetime of antibiotics.

Many media stories have been done on FMT. Here's a link to broadcasts done by the Australian network ABC. I recommend beginning with their two-part series "Gut Reaction Part 1" and "Gut Reaction Part 2."

Australia is also home to one of the leading researchers in this field, Dr. Thomas J Borody. Here's a paper from 2014. In 2011, Dr. Borody studied the improvements in three MS patients following treatment with FMT for chronic constipation. This paper is the closest description to my health issues, with bowel, bladder, and mobility the dominant symptoms. His summary:

"An infectious cause of multiple sclerosis (MS) has been speculated, though the potential for gastrointestinal pathogens to exert neurological effects remotely (as seen with many Clostridium species) has not been considered likely. In 2011, Borody et al.[38] reported three wheelchair-bound patients with MS treated with FMT for constipation. Bowel symptoms resolved following FMT; however, in all cases, there was also a progressive and dramatic improvement in neurological symptoms, with all three patients regaining the ability to walk unassisted. Two of the patients with prior indwelling urinary catheters experienced restoration of urinary function. In one patient of the three, follow-up MRI 15 years after FMT showed a halting of disease progression and ‘no evidence of active disease’."

A more detailed excerpt from this paper can be found here. 

Interest in the microbiome is expanding rapidly, as a quick Google search will reveal. Here's the link to Google Trends.

You can see the current PubMed results for the search terms "gut" and "multiple sclerosis" by following this link.

I also edit a weekly neurovascular health newsletter that often includes timely articles. You can find the current issue here.

Because the three of us are also volunteer board members with the Canadian Neurovascular Health Society, we want to share our experiences with interested members of the public and researchers. We are in touch with several researchers and will continue to monitor and document our results. I also intend to share our experiences in this blog, beginning with regular updates as we receive our transplants starting next week. You can also comment and ask us questions! Don't be afraid to "talk poop" – we are ready for it!


I'm sure one of the questions you'll have is about where we are going and the cost. We are headed to the Taymount Clinic in Hitchen (just north of London), UK. We are paying just under $10,000 each, plus cost of travel and accommodations. It's a heavy hit to our bank accounts, for sure, but we feel the potential for improvement to our health is worth it.

~Sandra