How to keep microbes from a donor's stool sample healthy ~ in a freezer and in our microbiomes!

We completed our 10 transplants and headed home. The final day was lengthy. We needed to collect all our home samples packed with medical ice in what looks like a cubic foot sized box. We were told not to open the box, which would expose the contents to air and lessen the time the microbes could be safely transported. 

Our time limit is 48 hours to get the samples to our home freezers. According to Glenn Taylor, clinic microbiologist, it's all about slowing the microbes. The clinic stores their samples at -80 degrees Celsius. Even at those temperatures, the microbes are s-l-o-w-l-y moving and trying to replicate. They can last quite a few months at these temperatures before there's a chance of mutation from the donor's microbiome. 

With this ever-so-slight chance of mutation from a live donor's microbiome, you might ask why does the clinic freeze the samples it uses for transplants done on-site at all? Could donors be lined up so there's essentially an assembly line of donor to scrubbing/screening microbes to recipient -- all occurring in real time with no time for mutation? Unfortunately, full screening cannot occur without freezing samples. Freezing for a minimum of three months means donors can be monitored and re-checked for emerging infectious or other disease. For example, if a sample screened clear, but the donor tested positive for hepatitis or HIV within three months, the sample would be destroyed. The three month donor test, then re-test ensures frozen samples are good to be used in clinic or sent home with a patient. 

Home freezers, however, are closer to -18 degrees Celsius than -80. Thus, as soon as we left the clinic with our sealed sample box, the clock was ticking. We had 48 hours to get them to our freezer and 6 months to use them. Despite outside temperature during our flight of -57 degrees or so, temperatures in the hold of an aircraft are approximately 7 degrees. So our 9-hour flight continued warming the microbes. Glenn Taylor said the rapid replicators (microbes that can reproduce in as few as 6 minutes) will be the first ones lost if they warm through transport, if our freezer isn't at least -18, or if more than six months passes. These rapid replicators, already moving slightly at -80 degrees, will speed up even more once in a home freezer. As soon as they manage to replicate, every million or so replications will result in a mutation. This mutation will adapt the fittest microbes to be ones that can live the best in a home freezer, not a human body. The more time passes and more replication cycles happen, the less our frozen transplants will resemble those taken from our live, healthy donors and the more they will look like microbes adapted to a frozen, plastic home. 

This whole dilemma of how to transfer live donor microbes into recipients while ensuring full safeguards of screening is also the issue with probiotics. Because these microbes are cultured outside a live body, many mutations will have occurred that make the microbes more and more removed from conditions in our gut. As I previously mentioned, probiotic microbes are transient, helping as they pass through our colon, but not taking up permanent residency. Given their mutated state (and maybe because of it??), that's probably just as well. 

If I use my two extra samples plus the two from Landon, I feel I can top up my clinic treatment quite nicely in the next 4-5 months. I can even get one or two additional from the ones we bought between the three of us to extend my post-treatment to six months. That's my plan. 

If I need antibiotics or get food poisoning, my plans will need to change. That will require at least two transplants in fairly close proximity after the assault on my microbiome ends. Fingers crossed I don't experience that type of setback anytime soon. I feel curiously protective of my new microbiome. I am going to treat my new microbes royally so I give them (and me) the best chance to succeed. 

We brought home several months' supply of Bimuno, a galacto-oligosaccharide resistant starch, which means it's only digestible by our microbiomes. Once I found out it dissolves tastelessly in tea, this has become part of my morning routine. Months ago, when I still had a severely dysbiotic gut, I tried the same thing with another prebiotic, inulin, but I ended up with very painful cramps and diarrhea after six weeks. I clearly didn't look up the potential side effects and heed the warning: "There is nothing inherently wrong with chicory root or Inulin. As a prebiotic, it has quite a few documented health benefits. However, most people can tolerate it only in small quantities, even if they tolerate other kinds of fiber quite well. The reason for this is that Inulin provides a veritable feast for certain types of gut flora. Many people don’t have a well balanced gut flora to begin with. In the age of antibiotics, dysbiosis is common. Feeding the wrong kind of bacteria can cause serious (no really, serious) amounts of gastro-intestinal upset, gas, explosive diarrhea and discomfort. This is obviously not good for nutrient absorption, either."

So far, I haven't experienced a similar response to Bimuno (well, almost). Each transplant has about 1/2 a sachet mixed into it in the incubator to give the microbes something to eat as soon as they are thawed. We were instructed to ingest a full sachet each morning. I experienced really bad bloating and gas on Day 2, which could have been the Bimuno or the war between my old and new microbes. The nurses had me cut back my Bimuno for a few days just in case, but I didn't experience any similar effects after I increased back to a full dose. I guess it was just a sign of the War of the Microbes!

Resistant starches are attracting a lot of research attention for their potential to cure disease, reduce inflammation, and maintain a healthy gut. In order to be also considered a prebiotic, a resistant starch must be able to survive passage through the stomach and small intestine, be able to be fermented by our gut microbes, and help our good bacteria reproduce and function. Learn more here and here.

~ Sandra