Up Yours! Why Artificially Cleaning Our Colons Might Not Be Such A Great Idea

Isn't the colon beautiful?

In 2004, I was scheduled for my first and only colonoscopy. I had been suffering from chronic constipation for decades, which had progressed into bloating and cramping as well. After ruling out parasites, my GP referred me to a gastroenterologist for a colonoscopy. The specialist told me I had two choices to clean out my bowel before the scope -- chemical or non-chemical. Everyone has heard horror stories about the chemical prep, so I opted for the natural route. He told me to eat like I had the flu for three to five days. Because I'm a bit of a worrier -- and because the reason I was seeing him was for sluggish bowels -- I extended my prep to at least seven days. I ate (drank) clear broth, Gatorade, ginger ale, and peppermint tea. I asked to watch the screen during my colonoscopy and I was delighted to see my colon walls were bubblegum pink! It was beautiful. My GI doc said I had a perfectly healthy colon and -- "good news!" -- my bowel problems were "only MS."

So, it appears the colon does a very good job of cleaning itself, even after decades of constipation. Fast forward to our prep for the fecal microbiota transplant. Normally the clinic has a patient do one colonic (colon hydrotherapy) session a month ahead. Because of my history with chronic constipation, the matron asked me to do two colonics plus 8 weeks of heavy duty magnesium therapy, beginning two months ahead.

 

Each of us received a final colonic immediately prior to receiving our first transplant of fecal microbiota. I must say the colonic they did in the clinic on our first transplant day felt much more effective. While one nurse managed the water input and output, another nurse massaged my abdomen. Not that I intend to do colonics in the future (see below), but I feel anyone needing a colonic should definitely look for a clinic that does this type of abdominal massage at the same time. 

All the slushing and sucking and waves of pressure certainly FELT like my colon was completely cleaned out during each colonic. Despite this "squeaky clean" feeling, you can rest assured that your colon is NOT cleaned out of its microbes! Your permanent microbial residents are embedded in your mucosal lining and not going anywhere. The bulk of your stool is their progeny, reflecting the full diversity of your microbiome. It's also a measure of your health – the more microbes as a percentage of your stool volume, the better you are at tending your microbial "garden."

I asked the clinic nurses if I should repeat my month long prep, including a colonic, prior to inserting each sample of microbes we took home. Their answer: definitely not! The nurses advised us never to have a colonic again. The clinic microbiologist shed further insight on what was behind their advice. As I mentioned previously, our gut microbes replicate anywhere from every 6-30 minutes, depending on species and conditions. The fastest ones (Glenn called them early replicators) get a head start on taking up all the space and nutrients after a colonic. This gives them an ever-so-important competitive edge over their slower-replicating microbe neighbours. The slower replicating ones are left behind and may never catch up or die off completely.

The net result? A potential shift in our microbiomes based only on how quickly the microbes can start dividing. Our guts slowly lose microbes that divide slowly and become occupied with progressively faster and faster (because they mutate to match your conditions) species. This is not exactly ideal and, over time, we lose microbial diversity. Because we just got ten transplants of healthy microbes in balance with each other, the last thing we want to do is start giving one type preferential treatment.

It's difficult to google these topics because so many places are trying to sell you products or services that they write convincing reviews with purported facts, but none of it backed up by actual research. Researchers find funding hard to come by that isn't underwritten by a commercial entity. That, I believe, is shifting as knowledge of the microbiome's significance to our health is accelerating.

Some articles, like this one, lay out the basic facts about our microbiome:

"The microorganisms living inside the gastrointestinal tract - also known as the gut flora - amount to as much as 4 pounds of biomass, with every individual having a unique mix of species. 

The microbiota is important in nutrition, immunity and effects on the brain and behavior. It is implicated in numerous diseases when the normal individual balance of microbes is disturbed"

I decided to look into potential damage to the microbiome from chemical cleansing -- such as the type performed before a colonoscopy. My hypothesis was any damage could be from the same phenomenon: early replicators get a jump start. This study found 3 out of 15 patients doing a colon cleanse prior to a colonoscopy had lasting changes to their gut microbiomes compared to 5 people who did not do a cleanse. However, the study found wide variations within microbial species and within each individual, with no consistent trend that resulted in statistical significance. A quick look at one of their charts shows you SOMETHING is going on (each colour equals one participant. Each participant had three samples tested, 1 month before (-1m), 1 week before (-1w), and 3 months post (+3m) colonoscopy. Control subjects were tested twice 3 months apart and are labelled A, B, C, H, and W. The closer the dots are for each colour, the more similar the test results of each person's microbiome.

Without seeing their data, I can only speculate that achieving statistical significance with a small study like this posed unique challenges. The researchers acknowledge some patients with ulcerative colitis (or on medications for UC or iron supplements) showed shifts in gut diversity in other small studies and their own. The control subjects (A, B, C, H, and W) appear to have more similar test results (shorter lines) than the numbered participants. Yet, because the net sum of these shifts zeroed out, the conclusion was there is no net change following chemical preparation for a colonoscopy.

It is possible the problem lies with the testing what is in the microbiome itself. We chose to pay for testing before we went for FMT through a crowd-sourced, open source citizen science project called the American Gut Project.

We are still waiting for our results from our pre-FMT testing. We will do our post-FMT tests at least three months after our last transplant. For me, that means waiting until I complete my four home transplants, which will likely be in July, so I will do a test in November.

If this subject of our microbiome interests you (which is obviously does because you're reading a blog about it!), it's well worth a few hours of your time to cruise through the website of the American Gut Project. You'll find the latest research, TED talks, blogs, and more. Go here: http://americangut.org/

However, sequencing our microbiome seems to be in, as one person called it, "cowboy country." A reporter sent kits to American Gut and uBiome, a commercial microbiome lab, and got dramatically different results -- from the same poop sample taken from the same piece of toilet paper!! Hmmm. If you're thinking about spending money to get YOUR microbiome sequenced, you might want to read her article about her problems with its accuracy. Her ultimate conclusion is we simply don't know, on the basis of these tests (and, speculatively, in gut research) what's in our poop. <sigh>

So, after three colonics, eight weeks of magnesium depth charges, and ten fecal transplants, I simply have to have faith that what I've done has made a difference to the make-up of my microbiome. I know it is making a difference to my clinical symptoms -- more on that next time!

~Sandra

(p.s. it may take you a minute to "get" this next cartoon, but it's worth it...!):