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