Just when you thought things couldn’t get an weirder:
“Some people with potentially lethal gut infections find that the only effective treatment is an orally-administered fecal transplant. The treatment is gaining acceptance among physicians.”
Olga Khazan pens a pretty interesting piece and in parts, resorts to what one has to do, I guess, and that’s just toss your hands up and laugh. First, some of the serious.
By the time patients arrive at the office of Bruce Hirsch, an infectious disease specialist at North Shore University Hospital in Long Island, they’re desperate. Many have diarrhea that strikes up to 20 times a day. They eagerly pay $1,200 out of pocket for the only thing that might make their lives normal again.
Hirsch offers them an orange pill, which they swallow. Underneath the pill’s outer shell are several smaller gel capsules. Inside the smallest capsule is a glycerin-suspended clump of bacteria that’s been extracted from human feces.
“It’s like a Russian doll,” Hirsch told me. “With a surprise in the middle.”
Hirsch is one of just a few dozen specialists in the country who perform fecal transplants—procedures used primarily to treat people who have severe gut infections caused by an overgrowth of a bacteria called Clostridium difficile.
C. diff is a big problem. According to the article, 250,000 Americans are hospitalized each ear and a whopping 14,000 die. Often, these infections are brought on by a round of antibiotics but often enough, just from contact with the bacteria itself. Even the most potent administration of antibodies don’t stop it and in fact can just make things worse, as those antibiotics will kill off the good bugs.
So here’s the kicker:
Increasingly, doctors are finding that their last remaining weapon is the bacteria from a healthy person’s bowels.
So, it it that C. is so difficult, or is it that the quality of the human gut biome has been so degraded over decades by bad diets, antibiotics as candy, and over sterilization? Recall the magnitudes greater gut health Tim “Tatertot” Steele developed with a clean diet heavy in prebiotic resistant starch, such that his biome was in better shape than anyone’s they had ever tested.
So basically, rather than try to kill it with complex, fancy, expensive, high-tech drugs, they just switch out a person’s shit with that of a healthy person.
In January, a study in the New England Journal of Medicine found that a far higher percentage of patients infected with C. diff recovered among a group being given an enema containing the stool of a healthy donor than did among those who were treated with antibiotics. Fecal transplants have been shown in that and other studies to cure 90 percent of C. diff infections within a few days.
Very low-tech, inexpensive cure, wouldn’t you say? Now, this part cracks me up.
Despite his years in medicine, Hirsch seems perpetually shocked by how poop—the archetypal odious substance—can be so curative. Shit’s inherent nastiness is, it seems, partly what’s been holding it back from curing countless C. diff patients by now.
“I mean, it’s really impressive how disgusting shit is,” he said. “Our experience of stool is this brief, six-inch flight time from rectum to water. But really, it’s not that it smells bad, it’s that the bad smell is deep. There’s a profundity. If you were describing a wine, it would be ‘woody notes, with a depth of pestilence underneath it.’”
At the same time, though, “Shit is a great drug.”
And by contrast:
Antibiotics, on the other hand, are “like a blitzkrieg on the gut,” explained Gerard Honig, a neuroscientist and the director of operations at Symbiotic Health, the startup working with Hirsch to take his poop pills to a broader market. Antibiotics usually kill what ails the patient, but they also sweep away much of the beneficial flora that keeps C. diff at bay. Meanwhile, C. diff hides out until the antibiotics have run their course, and then takes over the digestive system.
It’s well known that the microbiome—the bacterial makeup—of each person varies, but that of healthy people appears to be able to successfully settle and grow in the gut of a sick person.
First, the transplanted fecal material joins the stream that courses through the intestines. Once in the colon, the bacteria divide and propagate.
“The C. diff gets crowded out,” Hirsch said. “It’s basically lost its ecologic niche.”
Within a few days, most of Hirsch’s patients have a normal bowel movement, sometimes for the first time in years.
There you go. What could be simpler than a relatively clean diet, adequate probiotic fermentable fiber and of course, our old friend Resistant Starch. You still won’t be able to claim that your shit doesn’t stink, but you might be able to sell it anyway.