“The Excrement Experiment” by Emily Eakin. The New Yorker, December 1, 2014.
Crohn’s disease is a nasty, chronic inflammatory bowel disease that destroys the lining of the digestive tract. It is an autoimmune disease. As many as seven hundred thousand Americans suffer from it, but it is poorly understood and considered incurable. The only treatment is with potent immunosupressant drugs with serious side effects and often surgery to remove part of the damaged colon.
Now, fecal transplants from a healthy donors have shown amazing results in many patients. The Cleveland Clinic named fecal transplantation one of the top ten medical innovations for 2014.
The point of the transplant is to introduce a wide variety of helpful bacteria into patients who lack them, either as a result of a modern, sanitized childhood or from an antibiotic treatment.
To be perfectly clear and not mince words, a fecal transplant—the official term is “fecal microbiota transplantation,” FMT—is the transfer of feces, usually someone else’s, into your body. This is done by enema or simply swallowing the poo in a specially prepared capsule that will not break apart in your mouth. Human poo is about 40% microbes.
A single treatment may work, but swallowing a capsule once a week or so is typical for Crohn’s patients. This doesn’t matter much; the poo would have gone to waste, anyway.
You could simply ask a healthy friend for a sample, have it tested for pathogens (can be done by mail), and do it all yourself with only a blender, rubber gloves and a turkey baster, but hundreds of physicians now perform the procedure, and there is already a nonprofit feces bank to meet the increasing demand. A doctor has to get FDA approval since it is still considered experimental. In some hospitals, patients scheduled for aggressive antibiotic treatment are asked to bring in a stool sample so their own gut bacteria can be reintroduced.
For the do-it-yourselfers, Amazon carries “The Fecal Transplant Guidebook” in paperback (no pun intended).
If you would rather be a donor, the feces bank pays $40 for a generous sample (a monthly prize is given for the most generous sample), but less than 20% of potential donors can meet the requirements, which are:
- No antibiotics taken in the previous six months.
- No recent travel to a developing country.
- Pass a stool test for pathogens, such as B. hominis, a parasite that is found in up to ten percent of healthy people.
- Be able to provide a sample no more than one hour old at the bank in suburban Boston.
Scattered case reports in the medical literature had earlier described treatment of patients with Clostridium difficile infections (with symptoms similar to Crohn’s), some on their deathbeds, who received fecal transplants and recovered, often within hours. Then, in January, 2013, The New England Journal of Medicine published the results of the first randomized controlled trial of FMT, comparing the therapy to treatment with the antibiotic, vancomycin. The trial was ended early when fewer than a third of the patients given vancomycin recovered, compared with ninety-four per cent of those who underwent fecal transplants—most after a single treatment.