“Fecal transplantation”, “fecal transplantation”, “fecal microbiota transplantation”, “fecal bacteriotherapy”, “fecal therapy” stool transplant are names of the same process. The official name is fecal microbiota transplantation, or FMT. This is the “planting” of a healthy ecosystem of bacteria into the intestines of a person with a disease.
We tell you why and who needs a transplant, how it is done, and why you should not do it yourself.
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Why and who needs a stool transplant
Scientists have already realized that not all bacteria are bad, as they previously thought. Moreover, a whole ecosystem lives in the human intestine, which is responsible for the health of the entire organism.
A healthy intestinal microbiota is a balanced community of beneficial, neutral and pathogenic bacteria. This microbiota enhances the immune response, protects against inflammation, obesity, type 2 diabetes and ulcerative colitis, and regulates mood and behavior.
Research shows that transplanting healthy microbiota can help treat some inflammatory and infectious diseases.
As of 2023, intestinal microbiota transplantation is a recognized and effective treatment method only for pseudomembranous colitis . This is an acute disease of the large intestine, caused by a violation of the intestinal microflora and the bacterium Clostridium difficile .
The use of FMT for the treatment of dysbiosis and other conditions requires additional research. We’ll talk about this a little later.
History of stool transplantation
The first mention of fecal transplantation is found in a Chinese medical treatise of the 4th century. The author advises eating “yellow soup” to treat food poisoning and diarrhea.
The Bedouins recommended eating “warm, fresh camel feces” as a cure for bacillary dysentery. The effectiveness of this method was later confirmed by German soldiers of the Afrika Korps during World War II.
Camel feces contain Bacillus subtilis. This bacterium is not dangerous to humans and produces the enzyme subtilisin, which copes with dysentery.
In modern medicine, transplantation of intestinal microbiota in the form of an enema was first used in 1958 by the American doctor Ben Eiseman to treat pseudomembranous colitis. This is an acute disease of the large intestine, caused by a violation of the intestinal microflora and the bacterium Clostridium difficile.
How does gut microbiota transplantation occur?
Fortunately, modern doctors are unlikely to recommend “yellow soup” or camel feces to improve the functioning of your gastrointestinal tract.
Doctors and researchers have several ways to “inject” healthy bacteria into a person with a disease, but for any of them you must first obtain donor material .
To do this, a person with a healthy microbiota collects biomaterial (feces) into a sterile container.
Doctors who use FMT follow strict procedures when evaluating how the sample is prepared and delivered. Both fresh and frozen stool are used.
Then the biological material undergoes purification – specialists remove all unnecessary substances (food residues and fibers), add saline solution and filter.
By the way, for the Atlas Microbiota Test we also “filter” the stool sample, and then isolate the DNA of the bacteria. This allows you to assess the diversity of microorganisms, their ability to protect you and produce substances beneficial to the whole body.
You can introduce the resulting “cocktail” of bacteria into the body in several ways:
- Into the colon using a colonoscope.
- Through a tube through the mouth or nose.
- In the form of tablets – orally.
Straight to the colon
This method is considered the most effective . A healthy donor sample is emulsified with a saline solution, a long tube is inserted through the rectum into the colon, and the liquid is sprayed onto the lining of the organ.
In some cases, patients may have severe damage to this organ, making this procedure unsuitable.
Through the nose
A tube is inserted through the nose and, bypassing the acid barrier of the stomach, a liquid stool solution and a saline solution are delivered by the tube to the small intestine .
This can sometimes cause vomiting, and particles can enter the lungs and cause bacterial pneumonia, which is life-threatening.
Tablets (capsules)
The fecal solution is introduced into capsules with a special shell that protects from gastric juice.
In April 2023, the FDA (Food and Drug Administration) approved the first fecal tablet to prevent the recurrence of C. difficile infection.
The tablet is not yet available in Russia – doctors use only methods of direct injection of the extract.
The future of stool transplantation
An imbalance of the microbiota, dysbiosis , can occur after an illness, a course of antibiotics, due to stress or a poor diet. With dysbacteriosis, many beneficial bacteria die, which creates the opportunity for active reproduction of pathogens.
Dysbiosis accompanies inflammatory bowel diseases, such as irritable bowel syndrome and celiac disease, and is also associated with an increased risk of coronary heart disease, type 2 diabetes, obesity, Parkinson’s disease and more.
Doctors and scientists place much hope in fecal transplantation as a non-invasive and non-invasive form of treatment for dysbiosis and several serious diseases.
Inflammatory bowel diseases (IBD)
IBDs such as Crohn’s disease and ulcerative colitis cause lesions, scarring, and impair the absorption of nutrients. Occurs in adults and children in developed countries and increases the risk of developing certain types of cancer and Parkinson’s disease.
Although fecal transplantation is not a proven cure for IBD, there is research suggesting that FMT improves the symptoms of these diseases in some patients.
Metabolic syndrome
This group of diseases increases the risk of type 2 diabetes, cardiovascular disease and stroke. People with metabolic syndrome have high blood pressure, high cholesterol and blood sugar, and excess fat tissue in the abdominal area.
Intestinal bacteria influence many metabolic features of the body. Numerous studies show that a healthy gut microbiota increases protection against coronary heart disease and type 2 diabetes.
The Atlas Microbiota Test helps assess the contribution of the bacterial community to protection against ulcerative colitis, Crohn’s disease, type 2 diabetes, coronary heart disease, and obesity.
Graft versus host disease
This rare disease affects people who have received donated bone marrow or peripheral blood stem cells. This occurs when these grafts perceive the recipient’s body as foreign and attack it.
Small studies suggest that FMT has some positive results in the treatment of graft-versus-host disease.
Other diseases
The bacterial composition and proportions of the microbiota are associated with many indicators of the body. It’s not for nothing that scientists call microbiota the “second brain” and treat it as a full-fledged organ.
Medical scientists believe that FMT can help treat a wide range of diseases, including:
| Irritable bowel syndrome | Depression |
| Multiple sclerosis | Antibiotic resistance |
| Acute malnutrition | Obesity |
| Liver disease | Autoimmune diseases |
| Allergic diseases | Autism Spectrum Disorders |
More research is required to confirm the effectiveness of microbiota transplantation for treating these conditions . You should be especially careful with offers from some clinics to “lose weight” using FMT.
Elizaveta Gilman, head of the nutrition department of the biomedical holding Atlas
Expert quote:
“Stool transplantation has not yet been very well studied and can only be used for C. difficile infection. I have had clients who spent $10,000 on a transplant because some clinic promised them weight loss. And it didn’t happen.
But there was also a client who had a microbiota transplant, and her bacterial diversity increased, after which she began to feel better.
For now, people need to approach this very carefully, study all the pros and cons, and not fall for the promises of some clinics about losing weight . ”
The functioning of the entire body depends on the state of your intestinal microbiota. Want to know more about how microbiota affects your health?
Take a free mini-course from Atlas “My Happy Gut”.
How safe is gut microbiota transplantation?
There is a case where a woman received a fecal transplant to treat C. difficile. The treatment was considered successful until the patient gained excess weight in a short time, which raised questions about the quality of the biomaterial used. As a result, doctors discovered that the fecal sample came from an obese person .
This case not only demonstrates how the gut microbiome can influence the body, but also how important it is to choose a healthy donor when undergoing a transplant.
Each person’s microbiota may contain pathogenic and drug-resistant strains of bacteria, diseases and viruses.
Even minor infections in healthy people can put people with weak immune systems at risk.
In the United States, two immunocompromised patients were infected with multidrug-resistant organisms from donor samples. One of the patients died.
Fecal microbiota transplantation must be performed with the utmost care, exceptional quality control, strict sampling protocols and stool donors prior to use:
Scientists still do not know what the “ideal microbiota” should be, because the composition of bacteria is different even among identical twins. But some criteria are required when selecting donors. These are age, body weight, mental illness, recent use of antibiotics and visits to tropical countries.