Curious about a poop transplant? So are many of my patients.
I’ve heard fecal microbiota transplants can cure my gut health issues. What’s the latest science say?The “ick” factor of getting a poop transplant doesn’t faze many of my patients who are desperate to vanquish their gut health woes.Fecal microbiota transplant is the official name for the treatment, which involves taking poop from one “healthy” source and transplanting it into the colon of someone with a medical condition. We can do this via capsules or more invasive procedures such as colonoscopy.The idea is that by transplanting healthy poop to an unhealthy gut, we can alleviate certain illnesses, but so far, our hopes have gotten ahead of the data.I recently saw the Netflix documentary “Hack Your Health: The Secrets of Your Gut,” in which a woman with chronic gut symptoms makes her own poop pills. In the film, she claims she’s taken samples from her boyfriend and her brother.My takeaway: Don’t try this at home.The most common side effect after fecal transplants is abdominal discomfort, occurring in 13 to 30 percent of patients, but serious complications are not rare. A review published in PLOS One found that death occurred in 3.5 percent of patients and infection in 2.5 percent of patients — though to be clear, the majority of these were thought to be unrelated to the treatment itself and probably because people included in these trials were very sick to begin with.Chronic gastrointestinal disorders like irritable bowel syndrome and functional dyspepsia can dramatically affect the ability to live life, enjoy food and poop comfortably. The need for better treatments is so dire that we have patients who are willing to take needless risk and fly blind with DIY fecal transplants on the misguided belief they’ll be cured. But even a small chance of death or major infection is reason enough that none of us should try this on our own.The future of poop transplantsSo far, the data on fecal transplants has been consistently strong for only one condition: certain cases of a rare but very serious gut infection called Clostridium difficile.Research is underway to see whether fecal transplants can aid in the treatment of conditions such as inflammatory bowel disease, depression, obesity and more.In a seminal study published in Nature in 2006, researchers transplanted the gut microbiome from obese and lean mice into groups of healthy mice that ate a normal diet. When healthy mice received a fecal transplant from an obese mouse, they rapidly gained more body fat than those who had received transplants from a lean donor. The findings suggest there is a strong connection between our gut health and our risk for obesity.The microbiome — the collection of genomic information relating to the trillions of microbes living in our guts — is a thrilling area of research. Studies have clued us in to how critical a role it plays in human disease and health, including in metabolism, Parkinson’s disease, anxiety and colorectal cancer.But there’s still much we don’t know about the long-term risks of transporting samples from one microbiome into another.The garden of bacteria inside your microbiomeIn some ways, the human microbiome is like a garden, where sunlight, shade, water and soil nutrients affect whether you get weeds or beautiful flowers.As foods make their way down your gastrointestinal tract, different bacteria process the leftovers and create different byproducts. These byproducts vary depending on what we eat, giving you weeds or flowers. And they can have a big impact on our health. For instance, short-chain fatty acids are a well-known example of one such beneficial bacterial byproduct involved in our metabolism and immune system. They’re made more often by bacteria found among people who eat a high-fiber diet rich in plant foods and fish.We know that the microbiome is often altered in disorders like irritable bowel syndrome — and reduced microbial diversity is linked to worsened gut symptoms. But a 2019 meta-analysis of multiple randomized controlled trials did not show a benefit of fecal transplant for these patients.One reason is that there is no single microbial abnormality present in all patients with irritable bowel syndrome. Second, we’re still learning what roles each of the microbial species serves in our bodies and how they interact with the specific hormonal, dietary and neuronal influences within each unique host.In short, we still aren’t sure what combination of environmental conditions, including the microbes, will give any one individual weeds or flowers. The microbes we might think are “healthy” may just be typical for certain populations, and what we might think of as “unhealthy” may not actually be so harmful in others.What you can do now to boost your microbiomeWhile fecal transplant may not be the answer today, it’s clear most of us need to do something to boost our microbiome. What I recommend first is eating more fiber-rich foods. And if nothing else, take a daily psyllium supplement. These two steps not only are backed by rigorous data but also have virtually no risks.Your microbiome loves fiber. But chances are you’re like the vast majority of us who are not eating the recommended amounts. Women are recommended to consume 25 grams of fiber and men are recommended about 38 grams of fiber daily.One disturbing study published in Nature in 2016 found that with each progressive generation consuming a fiber-poor diet, the gut microbiota shifted. Eventually, subsequent generations lost huge groups of microbes that could not be fully recovered, even when they changed their diet to consistently eat high fiber.Eating whole foods and cutting down ultra-processed foods should be everyone’s aim — and adopting the Mediterranean diet is a perfect place to start.A psyllium supplement can also help. It’s a soluble fiber made from the husk of seeds that can increase short-chain fatty acid production. Psyllium is also a shape-shifter that responds in real time to your bowel needs: It provides bulk to stool when you have diarrhea but can also retain water, which softens up your poop when you’re constipated. For these reasons, psyllium is great for symptoms of irritable bowel syndrome and even fecal incontinence.In general, my patients find the powder easier to adjust into a dose that works for them. I usually recommend anywhere from 10 grams to as high as 30 grams daily, split between a morning and evening dose. Start on the low end and go up as needed.What I want my patients to knowToday there’s no way to comprehend the brain-gut connection — and our overall functioning — without thinking about the microbiome. If you’re suffering from chronic gastrointestinal problems, you may benefit from seeing a physician known as a neurogastroenterologist or motility specialist. Our work focuses on the brain-gut-microbiome axis, and it’s very common that I suggest treatments that other doctors haven’t yet considered because of how specialized the field is.
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I’ve heard fecal microbiota transplants can cure my gut health issues. What’s the latest science say?
The “ick” factor of getting a poop transplant doesn’t faze many of my patients who are desperate to vanquish their gut health woes.
Fecal microbiota transplant is the official name for the treatment, which involves taking poop from one “healthy” source and transplanting it into the colon of someone with a medical condition. We can do this via capsules or more invasive procedures such as colonoscopy.
The idea is that by transplanting healthy poop to an unhealthy gut, we can alleviate certain illnesses, but so far, our hopes have gotten ahead of the data.
I recently saw the Netflix documentary “Hack Your Health: The Secrets of Your Gut,” in which a woman with chronic gut symptoms makes her own poop pills. In the film, she claims she’s taken samples from her boyfriend and her brother.
My takeaway: Don’t try this at home.
The most common side effect after fecal transplants is abdominal discomfort, occurring in 13 to 30 percent of patients, but serious complications are not rare. A review published in PLOS One found that death occurred in 3.5 percent of patients and infection in 2.5 percent of patients — though to be clear, the majority of these were thought to be unrelated to the treatment itself and probably because people included in these trials were very sick to begin with.
Chronic gastrointestinal disorders like irritable bowel syndrome and functional dyspepsia can dramatically affect the ability to live life, enjoy food and poop comfortably. The need for better treatments is so dire that we have patients who are willing to take needless risk and fly blind with DIY fecal transplants on the misguided belief they’ll be cured. But even a small chance of death or major infection is reason enough that none of us should try this on our own.
The future of poop transplants
So far, the data on fecal transplants has been consistently strong for only one condition: certain cases of a rare but very serious gut infection called Clostridium difficile.
Research is underway to see whether fecal transplants can aid in the treatment of conditions such as inflammatory bowel disease, depression, obesity and more.
In a seminal study published in Nature in 2006, researchers transplanted the gut microbiome from obese and lean mice into groups of healthy mice that ate a normal diet. When healthy mice received a fecal transplant from an obese mouse, they rapidly gained more body fat than those who had received transplants from a lean donor. The findings suggest there is a strong connection between our gut health and our risk for obesity.
The microbiome — the collection of genomic information relating to the trillions of microbes living in our guts — is a thrilling area of research. Studies have clued us in to how critical a role it plays in human disease and health, including in metabolism, Parkinson’s disease, anxiety and colorectal cancer.
But there’s still much we don’t know about the long-term risks of transporting samples from one microbiome into another.
The garden of bacteria inside your microbiome
In some ways, the human microbiome is like a garden, where sunlight, shade, water and soil nutrients affect whether you get weeds or beautiful flowers.
As foods make their way down your gastrointestinal tract, different bacteria process the leftovers and create different byproducts. These byproducts vary depending on what we eat, giving you weeds or flowers. And they can have a big impact on our health. For instance, short-chain fatty acids are a well-known example of one such beneficial bacterial byproduct involved in our metabolism and immune system. They’re made more often by bacteria found among people who eat a high-fiber diet rich in plant foods and fish.
We know that the microbiome is often altered in disorders like irritable bowel syndrome — and reduced microbial diversity is linked to worsened gut symptoms. But a 2019 meta-analysis of multiple randomized controlled trials did not show a benefit of fecal transplant for these patients.
One reason is that there is no single microbial abnormality present in all patients with irritable bowel syndrome. Second, we’re still learning what roles each of the microbial species serves in our bodies and how they interact with the specific hormonal, dietary and neuronal influences within each unique host.
In short, we still aren’t sure what combination of environmental conditions, including the microbes, will give any one individual weeds or flowers. The microbes we might think are “healthy” may just be typical for certain populations, and what we might think of as “unhealthy” may not actually be so harmful in others.
What you can do now to boost your microbiome
While fecal transplant may not be the answer today, it’s clear most of us need to do something to boost our microbiome. What I recommend first is eating more fiber-rich foods. And if nothing else, take a daily psyllium supplement. These two steps not only are backed by rigorous data but also have virtually no risks.
Your microbiome loves fiber. But chances are you’re like the vast majority of us who are not eating the recommended amounts. Women are recommended to consume 25 grams of fiber and men are recommended about 38 grams of fiber daily.
One disturbing study published in Nature in 2016 found that with each progressive generation consuming a fiber-poor diet, the gut microbiota shifted. Eventually, subsequent generations lost huge groups of microbes that could not be fully recovered, even when they changed their diet to consistently eat high fiber.
Eating whole foods and cutting down ultra-processed foods should be everyone’s aim — and adopting the Mediterranean diet is a perfect place to start.
A psyllium supplement can also help. It’s a soluble fiber made from the husk of seeds that can increase short-chain fatty acid production. Psyllium is also a shape-shifter that responds in real time to your bowel needs: It provides bulk to stool when you have diarrhea but can also retain water, which softens up your poop when you’re constipated. For these reasons, psyllium is great for symptoms of irritable bowel syndrome and even fecal incontinence.
In general, my patients find the powder easier to adjust into a dose that works for them. I usually recommend anywhere from 10 grams to as high as 30 grams daily, split between a morning and evening dose. Start on the low end and go up as needed.
What I want my patients to know
Today there’s no way to comprehend the brain-gut connection — and our overall functioning — without thinking about the microbiome. If you’re suffering from chronic gastrointestinal problems, you may benefit from seeing a physician known as a neurogastroenterologist or motility specialist. Our work focuses on the brain-gut-microbiome axis, and it’s very common that I suggest treatments that other doctors haven’t yet considered because of how specialized the field is.