By Andrea Palmieri

The human gut microbiome and its relationship to disease is an excitingly new and rapidly evolving field of study. Over the last couple of decades, rapid advances in genetic technology and bioinformatics methodology have led to greater insight and appreciation of the microorganisms inhabiting the human body. More and more research scientists are making the connection that, apart from our own genome, these microbes may play a significant role in the state of our health.

Many people are surprised to learn that there are scary-sounding microbes lurking within us, like Escherichia coli ( E. coli ), but most strains are harmless and are actually an important part of a healthy human intestinal tract. Our microbiota confers many benefits, including metabolic, protective, and immunological function: It breaks down and absorbs undigested food that would otherwise be lost by excretion; they represent the first line of defence against pathogens; and are part of the regulation of the immune system.

When the gut microbiome becomes “unbalanced,” such as a loss of diversity of beneficial bacteria or an increase of opportunistic pathogens due to taking antibiotics, a person can develop diarrhea and other intestinal problems. There is a growing body of evidence that supports controlling the population of the gut microbiota by introducing beneficial gut bacteria to help combat infections and to alleviate the various adverse effects of gastrointestinal disorders.

A relatively new investigative method that can do this is fecal transplants, also known as fecal microbiota therapy (FMT), which is… exactly what it sounds like: the transfer of bacteria obtained from the feces of a healthy person into the gut of a patient through an enema or colonoscopy, with the aim of restoring a healthy microbial community. It has been primarily used in cases where traditional antibiotic therapy is ineffective against Clostridium difficile — a bacterial stomach infection that causes diarrhea and can lead to severe colon inflammation and even death.

Current evidence supports the safety and efficacy of this innovative alternative therapy and has reported very high cure rates, low relapse rates, and no serious adverse events. This method is approved and regulated only for treating this recurrent bacterial infection . Further research is needed to support the treatment’s efficacy with various other conditions such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).

Of course, nothing in this world is risk-free. Last year the U.S. FDA issued a warning aimed at healthcare providers using FMT after two immunocompromised adults developed infections from an antibiotic-resistant strain of E. coli following transplants from stool contaminated with the bacteria. One of the two people died following the infection.

The stool used in this case was not tested for these microorganisms prior to the transplant procedures. The FDA, as well as Health Canada, now recommends that doctors performing these transplants follow more stringent safety measures, such as screening donors for all relevant transmissible diseases and multi-drug-resistant organisms; and testing the donor stool to ensure it does not contain any harmful pathogens.

As this procedure has become more mainstream, there has been a movement of people advocating FMT and suggesting it can be performed at home by taking a pill or enema of feces from a healthy donor. There are many fecal transplant DIY videos online and groups on social media swapping tips and seeking donor referrals to cure everything from allergies to anxiety.

In 2013, for example, a man named Michael Hurst made a YouTube tutorial on how FMT cured his ulcerative colitis, and proceeded to demonstrate the methods and procedure on how to do this at home. Natural health pages like this one boast about the simplicity and cost-effectiveness of DIY FMT and having “instantaneous and enduring” effects. This has prompted some NGOs and Health Canada to formally denounce this practice at home and urge patients to wait for scientific evidence, due to significant safety concerns and risk of serious infection if not done properly in a medical setting.

It can be extremely tempting to want to try and cure yourself of a debilitating condition when there are no more options left. The benefits may seem to outweigh the risks for patients suffering daily. However, performing a DIY fecal transplant can make things worse. Conditions such as IBD are more complicated than a C.difficle infection — two doses can cure this bacterial infection, whereas the standard doses for other conditions have not yet been established.

The research surrounding FMT and its effectiveness for other conditions is still developing, as well as the research surrounding the gut microbiome and its greater effects on non-gut-related conditions. In the meantime, for those who believe FMT can help their condition, they can speak with the medical team helping manage their condition to determine whether they would be a good candidate for clinical trials in which fecal transplantation is performed in a safe, controlled setting.

This article appears in the May 2020 version of Critical Links.