Next time you go to the shop, go and look for something that is 1KG, like a bag of sugar. Pick it up and ask yourself how heavy it feels? Quite heavy, right?
That’s the weight of the microbes that live in your gut, yes, I know, that’s nuts. A healthy adult can contain 100 trillion gut microbes, that’s also nuts and I could give you more stats but I want to talk a little more about these microbes instead. Together they form the gut microbiome and they are our friends. Some scientists refer to them as an acquired organ and just like an organ, they too can be transplanted.
We humans provide them with a safe and cosy environment to live in. In return for this hospitality, these lovely organisms provide us with a bounty of useful functions. They help us extract more nutrients from the food we eat. They make vitamins that we can’t create. They also help to train our immune system to be more precise. I think they’re awesome.
Another crucial function of theirs is that by simply existing in our gut they create a barrier to stop bad bacteria from colonising our insides. The more diverse the gut microbiome is, the healthier it is, and the better it is at providing all of these shit-hot functions.
However, as you can imagine, things can go wrong. The fine-tuned balance of diverse microbes can shift. For example, if you take a strong course of antibiotics, it is likely that some, if not many, of your microbial friends will perish, leaving space for invaders to colonise. If some of these are baddies, such as the clostridium dificile bacteria, then you’re in deep shit. Before you know it, you’ve got a clostridium dificile infection (CDI), they’re wrecking havoc all over the place producing toxins and you’re running... to the toilet.
These CDIs are very common. They range from the mild runs to potentially lethal conditions. The treatment is a course of antibiotics which generally sorts it out. But about one in five people can go on to develop recurrent infections for which antibiotics become less effective. Luckily, these patients have an alternative. They can get a faecal microbiota transplant (FMT). FMT is a treatment that involves the repopulation of the gut microbiome with the help of someone else’s poop. It sounds icky but it’s totally legit.
A healthy donor provides some poop, it’s prepared by a clinician and then gets administered into the patient’s bowel. This injection of a healthy, diverse population of microbes helps to restore the gut microbiome and kill off the toxin-producing posse (i.e. clostridium dificile).
FMT has shown promising results in the treatment of recurrent CDI. Of the 500 cases that have been studied in the literature to date, the cure rate is almost 90%. That is awesome. Treating recurrent CDI with FMT also helps to forgo the use of more antibiotics. I like this treatment even more.
Unfortunately, FMT is not yet widely used. Perhaps the concept of poop donations is a little tough to swallow. However, medicine regulators are coming to their senses and giving clinicians more freedom to employ FMT. This makes me very happy because we are only starting to uncover the links between a dysfunctional gut microbiome and ills such as anxiety, depression, diabetes, colorectal cancer and liver disease.
I don’t think it’s too far off to think that one day we’ll be buying poop pills over the counter to transplant our gut microbiome.
Gupta, S., Allen-Vercoe, E., Petrof E. O. Therap Adv Gastroenterol. 2016 March; 9(2): 229-