Well written post ShaneM.
I'm glad to hear you are doing better, and better ! That's really great. You bring up many good points. Kudos.
I agree, eating the proper foods are pretty important. Our choice of foods influences which bacteria thrive in our gut. For example; fresh vegetables with resistant starches encourage the growth of our good bacteria, while eating sugary products increases the number of our bad bacteria. So diet is very important to our health. Including fermented foods in your diet, (if you can handle them) is also beneficial. I read this so many times. I just ordered my first fermentation crock from Stone Creek Trading. It's the 5 liter size and should be perfect for me. I tried a batch a while back in a glass cookie jar, but it didn't go very well, and I had to throw it out. The problem was in keeping the material below the brine, and maintaining an air lock to prevent the growth of fungi. The water seal airlock of the one I ordered is clever. I also liked the glass weights over the stone weights, as you don't need to boil and sterilize porous stones.. I've got one ordered for myself, and one for my son. It's a Boleslawiec design.
I've even read about 'fermentation festivals' that have started on the east coast somewhere. Apparently, it's catching on.
Since my successful transplant last year I have continued to ponder why some FMTs are successful, and some are not. I continually remind myself that I am basically a bacterial ecosystem, with bacteria cells outnumbering my human cells by 1.4 to 1. I am mostly bacteria, and I need to act like these bacteria matter, because they do play an amazing role in my health. The stacks of papers around my desk from research reports and other articles talk about the many aspects of this.
Recently, I've summarized my thoughts on improvements we can make, and hopefully have better outcomes. I've sent these to doctors that are doing FMTs in the sincere hope that we can improve outcomes. If just one thing helps them improve outcomes, it was worth my time. I'll review them here :
1. The 'Freeman' added a food product to the sample before transplant. At first I didn't recognize it's role. But, then I realized it's importance for giving the 'new' species of bacteria a boost when one is doing an FMT. However, since our good bacteria thrive on fresh vegetables, I make a suggestion to mix the sample with Healthy Greens (by V8) instead, thus giving the good bacteria a beneficial boost at this important step. So, now instead of mixing the sample with sterile saline, one could use Healthy Greens to homogenize the sample. Of course, we should try to do this in an anaerobic manner (the ziplock bag approach) to eliminate exposure to air, as much as possible, since air kills 90% of these bacteria. The blender approach that persists on the internet is terribly flawed.
2. The most experienced doctor in the world doing FMTs, Dr. Thomas Borody, does a clean out with Murilax, prior to the transplant. However most clean out protocols recommend a liquid diet of sugary products for two days prior to the use of the Murilax solution. I suggest using Healthy Greens, even during this step, in order to always promote the growth of our good bacteria, and limit the growth of our bad bacteria. One could also use Healthy Greens to mix with the Murilax instead of the Gatoraide. It's a healthy product with electrolytes that we need.
3. Some bacteria die in as little as 20 minutes, some take much longer. So, a couple of important things here. First, being completely empty after the use of the Murilax solution for a period of time may play a role. I started the Murilax at 1:00 pm. By 5:00 pm, I was completely empty, no more of anything coming out. I didn't do my transplant until 24 hours later. Sure, I was very, very hungry but I wanted to do everything possible to wipe out the existing species of bacteria that were giving me such problems.
The second part of this is; when the donor "delivers' the sample (in the ziplock bag with the air squeezed out) the transplant should be done, as soon as possible, thus limiting natural die-off. So, timing of everything is helpful.
4. Last year I realized that the appendix was playing a role in FMT success. I wrote to Dr. Borody about this. Six months later I read that the appendix is now thought to be a reservoir for bacteria which helps to repopulate the large intestine after a case of diarrhea. So, with this understanding, the practice of multiple 'top-off' infusions via enema,(after the initial transplant ) daily for 10 days, as Dr. Borody is doing, makes complete sense. It also makes sense that just one transplant procedure may not be enough to re-set the system for everyone, and thus doing it completely over again at one month intervals may be necessary in order to finally change out the bacteria that reside and dominate in the appendix and the rest of the system. We all want it to be easy, it's just not always that way.
5. The use of Biofilm Defense as mentioned in other posts may play a significant role in eliminating the existing bacteria population.
6. Avoiding processed foods. It was in the news this last year about the emulsifiers in processed foods. They are causing inflammation in the gut, to our microbiome. We can't expect to restore this ecosystem if we continue to mistakenly consume products that irritate or cause inflammation at the same time. So, both donor and recipient should be avoiding processed foods. Emulsifiers in these foods are under different names and are hard to spot.
Another reason for avoiding processed foods : the added sugars. Since it is well known that sugars are feeding our bad bacteria, and also contributing to pre-diabetes, and diabetes, we should avoid processed for this reason as well. Sugars are being added to just about everything in an attempt by food producers to encourage us to buy more of their product. Scientific medical research is beginning to understand that this is a big mistake.
7. Roundup. A recent, well written report has found that Roundup residues are killing our good, beneficial bacteria, while not harming our bad bacteria. It's also being connected with the rise in gluten intolerance. Since I have from 2,000 to 40,000 species of mostly good bacteria in my large intestine, this is a pretty bad product, and I am busy writing letters to bring attention to this harm. Roundup is used on GMO corn, soybeans, wheat and other products. It's even used to desiccate the foliage prior to harvest, thus putting more of that product on the seed kernel. So, trying to avoid gluten containing products may be helpful. I know this is a challenge, but when we know this product, even is small amounts, is harmful to our good bacteria, then we have to try to avoid it. I'm now using sprouted organic bread.
8. Finding the right donor. Donor selection is important. The average American has lost 40% of the diversity of this ecosystem of bacteria, the Human Microbiome. We know that athletes have more diverse microbiomes than the average person, so this is an important part of selection. The greater the diversity of this ecosystem is associated with better health, and thus making better donors.
Antibiotic use wrecks havoc on these bacteria. So, the longer the period of time since the last use of antibiotics the better. So, if you've got a donor that hasn't had any antibiotics in 10 years, and they exercise regularly, are slender and/or have an excellent BMI , and in absolute perfect health, no hay fever, depression, etc, etc. then you may have a good candidate. They need to be in perfect health, even have good oral health, no psychological issues, no allergies, no problems at all. Yet, they need to be athletic, and not have had antibiotics in a long time. I know this is a challenge, as so many of us have issues already from our over use of antibiotics and poor dietary choices. Donor health and donor selection is critical.
The donor should eat a diet high in fresh fruits and fresh vegetables for two weeks prior to the donation, thus increasing the numbers of good, beneficial bacteria. They should avoid all processed foods, and sugars, and avoid gluten. The recipient should do the same after the transplant. Cooked vegetables are OK. Reduce meat consumption. Encourage your donor to eat good fermented foods too. They help to provide the good bacteria that our bodies need. Increase your consumption of fermented probiotic foods.
9. Mouthwash and Chlorine. These both kill bacteria. So when we have this new understanding that we are mostly bacteria, it's pretty clear that these are not only killing harmful bacteria, their killing our good bacteria as well. We can't expect to restore this ecosystem of bacteria via an FMT if we continue to ingest products that are at the same time causing harm, and killing bacteria. I've installed a whole house chlorine removal system , and haven't used mouthwash in a long time. Toothpaste is a low grade poison. It hasn't been proven to cause no harm to our beneficial bacteria. So, until I find research proving that it doesn't harm my good bacteria, I won't use it. I still brush and floss daily with just water, and once per week use some baking soda. Of course, I've tried to eliminate almost all sugars from my diet.
10. Medicines and over the counter products. Several of these are harmful to our microbiomes. If you are taking one, please research whether it has an affect, or not, on your microbiome. Some example of ones that do : All antibiotics. NSAIDS. PPIs. Aspirin.
11. Chemicals. A recent news article talked about the long list of chemicals in our house dust. So, have these chemicals been proven to not cause harm to our good bacteria ? I am doubtful. I think we have to look at every area of our lives and ask, "Is what I am using or ingesting harmful to my good, helpful bacteria ?"
12. Antibacterial soaps and other antibacterial products. The average American has been found to be urinating triclosan. We have that much exposure. It kills bacteria. So, if we continue to use a product, whether it be a pair of scissors, or some other antibacterial impregnated product, or antibacterial hand soap, then we expose our good bacteria to something that is killing them. A big mistake. While I know that FDA has recently banned their use in new products, we have to realize we may still have products in our home that have these bacteria killers in or on them.
13. Cosmetic products. Cosmetics have no regulation or testing by the FDA. We simply have no understanding at all, if there are ingredients in these that are harmful to our good bacteria. Has anyone besides me, wondered why women tend to have more IBS, than men ? This is what research is finding anyhow. There just may be a connection here that science hasn't looked at yet. If you find anything on cosmetics and the microbiome, please share.
14. Palm oil has been found to be causing low grade inflammation. It is also known to have antimicrobial properties. So, I question it's use. I just use Canola oil, and I try to avoid hydrogenated oils as much as I can.
15. Oral health. Cass Nelson-Dooley makes some very interesting observations while talking with Dr. Kara Fitgerald. Our oral microbiome health plays a role not only in cardiovascular health, but it also plays a role in arthritis, and it also influences the health of our large intestine microbiome as well. Cutting out all sugars is good for our oral health and elsewhere. Flossing regularly is important for many reasons.
16. Exercise. We know that athletes tend to have more diverse microbes. There is some natural process here that influences your gut health. So, beginning and maintaining an exercise program in conjunction with an FMT should be part of the process.
17. Donor relationship. One report talked about there being a slight increase in success from donors that are related to the recipient.
However, Glen Taylor tries to use several different donors, thus increasing overall diversity of the sample. So, at this stage of understanding, it's unclear.
18. Some form of antibiotic 'knockdown'. I used Xifaxan, which is only effective in the Gi tract, and isn't absorbed into the bloodstream. ShaneM used a more natural product and also had success. Borody uses an antibiotic regimen before the clean-out phase.
At this point, it seems that some form of antibiotic 'knockdown' is helpful for success.
I know this has been a long post. I've tried to be concise and clear. I encourage anyone to look into my suggestions. I am hopeful that we can perfect this procedure and that many, many more people can find help from this. I know the biggest challenge for the DIY is to avoid contact with air; we can only do so much without the right equipment. I am saddened that this procedure costs so very much at the clinics that do offer it. We've got to look for every possible mistake and solve it, if we are going to increase our success rates.
I am continuing to do fine with no return of IBS symptoms. I still don't have dairy back, and just avoid it. My acid reflux is 95 % gone too, so that is nice. I continue to try to raise awareness about the human microbiome to local people, so they can understand and make better decisions for their health. I am intrigued by recent research on the microbiome and cancer and am hopeful that one day soon researchers will use an FMT to restore the bacterial ecosystem after chemotherapy and discover if this improves outcomes for deadly cancers that generally have poor outcomes with conventional treatment.
Shane has made such a great post and I'm really happy for his success. I just wanted to share in the hope that more people can have success.