Fecal Transplants: Ben's Story

Continuing my adventures in understanding the long hollow tube that is the human GI tract, I've been in correspondence with a blog reader, Ben D., for the past month or so regarding fecal transplants and our similarities in intestinal dysfunction.  We are definitely gut brothers from other mothers, as his symptoms match up incredibly well with my own.  When he told me he would be trying the human probiotic home infusion protocol a few weeks ago, I was very curious to follow his progress.  Ben was wonderfully light-hearted and humorous about the whole thing while providing very useful information regarding his 10-day transplant experience.  Here is his intestinal saga in his own words.  Thanks, Ben!

What's up gutsers? I am coming to the end of 10 days of fecal transplant therapy carried out at home with my doctor's blessing and prescriptions.

I am posting here because I want to answer any questions people have about the procedure, especially if they are considering doing it themselves. So far it has improved my symptoms quite a bit, but has not been a total cure. I think it is going to turn out to have been a very valuable tool in the treatment, and eventual cure of my condition.

Below is a short version of the whole story of my illness. Check it out before asking questions... the answer may be in there.

My name is Ben. I'm 25 and I've been dealing with Post-Infectious IBS-C since January 2010. It started on a trip to India with some diarrhea and then I became constipated for the next two months of the trip. I tried the usual fiber + probiotics and I think they just made things worse. Since nothing was moving, I think they just gathered in my small intestine and gave me a case of SIBO because I ended up with terrible bloating on top of the C.

I had stool and blood tests done, as well as a colonoscopy, while traveling and they all found nothing. The Indian doc diagnosed the P-I IBS-C and gave me Lactulose, a daily laxative. I took that for a while and it helped the constipation, but made the bloating much worse. I eventually got another case of diarrhea, took some antibiotics for the diarrhea, and all the symptoms went away. About a week after the antibiotics, some symptoms returned in a very mild form, but didn't bother me much.

Then in January of this year (strangely enough around the same date that the first flare began in India), after 8 or so months of relative health, the constipation came back. Again I tried more fiber in my diet and probiotics and again this produced the backed-up, SIBO-esque bloating. I had stool and blood tests and an ultrasound that found nothing. I then tried 3 rounds of various antibiotics, because they seemed to help back when I was traveling. None worked this time, so I started working with alternative treatments: Oregano oil, raw garlic, cloves, Wormwood, Black Walnut hulls, Aloe Vera, acupuncture, Chinese herbs, etc. I've also been on the Specific Carbohydrate diet since early April. Some of the alternative treatments helped, and the SC Diet keeps the bloating from being too crazy, but nothing was really moving me in the direction of a cure. I also saw a holistic doctor who had me do a stool test with Diagnos-techs. It found a very light amount of Candida, moderate pathogenic Strep, occult blood, and low SIgA.

I got a recommendation for a tropical medicine doctor in New York (Dr. Kevin Cahill). I saw him and he inspected a scraping of my colonic mucous that revealed an infection with Entamoeba Histolytica. I was relieved to finally have a more clear diagnosis. He gave me Paromomycin, an anti-amoeba drug, and Doxycycline, an antibiotic. I took them, was retested by him, and came up negative for the amoebas. He told me it may take a couple months to heal and feel well again, but after abouta month and a half I only felt worse.

At that point I began to assume that the amoebas and all the antibiotics I had taken had caused some other damage to my whole flora that needed to be addressed. My holistic doctor had mentioned fecal transplant as a possibility and so I began to look for donors. Without intending to actually ask her to donate, I mentioned the procedure to a good friend's girlfriend and her eyes immediately lit up. "Do you want me to shit for you, Ben?!," she excitedly asked.

She told me she was very comfortable gut-wise and went 2-3 times a day consistently, which sounded great to me considering I was dealing with constipation. I started the low-fiber diet part of Borody's protocol right away and got her a stool test kit. Her test came back clear, and after 3 weeks of the low-fiber, I started taking Vancomycin, as recommended by Borody, as well as Nitazoxanide, an anti-protozoal just in case any of the amoebas were left.

The antibiotics made me feel horrendous. They added to the general feeling of unwellness that I had been experiencing for months, made me more constipated, and worsened the depression that this whole experience had created.

On the first day of infusions, I noticed an almost immediate loss of that depression and malaise. It could have been simply the hope involved in trying a new treatment, but it felt like there was a more physical, medical connection. It made me even more sure of the brain-gut connection and the ability of our flora to effect our emotions. I remained constipated for a couple days, but on the morning of the third day, I woke up to an immediate, easy, giant, solid BM. Those easy morning BMs have continued, except for one more bad day on day 5. Tomorrow will be the last infusion and then time will tell how well the new bacteria will colonize my gut.

The bloating after meals remains so I think it is a related but separate issue. Like I said before, it didn't start until a week or so into the constipation flares, after I had eaten lots of fibrous foods and taken probiotics in trying to move things along. If it does not fade with time, I'm definitely going to get tested for SIBO, and then treat that somehow, possibly following up with more transplants to keep things moving well.

Fecal Transplants: The Turd Twister & A Historical Account

I have been voraciously exploring the world of human gut bacteria, fecal transplants, and the like as of late, and I wanted to update all you readers with some information that I've found particularly invaluable.  Well, okay the first bit of info isn't invaluable, per se, but it is pretty funny.  My awesome aunt, a frequent reader of this blog, recently sent me something she dug up as she was preparing for an estate sale.  I don't know if anybody else out there has heard of this.  It's called a "Turd Twister."  I thought it would make a great gag gift, especially for a potential fecal transplant donor.  There are many wonderful shapes that can be produced and presented with this device!  Anyway, the version I received is kind of old school and uses hard cardboard, but for more serious turd twisters, you might want to check out the website for a modern and far more comfortable-looking model.

Next, I wanted to reiterate a point I made in the comments of a previous post in order to further bolster the merits of the "sh*tshake" method.  Here is a comment from "Mike K" on the Freakanomics radio show website:

Forty years ago, we treated antibiotic resistant bacteria in the colon by giving the patient a dose of antibiotic sensitive E. coli in a malted milkshake. The sensitive bacteria would replace the resistant bacteria in a day or so. Our theory, or that of my professor who devised the treatment, was that “wild” or sensitive bacteria are better adapted to the normal colon environment. Antibiotic resistant bacteria can only take over when the sensitive bacteria are killed off by antibiotics, as when a patient has been treated for an infection like diverticulitis. When the antibiotics are stopped, the normal sensitive bacteria will quickly oust the resistant ones which are less adapted for life in a normal colon. All that is necessary is to provide a dose of the normal wild bacteria.

In the County Hospital, we used the same method although we did not have the nicety of cultured sensitive bacteria. We would take a fecal sample from a healthy patient coming in for hernia surgery, for example, and give it to the patient in a milkshake.

Needless to say that none of the patients were ever told the extra ingredient of the milk shake. 

This marks the second time I have heard of a fecal transplant used in such a manner.  The first time was from a retired nurse who basically said the same thing.  What surprised me in both cases is that the amount of "donation" required was minimal enough for the patients to not even realize they were drinking a poo concoction.  Also, one might think that the milk would cause a serious acid dump in the stomach and kill the beneficial bacteria, but this didn't seem to happen.  Must be a strength in numbers thing.  Anyway, this just goes to show that the essence of the fecal transplant's magic is actually pretty simple, and it certainly doesn't require some of the exorbitant costs and methods of implementation that are associated with it.

Next up, I have a very juicy post to share about an adventurous blog reader, Ben, and his recent foray into the fascinating world of home fecal transplants.  
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My Intestinal Saga, Part 10: Final Thoughts (cont'd.)

Okay, let's add some more notes to parts 5 through 9 of of the saga.

Part 5, Monastyrsky and Kwasniewski: The most important lesson I learned from this time period was that the heaviness in my body was directly related to being constipated 24/7, and that there were ways to restore my intestinal motility.  I highly recommend Monastyrsky's book, Fiber Menace, to anybody interested in the ins and outs (pun intended) of digestion and how to maintain a smoothly functioning GI tract, as this is what ultimately opened my eyes.  This book has a combination of the author's deep experience and thorough research, which makes it a very powerful read.  His recommendations are solid and very helpful to most modern people struggling with GI problems.


Part 6, It's All Digestive My Dear Watson: Damn, I wish I could eat all the fat I wanted without having gut issues.  Maybe someday I'll be able to if I ever resolve things completely.  Until then, I have to actually keep fat consumption at moderate to low levels because I get the same symptoms as I described in this post: the bad breath, the muscle tension, the bloating, the insomnia.  All of these things I believe are related to the slow motility of my intestines.  And I discovered this by thoroughly observing my body's response to eating food.  This is a fine art, and it requires an understanding of just how food travels through the body.

I have found through talking with others that the one place many folks get tripped up in evaluating their own bodies' digestive capacity is not knowing their symptoms connect with very specific parts of the GI tract.  For example, I have heard many people complain about "feeling full" after a meal, and they'll often say that their "stomach is full."  Yet, when I see where their hands go to describe this fullness, I realize it is not their stomach that is full at all -- it is actually their lower abdomen that is bloated and uncomfortable.  The stomach, of course, is just below the sternum a little to the left -- not around the belly button.  So this "fullness" is most likely coming from the last part of the small intestines.  This region is probably bloated from some kind of dysfunction and is putting pressure on the GI tract above it, including the stomach -- which gives the sensation of having eaten too much.  Knowing about little things like this can help a person really narrow down and target their specific digestive ailments.


Part 7, The Holy Grail of Probiotics ... Part 8, A Fecal Transplant Story ... Part 9, The Long Journey of Mister Poop: I'm covering all of these parts together because they fall under the same general category: taking someone else's poo and putting it in my body to restore intestinal flora.  There are many things that I would do differently now if I did the procedure again -- possibly antibiotics before the implant; better donor selection; make a more palatable concoction and pinch my nose (!) while drinking.  I'll outline my plan in more detail in an upcoming blog post.  For now, I will say that I have not ruled out this procedure and still have great hope for its use in the near future.

I believe very deeply that this is the ultimate tool in regaining digestive health and it deserves far more attention and research than it is currently getting.  However, word is definitely getting out, and I'm encouraged by some of the latest coverage of the treatment.  Here's a list of very recent and active links that I've found regarding fecal transplants:

Freakanomics Radio: The Power of Poop -- A good primer for potential donors on the merits of the procedure.  And it's entertaining.
Fecal Transplant - I Took the Plunge! -- On the "Healing Well" forum.  Exhaustive 5-part resource on individual experiences and questions regarding the treatment.
Home Fecal Transplants -- A group of people attempting transplants.  Some are beginning to consider doing an oral transplant similar to the one I did.

How Are Things Now?  

I am currently fairly stable in my gut as long as I follow certain rules that seem to work for me:

1) Low fiber diet: in addition to meat, butter, cheese, etc., I eat white rice or peeled potatoes for my starches and occasional bowls of homemade ice cream (with unrefined sugar).

2) No gluten: this without a doubt keeps my GI tract stable and happy.

3) Magnesium supplementation: prevents hard stools better than anything else I've tried.

4) Pancreatic enzymes: these appear to aid the digestion of foods in my stomach, particularly starches.

5) Moderate to low protein and fat: if I don't gorge on meat and fat (as much as I want to), things remain stable.

6) Two meals a day: this gives my digestive tract time to rest and be free of symptoms, and it appears to allow me to sleep through most of the night without intestinal disturbances.

7) Chewing fennel seeds: three or four times a day I'll grab a pinch of fennel seeds and chew them like gum.  I extract as much of the beneficial oils as possible before spitting out the fiber (when there is no taste left).  Really helps with expelling trapped gas and relaxing the gut.

When following these guidelines consistently, I find that my bloating is very minimal, my muscles have very little tension, and my mind is clear and focused.  Overall, I just have more energy.

This Is (Not) the End, My Friend

Well, here we are at the finish of my intestinal saga -- at least for now.  There will certainly be more updates in the future as I continue to discover more and more about my condition.  I still have a great amount of curiosity in exploring the mystery that is my GI tract, and only time will tell what kinds of crazy treatments I might stumble upon.  One thing all of you out there in blogger land can be sure of is this: you will hear about it.  Thanks for reading -- and happy digesting!
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My Intestinal Saga, Part 10: Final Thoughts

For this final installment of "My Intestinal Saga," I wanted to add a few notes and resources to each of the previous parts before I close with an assessment of where I am now, as well as ideas I have to further improve -- or possibly completely resolve  -- my digestive problems.  I would appreciate any input from others, as well.  Please leave a comment if you think you might have more insight into all this gut stuff.  Here we go again down the long, hollow tube!

Part 1, Dabbling in Parasites:  Here I delve into my childhood health issues a bit, which included headaches and TMJ (tempromadibular joint) disorder.  My best guess as to why these things were happening is the same reason that I experienced them in a more mild form as I grew older: digestive tension/pain.  There is a direct correlation for me.  I believe I had a problem with gluten as a young child, and this created a poor digestive environment and subsequent pain in the GI tract that referred pain and tension to my neck and jaw.  Here is a quote from a great blog post explaining this phenomenon:

In a nutshell, referred pain happens when nerve fibers from regions of high sensory input (such as the skin) and nerve fibers from regions of normally low sensory input (such as the internal organs) happen to converge on the same levels of the spinal cord. 

This is something to keep in mind for folks out there engaged in your own health explorations.  The body can be a tricky bugger sometimes, so it is important to stay open to what the origins of your discomforts truly are.

I also want to expand upon some of the thoughts I had in this post about bloating.  I was completely unaware that the bloating was a simple distention of my belly and not an actual "gut."  This unawareness created body image issues for me, as I thought I was fat and struggled to get rid of the belly.  No matter how hard I worked out, it remained, and it left me feeling frustrated and inadequate.  I imagine there are others out there for whom this may be the case, and I just want to say that bloating is not fat!  Even today, I can see my belly go flat and distend over a matter of hours depending on my mealtimes, types of foods eaten, etc.


Part 2, Lower Back Pain: This is where I discovered the magic of referred pain and what measures I truly needed to take to resolve it.  The tweaking of my back left me debilitated, and at that time I thought it was because I had a "bad back."  This turned out to not be the case, as I found out while working in the wilderness, where my back pain disappeared while eating very little.  It was all digestive, once again.

I want to share a wonderful resource that I came across a few years ago that shed a lot of light on how digestion is connected to much of the pain and discomfort I have felt in my life.  It is a book called, The Digestive Awareness Diet.  Interestingly enough, the author actually says that the reason we suddenly throw out our back or get a tweak in our neck isn't from muscle strain, but digestive tension.  This certainly rang true for me.  Check it out.  It might help you better understand your body.  I know it helped me.

A few more resources about general body awareness that might be useful which I utilized during my "yoga years" are the Feldenkrais Method and the Alexander Technique, both of which got me thinking about posture and what is and isn't the natural, optimal use of the human body -- or "use" for short.  One of the authors even suggested something I had already intuited: observing little kids and indigenous people to understand proper use. One thing to keep in mind, however, is that resolving digestive tension is a big part of regaining our bodies' natural ease.  Utilizing the body awareness techniques in combination with digestive understanding is a potent combination in restoring some of the light and easy feelings we are supposed to have in our bodies.


Part 3, Making Connections: Ahh, the wondrous world of the ileocecal valve (I found this page randomly on Facebook -- I am one of two people that like it so far.  Ha!).  Some natural health practitioners believe this is the root of many of our digestive ailments.  All I know is that it was directly related to my back pain.  The interesting thing is that once I got my posture back on point after doing yoga and the aforementioned body awareness methods, I was able to feel the pain exactly where it was -- my lower right abdomen -- as opposed to thinking it was only my back muscles acting up.  This reinforces the idea that, in order to come to more full understanding of what's happening in the body, an individual must use a multi-faceted approach to health observation.


Part 4, Gurus and Rotten Meat: One interesting occurrence from this period of wild dietary experimentation was a complete malabsorption of fat.  Looking back, I believe this was due to my duodenum just beginning to recover from years of being beat down by the gluten in my diet.  A classic consequence of such a beating is flattened microvilli, which inevitably leads to the poor processing of proteins and fats.  There is also a chance that Giardia played a role in this process.  Whatever the case may be, this problem resolved on its own after several months.

The chest pain I experienced during this time was exclusively due, once again, to digestive stress.  The chest pain was most likely my stomach being unable to resist the huge amounts of acid it was all of the sudden releasing for my high-meat diet.  I'm sure it was in a weakened state from years of malnourishment.  I swore I was having a heart attack.

I also describe a "heavy" feeling in the entirety of my body.  I believe this was a result of very slow intestinal motility and the hard stools I was constantly having.  Another symptom I didn't mention at this time was shallow breathing, presumably from the stiffness of my abdomen.  I have heard accounts from others of a similar phenomenon, and it is something that I still have now and again.

Final thoughts on "My Intestinal Saga" to be continued ...
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Accepting Donations From My Fellow Health Nerds

If you look to the right of my blog, you'll notice that I've set up a donation button for anybody interested in supporting this blog and my health explorations.  I would appreciate any amount you can offer.  I also accept gifts through the mail, such as gluten-free cookies or books that might be of interest to me.  Mostly, I just want cookies.  Donations of healthy poo -- freeze-dried and neatly packaged -- for my next attempt at a fecal transplant will be assessed on a case-by-case basis.  (Kidding!)  Thank you. :-)
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My Intestinal Saga, Part 9: The Long Journey of Mister Poop

Having decided that the best way to treat the entirety of my GI tract with a fecal transplant was through the oral route rather than rectally, I pondered just how in the heck I would get myself to consume my friend's sh*t -- I mean, it can't taste good, right?  Hmm.  Probably not.  Then there was the problem of administering the concoction.  I didn't have a nasojejunal tube and sedatives, as Borody's clinic does, so I would certainly have to just toss it down the hatch and pinch my nose.  One woman I was in contact with -- a retired nurse -- said that fecal bacteriotherapy used to be around in her day (the 60s) as a last resort therapy for ailing patients, and it often worked (interestingly enough without antibiotic or colon lavage preparation procedures).  How did they administer the therapy back then?  Milk + poo.  A sh*t-shake.  I thought this would be an easy and perhaps even pleasant way to go.  Heck, I might even have a burger and fries with it.

So, on day three of my adventure in feces shenanigans, I popped open the yogurt container with my donor's deposit inside.  Stinky!  (Duh.)  I mixed a bit of the stool with water and strained it into a mason jar.  I had some goat milk on hand and stirred it in.  The mad scientist was at it again, and nobody could stop him.  I looked at the whitish-brown beverage in front of me.  For a second I thought about sweetening it or something, but I had already begun to feel my body and mind rejecting the idea of consuming the liquid, so it was now or never.  Just do the damn thing before doubt takes over.  Glass to lips, in it went.  Oh, dear God!  It was the most acrid taste I've ever experienced in my entire life.  My gag reflex kicked in and almost kept me from swallowing, but somehow I managed to get it down.  Gurgle!  Gulp! ...  Holy sh*t.  I just ate sh*t.  The horrible taste remained, so I immediately began rinsing my mouth and smearing toothpaste all over my gums.  I must have rinsed for 20 minutes.  During this time, I realized I could have probably at least pinched my nose while I drank the poo drink.  Oh well.

And so the millions of bacteria were now in my stomach doing God knows what.  The long journey of mister poop had begun!  Thankfully, I had no need to vomit.  In fact, besides the objectionable taste, it was a downright quick and painless experience.  I wondered how this would turn out.  Would I have diarrhea or a food-poisoning kind of episode?  Only time would tell.  Surprisingly, that evening, as I laid down to go to bed, I had a feeling that I hadn't had since I ate very little food for several years and did yoga and meditation every day.  It was a feeling of complete and total comfort in my gut -- my body felt 100% relaxed.  I think it worked!  I fell asleep quickly and woke in the morning feeling refreshed and energetic.  I remember playing guitar and singing that day -- my voice was smoother than it had ever been.  I presumed this was due to my stomach not being bloated and stiff, so I could finally breathe fully again.  Amazing!

The afternoon rolled around and I felt a strong urge to sh*t.  When I did, it happened very quickly and without difficulty -- definitely something new for me, since I was usually the opposite.  It was a soft, well-formed stool and, hot damn, it smelled just like my friend's poo!  The poo cocktail must have survived the acid bath of the stomach and traveled the entire length of the intestinal tract.  The question was, would these feelings remain?  Unfortunately, they didn't.  That evening, I had trouble sleeping again and woke the next morning to another difficult bowel movement.  "Well," I thought, "maybe it will take some time for the bacteria to fully establish."  I was certainly done drinking sh*t-shakes, so I decided to stop the experiment.  Everything returned to "business as usual" in my intestines, and I decided that most impressive conclusion of this experiment was that nothing changed, good or bad.

Up next, Part 10 of "My Intestinal Saga" -- final thoughts ... 

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My Intestinal Saga, Part 8: A Fecal Transplant Story

I've done a lot of crazy things in my life.  I dropped a college scholarship to go live on an isolated homestead with a mountain man named Peter Bigfoot.  I lived in my car in frigid cold temperatures in the foothills of the Chiricahua Mountains, waking up in the middle of the night to high speed winds rocking my vehicle and groups of 50 illegal immigrants passing by; border patrol agents would flash their lights in my windows hours later.  I did several survival trips into the wilderness with little or no gear, sleeping on the cold hard ground and eating cactus, lily bulbs, any creature I could get my hands on -- lizards, rodents, grasshoppers, scorpions.  I went for years as a low-calorie, highly-active vegetarian, working as a wilderness guide for troubled youth for weeks at a time and hiking many miles on nothing but lentils and ash cakes.  I jumped into dumpsters to retrieve ripe avocados and flour tortillas to avoid buying food from our country's faulty factory-farm system.  I ate rotten meat because I thought it would improve my health based on the recommendations of a guy who calls himself Aajonus.  Oh, and I worked in a retail store at the mall once.

My friend and yours ... Fleet Eneman!

But all of that pales in comparison to the gastrointestinal exploration I was about to embark on.  Bathroom door closed behind me, a sealed yogurt container in front of me.  I popped the lid.  Smelled like sh*t.  Looked like sh*t.  It was definitely sh*t.  My friend had left it for me that morning, a gift -- "the good sh*t," we had earlier joked.  It was helpful to have a sense of humor around such an odd and awkward circumstance.  But with the backing of an MD and an ND, hours and hours of research, and the home infusion protocol in hand, I was confident in this circumstance.  I decided to skip the antibiotics in the protocol because I wanted to avoid them if I could, and I wondered if things would work without this step.  I also didn't do a colon lavage or bother to get any saline solution for mixing.  I wanted to see what would happen if I just did the damn thing with no preparation.

So this was it.  Now or never.  My friend's turd was my medicine.  I scooped out some poo with a spoon and mixed it in a separate container with a little water until I had a brown slurry.  I then poured the slurry through a strainer into another container.  This watery sh*t shake was then streamed into a small fleet enema bottle, after which the I screwed on the probe-like lid.  The concoction was prepared.  The mad scientist in me became excited for the unknown results of what I was about to do.  I got in enema position.  Then in it went, where the sun don't shine.  Squirt.  I held it, got up, cleaned up, and left the bathroom that cold winter morning with somebody else's crap in my colon.

I went about my day as usual, preparing some breakfast and sitting down to eat.  "Hmm.  No difference so far."  About two hours later, I felt the urge to "drop the kids off at the pool."  To my surprise, what came out wasn't my usual brew -- it smelled and looked exactly like my friend's sh*t.  And it came out much easier than was usual for me.  Okay, so obviously my donor's bacteria had multiplied and formed stool in my colon.  But would that last?  To my disappointment, I had my usual hard stools that evening.  The next morning I did the protocol again with the same result.  Again the following morning.  Damn.  Something isn't right.  I realized I might not be getting the bacteria far enough up the colon to make a difference.  In Borody's clinic they often implant the feces deep in the colon through a colonoscopy instrument -- all I had was a little squirt bottle.  Add in the fact that my bowel problems appeared to be more in my small intestine near my ileocecal valve, and I decided I needed to treat more than just the first few bends of my colon.  Knowing it wasn't possible at home to replicate the clinical procedure, I began pondering another route to get deeper into the GI tract.  Borody had employed another method of fecal transplant which involved a "nasojejunal tube."  This instrument was basically a complicated way of getting the feces into the small bowel through the nasal passage and stomach.  Well I wasn't about to snort some sh*t.  But crazy as it sounds, I was strongly considering drinking a sh*t shake.

Part 9 of "My Intestinal Saga" coming soon ... 
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