Fecal transplants

Aug 25th, 2015
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  1. Fecal Transplant
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  3. joenaturopath .
  4. Message 1 of 12 , Aug 20 10:46 AM
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  6. I am looking for a referral to send a patient in for a fecal transplant. She lives in NW Montana but is willing to travel where she needs to to get it done.
  8. Do any of you know of an office that does fecal transplants? If so could you please provide contact information for that office, it would be appreciated. Thanks.
  11. Dr. Joe Holcomb N.D.
  14. Joshua Goldenberg
  15. Message 2 of 12 , Aug 20 10:48 AM
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  17. I would try Dr. Mark Davis, ND
  19. Mark Davis, ND | Bright Medicine Clinic
  20. Dr Mark Davis specializes in natural gastrointestinal care with a focus on fecal microbiota transplantation delivered via capsules or retention enema.
  21.
  23. or Dr. Eric Yarnell, ND
  25. Dr. Eric Yarnell, ND
  26. We are the only naturopathic practice in the Northwest focusing on men’s health, urinary tract problems (in men and women), and kidney problems.
  27.
  28. Joshua Goldenberg, ND
  31. Shiva Barton, ND
  32. Message 3 of 12 , Aug 21 2:26 AM
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  34. Hi Joe,
  36. Or, you could have the patient try an Oral Probiotic Transplant at home.
  37. What are the reasons for wanting the transplant?
  39. Shiva Barton, ND
  40. Winchester, MA
  43. Emily Kane
  44. Message 4 of 12 , Aug 21 8:41 AM
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  46. Shiva
  47. Where do you get oral probiotic/fecal transplant?
  48. Thanks
  49. Emily Kane
  50. Juneau AK
  53. Shiva Barton, ND
  54. Message 5 of 12 , Aug 22 9:12 AM
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  56. Hi Emily,
  58. I've coined the term Oral Probiotic Transplant (OPT). I've been working on it for a few years. There is no reason to think that the only way to rearrange a person's intestinal flora is to do a fecal transplant. After all, we get our flora through our mouth, not through our butt :-) So, you can use whatever method you want to evacuate a person's colon and then replace with colostrum (the first thing down the hatch of an infant. sig 1000mg tid x 7 days) and with high dose natural flora. There are some limitations to what strains are available, unfortunately. I use one bottle per day of Ther-Biotic Complete Powder for 3-4 days (no affiliation) plus other flora - soil based flora, lacto sporogenes. Its still a work in progress but it is looking like it is helpful.
  60. Let me know if you have any other questions.
  62. Shiva Barton, ND
  63. Winchester, MA
  66. Eric Yarnell
  67. Message 6 of 12 , Aug 22 10:39 AM
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  69. I agree that fecal transplant is not the only way to change someone’s gut flora, but there is also only so much one can do by giving them only microaerophilic species orally and bovine colostrum (I would remind us all that the gut flora of breast-fed infants is about as different from adult flora as you can get, as they are about 90% Bifidobacterium whereas we are less than 0.01% Bifidobacterium, so I don’t think it really makes much sense at all that colostrum is going to have much if any significant effect on adult gut flora). Soil-based flora and spores of anaerobes might prove more effective or thorough in their effects but this is still far from proven. Anyway, I want Shiva’s version of OPT to be true but I think we have to have our eyes wide open about the possibility it isn’t and certainly that there are clear limits to this approach from the published research. I would note there is also the option of doing an oral fecal transplant, you just have to encapsulate the poop. I have patients but it in small size capsules then enclose those in enteric-coated larger capsules for more serious conditions like UC. Very little evidence on this too but perhaps it is what might make OPT a more effective option for those who don’t want to do a per rectum fecal transplant.
  72. Eric Yarnell, ND, RH(AHG)
  73. Seattle, WA
  76. Emily Kane
  77. Message 7 of 12 , Aug 22 3:28 PM
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  80. Hi Eric
  81. Are you having patients do it themselves at home? Ie find a suitable donor, blenderize poo with saline, double cap and swallow soon after? What's the shelf life of these caps? Refrigerated?
  82. Thanks!
  83. Emily Kane ND
  84. Juneau AK
  87. Eric Yarnell
  88. Message 8 of 12 , Aug 22 8:24 PM
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  90. Yes, at home. They prepare them and use them solely at the time of each fecal transplant; don’t try to keep them. Several sources are investigating freeze-dried preparations or the future; that’ll be interested.
  92. Eric Yarnell, ND
  93. Seattle, WA\
  96. Shiva Barton, ND
  97. Message 9 of 12 , Aug 23 7:33 AM
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  99. Hi Eric,
  101. All good points. I say it is a work in progress. Doing oral
  102. incapsulation of fecal transplants is probably more effective, but not
  103. yet widely available. At some point we will have OTC access to more
  104. species of flora. I suspect within 10 yrs we will have specific flora
  105. caps for specific illnesses. In the meantime... There is some
  106. fascinating research about evacuating the gut a la PEG colonoscopy prep
  107. and the time it takes for the flora to grow back (2-4 weeks depending on
  108. how you do it). If you get the gut as clean as possible, then transplant
  109. with oral probiotics in massive doses, you have a chance of repopulating
  110. the gut in a more positive fashion. How many of you in Nat Chat land
  111. have had patients who feel much better after a colonoscopies? - raise
  112. your hand... But it is usually transient because the previous gut flora
  113. grows back. OPT is a chance to shift the flora in the right direction.
  114. You could also go out and eat dirt, but that is another topic...
  116. Shiva Barton, ND
  117. Winchester, MA
  120. Karl Goldkamp
  121. Message 10 of 12 , Aug 23 10:03 AM
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  123. Perhaps helpful info. to add.
  124. 1. probiotics
  125. There is no research that I know of that shows that there is any sustained long-term benefit. Meaning the relief that a patient experience is sustained only as long as they are taking them. It's like renting versus owning.
  127. If anyone know of any info that supports the opposite I would love to read it. I wish this were the case. This is not to speak badly of probiotics... they are wonderful, but they will not rebuild, recolonize, 're-poopulate' the gut. But helpful and necessary in therapy, of course.
  129. 2. Fecal Microbiota (FM)
  130. In comparison, FM can be curative... (in my view). Some others think that as well. Those practitioners that I know who do feel that way are outside the US (Belgium and Australia). FM can colonize, and sustain itself but usually with multiple transplants (however it gets there, oral caps or rectal enemas, etc.). Capsulation appears to be the best, again from my experience, experiences from other Docs primarily. I have found nothing in the way of research that would allow one to endorse this method with unbridled enthusiasm. My understanding is that if one can get their transplant in the small intestine the better and faster will be the benefit. Therefore, encapsulation of FM that can make it through the stomach unscathed and can disperse into the S.I. is wonderful.
  132. Though I have done self-made capsulations of FM the process was problematic at best. I've triple encapsulated and then placed them in the freezer until I had a months worth of caps. I dosed 5 caps TID between meals 5 days/ week for 4 weeks. So I needed a supply of 300. The critical variable for me was the viscosity of the FM. Had to be watery enough to pipette it easily. and on advice of a MD in Austrilia, did this without the saline, just distilled water. Mentally you want is as thick as possible knowing there's more therapeutic substance present, but thinner is way easier to handle. I believe Mark Davis has a viable system for doing this from what I have heard. That would be great.
  134. Obstacles to efficacy
  135. To harbor the thought this FMT (in its various forms) is a one-time treatment is beyond reasonable. Short term, most people experience relief, Hallelujah. Long term this is usually not sustained. But it is a start, and not to be minimized.
  136. First disclaimer, is that really no two patient have the same expression of IBD, therefore, different experiences of the treatment.
  138. However the bigger issue, I believe, is Bio-films. And this is actually really interesting but problematic. There significant research available to learn about this. Coming from the position of complete ignorance of BF I chipped away at having a clue. Perhaps Eric can expound on this given his depth of understanding. An easy example of this is what happens when you don't brush you teeth for days (like when you went camping and forgot your toothbrush and paste) a film grows almost irrevocably over your teeth.... and your friends stop talking to you.
  140. In the Gut, This BF apparently is composed primarily of certain members of the Clostridia family. In fact they actually have it type out as in groups I through VI that clump together in layers over the intestinal lining making it very difficult to feed, repair, and replenish the mucosa. To me this ends up becoming the big 'well it depends' variable on how effect FMT will be initially and how long it may take to establish some benefit to the patients.
  142. Apologies for the long post.
  143. Karl Goldkamp ND., L.Ac
  144. CC Mass
  147. Mona Morstein
  148. Message 11 of 12 , Aug 23 7:05 PM
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  150. Hello, Eric,
  152. Are you saying you have patients get fresh poop and then they sit put them all in double-O capsules? And, then put those capsules inside other capsules. They must have better gag reflexes than the rest of us!
  154. Mona Morstein, ND, DHANP
  155. Tempe, AZ
  158. Kathleen
  159. Message 12 of 12 , Aug 23 8:06 PM
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  161. This is all very interesting to me. I have a five yo female who I am treating for PANDAS/PANS with a severe puritic rash and high anti dnase titer. So the microbiome stuff has unfolded for me in this case. I have had significant improvement but not what I would like nor what she would like. I would love to be able to discuss this at length with you Eric as I would not blindly do this without knowing all the details first.
  162. Kathleen Knights, ND
  163. St. J VErmont
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