Some poops are better than others
January 22, 2019 1:37 PM Subscribe
“Scientists often seem to be on a quest for sacred chalices or sterling ammo. But a group of microbiologists has now set out on a more odorous odyssey—one to find fantastical fæces. With data on poop’s therapeutic potential piling up, scientists have gotten wind of the possibility that some among us may be extraordinary excreters, dropping deuces with divine healing powers.
An FMT is exactly what it sounds like—fæcal matter containing gobs of gut microbes is dumped, squirted, gulped, or otherwise delivered into the bowels of patients. The idea is that the relocated microbial communities will restore or replace the patient’s own gut dwellers to improve health. Intestinal microbes can play a role in nutrition, metabolism, immune system function, and infection protection, after all. Thus, patients with gut communities that are imbalanced and dysfunctional—aka dysbiotic—or are overrun with pathogens stand to see health benefits from such an intestinal repoopulation.
An FMT is exactly what it sounds like—fæcal matter containing gobs of gut microbes is dumped, squirted, gulped, or otherwise delivered into the bowels of patients. The idea is that the relocated microbial communities will restore or replace the patient’s own gut dwellers to improve health. Intestinal microbes can play a role in nutrition, metabolism, immune system function, and infection protection, after all. Thus, patients with gut communities that are imbalanced and dysfunctional—aka dysbiotic—or are overrun with pathogens stand to see health benefits from such an intestinal repoopulation.
No.
posted by pxe2000 at 1:44 PM on January 22, 2019 [3 favorites]
posted by pxe2000 at 1:44 PM on January 22, 2019 [3 favorites]
The Guardian did a dump on this
I see what you did there.
posted by axiom at 1:45 PM on January 22, 2019 [8 favorites]
I see what you did there.
posted by axiom at 1:45 PM on January 22, 2019 [8 favorites]
Shit, even my poop’s crap.
posted by Segundus at 1:46 PM on January 22, 2019 [16 favorites]
posted by Segundus at 1:46 PM on January 22, 2019 [16 favorites]
This is awesome, and is going to save a lot of lives. In 100 years, people are going to be totally horrified by the destruction that current humans are constantly visiting on their microbiomes - they'll probably react to our indiscriminate antibiotic use like we react to those old-timey surgeons who never washed their hands between patients.
posted by showbiz_liz at 1:50 PM on January 22, 2019 [14 favorites]
posted by showbiz_liz at 1:50 PM on January 22, 2019 [14 favorites]
"A few interesting nuggets have floated out of the data" - Beth Mole is having an awful lot of fun with this.
posted by doctornemo at 1:53 PM on January 22, 2019 [20 favorites]
posted by doctornemo at 1:53 PM on January 22, 2019 [20 favorites]
Man alive did this author take every possible opportunity for a poop pun.
posted by showbiz_liz at 1:53 PM on January 22, 2019 [5 favorites]
posted by showbiz_liz at 1:53 PM on January 22, 2019 [5 favorites]
Like do you guys remember how 10ish years ago, it was literally impossible for any reporter to write an article about marijuana without cramming in about 75 weed puns of varying quality? This is giving me such flashbacks to that.
posted by showbiz_liz at 1:56 PM on January 22, 2019 [7 favorites]
posted by showbiz_liz at 1:56 PM on January 22, 2019 [7 favorites]
Don't like to brag, but mine doesn't stink.
posted by Alvy Ampersand at 1:56 PM on January 22, 2019 [2 favorites]
posted by Alvy Ampersand at 1:56 PM on January 22, 2019 [2 favorites]
Finally, a viable career!
posted by loquacious at 1:57 PM on January 22, 2019 [6 favorites]
posted by loquacious at 1:57 PM on January 22, 2019 [6 favorites]
Faecal transplant researchers identify 'super-pooper' donors
Beams are going to blind me
But I won't feel blue
Like I always do
because somewhere in my bowel there's... you
posted by GuyZero at 2:03 PM on January 22, 2019 [8 favorites]
Beams are going to blind me
But I won't feel blue
Like I always do
because somewhere in my bowel there's... you
posted by GuyZero at 2:03 PM on January 22, 2019 [8 favorites]
Shit just got real.
posted by It's Raining Florence Henderson at 2:04 PM on January 22, 2019 [18 favorites]
posted by It's Raining Florence Henderson at 2:04 PM on January 22, 2019 [18 favorites]
Woah - I've been fascinated by fecal transplants since I first heard about them, but I never knew that it had been independently invented a couple of times in the past, hundreds of years before microbiology was discovered.
posted by showbiz_liz at 2:05 PM on January 22, 2019 [5 favorites]
posted by showbiz_liz at 2:05 PM on January 22, 2019 [5 favorites]
"This is awesome, and is going to save a lot of lives. In 100 years, people are going to be totally horrified by the destruction that current humans are constantly visiting on their microbiomes - they'll probably react to our indiscriminate antibiotic use like we react to those old-timey surgeons who never washed their hands between patients."
I don't know, this seems more like leeches, blood-letting, or phrenology on the surface of it. I think in 0 years people will look at this and be horrified our medicine involved eating shit.
posted by GoblinHoney at 2:05 PM on January 22, 2019 [1 favorite]
I don't know, this seems more like leeches, blood-letting, or phrenology on the surface of it. I think in 0 years people will look at this and be horrified our medicine involved eating shit.
posted by GoblinHoney at 2:05 PM on January 22, 2019 [1 favorite]
I don't know, this seems more like leeches, blood-letting, or phrenology on the surface of it.
But it, like... actually works. For scientifically verifiable reasons. It has already saved the lives of c diff patients who had tried every other treatment and would have died without it. So why the skepticism?
posted by showbiz_liz at 2:07 PM on January 22, 2019 [15 favorites]
But it, like... actually works. For scientifically verifiable reasons. It has already saved the lives of c diff patients who had tried every other treatment and would have died without it. So why the skepticism?
posted by showbiz_liz at 2:07 PM on January 22, 2019 [15 favorites]
The New Yorker has squeezed one out on this topic too.
posted by Paul Slade at 2:09 PM on January 22, 2019 [5 favorites]
posted by Paul Slade at 2:09 PM on January 22, 2019 [5 favorites]
please just give it a nice corporate drug name like Tyrdocraptazine or something and don't tell me where it came from
posted by prize bull octorok at 2:20 PM on January 22, 2019 [17 favorites]
posted by prize bull octorok at 2:20 PM on January 22, 2019 [17 favorites]
Incidentally, "Deuce Dropper and the Extraordinary Excreters" is the name of my new band. We play Po(o)p music.
Unfortunately, we're a pretty shit band.
posted by Greg_Ace at 2:25 PM on January 22, 2019 [11 favorites]
Unfortunately, we're a pretty shit band.
posted by Greg_Ace at 2:25 PM on January 22, 2019 [11 favorites]
💩
posted by w0mbat at 2:39 PM on January 22, 2019 [2 favorites]
posted by w0mbat at 2:39 PM on January 22, 2019 [2 favorites]
be horrified our medicine involved eating shit.
The ancient Egyptians used to treat infected wounds with moldy bread. From our current state of knowledge, we can see what they were trying to do, though the delivery method is not idea and we would eventually refine both the right strain of mold and figure out how to extract it to make it more effective.
All I want to say is don't be too quick to poo-poo this research; movements forward in medicine may begin in unsettling ways.
posted by nubs at 2:39 PM on January 22, 2019 [8 favorites]
The ancient Egyptians used to treat infected wounds with moldy bread. From our current state of knowledge, we can see what they were trying to do, though the delivery method is not idea and we would eventually refine both the right strain of mold and figure out how to extract it to make it more effective.
All I want to say is don't be too quick to poo-poo this research; movements forward in medicine may begin in unsettling ways.
posted by nubs at 2:39 PM on January 22, 2019 [8 favorites]
"But it, like... actually works. For scientifically verifiable reasons. It has already saved the lives of c diff patients who had tried every other treatment and would have died without it. So why the skepticism?"
I wouldn't say I'm skeptical, it's just that on the surface, we have people pooping back and forth into one another and like the example given of egyptians rubbing moldy bread on wounds, presumably in the future there will be a method that isn't casually described as consuming someone's feces.
posted by GoblinHoney at 2:50 PM on January 22, 2019 [1 favorite]
I wouldn't say I'm skeptical, it's just that on the surface, we have people pooping back and forth into one another and like the example given of egyptians rubbing moldy bread on wounds, presumably in the future there will be a method that isn't casually described as consuming someone's feces.
posted by GoblinHoney at 2:50 PM on January 22, 2019 [1 favorite]
please just give it a nice corporate drug name like Tyrdocraptazine or something and don't tell me where it came from
There is an extremely high probably that most everything you eat or drink has at one time or another been the shit or piss of another creature.
The Cycle of Life is literally a shit show.
posted by srboisvert at 2:55 PM on January 22, 2019 [3 favorites]
There is an extremely high probably that most everything you eat or drink has at one time or another been the shit or piss of another creature.
The Cycle of Life is literally a shit show.
posted by srboisvert at 2:55 PM on January 22, 2019 [3 favorites]
presumably in the future there will be a method that isn't casually described as consuming someone's feces.
I feel like this is one of the points being made in the article when they point out that just the use of filtrates (without even any bacteria present) appears to be effective; we're essentially learning what is important and what isn't in terms of the extract. And the "super-donor" work may be what leads to an understanding of what compounds are the most effective for different conditions and donor-patient compatibility factors.
For the curious, this paper describes the methods currently in use for performing this type of transplant:
Hamilton et al. [17] have adopted an approach of using highly filtered human microbiota mixed with a cryoprotectant and then frozen for storage at −80 °C until required for use. This processing removes the fecal smell and reduces the volume of the filtrate. Use of such a standardized, purified tissue has been shown to have equivalent clinical efficacy in CDI to that of fresh, partly filtered feces...
...The route of the TM administration varies considerably between institutions and can be naso-duodenal, transcolonoscopic, or enema based.
The paper goes on to suggest that naso-duodenal is not a preferred method and has a lower success rate than the others methods.
posted by nubs at 3:03 PM on January 22, 2019 [3 favorites]
I feel like this is one of the points being made in the article when they point out that just the use of filtrates (without even any bacteria present) appears to be effective; we're essentially learning what is important and what isn't in terms of the extract. And the "super-donor" work may be what leads to an understanding of what compounds are the most effective for different conditions and donor-patient compatibility factors.
For the curious, this paper describes the methods currently in use for performing this type of transplant:
Hamilton et al. [17] have adopted an approach of using highly filtered human microbiota mixed with a cryoprotectant and then frozen for storage at −80 °C until required for use. This processing removes the fecal smell and reduces the volume of the filtrate. Use of such a standardized, purified tissue has been shown to have equivalent clinical efficacy in CDI to that of fresh, partly filtered feces...
...The route of the TM administration varies considerably between institutions and can be naso-duodenal, transcolonoscopic, or enema based.
The paper goes on to suggest that naso-duodenal is not a preferred method and has a lower success rate than the others methods.
posted by nubs at 3:03 PM on January 22, 2019 [3 favorites]
My people live long and are celebrated poopers.
posted by Slarty Bartfast at 3:20 PM on January 22, 2019 [5 favorites]
posted by Slarty Bartfast at 3:20 PM on January 22, 2019 [5 favorites]
The paper goes on to suggest that naso-duodenal is not a preferred method and has a lower success rate than the others methods.
and there goes my fantasy of snorting up lines of superpowered probiotic poop like Tony Montana
posted by prize bull octorok at 3:24 PM on January 22, 2019 [4 favorites]
and there goes my fantasy of snorting up lines of superpowered probiotic poop like Tony Montana
posted by prize bull octorok at 3:24 PM on January 22, 2019 [4 favorites]
I don't know if this is the best article I've read on this topic, but it's a solid number two.
posted by rouftop at 4:11 PM on January 22, 2019 [28 favorites]
posted by rouftop at 4:11 PM on January 22, 2019 [28 favorites]
I can’t wait for wellness influencer branded poop pills. I cannot think of anything creepier, and I love it.
posted by schadenfrau at 4:33 PM on January 22, 2019 [7 favorites]
posted by schadenfrau at 4:33 PM on January 22, 2019 [7 favorites]
I'm opting out in advance of the 2021 MetaFilter Holiday Poop Exchange
posted by prize bull octorok at 4:35 PM on January 22, 2019 [9 favorites]
posted by prize bull octorok at 4:35 PM on January 22, 2019 [9 favorites]
Does everything have to be a competition?
posted by peeedro at 4:43 PM on January 22, 2019 [2 favorites]
posted by peeedro at 4:43 PM on January 22, 2019 [2 favorites]
I mean, tell me Goop Poop won’t be a thing.
posted by schadenfrau at 4:48 PM on January 22, 2019 [12 favorites]
posted by schadenfrau at 4:48 PM on January 22, 2019 [12 favorites]
Does the Bear fecal donate in the woods?
posted by GenjiandProust at 5:10 PM on January 22, 2019 [1 favorite]
posted by GenjiandProust at 5:10 PM on January 22, 2019 [1 favorite]
FMT has a lot of really intriguing data, but the experimental design in C diff has been atrocious overall, and it’s impossible to accurately estimate the safety and efficacy of this entirely unregulated product (doctors either have a special protocol for using a local donor, or buy prepared FMT material from a universal stool bank [think Red Cross, except... Brown]). There is a very real risk of infectious disease transmission with FMT. Frankly, there’s just an unknown risk profile overall, because no one is doing proper, systematic safety follow-up on patients who have had FMT, especially on those receiving material from the stool bank. It absolutely saves lives. Microbiome interventions work. We just really don’t know how well.
But in this field, nobody’s end goal is to find magical super-donors. The goal is to figure out what makes them magical super-donors, and isolate those bacterial strains/combinations/metabolites for manufacturing in GMP-compliant facilities and get that magical mix through the drug development process. This is even the goal of the for-profit arm of the organization I described as the Brown Cross above. Donor-derived products are a first step.
posted by amelioration at 5:33 PM on January 22, 2019 [12 favorites]
But in this field, nobody’s end goal is to find magical super-donors. The goal is to figure out what makes them magical super-donors, and isolate those bacterial strains/combinations/metabolites for manufacturing in GMP-compliant facilities and get that magical mix through the drug development process. This is even the goal of the for-profit arm of the organization I described as the Brown Cross above. Donor-derived products are a first step.
posted by amelioration at 5:33 PM on January 22, 2019 [12 favorites]
dumped, squirted, gulped, or otherwise delivered
However it's done, always throw away the blender (Pooviously on Metafilter...).
posted by CynicalKnight at 6:35 PM on January 22, 2019
However it's done, always throw away the blender (Pooviously on Metafilter...).
posted by CynicalKnight at 6:35 PM on January 22, 2019
I'm opting out in advance of the 2021 MetaFilter Holiday Poop Exchange
But all I want for Christmas is poo
posted by Alvy Ampersand at 8:26 PM on January 22, 2019 [1 favorite]
But all I want for Christmas is poo
posted by Alvy Ampersand at 8:26 PM on January 22, 2019 [1 favorite]
Super pooper microbes go inside me
C. diff you are through
I've inserted poo
Feeling like a number two
Super pooper helping my gut flora
No, it's not much fun
But the battle's won
Somewhere up in my colon
posted by prize bull octorok at 8:47 PM on January 22, 2019 [3 favorites]
C. diff you are through
I've inserted poo
Feeling like a number two
Super pooper helping my gut flora
No, it's not much fun
But the battle's won
Somewhere up in my colon
posted by prize bull octorok at 8:47 PM on January 22, 2019 [3 favorites]
Studies of folks with C. diff
Caused scientists to get a whiff
Of a Potion du Jour;
They thusly procured
A tonic you won't wanna sniff
posted by Greg_Ace at 9:15 PM on January 22, 2019
Caused scientists to get a whiff
Of a Potion du Jour;
They thusly procured
A tonic you won't wanna sniff
posted by Greg_Ace at 9:15 PM on January 22, 2019
Gut microbes, doo doo doo doo doo doo
Gut microbes, doo doo doo doo doo doo
Gut microbes, doo doo doo doo doo doo
Gut microbes!
posted by peeedro at 9:47 PM on January 22, 2019
Gut microbes, doo doo doo doo doo doo
Gut microbes, doo doo doo doo doo doo
Gut microbes!
posted by peeedro at 9:47 PM on January 22, 2019
My people live long and are celebrated poopers.
posted by Slarty Bartfast at 3:20 PM on January 22 [3 favorites +] [!]/em>
Artsy Fartblast?
posted by Mei's lost sandal at 10:55 PM on January 22, 2019
posted by Slarty Bartfast at 3:20 PM on January 22 [3 favorites +] [!]/em>
Artsy Fartblast?
posted by Mei's lost sandal at 10:55 PM on January 22, 2019
On a more serious note, I'm probably seriously in need of an effective fecal transplant. I just haven't worked up the courage to seek one out yet. I won't go into details but I killed my intestinal fauna to a drastic degree a couple of years ago and nothing has worked right since. I haven't been able to get things built back up and healthy using other methods, so I'm going to HAVE to buck up and seek this out.
There’s an idea out there in the world that folks can just go to a willing doctor and get an FMT for anything GI-related, but it’s actually quite complex to access. If someone has recurrent CDI, it’s kinda/sorta straightforward (though I would *strongly* encourage anyone considering this to see if they’re eligible for a clinical trial instead, for a controlled dose, and consistent medical monitoring afterward). For any other indication (ulcerative colitis and IBD are most common, though investigators at universities are studying things as diverse as depression, multiple sclerosis, hepatitis, gut colonization with multiply-resistant bacteria, prevention of graft vs host disease post-bone marrow transplant, and obesity, among others), it is an arduous process. Either you enter a clinical trial, or your doctor has to fill out intensive paperwork for FDA called a single-patient Investigational New Drug (IND) application, and then negotiate approval of the treatment plan with FDA. Most community doctors aren’t willing or able to go through the IND process.
posted by amelioration at 4:13 AM on January 23, 2019 [3 favorites]
There’s an idea out there in the world that folks can just go to a willing doctor and get an FMT for anything GI-related, but it’s actually quite complex to access. If someone has recurrent CDI, it’s kinda/sorta straightforward (though I would *strongly* encourage anyone considering this to see if they’re eligible for a clinical trial instead, for a controlled dose, and consistent medical monitoring afterward). For any other indication (ulcerative colitis and IBD are most common, though investigators at universities are studying things as diverse as depression, multiple sclerosis, hepatitis, gut colonization with multiply-resistant bacteria, prevention of graft vs host disease post-bone marrow transplant, and obesity, among others), it is an arduous process. Either you enter a clinical trial, or your doctor has to fill out intensive paperwork for FDA called a single-patient Investigational New Drug (IND) application, and then negotiate approval of the treatment plan with FDA. Most community doctors aren’t willing or able to go through the IND process.
posted by amelioration at 4:13 AM on January 23, 2019 [3 favorites]
Not really related but for a while I dated a lovely man who lived on a 50 foot boat. Not rich, just determined. Here's the thing - boats' toilets don't go into a tank, like caravans. Oh no, poo is chomped up by the boat and released into the ocean. Now some places (including where I live) have boats permanently moored close to the shore, BUT you needn't worry about poo where you swim because ... the fish eat it!!! And that's why my friend wouldn't fish from his boat. In fact, in 3 years, I never once saw him eat fish. So if you want a conduit to your faecal transfer, eat fish caught near boats where people live.
posted by b33j at 4:59 AM on January 23, 2019 [1 favorite]
posted by b33j at 4:59 AM on January 23, 2019 [1 favorite]
))<>((
posted by aspersioncast at 4:59 AM on January 23, 2019 [5 favorites]
posted by aspersioncast at 4:59 AM on January 23, 2019 [5 favorites]
Fecal transplant for recurrent cdiff works INCREDIBLY well. A few years ago I was working with a doc doing research on different delivery methods for this kind of treatment (I'm a nurse with a vested interest in cdiff being very gone). He came up with a pill affectionately referred to as The Crapsule. He's awesome.
my fave quote: "“It’s like a Russian doll,” Hirsch told me. “With a surprise in the middle.”"
posted by emirenic at 8:17 AM on January 23, 2019 [3 favorites]
Something well worth trying while you're waiting for your crapsule is taking a 10ml syringe (with no needle!) and whacking a dose of live-culture yoghurt in through the out door. I tried this one day just on the off-chance that it would do something interesting, and it did; I need much less toilet paper now.
posted by flabdablet at 8:26 AM on January 23, 2019 [2 favorites]
posted by flabdablet at 8:26 AM on January 23, 2019 [2 favorites]
I'm opting out in advance of the 2021 MetaFilter Holiday Poop Exchange
You're assuming that people here will give a shit.
posted by srboisvert at 8:33 AM on January 23, 2019 [5 favorites]
You're assuming that people here will give a shit.
posted by srboisvert at 8:33 AM on January 23, 2019 [5 favorites]
I need much less toilet paper now.
Does that mean you're constipated?
posted by Greg_Ace at 11:17 AM on January 23, 2019
Does that mean you're constipated?
posted by Greg_Ace at 11:17 AM on January 23, 2019
Incidentally, "Rectal Yogurt Insertion" is the name of my new punk band.
posted by Greg_Ace at 11:18 AM on January 23, 2019 [3 favorites]
posted by Greg_Ace at 11:18 AM on January 23, 2019 [3 favorites]
> I tried this one day just on the off-chance that it would do something interesting
I am choke laughing.
posted by lucidium at 12:09 PM on January 23, 2019 [3 favorites]
I am choke laughing.
posted by lucidium at 12:09 PM on January 23, 2019 [3 favorites]
Metafilter: We already have a poop donor selected in case of emergency.
posted by Paul Slade at 2:24 PM on January 23, 2019 [4 favorites]
posted by Paul Slade at 2:24 PM on January 23, 2019 [4 favorites]
pls back the kickstarter for my new wellness product, Dr. Octorok's Paper-Saving Curative Butt Yogurt (don't sue me flabdablet, I will cut you in on this, have your ppl call my ppl)
posted by prize bull octorok at 5:18 PM on January 23, 2019 [3 favorites]
posted by prize bull octorok at 5:18 PM on January 23, 2019 [3 favorites]
Does that mean you're constipated?
Not at all, just more cohesive, less adhesive and rather better lubricated.
Dr. Octorok's Paper-Saving Curative Butt Yogurt
Side effects may include oversharing.
posted by flabdablet at 11:38 PM on January 23, 2019 [3 favorites]
Not at all, just more cohesive, less adhesive and rather better lubricated.
Dr. Octorok's Paper-Saving Curative Butt Yogurt
Side effects may include oversharing.
posted by flabdablet at 11:38 PM on January 23, 2019 [3 favorites]
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needs KeepMeFiClassy tag
posted by Johnny Wallflower at 1:40 PM on January 22, 2019 [5 favorites]