Review: The poop on Fecal Transplants

This is a periodic review of what is known reliability about fecal transplants in general, as well as for Chronic Fatigue Syndrome.  Fecal transplants is one way to rapidly correct the gut bacteria. I have corresponded with an Australian with CFS who went into remission twice for 6 months after a fecal transplant and then relapse —  so it is not a guarantee persisting remission by itself. It is definitely an approach that warrants review.

First, the FDA, true to tradition, has attempted to restrict this treatment but was forced to back down [article]. The rational was the same for preventing the over the counter use of Mutaflor(E.Coli Nissle 1917) in the US — it’s a biologic product (in fact, yogurt and keifer would also qualify technically) and thus needs regulation and testing before use. Yogurt and Keifer were probably exempted because they were grandfathered in, Mutaflor, not being a usual AMERICAN probiotics was not grandfathered…. this is a topic in itself.

Let us get back to the poop. There are 60+ articles on PubMed. A recent survey is available in full here. First, the polite name is “fecal bacteriotherapy” or FMT and appear to have been known for some 1600 years. For one condition:

  • 81% remission after one
  • 93% remission after two (89.6% reported in this 2013 study, 92% in 2012 study)

Neurodegenerative and neuro-immunologic disorders improves after FMT.  The summary also states that “studies with germ-free animals or animals given specific gut infections iatrogenically have implicated the fecal microbiome in certain mood disorders, cognition, and pain syndromes ” which suggests that FM may be connected with a dysfunction gut flora.

For CFS and FM, there is one published statistics on the use of FMT. The GI microbiome and its role in Chronic Fatigue Syndrome: A summary of bacteriotherapy, Dec 2012, reported 70% initially responded and 58% had a sustained response (no relapse after 3+ years).

Who is the best donor? According to this Medscape article  ” 75% of donors are first-degree relatives or spouses, and the donor is screened as vigorously as you would screen a blood donor.” I recall reading that the success rate for blood-relatives as donors was 50+% better than strangers. This same article states “A word of caution from Brandt and colleagues is that 2 of their patients had improvement in preexisting diseases, including rheumatoid arthritis and sinusitis. Four patients had subsequent complaints of development of rheumatoid arthritis, idiopathic thrombocytopenic purpura, or neuropathy. Whether these effects are related to fecal transplant remains to be seen.

A further word of caution: The variety of bacteria decreases with age, so a younger donor would be preferred over an old donor. A very healthy donor is ideal.