Poo transplant demand booming

Demand for poo transplants is booming in Australia, leading to a shortage of healthy stool supplies and a call for fecal matter donors.

But this is no experimental fad - the science is solid when it comes to the benefits of fecal matter transplants (FMT) to treat a particularly debilitating gut condition.

At present, FMT is used only to treat clostridium difficile infection - a bacterial condition that occurs in the gut and causes a disturbance in normal bacteria, allowing a dangerous organism to flourish.

Associate Professor Andrew Holmes, a microbiology expert at The University of Sydney's Charles Perks Centre, said FMT was "spectacularly successful" in treating clostridium difficile-associated disease (CDAD).

"Effective cure can be seen within one to two days of a single FMT treatment, and it seldom requires more than three treatments," Dr Holmes said.

And while the general public might offer a raised eyebrow at the idea of a poo transplant, he said sufferers of CDAD had "little to no stigma".

"Fear of missing out is a bigger problem than fear of faeces," he said. "And if you bounce back to health after treatment, no one is likely to hold it against you for whatever sh*t you ate."

So effective is the treatment that poo transplant clinics have popped up across Australia, and some are even operating as "poo banks" where people with healthy guts can donate their faeces to help others.

Fecal matter transplants are hugely effective in treating clostridium difficile infection.
Fecal matter transplants are hugely effective in treating clostridium difficile infection.

Professor Thomas Barody, something of a pioneer in poo transplants in Australia, runs the Centre for Digestive Health in Sydney and said demand for treatment had led to a stool shortage.

Potential donors are screened, with about one-in-12 found to be viable and able to become regular contributors at the poo bank.

They can drop off their donations at the centre. The stool is then used either in a direct transplant via an enema in the anus or turned into pill form, which Prof Barody refers to as "crapsules".

Dr Sudarshan Paramsothy, a gastroenterologist and researcher at The University of Sydney's School of Medicine, said fecal matter suspension was not overly new in an historical sense.

"Using fecal suspensions has been reported since fourth century China, but in terms of Western science, the first instance was in 1958," Dr Paramsothy said.

"But really, it's only been in the past decade or so that its use has grown significantly. It's something that kind of captures the attention because it seems a bit odd to use a stool to try to treat disease."

Dr Doug Samuel with nurse Vishala Raju demonstrate the infusion method of a fecal matter transplant.
Dr Doug Samuel with nurse Vishala Raju demonstrate the infusion method of a fecal matter transplant.

Sydney band Boy and Bear were at the height of their success when frontman Dave Hosking was hit with severe gut illness he described as a "living hell".

Eventually, he began FMT and felt almost immediate relief and learnt how to treat himself at home in a makeshift "lab".

Hosking even found a local donor, Harry, via a letterbox drop, who now acts as his "poo roadie", he told ABC's Hack program.

With his help, the musician was able to start making music and touring again, with Harry joining Boy and Bear on the road.

"I would never have guessed he'd come to Nashville and do all of that," Hosking told Hack. "It's kind of cool. I just appreciate all of his support."

 

Dr Sudarshan Paramsothy is a gastroenterologist and researcher at The University of Sydney's School of Medicine.
Dr Sudarshan Paramsothy is a gastroenterologist and researcher at The University of Sydney's School of Medicine.

Dr Paramsothy said the medical community had "latched on to FMT", as research into the role of gut bacteria in other conditions expands.

"We're learning that gut bacteria is implicated with a lot of conditions - not only gastrointestinal but others like obesity, cardiovascular disease, autism, liver disease and psychiatric issues.

"When (healthy gut bacteria) is disturbed, it can have quite profound affects that are beyond what one might simply expect."

While the treatment holds enormous promise for sufferers of untreatable gut conditions, particularly those battling severe symptoms, experts warn the hype surrounding FMT's potential use in other areas of medicine is yet to match the science.

"None of (the studies into other conditions) are at a stage where there have been significant studies showing benefit. We're very early in the research phase," Dr Paramsothy said.

Laraine Culnane had severe stomach problems caused by a condition she contracted as an aid worker in Asia. She had a fecal transplant in 2017 and was also prescribed ‘crapsules’ to put good bacteria back into her gut.
Laraine Culnane had severe stomach problems caused by a condition she contracted as an aid worker in Asia. She had a fecal transplant in 2017 and was also prescribed ‘crapsules’ to put good bacteria back into her gut.

In April, a University of Arizona study created shockwaves after researches demonstrated long-term benefits of fecal transplants in reducing autism symptoms in children.

A growing number of scientists believe gut microbiomes affect how the brain communicates with the body as well as general neurological health.

The study, published in the journal Scientific Reports, found a special type of fecal transplant improved gut health and eased autism symptoms.

"At two years post-treatment, most of the initial improvements in gut symptoms remained. In addition, parents reported a slow steady reduction of ASD symptoms during treatment and over the next two years," the research paper said.

"A professional evaluator found a 45 per cent reduction in core ASD symptoms (language, social interaction and behaviour) at two years post-treatment compared to before treatment began."

Fecal matter transplants are effective in treating CDAD, but the benefits for other conditions are yet to be robustly proven. Picture: Troy Snook
Fecal matter transplants are effective in treating CDAD, but the benefits for other conditions are yet to be robustly proven. Picture: Troy Snook

While the results are promising on the surface, Dr Paramsothy says it's "early days" when it comes to scientifically demonstrating the broader benefits of FMT.

"Developments like these are always promising, but what you really want to be seeing is randomised control trial data," he said.

"I can't comment on that particular study because I don't know the full details, but what I always caution is that sometimes the hype exceeds the science.

"It's important that we get confirmatory studies that demonstrate true benefit before we start advocating it as a main line treatment. There's a lot of work still to do."


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