Have you heard of fecal microbiotal transplant (FMT)? Are you confused as to what conditions it can help treat, or do you suffer from a chronic disease like ulcerative colitis or Crohn’s disease? In this episode, we take a look at FMT with a pioneer in the field, Dr. Mark Davis, ND.
In This Episode
Fecal Microbiota Transplant (FMT) Defined … 00:01:55
Dr. Mark Davis Bio and Experience with FMT … 00:02:38
Common Conditions FMT Can Be Used to Treat … 00:08:49
FMT and Metabolism … 00:19:47
FMT, IBS, and SIBO … 00:22:49
History of FMT and Methods of Administration … 00:36:16
Mistakes Made in Performing FMT … 00:43:37
When You Should Try FMT … 00:45:27
Dosing and Frequency of FMT … 00:48:48
Multiple Sclerosis, Chronic Fatigue Syndrome, and FMT … 00:52:20
Locations and Clinics Performing FMT … 01:00:36
Episode Wrap-up … 01:06:57
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Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. I am here with Dr. Mark Davis, who is an FMT specialist, I guess you could say. And he was mentioned a few weeks ago by Dr. Steven Sandberg-Lewis. And really happy to have Mark on the call today to be able to talk about FMT. Hey, Mark. Thanks for being here.
Dr. Mark Davis: It’s great to be here, Michael. Thanks.
DrMR: We met very, very briefly, kind of in passing, last year at the SIBO symposium.
DrMD: I remember.
DrMR: And I can tell you’re very passionate about FMT. And so I’ve had it in the back of my mind for awhile to get you on and kind of delve into that. And I guess before we jump in, I just want to give people my perspective and really what I’m personally, almost I guess you could say selfishly, hoping to get out of this call, which would be knowing when the best time to make a referral for FMT is.
We’ve got a good body of science emerging. And I think especially in the last maybe year to a year and a half, there have been a lot more studies starting to look at this just outside of what it’s typically used for, which is resistant clostridium difficile infection.
Fecal Microbiota Transplant (FMT) Defined
And I guess for me to take a big step way back for people who are listening to this who don’t even know what FMT is, FMT stands for fecal microbiotal transplant therapy. And we’ll go into more detail about this in a minute. But it’s kind of like doing an enema with someone else’s poop, so to speak.
DrMR: And sounds kind of gross. But it can be really helpful for this one resistant infection. But we’re starting to see more and more being published about other conditions, which makes me think that the clinical science is ahead of where the published literature is. So I’m thinking who better to get a clinical perspective on this than from someone who is doing this with a lot of their patients? So hence, enter Dr. Davis.
Dr. Mark Davis Bio and Experience with FMT
DrMR: So I guess, Mark, can you first tell us a little bit about what you’re doing and kind of how you got to be where you are right now?
DrMD: Okay. So Dr. Sandberg-Lewis was a mentor of mine when I was a student. And he sees a lot of patients with inflammatory bowel disease. And so I just thought he was super keen. And I did as many rotations with him as I could. So I was seeing a lot of people with ulcerative colitis and Crohn’s disease.
And oftentimes they had been to see many other naturopathic doctors, chiropractors, medical doctors, gastroenterologists before they came to us. So these are really stubborn cases. And we were able to help a lot of them with the typical tools of naturopathic medicine: diet and supplements and herbs and lifestyle. But there were many of them who were still suffering for sure.
So I’m a person who gets a lot of pleasure out of just spending time in the scientific literature, browsing around, finding what I can find. So I started swimming through the literature. What else is out there that we haven’t considered that might be able to benefit these people?
And one thing I found was a couple of papers from 2003 and 2004 by this Australian gastroenterologist named Tom Borody, talking about patients just like the patients I was seeing—patients with highly resistant ulcerative colitis and Crohn’s colitis not responsive to any other interventions who did this thing called—at the time, his papers called it human probiotic infusions, which is a name that I liked a lot.
DrMR: It’s a much nicer name, yeah.
DrMD: Yeah. But it’s more commonly known as fecal transplant. And now in the literature, it’s most often referred to as fecal microbiotal transplantation or FMT. So as a student under Dr. Sandberg-Lewis’s tutelage—he had not tried it before. I said, “I’m really excited about this thing. Can I suggest it to patients?” He said, “Sure. Suggest it to a few people.” For most people to whom I suggested it at that time, which was maybe 2006 or 2007, it was too much for them. The ick factor was just…They were like, “Uh, no. I’m not going to consider that.”
But I worked with one person as a student, a 39-year-old female with a four-year history of moderate to severe ulcerative colitis. And she had three- or four-year-old twins and was home with them. So she had definitely a high stress lifestyle. And we tried it with her and at first had no success. But after tweaking it after a little while, she ended up having what she described as about a 95% improvement in her picture, which she was not well-controlled even with Prednisone. So she was having a very hard time.
So that started my fascination. At that time, there was nobody focusing on using this therapy for patients with inflammatory bowel disease. There was one guy in New York, Larry Brandt, very, very highly regarded gastroenterologist, who was using a little bit for patients with IBD. But he didn’t have a donor bank. So I said, “I’m going to be the first guy in North America to set up a donor bank for treating people with inflammatory bowel disease.”
So it’s kind of a long story. But that was my road to being fascinated with this. And I spent a few years using my donor bank where I would regularly screen and re-screen very healthy donors, collect their stool, process it, and then administer it to patients from all around the world—patients with inflammatory bowel disease, patients with C. diff. infections, patients with other infections, patients with irritable bowel syndrome, and sometimes multiple sclerosis or other conditions. And I got to learn a lot about it. So that’s enough of a long answer, I think, to your initial question.
DrMR: No, it’s a good story. And it highlights your passion for this, which I think is important that people understand that you’re coming from a place of being frustrated with the tools that were available and trying to find something else.
And I think that’s really important to mention, especially for some of the audience that is really used to especially me being very critical and keeping a very close eye to the science because that’s one thing that we’ve really covered, which is how important it is to use the clinical trials to keep us from being mislead, misguided, wasting money on unvalued testing and treatment.
However, again I think this is an area where I really am getting the suspicion that the clinical science is ahead of the published science. And I think inflammatory bowel disease really illustrates that because—
And Mark, if you have tweaks on this, I’m totally open to them.
DrMR: But from my following of the literature, it seemed like there were some early reports using FMT for inflammatory bowel disease. And there seemed to be kind of mixed reviews. There was, I think, one or two papers published where people had reactions. There was one paper published where someone received a fecal transplant from someone who was overweight, and then they subsequently became overweight after receiving it.
So there was kind of some mixed data initially. But as more and more evidence starts to pour in, especially over the past maybe year, you start seeing more of these clinical trials really showing favorable outcome for IBD and even to the point where there has recently been a systematic review with meta analysis showing pretty favorable results using FMT in IBD (inflammatory bowel disease).
And that makes me beg the question—Where else? IBS, SIBO, metabolism, multiple sclerosis, other autoimmune conditions. Could this be a viable tool? And I have some thoughts to help people maybe with the sequencing. But that’s kind of the suspicion that I get.
Common Conditions FMT Can Be Used to Treat
So maybe with that as a jump off point, Mark, what are some of the most common conditions that you’re using this with? And what kind of results are you seeing?
And the one thing I just want to make sure to add into this question—people, I think, are confused about what kind of results to expect. You hear from some people it won’t work, from other people it’s a miracle. So as someone who’s seen a lot of this, what’s kind of a reasonable expectation for people?
DrMD: So that definitely varies by condition and by individual. I want to just throw out there that I share your love of science. As clinicians, science doesn’t tell us everything we need to know. There are a lot of things we have to go on that science hasn’t adequately commented on. But when the science is there—oh, my goodness!—use it. Use it! I love it.
DrMD: So for those of your listeners who really want to nerd out on this topic, I myself did an informal literature review that was published in—let’s see—this past August 2015 in the Natural Medicine Journal. So it’s a free article online. They can just Google Natural Medicine Journal. And the article is called “Clinical Applications of Fecal Transplant” by me, Mark Davis, N.D.
And what I did at that time was I went through all of the literature to say what indications are out there? And what does the literature tell us about what kind of benefits we can expect using it for antibiotic-resistant C. diff., using it first line for C. diff., using it for inflammatory bowel disease, IBS, metabolic conditions, and other things. So for people who want to spend a little bit of time nerding out, I think there are like 53 references attached to the article. So it’s a deep rabbit hole.
DrMD: So I want to first say, talking about FMT for IBD (inflammatory bowel disease), ulcerative colitis, and Crohn’s disease, and in fact, there have been three meta-analyses, three meta-analyses. My favorite is one by—David Rubin is the co-author. I don’t think he’s the first name. But they do a really, really excellent job. And what they find in this meta-analysis of case studies and case series is about a 25% remission rate, 50% response rate (so people who get noticeable benefit that approaches but does not reach remission), and a 25% no response rate which pretty closely mirrors what I find in my practice as well.
So when you say what can people with inflammatory bowel disease expect? Is it going to be a miracle? Is it going to be no reaction? The answer is all of the above. I’ve seen everything from people get no response, even when they do everything right, to people for it to really be a miracle. I have patients who I feel highly confident have their colon who otherwise would have had total colectomy if they hadn’t done fecal transplant, and possibly some patients whose lives were saved by this therapy because they had already been in ICUs at the brink of death because of kidney failure due to dehydration from having so much diarrhea or who have lost so much weight that their surgeons wouldn’t even operate on them even though their colons were so highly inflamed or who needed many blood transfusions. Anyway, a lot of stories.
So people can expect miracles. They can expect up to and including going from severely sick with inflammatory bowel disease to completely well, off all medicines, and with a varied diet. That’s best-case scenario. And I’ve seen that happen. Or they can expect no response.
Thinking about the trials, there are a couple trials that showed some adverse events. And I have to say I review those all in that article in Natural Medicine Journal. And the one trial I was so—I don’t want to defame anyone else’s work, but I think he went about doing the trial in a really weird way. Initially, they found some of the people they gave FMT to got a bit of a fever. And one thing they did was they rapidly removed them from all their medicines they were on—immunosuppressant medicines. If they were on Remicaid or Prednisone or whatever, they removed them from all of those. And then when people flared, they said, “Aha. They’re flaring after FMT.”
DrMD: Anybody that you rapidly remove from immunosuppressant medicines is going to have a bit of a rebound effect.
DrMD: So I attribute that to it. And I notice these people are getting febrile reactions. They were getting a fever. And they decided to administer anti-pyuretics to them or things to bring down a fever. And they gave them all antibiotics too in case it was an infectious fever. So their results were really weird, but I think it’s because they were going about it in a kind of weird way with all the interventions they were choosing to give or to remove. Trials that have gone about it in a different way have not seen significant amounts of adverse events or any reportable amount of adverse events and have seen generally significant response and remission rates with it.
DrMR: And I’ll second that because that’s—I think some of the initial literature was maybe a little bit biased because of some of those reactions that were reported in the study that you’re referring to. I didn’t dig into the methodology as much as you did. So it’s great to know where that was coming from. But what I had observed in watching the studies was it didn’t seem any of the other follow-up studies reported the reaction. And then even when you got to something like a systematic review, you didn’t really see much in the way of reactions reported. So that totally makes sense, yeah.
DrMD: Yeah. It looks very safe even among immunocompromised patients. There have been a couple review papers looking at patients on prednisone, patients with HIV/AIDS, patient who have had organ transplants, all these things that make people immunocompromised. And they get FMT. Is it significantly dangerous for those populations? Looks like it’s not. Looks like it’s still a safe therapy in those cases. And I also want to comment on that one case where you talked about, “Oh, somebody got fecal transplant and they gained a bunch of weight after that.”
DrMD: I also dug into the methodology of that case. One of the authors on that study is someone I have a ton of high regard for. Colleen Kelly is a gastroenterologist in Providence, Rhode Island. She has been a mentor to me, and I really respect her. And this was her patient.
So the patient was a woman who was experiencing a C. diff. infection that was not responding to antibiotic therapies. She didn’t have horribly severe disease. But she had loose, frequent stool and significant amounts of abdominal pain. And they said, “Well, you continue testing C. diff. positive.” In addition, in their workup, they found H. pylori. Okay, so Helicobacter pylori is an organism that lives in the stomach, burrows into the stomach and sometimes the first part of the small bowel wall, and is associated with peptic ulcer disease. And so they said, “Well, all right. Let’s treat the Helicobacter pylori and see if we can improve your abdominal pain.” So they gave her triple antibiotic therapy, triple therapy they call it, for H. pylori. And she still tested positive for H. pylori. So they treated her a second time for it. And they did eradicate H. pylori. But her abdominal pain did not improve. So they said, “You know what? It’s probably the C. diff. Let’s do the fecal transplant.” Now, her body mass index initially was 26. You may be familiar with BMI. 18 to 25 is considered a normal body mass index. So when I look at that, I think, “Oh, she was already a little heavy.” But when I spoke with Dr. Kelly about it, she said, “Really, her build was more athletic. She is a very muscle-y person.” And as you may know, in very athletic people, body mass index isn’t really necessarily an accurate scale. So her BMI was 26. She got fecal transplant from her—I forget—18- or 20-year-old daughter who herself had a body mass index that was under 25. So she actually was normal body mass index.
DrMR: Oh, okay.
DrMD: So she got fecal transplant, cured the C. diff. infection. Hurray! Fecal transplant succeeds in what it’s supposed to do. But over the next three- or four-month period, the patient developed about a 20- or 30-pound weight gain that wasn’t responding to dietary or lifestyle interventions. And so did the daughter. So they both gained weight at the same time.
DrMD: Now, is it about the daughter’s microbiome was about to predispose her to gain weight—
DrMD: And so sharing her microbiome with her mom predisposed mom to do the same thing?
DrMD: Well, maybe. Maybe that’s it.
DrMD: Because we know that we can make skinny rats fat and fat rats skinny just by doing fecal transplant between then. So it works with rats. Why wouldn’t it work with people? But there’s a bit of a confounding factor in there, which is that we know that H. pylori eradication is obesogenic. We know that. You get rid of H. pylori, you’re going to tend to gain weight that’s hard to get rid of. And she had H. pylori eradication therapy twice, which was successful in eradicating H. pylori.
So I called up Colleen, and I said, “Colleen. You didn’t mention that H. pylori is obesogenic. And you didn’t really focus on these other details.” And she said, “Really, the paper was a resident of mine who was very excited about it. And you’re right. I should have taken the time to write those details more specifically.”
So what I would say is we don’t have good data that you can alter body mass index tendencies in humans using fecal transplant one way or the other. And I have spoken with people who have tried to use it at home, using lean donors for themselves as an obese recipient of FMT. And I have not yet heard any stories of weight loss or resolution following that. So I would say we don’t have evidence one way or another in humans yet. Is it possible? Sure. We can do it with rats. But it’s a big question mark still.
DrMR: Sure. Well, very impressive digging into the details. And I love the fact that you’re doing that. And I really appreciate that. And I’m sure everyone listening really appreciates that because the audience has heard me say before it’s important that you look into some of the details. And I’ve done that with some of the literature on IBS and SIBO. And we’ve gone through that. And sometimes, the devil really is in the details.
DrMR: So thank you for sharing that. And I really want to come back to the H. pylori piece in a moment.
FMT and Metabolism
DrMR: But while we’re on metabolism, I know that there was that one study that was done with normal weight people giving FMT to the people that were—it was probably trying to quell type II diabetes. And there was really a marginal, if any, change in the diabetes. In the abstract, they concluded that FMT could be a viable treatment for diabetes. However, I question that because the fasting glucose and the hemoglobin A1c didn’t really seem to change.
There was another glucose kinetic marker that did change. But really the most meaningful clinical markers didn’t change. And the weight didn’t change. So that’s the one study I know of that really didn’t show much in the way of weight, which kind of corroborates what you’re seeing. But any comment on that study or anything else in this regard?
DrMD: Yeah, that was Max Nieuwdorp’s lab. Vrieze, et al. “Transfer of Intestinal Microbiota from Lean Donors Increases Insulin Sensitivity in Individuals with Metabolic Syndrome” is the title. And they did have a statistically significant result there. So insulin sensitivity significantly improved in these men with metabolic syndrome who received FMT from lean donors.
And all that is, is a hint. When you get something statistically significant in a randomized, controlled trial, I always sit up and take notice. And so I think that’s a hint that we need to do more exploring. But there’s a possibility that your colon microbiota can have a significant impact on your ways that you metabolize sugars and are sensitive to insulin. So we don’t have hard data there. But we have a randomized, controlled trial indicating that there may be some benefit there. So I’d say the jury’s out, but the jury is curious and wanting to know more.
DrMR: Sure. And I would agree with you there. I’m curious. I’m hopeful. With any of these therapies, I’m always hopeful but also a bit reserved and skeptical—
DrMR: So as not to just be jumping on a bandwagon. And the one thing I would maybe offer for people to keep in the back of their heads is being statistically significant and being meaningful in the real world can be two different things.
DrMD: Yes. Absolutely. Right. Statistical significance and clinical significance are two different beasts that oftentimes share the same bed, but they don’t always. So, right. So we have statistical significance. Do we have clinical significance? Not in these men. It didn’t make a difference in the lives of these men with metabolic syndrome in that one trial.
DrMR: And I think that’s the important thing especially if you’re not someone who is super keen on reading literature. But if you hear someone quoting a study showing blah, blah, blah significant difference, remember that statistically significant doesn’t always mean that for someone in the real world the effect is going to be something that you would really consider worthwhile.
FMT, IBS and SIBO
DrMD: Right. Right. The one thing I do want to note about that study that was meaningful for me and my practice is this had come out. And two or three years ago, I started to read about this infectious disease doctor in Canada, Thomas Louie, who had developed FMT capsules.
And I thought, “Oh, wow! That would be great” because it can be physically, mentally, and emotionally challenging for my patients who are having a lot of diarrhea for me to ask them to retain 150 mL of fluid in their rectum for four or more hours. That can be a big deal, especially when I’m saying, “Let’s do it every day for multiple days, five days.”
DrMR: Right, yeah.
DrMD: It can be a challenge. And in fact, it can be an obstacle to cure. And so I read that Tom Louie came out with his capsule program. And his initial report was something like—I think it was 25 out of 25 patients cured or whatever is—18 or 25 patients. There was 100% cure rate. He has gone on to do more and more of the caps and has not continued to have a 100% cure rate. But it’s about 95%.
So I said, “Great! Wow! What a good option this would be for some of my patients potentially.” But then I thought, SIBO. I thought, “Geez. If SIBO is marked by the presence of the types and quantities of bacteria normally found in the large bowel but stuck in the small bowel, what Tom Louie is doing, the infectious disease doctor with capsules, is putting the types and quantities of bacteria found in the large bowel into the small bowel.”
DrMD: Is he giving people SIBO? Well, he’s an infectious disease doc. He’s not a gastroenterologist or a chiropractor, a naturopath. So he wasn’t looking for SIBO. So I said, “Wow, I don’t know if this would be safe.” But in that study of men with metabolic syndrome—Vrieze, et al. that I mentioned—one thing they did was they went in and did upper endoscopy. And they used a little camera. And they looked around at their nice, healthy pink duodenums. And they did some biopsies and aspirates. Now that is the gold standard of looking for small bowel overgrowth, right?
DrMR: Right. Yep.
DrMD: Even more so than a breath test. So they did some biopsies and aspirates. And they specifically looked for small bowel overgrowth before FMT. They did not find it in any of these men with metabolic syndrome. And then after they had taken their biopsies and aspirates, they sprayed fecal slurry all over their duodenum. They’re not caps that might be released somewhere in the small or the large bowel. Straight up, unreservedly sprayed a bunch of fecal slurry from a lean donor right into the duodenum. And they came back a month later and did upper endoscopy again and did biopsies and took aspirates to look for small bowel overgrowth. And they didn’t find it.
DrMR: So they literally sprayed the small bowel.
DrMR: Because you cut out there just for a second, so I want to reiterate that in case anyone missed it. They literally sprayed the small bowel with fecal transplant. And then they found what?
DrMD: And they came in a month later and looked again. Do we have small bowel bacterial overgrowth here in the duodenum? No, they did not. They found it in zero cases. So that did not give me 100% confidence that there’s no risk of small bowel overgrowth. But I thought, “Okay. It looks like the limited data we have so far, it looks like you can put fecal microbiota into the small bowel in at least some cases without seeing any evidence of small intestine bacterial overgrowth.”
DrMD: So that gave me enough confidence at least to move forward preparing these capsules and giving them to my patients with antibiotic resistant Clostridium difficile infections. So now, it’s two years later. I’ve given caps to about 50 people—50, 60, 70, somewhere in that range. And what I have is two people with post-infectious IBS. They cured their C. diff. in both cases, so that’s great. They have post-infectious IBS marked by bloating with positive SIBO test beforehand.
In one of them, we did a SIBO test beforehand and did not find small bowel overgrowth. But we cured her C. diff. with FMT capsules. And she’s been struggling with this bloat-y, mushy-stool-type IBS since that time. So I have a suspicion. So two out of about 50 patients—50, 60, 70—who have this post-infectious IBS as their diagnosis. I suspect that if I had cured their C. diff. with FMT enemas instead they would not have this lingering condition they have. I am not 100% sure because, as you know, some people just have post-infectious gastroenteritis after C. diff. or other infectious disease anyway.
DrMD: So I don’t know that the caps caused it. But it is a concern for me. And I’ve actually gotten funding to, either later this year or early next year, do a trial giving FMT caps to people with Crohn’s of the small bowel and looking for SIBO before and afterwards. And we’re going to do it versus placebo. So we’re going to hopefully get a sense of—do we have evidence that FMT caps do increase your risk of small intestine bacterial overgrowth? So hopefully, my group will be able to answer that question in the next year or so.
DrMR: And so just to make sure I have this correctly, I want to make sure I heard that the right way. You had two out of about 50, 60, 70 where you felt like it made the IBS symptoms better? Or was it worse?
DrMD: No, worse.
DrMD: They did not have IBS beforehand—well, one of them kind of did a little. But mostly, they did not have IBS symptoms. They got C. diff. And then they had a lot of frequency, urgency, smelly, stinky, watery stool.
DrMR: Gotcha. Yeah.
DrMD: We gave them FMT caps. It did cure their C. diff. They tested negative afterwards. Their bad urgency—
DrMR: But then IBS…
DrMD: But since then, bloating and mushy stool and positive SIBO tests.
DrMR: Gotcha. And yeah, you asked a good question. Was it from the FMT or was it just in the wake of the C. diff. and some of the damage that can happen or potentially even some gut autoimmunity that can happen.
DrMR: Gotcha. So what about other patients? Because I know there are a lot of people probably listening with SIBO. What is your take on IBS/SIBO and the clinical utility of FMT for that?
DrMD: Yeah. So it sounds like you’re in the same camp as I am. I hear you saying IBS/SIBO because there’s a lot of overlap here.
DrMD: And IBS is a diagnosis. SIBO is not a diagnosis. SIBO is a finding. So patients come to me all the time. “I’ve been diagnosed with SIBO.” And I share with them my opinion that that’s not a diagnosis. It’s a finding. I have high white blood cells. Or I have high cholesterol or something. It’s a finding that then you associate with actual pathology in the tissues or actual symptoms. So we have people who have IBS and don’t have SIBO. And we have people that have SIBO and don’t have IBS.
DrMR: That’s a really important point, I think, for the listeners because there are patients that will clear a positive SIBO and still have symptoms of IBS.
DrMR: So it’s not all about—as you’re alluding to, it’s not all about treating a lab finding. It’s about treating the entire patient.
DrMD: Yeah, absolutely.
DrMD: And in fact, I will say, of those two FMT caps patients, one of them has continued to be a patient. One came from Seattle. And she’s not my patient anymore. She actually is working with Mark Pimentel down at Cedars-Sinai. But the other one is local. And she is still my patient. And we’ve gone through antibiotics and herbs for her for SIBO. And she does not test SIBO positive anymore. She tests negative, but she still has all these symptoms.
DrMD: So she’s a very interesting case. Okay. So we don’t have anybody except this one group with the men with metabolic syndrome who have looked for small intestine bacterial overgrowth in anyway regarding fecal transplant.
But we do have one group. It’s actually Larry Brandt, the gastroenterologist from the Bronx whom I mentioned earlier. His group did a little trial of giving FMT via the upper GI route to people with irritable bowel syndrome who were not responding to any other interventions.
Now, again, he’s a gastroenterologist and a very, very smart, highly respected guy. But he uses the tools of gastroenterology, which are diet, fiber, pharmaceuticals. So those are the tools. And these patients were not finding resolution of their IBS with any of those tools. And they did upper-GI-administered FMT. What they found was 70% of them responded that they had either a very good or complete resolution of their irritable bowel symptoms from upper-GI-administered FMT.
DrMR: Well, it makes sense from the perspective that bacteria—and this kind of being a probiotic, I guess we can say—that actually has antibacterial effects. One of the reasons why some of the studies may show that probiotics help with SIBO may actually be because of the probiotics’ antibacterial effects. So I wonder if that’s the mechanism through which this works.
DrMD: I wonder too. It’s a big mystery. The small bowel is this black box that is so hard to look into. And we try. We look with breath tests and with functional tests and make our best guesses. It’s hard to know what’s going on. But what matters more to me than any lab finding or anything is how is my patient feeling? How is their quality of life?
DrMR: Absolutely. Totally agree.
DrMD: And so hearing this response—70% of people had very good or complete resolution of their irritable bowel syndrome—makes me more favorable of FMT upper or lower GI than unfavorable. And I will tell you, in my population, I actually have never given upper GI FMT, which is nasoduodenal tube or capsules, to somebody with irritable bowel syndrome. But I’ve done enemas with many people.
Before the FDA regulations two and a half years ago, I was able to directly administer FMT enemas from my stool bank to people with IBS. And since that time, I’ve had patients with IBS who self administer FMT at home. And I’m able to track their progress. And I would say it’s maybe one out of three people in my experience, not as good as the 70%. So maybe the upper route is a better route in this regard. But in my experience, about one out of three people with longstanding irritable bowel syndrome can do FMT retention enemas and have a really appreciable improvement in their quality of life up to and including complete resolution.
DrMR: Gotcha. So this may be a good time to segue to the different methods. But before we segue to that, while we’re on the topic of IBS, have you given the capsule form to anybody with IBS?
DrMD: No. So as I alluded to earlier, almost three years ago now, FDA set out some guidelines—
DrMR: Gotcha. Yeah.
DrMD: Saying clinicians in the United States can only prepare or administer FMT for patients with C. diff. infections in their colon that are not responding to standard therapies. So that was almost three years ago. And I’ve only been doing my capsule program for about two years. So I’ve only been able to use capsules for people with C. diff. infections not responding to standard therapies.
DrMR: Yeah. It’s kind of handcuff there.
DrMD: Now, some of those people have had inflammatory bowel disease. And I’ve been able to see some awesome transformations in people’s inflammatory bowel disease with FMT caps. But in terms of people with irritable bowel syndrome, I haven’t tracked people improving or not improving in terms of IBS and also having C. diff. I can’t say I’ve noticed one way or the other with that group, although there have been some very dramatic IBD cases that I can refer to. The jury’s definitely out on that one.
DrMR: Gotcha. Okay. And so for everyone listening, one of the things I have in my mind to work to is kind of when to use this. So we’re getting there. But before we go there, we’ve talked about a couple of the methods. But Mark, can you describe some of the methods and maybe some of the pros and the cons that, if someone’s listening and they’re trying to figure out what to do or what have you, what kind of options they have for this?
History of FMT and Methods of Administration
DrMD: Okay. I want to mention briefly the history. So this is first reported, used taking stool from a healthy person, mixing it with liquid to make a fecal slurry, and giving it by mouth. That was the first report. That’s the fourth century, an author named Ge Hong in a text that translates something like Handy Book for Medical Emergencies or something like that. And this was not an everyday thing. This was for people who were suffering from diarrhea so bad that the clinician was fearing for their life. You could use what was called yellow dragon soup for these people.
And then in the sixteenth century, you have it again in China reported by an author named Li Shizhen and in Europe by an author Christian Franz Paullini who wrote a text called Heilsame Dreck-Apotheke, or The Healing Filth Pharmacy, where he talked about using fresh or dried feces and adult versus child versus infant feces or fermented human feces for different indications. And again, these are p.o. or oral applications. You’re drinking the poop soup.
And then in 1958 in Denver, Colorado, there were some patients with C. diff. colitis basically—they didn’t call it that at the time, but now, we know it almost certainly was that—who were on the brink of death. And docs were holding a grand rounds among the docs and the nurses and said, “Anybody have any ideas?”
And one of the nurses held up her hands. And she said, “Well, I was talking about these patients to my friend. And her grandfather is there who is from China and said in China they use this thing they call yellow dragon soup where they take human feces and they prepare it as an oral solution. They give it to the people. And it can save their lives if they have diarrhea that’s going to kill them.”
And the doctors said, “Well, could make sense. There are microbes in there. But we can’t give people poop soup. How about we give it to them as an enema and see if that works? Nurse, how about you take care of that?” So the nurse who has been written about but has kept her name anonymous said, “Okay.”
And she had some fecal samples screened. And she prepared them into a slurry and administered them as enemas to the patients. And indeed, all of them recovered. They would have been dead. But within 48 hours, all of them—their diarrhea had stopped.
So this is when we have the second method of administration—not the oral poop soup that most people want to avoid but the rectal administration, the poop soup enema, which still there is some ick factor to that but not nearly so much ick factor. And the risks seem astonishingly low compared to other types of therapies we use. And interestingly enough, something that can be done at home safely and, in many cases, effectively.
So most of the reports that you see and the literature are actually not about either of these methods. They’re about using a nasogastric or nasoduodenal or nasojejunal tube that goes through the nose, down the esophagus, into the small bowel usually and putting a fecal slurry into the small bowel like that or administering it via colonoscopy.
So you’re taking colonoscope. You’re winding it as far up the colon as you can, maybe all the way to the end of the colon. And then you’re administering the fecal slurry to various parts of the colon as you withdraw the scope. And enema is in there too. We have enema reports.
So it seems like for C. diff., that this has been most studied for, there is about an 85% cure rate with the upper endoscopic—oh, and then caps is the last method. About 85% cure rate with the upper endoscopy and about a 95% cure rate with colonoscopy, enemas, and caps. So I do not even know why clinicians continue to do the nasojejunal route unless they’re doing it with patients with Crohn’s disease of the small bowel. If you’re trying to affect the colon, I think put it directly in the colon, which leaves you colonoscopy or enema.
Colonoscopy, there are rare but real reports with FMT and without FMT of perforations because a colonoscope is a long, flexible tube that you’re winding up another long, flexible tube—the colon—and has a metal tip. And when somebody has inflammation in there, there are times when you can poke a hole in the colon and have feces spill into the abdominal cavity, which can be dangerous or even lead to death. Colonoscopy does not appear to be more effective than enema. So with the small but real risks of colonoscopy in addition to the risks of the anesthesia that accompanies it, I think that of those three routes, enema is the safest. So that’s what I largely recommend for my patients—enema-administered therapy—unless people have damaged anal sphincters, which some of my elderly patients or people who’ve had C. diff. or other things for a long time might have—anal sphincter damage or so much diarrhea that they simply can’t retain 4.5 ounces for four hours, in which case I think caps are probably the way to go. So those are the two methods that I am most in favor of, of everything that’s out there.
DrMR: Gotcha. Okay. So there are definitely a few options. And there are restrictions, though. Other than for patients that have C. diff., you can’t administer the caps. Or you can only go the enema or colonoscope route, correct?
DrMD: No. Yeah. So clinicians are highly restricted by FDA. This is not FDA approved for any indication. But FDA has said if patients have C. diff. infections not responding to standard therapies, you can go ahead and use it even though it’s not FDA approved. We’ll make an exception to our little rule because it’s so clearly life-saving for that condition. We don’t want to keep patients from that. So I really appreciate that FDA has allowed that exception. But clinicians can’t give caps or enemas or colonoscopy or NJ tube or anything else that’s FMT to a patient unless they have a C. diff. infection not responding to standard therapies or they’re doing an FDA approved clinical trial like the one with Crohn’s that I’m hoping to do later this year. So those are the only occasions that clinicians can use it.
However, this is not rocket science. This is something that thousands of people, maybe 20,000 people in the United States, have gone ahead and done at home.
I want to take a brief moment to place a shout out to the Fecal Transplant Foundation, the nonprofit group. And I’m on the board of directors there. And all that we do is advocate for clinician and patient education around the value of fecal transplant. And you feel free to go make a donation. We’re a great group. And our executive director especially works really hard.
Mistakes Made in Performing FMT
But the executive director has shared all kinds of stories. She hears it all from patients with C. diff. or other things who have tried FMT at home. People have decided, “Well, if it’s just about making poop into an enema and giving it to yourself, why not use my own stool?” So people have done it with their own stool without benefit, of course. The reason is they’re not getting the microbes to benefit them.
DrMD: They’re just getting their own microbes back. People using animal stool to do an enema, which that’s just such a wildcard. I would not recommend to anyone to do that.
DrMD: I love my dog. I love my dog a lot. But I just don’t think the interspecies thing is a—
DrMR: Yeah. Totally.
DrMD: Or the most common thing. People who are so sick and so desperate and so unable to have a clinician on their side that they just use stool from a generally healthy friend or family member who has not been screened for HIV, syphilis, viral hepatitis, C. diff., parasites, or other gut infections. And that is the riskiest thing because people can seem really healthy but have organisms in there that are not causing disease in them but, in somebody who already has C. diff. or already has ulcerative colitis or Crohn’s colitis, could cause a lot of harm.
So anybody at home thinking about doing this for themselves, go to a clinician, in the interest of harm reduction, who is familiar with how to recommend appropriate screening to make sure that this gives you the potential for benefit at least, if you have a condition that could respond to this, without giving you the potential for any known harms like transmitting an infectious disease.
When You Should Try FMT
DrMR: Completely agree. And that’s maybe a good segue into when for patients to use this. So I’d like to start with just giving my perspective on this.
And then, Mark, if you have a different perspective, please share. What I typically tell patients when they ask me about this is because there are—and granted, people are not asking me about this for resistant Clostridium difficile. They’re asking for predominantly IBD, IBS, SIBO, or another autoimmune condition, maybe rheumatoid arthritis or multiple sclerosis or what have you. So my typical answer is FMT definitely has some promise and shows a lot of potential. However, there are things that we also don’t know.
And because of that, what I recommend we do is start with the most tried-and-true therapies, which of course would be diet and lifestyle first and then a very comprehensive GI program for most of these patients, which may be, as you had alluded to earlier, Mark, the tried-and-true therapies for IBD or for IBS or for SIBO that natural and functional medicine has to offer. And if there’s thyroid autoimmunity, it’d be the treatments that we have available for that.
So work through the most well-established treatments first, leaving the FMT as kind of the end-of-the-line consideration should none of the other preliminary therapies work. I think that’s the best strategy, as you said, Mark, to mitigate risk—by working through these more well-established, tried-and-true therapies first and then leaving the FMT as kind of a last option.
DrMD: Yes. I am in very much agreement. And as a clinician, I am in a very similar place. How do I learn things? Well, through looking at folk traditions and looking at science and using my own clinical experience. And what do the folk traditions around FMT say, dating back to the fourth century? Only use this if this is something that is not responding to anything else and your health is significantly affected.
DrMD: Because it’s a weird thing. It’s not an everyday therapy for an everyday condition. It’s for conditions that are not responding to other things. So people at times often come to me. And they say, “I have ulcerative colitis, and I am interested in trying this.” And I’ll say, “Well, I think as far as we know, the risks are low.
So that part is good. But have you experimented around with diet? Have you looked at taking butyrate or short chain fatty acids or working with curcumin or boswellia or artemisia or any of a number of other therapies that I find can be highly beneficial? Vitamin E, liquid vitamin E, retention enemas, calendula retention enemas, probiotics—have you experimented with those?”
So these are things that I look at either the folk traditions or the science. And I say, “I feel highly confident that these things are safe and could have benefit for you because they’ve been used for a long time.” We have a very clear understanding of how they’re doing what they do. So I usually recommend working through those things with people.
DrMR: Absolutely. Yeah, it makes a lot of sense.
Dosing and Frequency of FMT
DrMR: And I know this may vary from patient to patient. But is there is a typical kind of dose or frequency that seems to be—? Especially if someone maybe finds a clinician locally who is willing to help them, but they don’t seem to know a ton about this.
DrMR: Are there some clinical bases? A good dose, a good frequency that people may want to be bringing to their doctor or incorporating into this?
DrMD: Yeah, well, first of all, I would say that I actually have so much passion about this that I offer free clinician consults. So if anybody is talking to a clinician and the clinician says, “Geez, I just wish I could know more about this,” any licensed clinician in the United States can call my office and arrange for a free consult where I will talk through cases with the clinician at no charge. That’s a possibility for their clinician potentially.
DrMR: That’s great.
DrMD: Yeah. But yeah, it actually doesn’t vary a ton from patient to patient because it is so variable. So I recommend the same kind of blueprint for almost everybody. Now, if you have C. diff., it’s three to five retention enemas. And if you’re not cured by then, you need to look into something else, because you might have an anatomical abnormality that’s preventing it from working. Or you might have a colon cancer. Or maybe you really have inflammatory bowel disease, because C. diff. should be cured by three to five retentions enemas or two rounds of caps.
If you have inflammatory bowel disease or if you have irritable bowel syndrome, I recommend starting with ten retention enemas, more or less daily retention enemas, and seeing where you’re at after that. Now some people, especially people with severely active inflammatory bowel disease may need 15 or 20 or 30 before they start to notice benefit. The vast majority of people who are going to benefit from this therapy with IBD or IBS are going to notice their benefit within ten days, I believe. That’s my best guess. So that’s where I usually have people start. And if they have seen no benefit by ten days, unless they have severe disease, I say, “Okay, we have to either just move on to other therapies. Or we have to tweak this therapy.” Consider using a different donor. Consider seeing if you can find a way to help you retain longer. Consider a round of antimicrobial treatment, followed by more FMT to try to eradicate something beforehand.
So if people have no benefit, we’ve got to try something else, either a tweak on this therapy or a different therapy. If people have complete or almost complete resolution of their symptom in ten days, which I have seen happen—it is awesome. In that case, I tend to recommend two retention enemas per week for another eight weeks before stopping to try to prevent relapse. And if someone’s in the middle, if they say, “Oh yeah, I am having a significantly beneficial response, but I’m not at remission yet,” or, “I am at remission, but I’m still on my prednisone or other therapies,” if they’re trying to get off their therapies, we work to get them off those other immune suppressive therapies and make sure they’re still not symptomatic before doing our two a week for eight weeks. Or if they’re off meds and they’re saying, “Yeah, I’m better but not all the way better,” I have them do it as often as possible, daily if possible until they’re either all the way better or almost all the way better, or they’ve plateaued out. They’re not getting continued improvement. And then we move to two a week for eight weeks. That’s my basic algorithm.
DrMR: Gotcha. Okay. Great. Any other common conditions there?
Multiple Sclerosis, Chronic Fatigue Syndrome, and FMT
And I guess maybe that begs the question—C. diff., IBD, IBS—are there any other conditions that this seems to be particularly helpful for?
DrMD: Well, I mentioned multiple sclerosis earlier, which is an intriguing one because Thomas Borody, whom I mentioned earlier, in Australia—he has three case reports of people with multiple sclerosis who also had constipation who came to his center for FMT to benefit their constipation. And he reports complete reversal of all MS symptoms in those three patients, including one young man.
He wasn’t even 30. And he was confined to a wheelchair. And he had an indwelling urinary catheter. And he was able to walk and urinate unassisted after his FMT. He had a complete reversal of his symptoms. So that is exciting and a little hard to interpret. But clearly these people had symptoms that were caused or contributed to by their gut microbes.
And so I, myself, have two patients with multiple sclerosis who were able to do FMT. And they both were early on in their course of relapsing-remitting multiple sclerosis when they came to me. So they did not have severe disease like needing a wheelchair or a catheter. And neither of them had a miraculous symptom reversal. They both still have some neuropathy last time I talked to them. But neither of them has progressed at all.
And one of them, I spoke to him maybe a year ago was the last time. And it was maybe two or three, two years after his series of FMT. He just did ten days’ worth. That was it. No follow-up. And he said a year after that he went to his neurologist to review his MRI. And his neurologist said, “You know what? You have the brain of a healthy person.” And he was like, “You mean like a healthy person with MS?” And he was like, “No, just like a healthy person. I can’t find any lesions on your brain MRI anymore” which doesn’t happen a lot with multiple sclerosis.
DrMR: Right. Right.
DrMD: So I’m tentatively excited about my two cases, and Tom Borody’s cases are very exciting as well. I would like to see a trial of that. And if I had multiple sclerosis, would I be considering it? Absolutely!
DrMR: Sure. Yeah, yeah.
DrMD: Because the known risk is so low and the potential payoff is pretty high. On a side note, which I won’t dwell on because we’re getting towards the end of our time, but the other therapy I would certainly try if I had multiple sclerosis is another thing I am obsessed with. It’s called helminthic therapy. And it’s the idea of giving yourself certain things normally considered as parasites but actually which may be able to benefit people with autoimmune and hyperinflammatory conditions. And as far as I can tell, helminthes basically pause MS. You don’t have any progression of symptoms.
DrMD: And I’ll send you a paper later if you’re interested in knowing more about this.
DrMR: Please. Yeah, please do.
DrMD: Okay. So anyway, MS is an intriguing one. And I want to bring up one last thing, which is a difficult-to-treat condition with some potential here in the literature, which is chronic fatigue. Chronic fatigue, like IBS, is a sort of hard to pin down diagnosis that I think has many causes. But Tom Borody in Australia writes of—oh, I think it was 50 or 60 people with chronic fatigue. I think it was 60 people with chronic fatigue, 56 of whom also had constipation or IBS and four of whom just had chronic fatigue. And he gave a version of FMT. At that time, he was taking healthy stool, isolating some of the microbes, culturing them in a group of a dozen or so microbes, and giving that as a retention enema—so a version of that, kind of cultured poop.
And he reported—I’m not remembering the exact numbers. I think it also was—yeah, I think it was a 70% resolution of their chronic fatigue. And then he did a follow-up 20 years later. And he was only able to contact maybe 15 or 20 of those patients 20 years later. But of that group that he contacted, they were all people who had had their chronic fatigue resolved. Fifty percent of them continue to be chronic-fatigue-free decades later from one short round of five cultured poop retention enemas. So that’s pretty exciting. If in maybe 30 or 40% of people with chronic fatigue, we could resolve it and have it stay resolved for decades—
DrMD: Through this simple therapy that someone can do at home. So again, that’s sort of one doc’s series of case reports but something that’s very, very intriguing.
DrMR: But I’m really happy to hear you bring that up because I reviewed some of these studies. And I believe if we’re referring to the same study, which I’m assuming we are because there have only been a couple, I think the chronic fatigue was 50% and the MS was 70%. And I’m glad that you’re familiar with this researcher because I saw these initial studies. I got really excited. And then I looked for more.
DrMR: And that was it.
DrMD: That’s it.
DrMR: And so it was like, ugh. I’d love to have a little bit more to kind of back up a recommendation to a patient regarding this.
DrMR: But I think if you follow the recommendations that we outlined a minute ago, which were start with the tried-and-true therapies, and if you don’t respond to those, this is something great to move on to. And I would suggest—my comfort zone is starting with a good evaluation and any other basics like screening for hypothyroidism. And if none of those majors are there, I like this as another therapy. I’m a bit more wary, just to give people my person perspective on this. Or I think it’s much more fickle. Things like mold exposure from maybe several years ago that’s not current or heavy metals—it seems like those are much more of a hit and miss.
DrMR: And just knowing in my own personal experience the immense power that improving the health of the gut seems to have, I look at this as maybe something to consider before one of those other types of therapies. But that’s just my perspective on it.
DrMD: We’re very similar, actually, in that regard. I think actually the literature, my personal experience with heavy metal chelation, and trying to go after theoretical molds with toxic agents—I ask all my patients to compare what we think of the risks and the benefits of any intervention. And so I’m all in favor of giving tonic, nutritive, adrenal-supportive herbs for long periods of time to people with chronic fatigue. And we see benefit there sometimes. It’s such a low-risk intervention with maybe high yield. And then next there are more question marks in my mind that—of course screening for hypothyroid and liver disease and anemia and other things are high yield, low risk. But if it were me or my family member, I would consider FMT before I would consider heavy metal chelation and other things you were mentioning.
DrMR: Yeah. Good.
DrMR: So we’re in agreement there. And I think it’s nice to hear that because I’m always kind of trying to organize these things in the best order to help a patient feel better as quickly as I can. And so that’s why. It’s not that I have anything against metals philosophically or theoretically.
DrMR: It’s just from all the interactions I have with patients, what seems to yield the highest results compared to where am I most disappointed. And because of that, that’s kind of how I organize these things.
Locations and Clinics Performing FMT
DrMD: Yeah. All right, so I know we’re kind of getting to the end. I just wanted to get back to your original question. When’s the best time to refer for FMT? And I just want to make a note that I think—well, you won’t be referring to clinicians to prepare or administer FMT for your patients unless you’re referring to out of the country.
I will say, there are a couple places where they’re doing responsible, good work in my opinion. One is Newberry Clinic in Buenos Aires, Argentina. It’s Dr. Silvio Najt, which is N-A-J-T. I have no financial or other relationship with him other than I think he is a good clinician. And he’s doing good work down there with his donor screening and material preservation and administration techniques and everything. So he will work with people with inflammatory bowel disease and irritable bowel and other things. And I think he does very good work.
And there’s another place called the Taymount Clinic. Their main clinic is an hour north of London. And they recently opened another clinic in the Bahamas, which I hear is a nice place to visit. And again I think they’re doing excellent work in terms of their donor screening and their processes around preparing their product and administering it.
So if people have enough health care funds to dedicate toward this, they can go to one of those two centers. Or I think rather than referring—and other clinicians do refer to me on a somewhat regular basis if they don’t feel super confident about it.
But I encourage clinicians to talk to their patients about the risks and benefits of the patients themselves doing it at home. And what is their potential payoff there? Because that is a low cost. With a properly screened donor, apparently there’s a low risk way to do a trial of this and see if you can get benefit. And many, many people can have excellent improvement there.
DrMR: So question there for you, Mark, is that how you’re helping patients with this? Are you kind of acting not as a clinician so much so, but just kind of advising them on how to do this on themselves?
DrMD: Yeah, exactly. I think about it like when I’m doing diet or lifestyle therapies. I’m not cooking the food for them.
DrMD: I’m telling them recommendations about how to eat at home. And I can’t do the exercise for them. And this is one of those things where I say, “Look. I can’t do this for you because of FDA’s regulations. But I can counsel you about how to do this at home and how to find an appropriately sourced donor.” And if they’re local and can bring their donor to me, I can screen that donor for them. So that’s how I’m working with this therapy with people with inflammatory bowel disease and other conditions.
DrMR: And I think that may be the most cost-effective strategy for people.
DrMR: Because it’d be great to fly out of the country and stay somewhere for a week. But gosh, I’m sure you’re going to be at least $3,000 plus when it’s all said and done.
DrMD: Oh, we’re talking in the $10,000 to $20,000.
DrMR: Oh. Well, so very cost prohibitive. But I like the fact that you can at least help people—
DrMR: Advise people, and make this something that will be more accessible.
DrMD: And I will say, the one reason that I wish I had more freedom to use this is when I could use it for whomever I wanted, I would have patients come to me every week who said, “Look, I just don’t have a healthy person in my life who I can ask that bizarre question, ‘Can you bring me your poop every day so I can use it as medicine and put it in my own body?’”
DrMD: There are many, many, many people in this world who just don’t have a person like that in their life. And so for me to be able to offer a donor bank where I said, “Here are screened people with good track records of their microbiota helping people with IBD. Yes, you can come to me. We can use this.” It offered so much relief to people. So I wish I could still do that. But I can’t. And every week, I have to turn people down who call up. And they say, “I don’t have someone like that in my life.” And I say, “Really, your only option then is international travel.” And sometimes, that is within people’s financial grasp.
DrMR: Gotcha. So if they can find someone to be a donor, then they can work with someone in the States, like you, to help advise them through the process.
DrMD: Absolutely. Yeah.
DrMD: And I will say that research project I mentioned—if people are like, “Wow! I really want to work with somebody who’s done this and has experience there,” they could check out my clinic, brightmedicineclinic.com. But for the next four to six months, I am absorbed in this research project of FMT caps for Crohn’s. So I have an associate, Dr. Emily Burke, very smart woman who’s been working with me for quite awhile and whom I trained, practices just like I do. And she’s helping people, both patients here in Portland and people doing remote educational consults who might call up from other states or countries and just want education about how to do this at home.
DrMR: Perfect. Perfect. I’m glad because it’s frustrating, I think, when people listen to someone and then they can’t work with them.
DrMR: And so, good. I’m glad that there’s some access there.
DrMR: I’m glad that you gave the name of the clinic.
DrMD: I’m still doing appointments. But it’s just a day and a half a week. And I’m kind of booked out a bunch of weeks. And Dr. Burke is available a lot sooner and costs less also.
DrMR: Gotcha. Okay. So a couple things, I guess, as we transition to a close here. Are there any other places you want to refer people if they want to find more about you?
DrMD: Well, so brightmedicineclinic.com is my clinic website. Microbiomes.com, that’s the lab that I co-own with Dr. Carmen Campbell, which produces FMT caps and enemas for our own patients and for other licensed clinicians around the United States.
I refer people to thefecaltransplantfoundation.com—Uh-oh. Is it—? I have to Google it. Okay the Fecal Transplant Foundation is the nonprofit I mentioned earlier. And it’s thefecaltransplantfoundation.org. Great group doing great work. You can go there if you have C. diff. to find providers to provide FMT for you. You can find clinical trials there. You can ask question and answer.
If you’re thinking about doing this at home, don’t go to Fecal Transplant Foundation. But you can go to thepowerofpoop.com where there’s actually a donor registry. And the website will connect you with potential donors who volunteered for that. Oftentimes, they charge for their stool. And also, watch tons of videos of people saying, “Hey. Here’s how I do this at home for myself or my child.” And, yeah, those are the places I would refer people.
DrMR: Perfect. Cool. So, Mark, you have been awesome. This has been a great call. I am going to try to set us up to do a follow-up call at some point if our schedules permit on helminthic therapy.
DrMD: That’s great.
DrMR: Because I think that’d be an awesome thing to follow up on.
DrMR: One closing reminder for people—if you are eating in Asia, do not get the yellow dragon soup because you may be surprised what you get.
But, Mark, thanks again. This was great. And hopefully, we’ll have you back on again soon.
DrMD: Great. Thanks a lot, Michael.
DrMR: All right. Take care.