Australia gives world-first approval for fecal transplants to restore gut health | Hacker News Reader

Australia gives world-first approval for fecal transplants to restore gut health

theguardian.com

109 pointsValentineC78 comments

I have a gut problem. I don't really know what it is. It's been like 4 or 5 years since it started.

Doctors don't seem to know what's going on but basically my stomach acid destroys my throat and I can even feel the acidity in my mouth but I don't have heartburn or any other common symptoms. I've been on omeprazole and other PPI and several more drugs without any improvement.

In all these years it stopped for around 3 weeks when the doctor prescribed me 2 antibiotics and domperidone. Then it went back to "normal". They won't prescribe me antibiotics again because after being tested everything came as negative. Now they basically tell me to take more omeprazole, which doesn't change anything.

All this made me realize that it could be a gut bacteria problem. Maybe the antibiotics killed it which made me improve and then it came back again. Maybe it was due a diet change. My only hope is that more research like this is done in the field and maybe one day I'll feel like a normal person again.

Hoping you get well soon and figure this out. Have you heard of the inter abdominal pressure theory for acid reflux, which you’re describing or a theory like Chris Kresser’s?

https://chriskresser.com/how-to-cure-gerd-without-medication...

It’s a fantastic write up, that I read through when going through something similar. For me, ultimately it was controlling my weight (I’m at 12% body fat now) and tons of fiber. I feel like my case was mild though.

Thank you for the link, I'll read it.

I've been told by my doctor that weight matters but I'm a fit guy, around 12-13% body fat, non smoker and rarely drink alcohol.

I also take care of my diet. I cook my own food, don't eat anything processed (maybe once in a while yes, but it's not part of my diet), I drink a lot of water, no sodas.

What do you consider "tons of fiber"? What do you eat in a day to accomplish it?

Hope you find some relief! It's frustrating how little is understood about reflux type symptoms.

Can you explain why you say you don't have heartburn? It sounds like you're describing canonical heartburn symptoms.

I know how heartburn feels, it's not that.

Some smoothies do give me heartburn most of the time. When I had my Esophageal pHmetry doctors told me to eat/drink anything that caused me heartburn and I did. I drank 3 berry smoothies, which usually makes me feel like I could spit fire, and my stomach handled it well. The pHmetry didn't show any spikes in acidity, everything was normal.

Have you been to a dentist recently? This could be related to bacteria from bad teeth being washed into the stomach which in turn over reacts.

I have no cavities/bad teeth but I don't think that'll last long due the acidity. My last visit at the dentist was a couple months ago.

I have this same thing, but I’m pretty sure it’s just heartburn.

Omeprazole 40mg daily maybe made it a little better, but the different was subtle. What actually cleared it up for me semi-permanently was quitting a stressful job.

I wish I could say it's stress but it isn't.

I took omeprazole 40mg twice a day (80mg total) for months without noticing any difference. If it's heartburn that should've made a difference.

If I get it, it means it means I need to lose 5-10kgs. It’s a depressingly accurate indicator that I’m getting too fat.

A number of studies have found a correlation between changes in the bacterial population of the distal esophagus and the onset of symptoms consistent with gastro-esophageal reflux disease and/or Barrett's Esophagus.[1][2][3][4] Your average practitioner doesn't necessarily keep up with trade journals, so it's unlikely most of them have any idea this is even a possibility.

What likely happened is as follows: Taking antibiotics that wipe out the comensal population of Streptococcus Mitis (read: oral bacteria) in the process of treating some other ailment created an opportunity for an invasive species to colonize your distal esophagus, thus leading to your observed symptoms. Subsequent application of additional antibiotics led to a temporary reprieve of your symptoms by virtue of partially (or even fully) wiping out the invasive species... only for them to subsequently recolonize your esophagus when no S. Mitis appeared to recolonize the area.

Prognosis: shrug Unless and until medical practitioners become aware of this correlation there's not a hell of a lot to be done. Ultimately, however, the solution would be to obliterate the invasive species with suitable antibiotics and then recolonize the area with S. Mitis or some other suitable species.

-- [1] https://pubmed.ncbi.nlm.nih.gov/16437628/

[2] https://pubmed.ncbi.nlm.nih.gov/23496929

[3] https://pubmed.ncbi.nlm.nih.gov/15104362/

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120752/

Thank you.

This is awesome! Do you happen to know anything about IBS-C that hasn't made it to medical practicioners?

Not really, no. Biology and medicine aren't really my field, and it's largely coincidence that I happen to know as much as I do about acid reflux disease.

Have you checked out butyrate? There are some sodium butyrate supplements on the market. And a Japanese probiotic with Clostridium butyricum which produces butyrate. Certain cells in the gut derive 70% of their energy (ATP) from butyrate. Butyrate deficiency => weak gut cells => inflammation + permeable gut lining.

„Protective Mechanisms of Butyrate on Inflammatory Bowel Disease“: https://pubmed.ncbi.nlm.nih.gov/30277149/

I actually haven't heard about this, will definitely give it a shot, thanks! Where do you usually find information about this?

IMO /r/microbiome is a great resource. Reddit in general, eg the nootropics subreddit is a treasure trove also. You could also search for „ameliorates [insert problem] pubmed“ or „[problem] [potential solution] pubmed“ in the search engine of your choice, and if an abstract piques your interest, view the full paper on sci-hub.

One thing I‘d like to stress is that the internet is full of scams and counterfeit products, and you can only be (pretty) sure a supplement is legit if you order it directly from the manufacturer. I think iHerb also has really good quality control, FWIW. Patented extracts are IME also preferable over run of the mill extracts, some of them are orders of magnitude more effective.

I mentioned to a doctor that my weird symptoms stop when I take doxycycline. He declared I had Sjogrens. An autoimmune condition. Says he’s seen that lots of times.

Went and got tested. Doctors told me I was nuts and antibiotics have nothing to do with autoimmune. All results came back positive. Doctors still say nothing related.

I also have GERD without many symptoms. Have you done an upper endoscopy, a barium swallow, and been tested for _H. Pylori_?

I did all of it, which showed mild damage to my esophagus, as well as some signs of stomach inflammation, which I thought was interesting. The radiologist said "everything is just coming right back up" and told me I had severe GERD. Negative for _H. Pylori_.

PPIs (lansaprazole, omeprazole) appeared to do nothing, so I stopped, given that the long-term health risks are negative.

Interesting that you think gut bacteria are related. In medical terms the gut refers to the intestines, not the stomach. I assume you mean stomach bacteria here. There's apparently not a lot that can survive the environment of the stomach, but strep bacteria can.

I recently read that getting more fiber in one's diet can help GERD.

I had an endoscopy, yes. They said my cardia was always open but that's not usually the cause for my symptoms and even if that was the problem, all the PPI I took would make me feel better.

I've been tested for H. Pylori a couple times, both negative.

I also had a manometry and pHmetry. Esophagus is working well and acidity seems normal.

A part of me feels like it's a lost cause maybe that's why when I see something about stomach/gut research I tend to think it's related to my problems.

What you are describing is LPR/respiratory reflux/silent reflux. It’s likely caused by diet, stress and posture that causes issues with the lower esophageal sphincter and unlikely to be bacterial overgrowth.

Check this whole blog out if you can: https://jamiekoufman.com/silent-reflux-silent-night/

Thank you.

I'll read more about LPR.

That's a fairly low quality med-spam internet article, like

> so take the quiz below. If your total score is 15 or more, there’s a 90+% chance you have LPR reflux.

with no quiz. It doesn't mention anything about posture, stress, or the lower esophageal. It seems like a new catch all stomach disease, much like the old catch all stomach disease.

And despite this, you assert that it must be LPR?

I didn't find the quiz there but it looks like there's a standard test for LPR where if your score is 13-15 or above means you probably have it.

I've done it and being "reasonable" and not exaggerating on my answers, my score is 20, so it could be it. Symptoms are there and there's no heartburn or typical reflux.

In any case it looks like I'm doomed.

I recommend trying apple cider vinegar https://www.youtube.com/results?search_query=apple+cider+vin...

Thank you, but I already did.

I suggest you to find a good gastroenterologist who is familiar with gut flora restoration treatments. My dad had this reflux issue for ~10 years, and we are both on a 1 year low fodmap diet combined with probiotics treatment. I have to say this is the best improvement that happened in our lives. I was bloated and had digestion issues from a young age that followed me, but now that is gone. No bloating, and no digestion issues at all. Doc says, the gut new gut flora will get strong within 1 year and then we can resume eating everything.

Really sorry to hear your story.

I spend 2.5 years diagnosed with acid reflux due to waking up with a horrible taste in my mouth. It was awful, I’d wake up at 3am every night and could rarely get back to sleep.

After years of tests - they all came up blank. I was then referred to an ENT doctor. Diagnosed a nasal drip issue (mucus dripping down my throat) causing the horrible taste and I was virtually cured in 2 weeks.

When my GP asked the ENT to see me, he said he wouldn't because this was a gastrointestinal issue.

I'll visit a private doctor to see if they can help me.

What was the cure?

Sinus rinse 2 x daily (worst thing in the world first time, but after a week, a breeze) + 2 x nasal steroid 'sniff's). - It's not 100% gone, but now completely manageable using this

how was it cured?

I have this too. My teeth are being eroded and my tongue is ‘burnt’ all the time. It sucks

Stop drinking coffee for a while. It can upset the GI tract.

You can probably do a lot yourself with adjusting your diet and time (simple base: rice, quinoa, potatoes, no need to vary too much, with things guts love like onion, garlic, spinach, all raw, possibly more or less lacto-fermented)

Wouldn't an easier way to do this be to control diet? For one thing, it slows the process of change down which would ease any shock-related side-effects. Of course, it takes a lot of work from the patient to adhere, but if they are at the point that they are considering fecal transplant, they're probably ready.

This also gives the biome a chance to adapt to anything particular about the individual, if possible (certain pharmaceuticals may not be able to be worked around.)

Also, I would think if you did the transplant and never changed your diet, you'd often just go back to the old biome after a time, but I could be wrong about that.

Diet alone can't restore strains that don't exist in a patient's microbiome.

You're probably correct that keeping the same diet could kill off the transplanted biome but a better diet can't necessarily improve the gut biome if desired microbes have gone extinct in that person. And there are likely cases where a person had the proper diet but some of their gut biome was destroyed by some other factor like a broad-spectrum antibiotic.

Okay makes sense, but exactly how do these diverse bacteria get into our GI tract in the first place if we can't ingest them?

Your mother, and through introduction from your anus and what you eat (a limited amount of bacteria can pass through your stomach, or are harboring in structures that don't fully break down in your stomach before being passed along).

Many GI diseases correlate with loss of microbial diversity. That diversity can’t be recovered with diet alone - lost strains are lost. Even most probiotics are rather short lived in the GI tract.

Is it possible, once scaled up and using an artificial biome as described in the article, that this could be used periodically by people without specific symptoms, as a prophylactic or to improve general health?

Or are there reasons that would be a bad idea? Reducing diversity in gut flora, perhaps?

Our understanding of the gut microbiome is really primitive, we really don't know what a great one looks like. More problematic is that quite a lot of the bacteria that are critical die in the presence of oxygen and are thus very hard to collect and reintroduce. So far no one has made a mechanism to keep them alive and reintroduce them into other people. I would not be quick to rush to a fake biome just yet, it will almost certainly be lacking in a whole range of areas.

That’s the problem of unculturable species that pervades microbiology and anything related like agriculture. We have no idea what percentage of bacteria species can even survive long enough to be studied in the lab let alone industrialized. Even if someone manages to grow them accidentally, we’d never know it because if they don’t absorb any of the known stains, it’ll just look like agar on a plate under a microscope.

Last I checked the “state of the art” was to use a freaking electron microscope and hope that the plating process didn’t destroy the sample.

Just shooting from the hip, I'm going to guess that deliberately destabilizing ecosystems that aren't known to be unhealthy is generally not going to make them more healthy.

I wouldn't say that it's impossible to come up with some sort of microbial suppository that can take a healthy (for the host) microbiome and make it even more beneficial to the host. But, given the level of inter-person diversity in gut flora, I can't think of any particular reason to believe that it's likely that there's some universal treatment that would be beneficial to everyone regardless of their existing flora.

I am not totally ignorant of this subject, but I'd be concerned about the unknowns involved in messing around with the very long term coevolution of gut biomes with particular diets, groups of people, and factors we might not know about yet. For one example, I don't believe that that gut viromes, the ecosystem of viruses that infect the gut biome bacteria, are very well understood.

There is real wisdom in "do no harm" as a principle. It would be a lot better for most people to lose weight, eat more fruits and vegetables, spend more time outdoors, and sleep more before they consider a prophylactic fecal transplant.

I'm afraid I think the long term coevolution of gut biomes ship sailed around the time we started indiscriminately slaughtering those gut biomes with antibiotics. (not to mention importing large numbers of unfamiliar alternatives through changes in food systems, and at least in some cases raising kids in crazy-sterile environments). So I tend to agree with you that this doesn't seem like a good thing to rush into, but it's interesting as a possible form of repair.

The huge amounts of preservative used in our food chain has been even more devastating to our biome because we consume them continuously.

If we set aside problems with storage and shelf-life, would it not be possible to cultivate these bacteria and offer the treatment in the form of capsule which would be swallowed and dissolved in the intestines?

It's not quite clear if this is cultivated or not but I know this MD was working on cultivation at one point. "SER-109 is composed of approximately 50 species of Firmicutes spores derived from stool specimens from healthy donors."

https://academic.oup.com/jid/article/214/2/173/2572105

That is mentioned in the article!

> oral delivery is expected to be available before too long.

At last you'll be able to eat shit for breakfast!

I can't wait for celebrities to start selling their poop.

On serious note, mostly have followed this over years from weight loss literature, wonder if it will be applied in reverse, find the most efficient gut flora and get transplantees to hold on to calorise more efficiently.

I bring this up to friends like once a year. It's only a matter of time until there is the stool-transplant equivalent to a sperm bank.

I often feel very fortunate to have had no mental health problems or struggles in my life, especially as I see depression and anxiety take hold in more and more of my friends in my 20s and 30s and for those who've tried literally everything else to no success I wonder what it would be like if I could be a gut microbiome donor to them. There have been studies showing reversal of mental health disorders after stool transplants. Feels like if your mental health is absolute garbage and you struggle with suicidality that rolling the dice on this couldn't get worse only better or do nothing.

There are already places where people who are healthy can sell their poop. They're apparently very selective. And some people do these things themselves at home out of desperation-- so there's also a sort of underground market for the stool of healthy people who never took antibiotics.

>It's only a matter of time until there is the stool-transplant equivalent to a sperm bank.

We've had one in Australia for a few years now!

https://www.abc.net.au/news/2020-03-09/first-public-poo-bank...

Here’s an interesting story and News York Times short documentary about Josiah Zayner, bio hacker and former NASA scientist, and his DIY fecal transplant to address his severe GI issues.

https://www.kqed.org/futureofyou/384757/a-year-after-ingesti...

I did this myself at home when my IBS was getting out of control. My girlfriend at the time, now - unsurprisingly - wife, was the donor.

I took a specific antibiotic to wipe out what I could and then we did the transplant. It helped significantly and pretty much instantaneously, though over the years I’ve regressed a bit.

I took antibiotics for acne as a teen for years, so it’s no surprise that when I stopped those I started having issues.

Out of curiosity, how does this compare to mixing diverse cultures of probiotics with short chained fatty acids and injecting them rectally?

Not a doctor, but I suppose its because its a complete mix and easier to do, because theres almost no prep needed?

Probiotics mix would be orders of magnitude less diverse.

I am also curious about that as well. How many strains of beneficial bacteria are in feces? The probiotics I use have 20 beneficial strains but the company won't send me a non-capsule pack of the powder. They also have one with 36 strains, 120 billion CFU so it takes a lot of capsules to get a meaningful amount and takes a long time to open all the capsules.

Based on my limited research it appears stool has about 100 billion per gram of wet stool but it also contains a lot of other material some of which may be harmful.

My understanding is that a lot of the beneficial organisms dining the presence of oxygen, making it challenging to collect, multiply, and package them into pills or powder. Perhaps this is why they only offer the pills, the powder form in a jar would render some of them ineffective?

I was thinking a sealed Mylar bag with O2 absorbers but I can see the cost issue that may arise especially if only a few self experimenters like me were interested to begin with.

As soon as you open the bag it's all exposed to o2. In a blister pack each does is in its own little chamber so when you open one dose it doesn't impact the others.

An interesting aside, they started doing this kind of thing in the last few years for inhalers. There are some medicines that come as a fey powder, and need to be inhaled as such. It's a challenge to keep a bunch of doses together in one container and dose doses out without impacting the rest, so they do the same thing. The inhalers have little blister packs with individual doses in them, each time you need to take a puff you rotate the inhaler which advances to the next dose, pops the blister pack, and then you inhale.

It's probably OK if a percentage of them are damaged by the O2. If I take 4 to 8 trillion each time it just means I would have to do it more often.

The only alternative I know is the usual and incorrect in my opinion way people consume probiotics which is significantly worse. Most are destroyed by the hydrochloride acid, digestive enzymes and bile. Worse, some of them survive and have to pass through the small intestine which is absolutely the wrong place for bacteria to exist, especially if there is even the slightest amount of inflammation of the junctions and especially if some remain in the mucus layer and grow in numbers potentially leading to SIBO.

With my current method they go straight into a container of short chained fatty acids which I understand they can feed off of for a while. The SCFA are also beneficial for the large intestine.

Table S3 here[1] starting on page 9 appears to show nearly 80 different genuses within stool samples after filtering out "vegetative (non–spore form) bacteria, fungi, parasites, and viruses" [2]. No word on how many strains per genus, but reasonable to assume multiple, if not hundreds in some cases.

[1] https://www.nejm.org/doi/suppl/10.1056/NEJMoa2106516/suppl_f... [2] https://www.nejm.org/doi/full/10.1056/NEJMoa2106516

On nice! I will save that one and read up on each species. I think it would be useful to know which of those are beneficial and are missing from the 20 I utilize.

Not exactly your question, but my reading of The Gene: An Intimate History says any microbiome changes from eating fermented foods like yogurt/kefir/kimchi disappears when the food leaves ones diet. This was published in 2015 so could be superceded by subsequent studies in same field and I didn't bother researching the studies referenced in the book, either. The book also talks about successful uses of fecal matter transplants (FMT) for c. difficile treatment, and it worked about 90% of the time, but required a periodic refresh because none of the patients in the studies could maintain the healthy microbiome without the FMT after a year or so.

correction, the first note about fermented foods came from Burn(2022).

I just saw a documentary on this the other night on Swiss television saying that CHUV in Lausanne is doing this. So maybe "first in the English speaking world that lazy journalists have access to" would be more appropriate.

> first in the English speaking world

I don’t know what regulatory regime CHUV is working under but the regulatory approval by Australia as a generally acceptable medical practice in the country is substantially different to the limited research scale programs employed elsewhere in the world.

The regulatory approval is a world first - they are happening all over the world already though

I could have sworn I hear about this every 2-5 years it seems.

Research and trials. Successful enough to see the treatment approved for general use. No more popping placebos because you turned out to be in the control group.

https://en.wikipedia.org/wiki/Xylospongium

oh the joys of medicine Down Under

Weirdest headline that I have encountered here. Had to read it twice just to make sure.

Then I guess you haven't heard of fecal transplants before

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