The Power of Poop is excited to welcome Taymount Clinic back to our group to answer questions from our members. Below is the question and answer session that took place this month.
Kerry Hi everyone. I am Kerry, I look after the marketing for Taymount, and I am sitting here with Glenn Taylor to answer your questions today
What is the recommended number of FMTs used for IBS-D and what is the timeframe to administer them ie every day for 5 days?
There are no formal recommendations in place that are based on formally conducted medical trials. Opinions appear to vary enormously. Our own methodology is based on compromise and stem from our original establishment as an English clinic, treating local patients and we could extend or shorten the periods between implants according to the patients’ needs and responses. As we became more publicized, patients travelled to our clinic from increasing distances. We then tried to develop a treatment plan that attempted to provide the patients with the maximum value in the shortest period of time. Travel costs, accommodation costs, time off work, displacement, emotional upheaval are all very real burdens that cannot be ignored so we tried to address them. In our program we expose the patient to a minimum of 10 different donors’ microbiome in the shortest time that is both tolerated and appears to be effective. We perform one implant per day for 5 days, give the patient 2 days rest and then complete with a further 5 days. We then provide the patient with a further 2 frozen day packs of implant and consumables, for self-implanting at home. This is a total of 12 FMT implants. Because every patient experiences a different pathway to resolution, we give patients access to further home kits if needed.
After 5 years of treatments and trying many different methodologies, we have settled on our program of treatment as the best for travelling patients. We continue to offer tailor-made program approaches for local patients.
Question Kyle: My question is concerning the anaerobes in the stool. Is every precaution taken to ensure the anaerobes are not disturbed?
Taymount: Yes, a very good question. Even before we offered the treatment we were concerned that our lab research work allowed for the fact that oxygen is poisonous to bacteria that are classed as Obligate Anaerobes. All our processes are anaerobic. Most laboratories involved in any kind of microbiome research use anaerobic methodologies
Question: What are your experiences with small intestine bacteria overgrowth and FMT? Most of the studies I have read have shown SIBO being fully eradicated when the FMT has been delivered by NJ Tube whereas the traditional route doesn’t seem to have much effect.
Taymount: We have also heard about isolated single study cases of reported resolution of SIBO by Nasogastric or Nasoduodenal/jejeunal delivery. On the other hand, we have also read reports of SIBO resolution via rectal delivery. We do not directly treat SIBO per se here at the Taymount Clinic, we are focused on restoring the diversity and density of commensal bacteria, fungi, viruses and protists into the gut. It is interesting to note that there is some research that transient bacteria are discouraged from engrafting in the small intestine by Primary Bile Acids that are produced in the Liver. If that is the case, then it would make sense that a full Liver Function Test could be a good place to start.
Question Tam: I’m interested in the use of multiple donors vs just one donor. I understand the need for diversity, but can using that many donors be a trigger for inflammation or overwhelm since you are getting a new set of bacteria with each infusion? Would that method of multiple donors change depending on illness?
Taymount: We have found that whilst a particular donor can give the patient a “comfortable” experience, it may be that particular donor’s profile is not providing the kind of specific diversity that is needed to challenge the patient’s immune system and provide the functionality that might be missing from the patient’s existing micro biome. You may have a point that the multiple donor methodology may “overwhelm” in some way and long-term double-blind, placebo-controlled, randomised trials would be needed for each and every disease and potential co-morbidity to define this.
Question Mary: Can I buy some home kits without need to travel to u at all?
Taymount: We are really sorry Mary but we cannot offer kits by mail order. Patients must attend the clinic for a whole raft of healthcare reasons.
Question Jaime: Probably a bit of an odd question but have you ever had a user fail their first round of FMTs but gain benefit with a second set of FMTs further down the road?
Taymount: Yes we have. In cases of IBD when patients have not disclosed that they are in a state of flare when they attend the clinic, and as we all know now, because bacteria are pro-inflammatory, FMT should never be used during a flare. Patients have brought their flare under control by traditional medical methods, and have responded favourably on a second course of FMT.
Question Duane: Have you had any experience treating metabolic syndrome and/or obesity with FMT, even as a side effect of treating other ailments such as c. diff?
Taymount: Whilst we don’t apply FMT for metabolic syndrome at present, many patients report either weight loss, or finding it easier to control their weight after FMT.
Question Solomon: I’ve been treated for Ulcerative Colitis for the past 10+ years and recently was diagnosed with recurrent C-diff. My insurance has approved C-diff and I want to get maximum benefit from it as I’ve suffered from fungal/bacterial infections for the past 2+ years due to excessive use of steroids/antibiotics in the past 10 years. Can you please suggest a diet that I should use after the FMT so that will help me get into remission of my Colitis symptoms also. Any other suggestions (supplements etc) are also welcome. Thanks in advance for your advice.
Taymount: Bacteria and Fungi do not necessarily thrive and prosper on just any old rubbish. Like teenagers, they can be extremely fussy about what they want to consume. Look in any microbiology lab that is culturing specific species and you will see that is being achieved on extremely specific substrates. If you want to encourage a wider diversity and density of microflora in your gut, you will need to start with a wider diversity of food on your plate. This is exactly what our Dr Enid designed the 50 Foods Grid™ for.
Question Rosa: Can FMT change the chromosomes and mutations such as MTHFR?
Taymount: Some of the best immunology departments in the world are researching this as we speak, so it is too early to say.
Question Thomas: I have been unable to get my UC flare under control with medications and still have fairly serious inflammation in my colon. I would like to try FMT at home but I am worried about having an adverse reaction. What are the risks associated with DIY fecal transplant and would you recommend against doing it while in a flare? Thank you.
Taymount: Thomas, you are quite right to question if there are risks associated with D-I-Y FMT. The risks are many and can be very serious indeed. The problem as I see it is that because all of us poop each day, we all ought to be experts at FMT right? Well there is significantly more to safe and effective FMT than just being able to poop. Correct and accurate testing to reduce donor transmission of infection is a significant factor. Losing effectiveness of the microbiome through the lack of the correct laboratory equipment and procedures is considerable. Applying FMT at the wrong moment with a flaring IBD is a huge risk that could eventually lead to surgery. The point I am making is that you would be best served by finding yourself an experienced expert rather than putting your health and safety in the hands of an amateur.
Question Sara: When having multiple transplants is it safer to have the from the same batch of donors each time rather than introducing different donors every transplant? It seems like your system would need time to adjust so many different types of colonies?
Taymount: We answered a very similar question earlier, so I have posted the reply again below for you. We have found that whilst a particular donor can give the patient a “comfortable” experience, it may be that particular donor’s profile is not providing the kind of specific diversity that is needed to challenge the patient’s immune system and provide the functionality that might be missing from the patient’s existing micro biome. You may have a point that the multiple donor methodology may “overwhelm” in some way and long-term double-blind, placebo-controlled, randomised trials would be needed for each and every disease and potential co-morbidity to define this. Hope that helps.
Question Sarah: I have had uc for about 10 years. I cannot pinpoint what may have caused it, but it started when I was in college in my early 20s. I have been on the usual Asocol, Lialda, prednisone which would work for a while and then stop working. I just started at home FMT yesterday with my husband as a donor. He has always had healthy stool and been very regular. How many and how frequent should I continue to do them? I was planning on every day for 30 days and then maybe once a week for maintenance. Is it something that should be done forever? Also, is it beneficial to take probiotics to help the FMT? I feel like I notice improvement even after the first FMT so I feel so hopeful and excited.
Taymount: I am sorry Sarah, but my answer to Thomas above about home FMT treatment applies to you also. Guesswork and hope are no substitute for professional help.
Question Sara: Some suggest prednisone to reduce the chance of rejection of a transplant and also keep inflammation down. Would a person on a biologic require this? And do you feel prednisone is necessary?
Taymount: Sometimes Prednisone is used to bring a flare under control to enable the use of FMT. How do we feel about Prednisone? It is an immuno-suppressant and any use of immuno-suppressants offers opportunities for extremely nasty conditions to sneak in. So whilst it has an important function, we don’t like it.
Question Scott: Is it advisable to clear out a candida infection with antifungals prior to FMT at Taymount? I took lamisil for three months last year and felt great until two weeks after stopping it i got really sick and my crohns came right back. It seems like the antifungals had wiped out most of the candida, but i didn’t have the good guys in place to prevent it from coming right back.
Taymount: Scott, you are on exactly the right track. Your fungal overgrowth is quite likely as a result of missing amounts of commensal/normal microbiome that regulate the amount of fungi that can survive in your gut. In cases of fungal overgrowth we always suggest that you co-operate with your healthcare provider to try and reduce the amount of fungal burden before FMT. We have found that transplanted microflora stand more of a chance in setting the overall balance if they do not have to face a major battle immediately on arrival by the pre-existing presence of a significant amount of localised pathogenicity.
Question Jamie: Have there been any follow-ups past 3 to 6 months to see if the new colonies of bacteria have stayed around in the persons gut? One of the concerns I keep coming across from people is that the biome is only transient not truly permanent.
Taymount: Bacterial engraftment in the gut depends on the recipient supporting the bacteria with the appropriate substrate. Remember that everything we do and eat and everywhere we go models our gut bacteria. Once we have received microflora, we become responsible for maintaining them. For example, if you receive the widest range of bacteria possible and go home and only eat junk food, you will lose bacteria rapidly, because they are not being fed. We do follow up with all of our patients over a sustained period to ascertain the effectiveness of the FMT because we are continually collecting data.
Tam: I’ve also seen follow up studies on FMT for C.diff at 3, 6 and 1 year. At 3 and 6 months, the microbiome of most recipients resembled their donor’s. There seems to be some fall off between 6 months and a year that lead to recurrences. But there weren’t many studies that followed up year later. It was mostly 3 and 6 months.
Question Rosa: What the rate of positive results for FMT in curing autoimmune diseases and autism?
Taymount: There are still no figures on autism yet. Which of the many auto-immune diseases are you referring to, so we can answer more accurately?
Rosa & others: MCTD? SLE? RA? Hashimotos, RA, lupus, adrenal fatigue, insulin resistance, diabetes 1 and 2, cancer, raynauds, for starters. Lyme disease
Tam: I can answer some of these. There aren’t any results for FMT for Hashi, MCTD, SLE, Lupus (adrenal fatigue isn’t actually a disease and the use of the term is falling out of favor as health practitioners get a handle on the real issue) and Lyme.
They’ve just started studies on RA, diabetes and insulin resistance, but results are preliminary. RA looks promising.
The only FMT for cancer study that I’ve seen is for improving outcomes during chemo. FMT helped in a very small study.
Question Sara: After completing transplants at your clinic is the patient prepared to continue DIY FMT at home with a screened donor?
Taymount: Can I just clarify… do you mean are our patients coached in home self-treatment using clinic-supplied implants? If so, the answer is yes.
Question Noelle: Are there any anti-inflammatory Rx or protocols that you find are more successful for FMT for IBD?
Taymount: Yes there are. We have developed a sympathetic epithelial salve that we have called Salvicol™. Early results are looking very encouraging.
Question Noelle Is this something we can get in the US via our pharmacies or providers? Or ???
Taymount: Yes there are. We have developed a sympathetic epithelial salve that we have called Salvicol™. Early results are looking very encouraging. The best thing to do is to email the clinic.
Question Sherry: Thank you very much for talking my questions. For the first time of my life at the age of 57 years old I was diagnosed with UC. My symptoms are alot of bleeding up to 7 to 10 times a day, I was constipated and the only thing that would come out was blood and alot of it. I have had very little really to no diarrhea with is unlike many others with UC that have diarrhoea as their main symptom. My symptoms started after taking antibiotics for a sinus infection. The only antibiotic that has ever helped with was Flagyl. Flagyl has stopped working. I am now talking Uceris. Uceris has helped in that I am not bleeding 10 times a day. Now I just have bleeding with bowel movements about 3 times a day. But I do have blood with every bowel movement. My stools are formed but they are bloody. I have also been told I have diverticular disease. Any other antibiotic that I have taken has made me bleed a great deal more. I can’t not take antibiotics or I will bleed really bad. Have you had anyone at your clinic with mostly bleeding with out the symptoms of diarrhea at your clinic? Because antibiotics make me bleed substantiallymore would I be required to take antibiotics if I had FMT at your clinic? Would FMT help a case with the symptoms that I have? How would my having diverticular disease make having FMT more dangerous for me in that I could have an attack of diverticulitis? Thank you for your answers to my questions.
Taymount: Sherry, you are right that you have slightly more unusual symptoms. Please forgive me, but I am not a medical doctor and therefore I cannot engage in medical conjecture with your condition. We do not use antibiotics in preparation for FMT for a whole host of reasons. Instead, we recommend mechanically reducing the burden of dysbiotic and pathogenic “legacy” microflora by a process of gradual gut hydration with osmotic Magnesium salts. It is well tolerated in most cases and is extremely effective. Dependent upon the effectiveness of the gut hydration we would then discuss the possibility of FMT. If it is considered safe to proceed with FMT, we would add an appropriate level of carefully controlled colon lavage with applications of our epithelial salve Salvicol™ immediately prior to the first FMT implant.
Question Sara: Do you test the patient’s gut biome diversity before transplants?
Taymount: Yes but this does come at an extra charge for a meta genome analysis, which can cost between $3000 – $5000.
Question Noelle: What is the range of follow-up treatment at home (amount of treatments over what time) you find is required to successfully treat IBD after the initial 10 treatments in 12 days at your clinic?
Taymount: Every single case is different so there are no standardised post-treatment protocols. Every patient responds differently
Question Robyn: Has the clinic had any success with Chronic Fatigue, we have had one FMT with little success but considering trying again with home infusion follow ups
Taymount: We have had a few cases and we have not experienced full resolution, but have seen marked improvements. We must stress we do not advocate DIY home implants.
Question Rosa: How and where can a lung microbiome transplant take place?
Taymount: Sorry Rosa, we don’t know who is working on that at the moment, but you can bet your life someone is!
Question Rosa: Has there been any research done on FMT and PTSD?
Taymount: Yes there has. We will shortly be involved in a program and when we have results we will publish them
Question Rosa: Has there been any real research on GMOs and microbiome?
Kerry: Not at this clinic no, but we are sure some research will be underway somewhere.
Question Sheila: What are some preparations for the colon to improve overall health and success of an FMT? What types of retention enemas are helpful: butyrate, aloe, …?
Taymount: Sheila, as I have pointed out with Sherry’s question above, gradual rehydration of the colon with an osmotic Magnesium salt has proven to be very effective for us, once the colon is evacuating efficiently on a regular basis, we would recommend the epithelial salve, Salvicol™ as a retention enema, which has as one of its ingredients, the butyrate that you have already suggested.
Taymount: Thanks so much to all of you for your questions. Any we haven’t covered this time, will be answered in next month’s Taymount Tuesday.