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Why Would Anyone Get a Fecal Transplant? Watch a Brother and Sister Explain

It isn’t very often that a medical procedure inspires a patient-advocacy movement, let alone an Internet fan club. Especially not a procedure that is, well, icky. But that’s undeniably what has happened with fecal transplants, a low-tech practice from back in medical history that has worked its way from outlaw home procedure to papers in major medical journals and a Food and Drug Administration clinical trial.

In case you’ve missed all of this: Fecal transplants are just what they sound like. They involve taking one person’s feces and putting them inside the colon of someone else. The reason, usually, is because the assortment of bacteria that live in the recipient’s guts have gotten gravely out of balance, and the bacteria that make up most of the donor’s feces (and yours and mine) rebalance things back where they ought to be.

The cause of the imbalance, usually, is a serious illness caused by a bacterium called Clostridium difficile, or C. diff for short. And that’s where the short film above, being released first here, comes in.

C. diff illness occurs when gut bacteria are destroyed by taking antibiotics. The various communities of bacteria, also known as the gut microbiome, usually keep each other in check, but when that ecosystem becomes disordered, C. diff seizes the spare living space to reproduce. The bacteria produce toxins that harm cells in the intestines, causing diarrhea that resists treatment, recurs frequently, and can be deadly. More than 250,000 people get C. diff infection each year, and 14,000 die. (Here’s the CDC’s best information on C. diff infection, a story I wrote for WIRED about it, and one from National Geographic.)

C. diff infection not only is caused by antibiotic use; it is also treated with antibiotics. That pushes patients into a downward spiral in which the microbiome slides further out of balance, C. diff bacteria proliferate, more antibiotics are given, and so on all the way down. Fecal transplants stop that spiral cold. After one treatment, they cure C. diff infection 94 percent of the time, compared t0 31 percent for antibiotics.

But, legally, fecal transplants (sometimes known as FMT, for “fecal microbiota transplantation”) are problematic: Are they a drug? Or a donated tissue, like a cornea? Should the Food and Drug Administration regulate them? Does it even know how?

Director Michael Graziano knew none of this when he began researching his 2014 film Resistance, which examines what happens when antibiotics no longer work, through patients’ heartbreaking stories and lost archival footage. (Disclosure: I am in it.) One of the families he encountered was the Guintinis of Tennessee, whose 15-year-old daughter developed C. diff after she received powerful antibiotics for a MRSA infection. After two years of doctors’ trying to cure it, and Lauren getting worse and worse instead, the family learned about FMT. The film shows what happened next.

I asked Graziano a few questions about why he decided to spend months of his life making art about someone else’s poop.

Maryn McKenna: What made you decide to tell the story of FMT?
Michael Graziano: While making Resistance I developed a strong interest in the human microbiome, and the way our burgeoning understanding of the ecology of microbes that lives in and on us is shaping the frontier of human health. I’d never heard of C. diff and FMT, and once I learned about them I discovered hardly anyone I spoke with knew about them either. This made me think I should try to help fill that knowledge gap.

A fecal transplant is a pretty intimate thing. How did you convince this family to participate?
I’ve been fortunate to work with some candid, open and honest physicians, researchers and patients, including at Vanderbilt University Medical Center. One introduced me to Dr. Maribeth Nicholson, a gastroenterologist at Vanderbilt who appears in this film and frequently performs FMTs. Lauren was her patient, and Dr. Nicholson told her and her family about my project. They told me they wished they’d had more information when they first learned Lauren had the infection. They agreed with helping other families going through the same ordeal.

FMT is still considered a bit outlaw by parts of the medical establishment. Did it feel that way to you?
There are aesthetic reasons for the slow uptake: the “yuck factor.” There are also some concerns about long-term implications of the procedure, because it is not 100 percent understood. But, once I looked at the number of peer-reviewed journal articles that demonstrate the outstanding efficacy of FMT, and talked with physicians who perform them, the value became crystal clear.  The data suggest an incredibly high safety profile—zero adverse events!—compared to the very real and alarming concerns associated with antibiotics.

Can you see this becoming more widespread?
I can, as more people and physicians learn about it. But there are challenges. The medical system understands antibiotics; there are clear business and regulatory structures in place. This structural comfort doesn’t exist with FMT. Despite the fact that FMT can obviate the need for antibiotics, its clear effectiveness, and the crisis of resistant infections we’ve created by overusing antibiotics, there’s no clear business model for FMT, and the regulatory guidelines are still not 100 percent clear.

33 thoughts on “Why Would Anyone Get a Fecal Transplant? Watch a Brother and Sister Explain

  1. There may be more to this than we realize. When I recovered from an intestinal infection earlier this year, I found that my roughly two decades of acid reflux problems were gone and that I was now lactose-intolerant. I’m not sure I like the trade, but it’d be great to be able to end one without acquiring the other.

    MM: It sounds like your gut microbiome “reset,” no? I’m curious about situations like this too. Clinical microbiome science is still so new!

    1. I love this! My friend who has MS just got a fecal transplant last week he’s had c-diff issues for months actually over the last couple of years thank God for this simple natural remedy I always say there’s more to us as human beings than we realize I’d like to help spread the word for this awesome procedure

  2. What is criminal is that her doctors didn’t tell her about the transplant. Also, I think there are better MRSA treatments that wouldn’t cause this problem in the first place.

    MM: Sometimes MRSA does require the last-resort drugs (speaking as the author of a book about it). And re her physicians: I didn’t report this so my knowledge of her case is second-hand, but it’s a pretty good example of how new knowledge percolates through the medical community. One set of doctors has suggested that FT should now become the “first line” treatment, versus trying antibiotics first, but there’s still a lot of dispute and many will want to wait for the FDA. She’s lucky that, when the need became dire, she was at a hospital where they were already practicing FT, and didn’t have to hunt someone down elsewhere.

    1. I agree, she was VERY lucky to be in the right place at the right time. I’m sitting here right now with a C-Diff infection that I’ve had for at least a year – – but after seeing this film, I am certain I know how I got it to begin with. I was pregnant with my second child and I am asthmatic. I caught SARS, and although lucky to not have died, (I was put on so many strong intravenous antibiotics) I started having bowel/stomach issues about a month after I got well. It turned into “Ulcerative Colitis” that ended up dehydrating me to the point that even my water sak was compromised and my daughter born a few weeks early and at first, not breathing. (She’s since become the healthiest kid I know – not even so much as an ear infection after almost 13 years). Anyways…I’ve been seen by Kaiser (I just choked as I called them “killsyouslower”) for almost 13 years now for this colitis, the worst of my symptoms beginning last March. I was basically in bed for most of this year, on Prednisone and antibiotics that did nothing but weaken my immune system more, and like Lauren, I too got a form of MRSA on my foot – they called it Cellulitis and immediately pumped me full of MORE antibiotics…and within a few days it was gone but the C-Diff made its entrance. I finally was put on Vancomycin, and it at least made me feel like I wasn’t going to die like I’d felt for so long, but once off it, I have had colitis non-stop – – some “good days”, but never gone…I have asthma and caught a cold and had to go on ANTIbiotics for my lungs (this was a week ago) and now I have the symptoms of C-Diff again. Once you have it, you never forget it, and JUST KNOW what it is when it starts up again. Kaiser (choke – killsyouslower) has their head so far up their own rear end that they aren’t doing at FT treatments…I’m willing to pay out of my own pocket to be done with this once and for all. I never had stomach problems until I caught SARS and was heavily medicated. I’ve been a walking, gassing, unreliable, weight gaining (I used to be a size 5 I’m a size 14 now), pooping mess of a woman for over a decade. Is there anything anyone can tell me or point me in the direction of FT because I’m ready to do the DIY thing. I know that’s not recommended, but sometimes you gotta do what you gotta do. Happy Thanksgiving Everyone!

    2. I agree, she was VERY lucky to be in the right place at the right time. I’m sitting here right now with a C-Diff infection that I’ve had for at least a year – – but after seeing this film, I am certain I know how I got it to begin with. I was pregnant with my second child and I am asthmatic. I caught SARS, and although lucky to not have died, (I was put on so many strong intravenous antibiotics) I started having bowel/stomach issues about a month after I got well. It turned into “Ulcerative Colitis” that ended up dehydrating me to the point that even my water sak was compromised and my daughter born a few weeks early and at first, not breathing. (She’s since become the healthiest kid I know – not even so much as an ear infection after almost 13 years). Anyways…I’ve been seen by my GI Dr. for almost 13 years now for this colitis, the worst of my symptoms beginning last March. I was basically in bed for most of this year, on Prednisone and antibiotics that did nothing but weaken my immune system more, and like Lauren, I too got a form of MRSA on my foot – they called it Cellulitis and immediately pumped me full of MORE antibiotics…and within a few days it was gone but the C-Diff made its entrance. I finally was put on Vancomycin, and it at least made me feel like I wasn’t going to die like I’d felt for so long, but once off it, I have had colitis non-stop – – some “good days”, but never gone…I have asthma and caught a cold and had to go on ANTIbiotics for my lungs (this was a week ago) and now I have the symptoms of C-Diff again. Once you have it, you never forget it, and JUST KNOW what it is when it starts up again. I can’t get my medical facility/insurance to call me back much less perform a FT. I’m willing to pay out of my own pocket to be done with this once and for all. I never had stomach problems until I caught SARS and was heavily medicated. I’ve been a walking, gassing, unreliable, weight gaining (I used to be a size 5 I’m a size 14 now), pooping mess of a woman for over a decade. Is there anything anyone can tell me or point me in the direction of FT because I’m ready to do the DIY thing. I know that’s not recommended, but sometimes you gotta do what you gotta do. Happy Thanksgiving Everyone!

  3. Thanks for posting this. There is an excellent chapter in Mary Roach’s book “Gulp: Adventures in the Alimentary Canal” that details this subject with similar results and commentary.

  4. Is there a hospital or list of Physicians in the New York City area who perform the Fecal transplant procedure??

    MM: Not yet that I know of, because it is not yet FDA-approved. But Dr. Lawrence Brandt at Montefiore Medical Center is one of the leaders of the FDA clinical trial and he has been pretty outspoken about the value of the procedure.

  5. i had no choice in the matter. I was dying in the hospital bed and after 6 days of throwing up and trying every medical possible the only option I had was a an FDA approved procedure. 24 hours later I was cured and alive to tell my story. My procedure was done by endoscopy because my colon had swelled so much that there was no way the procedure would take going directly in the colon.

    MM: Thank you for sharing your experience.

  6. I had my gall bladder surgically removed in 2013 and since then I had this problem of going to the toilet almost every after meal sometimes even just a small snack. my feces is mostly liquid. on average I would go 4 times but mostly on worse days it would be 10 – 12. what’s weird is that if I take a couple of shots of liquor, I would then have constipation the next morning…. but after that, I go back to very soft liquids feces. I am 57 years old and in Silver Spring Md. I hope you can help me. thanks and God bless.

  7. I had the new strain of C-Diff for a year. They kept giving me the old meds (which didn’t work and only made it worse). When my MD started lobbying the ins. co. for the new meds, they wouldn’t pay because those meds were so expensive (thousands of dollars). Meanwhile, I was researching alt. med. methods. I almost died and by babying my gut with high doses of quality probiotics and going vegan I kept myself alive but didn’t dent the C-Diff. I also learned about fecal transplant and I had no qualms. I knew it was not approved but just about 6 mo. into this I learned of the clinical trials that had been approved and I applied for the program. A few weeks before my interview, the ins. co. finally came through so I took those meds (which, by the way, can take 2 mo. to work). Because of that I was not eligible for the trials but I went to the interview anyhow. The MD was very kind and informative. She spent a lot of time with me going over the history, etc. and advising me. Because I had it so long, she thought it was in remission, not gone. I cannot take antibiotics again without it coming back. I wish I had the transplant and I hope in the future that option is open to me. Sometimes the only choice is antibiotics. So far I’ve been able to control normal mishaps with natural antibiotics but in today’s world there are so many things out there to catch. I restrict my time in public, eat organic (I slowly switched from vegan to vegetarian to adding some organic meat). This is like a sword over my head though. Fecal transplant works. It’s not mainstream in this country (although it is in others) because there’s no money in it for the pharmaceutical companies. Greed over health.

  8. On April 28th my husband was so dehydrated from diarrhea that he was not aware we took him to the hospital. The ERA doctor in our little hospital literally saved his life by diagnosing C-diff within 45 minutes of us being there. We spent the next 5 days in the ICU isolation unit of this hospital not knowing whether he would live or die. After 5 days he was well enough to go on a floor still in isolation. After 14 days they sent us home. He had gone from building homes to a walker and 20 pounds lighter. I t was heart breaking. After 4 days it was back. we went back in and then they talked to us about a FMT. The decease was new to us and the treatment way something I as a educator had to get my head around. We agreed to the procedure and within 2 hours he was up walking and eating. Again we went home. Two weeks later it came back. There is no mistaking the smell. I called the hospital we were in and they recommend we go to the larger hospital where specialist were. After being there they found he also had salmonella and that had to be treated first. We got great care at both hospitals but are home now and on hold for the FMT if this comes back. He is on Amoxicillin for the salmonella and Vancomycin for the C-diff. If it returns they are planning on doing a FMT using my fecal matter or one From
    a bank In Boston. We are confused as to who to use as we were told if we go to another family member it would cost us $3,000 to have it tested to even see if it would match. We would like very much to have your opinion.

    MM: Thanks for sharing your experience, and I’m so sorry that happened to you. I’m not any kind of a physician, let alone a gastroenterologist, so my medical opinion wouldn’t be useful! But I do know that the “fecal banks” have prescreened their donors and donations, so if there is an issue of “matching” (which is not something I am familiar with) then the work would already have been done.

    1. Jim, there’s no matching required — whether you want to use a donor that you know, or one from the stool bank, is entirely driven by how you feel about it. The bank route is probably cheaper, and because they have the time and scale to do it, they also tend to be more thorough with their screening protocols (the stool bank in Boston only accepts 3% of applicants http://www.openbiome.org/impact/). But some patients would prefer to have stool from someone they know rather than from a stranger, so that’s why doctors offer you the option.

  9. For those that are interested there is a company called Rebiotix currently enrolling participants in a clinical study for recurring c diff. Study is called PUNCH CD 2 and it’s in about 20 different cities around the US and Canada. You can learn more at rebiotix.com

  10. I had a friend introduce me to the idea of a fecal transplant. I had a couple surgeries a few years ago where I lost portions of my small and large intestines as well as the cecum part of my colon. I have suffered from IBS since then. Would a fecal transplant possibly help me or is it strictly for c. diff? I feel stupid asking, but this is very foreign to me.

  11. @Tiffany. Currently FMT is only approved as a treatment for C.Diff, but a great deal of evidence suggests the procedure as a viable and effective intervention for IBS, IBD and a host of other similar ailments. You should definitely consult a gastroenterologist about the possibilities

    1. Michael, I contacted C-Diff 20 years ago, it would raise its ugly head off and on, but more frequently as the years went by. Like the young lady in the movie, I too came in contact with MERSA after Sclerotherapy and the drugs for MERSA put me into a real horrible place with my C-Diff. In the past 20 years I had IBS also, my life rotated around “where’s the bathroom, and Depends”. I had my MFT August 6, 1915, the happiest day of my life. I walked in for the procedure and walked out a new person. On Aug. 9, my husband had a very, very unexpected heart attack, I needed to rush to the hospital 80 miles away and was with him for several days in the hospital, not one problem from my IBS. Not only was my C-Diff gone, but also my IBS gone (not always happens I understand)
      Now, be careful when introducing new food you have not eaten for years, it will take a bit for your body to tolerate them, like sweet corn, fried foods and fruits.
      But, within a month, I could almost tolerate any food with out a problem. Unfortunately, I now have a UTI that is not responding to home remedies, and the Dr wants me to go on Macrobit. Not sure what I am going to do about that, praying a lot for wisdom, I do not want to mess up my MFT, but if this does not go away, it could affect my kidneys, not a good option either. Good Luck

  12. My 18.5 year old daughter has been dealing with GI issues for the last several years. It has kept her from going to college, keeping a job, having friends (pain, diarrhea, and exhaustion keep her from being able to participate in life), and her dream of going to YWAM in Australia. She was diagnosed with SIBO this summer and given CIPRO to treat it. This gave the c-diff we already knew to be hiding in her system the ability to take over and make her even more miserable. She weighs 87 pounds and feels worse every day. Who can we contact about getting her a fecal transplant? We live in NC but I will take her anywhere!

    MM: Dear Shelley, so sorry to hear this. There is no central registry of physicians who perform this, but there are more doing it all the time; it helps to ask around. I would be surprised if there is no one in the major NC medical centers who does it! I know there is a FMT research group at Emory in Atlanta and at Vanderbilt in Nashville.

    1. Email me and I can give you the name of my Doctor and tell you where I am from. So sorry to hear about your daughter. I too, have suffered from this.

  13. I had one today for recurrent C-Diff. It is offered by Kaiser Permanente in the infectious disease department. I did not have to jump through hoops to get the referal, the doctor requested a meeting with me. Lets hope it works the first time.

    MM: Thanks for sharing you experience, and good luck!

    1. Sandy, can you email me which Kaiser you went to? You must be in California right? My Kaiser medical care acts as though I’m a monkey wanting to throw my poop at them. They barely even address the matter of recurrent C-Diff….hell they barely even return my messages…..They used to be so good. I used to really go to bat for them every time someone would say “Oh they are buthcers”…then they opened up a new facility in Northern California and it seems all hell broke loose. I was without a PMD, thus no referral for the GI, and when I did get both, they let me go along with C-Diff for weeks and then it took them 5 days to just open the chart and read the results and even then they didn’t prescribe medicine for it right away. They ended up calling me as I was boarding a plane to Texas to tell me “you have C-Diff”..I was literally boarding the airplane when they called me….I was so sick, I thought maybe I’d try changing the scenary after 6 months in bed sicker than a dog…so I was going to my nieces in Texas….I was boarding a plane with a highly contagious infection when they finally contacted me to tell me I had C-Diff. I knew I couldn’t use the restroom on the plane for obvious reasons. I just sat in my seat and prayed to God no one would get sick and prayed that I didn’t have to go to the bathroom…I made it to Texas alright, took the medicine and felt better than Id felt for months. You’d think they’d follow up with me. NOPE. And I pursue them and call them and I’ve written two letters to Member Services with complaints and STILL I get zero! It’s like they hate me. So I’m absolutely floored you received such immediate and necessary and effective care. I’m absolutely shocked right now! Wow! Good for you hun.

  14. Please help. My husband 52 years old, also a cancer patient acquired CDiff for the first time during a extended stay in the hospital in April, 2015. He was being treated with two very strong, wide spectrum antibiotics for blood and bone infection. Since his first bought of CDiff, he has gotten it again two more times. We are currently in the hospital for CDiff. They started him on the antibiotics to treat it on Christmas Day. He was averaging 15-20 stools a day. They were extremely watery and full of mucus. It is now January 2, 2016, and the diarrhea continues anywhere from 8-12 times a day. Still full of mucus and runny. There plan is to keep him on the vancomycin and taper him off of it over a few weeks. We are all for the fecal transplant. Infectious disease doctors are deterring us away from that. We want this taken care of and a chance to get back to some kind of normalcy. This bout has been worse than the others. They have kept him on IV fluids and it is causing swelling in his thighs, calves and feet. His cancer was on his spine and collapsed his spinal cord. He can’t move much on his own. He needs pt but due to the CDiff reoccurrence that is very difficult. Please, any help or advice would be greatly appreciated. Thank you so much.

    1. So Sorry to hear about your husband. That is awful. Did the Infectious diseases doctors offer any reasons for deterring you guys from FMT or did they just say you shouldn’t? There could be reasons not to perform FMT on your husband given his medical history, but I’m not a Dr. so couldn’t say for sure. If they haven’t given you reasons you should demand that they do. It seems like it would be worth consulting a gastroenterologist in any case. They are the doctors who perform the FMT procedures and probably have a great perspective on your husband’s case. Best of luck to him and you

  15. Hi Lyn,

    I’m not sure where u live but I called this medical center and they confirm can perform the transplant but you need to get prove from your primary Doctor u have one or more of the following illness.

    Montefiore Medical Center

    Contact: Latasha
    Tel: 844-556-6683 X17
    Fax medical report attn: Latasha
    Fax#: 718-798-6408

    Dr. Lawrence Brandt medical office address:
    3400 Bainbridge
    Bronx, NY

    Need to get medical documents faced over to Latasha at fax# 718-798-6408 and then call

    1) go to Primary Doctor to test these:
    – Clostridium Difficile (C-Difficile)
    – Ischemic
    – Ulcerative
    – Crohn’s Disease
    – Colitis
    – IBS (Irritable Bowel Syndrome)
    – IBD – Inflammatory Bowel Disease

  16. My 15 year old daughter was diagnosed with recurrent C-Diff in October, when she became ill after eating at a restaurant.We have concluded that hers was contracted from improper hand washing from someone who was infected with this. Most people assume it is from antibiotic use, but she had not been on any type of antibiotic. To date, she has lost approximately 15 pounds, had multiple tests, been on 2 rounds of Flagyl, and is currently on her second round of Vancomycin. She has missed over 20 days of her sophomore year, and continues to have good days and bad days. It is so very embarrassing for someone her age. We are meeting with another specialist on Monday to discuss the Fecal Transplant. Getting appointments and going through the process is so very frustrating, while in the meantime she continues this battle. I would love to be able to talk with someone whose child is going through, or has gone through this process.

  17. I just had my FTP today and I had C DIFF twice, once from antibiotic suffered over a year until I finally got a $2,000 antibiotic that stopped it (2012 -2014), then again this past October, 2015. Took Vancomycin from Oct. to yesterday then had the transplant today. Now I am hoping it won’t come back but realistically know that I have to be aware of everything I do, where I go etc…The spores live and the only way to kill them is to use straight purex on all surfaces etc…and wash everything in hot, hot, purex water and wash your hands. If you use bathrooms be aware of using covers on seats and wash, wash, wash. I also read on this site that a mother thinks her daughter caught it from eating somewhere where the food was prepared from someone who must not have washed their hands this is so scary but one never knows where the spores are lurking. Highly contagious. I smell like a bottle of purex because I cleaned everytime I used the restroom I never want to catch this or have anyone I know catch it. It is deadly. Read up on C Diff!

    MM: Thank you for sharing your story!

  18. My sister has been going to Dr. after Dr. for her gastrointestinal problems. She has had C-diff. Klebsiella from working overseas. I am trying to see if FMT would help her. She is giving up hope. dustyscw@gmail.com

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