[HN Gopher] Australia gives world-first approval for fecal trans...
___________________________________________________________________
Australia gives world-first approval for fecal transplants to
restore gut health
Author : ValentineC
Score : 75 points
Date : 2022-11-12 16:29 UTC (6 hours ago)
(HTM) web link (www.theguardian.com)
(TXT) w3m dump (www.theguardian.com)
| omnicognate wrote:
| 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?
| mumblemumble wrote:
| 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.
| PaulKeeble wrote:
| 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.
| akiselev wrote:
| 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.
| throwaway5752 wrote:
| 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.
| yetanotherloser wrote:
| 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.
| ViceCitySage wrote:
| Weirdest headline that I have encountered here. Had to read it
| twice just to make sure.
| kzrdude wrote:
| Then I guess you haven't heard of fecal transplants before
| lizardactivist wrote:
| 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?
| emmelaich wrote:
| 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!
| massaman_yams wrote:
| 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
| dirtyid wrote:
| 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.
| throwaway920102 wrote:
| 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.
| tsol wrote:
| 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.
| AussieWog93 wrote:
| >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...
| jeffrallen wrote:
| 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.
| jjcon wrote:
| The regulatory approval is a world first - they are happening
| all over the world already though
| bombcar wrote:
| I could have sworn I hear about this every 2-5 years it
| seems.
| nyokodo wrote:
| > 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.
| spfzero wrote:
| 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.
| massaman_yams wrote:
| Diet alone can't restore strains that don't exist in a
| patient's microbiome.
| Mountain_Skies wrote:
| 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.
| zug_zug wrote:
| 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?
| nanomonkey wrote:
| 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).
| manmal wrote:
| 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.
| DocFeind wrote:
| oh the joys of medicine Down Under
| GutThing wrote:
| 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.
| jijojv wrote:
| I recommend trying apple cider vinegar
| https://www.youtube.com/results?search_query=apple+cider+vin...
| GutThing wrote:
| Thank you, but I already did.
| sanjayio wrote:
| 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.
| GutThing wrote:
| 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?
| samingrassia wrote:
| 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/
| GutThing wrote:
| Thank you.
|
| I'll read more about LPR.
| treeman79 wrote:
| 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.
| atombender wrote:
| 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.
| GutThing wrote:
| 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.
| aradox66 wrote:
| 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.
| GutThing wrote:
| 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.
| dombesz wrote:
| 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.
| EarlKing wrote:
| 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/
| GutThing wrote:
| Thank you.
| jdhendrickson wrote:
| 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.
| GutThing wrote:
| 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.
| jjj123 wrote:
| 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.
| GutThing wrote:
| 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.
| lostlogin wrote:
| 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.
| jamestdsmith wrote:
| 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.
| GutThing wrote:
| 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.
| LinuxBender wrote:
| Out of curiosity, how does this compare to mixing diverse
| cultures of probiotics with short chained fatty acids and
| injecting them rectally?
| polskibus wrote:
| Probiotics mix would be orders of magnitude less diverse.
| LinuxBender wrote:
| 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.
| massaman_yams wrote:
| 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/su
| ppl_f... [2]
| https://www.nejm.org/doi/full/10.1056/NEJMoa2106516
| LinuxBender wrote:
| 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.
| iancmceachern wrote:
| 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?
| LinuxBender wrote:
| 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.
| iancmceachern wrote:
| 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.
| LinuxBender wrote:
| 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.
| diamondo25 wrote:
| Not a doctor, but I suppose its because its a complete mix and
| easier to do, because theres almost no prep needed?
| stevenwoo wrote:
| 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.
___________________________________________________________________
(page generated 2022-11-12 23:01 UTC)