FMT and the Power of Poop

POPSUGAR Photography | Mark Popovich
POPSUGAR Photography | Mark Popovich

FMT has been making major headlines lately, scoring a mentions on everything from Gwyneth Paltrow's website, Goop, to The New York Times with the support of gut experts nationwide.

What is it, you ask? Well, FMT stands for Fecal Microbiota Transplantation, which piqued my interest even further. Why have fecal transplants sparked so much buzz lately and why do they have the backing of celebrities and doctors alike? Anything using the word fecal sounds gross. Could this really be a revolutionary new procedure that's about to change the health game? Or just a trendy new topic that'll expire with Splenda? But given its success in specific areas, FMT shows promise in helping an array of gastrointestinal issues.

To help get to the bottom of it, I reached out to a couple of the best gut doctors in the game. The first is FMT expert and gastroenterologist Dr. Neil Stollman, MD, who is board certified in internal medicine and gastroenterology and has performed numerous FMTs himself. In fact, he is one the handful of doctors that coined the term "FMT," originally called Fecal Flora Reconstitution (FFR). I also reached out to Dr. Josh Axe, DNM, DC, CNS, who's never shy about tackling the most innovative wellness trends and has created the second-most-visited natural health website in the world. I knew, together, they could help me break it down right, giving us the best tackle at FMT.

POPSUGAR: What exactly is a fecal transplant? What does it entail?

Neil Stollman: FMT is putting new bugs into your intestinal tract. So fecal (the stool), microbiota (the bugs), and transplant (meaning putting it in). Now, you might say, "Isn't that what a probiotic is?" Yes, when you take a probiotic, you're taking it because you believe this is a good bug, and you want this good bug to set up in your intestine. So, in some sense, a probiotic is a form of FMT.

The problem with probiotics: What bugs? How many? How do you get them in there? And the short answer is, no one has a flippin' clue. So the current state of a fecal transplant, in some ways, is acknowledging that since we don't really know how to fix your biome, FMT says, let's just give you a new biome! Let's put someone else's biome inside you. And that's what we do. We flush out your biome. Most of us do it with colonoscopy — that's not the only way to do it, but it's how I do it. I stick a camera up your tush, and I put someone's else biome inside you.

This is not a new field. This has been done in ancient Chinese medicine, so I didn't invent FMT by any stretch of the imagination, but there was sort of a nucleus of six of us or so, about five or six years ago, that started doing this in a very scientific way.

PS: Why is it causing such a buzz in the wellness community?

NS: One, it's kind of weirdly sexy, right? Poop as therapy! If you think about it, poop as treatment — that's sexy. Or at least it's weird and weird sells. It's fascinating to people that you can use something that's considered putrid and waste to some people and actually turn it on its head and make it a therapy. The other reason is that it is logical, by the way. There is biome and there is such a thing as dysbiosis (a disrupted biome). It is logical that illness is caused by biome disruption. The third reason is that it's the new "new thing." For people with illnesses that are not easily fixable, they want the next "thing." And this is appealing intrigue that it could be the next new thing. I think that underlies why people want it to work.

Josh Axe: Nearly 75 percent of Americans are suffering from some form of digestive distress. This explains why probiotics are so popular as a supplement. Unfortunately, repopulating the gut with healthy bacteria from a probiotic supplement can take a very long time. The average probiotic will contain up to 30 strains of healthy bacteria, measured in billions of units. On the other hand, a sample of fecal matter from a healthy donor contains over 1,000 strains of microbes, measured in hundreds of trillions of units. Fecal transplants present a more efficient way of making our guts healthy.

PS: What conditions can it help improve? Any science to back it up? And where does the FDA stand on it?)

NS: There is only one illness today for which there is consensus among medical scientists that fecal transplants work and that is this gut infection called C. diff (C. difficile infection). That is the one scenario that the data has supported. There is unequivocal science now that you can cure C. diff with a fecal transplant. That's groundbreaking. That's game changing, really. So it's not just sexy, cool, and buzzy; it's extraordinary. We have now taken a human illness and we can cure it by changing the microbiome. No antibiotics, no chemotherapy, no X-rays, no tubes — I am fixing an illness with biome manipulation. And that's brand new. That's crazy and great.

Might work for MS? It might. Might it work for autism? It might. Might it work for Parkinson's? It might. But we don't know that for sure. You can't take a logical step from "patients with disease X have an altered biome" and complete that sentence with "so let's do an FMT and fix their biome and fix their illness and fix the disease X." We don't have a single example, yet, of fixing an illness with biome manipulation other than C. diff.

JA: As of 2013, the FDA only allows doctors to perform fecal transplants on patients with recurring C. difficile infections, but this may change in the future. There is quite a bit of early research that completely supports fecal transplants as an effective treatment for many conditions, including:

PS: Any risks or side effects associated with FMT?

NS: Not to be the cynic here, but there is risk of complications, potential infections — you're putting poop in someone, right? [But] we do screen our donors very, very carefully.

There could absolutely be long-term risks. The FDA actually makes us say that — that there are "unknown risks." So there are known risks (particularly infections) and there may well be unknown risks. So I have issues about long-term safety. It's not that there is only benefit and no risk or only risk and no benefit. Pretty much everything I do is balancing a risk and benefit. In this case, a clear benefit is for this one infection [C. diff], and a patient will take a small risk for a substantial benefit.

PS: Should we give it a try?

JA: If you have struggled for some time with a C. difficile, I do recommend you give it a try. The idea of implanting someone else's fecal matter can be unsettling for some, but it is a practice that actually dates back to 4th century China, and doctors in the US have been performing the procedure since the 1950s. Additionally, based on current research, fecal transplants are up to 98 percent effective and there have no reports of serious side effects.

NS: Biome manipulation as a therapy is an extraordinary thing and I'm confident that we will impact illness in a whole bunch of ways with that. I think there is science and there are studies being done. And hell yeah, they should be done! And we are doing it. Right now, there are at least 160 studies being done [into other conditions], as of today. That's exactly as it should be. I don't think it should be done willy-nilly. I don't think it should be done in hotel rooms with film crews. I don't think people should be doing it unsupervised.

I think this is deserving of and getting unbelievable attention. HIV, pancreatitis, etc. — think of something and someone's looking at it. That's great! That's how it should be. That's how it works. The promise is extraordinary. I think it's an extraordinary moment in medical history that we have taken an illness and fixed it by manipulating the biome. I think that's insanely impactful and will open the door to a lot more stuff.

OK, Dr. Axe and Dr. Stollman, you have my attention. With a little more investigating, I found that research into FMT and its benefits for other conditions, such as diabetes and autism, is being conducted but still developing. I'm definitely not as grossed out about it as I first was. Maybe a little about the "poop pills" (which is another form of FMT Dr. Stollman told me about for those that want to avoid the colonoscopy), but it definitely has my interest and I look forward to seeing where it goes next.

The Takeaway: FMT is not as new as I initially thought it was, but we're just at the tipping point of its potential; it's safer than I expected; and — dare I admit — I wouldn't actually turn one down if my health depended on it.

What do you think? Would you give FMT a go?