Translator: Rhonda Jacobs
Reviewer: Hélène Vernet I want you to picture yourself
as an ecosystem. The trillions of microorganisms
that live in you and on you are as diverse and complex
as any rain forest. Like many ecosystems around the world, there's a decent chance that yours
has been, to some degree, ravaged by civilization. A lot of the work that I do involves investigating damage that's been done
to my patients' gut ecosystems and trying to figure out how I can help. I use interventions
like nutrient therapies, diet changes, pharmaceuticals and herbs to do things like -
extending my forest metaphor - put out forest fires and feed the soil and prune some things back
and replant others. But every week, I get multiple e-mails
and phone calls to my office asking if I can use a particular therapy
for my patients and their ecosystems. And in many cases, I have to say no. Despite heartfelt pleading,
heart-wrenching stories, tears and sometimes bribe attempts,
I have to say "No." Even when I think that this therapy
is likely to be beneficial, even profoundly decrease
people's suffering and be safe for them, I have to say no. This is the weirdest, grossest,
most natural, and perhaps the most powerful thing
I do with my patients. Most clinicians call it "Fecal Microbiota
Transplantation" or FMT. Most people just call it
"fecal transplant." It's the process of taking stool
from a healthy screened donor, mixing it with liquid, filtering it to concentrate
the bacterial portion, and administering those bacteria
to a sick person, usually via a retention enema. Feces is a stinky, messy, magical mass of microbes. (Laughter) And we don't often
think of it as medicine. But in this case, it can be. It's kind of like the dank soil
of an old-growth forest, teeming with life. And fecal transplant can be
like taking a truckload of soil from an old-growth forest and moving it to a burn site
or a clear-cut to repopulate. A lot of animals do some version of this,
it's called "copraphagy," and some animals even need it to live. The first human recorded use of this
is from the 4th century, a Chinese physician
named Ge Hong wrote about this. And in modern times,
the first recorded usage is from here in the
United States, from 1958. A group of physicians
wrote about a series of patients who were dying of an infectious colitis. Their diarrhea was so bad
they were on the brink of death. Having exhausted all of their options,
these doctors did something fearless. They broke one
of the deepest human taboos, and they took human stool,
blended it, and filtered it, and gave it to their patients as an enema. And, miraculously, their patients
were saved from the brink of death. In fact, within 48 hours,
all of their symptoms had gone away. The docs in 1958 were almost certainly
battling an organism called "Clostridium difficile" or C. diff. It's difficult to grow out;
it's difficult to battle. It produces toxins
that cause damage to people's colons and can even lead to death. In the United States today, half a million people a year
are infected with Clostridium difficile, and of that group, a little
over 5% die because of it, a little over 26,000. Just putting that in context, about 13,000 people die of AIDS-related
illnesses in the United States every year. C. diff is characterized
by frequent, profuse, excessively foul-smelling
yellowish diarrhea. It most often strikes
when people's healthy gut ecosystem has already been disturbed
by taking a course of antibiotics. Traditional medical therapy is -
you guessed it - more antibiotics. But this actually works. About 65% of the time, people who've received
a single course of antibiotics get better from their C. diff,
and they stay better. But, of that group that relapses, the odds are less good of them getting
well and staying well with antibiotics. And each time you relapse,
your odds decrease. Using fecal transplant, in the best scientific literature
and in my practice, is able to cure these people
over 90% of the time. It's a lot of lives saved. These are the people who call my office, and I get to say, "Yes, I can
use this therapy to treat you! Thank you, FDA." You see, the FDA has not approved
fecal transplant for any indication. And, two years ago,
they defined "poop" as a drug when it's used as a medical intervention. But, the benefits
are so stupendously clear when used for C. diff colitis, that they have given clinicians
in the United States permission to use it anyway. Before the FDA defined poop as a drug, I was using fecal transplant for people
with a variety of indications - autoimmune inflammatory bowel diseases, like ulcerative colitis
and Crohn's disease, refractory, tough-to-treat
irritable bowel syndrome, multiple sclerosis and other things. Because interestingly enough,
what happens in the gut can have profound impact
on what happens in the brain and on inflammatory
and immune functions globally. This is the group of people that I have to tell no
when they call my office at this time, since the FDA's guidelines, two years ago. So why has the FDA called poop a drug? It's because it is so clear that this therapy
can prevent and treat disease, that they say, "Well, if it can prevent
and treat disease, it's a drug." I'm a naturopathic doctor,
or N.D., by training, so for me, this is a stretch. The entire foundation of my profession
is that we can use things that are not drugs
to prevent and treat disease. I can and do prescribe strong antibiotics and powerful immune suppressants
for my patients when they need them, but I give probiotics with the antibiotics to try to prevent C. diff
and other bad outcomes. I give DHEA when I prescribe Prednisone
to try to prevent bone loss, depression and insomnia
and other things. I use saffron and St. John's wort
for my patients with depression, and I use wormwood and vitamin E for my patients with
inflammatory bowel disease, and the list goes on: all things that are not drugs
to prevent and treat disease. Despite the fact that I am
a person who takes poop, centrifuges it to remove
the 90% that is not bacteria, and then triple encapsulates
the bacterial portion and gives it to my patients
to take orally, when the FDA tells me that poop is a drug,
I have a hard time swallowing that crap. (Laughter) I want to tell you the story
of my youngest FMT patient. Landon's mom called me
from a hospital in Kansas because Landon,
at less than two years old, had been diagnosed with an autoimmune
condition called "ulcerative colitis." His immune system was causing
so much inflammation in his gut that it was eating holes,
or ulcers into it, and he was bleeding
from those ulcers so much, he'd required three blood transfusions
in the previous couple of months. She wanted to know if FMT could help. At that time, there were no reports of using FMT for children
in the literature - zero, not one - and I hadn't used FMT for children
in my own practice either. So I had to tell her, "I don't know.
We don't have data. I don't have experience about
'Could this be beneficial for Landon?'" But, based on my experience
with adults with ulcerative colitis, if this were my child,
I would absolutely try it, as soon as he was medically stable. So shortly after he was discharged, Leslie and Landon
flew to Portland to my office. And I remember that office visit. Landon was a bright, fun, sparkly toddler. He needed three diaper changes
during that first visit, and there was as much blood
as stool in all of them. This was a sick kid, having ten or more
diapers like this a day, every day. His mom and I figured out how to do
pediatric fecal transplant, and we watched over the course
of a week and a half, as his stool frequency decreased, his stools became more formed,
and we saw less and less blood, until there were days when he was having two or three formed,
bloodless bowel movements per day. Landon's story is complicated
with ups and downs over the years, but I'm happy to say
that today, he's doing phenomenally. I talked to his mom
just a couple of days ago, and it's been over a year
since he's had any symptoms or used any drugs
to affect ulcerative colitis. It's as good an outcome
as we could have hoped for. Indeed, when I look at the medical
literature for safety and efficacy data, I'm astounded. FMT appears to be as beneficial for people with stubborn
inflammatory bowel disease as the newest, most expensive
and modern IV immune-suppressant drugs but without the increased risk of cancer and other serious adverse events
that we see with the drugs. Now, the studies are smaller
and they're early, but so far, they look
amazingly optimistic. A colleague recently remarked to me
that we used to live in a world where exposure to feces made us sick,
and antibiotics saved our lives. Now, we live in a world
where antibiotics are making us sick and feces saves our life. I no longer think of my patients
as just themselves. I think of them as a garden to be tended, or sometimes, as an entire galaxy
filled with trillions of lives. I think of our decisions,
as a society and as individuals to give antibiotics to our cattle
to fatten them up, to use antimicrobial soaps
and our diet changes like the decisions of the gods of old, whose decisions ripple out
among trillions of lives across a galaxy. If there's a take-home message here, it's to tend your own garden. Eat diverse fiber foods at most meals. Don't take antobiotics casually. Let the dog lick the kid. (Laugher) I think that knowing
our own internal garden, knowing the flora and the fauna,
the weather and the soil, is knowing ourselves. I think that knowing
how to nourish that ecosystem, and even how to completely
reboot it when necessary, may be the most high yield
area of medicine today, and I thought that
that was an idea worth spreading. (Applause) (Cheers) Thank you.
