September 15, 2014

How do I make Fecal Transplants work for Ulcerative Colitis?

One thing that has come to my attention recently is that some people who have tried to use fecal transplants to treat their case of Ulcerative Colitis have not yet been successful in their attempts to do so. While fecal transplants were a huge part of my experience in recovering from Ulcerative Colitis they were not the only factor. I also did them for a longer period of time than Dr. Borody’s patients who did them for 5 days in a hospital setting using a colonosope. To the best of my knowledge this is the process that the few doctors who have done these for Ulcerative Colitis are most likely using.

As I cover in my book, I believe there were several keys to making this work for me and which might have been left out by anyone who has done these and not yet been successful.

- Do the fecal transplants for long enough to make sure the new bacterial colony has established itself.

I did the fecal transplants for almost 5 weeks every day and then stopped. I really can’t say if I needed to do them for this long or if after a week or two, tapering down the enemas to where I was doing them every other day, once a week or once a month would have been just as effective. However what I do think needs to happen is to keep the newly introduced bacteria at elevated levels to act an anti-biotic for what may be “bloom” cycles of various bacteria that reproduce from spores embedded in the intestinal walls.  Basically do the FTs for a long enough period of time to really get the new bacteria established and dominant over the “bad” bacteria.

- Continue on maintenance medications while doing the fecal transplants and for a significant period of time you have stopped doing them.

The reason for this is to limit inflamation and manage immune system responses to new bacteria which can include a flare of symptoms, fever and more. A flare could result from the body actively fighting the inflamation causing bacteria or toxins released by dying of large amounts of bacteria. Your body’s immune system could be recalibrating and readjusting to a new mix of bacteria in the colon. Until it has relearned what is friend and what is foe, your body could attack some the new “good” bacteria in the process, triggering more inflamation. However know to expect that these symptoms are a part of the process toward restoring good health and keep going.

- Help retain the enemas and manage bloating from gas by using over-the-counter drugs like Immodium and Gas-x.

Retaining enemas can be a challenge at first, however you will get better at it with experience. Making sure to lie on your left side and then roll onto your back and then your right side will also help the fecal enema mixture navigate its way up the colon and reduce urgency caused by the enema mixture being in the lower colon or rectum.

- Treat symptoms like diarrhea, muscle spasms, and indigestion with drugs therapies like in IBS.

I believe this is an important step in the process however it may be more important to some people than others depending on the extent of Irritable Bowel Syndrome symptoms, anxiety or depression. Anti-depressants and anti-anxiety drugs have long been used to treat IBS. Also flares of Ulcerative Colitis often appear to be triggered by extra emotional stress, change of seasons to fall or winter. Improper digestion and frequent diarrhea may also further fuel a mix of bacterial which triggers inflammation too. Other than blood in stool, Ulcerative Colitis shares some similarities with severe cases of Irritable Bowel Syndrome, especially diarrhea. In addition to helping newly transplanted bacteria become established, slowing diarrhea also helps drugs like Mesalamine work and could support a more helpful mix of bacteria.

- Get high levels of protein using supplements to help the intestine heal more quickly.

Just like the body needs protein to recover from surgery and body builders use it to build muscle, we need protein to heal the intestines, especially if we have been eating restrictive diets in an attempt to cope with the illness. More protein can help heal ulcers and regain elasticity lost during inflamation and resulting scar tissue. This is another key step that I believe some people are leaving off. I started drinking 3 protein shakes a day to prepare my body for surgery on the advice of the colo-rectal surgeon who would have removed my large intestine. However it turns out the same amounts of extra protein needed to recover from weight training workouts and surgery was also necessary to heal my colon and regain elasticity lost due to ulceration and resulting scar tissue.

Based on my experience and reports I have gotten from those who have been successful with fecal transplants I believe that most of the successful people have done some of all of the above steps and most of the people who have not yet been successful left out one or more of the above steps.

  • shemen

    i tried for the second time the fmt i’m after a flare still get off the prednisone a few days after i started both times the bleeding came back . any advice ?

    • admin

      Its hard to have a complete answer without knowing more detail about your particular case including which disease you are trying to treat, what the course of your illness has been and what immunosuppressant and / or anti-inflammatory drugs you are taking or have taken in the past. To the best of my knowledge from published studies, flares are generally not a problem if you are treating Colitis caused by Clostridium Difficile bacteria. However I can say that it is quite possible that fecal transplants can trigger a flare when treating Ulcerative Colitis, and that there can be some ups and downs through this treatment process. I ended up using drugs to help control inflammation during FMT as did Dr. Borody’s 6 patients in the 2003 article “Treatment of Ulcerative Colitis using Fecal Bacteriotherapy.”

      While it is hard to say with certainty exactly what is going on in your particular case or in other cases of Ulcerative Colitis where a flare in symptoms develops during FMT, here are a few possible reasons.
      1) Your immune system sees the new bacteria as foreign to your body and therefore is something to be attacked, this increase in inflammation to fight bacteria or from dying bacteria also causes inflammation in the intestinal walls.
      2) Another possibility is that the gut barrier is damaged from years of inflammation which also makes you more sensitive to newly introduced bacteria.
      3) Still another possibility is that the newly introduced bacteria from FMT is in fact working and inflammation-causing bacteria is dying off and releasing toxins which trigger inflammation as they interact with intestinal walls which are already inflamed but not to the point where you are having obvious symptoms.
      With any of all of those possible causes of inflammation Prednisone or other immunosuppressant drugs could help in the short-term to control an immune response and flare. Immunosuppressant or anti-inflammatory drugs during and for some time after fecal transplants have stopped could potentially help make FMT work for Ulcerative Colitis and / or Crohn’s Disease.

      Still other possibilities which I mention in my book include pre-treating with a course of antibiotics to wipe out existing bacteria before FMT and also anti-spasmodic drugs to slow diarrhea and urgency.

      • Ruth P Roberts

        Have been on FT for 5 days and stopped yesterday to treat my UC. Prior to FT was down to 5 mg prednisone-no bleeding/diahrrea, just gurgling and nausea. These two symptoms continued until the fourth day when they stopped! I took 5th treatment last night. Today the cramping is coming back-more frequent bm and lots of gurgling and sligh nausea. I had planned to just do 2 treatments a week from now on. But after reading rhR you did it EVERYDAY for weeks, am wondering if I need to do the same. Have been on pred nisone (started at 40 mg in Dec.) and was reduced to 15 by Feb. Colonoscopy showed mild/moderate conditon with NO ulcers. Yet they are telling me that when I get off prednisone ns have bleeding again, I have to go on Remicade! As I have severe resisitance to most drugs I am not wanting to do this. I am told that if Rem. doesn’t work I’ll need a colectomy!! This for mild/moderate disease! So, are you aware of any other protocol where patients are doing FT EVERY day for months and this actually makes a difference? Any advice is welcome. One other question: Did you notice when you felt nauseas or gurgly (my first signs of a flare tryng to rear its head) that yu felt more depressed? This has definitely been a reacton for me. Almost like a severe clinical depression–for women like major PMS!!

        • admin

          Yes, depression would often precede a flare for me. It makes sense that depression / anxiety would help trigger a flare since it can trigger diarrhea predominant Irritable Bowel Syndrome (IBS) symptoms. This is why low doses of anti-depressant or anti-anxiety drugs are sometimes prescribed to treat IBS.

          What sent me case of Ulcerative Colitis into permanent remission (cure) after starting the fecal transplants was the addition of Bupropion to my treatment regiment along with a lose dose of Doxepin (6 mg of brand name Silenor, later about half a 10 mg capsule of generic Doxepin.) Since that time I have noticed if chronic diarrhea starts to become a problem that taking Bupropion again rapidly helps get me back to regular solid stool. I now believe that I had a combination of IBS AND Ulcerative Colitis and that the two conditions often overlapped and were part of a vicious cycle of diarrhea and inflammation. I believe breaking the cycle involves changing the native bacteria, limiting inflammation while healing the gut barrier and controlling diarrhea – to help with establishing a new bacterial colony and helping the gut barrier to heal.

          As I mention here on this site Bupropion can be a good alternative to Remicade and it worked very quickly for me. http://fecaltransplant.org/bupropion-as-a-treatment-for-ulcerative-colitis/ There is also some research showing that Bupropion (Wellbutrin) helps inhibit TNF in mice and it most likely does the same in humans. So I think it is worth trying before Remicade, given the extremely high cost and potentially dangerous side effects of Remicade. For me Remicade contributed to two out of control infections which resulted in hospitalization and in rare cases in some people it can also cause a deadly form of lymphoma cancer.

  • Ruth P Roberts

    Thank you. Have been doing FT 3 weeks. BM are normal. But I have more and more nausea. Have you had nausea with your UC?? I didn’t have this with previous bouts.

    Ended up in ER last week with several abdominal pain and vomiting. It lasted about 1 hour. Was tested for gallbladdere problem and I don’t have that. Have been doing FT for 3 weeks–the past few days have had much more abdominal pain, low grade fever. headaches, flu like feeling. (Yesterday I didn’t have these symtoms and felt pretty good!) Today I woke with strong abdominal pain and flu like feelings. I admit, I have been coming down from the 5 mg.prednison-don’tknkow if that is the problem. OR if as you say, i am having flares due to immune system vs. bacteria. Although my donor was tested, is it possible he is not a good match? (I couldn’t do the pre-antibiotic treament as I am intolerable of them except for pennicillin–is that one that can be used???)

    I also wanted to know if there is a private e-mail address where I can ask you a question. Thank you for all you do!!!!

    • Michael Hurst

      Hi Ruth,

      It sounds like recently you have had quite an ordeal with your health lately. The flu-like feelings could be caused by bacterial die-off or other things relating to bacteria. I would not reduce any drugs used to control immune suppression or inflammation immediately before, during or after fecal transplants. There is relatively little knowledge over whether or not a donor’s bacterial flora would be a compatible with a recipient or not and cause an increase in symptoms. However when the colon is inflamed past a certain point many things can trigger an increase in symptoms even good bacteria. This is why controlling for other symptoms during fecal transplants is key.

      I am pretty busy these days with many different projects and so it is hard to make time to respond to all messages right away. I do offer some additional support for those who have purchased and read my book as it answers many questions that people may have.

  • Ruth P Roberts

    Have youheard of patientstaking ldn?