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Published: 4 years ago

Fecal Microbiota Transplant: Science & do-it-yourself Instructions for Chronic Disease (DIY FMT)

Fecal Microbiota Transplant: Science & do-it-yourself Instructions for Chronic Disease (DIY FMT)

In this video I present: - The idea behind Fecal Microbiota Transplantation (FMT) - Science based considerations that help to plan and implement do-it-yourself FMT - A demo of the actual implementation Important Points: • FMT, Fecal microbiota transplant. • FMT is a therapy, where we take the stool of a healthy donor and transplant it into the GI tract of a patient. • Goal of FMT is to correct a microbial dysbiosis in the GI tract. • The acronym FMT is used for fecal microbiota transp/transplantation, for fecal microbiome transplant or for fecal matter transplant. • Fresh fecal matter is composed of approx 75% water, 15-20% of food residues and toxins and 5-10% live microbial mass. • It is the ultimate probiotic formula, by no of strains as well as by no of microbes per strain. • Stool also contains SCFA, these molecules are the main source of energy for colonic cells. • In current medical practice FMT is only employed for recurrent CDI. An infection that usually results from a generous use of ABX. FMT works by correcting bacterial dysbiosis. • In research literature we find quite strong evidence (many studies) suggesting FMT can drastically improve and even resolve UC. • Otherwise there are some pieces of evidence suggesting efficacy for other pathologies, documented mostly in case studies, case reports. • Theoretically all conditions linked with a GI dysbiosis could benefit from FMT. • As with most medical therapies there are desired and undesired effects with FMT as well. • FMT is considered a low risk intervention, both in scientific literature and by today’s medical practice. The majority of adverse events appear to be mild and of gastrointestinal nature. I have included a list here with the most commonly reported adverse events. • More serious side effects have been reported but are rare, as examples I have listed weight gain and neuropathies. FMT can also trigger disease flares. Modalities: • How long should your treatment last? The duration of an FMT therapy for other disease varies and depends on many factors. It is a good idea to start with what has worked for other patients. Experience with different autoimmune disease has shown how periodic top ups can help maintain a healthier microbiosis. • Regarding route of administration if we look at data from C Diff, thus far we can say endoscopically performed FMT and self admin enemas have pretty much the same efficacy and are superior to nasogastric delivery. • Comparing clinics performing FMT via enema and DIY applications at home I think we can say that clinics likely have an edge when it comes to experience as well as to donor selection, which makes them a better solution on the short term. If periodic top ups are necessary DIY is probably the better solution to adopt from the start. • Comparing single vs multiple donors. In theory diversity in the GI microbial composition has found to be associated with a better disease resistance • Comparing fresh with frozen stool: Same efficacy in C.Diff treatment. If used fresh than then the fresher the better, if used frozen freeze as soon and as cold as possible (-70/80° C) • Regarding patient preparation: in theory a clean colon with a low bacterial load are advantageous to improve the chances of colonisation by the new microbes. • Regarding donor preparation: A more diverse diet leads to a biodiverse microbiota, which we want. If the patient has strong intolerances, it makes sense to have the donor avoid or considerably reduce these foods (min 4d before treatment). FMT Steps: 1. Define/design the protocol: a. Prepare patient-donor agreement, questionnaire, test criteria 2. Find a suitable donor: . Questionnaire a. Sign agreement b. Blood and stool testing 3. Prepare for the therapy according to protocol: . Patient equipment, clean colon, reduce intestinal permeability, a. Donor equipment, diet b. Patient-donor logistics 4. Implement therapy 5. Maintenance phase

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