Fecal bacteria transplant update

This is a longer post but well-worth reading as the information has effects on many diseases at once.

What is fecal transplant (FT)?

It's when feces from a healthy donor is given to an unhealthy person. FT is non-invasive. No cuts are made, sometimes it is given through a tube in the nose, a capsule form containing freeze-dried bacteria, enema, or other non-invasive ways. Side effects are few.

What are microbiota? 

Microbiota are all the bacteria and microscopic organisms that live in your gut. They help you turn food into vitamins that can be absorbed into the blood stream. There are good bacteria (which help you digest food), and bad bacteria. Under certain conditions, like a chronic lack of fiber, or eating too much sugar or processed foods, the bad bacteria out compete the good bacteria and this syndrome might be linked to diabetes and other illnesses.

Some bullet points:

1. Fecal transplants have been used for at least 1700 years. Source. 
2. 99% of the DNA inside us comes from bacteria. Source. 
3. Limited cases show the treatment is effective in Parkinson's disease, multiple sclerosis, chronic fatigue syndrome and irritable bowel syndrome.
4. FT can be given by nasogastric or nasoduodenal tube, colonoscope, enema, or capsule. 
5. Thinner people have a wider variety of Bacteroidetes, a large tribe of microbes that specialize in breaking down bulky plant starches and fibers into shorter molecules that the body can use as a source of energy. (Source)
6. One bacterium associated with obesity might be a stomach bacterium called Helicobacter pylori. Research by Martin Blaser of New York University suggests that it helps to regulate appetite by modulating levels of ghrelin—a hunger-stimulating hormone, but the use of antibiotics has all but made H. pylori extinct in human stomachs.
7. Since FT is so new, it's probably not covered by any medical insurance in the US.

In China they used to make "poop soup" containing fecal matter and fed it to newborns. This jump started the babies' immune systems and gut bacteria populations. They called it "yellow soup". Initial studies show fecal transplant (FT) works in treating Parkinson's disease, fibromyalgia, chronic fatigue syndrome, myoclonus dystopia, multiple sclerosis, obesity, insulin resistance, metabolic syndrome, and autism.

What are the bad diets like?  What problems might bad diets cause?

At this point scientists have very reasonable theories on how this works, but the truth is they cannot claim they know everything about this issue.

But a bad diet is a diet consistently high in sugar, processed foods and low in fiber. The good bacteria need the fiber to survive. It's their food. So grab those prunes and munch with pride!

When would a person need a fecal transplant? 

Fecal transplants are not yet legal for humans in the US except under limited circumstances, like a persistent C difficile infection, Crohn's disease or ulcerative colitis. But this link says the cure rate is "nearly" 100% out of 200 patients. More studies must be done on how to package, ship and ingest the bacteria so they live and can benefit the person.

A study: "The Impact of Diet and Lifestyle on Gut Microbiota and Human Health".
From NIH. (Lots of good info here!)

1. Both short- and long-term dietary change can influence the microbial profiles. I.e. a little "cheating" in the diet can still be bad. 
2. Most of the microbes are bacteria, the gut can also harbor yeasts, single-cell eukaryotes, viruses and small parasitic worms. Not all of these organisms are harmful by themselves, but they can make the populations of good bacteria decrease, which IS harmful. 
3. The most common bacteria in adults are Bifidobacterium, Lactobacillus, Bacteroides, Clostridium, Escherichia, Streptococcus and Ruminococcus. Approximately 60% of the bacteria belong to the Bacteroidetes or Firmicutes phyla.
4. The Human Microbiome Project (Wikipedia page) shows that bacteria populations vary a lot among individuals. 
5. Gut microbes produce a large number of bioactive compounds that can influence health; some like vitamins are beneficial, but some products are toxic.
6. The use of a range of fibers, may be the best way of maintaining a healthy gut microbiota population. (Other studies say avoid sugar, and processed foods.)
7. Bacteria such as Bifidobacterium can generate vitamins (e.g., K, B12, Biotin, Folate, Thiamine). B12 is very important for neurological function, and a lack of B12 can cause some symptoms of depression.  
8. The Bacteroidetes phylum bacteria tend to dominate numerically during youth but numbers decline significantly by old age, whereas the reverse trend occurs for bacteria of the Firmicutes phylum.
9. High fat diets induce increased circulating levels of bacteria-derived LPS in humans, possibly as a consequence of increased intestinal permeability (related to leaky gut syndrome?). LPS is an immune system modulator and potent inflammatory agent linked to the development of common metabolic diseases.

Links

1. "How gut bacteria make us fat and thin." Scientific American. June 1, 2014. READ THIS if nothing else.
2. List of clinics that do FT here. 
3. Wikipedia link to "fecal microbiota transplant".

A summary of fibromyalgia.

When one talks about alternative medicine one cannot forget conditions like ME/CFS and fibromyalgia. These have both been dismissed by the majority of American doctors, much like they dismissed Celiac disease (discovered in the 1950s) and HIV. Here is a summary of facts.

1. About 2-5% of US adults have fibromyalgia. 
2. It can take an average of 5 years for a person to get a diagnosis of fibromyalgia. It is not well understood, so it must be diagnosed by eliminating other possibilities. 
3. FM is characterized by: pain in at least 11 of 18 points. 
4. Sleep disturbances. Trouble getting to sleep, feeling tired when they wake up.
5. Irritable bowel or similar symptoms.
6. Cognitive problems also called "fibro fog". 
7. Fibromyalgia often occurs (up to 25-65%) with other rheumatic conditions such as rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis.
8. Fatigue that won't go away.
9. Widespread stiffness, aching, and burning sensations. (Of course this will lead to sleeping problems and fatigue!)
10. Many patients report they can't get to sleep, and when they do, they wake up still feeling tired. This might be a lack of proper REM sleep. A sleep study might help determine if they get enough REM sleep but many American insurances do not cover this.
11. Frequent peeing caused by bladder spasms. 
12. Researchers have also found abnormalities in the hormone system known as the hypothalamus-pituitary-adrenal gland (HPA) axis. The HPA axis controls important functions, including sleep, the stress response, and depression. Disturbances to the HPA axis is correlated to exposure to BPA. See Chen 2014 below. 
13. Fibromyalgia can be triggered by infection of Epstein-Barr virus or Lyme disease, chronic physical or emotional stress, hormonal changes, emotional trauma of an accident, "seeing the elephant" (believing you will truly not survive a given situation), or medications.
14. Abnornally thick vascular walls, which may prevent enough oxygen from getting to the muscle.

For medical coding using ICD9-CM, FM is usually coded as 729.1, "Myositis and Myalgia, unspecified". Overall, many of the symptoms above seem to be inflammatory symptoms.

Treatments
FM is not well understood so not all treatments will work well for all, or even a majority of people. Treatments include:

1. Aerobic and resistant exercise for the pain. 
2. Psychological support to deal with the frustration and depression. 
3. Some medications to address the pain and lack of good sleep. Some medications the FDA has approved for fibromyalgia: Lyrica, Cymbalta, Savella, which all help reduce pain.
4. Relaxation training. 
5. Acupuncture, chiropractic treatments help most patients. But again, many American insurances cover neither.

FM can be difficult and expensive to diagnose and patients have to put up with pathological disbelief, but, with much persistence, once diagnosed it can be treated. But not all treatments will work well for all people. 

Sources

1. Chen F, Zhou L, Bai Y, Zhou R, Chen L. Hypothalamic-pituitary-adrenal axis hyperactivity accounts for anxiety- and depression-like behaviors in rats perinatally exposed to bisphenol A. J Biomed Res. 2015 May;29(3):250-8. doi: 10.7555/JBR.29.20140058. Epub 2014 Nov 12. PMID: 26060449. Link to NIH abstract.
2. CDC. Fibromyalgia page from the CDC. Last accessed Apr 10, 2016.  
3. FDA. Living with Fibromyalgia. Last accessed Apr 10, 2016.  
4. Fibromyalgia center. University of Maryland. Last accessed Apr 10, 2016. 
5. Fibromyalgia: Maligned, Misunderstood and (Finally) Treatable. Scientific American. May 27, 2014.
6. Fibromyalgia criteria from American College of Rheumatology. Link to PDF.  
7. Fibromyalgia on Medscape.
8. Fibromyalgia treatment on Medscape. 
9. JAMA articles on musculoskeletal issues.
10. National Fibromyalgia Association page. Contains history of FM and latest research and much more info. Last accessed Apr 10, 2016.
11. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Last accessed Apr 10, 2016.
12. NIH Pubmed page on fibromyalgia. Lots of links to studies here. Last accessed Apr 13, 2016.
13. NORML and fibromyalgia and pot. A few small studies show THC reduces pain. Last accessed Apr 10, 2016.
14. ScienceDaily Fibromyalgia articles. Last accessed Apr 10, 2016.
15. Understanding Fibromyalgia and Its Related Disorders. (2008). Primary Care Companion to The Journal of Clinical Psychiatry, 10(2), 133–144. Link to NIH study.