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Fecal microbiota transplantation for IBD and autoimmune disease
Intestinal microflora is emerging as a major pivot between health and disease. The numerous microorganisms that make up our intestinal flora outnumber our human cells 10:1 and our DNA 350:1; as such, proper gut microbial ecology is compulsory for optimal human physiology.
In this webinar, Dr. Mark Davis will discuss cutting-edge microbial-based therapies. He is one of the few clinicians in North America that has pioneered the use of fecal microbiota transplantation (FMT) in clinical practice.
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02:00 Dr. Davis’ Fecal Microbiota Transplantation/Gut Journey: Steven Sandberg-Lewis was his favorite professor. As a student, he would do as many rotations as he could with him. They saw many IBS patients, some of whom were not healed. This inspired Dr. Davis to dive into the medical literature from around the world. He found a 2003 paper talking about dramatically reversing the course of ulcerative colitis in very sick patients who were not responding to treatments. This reversal was from using fecal slurry retention enemas. Look to the healing power of nature is one of the tenants of naturopathic medicine. The human body is a naturally self-healing organism, so support the natural process of healing. Look to nature and how the processes of nature unfold. Use natural things from the world. The use of live microbial medicines are the panicle of the healing power of nature.
05:23 The History of FMT: Fecal Microbiota Transplant therapy dates back to the 4th century, according to Chinese literature. Sixteenth century Chinese literature weighs in the on the efficacy of different types of feces (fresh, fermented, infant, etc) to fight diarrheal diseases. At the same time it was discussed in a German publication. It appears again in a paper in1958 in the US, where a fecal retention enema was used on 4 patients who were expected to die of their diarrheal diseases. All four patients recovered within 48 hours.
07:21 Dr. Davis’ First FMT Patient: As a student with Dr. Sandberg-Lewis, Dr. Davis had a patient, a 37 yr old woman with a several year history of ulcerative colitis. She also had 2 year old twins. She was exhausted. Other treatments helped with her energy and frequency, but she was still quite sick. At the time they called it a human probiotic infusion. She used some stool from one of her twins. She had a difficult time retaining the small volume for the 4 recommended hours. After 5 days, she had no benefit. Dr. Davis was discouraged. After 3 months, she returned wanting to try again. She was hypovolemic and was put on prednisone. IBS used to have a 70% mortality rate. Prednisone turned that around. The mortality rate for IBS today is 3%. On the second attempt at FMT, they used an adult donor, continued other therapies and made sure she had support at home. She was able to retain a significant volume for 4 or more hours for at least 5 days. She described a 90% improvement.
10:21 FMT Donor Bank: There was no one in North America who had a donor bank to provide FMT for people with inflammatory bowel disease. In 2011 Dr. Davis started the first FMT donor bank.
10:45 Prednisone and FMT: FMT requires retention of 150 ml for at least a few hours. For those who cannot retain the treatment, prednisone calms the digestion enough to help with retention.
11:51 Unexpected Benefits from FMT: The following were recorded in a US study. In one case a patient with Parkinson’s was being treated with FMT for a digestive issue and his Parkinson’s was reversed. Three out of 6 cases of people with a-typical multiple sclerosis had symptoms reversed. One of these patients was wheelchair bound and catheterized and he/she was able to return to normal walking and normal urination. Dr. Davis treated two adult males with MS diagnosis and they have seen improvements in their MS symptoms and one with type-1 diabetes had lower insulin needs for several months. In China and the Netherlands FMT is being studies for its effect upon type-2 diabetes. One case of idiopathic thrombocytopenic purpura (ITP), an autoimmune condition disappeared after FMT. However, there are a few report of ITP appearing within a year of FMT. ITP appears spontaneously and may or may not be connected to FMT. There is evidence of remission from chronic fatigue and chronic constipation.
15:51 Obesity and Body Fat Changes from FMT: You do not want to get a transplant from an obese donor. The colon microbiome from an obese person could lead to obesity in the recipient. Benefit can be seen in people with metabolic syndrome and obesity when a donor is lean. It is expressed in fasting triglycerides, energy levels, and weight loss for 2 to 3 weeks. Regular FMT treatments for a year may have a greater and longer lasting impact, but that is speculation.
18:08 Donor Criteria: One woman performed her own FMT using her husband’s stool. Her husband is diabetic and two months later, she is showing diabetic changes in blood sugar. Donors should not have diabetes, metabolic syndrome, any autoimmune disease, atopic disease (eczema, allergic asthma), seasonal allergies, chronic pain, fibromyalgia, any gastrointestinal disease, most cancers, or antibiotic use within 6 months (although some microbial changes from certain antibiotics last as long as 2 years). You want a donor who has a formed, painless bowel movement every day or nearly every day. Donors should be tested for infectious disease. Dr. Davis wants donors to report clear thinking throughout the day and have clear skin. You want someone who was delivered vaginally, breastfed and had minimal or no exposure to antibiotics throughout their life. They should eat a diverse fibrous organic diet. A donor should have a positive good outlook on life.
22:09 The Perfect Microbiome Diet: There is no perfect diet for everyone. Dr. Davis charges his patients with the task of treating their bodies like a laboratory to find out what works for them and what does not. Generally, a diet full of whole foods (including fermented foods) will be a microbiome-enriching diet.
23:20 Should We Wash Organic Vegetables? “Unless you know the first name of your farmer, you don’t know where your food is coming from.” The word organic means alive and it originally referred to the soil. Big chain organics can grow food without pesticides, but the soil may be dead. Gardening and playing in rich alive soil can eventually be beneficial to your gut soil.
25:50 New Developments: FMT has been found to be 92 to 100% effective for c. diff colitis in adults, elderly, people with multiple co-morbidities, people who also have IBS, people with organ transplants and immunocompromised and people who have failed with every antibiotic. To help with c. diff colitis, donors just need to be healthy. FMT is also effective in treating Crohn’s colitis, ulcerative colitis and inflammatory bowel disease. Generally, adverse events are minor and temporary. There is a report of a 2 yr old with inflammatory bowel disease who received FMT from an age-matched donor. She did not see benefit. They then used her older brother as a donor and she went into anaphylactic shock. However, she saw great benefit to her inflammatory bowel disease. During the second treatment from her brother, she had a smaller shock reaction and continued to see improvement. After a third infusion, she became a-symptomatic off of meds.
29:53 Helminthic Therapy: This is the use of microscopic worm-like organisms that have been traditionally classified as parasites. Dr. Davis argues that some are not parasites, but mutualists. They benefit and we benefit from the relationship. The human hook worm, human whip worm, pig whip worm and recently a rat tape worm, hymenolepis diminuta. These types of parasites have been part of our personal ecosystems. Removing them is depleting our microbiome. The rat tape worm and pig whip worm are not meant to live in humans, and their residence in our gut is short lived. People tend to reintroduce every 2 weeks.
32:21 Access to Helminthic Therapy: The company Autoimmune Therapies in the UK has been providing therapeutic parasites the longest. Wormtherapy.com, run by a microbial ecologist, is another. Inoculation can also be done by a company in Mexico. Tanawisa.com provides the pig whip worm. Biomerestoration.com in the UK is the most affordable vendor.
35:57 Dr. Davis Experience with Helminths: Dr. Davis is about to try HDC (hymenolepis diminuta, rat tape worm) on himself and two patients. The human hook worm, human whip worm and pig whip worm, Dr. Davis has used with a few patients. Some people do not benefit from it. For some it made a huge difference. For some people, recovery means restoring the flora and the fauna.
38:45 Gut Life: Healthy gut fauna are benign protective multicellular organisms. Bowel flora are the bacteria. There is also a virome, the viruses. There is also a fungome, healthy fungi that are living in the gut. The gut mucosa, gut soil, provides the blood flow through the gut. It is the integrity of the gut barrier and the types of mucus we secrete, as well as the types of immune cells we are producing. Dr. Davis likes to work with the gut mucosa as an organic gardener and the soil by giving glutamine, demulcent herbs, putting out the fires (which can mean using prednisone with DHEA) and sometimes it means giving strong antihistamines, colostrum, and dietary changes.
40:40 Dr. Davis Favorite Herb or Nutrient: His favorite product for IBS is a product called GI Repair, a combination of dried demulcent herbs, glutamine and other gut healing factors. He sees great benefit for patients with diarrhea predominant IBS.