What is FMT and where to get a Fecal Microbiota Transplant

What is FMT, aka “stool transplant” or “poop transplant”?

A fecal microbiota transplant (FMT), sometimes colloquially referred to as a “stool transplant” or “poop transplant”, is a medical procedure that involves transferring fecal material from a healthy donor to the gastrointestinal tract of a patient who has a microbiome imbalance or disease. The goal of FMT is to restore the balance of microorganisms in the gut.

The fecal material is collected from a healthy donor, screened for pathogens and other contaminants, and then usually processed into various forms, such as liquid suspensions or pills. It is then delivered to the patient's gut through various methods such as a colonoscopy, endoscopy, nasogastric tube, or oral capsules.

It's important to note that FMT is still considered an experimental treatment and should be supervised by a qualified healthcare professional. The decision to undergo FMT should be made on a case-by-case basis after a thorough evaluation of the patient's condition and medical history.

Why is FMT needed?

A 2018 review said: "It is now clear that the gut microbiota contributes significantly to the traits of humans as much as our genes, especially in the case of atherosclerosis, hypertension, obesity, diabetes, metabolic syndrome, inflammatory bowel disease (IBD), gastrointestinal tract malignancies, hepatic encephalopathy, allergies, behavior, intelligence, autism, neurological diseases, and psychological diseases. It has also been found that alteration of the composition of the gut microbiota in its host affects the behavior, intelligence, mood, autism, psychology, and migraines of its host through the gut-brain axis."

Antibiotics do long-term damage by killing off the host-native microbes that have been evolving alongside us for millions of years, and perform essential functions for our health and well-being [1]. C-sections, lack of breastfeeding, and junk food diets are also thought to be ways in which we have been extinguishing our microbiomes [1][2].

FMT is the only way to restore lost host-native microbes. Fermented foods do not contain host-native microbes. Most probiotics do not either; and the ones that do contain a drop in the ocean compared to FMT — a human-sourced probiotic!

FMT for C. difficile

FMT has been shown to be highly effective (90%+) for Clostridium difficile [1][2][3], a deadly gut infection. The first line of treatment for C. Difficile has been antibiotics. That’s problematic because antibiotics do collateral damage, both to the immune system, and by killing off beneficial gut microbes, which allows C. Diff to become pathogenic in the first place. Restoring eubiosis with FMT to suppress C. Diff solves the underlying problem while avoiding the harsh effects of antibiotics.

Isn’t FMT gross? Consuming someone’s feces?

Many people may have this perspective; I sure did many years ago. But after countless FMTs from more than a dozen donors, I learned that this notion stems from those of us in poor health having unhealthy stool. Healthy stool is not repugnant. I dare say that healthy stool can even be appealing, with a rich & pleasant odor, or a very mild one.

Coprophagia (consumption of feces) is widely practiced in the animal kingdom, and by animals with much greater senses of smell than our own. They are able to identify healthy poop with their sense of smell and recognize that it has potential benefits for them. Even though humans seem to have largely given up this practice at some point, we likely still have some ability to detect healthy stool via our sense of smell.

FMT capsules, aka “poop pills”

Also known as “poop pills” or “crapsules”, oral FMT capsules are simple and safe — you just swallow them! They also have the benefit of coating the whole small intestine. FMT capsules are double-encapsulated to avoid leakage. There is generally no taste or smell. You can buy pre-made capsules from our stool donors, or you can use their stool to make your own.

FMT has commonly been done via colonoscopy, which only coats the large intestine, and requires a laborious medical procedure that carries risks (perforation), extra costs, and inconvenience.

An easier, safer, and equally-effective alternative for the lower route is a deep retention enema. You do a regular, simple enema at home, and use gravity to get it to flow through the full large intestine. [DIY FMT directions]

Where to get FMT (Fecal Microbiota Transplant)?

Human Microbes is the only source that is taking stool-donor quality seriously. We are screening hundreds of thousands of people to try to find super-donors that will be both safe and highly effective. Due to the extinctions of our host-native microbiomes, and the epidemic of chronic disease, people with unperturbed, disease-resistant gut microbiomes are extremely rare.

Most sources of FMT are only screening a handful of people and then using whoever isn’t obviously ill. Giving little concern to how effective the donor would be, and even not accounting for long-term detriments. It is critical to only use the best stool donors to ensure the best results, and reduce the possibility of getting worse or developing new problems.

We are also the only stool source that is publicly tracking & reporting results. We are doing science, and genuinely striving to find highly effective donors. Virtually every other source is simply trying to sell you a black box, and thus are unwilling to display their results.

Human Microbes provides the ingredients for you to DIY FMT with oversight from your doctor. FMT has generally been done as a medical procedure in a hospital. But since you can get better results and lower costs from the comfort of your own home that seems like the optimal choice. You can go to a clinic or hospital, but do you really need a doctor to help you swallow pills? An enema is also very easy and convenient to do at home. And taking donor quality in mind, you'd be paying much more for worse donor quality at clinics and hospitals. The at-home method also allows you to continue the treatment for as long as you need.

Thus, we believe that our offering provides the optimal mixture of quality, convenience, and affordability. And of course, you can always bring the capsules with you and swallow them in the presence of your doctor. We can also ship stools and pills directly to your doctor for them to perform FMT on you.

You can learn more about our screening and ordering on our Orders page and blog. We’re focused on the USA and Canada, but can do international dry ice shipping to many countries.

What diseases can FMT treat?

FMT is not yet approved to treat any specific condition, but given all the ways in which we know the gut microbiome regulates human health and development, FMT is being heavily researched as a potential treatment and prevention for nearly every chronic illness [1].

Some of the conditions that might be treatable with FMT include:

Clostridium difficile infection: This is the most common indication for FMT. C. difficile infection occurs when the normal balance of bacteria in the gut is disrupted, often due to antibiotics, allowing C. difficile to overgrow and cause severe diarrhea.

Inflammatory bowel disease: FMT has been shown to be effective in around 30% of patients with ulcerative colitis and Crohn's disease.

Irritable bowel syndrome: Some studies have shown that an FMT “super-donor” can be effective for as many as 70% of patients with irritable bowel syndrome (IBS).

Metabolic disorders: FMT has shown potential for metabolic disorders such as obesity and diabetes. But more research is needed before it can be accepted as a viable treatment for things like weight loss.

Neurological conditions: There is a strong gut-brain connection, and thus ample evidence that the gut microbiome plays a major role in many neurological conditions, such as Parkinson's disease and multiple sclerosis. FMT has been studied as a potential treatment for these conditions, with some early promising results, but more research is needed.

Mental health: Research on the gut-brain axis has elucidated the importance of the gut microbiome in mental health disorders like depression, anxiety, and bipolar. And FMT has already been shown to be beneficial in some early clinical trials.

Autism: FMT has been shown to reduce unwanted symptoms of autism.

Autoimmunity: There is growing evidence that autoimmune conditions such as fibromyalgia, chronic fatigue syndrome (CFS), and alopecia (hair loss) may be able to be treated with FMT.

Skin conditions: The gut microbiome regulates other body sites’ microbiomes, and plays a major role in conditions such as acne, dermatitis, eczema, psoriasis, and more. So it’s quite likely that FMT will be able to treat these skin conditions. But so far there haven’t been many FMT clinical trials in humans for skin conditions.

Anti-aging: There is evidence that the gut microbiome plays a major role in the aging process, in addition to all the “diseases of old age”. FMT has been shown to have anti-aging effects in animal models and some early clinical trials in humans, but more research is needed.

FMT may also have potential applications in the treatment and prevention of cardiovascular disease, cancer, and more, but the research is still in the early phases.

How long do patients need to receive FMT for it to be effective?

The number and frequency of fecal microbiota transplant (FMT) treatments needed to achieve effectiveness may vary depending on the individual patient's condition, the severity of the illness, and other factors. In some cases, a single FMT treatment may be sufficient to restore the balance of gut microbiota and improve symptoms. In other cases, multiple treatments may be required.

For example, in the case of recurrent Clostridium difficile infection (CDI), a single FMT treatment has been shown to be effective in approximately 85-90% of patients. However, some patients may require multiple treatments, especially if they have had multiple CDI episodes or other underlying health conditions.

Similarly, for IBS (irritable bowel syndrome) there are cases of lasting benefits after only 1-2 treatments, but in other cases a longer treatment length is required. For inflammatory bowel disease (IBD), the optimal number and frequency of FMT treatments are still under investigation. Some studies have shown that a series of FMT treatments over several weeks or months can lead to sustained remission of symptoms in some patients with ulcerative colitis or Crohn's disease.

The ASU autism team did a daily dose for 2 months and saw continued benefits throughout: https://autism.asu.edu/

Overall, the duration and frequency of FMT treatments may vary from patient to patient and should be determined on a case-by-case basis by a qualified healthcare professional.

How much does FMT cost?

As noted above, this will vary due to individualized treatment length. Human Microbes is one of the most affordable sources of stool, despite our high donor standards. Capsules are generally $300 for 30, plus dry ice shipping. Our stool donors can adjust their prices and offerings. Costs of shipping vary; mostly based on whether you’re in the USA, Canada, or other countries. Stools are $1000 and split into 10 pieces/doses, so about $100 per enema. You can use whole stools to make your own capsules, which may be more affordable than paying for the donors to make them.

You can read more details on our blog about our pricing and how it compares to the alternatives.

You can visit our Orders page for more details on ordering.

What kind of people make good FMT donors?

Fecal microbiota transplant (FMT) donors should be exceptionally healthy individuals who have a diverse and stable gut microbiome. The precise criteria for highly effective donors is still being researched. You can read more details about Human Microbes’ donor criteria on our blog. Some of the basic criteria are the following:

Free from any current or recent gastrointestinal symptoms or infections: Donors should not have any current or recent gastrointestinal symptoms, such as diarrhea, abdominal pain, nausea, or any history of gastrointestinal infections or diseases.

No recent antibiotic use: Donors should not have taken antibiotics in the past six months, as antibiotics can disrupt the gut microbiome and reduce the diversity of gut bacteria.

No chronic medical conditions: Donors should not have any chronic medical conditions, such as diabetes or autoimmune diseases, that could affect their gut microbiome or overall health.

No recent international travel: Donors should not have traveled internationally in the past three months, as travel can increase the risk of exposure to infectious diseases.

Willing to undergo screening and testing: Donors should be willing to undergo a thorough screening and testing process to ensure that their fecal material is free from pathogens and other contaminants.

Age between 1-30 years: In general, FMT donors should be between 1-30 years old, although this may vary depending on the specific guidelines of the healthcare facility or research study.

It's important to note that FMT donors should be carefully screened and selected by a qualified healthcare professional to ensure the safety and effectiveness of the procedure.

Has the FDA approved FMT?

Fecal microbiota transplant (FMT) is currently not approved by the U.S. Food and Drug Administration (FDA) for any specific use. Under an FDA enforcement discretion policy, doctors are allowed to use it for the treatment of recurrent Clostridioides difficile (C. diff) infection that has not responded to standard therapies. The FDA considers FMT an investigational treatment and it is still being studied in clinical trials for other indications.

One of the reasons that FMT has not been fully approved by the FDA for other indications is that the long-term safety and effectiveness of the procedure have not yet been fully established. There is still a limited understanding of the mechanisms of action, optimal dosing, and long-term effects of FMT.

In addition, the FDA has expressed concerns about the potential risks of FMT, including the transmission of infections or other complications if the donor fecal material is not properly screened for pathogens and other contaminants. The FDA has issued guidance documents for healthcare professionals and researchers on how to safely and effectively perform FMT, including guidelines for donor screening and testing.

However, there is ongoing research on FMT, and some experts believe that it has the potential to treat a wide range of conditions related to gut dysbiosis. As more research is conducted, the safety and effectiveness of FMT may become more established, potentially leading to its wider use and potential FDA approval for additional indications in the future.

Human Microbes is attempting to aid in this regard by figuring out what makes a high-quality (safe and effective) donor, and then making those high-quality donors widely available.

What are the risks of performing an FMT?

While fecal microbiota transplant (FMT) is generally considered safe, there are some potential risks and complications associated with the procedure. These risks may include:

Infection: There is a risk of transmitting infections, such as bacterial or viral infections, if the donor's fecal material is not properly screened for pathogens and other contaminants.

Gastrointestinal symptoms: Some patients may experience temporary gastrointestinal symptoms such as diarrhea, bloating, or abdominal pain after the FMT procedure.

Adverse reaction to the donor fecal material: In rare cases, a patient may have an adverse reaction to the donor fecal material, which could lead to an allergic reaction or other complications.

Long-term effects: The long-term effects of FMT are not yet fully understood, and there is some concern that the procedure could have unknown or unexpected effects on the patient's gut microbiome or overall health.

Procedural: Some procedures, such as colonoscopy or naso tube carry slightly more risk than others, such as FMT capsules.

The potential risks and benefits of FMT should be carefully weighed by the patient and their healthcare provider before deciding to undergo the procedure.

How can I maintain or improve my microbiome?

It's important to note that the gut microbiome is complex and individualized, so what works for one person may not work for another. It's always a good idea to consult with a healthcare professional or registered dietitian for personalized advice on how to improve your gut microbiome.

That said, here are some general recommendations to improve your microbiome:

Eat a healthy, diverse diet based on whole foods: A diet rich in fruits, vegetables, whole grains, legumes, nuts, and seeds can provide the fiber, prebiotics, and other nutrients that help support a healthy gut microbiome. Though this advice varies from person to person due to each person’s unique gut microbiome. Many people may not have the microbes required to properly digest some healthy foods.

Avoid processed and sugary foods: Processed and sugary foods can disrupt the balance of bacteria in your gut, leading to an unhealthy microbiome.

Some people may benefit from probiotics: Probiotics are beneficial bacteria that can help support a healthy gut microbiome. They can be found in fermented foods, such as yogurt, kefir, sauerkraut, and kimchi, or taken as supplements. They are not universally beneficial though, and may be disruptive for some people [1].

Reduce stress: Chronic stress can have negative effects on your gut microbiome. Find ways to manage stress, such as through exercise, meditation, or relaxation techniques.

Get enough sleep: Poor sleep has been linked to an imbalance in the gut microbiome. Aim for 7-8 hours of sleep each night.

Exercise regularly: Exercise has been shown to support a healthy gut microbiome by increasing microbial diversity and promoting the growth of beneficial bacteria.

Avoid unnecessary antibiotics: Antibiotics can disrupt the balance of bacteria in your gut, leading to an unhealthy microbiome. Only take antibiotics when absolutely necessary and always follow your healthcare provider's instructions.

Consider prebiotic foods & supplements: Prebiotics are types of fiber that feed the beneficial bacteria in your gut. They can be found in certain foods, such as onions, garlic, and asparagus, or taken as supplements. Again, there is significant person-to-person variation when trying prebiotics.

Avoid smoking and alcohol consumption: Smoking and alcohol consumption can negatively affect the gut microbiome.

Fecal microbiota transplant: Much of the time we do the best we can using the methods above and it’s still not enough. That’s where FMT comes in. Visit our Orders page to learn more about ordering.