Half a million stool-donor applicants...
The bulletproof glass shattered. 500k+ applicants came flooding through.
That price & payout increase seemed quite effective... After many years of struggling to find high-quality donors, we are very appreciative of so many applicants. Thank you all very much.
We were not set up to process this many applicants, but we've mostly adjusted now. We were previously trying to roughly rank all potential donors, but that's not viable with this many applicants, so we switched to a tier-based ranking with some categories.
There’s no sign of this “wave” letting up, and I’m still focused on getting through all the applicants. I cannot delegate this work to others because I need to learn from it. The best future direction would likely be to turn the screening process over to an AI.
Some rough stats:
Out of 30 million social media views, 300 thousand (0.01%) applied. Out of the ones who applied, about 70-80% get disqualified from the questionnaire, with a majority of them being very unhealthy. Of those who submit the next steps, about 90% don't qualify or rank high.
The percentage of people who qualify is far lower than I had imagined. We've gotten many applications from very high-achieving athletes, and I've been surprised and discouraged by how few of them qualify or rank high.
I’m still working through all the applicants, but have around 50 in the top tiers at the moment. And 200+ that are healthy and would likely be helpful for many people, but probably less effective on average and a little riskier. And hundreds more in categories like “C. Diff only”.
Since no candidate has met the ideal criteria, I’m prioritizing testing various hypotheses. For example, is stool type more important than breastfeeding? I think it is. Let’s find out! There were a few donors I was interested in, just to test my stool-type hypothesis, but they all fell through.
Some observations:
There seemed to be an association between stool color and physique, but after a larger sample size, it seemed to fade.
Overall the relationship between stool characteristics and physique varies significantly. It would probably require an AI to identify firm patterns.
Stool color does not seem to be associated with birthing method or breastfeeding. Based on a small sample size, stool characteristics seem to be largely heritable from the mother (haven’t checked many/any fathers).
I've been continually surprised by the amount of very fit & muscular people with terrible stools. It's perplexing to me how they're able to achieve such great physiques with such seemingly-dysbiotic gut microbiomes.
It's plausible that part of it may be explained by a person having a more ideal gut microbiome when younger, but then damage it throughout life and thus they retain much of the good physical development but stool type starts to change and decline with age.
It seems fairly common for distance runners to have soft stools. Sprinters seem to have firmer stools on average.
A few recipients had bad results from our first donor, and better results from our second. But for others, it was the opposite. This supports the idea of donor-matching – something I've been very skeptical about. I've described donor-matching like a jigsaw puzzle. If you have donors who are missing many pieces, then you'd need to find the right donors with the right pieces for the right recipients. But once you get donors with few-to-no missing pieces, donor-matching should become less important. This is one reason I've always been focused on donor quality – finding high-quality donors with few-to-no missing pieces.
So far, there’s no indication that our stool-type hypothesis is wrong. If anything, our results emphasize the necessary strictness of it.
One of our donors improves protein/meat tolerance and increases cravings for meat. In the past, I've used high-quality donors that thrive on vegan diets. The latter is better for our planet and animal welfare. If we can find a donor that allows others to thrive on vegan diets, it would have benefits far beyond personal health.
The Invisible Extinction; where to find stool donors?
Martin Blaser and Maria Gloria Dominguez-Bello are leaders in this field and have been warning people for decades about the collateral damage from antibiotics and other perturbations. They recently released a documentary titled The Invisible Extinction. While they and other research groups tend to focus on secluded tribes, I look for people in modern society:
I know from past experience that high-quality donors exist in modern society. Though they are probably becoming more and more rare.
While I think that people like Mbappe, Haaland, Virgil van Dijk, Mohamed Salah, Giannis Antetokounmpo, Ja Morant, etc. are ideal candidates, I know that good donors exist outside of the most elite circles.
People are giving antibiotics to secluded tribes like the Hadza.
Rural tribes have many pathogens from their environment.
Even the health of indigenous people is degrading. For example, Hadza women suffer from obesity.
Many rural/indigenous people are being poisoned by environmental/industrial pollutants.
Even if tribes were ideal, the logistics are nigh impossible.
Luck and choices:
It's unfortunate how much luck there is involved in health. Some people do everything right — vaginal birth, breastfeed for years, avoid antibiotics, eat whole foods, drink water, avoid harmful substances, live a healthy lifestyle, etc. — yet due to bad luck they are left with poor genetics and/or a poor microbiome.
The lucky few who've been handed great genetics and an ideal microbiome are who we're after. But it's likely that most of them are living in a bubble where everything is all roses and sunshine and there is little reason for them to be concerned about anything.
I came across a 3rd category: Unhealthy parents with a surprisingly healthy child.
It was incredibly saddening to see that despite the extremely lucky hand they were dealt, they were doing everything in their power to throw it away. This child's health & microbiome were being destroyed by junk food, and it reflected very obviously in their stools. Not even $180,000/yr was enough for this middle-to-low-income family to consider their child's health to be something worth protecting.
When I see headlines like "There is concern that AI will destroy us", all I can think is that there will be nothing of value left for anything to destroy. We've already done so much damage to ourselves and our planet.
The best-case scenario might be that an AI would stop us from continuing on this path. Perhaps due to the AI's desire for self-preservation. Humans in our current state are incredibly destructive. And in my experience, most people opt to kill the canary rather than adjust their behavior.
Eugenics:
It's generally unsurprising when an unhealthy person is the result of two unhealthy people procreating. But there are some notable exceptions that intrigue me. There are instances of extremely healthy, fit, high-performing, top athletes who have very unhealthy parents. I would be very interested to see the parent's stools, and also survey them on how their health and stool have changed over their lifetime.
For example, I've had an applicant with very poor physical health, yet quite a decent stool type. It wouldn't surprise me if this person were able to create a healthy child that went on to be a top athlete. But I would not expect the same of someone with a bad stool type.
Conversely, you have very physically fit people with terrible stool types. I would be interested in observing their children's health, development, and stool types. Good genes can only go so far, and I would expect a bad stool type in the parents to have a detrimental impact on the child.
This is eugenics. Figuring out what factors influence the health and development of offspring, and improving those factors in order to have healthier, well-developed, well-functioning, intelligent, capable, happy children.
And for people who are already alive, the ideal goal would be to make them the best possible versions of themselves.
Where to go from here?
We started off by screening 23,000 people before activating a single donor. So we are very serious about donor quality. Unfortunately, that donor has not been highly effective for most people, so we kept searching for some very specific criteria that we think will be more effective. We activated a second donor sometime later, and still the results were mediocre.
After making it through ~200,000 donor applicants, I still haven't found the precise criteria I'm looking for. I tried the #1 rank out of 100,000 and experienced no benefits, only detriments. So that shows how complicated and experimental this is. It also shows the risks recipients are taking, as well as the dangers of antibiotics. After countless FMTs from 12 different stool donors, I still haven’t been able to reverse the damage from antibiotics.
It may turn out that our current donor hypothesis is wrong. If so, many people who are currently not considered prime candidates may turn out to be one. In that case, we'll likely need to pair with other research groups to figure out other ways to evaluate all our donor applicants.
Additionally, we work on supply and demand. If demand increases, we'll activate more donors. So far, we've been operating on the idea that if we find one or more highly effective donors, demand will then greatly increase. Most of our recipients right now are looking for "super-donors" for things other than C. Diff. And finding a super-donor has been our major focus.
Chances are slim that anyone outside our top tier would become an active donor with us. However, other companies & organizations may have an interest in these other categories of donors.
One recipient has documented that only certain parts of stools are beneficial, and other parts can be detrimental. So if we can't find a donor who regularly has whole stools of the ideal type, then that complicates our pricing, since recipients are unlikely to be willing to pay $1000 for a single dose/small part of one stool (usually a stool is split into 10 pieces/doses).
Upgrading stool donors:
In general, qualifying to be a stool donor is very luck-based and if a person doesn't qualify there's not much they can do other than FMT from someone who does qualify.
Trying to upgrade a "7/10" quality donor by having them do FMT from a "10/10" donor is likely something we'll try in the future, but I'm not yet sure of the specifics of how we would go about that. We'll have to find a 10/10 donor first and demonstrate them to be highly effective.
Perhaps this will be a way that we will be able to begin to reverse the exponential rise of chronic disease.