Know your shit

Lifesavers illus 1One day this year a male patient lay down in an operating theatre in New York City, was administer­ed anesthetic, and had a dose of someone else’s feces delivered into his anus. Like up to 3 million other Americans, Patient X – he prefers to remain anonymous – had been suffering from Clostridium difficile, a bacterial infection that can cause long-term and painful diarrhea (up to 40 times a day), weight- and hairloss, and death. “I took antibiotics for C. diff for years and still relapsed,” he says. “This was the last resort.”

The night before the operation, a donor – it can be a volunteer, but in this case was the patient’s sister – was given a gentle laxative. In the morning, she provided a sample of feces to Dr. Lawrence Brandt, the New York gastroenterologist who would perform the operation. Both donor and stool are screened: ex-prisoners or men who have sex with men are ineligible, while the shit must be free of HIV/AIDS, syphilis and a variety of viruses. If all is well, the sample is mixed with saline to a milkshake-like consistency. (Some doctors use a blender, but Dr. Brandt prefers to stir.) It can be administered nasally or through the rectum with a colonoscope, Brandt’s preferred method: with a nasal tube, a nauseous patient risks vomiting feces, and a colonoscope propels the sample directly to the colon where C. diff lives. The procedure should take 20 minutes, and then you wait and see.

The concept behind fecal transplant is not complicated. Antibiotics can wipe out “good” bacteria as well as the bad kind. (X had contracted C. diff after being given antibiotics after surgery.) A dose of healthy feces, with its 35,000 families of bacteria, can replenish the gut’s flora and settle it back to normal. It worked for X: “All my symptoms were gone after 36 hours. I haven’t had any problems since → and am free of medication.” Ninety-one percent of patients who have a fecal transplant are healed, says Dr. Brandt. “There is nothing else with this rate of cured patients.”

A dose of healthy feces, with its 35,000 families of bacteria, can replenish the gut’s flora and settle it back to normal.

The first human fecal transplant was recorded in the US in 1957, but Thomas Borody, a gastroenterologist in Sydney, Australia, is its modern champion. He has performed 1,550 procedures so far, and expects to get busier. “In America and Europe, C. diff is estimated to be killing 100,000 people every year,”
he explains. “It’s an epidemic.”

Yet fecal transplants are still treated with suspicion. There is the disgust factor – even though patients don’t smell or see the shit – and scientific reserve. “Doctors are resistant to it,” says Brandt. “There are no adverse effects, but society and science are skeptical. They want scientific proof.” When a gastroenterologist named Caroline Kelly surveyed 72 of her peers, she found only seven had performed the procedure. “Doctors cause so much protracted suffering by not embracing these transplants,” says Patient X. “I know it’s weird in concept. But the sheer simplicity of it and the staggering success rate made it an easy choice. That said, I’m no fonder of shit than I was before.”

Lifesavers illus 2Blender

C. diff antibiotics can cost US$40,000 a year. Luckily, DIY bacteriotherapy is not difficult. You will need saline, an enema kit, a kitchen blender, and a stool sample from a healthy donor.

Lifesavers illus 3Enema bag

Ensure the sample has been created less than 30 minutes before the procedure, then place 50ml in the blender with the saline. Mix to a thick liquid and pour into an enema bag. A mask is optional.

Lifesavers illus 4Positioning

You will need a friend to administer the enema. Strip below the waist, make yourself comfortable and make sure to lie on your left side, as this dampens any need to defecate.

Lifesavers illus 5Tube

Once the sample has reached your insides, hold it there for as long as possible. The best time for the therapy is directly after your first bowel movement of the day. If diarrhea ensues, wait one hour, wash your equipment and repeat.


From the pages of COLORS #82 - Shit.