Fecal Transplant FAQs

About FMT

Fecal microbiota transplant refers to the infusion of fecal microbiota from a healthy person to a sick person. This is done via enema infusion, colonoscopy, nasogastric tube or capsules. For more information see About fecal transplant. .

The only condition that is scientifically proven to benefit from fecal transplant enough to satisfy the mainstream medical community is treatment of Clostridium difficile (C diff).

However, what the C diff success story tells us is that so far the risk in properly screened fecal transplant is minimal. Anecdotal experience and success stories on this site indicate that fecal transplant has helped various conditions as one part of an integrated recovery strategy.

The clinical experience of world expert Professor Thomas Borody’s Centre for Digestive Diseases suggests that fecal transplant can help Ulcerative Colitis, Crohns, IBS, Constipation, Autoimmune disorders, Obesity, Parkinsons, Multiple Sclerosis, Chronic Fatigue, Anxiety & Depression. Recent research is backing up his work that FMT may be affective or helpful with these conditions.

PoP has published interviews with RDS Infusions (Florida USA), Bright Medicine Clinic (Oregon USA) and Taymount Clinic (UK) about their success rates. Ultimately all these experiences are anecdotal and further research is still needed.

This site is not about giving you false hope. The truth is that fecal transplant works for many, but not all. Re-booting the microbes in your gut might be the circuit breaker you need to send your condition into remission and give you an opportunity to address other factors that predispose you to microbial imbalance. However, inflammation, intestinal permeability, diet, stress, lifestyle etc. all play a factor There are no guarantees.

We therefore strongly recommend you discuss fecal transplant and your other options with your doctor and research widely before making the decision to do it. Ultimately, it will come down to the risks of the drugs you are now taking, versus the risks of fecal transplant and how much you can bear living the way you are.

All medical interventions come with risk. The drugs that most people are taking to manage chronic illness are risky. Living with a chronic illness is risky. FMT is no exception and comes with its own risks. The important thing is to go in with your eyes open and make an informed decision.

The risks of FMT are listed below:

  • Physical injury from enema, nasogastric tube or colonoscopy. Ex. a tear or infection OR if capsules are used, developing SIBO (small intestinal overgrowth).
  • Transferring a parasite or pathogen from your donor. It may be asymptomatic or even helpful in their gut but cause trouble in yours.
  • Transferring a blood-borne illness like hepatitis or HIV. Don’t skip the testing or assume family members have never travelled to high risk countries, had a blood transfusion, unsafe sex or used IV drugs (yes – even your mother!)
  • Transferring dysbiosis (unbalanced gut microbiota) overweight in nasties such as candida and strep, from a seemingly healthy donor.
  • Just as FMT has been reported to help autoimmune conditions,there are also reports that it can trigger them.
  • There were a couple of cases reports of doctors treating patients with FMT for C diff and them subsequently coming down with inflammatory bowel disease. It is not clear if it was the damage from C diff or the FMT that triggered the IBD.
  • Bacteremia. A rare but possible complication where microbiota gets into blood through an abrasion in the gut wall and causes an immune reaction and dangerous fever. There is one documented case of this and the patient concerned already had a history of bacteremia. He was treated with anti-biotics and recovered, from both the bacteremia and the C diff.
  • Extra care should also be taken with FMT if you are immunocompromised in any way.
  • Transferring other characteristics from the donor that we are not even beginning to understand eg obesity, mental illness, morning sickness. (Note to self: don’t use a sick, fat, crazy, pregnant donor!)
  • Everything else we don’t know we don’t know.The biggest immediate risk is contracting a blood-borne or fecal borne illness from your donor. Testing will eliminate some of this risk, but not all, as tests are not fail-proof and it’s not possible to be tested for everything. Many healthy people carry asymptomatic parasites that cause no problem in their healthy gut (or possibly even help them), but may cause a reaction in your sick gut.

It is important to remember that in research done to date, the incidence of such adverse side-effects are extremely rare, although more research still needs to be done. Also remember that gut problems can be triggered by pro-biotics, anti-biotics, anti-inflammatories and food. 70% of the body’s immune cells lie in the gut wall, therefore if you are a reactive person, the bottom line is that your system may react to fecal transplant.

Unfortunately, not enough is known at this point and more research needs to be done.

Mayo Clinic article on side-effects.

Also, if you are confused as to whether FMT is right for you, then Read This.

Here is an Overview of This Site that may help.

If you want to understand the process of FMT, then going through our Do-It-Yourself Guide will provide a more thorough understanding.

If you want to see how it has helped others, you can see our Success Stories section that is arranged in categories by disease type.

Some of the factors you should consider are covered in Is fecal transplant for You and Rehab for the Gut.

No. Not everyone will achieve full remission, or even a result. Some people have great results, then go backwards. In a few rare cases, people have gotten worse. By far the most common complaint is no result at all.

Anecdotal reports suggest the longer you have been ill and the more complications you have, the less likely you will be to achieve full remission. Perpetuating factors and Intestinal Permeability (Leaky Gut) can interfere with the sustained growth of intestinal flora. However fecal transplant may still be worth a try and any improvement will make your life easier.

99% of the time it is not a good idea to take probiotics with FMT. Fecal transplant is the Ultimate probiotic and nothing you buy in a bottle compares.  Too much of a good thing can be a bad thing. Taking probiotics with FMT might unbalance the new flora and cause a new kind of dysbiosis.

If you know there is a probiotic that is helpful to you, it might be worth adding it to see if it will kickstart the growth of the new microbiota.

Prebiotics are fiber than feed microbiota. Prebiotics in moderation can be taken with FMT but are not mandatory. Ideally your microbiota will source all the fiber they need from a high fiber diet. However if you know there is a prebiotic that works well for you, then try it.

Under no circumstances should you take any probiotics, prebiotics, supplements or food you have not successfully tried before, because any adverse reaction will upset growth of the new microbiota.

There is a temptation with FMT to over-engineer it. Resist the temptation and let nature take its course.

“Yes. The Fecal Transplant Foundation was founded by a C diff survivor and has a board of doctors and scientist committed to raising funds for research.

There are 3 ways you can support thepowerofpoop.com

  1. Volunteer to join Team PoP and help spread the word about the importance of the microbiome in human illness and fecal transplant as a treatment option.
  2. Write an article on a topic relating to our mission to promote FMT and protection of the human microbiome.
  3. Support PoP financially, by clicking on advertisements or using our referral links to buy products – at no extra cost to you.

 

Doctor & Clinical Information

Some are converts, some are skeptics, but most are simply in the dark and waiting for more research. If you are one of those too sick to wait for the research, take time to read this interview with a medical doctor and with a naturopathic doctor, both who practise fecal transplant.

Doctors are influenced by research and logic, not anecdote and emotion. The research page contains many papers you may wish to discuss with your doctor.  If you are in the USA and your doctors needs information about the regulatory issues surrounding FMT, see the AGA FMT website and the FDA guidance papers.

See this list of clinics. Fecal transplant for C diff patients is growing in acceptance amongst gastroenterologists around the world as it responds extremely well to fecal transplant. If you google fecal transplant you will find many articles on fecal transplant and most of them refer to a gastroenterologist who has undertaken the procedure.

However if you want to treat a non C-diff bowel condition, it’s not so easy and you will need to shop around.  If you are in the USA, as at April 2013 the FDA has classified fecal transplant as an Investigational New Drug. Until it is formally approved, its use is restricted to C diff. This does not stop doctors assisting you by screening your donor. If you do DIY Home fecal transplant then keep searching for a sympathetic doctor willing to do the donor testing as a harm minimisation strategy. Show them research on the procedure or this particularly good summary.  Present your case as a sane well-informed patient who has tried everything. Agree to sign a legal waiver if necessary. Go direct to a pathology lab. But don’t DIY without having your donor tested. Even your seemingly healthy spouse with whom you have intimate relations can be carrying an asymptomatic parasite. The last thing you want is someone else’s health problems.

See Pathology Tests.

If you have C diff then your doctor should already know about fecal transplant and be willing to organise it for you, if you have not responded to standard treatments. If not, then you will have to educate him/her with a copy of this research paper, a link to this website. The actual fecal microbiota can be purchased from OpenBiome in USA or Taymount Clinic in UK.  Taymount ship internationally. Clinics in other countries may have their own donors or request you to find one.

If you have another condition that you want to treat with fecal transplant, then you need to be aware that your doctor is not obliged to help.  Medicine is rightly a conservative, evidence based profession.   Fecal transplant for other conditions is experimental and so far there is inadequate research available to date for a doctor to recommend it, or carry out the procedure for you.  If you live n the USA, you should be aware that the FDA expressly  prohibits doctors from doing FMT for conditions other than C diff (unless part of a clinical trial) so you can’t expect them to break the law.

However none of this stops an open-minded supportive doctor from agreeing to test your donor if you decide to do home FMT.  To gain their cooperation, you will need to make your case in a manner than is logical, scientific and respectful of your doctor’s position and does not jeopardise his/her liability insurance. You will also need to convince them that whatever the risks of fecal transplant, you are willing to take them when faced with the alternatives (eg dangerous drugs, losing your colon, unemployment, death etc).

For more information on how to talk to your doctor see: How to talk to your doctor about fecal transplant: a doctor’s perspective How to talk to your doctor about fecal transplant: a patient’s perspective

Some FMT clinics have their own tested donors, who deliver stool daily. Alternately your doctor may ask you to find a suitable donor.

If you are in the USA there are two non-profit stool banks OpenBiome in Massachutets and AdvancingBio in Sacramento. In accordance with US FDA requirements these stool banks can only provide stool to doctors who are treating patients with C diff infection (Clostridium difficile) that has not responded to multiple courses of antibiotics.

Taymount Clinic in the UK provides fecal microbiota to hospitals.

OpenBiome and Taymount ship internationally. You will need to check the customs requirements in your country before importing frozen stool.

Donor & Stool Information

If you are a patient at an fecal transplant clinic they may offer take-home frozen FMT capsules.

If you are in the USA OpenBiome sells frozen fecal microbiota and capsules to hospitals and doctors. You cannot order microbiota from them directly and will therefore need the support of your gastroenterologist or infections disease doctor. At the moment the FDA has only approved FMT for treatment of C diff in the USA.  That means fecal pills are only available for C. diff.

If you are in the UK Taymount Clinic supplies microbiota to hospitals (not capsules).

Several other companies are innovating to produce microbiota capsules and fake poop. See the Innovation page for a summary of commercial development efforts.

If you have decided to go with DIY Donor FMT then don’t jump in too quickly. Start by reading this article It’s tough to find a good fecal donor. Take the time to make a list of your requirements.  Finding a suitable donor in a world where people poop daily is not as easy as it may seem. But nor is it as difficult as the screening process and embarrassment factor might suggest.

Be in no doubt that “all poop is not created equal”. Someone with no history of gut problems can still carry bugs in their gut that create other conditions in their body. Something as seemingly unrelated as acne, thrush, UTIs, fibromyalgia, or mood swings can be linked to dysbiosis in the gut. People with heartburn, allergies and autoimmune disorders are definitely out. There are links between all of these and gut dysfunction. No one really understands this links yet, but it is not worth the risk.

Write a ‘must have’ and ‘wish list’ to screen your donors. Remember to be practical. Fresh is best so ideally your donor will need to live nearby. They must also be predictable in their bowel movements and willing to help. You need a donor who will not add to your stress by being unreliable.  At a minimum your donor must have:

  • regular bowel movements that are firm and formed but not hard
  • good general health
  • good digestive health
  • not prone to gastric upsets
  • no history of anti-biotic use
  • no regular use of anti-inflammatories or painkillers (occasional is ok)
  • no sign of a mood disorder

Male donors are preferable as women have more gut problems.  Some clinics do not recommend children under 16 as their fecal matter has not yet matured.  However others have used them without problem and research suggests the microbiome stabilizes around 3 years of age.

A person who was breast fed and vaginally delivered will have a lower risk of dysbiosis as these are a key to healthy colonisation of intestinal flora in newborns. Families share more of the same intestinal flora. This could make them better or worse donors depending on their health. Health problems run in families and shared intestinal flora may be the cause. Clearly it depends on the health of your family and this is where you must be the judge.

Some say that multiple donors are better as this injects hybrid vigour into your gut.  Others disagree.  Some say that relatives are better, others disagree as families can share dysfunctional microbiota.

Let common sense prevail. For tips on how to find and approach a donor see here. Screen your donor before paying for tests buy using this FMT Donor Screening Questionnaire.

Whoever you choose, make sure you test your donor.  Even seemingly healthy people can harbor pathogens and dysbiosis.

To register as a donor, a healthy person can approach their local hospital, ask to be put through to the department of gastroenterology. Ask if they have a fecal microbiota transplantation program and are in need donors.

Another option is to peruse our list of doctors and clinics and contact one of them.

Yes. This has been anecdotally reported by FMT Clinics and the experience of some in the FMT discussion group. It has also been indicated in research however more research is required to determine why this is so.

For the minimum recommended testing of a donor see the list of Fecal Transplant Donor Tests issued jointly by the US AGA and other health organisations.

However most FMT clinics recommend additional testing. Here are their recommendations:

Different doctors have different views on testing so please discuss with your doctor. As a starting point, print out these Fecal Transplant Donor Tests and discuss with your doctor.

Some patients also obtain fecal diversity tests through naturopathic practitioners (see next question).

In addition to the mainstream medical tests referred to in the previous questions, some patients also obtain fecal diversity and digestive function tests through naturopathic practitioners.

Whereas traditional fecal pathology tests conducted by allopathic doctors look for microbiota that should not be in your gut, fecal diversity tests measure the balance of normal microbiota in your gut. As microbiome science is a new field and more research still needs to be done, a mainstream doctor is unlikely to offer these tests and may even dismiss them.  You can obtain them through naturopathic practitioners, or in some cases direct from the lab.

 

Pathology Providers that do Fecal Diversity Tests 

Doctors Data Great Plains Lab UBiome Direct Labs (USA)

Parasitology Centre (USA)

Metametrix / Genova (USA)

Biohealth Lab (USA)

TrueHealth Labs (USA & Europe)

PrivateBloodTests (UK)

My Microbes (Europe)

Metametrix/Genova (Australia)

Bioscreen (Australia)

It is overwhelming working out what tests to do and how to interpret them.  This is not helped by the fact that opinions differ among professionals. Below are some resources that will help you navigate this maze.

This article discusses the pros and cons of different kinds of tests.

How to interpret a Genova Comprehensive Digestive Stool Analysis

How to interpret Metametrix GI Effects stool profiles

How to interpret a Doctors Data Comprehensive Stool Analysis & Parasitology (Video)

 

Yes. Anecdotal reports suggest that some donors are more compatible than others, even within the same family. However the reason for this is unknown. So if the first donor doesn’t work,  it is worth trying another.

Males have a lower incidence of gut problems than women, so a male donor is preferable. However given the choice between a healthy female and an unhealthy male, it is better to choose good health over the donor’s sex.

Not so far as is known. More research needs to be done, but so far there hasn’t been a correlation.

 

Pregnant donors are not ideal as research has shown that the microbiota change during pregnancy.  One doctor reported that his patient ‘caught’ morning sickness from his pregnant wife’s donation.

Also, estrogen is a risk factor for both gut illness and autoimmune illness, which is why autominne illness can be triggered or go into remission, during pregnancy. This is why male donors are preferable to female donors.

However there are no perfect donors and given the choice between a healthy pregnant donor and an unhealthy non-pregnant donor, it is better to choose the donor with good health.

The same goes for birth control. However, while it is not ideal, birth control is not a deal-breaker for most people.  If you are a male with a female donor, keep this issue in mind if you have reactions after FMT.

No one knows for sure, as insufficient research has been undertaken.

One study showed that the fecal microbiota of children is not established until three years old however anecdotally some have used younger donors successfully. That may be because the microbiome of infants and children are usually mostly breast milk microbes.  They still have 700+ variety of microbes but are not fully developed.

Research suggests that as a person ages their flora is likely to deteriorate with their health generally.   However this would suggest that if an older person is very healthy for their age, they may in fact be a good donor whose microbiota has survived the test of time.

Overall, given the choice between a healthy older donor and an unhealthy younger donor, it is better to choose good health over the donor’s age.

No.  Don’t even think about it.  The reasons why this is not a good idea would fill a football arena. Just as you wouldn’t consider getting a heart transplant from a cow instead of a human, it is not suitable to use animal poop for FMT.

While the human microbiome has some similarities with animals, there are also significant difference that could make you very sick.

See the Bristol stool chart and this article. Make sure you give a copy to your donor and stress that it’s important. They are not necessarily going to want to discuss the details of their stool quality with you.

See How to Find a Donor for tips on how to find and approach a donor.

Some FMT clinics have their own tested donors, who deliver stool daily. Alternately your doctor may ask you to find a suitable donor.

If you are in the USA there are two non-profit stool banks OpenBiome in Massachutets and AdvancingBio in Sacramento. In accordance with US FDA requirements these stool banks can only provide stool to doctors who are treating patients with C diff infection (Clostridium difficile) that has not responded to multiple courses of antibiotics.

Taymount Clinic in the UK provides fecal microbiota to hospitals.

OpenBiome and Taymount ship internationally. You will need to check the customs requirements in your country before importing frozen stool.

Fecal Transplant for Clostridium difficile

Studies differ however most research seems to indicate that the rate of success using FMT to treat C diff is around 90%.

The rate of success for refractory C diff is around 55%.

Fecal Transplant for Crohns & Ulcerative Colitis

Preliminary research undertaken on fecal transplant and inflammatory bowel disease has been inconclusive with some studies showing promise, and others not.  Please see the research page for links.  The research is not yet sufficiently conclusive or exhaustive for mainstream medical practitioners to recommend FMT as a therapy. It should therefore be viewed as experimental and any requests you make to your practitioner should be in that context.

Anecdotal evidence and success stories  indicates that FMT can trigger remission in some, and used long term can often help IBD as part of a 3-part strategy involving microbiome restoration, diet and healing of the gut wall. Unfortunately research tends to focus on such variables in isolation, when all indications are that a multi-factorial approach is required to what is a multi-factorial illness.

Based on the experience of group members, UC seems to respond better than Crohns.

In summary, FMT is occasionally a miracle cure for IBD, but more often a complimentary tool in the IBD toolbox. More information about Fecal Transplant and Ulcerative Colitis

Patient reports indicate that fecal transplant works better when flares are controlled, with whatever medication you need to achieve this.

For those with ulcerative colitis, one of our members has come up a protocol that has been successful for many of our members.  Read it here and discuss it with your doctor.

This is a conversation you need to have with your doctor. However anecdotal evidence suggests that it’s best not to stop your meds until you have healed the gut wall, which may be long after symptoms cease. People in our online discussion group have experienced miraculous recovery for months on end, then flared uncontrollably. It’s best to be careful. Wean off meds slowly to allow your gut time to heal and get tested regularly for inflammation markers.

Fecal transplant is rarely a silver bullet for IBD, it is more often that not a long slow healing journey with a holistic approach required. Boosting the flora is only half the battle, you need to heal the gut wall to ensure the pre-conditions for inflammation and dysbiosis do not arise again. It is critical to minimise inflammation (with drugs if you have to), eat an anti-inflammatory diet and adopt a nutritional regime to repair the intestinal permeability/leaky gut.

One approach that has worked for many online patients is Briggs Protocol.

How to Do It Yourself

Using untested donor stool is not recommended. It could be carrying a health problem or an asymptomatic parasite that causes no problem in your donor’s gut but will wreak havoc in your fragile gut. BUT… if you feel you have no choice but to do fecal transplant with an untested donor, and are determined to take the risk, then there are two precautions you can take: Common Sense (see Is fecal transplant for You?) and to take advantage of every free test your country offers (eg blood banks and STI clinics) which will at least screen the basics.

US$ 50 is the minimum recommended to make it worthwhile to your donor to bother with the testing, timing, delivery and dietary requirements. The donor (person giving the donation) is responsible for the liability agreement. The recipient (person receiving the donation) is responsible for the cost of all testing. There is a shortage of willing and suitable donors. Generally speaking, the easier your make the whole process for your donor, the more likely they are to help you, and keep on helping you.

Below are two examples of liability agreements people have used. Please note that the primary purpose of these agreements is to promote understanding, not to be enforced in a court of law. This is a difficult area legally and these agreements would be unlikely to be watertight if tested. So the best approach is to discuss and document all the issues so that you and your donor are on the same page and disputes do not occur.

Donor agreement 1

Donor agreement 2

Note: thepowerofpoop.com takes no responsibility for use of these agreements. They are provided by way of example only.

Follow these DIY Fecal Transplant Instructions after discussing with your doctor and testing your donor.

Your donor needs to pass the stool into a disposable container or a zip-lock bag. Do not use stool from a toilet bowl.

The microbiota start to deteriorate the minute they leave the gut of your donor, so you should aim to use the stool, or freeze it, within 0-2 hours of delivery. 3 hours at most.  If you can’t collect it from your donor in time, then ask them to freeze it.

Note, opinions differ on this topic even amongst doctors.  Patients have reported using it after storing in the refrigerator for up to 24 hours, but this is not ideal. Think about it. Once exposed to air, light and a decreased temperature some microbiota die more quickly than others so the longer you leave it, the more unbalanced it becomes. Old poop is unlikely to kill you but nor is it likely to give your gut the fresh mix of microbiota it needs.

Ultimately not enough research has been done for anyone to say for sure. However there is no doubt that fresh is best.

Fecal transplant can be prepared using distilled water or saline. Patient and clinical opinions differ on which works best. Some people react to saline but distilled water can be more difficult to hold in. Try both and see which works best for you. Never use the kind of saline solution sold for enemas as this is designed to irritate and evacuate the bowel. If in doubt – make your own saline with distilled water and additive-free sea salt. The ratio is 1 heaped teaspoon salt to 1 litre/quart distilled water. Distilled water can be purchased at pharmacies, in the laundry section of most supermarkets or you can buy water distillers..

Enema bags and bottles are available widely online. Some are disposable and others can be re-used. Start with Amazon in your country.

Here and here and here and here and here and here and here are examples of what people have used.  They are not expensive so it is prudent to do a test run on a few methods using water to see what works best for you. You don’t want to have to learn how your enema delivery method works (or doesn’t work) when the bag/bottle is full of poop or you could end up with a stressful mess. Practise first. Other items you may need are personal lubricant, paper towels, toilet paper. If you don’t have a bath, invest in a big brown towel so that you can lie on the bathroom floor and absorb any spills. Assume that you will have a spill then it won’t be such a big deal if it happens. For more detailed information see the DIY Instructions.

When blending or mixing the fecal transplant always remember that less is more. Water, heat, cold, air – all reduce the quality of the flora. Obviously you will have to expose it to all of these elements before you can get it into you, but just don’t overdo it. But don’t stress over this too much as fecal transplant done badly still seems to work. You’re not aiming for perfection, you’re aiming for good enough to work.

Which is better, enema bag or enema bottle?”] Both have their advantages. Enema bags are hung on the wall (or held up high by an assistant) thus using gravity to push the FMT higher up into your colon. Enema bottles are easier to use, so are better when you’re in a hurry.

The best way to keep it hygienic without chemicals is to keep it in a bucket of sea salt (500mg bag of salt). If you’re not using it hang it out in the sun to dry or in a heated room before storing.

About an inch or 2.5cm. Only insert the enema tip as far as it needs to go to be stable while the fecal transplant is flowing. Your rear-end is pretty tough and injuries are rare, but you still need to be careful.

Re-program your brain to see the fecal transplant as Liquid Gold. Greet it as health-giving medical treatment for your ravished gut. Banish the school-yard attitudes your mother taught you. Think of it as no worse than changing a baby’s diaper. Put a clothes peg on your nose. Get over it.

Bear in mind that you may have food intolerances because you don’t digest your food properly. You donor doesn’t have this problem so the food should be nicely digested once your donation arrives.

Nonetheless if you have an inflamed leaky gut you may still react to donor food. There are three ways to minimise this. Firstly, ask your donor to avoid the offending foods two days prior to donation. Secondly, use less FMT more often so that you don’t react. Thirdly, strain out as much solid matter as possible – but only do this if you have to as the more you mess with the fecal transplant the more it’s quality decreases.

There is no rule about how much stool/saline you should use. It depends on the size and consistency of the stool. Use all the stool if you have a regular donor and don’t plan to freeze it. Use less stool if you are someone who has trouble holding it in.

Add enough saline/water until the slurry (mix) is the consistency of paint or pumpkin soup.

You will have good days and bad days with FMT. It will depend on how irritated your gut is and how much fecal matter is already in your colon on the day.

Imodium can help. Try both saline and distilled water and see which works best for you. Using less FMT or a little every half hour will help. Lying down with your rear in the air will help.

Opinions differ regarding lying on left side, right side – or indeed various yoga-like positions. Start with the rotating positions as per the DIY Instructions and find out what works for you. Download a diagram of the colon so that you have a picture in your mind of how the FMT  will travel up your colon as you move around. This will help you be more effective with your positioning. If you can hold it in for an hour or so the fluid should absorb and stay in comfortably from then. Lastly remember to hold tight. It’s easy to forget this when you are trying so hard to get everything else right.

CAUTION: There is a risk of SIBO with top-down FMT. Please try bottom-up first and be very sure that top-down is the best option before doing it.  You definitely should not do it if you have low stomach acid or motility problems.

There are three ways to do top-down:

  1. Nasal gastric tube (DIY instructions on YouTube but tricky & risky if you get it in your lungs)
  2. Capsules (messy and time-consuming)
  3. Drinking it (disgusting).

CAUTION: There is a risk of SIBO with top-down FMT. Please try bottom-up first and be very sure that top-down is the best option before using this method. You definitely should not do it if you have low stomach acid or motility problems.

You can buy a capsule-maker here and here (mixed reports) or do it by hand.

Standard gelatin capsules are widely available and as long as you take them on a very empty stomach away from food, they will survive the stomach acid. However for optimal effectiveness gastro-resistant capsules can be purchased here or enteric-coated capsules here and here and here.

How to Make Microbiota Capsules

 

Before you freeze FMT, be aware that freezing in a home freezer is not the same as freezing in a laboratory freezer or on dry ice which has a much lower temperature.  While home frozen can be effective for some, most users report getting a bigger “hit” from fresh.  So it’s important to try fresh before you try frozen to make sure it works for you.  Otherwise if FMT doesn’t work, you won’t know if it’s the FMT or the freezing that is the problem.

There are two ways to freeze FMT and both have their advantage and disadvantage.

  1. Mix the FMT as per the DIY Fecal Transplant Instructions, add a little glycerol (not too much as it is a laxative) and freeze in ice cubes. The addition of glycerol stops the cell walls from breaking during the freezing process.
  2. Freeze the stool whole (or in sections) and thaw when required. This will minimize exposure to air prior to freezing. Minimizing exposure to air is important to preserve the anaerobic microbiota.

Method 1 maximises preservation of all microbiota. Method 2 maximizes preservation of anaerobic microbiota, which deteriorate significantly during the FMT process.

To de-frost, place in a coffee mug in a bowl of warm water ensuring that the end temperature of the mix is tepid. Tepid is not only the optimal temperature for the flora but the most comfortable temperature for you. If it’s too cold your bowel will expel it. The amount of frozen FMT  used will depend on when you are next going to see your donor. A few ice cubes are enough. Quality is more important than quantity. No one knows how long it can be kept. One person has used it after 10 months, frozen with glycerol, without adverse affect.

If you are interested in using dry ice, see the separate FAQ on this topic.

Fresh is best. The effectiveness and potency of fresh fecal transplant has been demonstrated in reputable clinics across the world. Frozen is increasingly being used in clinics and by people doing fecal transplant at home.

However research has shown that frozen takes significantly longer to colonize. Anecdotal reports are that it does work but you don’t always get the same ‘hit’ from it.

Nonetheless frozen is ideal if you and your donor work and you can only get to your donor on the weekend. Use fresh on the weekend and frozen during the week. Remember, if you have a tough condition it’s better to get it into you regularly. For more about frozen see the DIY Instructions.

Before using dry ice please read this information on how to use dry ice safely.

If there is any risk of children accessing the dry ice it is best to avoid using dry ice.

Microbiologists advise it is likely that fecal microbiota can survive for up to 6 months at below -20°F. Home freezers are around 0°F. Dry ice is around-109°F.

You will need:

  • A small fridge
  • A sturdy thick cooler than will fit into the small fridge
  • Around 10lb – 5kg of dry ice
  • Large zip lock bags

Steps:

  • Read the safety instructions for handling dry ice
  • Google to find a dry ice supplier
  • Buy dry ice and store in cooler in bar fridge

To make the dry ice last you need to put it in a sturdy thick cooler and then find a place to put that cooler which is as cold as possible. Do not put it a home freezer or it may break the thermostat. If you put it in a refrigerator it will freeze the things around it, so it is best to buy a second hand bar fridge for the purpose of storing the dry ice.

Ask your donor to deliver their donation into a large zip lock back. Press out the air and squash the donation as flat as possible on a bench to maximize the surface area so that it will freeze quickly. This is optional as it does expose more microbiota to air and may be counterproductive, but it achieves the purpose of freezing the donation as quickly as possible.

Put the donation in the cooler and make sure it is fully submerged in the dry ice pellets. The sample will freezes in a matter of minutes.

We do not recommend frozen FMT for first-time donation.  The reason is that freezing FMT in your home fridge is not as effective as the freezing technology used by the stool banks because the temperature is not low enough. While home-frozen FMT still works for most, albeit with less of a ‘hit’, to then impose a further deterioration in quality by shipping is not recommended until you are sure FMT works for you.

The risk for you is that if it doesn’t work, you won’t know if it is the FMT, donor, freezing or shipping that is the problem. Only once you are certain that fresh works, is it worth taking a risk with frozen shipping. At least you will have something to compare it to then. If you do decide to ship frozen FMT make sure you are familiar with the regulations in your country for shipping bio-hazardous goods.

The use of dry ice can more effectively freeze the FMT. See the separate FAQ on this topic.

Diet is important to help grow your new flora. Key points to remember:

  1. Fiber feeds microbiota so a low fiber diet is important in the two weeks BEFORE fecal transplant to starve the bad microbiota.
  2. A high fiber diet (soluble and insoluble) is important AFTER fecal transplant to feed the new microbiota. Don’t overdo it as too much of a good thing may unsettle your new residents. Most importantly, be aware that fiber can irritate your gut if you have Inflammatory Bowel Disease, in which case you should only introduce fiber gradually once the inflammation is under control. Always listen to your body.
  3. Eat healthy unprocessed food.  Minimise gut stressors like processed foods, gluten, sugar and alcohol.
  4. Fermented food, if you can tolerate it, should be part of a gut recovery diet as it encourages the growth of good microbiota. If you react to one type of fermented food, try another or start with very small doses and build up gradually. Get into the habit of eating a wide variety of fermented food types to maximise the diversity of microbiota consumed eg kefir/yoghurt for breakfast, sauerkraut for lunch, miso or beet kvass with dinner. Don’t overdo it as too much of a good thing may unsettle your new microbiota.
  5. Probiotics are not necessary after fecal transplant and may upset the new flora. Remember, fecal transplant is the Ultimate Probiotic. However if you have a probiotic that you know works well and feel you need it, listen to your body and take it if you need to.
  6. Don’t risk experimenting with a new diet after fecal transplant as it might unsettle your new flora. Stick to safe, known foods for at least 3 months then gradually introduce new foods.
  7. Don’t be swayed by what everyone else says is a good diet. There are arguments for and against low carb / high protein diets.  Be aware of the top 5 gut irritants: sugar, grains, soy, corn & dairy.  The most important thing is to find out which diet works for you BEFORE you do fecal transplant. Keep a food diary and listen to your body. Aim to identify any foods that trigger your condition so that you can avoid them after fecal transplant and give your new intestinal flora the best chance of thriving.
  8. Don’t over-engineer it, leave Mother Nature alone to do her good work.

 

99% of the time it is not a good idea to take probiotics with FMT. Fecal transplant is the Ultimate probiotic and nothing you buy in a bottle compares.  Too much of a good thing can be a bad thing. Taking probiotics with FMT might unbalance the new flora and cause a new kind of dysbiosis.

If you know there is a probiotic that is helpful to you, it might be worth adding it to see if it will kickstart the growth of the new microbiota.

Prebiotics are fiber than feed microbiota. Prebiotics in moderation can be taken with FMT but are not mandatory. Ideally your microbiota will source all the fiber they need from a high fiber diet. However if you know there is a prebiotic that works well for you, then try it.

Under no circumstances should you take any probiotics, prebiotics, supplements or food you have not successfully tried before, because any adverse reaction will upset growth of the new microbiota.

There is a temptation with FMT to over-engineer it. Resist the temptation and let nature take its course.

Patient Experience

See the success stories or join a discussion group to chat with others about their FMT experience. Please be aware that despite what you might read in the media, not all fecal transplants end with a success story. To keep anecdotal records of patient experiences, good and bad, we have started collating results via this survey.

Preparing for FMT

The mainstream approach to preparation is the CDD Protocol for Recipient & Donor. A more detailed instruction can be found in these DIY Instructions. ‘Natural’ less violent preparation has also been reported to work (see FAQ on alternatives to antibiotics). There are no hard and fast rules as this is an experimental therapy and everyone is different. Here’s a checklist for you to consider:

  • Donor selection and testing is critical
  • If you have IBD stabilize your condtion with medication. If you have other conditions, settle your perpetuating factors first: diet, leaky gut, low stomach acid, pancreatic enzymes, bile, allergy, nutrition, and inflammation. Your digestive system is like a chain, only as strong as its weakest link. The longer you have been sick the more problems you may need to resolve. See Rehab for the Gut.
  • Decide how you are going to prepare the bowel to welcome fecal transplant (lavage, natural or traditional antibiotics, biofilm busters, fasting etc).  If you choose to purge/lavage, only do this prior to the first fecal transplant in a series as it will otherwise disrupt growth of the new flora. If you have a pathogen it should always be treated before fecal transplant.
  • Starve your microbiota for two weeks before fecal transplant as most have a two week life cycle. This means going on a low carbohydrate, low fiber diet. If you are very sick an elemental liquid diet may be necessary both to reduce microbiota and inflammation.
  • Know your dietary triggers and AVOID them for 3 months afterwards. If you have sensitive gut, do not try any kind of new diet or supplements after fecal transplant, stick to what you know.
  • Support your liver to assist with detox – the first thing it will want to do once its feeling better is dump a whole lot of toxins – it will need nourishment and support to get through this. Liver repair tonics and protocols are widely available through natural health practitioners or find a reputable one online. Better still obtain a functional liver detox profile to see what areas need support.
  • Adopt an ongoing leaky gut protocol to help heal your gut wall.
  • Reserve judgement for 2-3 months afterwards and don’t be disheartened if you don’t have a miraculous turnaround. Any improvement will make your life easier. FMT Is only one tool in a digestive illness toolbox and if you have been sick for a long time you may need long term fecal transplant integrated with a rehab plan to address all of the above.

More information on preparing for FMT

Opinions differ. The pro-antibiotic advocates say that you should knock out as many bad microbiota as possible with anti-biotics (ABX) to give the new microbiota the best chance of winning the battle of the bugs.

However some people have adverse reactions to ABX. There is also the risk with broad spectrum ABX that if fecal transplant doesn’t work you may lose whatever’s left of your good flora and be worse off. ABX may also aggravate the gut and trigger a flare.

If you have a test that shows you have a bug that will respond to a targeted ABX, then it may be a good idea to knock this out with ABX first. However if you are not sure what is causing your problem then you will need to make a judgment call whether it’s worth the risk of taking broad spectrum ABX to kill as much as possible (good and bad) beforehand.

Other non-antibiotic options some have used include intermittent fasting (16 hours overnight repeated fasts for a few weeks before FMT as it switches on autophagy that may kill intracellular pathogens), herbal anti-microbials and a very low carb diet to starve bacteria. It’s important to stop these interventions once FMT starts though and switch to a bacteria-feeding strategy by eating plenty of different types of fibre and resistant starch, avoiding chlorine in drinking water, avoiding antibiotics etc. See here for natural alternatives to anti-biotics and other natural ways to prepare for fecal transplant. If these methods don’t work, then you can always use the ABX next time.

Always make sure your bowel is free of all anti-biotics,anti-fungals and natural anti-microbials for 24 hours prior to fecal transplant if the bowel has been purged and at least 48 hours without a purge.  This is to avoid any residue killing your new microbiota.

Opinions differ amongst FMT clinics as to the merits of a purge/lavage.  You have 3 options .

  1. a robust pre-colonoscopy purge (you can buy these over the counter at most pharmacists)
  2. a gentle water fast for a few days to clear out your gut as much as possible
  3. no purge

Ultimately you are the best judge of what will work for you. Stressing your body with a violent pre-colonoscopy purge is not a good idea if you have IBD and know it will trigger a flare.  Fasting is not a good idea if it will mess with your blood sugar or liver, thus stressing your digestive system. Your gut wall is less likely to grow the new microbiota if it is stressed. On the other hand, if you are constipated it makes sense to clear out as much microbiota as possible. Out with the old, in with the new.

What other conditions does FMT treat

Research has not been undertaken in this area. Anecdotal evidence is that fecal transplant can help rebalance the proportions of microbiota that ordinarily live in the gut. If you have candida it is a good idea to take anti-fungals prior to FMT.

Research has not been undertaken on fecal transplant and SIBO. It depends on why you have SIBO (small intestine microbiotal overgrowth). SIBO may be the cause of your problems or just a symptom. If the SIBO is a symptom it may resolve after fecal transplant.  However if you have perpetuating factors causing the SIBO such as diet, low stomach acid, insufficient pancreatic enzymes/bile or motility problems then these need to be addressed as part of a holistic strategy to repair your digestive system.

Research has not been undertaken on fecal transplant and food intolerances. It is important to realise that food intolerances come from a over-reaction of the gut wall to the food you eat, not from the microbiota in the gut. While healthier gut flora, may reduce inflammation in your gut wall and indirectly help food intolerances, it is not recommended that you do FMT for this purpose alone.

Research has not been undertaken in this area however there have been anecdotal reports of FMT triggering both onset and remission of autoimmune illness. There are links between AI illness and microbiota (see the research section) however correlation does not equal causation and more research needs to be done.

Research has not been undertaken in this area however there have been anecdotal reports of FMT improving mental health symptoms for some people. Brain-fog often clears within the first few days. There are links between mental health and microbiota (see the research section) however correlation does not equal causation and more research needs to be done. It depends on what is causing the mental health issues. If microbial imbalance is a factor, then FMT might help.

Research has not been published in this area although anecdotally some have reported promising results with both conditions. If microbial imbalance is a factor in your illness, then FMT might help.

Research has not been undertaken in this area although anecdotally some have reported results. It depends on what is causing the body odour. If microbial imbalance is the cause, then FMT might help.

SIBO stands for Small Intestine Bacterial Overgrowth. Your large intestine is supposed to be full of microbiota, your small intestine is not. It has relatively few microbiota and needs to stay that way for you to be healthy.

A good SIBO website

 

What to Expect After FMT

Side-effects such as bloating, wind, cramping, constipation, fatigue, low fever, loss of appetite and generalised detox symptoms are commonly reported. Some people have no side effects.

Listen to your body and do NOT dismiss serious symptoms that cause you distress as a ‘healing crisis’ or ‘die-off’. Remember that even if such symptoms are a healing crisis or die-off, it may be necessary to reduce or stop treatment to relieve the stress on your body.

Side effects are one of the many reasons why it is recommended you undertake FMT in consultation with a health practitioner. If something goes wrong, or if you simply have concerns and questions, you will need someone to talk to. While it’s helpful to speak with others in a discussion group online, be aware that their advice is on an “all care, no responsibility” basis. In contrast your health practitioner has your medical history, a duty of care and legal responsibility.

Diet is important to help grow your new flora. Key points to remember:

  1. Fiber feeds microbiota so a low fiber diet is important in the two weeks BEFORE fecal transplant to starve the bad microbiota.
  2. A high fiber diet (soluble and insoluble) is important AFTER fecal transplant to feed the new microbiota. Don’t overdo it as too much of a good thing may unsettle your new residents. Most importantly, be aware that fiber can irritate your gut if you have Inflammatory Bowel Disease, in which case you should only introduce fiber gradually once the inflammation is under control. Always listen to your body.
  3. Eat healthy unprocessed food.  Minimise gut stressors like processed foods, gluten, sugar and alcohol.
  4. Fermented food, if you can tolerate it, should be part of a gut recovery diet as it encourages the growth of good microbiota. If you react to one type of fermented food, try another or start with very small doses and build up gradually. Get into the habit of eating a wide variety of fermented food types to maximise the diversity of microbiota consumed eg kefir/yoghurt for breakfast, sauerkraut for lunch, miso or beet kvass with dinner. Don’t overdo it as too much of a good thing may unsettle your new microbiota.
  5. Probiotics are not necessary after fecal transplant and may upset the new flora. Remember, fecal transplant is the Ultimate Probiotic. However if you have a probiotic that you know works well and feel you need it, listen to your body and take it if you need to.
  6. Don’t risk experimenting with a new diet after fecal transplant as it might unsettle your new flora. Stick to safe, known foods for at least 3 months then gradually introduce new foods.
  7. Don’t be swayed by what everyone else says is a good diet. There are arguments for and against low carb / high protein diets.  Be aware of the top 5 gut irritants: sugar, grains, soy, corn & dairy.  The most important thing is to find out which diet works for you BEFORE you do fecal transplant. Keep a food diary and listen to your body. Aim to identify any foods that trigger your condition so that you can avoid them after fecal transplant and give your new intestinal flora the best chance of thriving.
  8. Don’t over-engineer it, leave Mother Nature alone to do her good work.

 

Die-off is uncommon however does happen for some people. Charcoal, Bentonite Clay and nutritional support for the liver, are all likely to help absorb the die-off.  But don’t be a hero about it. Your job is to nurture your body through this experience, not stress it too much.   If you experience brutal die-off then it’s best to reduce the frequency of fecal transplant to a level you can tolerate.

Despite what you might read in sensationalist headlines about FMT, unless the condition you are treating is C diff, very few people experience overnight cures. Even people with C diff are often left with gut problems like post infectious IBS, constipation or IBD.

Ultimately FMT is just one tool in the digestive illness toolbox. The next challenge is to heal your gut wall so that the new microbiota want to stay living in your gut.

Leaky gut is the common name for intestinal permeability, a huge topic that is finally starting to be taken seriously by mainstream medicine. If you’ve had dysbiosis (microbial imbalance) for a while, then you probably also have a leaky gut.  It’s critical to heal leaky gut to provide a happy home for your new microbiota and make sure the preconditions that caused the dysbiosis do not take hold again.

You can obtain an intestinal permeability test through a naturopathic practitioner who will help you measure and treat the condition, or simply assume that you have it and start treating it, as it is not an invasive protocol.

Healing the gut wall requires a healthy anti-inflammatory diet, low stress, good nutrition, low irritant protein and nutritional repair supplements such as contained in Perm-a-Vitecolostrumbutyratecurcumin and zinc. Specialist gut repair formulas can be obtained from naturopathic practitioners on prescription. Green juices and nutrient dense smoothies are a good way to get nutrition into a fragile gut and can be tailored to suit individual needs.

Diet is critical, but be aware that different things work for different people. Ignore the one-size-fits-all diet evangelists.  Keep an open mind, try everything, but ultimately you must listen to your gut and do what’s right for you. When in doubt, listen to your gut. Avoid known triggers and don’t become overconfident or fall back into old bad habits.  Treat your gut with the same reverence and care that you would treat a newborn child.

If you have IBD then test your inflammatory markers regularly to spot a setback before it arrives. TNF inhibitors (both pharmaceutical and herbal) can help reduce inflammation. Low Dose Naltrexone is used by many as a low-risk option to quell inflammation long term. For those who experience CFS/ME/multifactorial illness it’s critical to manage other health conditions that may have been triggered while you’ve been sick as they will be stopping your gut healing (eg thyroid/adrenal/autoimmune/hormones/methylation). Don’t assume fecal transplant will fix everything. Give your body support and tackle your recovery holistically.

Leaky gut is a big topic and you will find an abundance of information if you google. If you are time-poor then find a naturopathic practitioner to help. This interview with Dr Leo Galland is a good place to start learning about leaky gut. If you prefer primary research documents Alession Fasano is a recognised intestinal permeability expert. Read his research papers at PubMed.

Avoid anti-biotics unless your life depends on them.

According to the Centre for Digestive Diseases, the antibiotics that cause the LEAST disturbance to the gut flora are: co-trimoxazole, doxycyclin, metronidazole and cephalosporins (cefaxlor, cefadrine, cefotaxime and ceftazidime only). The antibiotics causing the MOST disturbance to the gut flora are: penicillins, cephalosporins (except those four listed above), aminoglycosides, erythromycin, chloramphenicol, and clindamycin.

If fecal transplant doesn’t work or stops working, it is usually for one of three reasons:

  1. The donor is unsuitable
  2. Your problem is not microbial.
  3. There are other factors perpetuating the microbial imbalance in your gut and and infusion of new microbiota was not enough to quell them. If you have been sick for a long time you are likely to have a leaky gut and other perpetuating factors that stop good microbiota growing in your gut and form part of a vicious cycle of digestive dysfunction. An inflamed bowel can simply reject the new microbiota.

Don’t give up. You may have lost the battle, but you haven’t lost the war.  Learn from your experience, gather the troops and reformulate your battle plan. Some people have achieved much better results using a different donor. We don’t yet know why some donors are better than others, but it’s worth a try.

To find out more see the article  Why FMT Doesn’t Always Work.

What to Expect During FMT

Diet is important to help grow your new flora. Key points to remember:

  1. Fiber feeds microbiota so a low fiber diet is important in the two weeks BEFORE fecal transplant to starve the bad microbiota.
  2. A high fiber diet (soluble and insoluble) is important AFTER fecal transplant to feed the new microbiota. Don’t overdo it as too much of a good thing may unsettle your new residents. Most importantly, be aware that fiber can irritate your gut if you have Inflammatory Bowel Disease, in which case you should only introduce fiber gradually once the inflammation is under control. Always listen to your body.
  3. Eat healthy unprocessed food.  Minimise gut stressors like processed foods, gluten, sugar and alcohol.
  4. Fermented food, if you can tolerate it, should be part of a gut recovery diet as it encourages the growth of good microbiota. If you react to one type of fermented food, try another or start with very small doses and build up gradually. Get into the habit of eating a wide variety of fermented food types to maximise the diversity of microbiota consumed eg kefir/yoghurt for breakfast, sauerkraut for lunch, miso or beet kvass with dinner. Don’t overdo it as too much of a good thing may unsettle your new microbiota.
  5. Probiotics are not necessary after fecal transplant and may upset the new flora. Remember, fecal transplant is the Ultimate Probiotic. However if you have a probiotic that you know works well and feel you need it, listen to your body and take it if you need to.
  6. Don’t risk experimenting with a new diet after fecal transplant as it might unsettle your new flora. Stick to safe, known foods for at least 3 months then gradually introduce new foods.
  7. Don’t be swayed by what everyone else says is a good diet. There are arguments for and against low carb / high protein diets.  Be aware of the top 5 gut irritants: sugar, grains, soy, corn & dairy.  The most important thing is to find out which diet works for you BEFORE you do fecal transplant. Keep a food diary and listen to your body. Aim to identify any foods that trigger your condition so that you can avoid them after fecal transplant and give your new intestinal flora the best chance of thriving.
  8. Don’t over-engineer it, leave Mother Nature alone to do her good work.

 

C diff responds to one or two treatments in over 90% of cases.

For other conditions at least two weeks is recommended, then reducing slowly over time. Hard core cases may require ongoing fecal transplant. Think of it like a pro-biotic from a bottle in the refrigerator – it may be required for a few months until things settle down. However ideally you will have some indication of success, some positive signs, before doing it for months on end.  If not, there are many perpetuating factors that may be stopping the fecal transplant from growing and these should be investigated. The longer you have been sick the more likely it is that you will need a holistic approach to repair and FMT Is only one tool in the digestive illness toolbox.

If you are a hard core case, then wean yourself off slowly. If you don’t live with you donor, try frozen fecal transplant to make regular infusions easier. Always start with 2 weeks fresh to give yourself the best chance of success. Know the triggers that flare your condition and quickly do a fecal transplant top-up if you have a setback. Most people would happily take probiotics from a bottle in the fridge for 3 months before giving up on them. Likewise, don’t give up on fecal transplant quickly. If you use frozen fecal transplant, it becomes as straightforward as brushing your teeth daily. Why not persevere?

Reserve judgement about the success of fecal transplant for 2-3 months afterwards. Research has shown it takes that long to stabilise the microbiota.

Do it for 2 weeks regardless. If you don’t achieve any benefit within 2 weeks, give it a rest and see what happens over the next 10 weeks. There are many reasons why fecal transplant might not work. Microbiota might not be the only problem. You may have a parasite that didn’t come up on your fecal pathology test. The donor may not be suitable. Anecdotal reports suggest that it is worth trying another donor if the first one doesn’t work.

However the most likely reason for fecal transplant not working is that you have residual issues which encourage microbial imbalance in your gut. Don’t give up. If you have IBD, try Briggs Protocol. If you have IBS/CFS/ME start by adopting a leaky gut protocol.

 

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