Glenn Taylor is Clinic Director & Food Bacteriologist at Taymount Clinic in Hitchin, Hertfordshire, UK. Taymount is a natural medicine clinic that specialises in health conditions influenced by the functions of gut flora.
What’s your background, and how did you come to run a fecal transplant clinic?
Firstly, could I make a distinction – at the Taymount Clinic we perform fecal microbiota transplants, and not a fecal transplant – which I will expand upon later.
My personal history is in engineering and it was through my wife’s work as a Doctor of Naturopathy, specialising in food and digestion, that my interest in biology was re-kindled. I should at this point stress, that I am a microbiologist and not a medical doctor. The reality is, that were I a doctor, I probably would not be able to be involved with FMT – and more about that later, too.
I first got involved with digestion and colon health back in 2002 and trained up to the level of Instructor and we ran a therapist training school. From the very beginning, I was aware that cleansing a colon was not a complete treatment. It made no sense to me to be completely removing bacterial colonies from patients who had digestive problems. It did not seem reasonable to expect the gut to regulate the restoration of the microflora unaided.
I worked with various probiotics, both as manufactured and naturally occurring forms in an attempt to create a favourable environment so that bacteria would re-establish in what we would call a normal fashion. It was not too long before I realised that manufactured probiotics were only useful whilst they were being consumed and they didn’t perform any lasting improvement.
One day we received a phone call from a young man who apologised for his enquiry, almost as if he knew it might cause offence, and he asked if we performed fecal transplants. We explained that we didn’t but for the rest of the day, my mind was completely restless and I threw myself into research of how to restore the whole microbiome to an imbalanced gut. The answer was quite plain and obvious – there is only one way to fully restore the human gut microflora – the microbiome – and that is to do exactly what happens at birth, the gut is inoculated with a living microbiome from a healthy donor.
What services do you offer patients?
We specialise in FMT so that is the main service we offer. We offer lab tests relevant to gut health and food allergies.
What kinds of patients does your clinic see?
We are seeing an increasingly broad range of patients from all walks of life and from all over the world. They all have dysbiosis in common, but for a variety of reasons and in a variety of expressions. From IBS, to IBDs, to Neurological conditions and even TMAU. The more we learn, the more we realise that we simply do not know the limits of conditions that may be influenced by changes in gut microflora. So when I receive an enquiry for an obscure condition, my initial response is “Why not?” We are in a pioneering developmental stage and who are we to decide what the limits are.
How long have you been offering FMTs and how many have you done?
We have been quietly working to provide FMT for almost three years on a very limited basis. Then word of our existence hit the internet probably from chat forum sites and word of mouth. We started slowly and we are now treating between 6 and 8 patients per month. We have seen over 40 patients so far this year alone, of varying lengths of programs, but this roughly equates to some 400+ procedures.
What kind of results have you seen with FMT?
It ranges from no effect whatsoever to complete remission. But the outcome depends on the patient’s presenting condition. It ranges from disappointing to truly rewarding and remarkable. Some are slow to respond, some respond very quickly. As well as symptom relief, we have seen great changes in mood, behaviour, aspect and energy. Appetites return and food allergies seem to resolve sometimes very quickly.
What has been your most memorable success?
The one that sticks in our mind most of all is the 84 year old lady who by her own admission, was on her last legs with recurrent C.diff infection at 6-weekly cycles which were getting progressively worse each time. She had actually asked her doctor not to resuscitate at her next flare of this completely debilitating disease. Her next flare was due the week after her clinic booking.
She was carried into the clinic by her family and expressed very poor communication; little eye contact and very pale and weak.
We carried out 3 implants over three consecutive days. Each day her energy and activity increased in leaps and bounds. On the third day, she came up the stairs unaided and said we had to hurry up as she was off to the pub for lunch afterwards! Her son said she would not stop talking now, what had we done?! She had improved eye contact, energy levels, colour in her face and brightness of eye. The staff on our front desk remarked on her dramatic and noticeable improvement.
She remains free of c.diff and in her own words, is “…thrilled.”
Where do you get your donors and how do you screen them?
You have to kiss an awful lot of frogs to find the Princes. It is purely by word of mouth. The testing is extremely expensive because it is not just a case of finding them, but to ensure that they remain appropriately clear to continue being donors. So we have to test, every one to two months to check levels and to sometimes swap transplants between donors to make sure that they are all producing the maximum amount of beneficial bacteria. We should point out at this stage that we use the Standardised Donor system, we do not support patients using their own donor. Our experience and research shows that filial and spousal donors carry the risk of already having the same deficiencies in their microbiome as the patient.
We take stool and blood tests. We utilise very respectable main-stream testing laboratories using the latest qPCR assay techniques. There is a formidable list of the communicable conditions that we test for rigourously.
Do you think donor diet matters?
Absolutely. Our donors are coached to eat the best organic diet, high in fruits and vegetables and pasture-fed animal products. They eat high fibre and eat natural sources of probiotics, supplementing with kefir and probiotic yogurts on a regular basis.
Without the right diet, the beneficial bacteria would not thrive. The microbiome is like the most exotic pet shop in the world; if you bought a pet, you would ensure that you were feeding it properly. The same goes for the gut microflora, which individually thrive on particular food groups; absence of these food groups results in the absence of a bacterial group.
Along with the diet, it is important that the donor does not smoke – all the pathogenic smoking debris gets transferred into the swallowed mucus and ends up in the digestive tract to be excreted in the feces.
We would also not use a donor who drank a lot of alcohol for obvious reasons.
Do you do FMT Top-down or Bottom-up?
We do bottom up. The top-down application via a naso-gastric tube is somewhat risky in our opinion. Once a stomach is loaded with something it might not want, it has a habit of contracting and sending the contents back p through the throat and mouth. Vomiting in this case would be extremely unpleasant and in the event of choking and inhaling some fecal matter, this could be potentially fatal. I know the naso-gastric tube is intended to pass through the stomach and out through the pyloric sphincter, actually into the duodenum, but there is a chance the stomach could back-fill anyway, and then want to empty. These are colon-resident bacteria, so we feel that they should be deposited directly into the colon. We just feel that it is safer going into the sigmoid and descending colon and depositing the implant in that area instead. We don’t like to describe our actual method as we fell this to be a clinically confidential matter (a trade secret if you like).
Have you used frozen FMT? Do you think it is as good as fresh?
We initially used fresh stool, recently processed and refined and extracted, but we found that the timing was fraught with possible problems, and our donors cannot always perform to a tight patient schedule. An element of performance anxiety even crept in! Seriously, we feel that the only safe implants are ones stored in laboratory Ultra-Low Freezers (-86°C) between two tests. Once you take a battery of screening tests, you know your donor material is starting off clear of disease, but it is an unknown just when a disease or infection can step in. So the only safe implant is one which is taken and stored between an opening test and a closing test after an interval – say one to three months. If the donor fails the closing test, then all those implants are scrapped. How else can you be sure your donor material is completely free of any communicable disease? Using fresh is just not reliably safe, in our opinion.
How long does stool stay fresh once exposed to air?
We do not expose our donor material to air. It is delivered into a de-oxygenated saline solution (another trade secret) and is processed using nitrogen to keep the obligate anaerobes safe from their undesired oxygen environment. We then centrifuge and rinse the bacterial “pellet” with more de-ox saline, which allows us to extract the bacterial colonies almost clear of debris and waste products. If you consider that fresh donor stool contains things like: mucus, bilirubin (old red blood cell debris), epithelial cells (old digestive tract skin cells), metabolic liver waste as well as old food debris, nasal and bronchial mucus laden with environmental pollution… there is a lot that you would not want to have implanted. So we have perfected this refinement procedure to extract the Microbiome itself; we then add a special safe anti-freeze protection fluid and place it in the Ultra-Low freezer. This is then stored at -86°C to await the closing tests for that period. It can safely be stored at this temperature where it will stay good for up to 5 years. This microbiome extract actually doesn’t even smell very much, unlike the raw stool, so this is a much more aesthetically acceptable entity altogether.
What is your view on antibiotics prior to FMT?
We feel that it is only really necessary for patients where they have C.diff infections and then only to reduce the microbial load so that the FMT implants don’t have quite so much to do. It does seems that it is antibiotic over-use which eventually leads many patients to seek FMT to restore their somewhat ravaged microbiome.
If we feel that a patient is suffering from an active infection, we refer them to their doctor for the appropriate treatment first as we see FMT as a restorative rather than a curative.
Again, it is an individual case-by-case situation.
What side effects have you observed from FMT?
During the program, there are a lot of changes going on in the gut and this can be experienced as increased gas, diarrhoea or other disturbances. We often warn patients that they may feel a little strange as the “germ warfare” going on in the gut settles down with the new microbiome.
As for side effects from the treatment in terms of unwanted effects, we have not experienced any adverse effects from FMT and to date there remains no reports on such side effects. It is currently regarded by its medical proponents as one of the safest treatments available.
How long should medication be continued once symptoms subside?
This is a matter strictly for the patients and their prescribing doctors. We can never tell patients to reduce or stop their prescribed medications. Obviously, if symptoms start to subside as remission occurs, then the prescribing doctors can decide if the dosage can be reduced or discontinued, but this is not for the clinic to indicate.
What do you see as the risks of FMT?
The only risks we can see is that people will expect it to be the instant miracle salve which will end all their problems. So over-expectation is a real risk. It is totally safe, providing the proper donor testing is done at intervals and implants used from the period between successful tests. We just worry that people expect this to act like a medicine or a magic salve to heal in short times. This is a gentle, non-dynamic and normalising treatment. It is not a miracle cure, it simply resets the bowel flora to that which should be there and which would have been there in a healthy person.
It takes times to get chronically sick, with all its attendant changes and degeneration, so it takes time to gently and naturally re-establish the normal environment and rebuild healthy tissue where previously there was damage and inflammation. It takes time, and we never know how much time as each person is an individual and their condition will respond individually.
Speaking of the risks in a more general sense, there is the worry that colon hydrotherapists, beauticians and hairdressers will regard FMT as a great money-making adjunct to their colon hydrotherapy business. We dread the awful mistakes that will be made when people try to cut corners, save money and increase profits by reducing the testing or eschew it altogether. Then someone will catch something unpleasant and the whole FMT treatment program will come under strict regulation. If this makes it safer, this will be a good thing, but if it makes it harder for patients to find and obtain and harder for dedicated and conscientious clinicians to provide this much-needed service (like it has in the US), then this will be a shame for the people who need this and for the clinics who are providing a quality and safe procedure. Also this will threaten the future acceptance of FMT as a main-stream medical procedure.
Be aware that one particular international colon hydrotherapist member organisation (based in the UK) is offering a “Crash Course in Fecal Transplant” as an A4 laminated education card with information directly garnered from Wikipedia, and given away free with colonic disposables orders. Advice to use a family member, mix the stool with milk and use as an implant enema – just chills the blood. No mention of the removal of the unwanted waste products that raw stool contains. Until suitable licensing comes into force, it is very much a case of “buyer beware”.
Why is the mainstream medical profession so reluctant to investigate and offer FMT? Given the success with C.diff, what’s wrong with trying it for more difficult chronic gut conditions?
With many articles that we have seen written by mainstream medical doctors, we have found repeated reference to the “Yuk” factor. It might just be that doctors just don’t want to get involved with something as basic as feces. Doctors, during their extensive medical training, do not get enough training in the basic biological and microbiological world of the gut microbes and what feces really contain. All the while our attention is turned to the drug companies to come up with a pill for every ill, the doctors will continue to study medicine and not biology.
It might also be a factor that the major pharmaceutical companies would not want a relatively cheap and effective solution to be used to replace expensive and on-going pharmacological drugs and they will not be in favour of doctors trying anything so natural and freely available as feces to bring about the drug-free remission called health.
What’s your view on DIY FMT?
Mainly for the reasons described beforehand, we are against DIY FMT where there is not enough research or testing done. It is not safe to assume someone is a healthy donor just because they look healthy and perform daily bowel deposits. A donor may be a carrier of a disease of which they are asymptomatic and usually people with gut problems are immuno-compromised or may even be on immuno-suppressant drugs, which will make them dangerously vulnerable to infections from untested donors. Also, in the clinic, we do opening and closing tests to ensure that a whole batch of implants is safe. After all, supposing a donor unknowingly catches sometimes nasty on the way home from having their testing done? Only when two batches of tests are done are the implants safe from that period alone.
Having said all that, we do issue kits for physicians’ use. Once a patient has been to the clinic and experienced the whole FMT procedure, we are happy to let them take kits to their doctors or other health professionals for them to use to continue the treatments. This is the only DIY method we endorse.
Where FMT doesn’t work in a patient or only works for a while, what factors do you believe perpetuate the dysbiosis?
We find that often people want to be fixed so that they can go home and continue a detrimental lifestyle once more. We often tell them that if they continue to do what they have always done, they will continue to get what they have always got. It is the true definition of madness to repeat an action and expect a different outcome. We try and educate them to realise that they hold their health between their knife and fork. What goes into their mouths will dictate their gut health.
Where there is compliance and a conscientious adherence to a sensible eating regime, relapses can occur for many reasons. Sometimes we wonder if there are some microbes who go into zygospore (like a hibernation) when conditions are not favourable to it, and then they re-emerge and begin a life-cycle all over again a bit later on. Some parasites are known to do this and we can order up specific stools tests to identify suspected parasites. The treatment for these varies according to what species is featured.
We would also repeat what we said earlier – that this is not an instant cure and it takes time for people to get sick, so it takes time for the body to heal and become well again.
Sometimes there are outside factors that will overwhelm the new gut flora, such as extra stress, bad food choices, food poisoning, travel bugs, antibiotic use, viruses etc.
We often recommend top up sessions at intervals which are individually agreed with the patients, depending on the progress they are making. Some of out patients come back for top ups every couple of months or so, just as a reassurance, like a reinforcement.
What do you think of the efforts of some to manufacture their own fecal microbiota?
Synthesized or “farmed” probiotics lack the protein marking, like tagging, that the immune system does to recognised and accepted microbes. When a microbiome is extracted from a healthy donor, his or her immune system has marked these bugs as approved and safe. They enter the host and even if they are a species which has never been in that gut before due to lifelong dysbiosis, somehow the immune system “recognises” the tagging and will respond favourably. This does not happen with the synthesized microbes, although they do some good whilst they are passing through, their failure to be accepted means they are unlikely to colonise and cannot stick around to do long term beneficial changes.
Freeze-dried probiotics also have the disadvantage that the freeze-drying process can damage their fine finger-like extrusions (pili) and this is what they use to hang on to their new hosts. They can take up to 24 hours to “imbibe” or rehydrate and wake up and then with their pili damaged, they cannot stop themselves being excreted unceremoniously with the next bowel movement. Again, we need colonising microbes which will bring about long-lasting beneficial changes which are sustainable.
Lastly, we are aware of “Robogut” from Canada, which is the most sophisticated system yet for trying to mimic the human gut. The human gut consists of some 1150 different strains of bacteria; Robogut consists of 33. When trying to normalise the gut, should we use 33 strains or 1150?
What research is on your wish list?
This is obviously something I can’t talk about without risking spilling my candy in the lobby. We are looking at more aesthetic delivery systemsand that is all I am prepare to say on the matter at this point!
In view of the decision of the US FDA to stop doctors offering FMT for non-C.diff conditions, where do you think the regulation of FMT is headed in the UK and Europe?
I am not going to get drawn into regional politics and the future is very difficult to predict. At this moment in time, the UK is known to have a refreshingly laissez-faire attitude towards alternative therapies. There is no doubt that with increasing success of the treatment, FMT will fall under the purview of the authorities and regulation will become a necessity. I can see this only as a good thing; I only hope that Draconian measures are not applied before sufficient meaningful research is completed.
As a practitioner working in a fringe area of medicine, how do you manage liability in your practice?
The UK market is well-served for specialist insurance companies offering cover for alternative and non-conventional health professionals and offerboth professional indemnity and public liability insurance.
What do you enjoy about your work? What are the frustrations?
The frustrations are the patients who come to us quoting things they have read on the internet, mostly without scientific foundation. As useful as the internet is for gathering information, it also has its fair share of absolute rubbish!
What we enjoy about our work is seeing the improvement in patients, hearing them report how many different foods their previously tricky gut is now tolerating, how well they feel and how they can hold down a job now, how they can carry out a journey without planning toilet stops, how it has changed their personal relationships, etc.
What is there for international visitors to do in Hitchin?
Hitchin is a charming and ancient market town, dating back to 1100 or even earlier. It is something of a cafe society, with many different bistros, restaurants, bars and it is lively all day and well into the evenings. It is a lively place to be and nice to walk through or sit in the cobbled town square and just watch the people go by. There is a general market on Tuesdays, a flea market and antiques on Fridays and another general market on Saturdays. So it bustles and buzzes on many days of the week. There are lots of little individual boutique shops as well as the usual large high street chains, but lots of character and history.
For entertainment, there is the delightful Market Theatre, in Sun street, it is the tiniest theatre I have ever seen, seats about 50 but has pretensions and murals to suggest that it holds many more – it doesn’t! It has a charming upstairs bar with painted murals of rows of seats and theatre-goers that just aren’t there! It is simply charming and the plays are good quality and it is just extremely intimate and exquisite. There is also the larger and more mainstream Queen Mother Theatre with a much larger capacity and still great live theatre, great value for money. On the Cambridge Road, the south west side of Hitchin. Hitchin is home to the Benslow Music Academy and can boast the origin of the first ladies college in UK – the Girton (Cambridge) college started its life in Hitchin: .
Stevenage is one train stop away and the railway station opens straight into the Stevenage Leisure Park, offering 16-screen cinema, bowling alley and lots of popular restaurants like Ask, Frankie & Benny’s, etc., night clubs and meeting places. It is the hub of Stevenage. Shopping is well served by both Hitchin and Stevenage. 3 miles away is the world’s first Garden City, Letchworth Garden City; founded 1903 by Ebeneezer Howard, co-social reformer and friend of William Pryor Letchworth (from Letchworth State Park, Upper New York State, USA). Offering a museum and a calming and country-side feel to a small town. Again, one stop on the train, in the opposite direction from Stevenage.
As for places to stay, Hitchin has a lovely old manor house hotel called The Priory, which has very nice grounds, riverside and lots of ducks to feed! Nearer to Luton airport but still only 12 minutes away is the delightful Offley Place, which people have described as a small Downton Abbey! La Bella Vita in Sun Street is a gorgeous Italian restaurant which is also a boutique hotel, featuring 8 – 10 rooms with heavy wooden four-poster beds and exquisite furnishings, each room totally unique in style and character. There is also pub/inn style accommodation with the Sun Hotel, the Lord Lister public house and other B&B nearby.
Hitchin is a lively town and as the clinic is situated on the upper floor level, facing a busy junction of the High Street, Brand Street and Bancroft, we often look out the window and watch the world go by and chuckle at the parking antics of some of the drivers trying to wedge themselves intoparking spaces outside their favourite shops!
How can someone make an appointment to see you?
Visit our website, contact us and make an appointment. We also do (paid) phone consultations.
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