Thursday, May 9, 2013

fecal transplant



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Thank you  for reading this! 

There is a treatment for Inflammatory Bowel Disease (IBD) that is being studied in clinical trials and will take about 3-5 years to become mainstream. The treatment has already been shown in smaller studies to be effective, and may even cure the condition. Amazingly, it is very simple and can be done at home safely. I have talked to two doctors  and they said if they were me, they would  try it now since there is scientific evidence of safety. To do the treatment, it requires obtaining a stool sample from a healthy donor, and transferring it into someone with IBD to replace bacteria that have been damaged.



I am looking for someone to donate one stool sample to me. Then if further treatments are needed, 2 samples per week for 1-2 months. Its not clear how many times i will need to do this until i fully improve. I should only need 1 donation from the donor, but further stool donations may be needed. To determine whether someone can become a donor, they must be healthy and take a blood test, which i will pay for. Everyone in my immediate family said they would be willing, but are ineligible.

  

To collect the sample, I’ll give you a stool collection tray that goes over the toilet, all you have to do is get it in the tray, put it into another container with a spoon and put it in the refrigerator. Then, call me and I’ll come pick it up.

The only required reading to become a donor is section five to see if you are eligible to become a donor, But its a good idea to go over these sections:

Section 1- Lawrence J. Brandt’s video 1 and 2
Section 4- Codys testimony, skip to summarized parts in videos
Section 5- for specific donor health requirements,


Anything else you choose to view will further confirm the legitimacy of this treatment. I have provided reference links which lead to articles that can be long, you don't have to read the entire articles.



OUTLINE

1. General Information
2. Clinical Studies- currently in progress
3. History of Fecal Transplant in Inflammatory Bowel Disease- Its Success so far.
4. Testimonies From people that have cured themselves already.
5. How to select a Donor.

1. GENERAL INFO

Here are some general videos explaining how this treatment has potential for IBD and many other diseases. Various environmental toxins and even antibiotics are suspected to be involved in damaging intestinal bacteria, which may contribute to developing these conditions.

-Video, By Cara Louise Santa Maria - Science educator, Masters
Degree in Neuroscience







-Video Interview of Lawrence J. Brandt.

Here are some credentials/education: Chief Emeritus of Gastroenterology and Professor of Medicine and Surgery at the Albert Einstein College of Medicine. 

He also has been performing studies on fecal transplants in C difficile in the U.S. since about 1999. C. difficile is very similar to Inflammatory Bowel disease which the mains symptoms are chronic diarrhea and often include colonic inflammation just like inflammatory bowel disease.

Part 1-


Video Length- 6:30 minutes
-he describes his Credentials and talks about his experience studying and using fecal transplants to cure C. Difficile Infection.


Part 2-


Video Length 3:57 minutes
-his opinion on fecal transplant overall safety, and its potential for other diseases.



Part 3-


Video Length- 5:52 minutes

SUMMARY-
1:10  history of fecal transplant in veterinary medicine
2:18 different routes of administration of Fecal transplant
2:50 self/home administration of fecal transplant
4:00 more on the future and potential of Fecal Transplant
5:38 mentions pill form as the final future method of administration in the future for fecal transplants.



More detailed overview on Fecal transplants in a wide range of diseases- here is an article published on February 13, 2013 by Lawrence J. Brandt and another professional which was published in current opinion in gastroenterolology

Fecal Microbiota Transplantation: Past, Present and Future
Olga C. Aroniadis, Lawrence J. Brandt
Curr Opin Gastroenterol. 2013;29(1):79-84.
link to article-
About the journal where the article was published- http://www.medscape.com/viewpublication/826_about1






-Professor Thomas J. Borody Quotes- 

"In the past six decades, our gut microbes have been under constant antibiotic assault in the form of medical therapies and routine use of antibiotics in farming practices. The concerns over potential unanticipated health consequences are only now beginning to be realized, with multiple diseases associated with Western lifestyles hypothesized as causally linked to alterations in the gut microbiota,3–5 including constipation, IBS, IBD, neurological diseases, cardiovascular diseases, obesity, the metabolic syndrome, autoimmunity, asthma and allergic diseases, many of which have reached epidemic proportions in the past few years.

Technological limitations have hampered our attempts to enumerate the various gastrointestinal microbial populations, with the vast majority of dominant anaerobic species largely individually unculturable by traditional microbiological techniques. However, the introduction of high-throughput DNA sequencing technologies, increasing computational capabilities and new analytical techniques have revolutionized this area of science and provided the opportunity to speculate about the existence of a ‘phylogenetic core’—a core microbiota persistent and abundant among most members of the global population. Major efforts are now underway, such as the Human Microbiome Project in the USA and the MetaHIT project in Europe, that are aimed at characterizing the microbial communities of the human body to determine their role in both human health and disease."


Quote derived from-

Fecal microbiota transplantation and 
emerging applications
Thomas J. Borody and Alexander Khoruts
Nat. Rev. Gastroenterol. Hepatol. 9, 88–96 (2012); published online 20 December 2011;







2. CLINICAL STUDIES- currently in progress

 There are now 7 studies being done, some are in the United States and some in other countries around the world. Most will be done at the end of 2014.
These studies were found on www.clinicaltrials.gov this website is associated with the United States Institute of National Health. To verify their existence, enter the identifier code into the website search engine.

The Information on the safety of Fecal transplants has already been well established in previous studies for another Gastrointestinal condition called C. difficile infection, which symptoms are almost identical to inflammatory bowel disease. Lawrence J. Brandt makes a reference to this in one of his videos in section 1 of this paper citing approximately 350 cases of c. difficle worldwide that have been successfully treated with fecal transplant with a very low rate of adverse reactions and a very high cure rate. So evidence for Safety is not a very big question anymore for fecal transplants, the biggest questions for Fecal Transplants is how effective it is for other conditions like IBD and what are the proper dosing requirements.

IBD consists of two forms Ulcerative Colitis and Crohn’s colitis so some of these studies will be on either one or the other or both forms of IBD.

------------------------------------------------
1. Pediatric Inflammatory Bowel Disease(Ulcerative colitis)
HelenDeVosChildrensHospital (HDVCH)
Grand Rapids, Michigan, United States, 49503
ClinicalTrials.gov Identifier: NCT01560819
Estimated Primary Completion Date:             May     2013


recently released study results April 4, 2013-

excerpt-
“Results showed that, 78 percent subjects achieved clinical response within one week while 67 percent subjects maintained clinical response at one month after FMT. Thirty-three percent subjects did not show any symptoms of ulcerative colitis after FMT. Patient's clinical disease activity (PUCAI score) significantly improved after FMT compared to the baseline. No serious adverse events were noted. “Patients often face a tough choice between various medications that have significant side effects. Allowing the disease to progress can lead to surgical removal of their colon," said Dr. Kunde. "Our study showed that fecal enemas were feasible and well-tolerated by children with ulcerative colitis. Adverse events were mild to moderate, acceptable, self-limited, and manageable by patients."



 2013 Jun;56(6):597-601. doi: 10.1097/MPG.0b013e318292fa0d.

Safety, tolerability, and clinical response after fecal transplantation in children and young adults with ulcerative colitis.

Source

*Spectrum Health, Helen DeVos Children's Hospital, Grand Rapids †Michigan State University, Grand Rapids, MI ‡Emory University School of Medicine, Atlanta, GA.

Abstract

BACKGROUND AND OBJECTIVE:

: Colonic dysbiosis contributes to the development of colonic inflammation in ulcerative colitis (UC). Fecal microbial transplantation (FMT) is being proposed as a novel treatment for UC because it can eliminate dysbiosis; however, no prospective data exist. We initiated a pilot study to evaluate feasibility and safety of FMT in children with UC.

METHODS:

: Ten children, 7 to 21 years of age, with mild-to-moderate UC (pediatric UC activity index [PUCAI] between 15 and 65) received freshly prepared fecal enemas daily for 5 days. Data on tolerability, adverse events, and disease activity were collected during FMT and weekly for 4 weeks after FMT. Clinical response was defined as decrease in PUCAI by >15, and decrease in PUCAI to <10 was considered clinical remission.

RESULTS:

: No serious adverse events were noted. Mild (cramping, fullness, flatulence, bloating, diarrhea, and blood in stool) to moderate (fever) adverse events were self-limiting. One subject could not retain fecal enemas. Average tolerated enema volume by remaining 9 subjects was 165 mL/day. After FMT, 7 of the 9 (78%) subjects showed clinical response within 1 week, 6 of the 9 (67%) subjects maintained clinical response at 1 month, and 3 of the 9 (33%) subjects achieved clinical remission at 1 week after FMT. Median PUCAI significantly improved after FMT (P = 0.03) compared with the baseline.

CONCLUSIONS:

Fecal enemas were feasible and tolerated by children with UC. Adverse events were acceptable, self-limiting, and manageable by subjects. FMT indicated efficacy in the treatment of UC.


note-
Never before has  a treatment for Ulcerative colitis so rapidly induced a complete remission Typically with medication, a remission or response to treatment in IBD can take 8-12 weeks. Earlier studies on FT used antibiotics and certain dietary requirements before hand, which I don’t believe this study used, so it may appear that the success rate is low, but it is actually pretty high. It is likely that the success rate in this study could have been higher if dietary changes were followed similar to previous studies. Also, some previous studys used 30-65 total transplants, and this study used only 5, so there are many reasons to explain why more patients didn’t achieve better results. Upcoming studies will perfect the process to increase success.
----------------------------------------------------------
2. Ulcerative Colitis
University of Washington
Seattle, Washington, United States, 98103
ClinicalTrials.gov Identifier: NCT01742754
Estimated Study completion Date:               April         2013
------------------------------------------------------------------------
3. Ulcerative colitis
AcademicMedicalCenter
Amsterdam, Netherlands, 1100DD
ClinicalTrials.gov Identifier: NCT01650038
Estimated study Completion Date:                December    2013
------------------------------------------------------------------------
4. Ulcerative Colitis
Hamilton Health Sciences / McMasterUniversity
Hamilton, Ontario, Canada, L8N 3Z5
ClinicalTrials.gov Identifier: NCT01545908
Estimated Primary Completion Date:            March         2014
-------------------------------------------------------------------------
5. Crohn’s disease and Ulcerative colitis
Seattle Children's Hospital
Seattle, Washington, United States, 98105
ClinicalTrials.gov Identifier: NCT01757964
Estimated Primary Completion Date:            December   2014
--------------------------------------------------------------------------
6. Crohn’s Disease
MedicalCenter for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University
Nanjing, Jiangsu, China, 210011
ClinicalTrials.gov Identifier: NCT01793831
Estimated Study Completion date:               December    2014
--------------------------------------------------------------------------
7. Ulcerative Colitis
MedicalCenter for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University
Nanjing, Jiangsu, China, 210011
ClinicalTrials.gov Identifier: NCT01790061
Estimated Study Completion Date:               December    2014



3. History of Fecal Transplants in IBD, Its Success So Far-

These studies were done by a doctor in Australia, Thomas J. Borody who is trained in Gastroenterology in addition to other education and experience in scientific research.

Educational/Career background on Doctor Borody.
BSc (MED) (HONS)(Bachelor of Science), MBBS (HONS)(Bachelor of medicine, Bachelor of Surgery), MD(Doctor of Medicine), PhD(Doctor of Philosophy), FRACP(Fellow of the Royal Australasian College of Physicians), FACG (Fellow of the American College of Gastroenterology), FACP (A Fellow in the American College of Physicians), AGAF (American Gastroenterology Association Fellow)

Link to his website where this information was derived-
Here is a link to the U.S. National Library of Medicine /National Institute of Health where a search on his name will show some of his published contributions to various Medical/Scientific journals, search results on this database reveal 74 references to his name which illustrate more documentation of his professional experience. These references date from as recent as 2013 to as far back 1979, spanning about 34 years.
Fecal Transplant Studies on IBD -
1989 – Doctor Borody first used fecal transplants in 55 patients with a wide range of Gastrointestinal disorders ranging from constipation, diarrhea of unknown cause, Crohn’s disease and ulcerative colitis. 20 were considered cured. 9 were improved and 26 were unchanged. At least one of the cured patients were cured of Crohn’s disease and one of ulcerative colitis. This is an early study so it was unknown how many times a transplant may have to be done to get any results.
link-
1989 fecal transplant study



2003- Doctor Borody tried this therapy on 6 patients with ulcerative colitis, that elimated all signs of disease symptoms without drugs ranging from 1-13 years after therapy. These patients are considered to be cured since there is no sign of disease, no longer need medication beyond 2 years and they remain disease free to this day. This study was published in the journal of clinical gastroenterology.
http://prdupl02.ynet.co.il/ForumFiles_2/28701499.pdf


2011- The same researcher, Dr borody, reported results in a group of patients from  with Crohn’s disease and all patients ha dno symptoms of disease. These were severe cases that didn’t respond to any medication. The results and details of this study were presented at the AmericanCollege of Gastroenterology’s (ACG) 76th Annual Scientific meeting in Washington, DC in November of 2011. Here is the Official news release from the American college of gastroenterology-
more references for the 2011 fecal transplant study on crohn’s, to further verify its existence-


Here is an interview with Dr. Borody about the 2011 AGC meeting and his 2011 Fecal Transplant Studies for Crohn’s patients-


Some reports of the ACG meeting in 2011 on various news websites
http://www.sciencedaily.com/releases/2011/10/111031114945.htm

Here is a link to 2011 Crohn’s study on Borodys website- 
link will have to be copied and pasted into web browser or search engine-
http://www.cdd.com.au/pdf/publications/All%20Publications/2011-reversal%20of%20inflammatory%20Bowel%20disease%20(IBD)%20with%20recurrent%20feacal%20microbiota%20Transplants%20(FMT),%20TJ%20Borody,%20M%20Torres,%20JL%20Campbell,%20SM%20Leis,%20A%20Nowak,%20American%20College%20of%20Gastroenterology%20p741.pdf



Fecal Transplant in C. difficle infection-
In section 1 of this paper, Lawrence Brandt made a comment in a video on the history of safety of Fecal transplant in C. difficile infection, it has been well studied in approximately 350 patients worldwide with an extremely low rate of adverse events, so its safety is very well established.

Fecal Transplant has also just been proven to be more effective then the standard antibiotic therapy for C. Difficile infection, which is very similar to inflammatory bowel disease in that the main symptoms are chronic diarrhea and occasionally inflammation of the colon. From these results, it will become the new standard therapy in for C. difficle infection. Prior to Fecal bacteriotherapy, up to 70% of people with c difficle would die from it, now they will be able to cure 99% of patients, in a few days, so almost no one will be dying from c. difficle anymore when it is treated with a fecal transplant.

Here are some reports about the latest study on c diff outperforming standard therapy-
Here is a link to the actual study published in the New England journal of medicine 2013
EXCERPT from the study-
“The study was stopped after an interim analysis. Of 16 patients in the infusion group, 13 (81%) had resolution of C. difficile–associated diarrhea after the first infusion. The 3 remaining patients received a second infusion with feces from a different donor, with resolution in 2 patients. Resolution of C. difficile infection occurred in 4 of 13 patients (31%) receiving vancomycin alone and in 3 of 13 patients (23%) receiving vancomycin with bowel lavage (P<0.001 for both comparisons with the infusion group). No significant differences in adverse events among the three study groups were observed except for mild diarrhea and abdominal cramping in the infusion group(fecal transplant) on the infusion day.


Here is a quote by University of Minnesota Doctor and Researcher Alex Khoruts
"Those of us who've been doing this procedure(fecal transplant) for some time didn't need any more convincing, but the large medical community needs to go through these steps," Dr. Alexander Khoruts, a gastroenterologist at the University of Minnesota in Minneapolis who was not involved in the new study, told Nature. "It's an unusual situation where we have more than 50 years of worldwide experience and more than 500 published cases, and only this far along does a randomized trial appear.”

4. Testimonies from people that have cured themselves already -



Testimony #1

This is the best testimony I have found so far because it is so detailed. This is a guy who used his son and his wife as donors.
You don’t have to watch the entire videos, you can skip to the parts in the summary to verify the story.
You will notice in the last video that the energy in his voice changes, his speaking ability improves a bit and his mood seems slightly improved, which are signs his health has improving due to the fecal transplants.


Video #1 –


video length- 33 minutes

Summary of video/skip to these parts-

2:52 - 30 years old, Married for 8 years, Bachelors degree in Business Adminstration, Self Employed, Works in financial services industry, Healthy most of life. Has had ulcerative colitis for about 5 years.
7:20 - Took antibiotics for 2 years for staph infections on legs, he suspects the antibiotics had something to do with his development of IBD as symptoms appeared while on antibiotics.
9:50 - Description of  initial onset of disease.
14:30-19:00 -Describes symptoms before doing the fecal transplant which include Fistula, fissures, hemmoroids. Starting transplants on meds @ 40 mg prednisone recently at 80mg. explains all the medications he has tried during the course of his disease for IBD.
26:00 - when and how he heard about fecal transplants


Video day#3-



Summary
1:25 - bowel movement frequency reduced from 20X per day to around 2x per day, in about 5 days


Video Day #20 



2:50 -almost entirely off of medication at this point. he’s generally still doing very well bowel wise and feeling pretty good.
6:00 - encourages people to try it, considers it a miracle for him and his condition.




Latest update April 30th, 2013-


0:00-3:30 gained 30 pounds since starting fecal transplants, eats a normal diet now and most symptoms are gone without medication.
3:30-7:32- tips on how to perform the transplant


Testimony #2-

here is a guy who had guidance from lawrence brandt on his fecal transplant-

http://www.healingwell.com/community/default.aspx?f=38&m=2501639


Testimony #3

His screen name is Dr. Briggs and he is a university physics professor who is trained as a scientist and who has done the treatment successfully at home using his wife as a donor.
link to the forum discussion where this testimony was found- 
http://www.healingwell.com/community/default.aspx?f=38&m=2541306&p=4

summary- he has had ulcerative colitis for 12 years, then later was diagnosed with crohn’s disease. He suspects that a course of antibiotics had something to with him developing IBD.
symptoms before starting the Fecal transplant were 3 bm’s per day, previously he has had up to 20 per day. after the transplants he averaged 2 bms a day and he was able to eat foods that used to cause his symptoms to worsen, this indicates a major change occurred in his ability to digest food.

A few quotes from his fecal transplant experience-

posted on 11/27/2012

Dr Briggs-
“So, things are going very well. To recap - I was diagnosed with UC about 12 years ago, and spent time on sulfasalazine and prednisone with no benefit (15-20 bloody very loose stools a day), then eventually Remicade after developing a fistula. I was on the Remicade for a little over 7 years, which partially controlled things (5-7 loose stools a day, no bleeding as long as I got infusions every ~11 weeks).
I am now off all medications, and doing great. Two well-formed stools a day.”





Posted 2/28/2013 1:14 PM

Dr briggs- “Sorry for not responding sooner (a lot sooner) - with my UC seeming to be completely gone, I'm getting caught up in other things, so I have to remind myself to occasionally check out this thread.
Potatoes are often not well digested if you have a compromised GI system, they have lots of complex starches in them. I can eat them now without problems, but before the transplants they gave me issues - and early on after the transplants when I ate potatoes they would give me a very mushy stool afterwards (I have continued healing since the transplants, and now tolerate everything very well it seems - except wheat). “


Testimony# 4
Here is another testimony from a women with the screenname bustersmom, she avoided a colectomy by doing a fecal transplant at home using her husband as a donor-
link to forum discussion- http://www.crohnsforum.com/showthread.php?t=15548&highlight=bacteriotherapy 

Post # 139

I have Crohn's disease and was on Flagyl and Cipro for over two weeks and got three abscesses. I figured i had nothing to lose by trying the transplant. I waited three weeks after finishing the antibiotics and was in bad shape. abscesses were terrible. I did the transplant daily for a while and the abscesses, Two which were large, Began to shrink every day. After a month they were gone, and made NO fistula! I haven't had one bit of trouble down there since. I believe the transplants work. I don't know if it works all through the colon, but it worked on me in my lower colon and i was a complete mess. Bree





5. How to Select a Donor.

Overall, as long as the Donor is in good health, there is very little risk with doing a fecal transplant. Even in some of the documents below they reported bypassing blood tests and health screening for some patients who chose a donor that was a family member that they knew and trusted, buts it probably best to take precautions.  All the criteria for selecting a healthy donor and directions for what blood tests they need were obtained from these two papers, one of which was written by doctor Borody and other professionals in the field.

Donor Health Requirements:
check the list of some of these conditions. As long as you have never been diagnosed with them, and do not have any of the symptoms, or any symptoms that might require a doctors attention, then you will likely be a good donor.



-No antibiotics in last 6 months or ever is best.

-No Gastrointestinal complaints like frequent diarhea, constipation/excessively firm/dry stool that is hard to pass, no blood, No Mucus  in stool  or intestinal pain/cramping. You should have a generally regular stool frequency of 1-2 bowel movements per day. on average they should be soft.

-Absence of metabolic syndrome- 
http://en.wikipedia.org/wiki/Metabolic_syndrome
Symptoms and features are:
-Fasting hyperglycemia — diabetes mellitus type 2 or impaired fasting glucoseimpaired glucose tolerance, or insulin resistance
-Central obesity (also known as visceral, male-pattern or apple-shaped adiposity), overweight with fat deposits mainly around the waist
-Decreased HDL cholesterol
-Elevated triglycerides
Associated diseases and signs are: hyperuricemiafatty liver (especially in concurrent obesity) progressing to NAFLDpolycystic ovarian syndrome (in women), and acanthosis nigricans.

-No autoimmune conditions-
 list of conditions-
-No allergic diseases - asthma, atopic dermatitis (eczema), allergic rhinitis (hay fever), food allergies



Required Blood Tests for donating-
 full blood count, liver function,
Negative viral screening for HIV 1 and 2,  Hepatitis a, b, c. cytomegalovirus, Epstein Barr Virus, Syphilis.





Some studies have bypassed donor screening only in cases where close family members have been selected as donors.

None of the Testimonies I listed in sections #4 of this paper mentioned taking the suggested  precautions to follow the donor selection criteria, as most were able to get help from family members who they were confident were healthy. I plan on taking full precautions no matter how healthy my donor is, or whether they are a family member or not. I also have additional criteria that go beyond the advice listed here.

It is not required that you read these papers with the web links listed below, but if you would like to look them up to verify they exist, feel free to do that.

Article 1
Details on page 3-
Title: Standardized Frozen Preparation for Transplantation of 
Fecal Microbiota for Recurrent Clostridium dif´Čücile Infection


Article 2
Details on page 479-
http://www.cdd.com.au/pdf/publications/paper12.pdf
Title: Bacteriotherapy using fecal flora: Toying with Human Motions.




Recommended diet while donating-
start this one week before the first donation.
This will encourage all the good bacteria in your intestine to grow dominate and make it a more potent medicine. you dont have to be too strict with your diet, its not that crucial to the process, but it will definitly help.

High fiber foods, like whole grain oats and wheat
Berries.
eat at least one apple per day.
cooked veggies.
avoid fresh spinach and other lettuces to prevent exposure to e. coli.
if you smoke, reduce your smoking as much as possible.
excessive alcohol intake is probably not good for this but 1-2 beers is likely not an issue.

Things to avoid- 
artificial sweeteners- anything with aspartame, sucralose or saccharin in it most diet sodas have these. 
Avoid excessive amounts of processed food in packaging as it may contain preservatives that inhibit bacterial growth.
Avoid over consumption of meat-  beyond 8 ounces in a day would be excessive.

Closing

if you feel you may be a good donor based on the information above, then we can move on to blood tests and you can become a donor!!