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The new fron­tier

In a world where fer­mented food, pro­bi­otics and ‘good bac­te­ria’ have be­come buzz­words, every­one from your hair­dresser to your work­mate’s sec­ond cousin is talk­ing about gut health. Over the past few years, we’ve heard about how to boost our flora, max­imise our mi­cro­biome, and how the hot­bed of highly sen­si­tive bac­te­ria we all host in our di­ges­tive tract can in­flu­ence ev­ery­thing from our mood to our im­mu­nity.

But in spe­cial­ist labs across Aus­tralia, New Zealand and fur­ther afield, sci­en­tists are un­lock­ing a brave new fron­tier in gut health, and it’s all about... fae­ces. Whether you see it as revolting or rev­o­lu­tion­ary, gut mi­cro­biome trans­fers – where a stool sam­ple from one per­son is im­planted in an­other – have health ex­perts in­trigued. There’s a lot more work to be done, but some re­searchers are al­ready say­ing they could help to treat ev­ery­thing from chronic ill­ness to obe­sity.

Tiny mi­crobes, huge im­pact

While these trans­plants have only re­cently been part of for­mal lab stud­ies, the con­cept is said to date back to an­cient Chi­nese medicine. The trans­plants were car­ried out in the Western world in the 1950s, but a com­bi­na­tion of a lack of mod­ern tech­nol­ogy and gen­eral squeamish­ness meant it wasn’t some­thing that spurred wide­spread in­ter­est – un­til now.

A gut mi­cro­biome trans­fer or (GMT) in­volves, in cut-to-the-chase terms, tak­ing poo from one per­son, re­mov­ing the waste and im­plant­ing it into an­other, via colonoscopy, an en­ema, or as a (taste­less

These have only re­cently been part of for­mal lab stud­ies, but the con­cept dates back to an­cient Chi­nese medicine

and odour­less) cap­sule. The idea is that healthy bac­te­ria from the donor then takes up res­i­dence in the re­cip­i­ent, en­cour­ag­ing more good bugs to grow, bal­anc­ing out harm­ful mi­crobes and even­tu­ally restor­ing or­der to the di­ges­tive tract. In some clin­ics, it’s known as a fae­cal mi­cro­biota trans­plant, and while the con­cept might sound cringe­wor­thy, it’s al­ready more main­stream than you think. In some pub­lic hos­pi­tals and pri­vate clin­ics, the pro­ce­dure is used to treat Clostrid­ium dif­fi­cile bac­te­ria, a se­vere, an­tibi­otic-re­sis­tant in­fec­tion that can wreak havoc on the bowel. So far, the num­ber of pa­tients treated with this pro­ce­dure is still rel­a­tively small, but for this par­tic­u­lar in­fec­tion, GMT can give re­sults af­ter con­ven­tional treat­ments have failed. Some stud­ies put the suc­cess rate at 90 per cent af­ter a sin­gle pro­ce­dure, and re­searchers from Univer­sity of Alabama at Birm­ing­ham have found ev­i­dence to sug­gest that cer­tain strains of donor bac­te­ria have re­mained in the re­cip­i­ent’s gut for up to two years af­ter the trans­plant. How­ever, whether it can be as ef­fec­tive for other con­di­tions is still largely un­proven. But it’s safe to say it’s a con­cept that has re­searchers the world over tak­ing a closer look at the com­plex world of mi­crobes.

Po­ten­tially pow­er­ful

At the Lig­gins In­sti­tute in Auck­land, re­searchers are study­ing the way gut bac­te­ria can in­flu­ence obe­sity. The ‘gut bugs trial’ in­volves a group of 80 obese teenagers who are re­ceiv­ing mi­cro­bial trans­plants from slim, healthy donors. The trans­plants are taken as a cap­sule in­side a sec­ond cap­sule, af­ter the raw ma­te­rial has been thor­oughly cleaned, and care­fully screened for in­fec­tious bac­te­ria. Re­search is still in the early stages, but study co-leader and pro­fes­sor of paediatric en­docrinol­ogy Wayne Cut­field says sci­ence is steadily learn­ing more about the tiny mi­crobes we all share our body with.

“It’s an al­most un­be­liev­ably fas­ci­nat­ing con­cept that bugs in your bowel, that 10-15 years ago we thought were just chomp­ing up waste, ac­tu­ally in­flu­ence our health and well­be­ing,” he says. “They re­lease chem­i­cals that in­ter­act with our brain, and they may ac­tu­ally in­flu­ence our ap­petite and be­hav­iour. They can also in­flu­ence the risk of di­a­betes, obe­sity, and po­ten­tially the risk of heart dis­ease, along­side al­ler­gies, eczema, and in­flam­ma­tory bowel dis­ease.”

Other stud­ies into fae­cal trans­plants in­clude re­search from the Univer­sity of New South Wales that found en­e­mas with healthy bac­te­ria were ef­fec­tive for treat­ing the chronic bowel con­di­tion ul­cer­a­tive col­i­tis, while doc­tors at the Mel­bourne FMT clinic claim the trans­plants can be used to treat Crohn’s dis­ease and ir­ri­ta­ble bowel syn­drome.

Just hype?

Some re­ports into the ef­fec­tive­ness of GMT sug­gest fae­cal trans­plants could ben­e­fit con­di­tions that may be af­fected by the mi­cro­biome, like autism, mul­ti­ple scle­ro­sis and rheuma­toid arthri­tis – although there have yet to be any stud­ies to prove it.

With news of gut mi­cro­biome trans­fers ap­pear­ing in ev­ery­thing from mag­a­zines and news­pa­pers to so­cial me­dia and TV chat shows, some ex­perts are now warn­ing against get­ting caught up in the pro­pa­ganda. Dr Justin O’sul­li­van, who co-leads the gut bug trial at the Lig­gins In­sti­tute, says while the­o­ries sound in­ter­est­ing, it all comes down to solid ev­i­dence.

“There’s a lot of hype around FMT, or GMT, and it’s all based on prom­ise,” he says. “The ab­so­lute proof that it works is ab­sent at the mo­ment, and that’s what we’re try­ing to gain.”

Bac­te­ria 101

When it comes to de­ci­pher­ing our mi­crobes, map­ping tril­lions of bac­te­ria is no easy feat, and it’s not clear yet which or­gan­isms give which par­tic­u­lar health ben­e­fits. Each of us car­ries around our own per­sonal cache of 30-40 tril­lion mi­crobes, equat­ing to about 1.5kg worth of bac­te­ria. Even more im­pres­sive is that each per­son has a unique makeup of bugs, and while hu­mans share 99 per cent DNA, two peo­ple may only have a 10 per cent cross­over in their mi­crobes.

This com­plex pop­u­la­tion of bac­te­ria in­ter­acts in count­less ways, and if the bad bac­te­ria out­num­ber the good or the lev­els get de­pleted, this im­bal­ance can lead to ev­ery­thing from se­vere gas­tro up­sets and poor di­ges­tion, to al­ler­gies, yeast in­fec­tions and fa­tigue. And it’s not just about the num­ber of bac­te­ria in our bod­ies, but the va­ri­ety. Ex­perts have come to agree that the health­i­est mi­cro­biomes are those with the most di­ver­sity, but our gut flora is get­ting de­pleted – and mod­ern life­styles may be to blame.

In the book The Mi­cro­biome So­lu­tion, Dr Robynne Chutkan says to “live dirty, eat clean”, mean­ing we should limit the use of chem­i­cal sani­tis­ers, and not be afraid to get some dirt on our hands. She claims that while clean­ing prod­ucts might be ef­fec­tive for culling bad bac­te­ria, they are killing off the good bugs too.

“Harsh clean­ers and an­tibac­te­rial prod­ucts su­per-sani­tise our bod­ies and our al­ready ster­ile en­vi­ron­ment, threat­en­ing the ex­is­tence of what few mi­crobes re­main,” she says. In the book The Clever Guts Diet, Dr Michael Mosley says wide­spread an­tibi­otic use, chem­i­cals in pro­cessed foods, and a lim­ited diet are the key cul­prits.

“We eat such a nar­row range of foods, so our gut bac­te­ria have to live on a re­stricted diet,” Mosley says. “Of the 250,000 known ed­i­ble plant species, we use less than 200. Seventy-five per cent of the world’s food comes from just 12 plants and five an­i­mal species.”

To add to its com­plex­ity, part of our mi­cro­biome is de­vel­oped long be­fore we’re old enough to choose what food we eat.

“The mi­cro­biome is pop­u­lated in the womb,” says O’sul­li­van. “You have cer­tain ge­netic pre­dis­po­si­tions in your DNA, and cer­tain se­quences that are spe­cific to you. It seems there’s a cor­re­la­tion be­tween some of those vari­ants and the pres­ence of par­tic­u­lar bac­te­ria in your mi­cro­biome.

“It fluc­tu­ates quite a bit; it de­pends on what you eat, is in­flu­enced by all the sur­faces you touch, it’s on your hands, it’s chang­ing all the time. It’s an eco-sys­tem. It’s like if you wa­ter a cer­tain plant in your gar­den, that plant is go­ing to grow a lot and it’s go­ing to shade other plants and pre­vent them from grow­ing, and it will change the en­vi­ron­ment around it, and that’s ex­actly what hap­pens in your gut.”

While sci­en­tists are still work­ing on the proof that fae­cal trans­plants ben­e­fit the del­i­cate sys­tems of the mi­cro­biome, one thing the ex­perts agree on is that no amount of pro­cessed poo is go­ing to can­cel out a bad diet and un­healthy life­style. “Es­ti­mates say diet in­flu­ences about half of the be­hav­iour of the gut mi­cro­biome, and it’s about the bac­te­ria that are there, but also which ones are busy,” says Cut­field. “So you can have a whole lot of bac­te­ria there but if you’re feed­ing them crap, it’s a whole lot of bad bac­te­ria that are go­ing to be busy. Our mi­cro­biome is a prod­uct of our own genes and our unique­ness, but diet and ac­tiv­ity are pow­er­ful play­ers.”

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