The superorganism concept
From a microbiologist's point of view, no animal including Homo sapiens is an individual but, rather, a superorganism that only thrives because the members of this community have been living together since primeval times. Intestinal bacteria contribute 36 percent of the small molecules that are present in human body. The aggregate of all inhabitants of the body, the so-called microbiota, constitutes an independent organ. Weighing in at 2 kilograms in humans , it's heavier than the brain and has a biochemical activity that is comparable to the liver's.
This superorganism has evolved over millions of years -- and doesn't cope well with some of the innovations of the modern world. Antibiotics, for instance, may destroy dangerous bacteria, but beneficial ones also unfortunately suffer. Only two treatment cycles of the synthetic antibiotic ciprofloxacin are enough to deal a painful blow to the microbiota. Although the intestinal bacteria eventually grow back, it's now known that they don't regain their original degree of diversity.
Importance of gut microbiome and clinical application
The full role of healthy microbiome is only recently being discovered. Researchers are increasingly becoming aware that the mammalian immune system, which seems to be designed to control microorganisms, is in fact controlled by microorganisms. [1] There are now more than 25 different diseases and syndromes -- ranging from Alzheimer's and arteriosclerosis to depression and rheumatism -- that have been linked to an abnormal microflora. It seems that even obesity can be linked to intestinal microbes. By transplanting intestinal microflora from one mouse to another researchers have managed to also transfer the weight gain [2]. It seems this process works the other way around too.
Willem de Vos, from Wageningen University, recently conducted a study with 18 men who were obese and had an abnormal sugar metabolism. Half of the patients had feces from slender, healthy donors flushed into their intestines. The others constituted the control group and were given samples of their own stool. Six weeks later, the overweight subjects who had received foreign matter had a richer intestinal flora. No less than 16 bacterial strains had shown vigorous growth. The individuals' sugar metabolism had also normalized. By contrast, there were no such changes among the individuals in the control group.
Now, de Vos is looking for particularly beneficial bacterial strains that he intends to use to develop a groundbreaking microbiota transplant. He can draw on a collection of over 5,000 samples. But these stem from people from countries like Germany, Finland and the US -- and may have been ruined by a Western lifestyle.
Even in veterinary medicine fecal transplants have been "the thing" for last few years. Integrative veterinarians from around the world report excellent results in treatment of gastrointestinal disorders (Chronic diaroea of unknown etiology, Irritable bowel disease, ulcerative colitis), autoimmune disorders like canine atopy and even behavioral disorders. I have had great results using fecal transplants in my clinic severals times. This is not surprising if we have in mind previously mentioned "superorganism concept". Despite the rather strange and gross nature of microbiome restorative therapy, this method is meeting worldwide acceptance in recent years. In the US, fecal transplants to treat C. diff are widely accepted as being 97 percent effective in curing the infection in humans.
I consider FMT cutting edge alternative treatment which will likely go mainstream in the years to come. In the past 50 years antibiotics have been over used and abused in veterinary medicine, when we begin to grasp the importance of healthy gut microbiome we will certainly think twice before we reach for that antibiotic both as practitioners and as patients.
Clinical Protocol
Under no circumstances I advise doing this at home. For various reasons fecal transplants have to be done under supervision of your veterinarian. You also need to discuss with your veterinarian if the condition your dog suffers from can be treated with FMT in the first place. Dr. Kim Henneman, DVM, DACVSMR kindly volunteered her protocol for Daily Pet and I am publishing it here mainly for the benefit of other colleagues who would like to introduce this procedure.
HOW TO DO A FECAL TRANSPLANT (Dog/Cat) ©2013 Kim Henneman, DVM, DACVSMR (K9, EQ)
INTRODUCTION: The purpose of a fecal transplant is to restore proper gut bacterial populations to both thesmall and large intestinal ecosystem.
Recently, several studies, both in Europe and in the US, have shown the benefits of using bacteria from healthy donors to help with Clostridium difficile infections and other digestive and immune-mediated problems in people.
Fecal transplants can be done either orally or rectally depending on whether the goal is to restore small intestinal or colonic bacteria.
This technique is based on modifications of the published protocols in the human literature.
1. DONOR SELECTION:
- The donor animal must be healthy and preferably lean. It is important to verify whether or not the animal has had any antibiotics within a 5 year period and preferably no antibiotics at all.
- Fecal exam for parasite ova and giardia is STRONGLY recommended within a week before performing the fecal transplant.
2. PREPARATION:
- Collect approx. 2 TB of a fresh fecal sample from the donor (1 TB if cat).
- Mix the sample with 2 oz (60 ml or cc) of saline (it is ok to use contact lens solution if it does not contain if any preservatives – use 1 oz (30cc/ml) for a cat. Mix until the fecal material is completely liquefied.
- Pour the mixture through a strainer and collect the liquid as many times as necessary to remove solid material. I will press the solid material in the strainer with a spoon or tongue depressor (non-reusable ones) until most of the liquid has been pressed out of the solid material.
- Discard the solid waste as you would with the waste from normal yard cleanup.
3. ADMINISTRATION:
- Administering the fecal ‘smoothie’ orally is the preferred method to allow for bacteria to inoculate the upper small intestine.
- Giving it as a liquid is preferred to speed passage through the stomach, however, if your dog absolutely, positively will not allow a syringe to be placed in its mouth, try mixing with chicken or beef broth or heavily watered down canned food or rehydrated freeze-dried raw food.
- If administering it by syringe, draw the fecal liquid up into a syringe (we recommend a 60cc catheter tipped syringe or a turkey baster) and syringe it into the animal’s mouth. Give the entire contents. Have the dog wear a bib or plastic bag with a hole for its head to minimize the need for a post-syringing bath. The person administering should not wear good clothes or shoes either.
- Be cautious not to tip the dog’s nose too vertical as this could lead to some of the fluid running into the trachea and lungs. Syringe a small amount into the mouth with the nose horizontal; if the dog refuses to swallow (eating disgusting crap seems to be enjoyable only if it is their idea), put in a small amount then elevate the nose 45° from the horizontal to encourage swallowing. DO NOT rub the throat. No one swallows when that is done. Dribble a little in at a time – do not forcefully shove the entire syringe in quickly.
4. RECTAL:
- If giving rectally, use an enema tube inserted gently into the rectum with the assistance of vegetable oil or petroleum jelly.
- Mix the fecal material with warm (not hot) water and administer the same method as giving an enema. While some people have reported mild cramping after a fecal transplant, our clients have reported little to no problems after this technique has been performed on their dog or cat. Check with your veterinarian on which medications will not interfere with the new bacteria and ABSOLUTELY do not give any antibiotics for several months if at all possible. Remember, those are the drugs that killed off the good bacteria to begin with. Good luck!
References:
3. Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile, The New England Journal of Medicine vol. 368 no. 5
4. Biomarkers for the 21st Century: Listening to the Microbiome; Rodney Reynolds Dietert* and Ellen Kovner Silbergeld
