Imagine my surprise and excitement when I saw last week a front page article, (http://www.nytimes.com/2013/01/17/health/disgusting-maybe-but-treatment-works-study-finds.html?_r=0), in the NY Times on one of my three favorite subjects: fecal transplants. Fecal transplants have hit the big-time with a study published on Tuesday in the New England Journal of Medicine. The study from a group in the Netherlands reports that 15 of 16 patients with c. difficile were cured of their illness. This substantiates previous anecdotal reports of fecal transplant successes in c. difficile.
Fecal transplants have been happening, on and off, for some time. Important work is being done by Dr. Alex Khoruts at the University of Minnesota and by Dr. Thomas Borody in Australia.
The tone of this article sucks. Where is David Tuller when we need him?
Various historical examples of fecal benefit going deep into the past ("yellow soup") are cited in the comments section of the NY Times articles. These comments, nearly 300 of them, are particularly fascinating and insightful. In wading through them one can learn a great deal about the subject of fecal transplants, along with many parallel issues regarding gut integrity and health. The commenters are articulate, sharp and often describe benefit from various curative gut programs. It is surprising how many positive comments are made about various forms of pre and probiotics. There is even a comment by Dr. Gregory Plotnikoff of Minneapolis. (I have unsuccessfully tried to enlist Dr. Plotnikoff for help with my daughter.) Dr. Plotnikoff is publishing a book on gut health in April 2013. It can be purchased here on Amazon.
Other comments point to these other stories on the subject of gut ecology.
It remains to be seen what the FDA is going to do regarding fecal transplants. The FDA's first obsession in all matters is to regulate. But how? - this is a sticky wicket. The near 100% success rate, which can be deemed "pretty good", is going to give the FDA something beyond the ordinary with which to wrestle. Still most researchers working in the field are hanging fire to see what the FDA is going to do.
The NY Times article contains this distressing comment from Dr. Brandt, a leading researcher in the United States. "Dr Lawrence J. Brandt, a professor at the Albert Einstein College of Medicine in New York, said that the Food and Drug Administration had recently begun to regard stool used for transplantation as a drug, and to require doctors administering it to apply for admission, something that could hinder treatment." Will the FDA declare feces a controlled substance?
The attractive, even enthralling, aspect of this therapy is the combination of simplicity with a "level of unexpectedness" or sheer surprise. Certainly, in this age of scientific marvels, FT cannot be seen as representing the Progressive wing of medicine. This treatment is simple, effective and unexpectedly cheap - a nice combination.
I suppose the question can be asked - what does all this have to do with ME/CFS? I would answer that gut integrity and gut ecology have a great deal to do with ME/CFS - and that any serious research into the gut will yield treatment options for ME/CFS. Certainly the illness is complex, but gut biome issues play a very important part in this complexity - and there is much to learn with much, much more to come.