Would you donate your poop for a loved one?

The internet is ripe with bizarre stories of how a brother/ sister/ friend/ lover (even estranged husband’s lover) donated an organ to save the life of a patient in a precarious condition. Call it love or just humanity, we tend to delve in such selfless behaviours from time to time be it for our loved ones or even complete strangers.

The very fact that blood donation camps have been held regularly around the world and continue to attract donors every time is a testament to human goodwill. Many donate their organs while living or after their death and that is a noble cause. Sperm donation is also quite common but does not come with the nobility of organ donation. But what about poop? Would you consider it a noble cause to donate poop? Should the need arise, would you rise to the occasion and make a deposit?

If you look at it for what it is, your poop is of no use to you whatsoever. Everybody just dumps their collection sooner or later. So, there is no reason for not doing so. We should be more than happy to donate it rather than just wash it down the drain. Yet, come to think of it, we shrug away from the very thought of donating it.

Why?

Because its poop.

Why would anyone DONATE it? Who would accept poop as a donation? Who is in such darn need of poop?

Truly nobody wants poop. Even science neglected poop for quite a while. Poop is what is left from what we eat and could not digest. So, poop can contain seeds, which, when dispersed and planted, can help plants grow. Poop, by itself, is packed with multiple nutrients and therefore acts as food for many animals.

Dung beetle can carry loads of 250 times its body weight but it is carrying something with millions of microorganisms.

Remember the super strong dung beetle that is popular for carrying 250 times its own weight. Most of the time, it carries dung, which is basically its food. The beetle carries the extra weight, because it is his food that he wants to store. But its not just this arthropod that eats poop. Pet lovers could vouch for seeing their pet rabbits eat their own poop, whereas even the elephant calves consume their mother’s poop.

Why is poop so popular?

Most of the information we have about poop dates back to the 1970s and 80s, when basic microscopy revealed that human poop had lots of bacteria, solid matter, and water. The primary reason why poop is so popular in the animal kingdom is that it comes with a bunch of microorganisms that usually reside in our guts. These microbes are a mix of good, bad, supportive, and disruptive microorganisms that we know of and are within each and every one of us.

Modern science calls it microbiota. Just like we found the sequences of the Human Genome, research is currently underway to understand which organisms are actually dwelling within us and what their genome looks like and does within us. Together, their genetic information is called the microbiome, and efforts are underway to understand the microbiota and its functions.

To cut the long story short, our poop is rich with our microbiome. Rabbits and elephants are basically ensuring that their microbiota is retained and simply eat their poop to do so. Even the mighty dung beetle has its preferences for poop while feeding its young ones, and the use of antibiotics in cattle has altered the dung beetle microbiome, according to this recently published study.

Why poop donation?

All this sounds good. But why would anybody need a donation of poop? Let’s get to that.

Patients with severe infections with Clostridium difficle, face an uphill task to recovery. This particular organism is usually a part of the microbiota but sometimes takes over the gut microbial machinery and results in severe symptoms such as abdominal pain, fever, weight loss, pus in the stool, and diarrhea up to 15 times a day.

Treatment usually comprises antibiotics and is supplemented with probiotics to restore the gut flora as soon as possible. However, severe cases of C.difficle usually end up claiming about 20,000 patients a year in the US alone. What is worse is that the incidence of C.difficle is on the rise in Europe, Taiwan, Korea, Canada, etc., and our resources to handle these cases are few, and general methods such as washing hands with soap and using alcohol sanitizers are not very effective.

Clostridium difficle is more like Clostridium difficult, because the infection is very hard to treat.

In 1999, Dr.Lawrence Brandt and his colleagues transferred fecal matter from a healthy donor to a patient who was critically ill and found some success. But Dr. Brandt himself credits the technique to being over five decades old and is amazed that it was successfully carried out at a time when modern science had not identified C.difficle as an organism. The first published record of such fecal transfer is a study by JD Bennet who carried out the study on himself in 1989! Kudos to the man for his treatment methods and the courage to try it on himself.

As the word spread about Dr. Brandt and his successful attempts of treating patients with C.difficle, the adoption of fecal material transfer grew. Since the poop of a healthy donor is actually transferred to the patient, the treatment is referred to as a transplant. As our awareness about our gut has increased in recent years, the treatment is popularly known as Fecal microbiota Transplant (FMT).

What makes FMT Special?

While FMT is being used as a last resort for patients, the recovery rates are as high as 91% without the use of vancomycin (an antibiotic) and increase up to 98% after treatment with vancomycin, making it one of the most sought out transplants in the medical world.

Rise in in publications about fecal microbiota transplants. Image credit: http://journals.plos.org/plosbiology/article?id=10.1371%2Fjournal.pbio.1002503

Image shows the dramatic rise in publications related to FMT in recent years.

The other factor contributing to the success of FMT is the ease of finding the donor. All you need is a healthy individual who may not necessarily be a relative but needs to be negative for HIV or HBV and HCV. Once a donor is identified, fresh stool sample or a frozen one is taken and transplanted into the recipient to restore the microbiota. There are no complications of a mismatch or a lengthy process of registering to be a recipient. This is helpful because C.difficle acts fast and can go from mild to lethal in about a month’s time.

As more studies are being published about the efficacy of FMT, the treatment has also been linked to reducing obesity and increasing toxin tolerance. Although these are findings in mice, it is still exciting, because that’s where modern science starts, in labs and on mice (or other model organisms)

So what goes in a FMT?

Now this is a question that is hard to answer. With all its high success rates, FMT is popular. But it’s exact mechanism is something we know very little about. A review paper published in PLoS by Diana Bojonova and Seth Bordenstein of Vanderbilt University tries to answer this question.

The most obvious answer is loads and loads of bacteria that find a new home and want to occupy it. These bacteria fight tooth and nail with Clostridium, which has been ruling the roost, and defeating it, thereby restoring the patient’s gut.

The gut microbiome is keeps your gut healthy.

The additional answer is viruses that infect these bacteria. Called bacteriophages, these viruses help in checking the Clostridium infection and restore balance in the microbiota. Archaebacteria and fungi are also part of the microbiota that fight for their place in the human gut against Clostridium.

A recent publication in Science from the team of Howard Ochman at the University of Texas has shown that gut microbes from humans and our nearest relatives, the apes, are quite similar and have been co-evolving in their hosts from the time we split into humans and apes. This goes on to show that microbiota has a bigger role in our evolution as well, something that we might be able to determine in the years to come.

But we are not at the mercy of this cocktail of organisms in our gut alone. Epithelial cells from the human colon are also aplenty in (10 to the power of 7 in every gram of) human stool and can survive in fecal matter. When transplanted, they may be responsible for creating an additional layer of protection between microbes and the colon providing it with a buffer that was lost during the recurrent diarrhoea.

Yet, these are theories, and a lot needs to be found out before we can determine the exact mechanism of how FMT works.

If you’d like to know more about how FMT helps save lives, watch this video from Seeker on YouTube

Would you do it?

So now that you know the science behind the FMT, its success rate, the role of microbiota and what it means to us, we come back to the original question? Would you donate your poop for a loved one?

I hope this article has managed to change the way you think about poop. If not, do let me know in the comments section below, why not?

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References:

Hammer, T., Fierer, N., Hardwick, B., Simojoki, A., Slade, E., Taponen, J., Viljanen, H., & Roslin, T. (2016). Treating cattle with antibiotics affects greenhouse gas emissions, and microbiota in dung and dung beetles Proceedings of the Royal Society B: Biological Sciences, 283 (1831) DOI: 10.1098/rspb.2016.0150

Bennet JD, & Brinkman M (1989). Treatment of ulcerative colitis by implantation of normal colonic flora. Lancet (London, England), 1 (8630) PMID: 2563083

Bojanova, D., & Bordenstein, S. (2016). Fecal Transplants: What Is Being Transferred? PLOS Biology, 14 (7) DOI: 10.1371/journal.pbio.1002503

Would you donate your poop for a loved one?

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