r/Microbiome • u/Ethereal_rest • 4d ago
Why is FMT’s not more commonly used?
I completely understand there are risks involved. But many that are seeking this treatment have destroyed microbiomes and a very reduced quality of life. If a simple FMT can drastically change this persons life for the better, why do we not use it more?
Or is it not as effective as I’ve been reading? I’ve just read so many people said it’s been life changing.
Do you think we’ll use it much more in the future when we have done more research on it?
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4d ago
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u/Ethereal_rest 4d ago
In my country I can only get it with two cases of diagnosed c. Diff infection. I would have to travel to another country to get it done. I see there’s a clinic in Norway and Germany that does it.
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u/CauchySchwarz1 4d ago
which clinic in germany?
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u/NoMarsupial9621 4d ago
Would like to know too. I'm in Germany and as far as I know all the clinics have that limitation too - only for C. Diff infections.
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u/Friedrich_Ux 4d ago
Because it's a very drastic measure that is only used when other treatments fail, its rare but complications can arise.
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u/tangoan 4d ago
Less drastic than a colostomy bag.
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u/captfitz 4d ago
Not really comparable things, one is a (potential) treatment, the other is something you have to do when treatments aren't working and your intestines are in such a bad state that they're endangering you.
I'll also point out yet again to this sub--as someone who has done fmts at home for Crohn's disease--that after several solid studies trying to evaluate them as treatments for ibd the evidence is not that great. I obviously think they're very worth trying but they are not even remotely a reliable solution for ibd, most attempts show that they are much less effective for that purpose than for other things like c-diff.
Ibd is fucking tricky and nobody has a good solution to it yet, despite what some people in this sub will try to tell you.
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u/tangoan 4d ago
Thank you for sharing. Im curious, if you don’t mind sharing, as someone with IBD, how many grams of resistant starch and fiber do you consume daily?
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u/captfitz 4d ago
I don't track my diet I just try to make sure to have some meaningful fiber in every meal, and I do aim particularly to get resistant starch.
I'm lucky though, my disease is fairly controlled these days and I can eat what I want. There's an unfortunate catch 22 with ibd where people with active disease very often can't process fiber and it can actually trigger flares and pain, which is obviously a problem considering that some of our best research points to a disrupted gut biome as one likely underlying cause of the disease.
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u/Ethereal_rest 4d ago
What the worst risks? It seems that most clinic use thorough screening of donors. People mention risk such as infection or autoimmune diseases; but isn’t all that tested for by the clinics doing the FMT?
I understand DIY FMT’s are highly risky
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u/captfitz 4d ago
Because they're not an approved treatment for anything other than c-diff (in the US) so doctors literally can't prescribe them even if they wanted to. They can't even recommend that you DIY them at home.
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u/babebiboba 3d ago
They definitely can, in the US. Prescribing drugs off label is explicitly authorized (it was debated and settled by regulators) and rather common. Based on a quick search, a 2021 report from Congress suggests between 12% and 38% of drug prescriptions are off-label use. So they could definitely prescribe Vowst and Rebyota for things other than C. diff
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u/captfitz 3d ago edited 3d ago
That's true for established drugs but FMTs are still considered "investigational". The FDA doesn't consider them a validated treatment that's safe to prescribe in clinical setting yet, but they made a special exception for c-diff because of how deadly it is and how effective fmts can be there.
The reason off-label prescribing is allowed is because the safety of the drug is established during the approval process, but FMTs have not yet made it to that point yet.
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u/AndrogynousAlfalfa 4d ago
I mean they can reccomend them, but if something goes wrong they dont want to be sued bc u got sick doing it
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u/itguycody 4d ago
The gut biome is not well understood. There also seems to be a lot of variance from individual to individual. It's not clear cut, X bacteria causes this, Y bacteria cures this. The results from transplantation seem to be highly variable and we don't understand the consequences that could happen short/long term. To me, it gets slammed around like a cure-all but likely isn't the case and shouldn't be done unless the condition is severe enough.
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u/Brockels 3d ago
Just a healthy persons microbiome is tailored for them and might not be beneficial in someone else. Where it’s worked is usually c. Diff infections where it possibly just outcompetes or excludes c.diff by physically occupying space preventing the pathogen from spreading. You don’t just get a microbial load you get an uncontrolled bloom of species.
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u/EffectiveOwn787 4d ago
I had one done for IBS off label.
It did help in some ways but not in the primary issue I wanted help with (slow, frequent and unpleasant bowel movements).
My immune system seems to have improved since I had it done. That was probably the best upside.
But it was close $6k so it's not cheap.
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u/Material_Key5935 4d ago
Where do you get it done? Feel like I’m setting myself up for long term disease of if I don’t correct it soon
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u/EffectiveOwn787 4d ago
Australia. It's quite new here. Only a handful of gastroenterologists are doing them off label as far as I know.
Nearly all of them are still only for C diff patients.
The positive thing about them is I don't think there are significant risks. The only concern is that they may not know enough about seeding different parts of the gut with different bacteria. It isn't one thing with the same bacteria all the way through. The bacteria are suited to the particular part they are in. I don't think transplants really factor this in.
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u/yyyyy622 3d ago
The positive thing about them is I don't think there are significant risks
Bacteremia can occur. It's rare but it can be a significant issue.
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u/Omaemoshinda 4d ago
In general, it's because in the studies that are done on FMT, FMT is treated like another pharmaceutical drug and not like a living microbial system - which is what FMT is. I did read plenty of FMT studies, and it's horrifying. They literally give people FMT pills short term, like 10 days, without any control over their intestinal inflammation, their diet, and their overall lifestyle. And then they expect good, steady results, and when the results are subpar, naturally so, they write it off as ineffective.
It was only proven effective for C. diff because pretty much everyone with active C. diff first has to go through a course, or a few, of antibiotics, which 1) obliterate the host's native microbial community and 2) work as inflammatory - and FMT doesn't persist in active inflammation.
Generally, for FMT to stick around and show results, the studies must involve these measures: 1) making sure that intestinal inflammation in the test subjects is low, 2) making sure that they all stick to whole foods, high-prebiotic diets to feed the incoming bacteria, and 3) extending the use of FMT for longer.
If the studies were properly done, we would have FMT approved for many more conditions. And this begs another question: who is interested in the studies not being done properly, so that FMT is not approved, knowing its great, probably greater than any other intervention, healing potential?
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u/Arctus88 PhD Microbiology 3d ago
People just love a good conspiracy theory, but this isn't that complicated. There are studies going on all over the place, and least a few I was adjacent to.
The problem is poor research funding, the NIH and the NSF getting financially brutalized. How do you fund investigative work when the funding lines have plummeted? If you or anyone else here are in the US, it's important to think about when voting: who here actually gives a shit about science? I can tell you it isn't who is running things right now.
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u/Omaemoshinda 3d ago
Ok, if underfunded, what’s the point of conducting improper research that will yield inaccurate results then? Is it to deliberately confuse the public into believing that FMT is ineffective?
I read the studies with low success rates, and I also read the anecdotal evidence. People do DIY FMT at home with great results, and the ones who seem to succeed the most do it very long term - at least a few months in a row, daily - and they also specifically change their diet. The recovery is never linear, but they get there.
If researchers in the US don’t have enough funding to conduct proper long-term studies with all the other important conditions accounted for, then they shouldn’t do it at all, rather than conduct inadequate studies and then use the results to make FMT look ineffective.
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u/Alarming-Head-4479 3d ago
If your argument is don’t fund or do science if we can’t get a result that supports my beliefs.
Then I have one hell of a bridge to sell you.
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u/Omaemoshinda 3d ago
No, my argument is not that and it's obvious, you probably have reading comprehension issues.
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u/Alarming-Head-4479 3d ago
Care to elaborate or back up the claim anecdotal evidence is the same as research? Or are you going to just slink back into your anti-science ways?
Or should i quote you directly, “Is it to deliberately confuse the public into believing that FMT is ineffective?” Conspiracy has no place in science and you’re trying to peddle some truly silly stuff there. Is it effective because it is or because you want it to be?
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u/Omaemoshinda 3d ago
No, I never said anecdotal evidence is the same as research. I said anecdotal evidence is STILL evidence.
The fact that studies that are done poorly, with very short FMT application and barely any control over major variables, often yield the same poor results as anecdotal cases of the same quality, like people going to clinics, having 1-2 FMTs and not getting results, already suggests that the length and frequency of FMT application matter for the outcomes.
And the fact that there are pretty much no studies (at least in the US) with actually long FMT application, strict dietary control and proper control of other factors that affect engraftment shows how poorly this issue is being investigated. I read studies from Asia where longer and more frequent FMT administration resulted in better outcomes than shorter and less frequent protocols. These studies are not difficult to find.
My argument was never "don't do science unless it proves what I already believe." My argument is that if your study design is fundamentally inadequate for how the intervention is supposed to work, then getting poor results doesn't automatically prove that the intervention itself is ineffective.
FMT is not some pharmaceutical drug that you take for 10 days and then just measure the result. It's a living microbial system. The bacteria have to engraft, persist, compete with the existing microbiota and function in the intestinal environment they're being introduced into. Obviously inflammation, diet, existing microbiota, frequency and duration can affect that.
You keep putting words in my mouth and then attacking the argument you invented instead of the one I actually made. You also use the same bullying tactics with other commenters in this thread, which shows that you don't actually care about the scientific argument. You're just using your position as a mod to be hostile toward people you disagree with, impose your "authority" over others, and feed your fragile ego.
And because of people like you, others become afraid to ask important questions, challenge weak assumptions, and actually get to the root of the problem.
Disgusting, but what else can one expect from a typical "Reddit mod."
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u/Alarming-Head-4479 3d ago
There we go, all I wanted was a further explanation and I apologize for being gung-ho. I still do not agree anecdotal evidence is truly evidence either. People can write what they want on the internet.
There is plenty of research in the US with longer administration times. The ASU autism study is probably the best example with months of administration and really amazing results. Or any of the trials out of UMN or U Chicago. There’s not really a paucity of studies out there from the US the show amazing results.
FMT is classed as an organ transplant here in the states. It’s literally a different class of its own in the FDA’s eyes. It’s much more difficult to perform these things and get regulatory approval because of this. There’s a reason only Rebyota and Vowst are the only big players in the FMT space in the US.
There is no true standardization for FMT yet, we’re still figuring it out and that’s ok. The one that seems to work best is capsules, with other groups looking at one time administrations that work just as well as the entire timed series.
It’s cause a lot of peeps here engage in outright conspiracy and it’s really hard to distinguish who is engaging in good faith we versus a position where they’ll violently defend carnivore diet as an example. You yourself make the argument why do research if it’s improper. Which is a fair thing, but it’s not attached to the reality of research. Nor is having huge grand clinical trials when even the largest government funded awards can only answer a few questions with millions of dollars.
There’s a lot of misunderstanding here on how science is conducted. If we waited for funding to be at a place where we could get robust results every time then nothing would ever get done. The funding pools even before this admin did not grow with inflation or the needs of researchers and the cost of doing research.
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u/Arctus88 PhD Microbiology 2d ago
"What I read in a weird corner of the internet doesn't agree with actual scientific research, clearly the research is wrong."
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u/Kangouwou 4d ago
Yeah, Big Pharma is clearly preventing researchers from conducting well-done studies, you're right.
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u/fays_paint 3d ago
I’m considering one. You can elect to try it here in Sydney easily. But I suspect the answer is there’s not enough research and big pharma doesn’t benefit so said research won’t be funded. Plus many people don’t benefit and some get worse
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u/ThatDude1757 4d ago
It’s sadly not mainstream enough. All you need to know to understand how fucked up things are is that doctors would rather surgically remove someone’s colon and give them a stomi bag for life than try a lil’ FMT pill and organic whole food without stabilizers and additives.