A Promising Pill, Not So Hard to Swallow
nytimes.com
nytimes.com
I'm just curious what the mechanism of action. Is it through it's mu receptor antagonism or something else?
I had IBS from the age of 10 to the age of 30. First off I have to say that IBS is not even remotely comparable to IBD. For most people, IBS is a very inconvenient life-altering syndrome. IBD is often 100x worse, increases the risks of colon cancer and can be life threatening. I wouldn't wish ulcerative colitis or Crohn's disease (IBD) on my worst enemy.
Beyond that, I'm not sure why you think this pill would help your IBS. It is specifically meant to treat one particular problem - a clostridium difficile infection. Typically the colon is populated by helpful or otherwise non-harmful bacteria. Clostridium difficile is an opportunistic infection that often takes hold after someone takes a course of antibiotics that kills all the helpful bacteria. The fecal transplant puts back the normal bacteria into your colon, attempting to crowd out the clostridium difficile bacteria. There is anecdotal evidence of fecal transplants helping IBS or IBD but it has not been studied well. Source: http://www.mayoclinic.org/medical-professionals/clinical-upd... I would suspect much of the benefit to IBS from a fecal transplant (or fecal transplant pill) derives from the placebo effect.
After 20 years of having IBS, the best cure I found for myself was to eat a lot of dietary fiber and drink a lot of water. I haven't had symptoms of IBS for over 12 years now since doing that. Unfortunately I find I have to eat about 40 grams of dietary fiber and drink about a gallon and a half of water per day. That takes actual work, but it's worth it. Source on dietary fiber treating IBS: http://www.aboutibs.org/site/treatment/diet/dietary-fiber
The IBS issues I've dealt with have lead to some catastrophic effects. Twice after dealing with stomach flu/food poisoning I developed gastroparesis or severe gastric motility issues. I lost 60 lbs during the first bout in 2006 and 45 lbs during a second bout in 2012. My quality of life was horrible during these periods of time. I basically lost a year of my life each time.
Luckily you found a solution for your IBS, many people have not. If simply upping my fiber solved the problem then I would be set, but fiber lead to more gas and pain for me. Probiotics on the market often leave me constipated and nauseated. Even if I stick to a regimen irregularities continue, and my body still seems to ebb and flow. So far regular strenuous exercise seems to help me, but IBS often leads to fatigue.
This all happened to me after I went swimming in a river with friends and got ill later in the evening. I may have swallowed river water contaminated with agriculture run off. Nothing has been the same since then. This is similar to many people's stories about IBS. The hope is that the pill would restore whatever was killed off due to the initial illness, which might result in regulation and relief. Yeah it's a shot in the dark and not officially meant to treat ~anything~, but at least it's something with some promise. The doctors over the years haven't had an answer for me. Treatments are also used off label all the time and trials are often very narrow in scope to meet regulatory guidelines. Somehow I think you know this already and are being a bit of a smartass.
http://www.aboutibs.org/site/what-is-ibs/intro-to-ibs/diagno...
Dramatic weight loss as you've outlined is a sign you're suffering from something more serious than IBS. That makes sense since you list several other non-IBS related disorders ("stomach flu (sic) / food poisoning" as well as gastroparesis). The thing that doesn't make sense to me is why you attribute these things to IBS?
If simply upping my fiber solved the problem then I would be set, but fiber lead to more gas and pain for me.
There is nothing "simple" about increasing your fiber in a manner to solve IBS. As I mentioned in my original comment, it takes actual work. First, you have to eschew eating anything at all throughout the day that doesn't have dietary fiber. Second, you must gradually increase your fiber intake over a period of a year to avoid gas buildup and pain. Third, you must actively seek out fiber rich foods to eat throughout the day. As I said, there is absolutely nothing simple about it.
This all happened to me after I went swimming in a river with friends and got ill later in the evening.
Again, I'm questioning why you think this has anything to do with IBS. You don't catch IBS by swimming in a river.
I am not doubting the work it's taken you to achieve your remission of IBS, but I am saying your cure may not be the cure for others dealing with IBS.
>>You don't catch IBS by swimming in a river.
In a contaminated river you certainly can.
Have you really researched IBS fully? Post-infectious IBS is quite common. There have been major studies on it.
http://www.aboutibs.org/site/what-is-ibs/intro-to-ibs/post-i...
http://fhs.mcmaster.ca/main/news/news_2010/walkerton_study.h...
because of this public silence i thought for the longest time that the way i shit was just the way all people shit: a roulette roller coaster ride through the whole bristol stool scale
once i removed wheat flour from my diet and began eating a quinoa`oatmeal hybrid everything changed for the better
it has to be tricolor quinoa because the three colors: white, red, and black; all burst at different rates when boiled
what you want is the whites to be fully popped, some reds to be beginning to pop and the blacks unpopped to pass through you like diamonds on a drill bit
cook the quinoa, then drop in an equal dose of oatmeal with some water and stir until the oatmeal is as soft as you like it
oatmeal alone is a poor rice substitute, but the mix gives a texture that makes the combination a perfect substitute for any meal where you might use rice
my body has since thanked me in all those wondrous popsci ways: more energy, better focus, less irratibility
i feel better and the difference was noticeable in days
On another note I have a pet theory that the increasing prevalence of IBS is caused by the widening use of antibiotics everywhere, both as medicine but also in food production.
Now that you mention it I haven't ever seen it abroad. Apparently the common alternative is Lactobacillus acidophilus LA-5: http://en.wikipedia.org/wiki/Lactobacillus_acidophilus
Wikipedia lists Chr. Hansen as the manufacturer, coincidentally also a Danish company: http://www.chr-hansen.com/products/product-areas/probiotics-...
[1] http://www.nytimes.com/2012/05/17/health/research/popular-an...
Anywhere in the 3rd world, especially around the equator. Not everywhere is too concerned with cleanliness and food safety, and even if it's OK for the locals, coming from a foreign country/continent you won't have immunity...
At least to me this idea seems very strange. Not only are there side effects and antibiotic resistance to consider, but they also won't help you at all against viral diseases or protozoans (unless you take special antibiotics).
Not to mention the effects on antibiotic resistance.
Traveler's diarrhea is pretty common, and antibiotics are one of the prescribed remedies.
"If you can just open a freezer and take out a poop pill, that’s wonderful.”
While the pills are not being marketed yet
(though the science behind it, in itself, also still seems shaky at this point)
Repulsion shouldn't play a factor. People will get used to it. Remember when pig heart valve transplants were a big issue?
Podcast #59 Glenn Taylor - Fecal Microbiota Transplants
>For more info visit http://lessdoing.com/ Ari's book http://www.lessdoingbook.com In this episode Ari talks with Glenn Taylor of the Taymount Clinic. Glenn specializes in applying Fecal Microbiota Transplant (FMT) techniques to a broad range of gut conditions. FMT restores normal gut microbiota by implanting Standardized Gut Flora from tested and optimized sources. Listen to how Glenn has seen patients literally cured from debilitating illness such as Crohn’s, Ulcerative Colitis, IBS, Multiple Sclerosis, Rheumatoid Arthritis and other disease simply by restoring their gut bacteria to a normal balance.
Can they please figure out which bacteria are actually important and then I will take that? Instead of eating actual shit. Thanks.
Your digestive tract is a jungle, with more species than man will ever fully know about. When too many of certain types go extinct, the ecosystem breaks down, and bad shit starts to happen (come to think of it, literally).
It may take decades to figure out all of the specific species that matter most, and in what proportions. We aren't even certain which bacteria are common to all people, and which are specific to certain cultures / races / geographies / genders / who-knows-what-else. I bet people who eat a lot of KFC have a very different personal biome than I do.
In the meantime, here's 'one weird trick' that seems to just work.
The more this works, the more we'll be inclined to study it. We'll know eventually.
Even brewer's yeast is discarded after a few generations, usually, since it mutates enough to change the flavor of the resulting beer, and that's in an extremely well controlled environment.
Imagine that happening every six weeks in your gastrointestinal tract. Multiply by 6 billion people. I'd guess it's extremely unlikely we're going to thoroughly investigate all of those different variations on the theme.
Is it out of the question for people to be consistently pooping & supplying this data so we have ongoing tracking of the ratios of the various bacteria present in the population? Some clear patterns may arise.
http://academy.asm.org/images/stories/documents/FAQ_Human_Mi...
That represents the consensus view (ie no exotic theories). The really good stuff starts on page 10.
They talk about mother's milk/breast milk being a source of microbes for babies at birth. I have heard this before and I wonder if it could be an alternative to this pill/fecal transplants?
Mother's milk is mostly viruses, so it's unlikely this would work against CDiff. For other users is sounds interesting though!
> Can they please figure out which bacteria are actually important and then I will take that? Instead of eating actual shit. Thanks.
That's exactly what my co-founder and I are doing :) http://www.generalbiotics.com/probiotics
In the future the medical system will analyse your gut flora and identify the specific mix of strains you need to take to remedy the situation.
The alternative to taking one of these foecal pills would be to take lots of different probiotics, in appropriate portions, over time. This is, after all, what animals do naturally to create gut microbiomes in the first place. (It's hypothesized that this is why we like the taste of things like blue cheese: maximizing gut-biome biodiversity is apparently good for reproductive fitness, so we've evolved to enjoy the taste of things with novel bacteria on them.)
Instead of going straight for the generic criticism, you might ask "what's cool about this study?"
Overall open-label studies just give false hope to people who don't understand science and the placebo effect (i.e. most people).
You understand how the placebo effect works then? You'd be the first person in the world that did.
As kevinalexbrown said, this trial can be seen as a first step, nobody who read the article could reasonably expect the FDA to approve this tomorrow.
What I meant is that - as I pointed out above - this study will have a siginificant placebo effect, and the results should therefore be treated with extreme caution.
We still have no idea whether this treatment actually works, and I'm constantly surprised that studies like this continually make the first page of HN.
I think the problem is that most people don't know that the placebo effect actually exists (or at least, they forget about it when they read a study like this, or downplay its significance). Even many researchers underestimate the placebo effect, and then we end up spending billions of dollars a year on a useless treatment until someone actually proves that it is no better than placebo.
http://www.nytimes.com/2014/10/07/upshot/the-placebo-effect-...
You have no way of proving this. Let's face it, we do not have a good grasp on the factors involved in the placebo effect, for example we don't know whether someone needs to be susceptible to it for it to work, we don't know how to reliably trigger it, we don't know whether there are limits on its effects in the body. As you're an author of a book on the subject, you already know all this.
Regarding people's hope, there's no guarantee that people will read more into the study than they should, but we should give people the benefit of the doubt. It's fairly common to read about promising scientific studies that take a long time to develop into something more tangible, if at all (for example, here's a whole website full of such stories... http://phys.org/). Anyone with an interest in science is going to be used to these stories by now, but it doesn't mean there isn't something promising that can come of single research studies, once the data can be verified.
http://www.webmd.com/ibs/news/20101221/secrecy-may-be-unnece...
A Nature review looking at fecal transplants for C difficile cautions that a strong placebo effect is common with invasive procedures. (This particular study isn't invasive, but it is highly novel, and that has also been shown to correlate with a large placebo effect).
I don't disagree with this conclusion at all. The existing data is very encouraging, but more studies are needed before it can be considered for widespread use.
If an open-label, uncontrolled study of fecal transplants cures a ton of people, that's very strong evidence that it works.
Closed, double-blinded clinical trials offer different value for different diseases.
That's why the FDA will accept an open-label, uncontrolled clinical trial for a drug that treats cancer.
http://www.webmd.com/ibs/news/20101221/secrecy-may-be-unnece...
Also, there are currently no RCTs showing the effectiveness of fecal transplant for C difficile, and a Nature review cautions that there will be a strong placebo effect for invasive procedures:
http://tcminfection.com/pdf/5%20(119).pdf
(This particular study isn't invasive, but it is highly novel, and that has also been shown to correlate with a large placebo effect).
I have seen other open-label uncontrolled studies for fecal transplant that had some pretty spectacular outcomes. Is such a trial as rigorous as a RCT? No, but it's a pretty positive signal.
Anyway, thanks for helping to prove my point that most people don't understand the placebo effect (the downvotes also help to prove it :)
I don't see how diarrhea factors into it. Are you saying that you think the patients will experience less diarrhea because they knew they were swallowing poop?
Interestingly the study did a stool test for C dificile before the study (to see if the participants actually had the infection) but they didn't do any stool analysis after the study.
All in all, there are a lot of deficiencies with this study and it doesn't really tell us much.
And yes, the placebo effect has been shown to reduce diarrhea (as I pointed out above). This is expected, as the HPA axis (the body's stress system) is one of the systems that controls bowel movement.