Dispelling the myths – The facts about FMT and questions you should ask when choosing a clinic
When considering a new and innovative treatment such as FMT, the first consideration is patient safety. “First, do no harm”.
At the Taymount Clinic, medical doctors provide clinical and medical compliance. FMT implant procedures are conducted by Registered Nurses with current registration.
This treatment is all very new, what if something goes wrong?
This question is seldom far from the thoughts of patients during a treatment program. For peace of mind, the Taymount Clinic have pioneered the world’s first FMT-specific Medical Insurance for both the treatment AND the implant product. We are working to specification from the UK’s largest medical insurance provider BUPA to enable FMT to be available under private medical insurance for patients whose doctors recommend it.
What standards are in place?
We work to Clinical Pathology Accreditation (CPA) standards and our laboratory is currently undertaking Medical Laboratory Accreditation ISO15189 which identifies our laboratory as being managed and operated at the highest level of Health and Safety.
Are the donors safe?
Before the laboratory screening processes, our donors undergo an exacting selection process where they are asked about high-risk sexual activities, recreational and other lifestyle habits (open water swimming, foreign travel, recreational and medical drugs, high medical risk activities, obesity, mental health, etc).
Successful donors are professionals with a strong altruistic tendency, who care about their health and diet. They understand the direct connection between their own health and their food intake and they make discerning quality choices (often choosing organic produce). The selection process very quickly identifies and eliminates those who are focussed on donating for the money. We are only permitted to reimburse and compensation for time and travel and not to reward our donors. Our donors tend to be people who are in public-serving careers like firefighting, police, medical and other altruistic work. Making a difference to peoples’ lives comes naturally to them. We coach and monitor Donor food choices, set challenges and run league tables to encourage them to eat a wide diversity of foods to broaden their microbiome.
Donors are tested for disease every single month. The full range of tests and analytes are featured in our FAQ section of the website www.taymount.com. This regular testing gives the donors a unique and very valuable insight into their control over their own health.
Do you use faecal transplants? Is it whole poop?
Perhaps the most important part of our approach to FMT is how we process the raw material very differently from other facilities. The single purpose of FMT is the “M” the Microbiota; the community of microscopic organisms. A transplant of microbiota increases the diversity of bacterial species and also increases the density (numbers) of each species. Therefore we only want and need the microflora, everything else in poop is either irrelevant or potentially disruptive or harmful.
We start the process by removing the food; what if the patient is allergic to food that the donor ate the day before he or she donated? We remove the donor’s gut epithelial cells (human cells that are worn off and thrown away by the gut lining). We remove toxins which have been dumped into the poop by the donor (this is another of its primary functions). We dissolve and remove a large quantity of the supernatant solutes like the donor’s hormones and other unwanted substances.
Hormones? Imagine a female patient whose female testosterone is already at her very upper limit, receiving a whole poop implant from a series of male donors also at the upper limit of their male testosterone. This could add unwelcome hormonal complications to someone who was already facing significant health challenges.
Top Down or Bottoms Up? …and what about tablets or capsules?
Capsules may well be the delivery method of the future, but currently, attempts to provide protected microflora in the required density and diversity and delivered to exactly where they are needed, is proving a hit and miss affair. Techniques and materials will doubtless improve over time.
Mouth or South? Endoscopic oral delivery brings its own difficulties and hazards. Rectal delivery is recognised as highly effective, but colonoscopic delivery is expensive, poorly tolerated, has risks, frequently requires sedation, is time consuming and is expensive. The Taymount choice has always been by rectal catheter. It is is safer, cheaper, highly effective, accurate and exceptionally well tolerated and is being increasingly copied by other clinics which is the ultimate compliment and an indictment that we used good science and made the right choice, right from the start.
What is this “anaerobic thing” all about?
95% of the species that are commensal (normal) to the human gut are in a group called Obligate Anaerobes – they cannot survive in oxygen and will die when exposed to it (like in a kitchen sieve and a food blender). It is not just home treatments that are conducted in this way, but an alarmingly large number of clinical preparations ignore this vitally important bacterial characteristic.
The Taymount clinic has always recognised the fragility of the anaerobes and has used anaerobic laboratory processes from the very start of the FMT program. It is good science. Our laboratory processes in a Carbon dioxide and Nitrogen environment.
Isn’t fresh better than frozen?
Donor testing is not a straightforward Pass/Fail situation. It is not a matter of testing today and declaring them clear of infection/disease. Some diseases take quite a bit of time to incubate to the stage where they can be recognised by testing. In the meantime they can be quietly developing a disease that could potentially be very serious for an already immune-compromised patient.
At Taymount, we quarantine the implants at -80°C for 3 months. This is the standard period of time where most diseases will have very clearly infected the donor and produced identifiable symptoms or the disease will have sufficiently developed to be very easily identified by laboratory testing.
Does freezing damage bacteria?
Yes it can if the correct cryo-protectant is not used. Taymount takes care to use professional microbiology cryo-protective techniques to keep the bacteria perfectly safe.
If your FMT treatment is offered to you fresh, ask yourself how it can be guaranteed safe, were the obligate anaerobes protected? Does it contain a lot of hormones and toxins? What about the donor’s food material, are you allergic to it or will it prompt an immune response from you?
What makes a good donor?
Dr Jeff Leach (Author, “Rewild”) has said:
…. By reducing our exposure to the terra firma of nature and its microbes and carpet-bombing our guts with medications and monotonous diets, we likely harbour a less diverse and thus less resilient gut microbiome of any generation in human history. All of us – every last one of us – are in varying stages of gut dysbiosis. If fact, we may be so compromised as a generation, that any attempt to model a normal or optimal gut microbiome from our ranks, may be seen as some kind of fool’s errand.
In recognition of this alarming and poor indictment of the human state, we have hunted down the healthiest donors that we could find, but even they cannot provide us with the diversity that we were looking for. People directly model their gut bacteria with their immediate environment – that is, their food, their geolocation, activities, occupations, relationships and many other factors that make them each unique.
Each of our donors is very good at some part of their microbiome, but not one of them is good at all of them. We have a set of “donor superheroes”, each with a particular superhero microbial talent. We have donors who are like proverbial Ironmen, or Captain America, or The Hulk. When we put them together, they make the “Avengers”. Each day, a Taymount patient receives a different implant from a different donor; this way we create the broadest diversity our environment can provide and help to offset Jeff Leach’s grim condemnation of modern life.
So, is all FMT the same? We hope we have challenged you to consider very carefully where your FMT comes from.
The Taymount Clinic are exclusive specialists in FMT since 2012. Over 8000 implant procedures.