Eric Hopton for redOrbit.com – Your Universe Online
Doctors call it a fecal microbiota transplant (FMT). To the man in the street (or the hospital bed), it is often called a “transpoosion”: taking a sample of fecal matter from one person and transplanting it into another. This is done as a treatment for recurrent clostridium difficile infection (CDI).
But for one unnamed 32 year old woman who underwent FMT, the treatment had an unexpected and very unwelcome side-effect. After the procedure she began to pile on the pounds – 36 to be precise – and she is now classed as clinically obese. So, can someone else’s poo really make you fat, and is the procedure worth the risk?
Well, for starters, CDI is a very nasty condition. Around 5% of us have the Clostridium difficile living harmlessly in our gut. But the bacteria can start to run rampant following the use of broad-spectrum antibiotics and immunosuppressive agents to treat other conditions. CDI symptoms include purulent watery diarrhea, abdominal cramps, nausea and dehydration, progressing in some more severe cases to bloody diarrhea and fever. For the unlucky few, CDIs can cause pseudomembranous colitis, sepsis, toxic megacolon, and colonic rupture. When it gets this bad it is potentially fatal. Mortality risk is higher in patients with multiple conditions.
Clearly, CDI needs to be treated quickly and efficiently to protect the patient and prevent the spread of infection.
When the 32-year-old female in question developed recurrent CDI, she agreed with her doctors at the Medical School at Brown University that she would opt for a fecal transplant. She chose her daughter to be the donor. The patient had been suffering from diarrhea and abdominal pain after antibiotic treatment for bacterial vaginosis and had also been exposed to a family member who had CDI. Various other treatments didn’t control her CDI or the H. pylori infection that was compounding her condition. FCM was a last resort.
Until the transplant, the patient had always been a normal weight and was around 136 pounds with a BMI of 26. Her stool donor, her 16-year-old daughter, weighed 140 pounds (BMI 26.4).
One problem gone, another ‘gained’
The treatment was apparently fully effective. The patient did not suffer a further CDI recurrence. But within 16 months the woman had piled on 34 pounds. She weighed 170 pounds and, with a BMI of 33, was now considered obese. She had not lost any weight over the months she was being treated for CDI. In spite of her best efforts, including diet and exercise, she continued to gain weight. 36 months after FMT she was 177 pounds and presented with constipation and unexplained dyspeptic symptoms. Her daughter had also gained a considerable amount of weight.
The authors of the report, published in the journal Open Forum Infectious Diseases, said that there is a “possibility that the obesity was at least in part a consequence of FMT. The hypothesis of FMT triggering or contributing to obesity is supported by animal models demonstrating that an obese microbiota can be transmitted.”
They added that, “With the occurrence of weight gain after FMT in this case, it is now our policy to use non-obese donors for FMT. The untoward consequences of using non-ideal FMT donors are important, because patients may prefer to use a family member rather than an unrelated or unknown stool donor due to the perception that these sources are safer. However, studies have shown that FMT using a frozen inoculum from unrelated donors is effective in treating relapsing CDI.”
So, for those unlucky enough to contract severe recurrent CDI it may be best to rely on the doctor’s choice of donor and it seems that there are in fact a bunch of “professional” stool donors just waiting to give us their best offerings. These hardy souls are screened for good health, including a normal BMI.
In this case the treatment produced a cure for a serious condition and, while the risk of obesity is there, each patient will need to balance the risk and reward calculation.
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