Poop is the best cure?

This column is written by Stig Bengmark – Professor Emeritus, scientist, lecturer and writer. Read more of Stig Bengmark’s columns here.

It’s increasingly becoming accepted that most diseases have their root cause in poorly functioning intestinal flora and thereby a poorly functioning immune system with increased permeability of bacteria and toxins into the body (leaky gut) among other things. In the long term, this leads to increased general inflammation in the body with impaired mood, fatigue, itching, and much more as a result, which in the long run leads to chronic, often fatal, diseases.

In a properly-functioning intestine, there should be 1.5 kg (and preferably 2 kg) of intestinal bacteria that form a kind of ‘poop organ’. This ‘organ’ is the same size, if not bigger, than the liver, and has a lot of important functions for our health. There should be at least 10 times as many bacterial cells here as there are ordinary cells in our body, and each bacterium has its own specific function in the ‘conveyor belt’ formed by the gut. Each bacterium is dependent on the bacterium before them on the ‘belt’ having performed its task well and, for the whole thing to work optimally, there should be about 1000 different types of bacteria – all with different special tasks on the ‘belt’. This adds between 100 and 150 times more genes that enable a large number of additional functions for the metabolism of the body and for our health. There also needs to be a lot of bacteria, a very large amount. It’s been estimated that there should be around 100 billion.

Bacteria need a lot of food in order to function

For those of you who have read Giulia Enders international bestseller ‘Gut – The inside story of our body’s most underrated organ’, it’s no news that poop and pooping habits are very important for our health. Unfortunately, those of us who have assimilated to the comfortable lifestyles of the West and the habit of eating industrially processed food, have in fact lost forever about 40% of the intestinal bacteria that our ancestors had and thereby lost the possibility of digesting and utilising the content of so-called tough fibres. The main reason for the ‘poop organ’ decreasing and no longer working properly is that we’re not eating the 1.5-2 kg of fresh fruits and vegetables that we should normally be doing (the majority should be vegetables and preferably raw and unripe) – then we might literally have a properly-functioning ‘poop organ’.

Raw food fundamentalists have test values that we rarely see these days

The amount of poop should be ample, 600-800 g, unlike nowadays when it’s around 60 g. The journey from mouth to rectum should take place quickly, 20-24 hours, unlike the 4-5 days it normally takes these days. Vegans have amazing test values: a systolic blood pressure of around 105, a diastolic blood pressure of just over 60, blood sugar of 4.7 mmol/L, an insulin value of 2.8 mU/m /mL, a CRP (inflammation value) of 0.52 mg/L (one-fifth of that of the control group), a HOMA-IR (quantifies insulin resistance and insulin production) of 0.59 (control group 1.36) and a triglyceride value (blood fat) of 56 mg/dL (control group 1.20), etc. (1).

Stress, chemicals, and medicines – lethal dangers to the ‘poop organ’

The most harmful effects on the ‘poop organ’ are caused by stress and added synthetic substances (mainly medicines), followed by environmental toxins of various kinds. It’s a complicated dilemma – you actually have to either choose between having a good intestinal flora or treatment with medication – ‘both of them’ doesn’t work, unfortunately. In principle, all medicines constitute a threat to the ‘poop organ’ – antibiotics, blood pressure medicines, sedatives, stomach medicines, and sleeping pills. Adding antibiotics has been shown to destroy about 90% of the intestinal flora and thus largely ‘extinguish’ its important functions such as digesting food, producing vitamins and other nutrients, sealing the intestinal wall to prevent leakage of toxins into the body, metabolising bile acids and synthesising important substances such as prostaglandin hormones and steroids (2). It takes months before the vital bacteria come back, if they even do. The same is true for the use of chemotherapeutic substances as standard cancer drugs – they reduce intestinal flora by a hundredfold, they reduce the important anaerobic flora by 10,000-fold, and they increase the amount of toxic bacteria in the intestine by a hundredfold (3). This type of treatment actually knocks out your own immune system and you become completely dependent on the chemical treatment being a hundred times more successful – otherwise it has made the situation worse, much worse. Such treatment must therefore be given only exceptionally, as with treatment with antibiotics and other drugs, and not routinely as is so often the case.

Resetting/reconditioing the ‘poop organ’

Maintaining the ‘poop organ’ needs to be given maximum priority. We need a constant supply of new bacteria, something that modern hygiene makes very complicated. Especially important is a large intake of raw plant foods – uncooked vegetables are actually very rich in healthy bacteria. It’s well known that children who grow up on farms do not suffer from allergies as often and, most likely, other diseases. The farmer should also have this advantage – if he hasn’t been exposed to stress and lots of agricultural chemicals – but unfortunately this is not the reality.

Exchanging poop

There are lots of animals in the natural world who eat poop – these animals are known as coprophages. Coprophages often eat their own faeces as well as that of others, which means that the bacterial flora is renewed both in the mouth and the gastrointestinal tract generally, as well as contributing to a regeneration of the ‘poop organ’. Coprophagy contributes, among other things, to faster growth/regeneration of the gastrointestinal tract and thereby to improved digestion. Veterinarians have practiced transfaunation (transfer of faeces) between different species for centuries. They’ve used it in particular for conditions which in cattle are called ruminal acidosis and in horses especially with chronic diarrhoea or constipation, as well as with the intention of increasing fertility.

Treatment with faeces has also been an important part of human medicine – something we started doing long before we knew anything about the existence of bacteria. This type of treatment could be seen in Greek medicine 2500 years ago. However, it was not until 1700 years ago that it was properly described in a handbook of emergency medicine by the Chinese physician, Ge Hong. Even in western medicine, faecal transfer has also been widespread. The German physician Franz Christian Paullini (1696), for example, gives a description in detail about its huge importance in a handbook called ‘Healing Stool Pharmacy’.

Among the peasantry, this form of treatment persisted for a long time. When I didn’t want to eat my porridge as a child, my grandfather (born in the 1860s) said: ‘Eating porridge is nothing – when I was little, if i had stomach problems, my father went out to the stable, took a ‘horse pear’ (Scanian slang for a clump of horse manure), squeezed out the juice and made me drink it’.

The introduction of antibiotic-resistant strains has changed everything permanently

There was an enormous sense of euphoria after the discovery of antibiotics – they thought they’d fixed the problem of infections forever. And the initial successes were great – it was really an unparalleled success story – large groups of diseases which were previously difficult or impossible to cure were dramatically reduced in number, some were even eradicated. But it wasn’t long until the bacteria turned out to be more cunning than humans and adapted to the situation, developing their own resistance to antibiotics.

Maybe it’s actually good luck in the long run, since we need our bacteria and antibiotics do actually kill all bacteria indiscriminately. In the short term, however, it creates an almost unsolvable situation – we don’t have alternatives that society is prepared to accept, and this is something we need to think seriously about. As soon as 2050, death from resistant strains is estimated as being the most common cause of death on the planet – significantly more common than cancer (and this despite the fact that the incidence of cancer will have tripled by then).

There are several varieties of resistant strains and one that created huge problems early on was Community-Acquired Clostridium Difficile Infection (commonly abbreviated to CDI). It really is a nightmare. Even today, it’s the most common cause of death from gastrointestinal infections and in the United States alone (with 300 million inhabitants) it’s estimated to cause no less than 100,000 deaths annually. Even worse, these numbers are rising quickly, making the situation unsustainable – even now, the treatment of CDI alone costs the US health care system $1.5 billion, and it’s increasing at a record pace. Despite treatment with the strongest and newest antibiotics (Metronidazole, Fidaxomicin, often Vancomycin), 83,000 people suffer a relapse each year, according to a new report (4). At least 20% of the population carry the Clostridium bacteria, but as long as we have a well-functioning immune system, they do us no harm. But when the ‘poop organ’ can’t do its job – such as after antibiotics or other difficult treatments on mostly elderly people (92% of patients are over 65 years old) – the bacteria take the opportunity to ‘strike’ and do so with full force. This is particularly common in nursing homes of various kinds – half a million cases are registered annually in nursing homes alone, of which at least 30,000 die.

CDI is not only fatal, it also causes significant pain before the person finally dies. One severe manifestation of CDI is a condition called pseudomembranous colitis, an often fatal condition in which the intestinal mucosa is completely peeled off and replaced by thick ‘furs’ of bad bacteria, for example, which leak into the body in large quantities and make the individual seriously ill. In the past, the only solution was to remove the entire intestine – a treatment that was never really successful – the mortality rate was at least 50%. Fortunately, a good friend of mine, the surgeon Ben Eiseman, finally solved the problem – he simply reintroduced the poop treatment and the patients who received repeated enemas with donated stools miraculously recovered, all six of them.

One might think that the problem was now solved and that one would choose to go ahead and test the method in large clinical series of tests, but unfortunately this hope was completely misplaced. The antibiotic, Vancomycin, also proved to be effective and our society and the authorities chose to prioritise this treatment over faecal transfer. For very understandable reasons, faecal transfer is not appealing to either individuals or licensing authorities, and it would be several more decades before it became a relevant topic again. Now, however, it has been shown that faecal transfer is a superior form of treatment for this condition and repeated treatments with Faecal Microbial Transplantation (or FMT as it is now called) have proven to be extremely successful. The method is very promising but lots of studies are still needed before it can be completely accepted.

Good donors are hard to find and nobody in the West has an optimal ‘poop organ’. Repeated studies show that FMT is more effective than treatment with Vancomycin, which not only often leads to relapse but also causes irreparable damage to the ‘poop organ’ and the immune system. For understandable reasons, the authorities are hesitant to fully allow FTM treatment but have nevertheless been forced to accept that FTM may be used after two treatments with Vancomycin have failed.

Even if it doesn’t happen often, you can in fact become infected by other people’s poop. Preparing and giving enemas with faeces is not particularly appealing to either staff or patients and it’s also difficult to find ‘poop organs’ containing the most useful bacteria. The logical choice should be to find donors among people who still live the way our forefathers did, and who have a large and varied ‘poop organ’. Maybe someday, deep-frozen poop from the South American Yanomami people, from the Hadza, or from Burkina-Faso, where people live like our forefathers and have between 20-40% more types of bacteria to offer, will be a commodity?

So how do we move forward? Maybe ‘synthetic poop’ – a composite created in a laboratory to be similar to poop – is a solution?

Literature references:
1. Fontana L et al . Rejuvenation Res. 2007;10:225–234
2. Caetano L et al. Antimicrob Agents Chemother. 2011;55:1494-15
3. Van Vliet MJ et al. Clin Infect Dis 2009;49:262-270
4. Rao K, Safdar N. J Hosp Med. 2015 E-pub
5. Eiseman B et al. Surgery. 1958 Nov;44:854-859