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| Steven Lawrence is the co-director of The Invisible Extinction, a documentary following two globetrotting microbiologists on a race to stop the destruction of our microbiome. We spoke with him about gut health, fecal microbial transplantation (FMT), and his own experience trying this alternative treatment option. |
| *This interview has been edited for length and clarity. |
| Q: | This is a loaded question, but how can poop transplants work to cure chronic illness? | |
| A: Scientists believe that a poop transplant from a healthy donor cures C. diff by rebalancing a person's gut microbiome. So, unlike antibiotics that kill a broad spectrum of our gut bacteria, FMT helps establish a healthy ecology, neutralizing the opportunistic bad guys. |
| The interest in trying poop transplants to treat illnesses like IBS, food allergies, and Parkinson's came out of the success of using FMT to cure recurrent C. diff infections, [when] antibiotics were ineffective. The cure rate of FMT for these infections is over 90%, which is astonishing. |
| FMT has also helped improve the efficacy of immunotherapy in some cancer patients being treated for melanoma. |
| There are a lot of studies happening globally to see if poop transplants can help diminish symptoms in these and other diseases, including Crohn's, ulcerative colitis, MS, depression, Alzheimer's, dementia, and autism. So far, the Food and Drug Administration (FDA) has only approved FMT for C. diff. No one knows what the future will hold, but the scientists we spoke to are optimistic that targeted microbial treatments will emerge in the next 5–10 years. |
| Q: | Can you talk about the process of what it's like to receive an FMT treatment? | |
| A: Receiving a poop transplant was not painful at all, but the prep was unpleasant. My FMT experience happened in 2014–2015, so it was fairly early days for the procedure. I tried infusions, which were administered to the colon through a rectal catheter. Subsequently, I also took capsules, which are sometimes jokingly referred to as "crapsules." |
| I need to emphasize that poop transplants should only be done under strict medical supervision with thorough screening of donors for all possible infections, which include viruses like hepatitis and even monkey pox. FMT comes with risks, some of which are unknown. Do not try FMT at home. |
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| Q: | What has your personal experience been like in trying FMT to improve your gut health? How do you feel now compared to when you first started? | |
| A: I had chronic IBS-C. After two FMT infusions, I had my first normal bowel movement in years and generally had improved gut health for 3–4 months. But after that, the benefits faded and I was pretty much back to where I started. |
| Subsequent use of capsules helped a bit, but again, the benefits weren't long-lasting. It's possible I needed more infusions to begin with or that regular infusions need to be given over a period of weeks or months. No one knows for sure. |
| Some studies have shown there is significant colonization of the gut with donor microbes, but that doesn't always translate into relief. And there is the unanswered question of how you match donor with recipient. |
| Q: | I was wondering about that. How does a person go about finding the right donor? | |
| A: The common wisdom is to seek a healthy donor who has never or rarely used antibiotics and is dietarily and physically similar to you. I'm slender and have intolerances to gluten and lactose, so made sure my donor was also slender, gluten-free, and didn't consume dairy. |
| The donor's poop was carefully screened by the doctor I was working with, but something happened to me a few weeks after the transplants that was a big surprise: I completely lost my taste for animal protein, which had been a mainstay of my diet for years. Searching for an answer, I remembered that my donor was vegan, so I assumed what happened was that his microbes were talking to me — perhaps through the gut-brain axis — altering my orientation to food. |
| Of course, this is just a theory, but my experience suggests not only the power of gut microbes but how much we still have to learn about them and how they affect our immunity, metabolism, cognition, [and] even taste! |
| Q: | What are some of your biggest learnings and takeaways from co-directing The Invisible Extinction? | |
| A: Co-director Sarah Schenck and I had so many learnings and takeaways from making the film that it's hard to answer briefly, but let me hit the key ones: |
- A diverse gut microbiome is not just important for our digestion but also for our immunity, cognitive function, and mental health.
- In America, the average child gets 3 rounds of antibiotics by age 3, 10 by age 10, and 20 by age 20. Disrupting our gut microbes is especially risky in childhood when our microbes are helping to train our immune system and we're developing brain function.
- Antibiotics are miraculous lifesavers, but because of their impact, you should try to make sure to only take them when needed.
There are many more exciting and important takeaways from the film, but I'll stop here, except to say that scientists in the U.S. don't get enough recognition for the hard and heroic work they do for humanity. It was a great pleasure to film with [them] and to give their work the spotlight it deserves. |
| Q: | Do you have any words of support or encouragement for folks living with gut health issues who may be thinking about alternative treatment options like FMT? | |
| A: Aside from doing your best to be patient, I'd suggest working with a doctor who is nutritionally-oriented and using scientifically valid tests to guide treatment. Everyone is different, so you need to understand that what works for someone else may not work for you. There's a lot of trial and error involved, and this will continue until science delivers better diagnostic tests and treatments. |
| The best and easiest way to improve your gut microbiome is by eating a high fiber diet. A lot of people also benefit from fermented foods, like yogurt and kefir, sauerkraut, kimchi, etc. |
| I'm really excited about the future when I think our understanding of the microbiome and genetics will make truly personalized medicine possible. Targeted "next generation" probiotics will be part of it. |
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