Enter the Poop Pills…

Just over three years ago I reported on a very promising scientific result battling C difficile infections. This infection has the debilitating effect of chronic (think years on end) diarrhea. The proposed but experimental way to cure it was doing fecal transplants, basically taking stool from a healthy person and, after treatment, inserting it directly into the intestines of the patient. The results were stunning: people got better really quickly.

A photo of generic capsules, since who wants a more specific image of "poop pills" than that? Courtesy of Gokalp Iscan via Pixbay.

A photo of generic capsules, since who wants a more specific image of “poop pills” than that? Courtesy of Gokalp Iscan via Pixbay.

There is, apart from the icky nature of the transplant, another issue: the stool is delivered by a tube through the nose all the way into the intestines. It’s not very easy. At the end of my previous article I mentioned that work is ongoing to identify the bacteria present in the stool and deliver them to patients in pill form. At that time, this was called “pseudo poop” (because it’s only the identified bacteria, not an actual sample). Not the best choice of words, marketing-wise.

Just last month, I read about a clinical trial that will start next month in Boston by a team in the Massachusetts General Hospital, lead by Dr. Eliane Yu. People will either receive a tiny amount of stool in a pill, or a placebo (the study I reported on in 2013 wasn’t double blind). And yeah, even though the official term is “fecal microbiota transplant capsules,” a Washington Post article reported on it the treatment as “poop pills.”

Because it still is poop. Apparently it’s easier to very critically select a donor than it is to identify the needed bacteria. There is another article on the Washington Post’s website detailing what the process is. Do note that these donors are now strangers; in initial trials they were relatives of the patient.

So, what is the goal of this clinical trial? Treatment for some other debilitating disease? Well, this time it’s a test to see if taking these pills can reduce weight. The article headline put it more succinctly: “Eating poop pills could make you thin. Seriously.” The test here is to find donor “samples” from lean persons, give them to other people and track their weight. That seems more like speculation, but there appears to be some ground for this. According to this line of thought, bacteria in our intestines might predispose us toward obesity or not. Apart from a less perfect observational study (measuring gut fauna and correlating it to weight), double blind studies like the one here might make the matter clearer. Though I would like to caution for having too much optimism: a pill alone will not solve the obesity problem.

About Bruno Van de Casteele

Philosopher by education, IT'er by trade. Allround Armchair Skeptic, History Enthusiast, Father of Three. Twitter @brunovdc Personal website: www.puam.be
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8 Responses to Enter the Poop Pills…

  1. T M says:

    My mother-in-law has been dating a guy in Washington who has been harvesting his poop and putting it into pill form for many years. He has been selling it to unsuspecting buyers as part of the ‘Good Bugs’ movement (I don’t know how they refer to themselves, but this sums it up). Somehow, this modern messiah has convinced these people – or at least himself – that the bacteria in his gut is somehow superior to everyone else’s and by eating his poop it will cure them of diseases and make them live longer. I don’t know how successful he is, but this has been going on for many years.

  2. Helmut says:

    Hi Bruno,
    thx for what is again an interesting follow up blog! One comment to add: I’m a bit surprised that you only mention an injection via the nose (next to the pill that is still under development) as mean to introduce the stool in the patient’s body. Typically, as you can read on their website, university of Antwerp is using the injection via the nose only in 25% of the cases. In 75% injection is done using coloscopy. Same is true at the university of Leuven. Guess it must be the same in most major university hospitals.
    Cheers,
    Helmut

    • thanks for that comment. The articles I referred to in 2013 and now indeed only mention injection via the nose. I did some reading, and indeed it seems via colonoscopy is done more – you are correct. Clinically that seems more straightforward to administer (shorter route).

      However, why did I only find initially about injection via the nose? I guess it’s a media bias … it’s easier to portray in the media …

  3. PJ says:

    There is some evidence that one patient who was suffering from C-Diff was given a transplant from her daughter who was overweight. The mother’s weight then went up dramatically, leading researchers to think that it’s not just the stool but the donor of the stool that may have an influence on the recipient. I don’t think the intention of the transplant to the mother was to improve her microbiome in order to help her lose weight. She was already underweight from diarrhea brought on by the C-Diff.

  4. Ray Loscalzo says:

    Fecal transplant pills help patients avoid invasive procedures while restoring healthy gut bacteria.

  5. bandit, Albuquerque says:

    Don’t have the source handy, but there is a version of the pill that has several layers, designed to be taken by mouth and will not dissolve until in the gut. Need roughly 20 of the suckers… and they are not small.

    Otherwise, the article is consistent with what I have read about this. The main reason is severe diarrhea. The weight loss was based on an observation in one patient.

    The other thing is a huge dose of antibiotics to kill off the existing gut bacteria. Then come the pills.

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