I figured out my gut biome issue, might explain why FMT's don't take: B12 and folate deficiencies creating an environment that hinders the success of FMT Enhancing 

Enhancing the outcomes of FMT

bizzoc

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I've been sick for a while trying everything and finally found the solution. After going through all different diets, I landed on a high prebiotic WFPB diet (100-150g/day) and after 3 months, a qPCR stool test (GI MAP) showed low levels of Strep/Staph/Candida and no other pathogens in the problematic range. It also showed lower levels of Bifido/F prausnitzii/Lacto/Akkermansia. The most interesting was the inflammatory markers which were extremely low, which is the only way the biome will grow as I understand it. Unfortunately no improvement with my stool appearance (color/consistency).

I discovered methylfolate after stumbling on to a guide about correcting a B12 deficiency. It is important to note that my B12 levels in all my blood work for years has been good (high) despite illness, but apparently that means nothing, and considering how important B12 is for gut health, this was intriguing to me. After 1 month of high dose supplementing with methyl-B12, in addition to the above diet, no change. The guide also mentions how critical methylfolate is for B12 utilization, but my diet has 6x the RDA of folate, so I assumed it was fine. I then came across some studies on how high doses of methylfolate are required to heal the central nervous system, but didn't think anything of it's effects for the gut given the 6x RDA of folate. Turns out there are a variety of reasons why high amounts are required for any noticeable affect, MTHFR, COMT, illness. So I decided to try a bottle and I experienced instant effects. I was in bed for a week which is normal and known as "wake-up" symptoms, suggesting there is a serious deficiency and your deficient symptoms are "waking up" essentially. After the week, I upped the dose as tolerated to 4mg/day (10x RDA) and stayed there to test. Within 1 month, my stool returned to "normal", the fungus was gone, along with some psychological symptoms (irritability, anxiety, depression, fatigue). Before the fungus in my stool disappeared, I saw pieces of undigested meat (steak) come out in my stool when I hadn't eaten any for about 4 months! I believe the steak was feeding pathogens in the small intestines that were producing toxins and metabolizing the bile before it reached the colon, or perhaps simply crowding out the beneficial bacteria (BSH enzyme producing) in the colon that metabolizes bile and turns it brown. I believe this worked because the deficiency in methyl-B12/folate caused nerve degeneration and since the gut is filled with nerves (enteric nervous system), it negatively affected my gut motility which allowed the steak to sit and rot.

Perhaps this can help others as it is foundational to the gut and not commonly found as most blood tests are inaccurate. It is important to note that the guide mentions the entire B12/Folate utilization system is dependant on a variety of other vitamins/minerals, so if you are deficient in one of them, utilization will go down. Those are zinc, magnesium, iodine, molybdenum, potassium, iron, B-complex, and vitamin C/D/E.

I would post a link to the guide but I'm not sure if I'm allowed.
EDIT: https://web.archive.org/web/20241205051028/https://old.reddit.com/r/B12_Deficiency/wiki/index

Here is an excerpt of what a deficiency in the above two vitamins does to the gut:

Vitamin B12 deficiency impairs mitochondrial metabolism in ileal epithelial cells, reducing their mitochondrial respiration and fatty acid β-oxidation, which compromises epithelial oxygen consumption and disrupts intestinal oxygen homeostasis. This leads to altered epithelial cell metabolism, diminished proliferation capacity, and increased susceptibility to inflammation and pathogen expansion, such as aerobic Salmonella growth. B12 deficiency also alters the gut microbiota composition, reducing beneficial short-chain fatty acid–producing microbes and metabolites that support epithelial health. Additionally, B12 deficiency can weaken the intestinal barrier by impairing junction protein expression and increasing inflammation. Folate deficiency in the gut mucosa causes increased crypt depth and nuclear size but reduced epithelial cell mitosis, indicating impaired epithelial renewal and function. Both deficiencies thus promote epithelial dysfunction, inflammation-prone states, and dysbiosis, disrupting gut homeostasis and barrier integrity.
 
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What is the reasoning behind "might explain why FMT's don't take"?
B12 and folate deficiencies compromise gut health, creating an environment that hinders the success of FMTs. These vitamins are essential for DNA synthesis and cell division, which are critical for the rapid turnover of gut epithelial cells. In a deficient state, the gut epithelial barrier becomes weakened, leading to increased inflammation, often exacerbated by elevated homocysteine levels, which promote oxidative stress. This inflammatory environment reduces microbial diversity, increases susceptibility to pathogenic infections, and disrupts the mucus layer—a key nutrient source and habitat for beneficial gut bacteria.

FMTs rely on a stable, nutrient-rich, and non-inflammatory gut environment for transplanted microbes to "take" or persist. B12 and folate deficiencies impair this environment in several ways. First, they limit the metabolism of beneficial bacteria, such as Bifidobacterium and Lactobacillus, which depend on these vitamins for growth and function, reducing their ability to colonize the gut post-FMT. Second, deficiencies disrupt immune tolerance in the gut, causing an overactive immune response that may reject transplanted microbes. Third, a compromised mucus layer due to deficient epithelial cell production fails to provide a suitable niche for FMT microbes to establish themselves. Finally, systemic effects like hyperhomocysteinemia further exacerbate gut inflammation, making it harder for FMTs to restore a healthy microbiome.

Correcting B12 and folate deficiencies can address these issues by restoring epithelial integrity, reducing inflammation, and enhancing mucus production, all of which create a more hospitable environment for FMT microbes. Additionally, adequate B12 and folate levels support the metabolism of beneficial bacteria, improving their chances of engraftment. Clinical studies suggest that correcting these deficiencies can reduce gut inflammation in conditions like inflammatory bowel disease (IBD), where FMTs are often used, thereby increasing the likelihood that FMTs will "take" and provide therapeutic benefits.
 
So methyl-B12 is not enough, it has to be methyl-B12 plus methylfolate?

I assume "wake-up" is what's usually referred to as "die-off" (herxheimer reaction) with symptoms like fever, chills, shivers, feeling sick, headache etc, and this lasted an entire week for you?

But after 1 month you were fully cured of your health problems? Could you discontinue the use of the supplements or do you permanently have to stay on them to keep the effect?
 
So methyl-B12 is not enough, it has to be methyl-B12 plus methylfolate?

I assume "wake-up" is what's usually referred to as "die-off" (herxheimer reaction) with symptoms like fever, chills, shivers, feeling sick, headache etc, and this lasted an entire week for you?

But after 1 month you were fully cured of your health problems? Could you discontinue the use of the supplements or do you permanently have to stay on them to keep the effect?

Methyl-b12 supplementing is great, but it is pointless if you do not have sufficient methylfolate and other co-factors. Methylfolate is converted from dietary folate in the liver, so out of the 500-1000 liver functions, if yours isn't working properly and your stores of methylfolate are low, it's pointless as the methyl-b12 will just float around and get excreted. It is not usable by the body, like a 2-part system, you need adequate amounts of both or it is irrelevant. The other co-factors are important but to a lesser extent. I entered my entire diet into an LLM (Grok/ChatGPT/etc) and asked which vitamins/minerals it is low in from the above list, and a lot were low despite the high amount of raw vegetables. I gave up and am playing it safe by supplementing everything, lol.

The wake-up symptoms are interesting, like re-growing nerves (myelin sheath) in hands/feet will cause pain, so it's not the exact same as a herx reaction, but there is a wide array of symptoms one can experience. Since methylfolate is involved in methylation and indirectly affects detox, I believe mine were related to detox since my nerves were fine (no numbness/weakness). My wake-up symptoms when starting methylfolate were dizziness/lightheadedness/fatigue which I believe were related to neurotoxins. I had some really high levels of neurotoxic heavy metals that I detoxed prior, so that's where I believe they came from. The symptoms lasted about 1 week and then began to dissipate, so roughly 1.5weeks before I was up and about as normal, albeit slightly more tired than usual. If you are low in any of the required vitamins I mentioned, when you supplement with higher doses of methylfolate it'll put a strain on all the others, so you may experience deficiency symptoms in those that are low which is another reason why I supplemented with everything.

Yes, after 1 month my digestive issues were all gone, no more Candida in my stool, color/consistency returned to normal, and energy was back to my normal. It was disappointing as everyone I spoke to kept saying you're just old but I knew something else was wrong. People are stupid, no one knows your body like you.

Discontinuing the use of the high dose supplements and just using a high quality multivitamin is what I intend to do once my folate-->methylfolate condition is resolved. I believe it is a liver issue as that is where it takes place, so I'm just trying to heal it as best as I can with food and then I'll take an MTHFR test and see. If I'm negative, I'll stop and wait a few months before testing my RBC-Folate levels as they show a more accurate picture of methylfolate in the body. Currently though I'm doing high dose methylfolate+methyl-b12 as I read studies about healing central nervous system issues with higher doses, so I'll probably stop after a couple more months. I'm hoping it fixes my tinnitus which can be caused by an inflamed vestibular nerve, but if not, that's fine, at least I tried. Methylfolate is also great for the liver, so it's beneficial either way.
 
Wow, this is supper interesting. I have a genetic issue that prevents me from absorbing B12, leading to Pernicous anemia (didn't identify the issue until 2 months ago when I was almost dead -vomiting all day/night, diarrhea, parkinson's/MS type symptoms, brain damage, 89 pounds, sick all the time, could not stand up without losing consciousness). Started b12 shots, IMMEDIATE improvement! I'm still battling the horrible candida issues (nystatin doing nothing), but hopeful FMT will tip the scales in my micriobiome after being prescribed 4-6 rounds of antibiotics a year for the bast 30 years. My micriobiome tests show ZERO good bacteria. I used phages to target the bad, but still cannot repopulate with probiotics. Perhaps, consider/research b12 shots, it was a game changer for me :) I do them myself now and no longer use a doctor.
 
Wow, this is supper interesting. I have a genetic issue that prevents me from absorbing B12, leading to Pernicous anemia (didn't identify the issue until 2 months ago when I was almost dead -vomiting all day/night, diarrhea, parkinson's/MS type symptoms, brain damage, 89 pounds, sick all the time, could not stand up without losing consciousness). Started b12 shots, IMMEDIATE improvement! I'm still battling the horrible candida issues (nystatin doing nothing), but hopeful FMT will tip the scales in my micriobiome after being prescribed 4-6 rounds of antibiotics a year for the bast 30 years. My micriobiome tests show ZERO good bacteria. I used phages to target the bad, but still cannot repopulate with probiotics. Perhaps, consider/research b12 shots, it was a game changer for me :) I do them myself now and no longer use a doctor.
Probiotics do not colonize the gut, so they will never repopulate. What is your diet like? The only studies I've read that show significant growth of the microbiome is ones with high amounts of prebiotic fibers, so that's what I did. 100-150g/day of a variety of prebiotic fibers, but Bacteroidetes is still dominating, so I'm focusing more on resistant starch and RFO's to help grow Firmicutes and Bifido.

Regarding the B12 shots, yes I had a milder veresion where my red blood cells were enlarged (macrocytic anemia, high MCV/MCH) to the point where I saw it on a home microscope and it looked disturbing. I believe I read that taking B12 shots/supplements would help with the symptoms but without sufficient methylfolate, one would need them indefinitely. I was taking 15mg of methyl-b12 sublingually for over a month with no change until I added in methylfolate.

If you have zero good bacteria, I think that's a sign your gut environment won't be able to accomodate the bacteria from an FMT until you correct that. I think the vitamins/minerals suggested in the guide I attached in the main post would prove beneficial in this case as if you're deficient in those, your gut epithelial cells will be prone to inflammation and infection which explains your low good bacteria. I was taking high dose methyl-B12 and not making any progress until I added in methylfolate, and since they are "partners" that depend on each other, it makes sense. Doing the FMT without correcting it might be pointless, like trying to get tape to stick to a wet wall.
 
@bizzoc, Very interesting and informative thread! This sounds like it could have some potential so I'm going to give it a try and see what happens.
 
@bizzoc, Very interesting and informative thread! This sounds like it could have some potential so I'm going to give it a try and see what happens.
I'm a big fan of experiments (when they're safe), and since there is no upper limit of toxicity for methylfolate and methyl-b12, I didn't see the harm in trying it out. One study I read actually had the author saying the tests we have to measure B12 deficiency aren't accurate so if a person has the symptoms, they should began supplementing, so that's what I did.

Post back how it goes. Since this is not talked about in forums with chronic gut health conditions, I'm curious how well it works for people. I doubt it'll be able to overcome a bad diet, but if it cured my symptoms within 1 month on a strict veg/fruit diet, it makes me think this will work for people on more "reasonable" diets, albeit slower.
 
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