In response to criticism about Steve Baskin's lastplace.org.au shipping non-frozen stool for as long as 8 days, I've looked at the evidence I'm aware of in regards to freezing, refrigerating, and room temp storage. (2021)

Michael Harrop

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There was a criticism made about Steve Baskin's https://lastplace.org.au, regarding him using a non-frozen shipping method that takes as long as a week https://web.archive.org/web/20210414080155/https://lastplace.org.au/product/fmt/

It would be nice if shipping fresh stool by ground (5 days) were possible. And ever since I had seen him say he was doing non-frozen shipping I had in mind to go through the studies I had seen to refresh my memory. So I went through the dozen or so studies I've saved on this.

I would say there is some evidence that a stool sample may be safe at fridge temps for a week, but it definitely doesn't seem conclusive. And thus it does seem to carry some risk. The safest recommendation seems to be to keep it under 72 hours for fridge temperatures.

For c. diff the evidence shows that frozen is fine https://humanmicrobiome.info/fmt/#freezing. And there's even some evidence that frozen is fine for other conditions like IBD. So it seems wise to opt for frozen unless some substantial evidence arises that demonstrates fresh is significantly superior to frozen for efficacy in one or more conditions.



Fridge temperature = 4C, 39F. Freezing = 0C, 32F.


48 hours at room temp was "fine":
Impact of time and temperature on gut microbiota and SCFA composition in stool samples (2020) https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236944

I find this result surprising and I'm skeptical, but it does suggest that a week at fridge temps would be fine too.

Not completely "fine":
The absolute levels of acetate, propionate and butyrate increased dramatically within 24 hours, indicating general metabolic activities. Even storage at 4°C could not completely suppress metabolic activities, but proved to be clearly beneficial. Interestingly enough, the effect of time and temperature was strongly diminished when looking at ratios instead of absolute values.

Another "mostly fine" after 72 hours room temp:
Influence of Fecal Sample Storage on Bacterial Community Diversity (2009) https://benthamopen.com/FULLTEXT/TOMICROJ-3-40 - minimal (10%) differences in community composition and relative taxon abundances after 72 hours at room temp.

"Lauber et al. reported stability of the microbiota even for up to 14 days at 4°C and 20°C":
Effect of storage conditions on the assessment of bacterial community structure in soil and human-associated samples (2010) https://academic.oup.com/femsle/article/307/1/80/472147

This seems hard to believe, and I assumed they must have purified the sample (IE: extracted only the microbes, thus removing any substrate they can feed on), but it doesn't appear that they did.

"even though we did observe shifts in the abundance of some taxa in our small sample set under different storage conditions, this did not mask interpersonal differences in the overall fecal bacterial community composition, and did not affect our ability to differentiate the host origin of the two fecal samples"

Major caveat:
it is not currently possible to resolve changes in bacteria at the species or the strain level

72 hours at 4c (39f) seems to be ok:
A Guide for Ex Vivo Handling and Storage of Stool Samples Intended for Fecal Microbiota Transplantation (2019) https://www.nature.com/articles/s41598-019-45173-4

An ambient-temperature storage and stabilization device performs comparably to flash-frozen collection for stool metabolomics in infants (Feb 2021) https://bmcmicrobiol.biomedcentral.com/articles/10.1186/s12866-021-02104-6 - they used a special storage device (OMNImet.GUT tube), and stored at room temp for 3-4 days.

While the optimal method for metabolic profiling of stool is likely extraction within 1 h of collection [17], this method is out of reach in the vast majority of circumstances. It is therefore accepted that the next best method and more practical “gold standard” is flash-freezing of stool below − 20 °C [18].

Probably the strictest recommendations I've seen:
Methods for Improving Human Gut Microbiome Data by Reducing Variability through Sample Processing and Storage of Stool (2015) https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0134802

We experimentally determined that the bacterial taxa varied with room temperature storage beyond 15 minutes and beyond three days storage in a domestic frost-free freezer. While freeze thawing only had an effect on bacterial taxa abundance beyond four cycles

We recommend that stool is frozen within 15 minutes of being defecated, stored in a domestic frost-free freezer for less than three days



(22 comments on /r/HumanMicrobiome).
 
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I've also been asked my general opinion on Steve Baskin and what he's doing.

I think I wrote in my FMT experience report about developing severe misanthropy towards potential donors due to people not even being willing to give up their feces to save someone's life. But then I see the patient community behaving in similar ways, displaying disgusting amounts of irrational selfishness and leach behavior, despite the fact that they should know better from experience, really disgusted and angered me even more.

Then there are the dozens of people lucky enough to know a high-quality donor, and use them to cure themselves, but then just completely disappear afterward, and they and/or their donor not willing to help out all the other desperate people not lucky enough to know a high-quality donor. Literally leaving many people to die.

So I'm very appreciative of the few people like Steve Baskin, who attempt to help others, rather than the much more common phenomenon of "f**k you I got mine".

I was initially impressed with Steve as it seemed he was one of the few people who thoroughly reviewed my wiki, learned from it, and went about FMT in a rational manner, and did a good job at dismissing people who were prone to ignorant & hysterical statements. I was quite hopeful when he first offered his donor to other people and was interested in using her myself. But he's done a number of things since then that have made me very disappointed and a bit sketched out. One of the main ones is his refusal to provide a detailed questionnaire & stool pics. Another was a claim that an unidentified text file of numbers and species that looked like it was from one of those useless ~$100 commercial gut tests was proof that the donor was safe and effective. This was later deleted and replaced with an identified Microba test https://archive.ph/sl1fa (still mostly useless, and which currently seems to be missing).

All this is why I haven't bothered to order for myself and have largely lost interest.



Here's a quote with another criticism by Jane Dudley:
He also claims that there is ZERO risk of people having an adverse reaction to the donor stool because no-one out of the literal handful of people who has received the donor stool has had an adverse reaction. I’ve been on these forums long enough over the last few years to know that there is no such thing as a 100% “Safe” donor. Even donors that meet the international guidelines for donor selection and screening and pass all the blood and stool tests have caused adverse reactions in recipients. My friend recently had a severe adverse reaction to a “safe” donor who was properly screened as per international guidelines. She experienced thoughts of self-harm, severe depression and suicidality.

Steve repeatedly claims that the donor is a “super donor”…whatever that is. So far the donor has helped exactly 1 person (Steve) achieve remission from his bipolar depression. However he is literally 5 months into his healing journey and there is no way he can claim he has cured his bipolar for at least 2 years. The other recipients of the donor stool received fresh FMT administered within a very short time of defecation, and although they experienced a reduction in their symptoms within the first week they did not achieve remission from any of their illnesses. They had multiple FMT’s. Did they need more FMTs? Maybe. However they did not achieve remission so how can Steve claim that the donor is a “super donor”?? Steve continues to make baseless claims that he refuses to back up with any evidence. I am making this public statement because he refused to answer my questions privately.
EDIT: apparently Steve Baskin is now blocking anyone on Facebook that would potentially criticize him or have knowledge to refute claims he wants to make. This way he gets to say whatever he wants and it will seem like everyone agrees and no one has any counter points. In my opinion this is the biggest red flag so far.

My comment:

Anyone who solely relies on the International/EU guidelines as if they were anything but a bare minimum is:

a) Ignorant.
b) Irresponsible.
c) Apathetic/unethical.
d) Lacking intelligence/intuition.
e) Some mixture of the above.

This goes for researchers as well, and I've written to many of them to tell them as much.

EDIT: to clarify, Steve isn't even doing the bare minimum per the International/EU guidelines.



More discussion and responses from Steve Baskin.
 
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