My detailed experiences & lessons from 13+ different FMT donors (Jun 2018- )

Michael Harrop

Michael Harrop

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Fairly long so probably won't be able to review it all in one sitting/day. https://docs.google.com/document/d/1cagQpzRCa7Uy8QZYV6NiywDhPELBlzHxUk1OWPR3kNM/


Originally posted on 21 Jun 2018 (26 comments) after 8 donors. Here is the summary that hasn't changed much since then:

High-quality donors are likely a panacea but most official sources of FMT are using low-quality donors and horribly/dangerously inadequate screening/selection. Low-quality donors can be dangerous, and mostly ineffective. Every donor is unique. High-quality donors are similar in most aspects. The FMT screening questionnaire in the wiki is a vital screening tool.

I did put some bullet points in the beginning of the document. I'll quote that part here:
A few takeaways:
  • There seems to be major signaling along the entire intestine. Stuff that seems upper GI related can be impacted via colon FMT.
  • Neither Xifaxan or Metronidazole made low quality donors more effective.
  • Flagyl very effective/helpful once it makes it through the whole colon, yet using it via enema does nothing. Major differences between IV, oral, or enema flagyl.
  • Long term (months) FMT is likely needed for more complex conditions. Yet some things (bile acid diarrhea) seem easily fixable via 1-2 FMTs with the right donor.
  • Doing the retention enema right after a BM seemed as, if not more, effective than doing a complete colon cleanse via inducing diarrhea. Though the donor stool quality was not consistent. I made sure to lie in inclined positions to get it to flow through the whole colon. Inducing diarrhea itself though seemed to possibly have some impacts, such as improvements to skin, and possibly impacting some pathways and thus changing location of some problems and possibly helping flush some others through. Some support: Transient Osmotic Perturbation Causes Long-Term Alteration to the Gut Microbiota (2018): https://www.cell.com/cell/fulltext/S0092-8674(18)30585-3 But one of the agents I used for inducing diarrhea (h202) probably played a primary role.
  • Pathways - it seems like often things don't get fixed but rather the problem gets moved to another pathway/location. Arthritis, some rough skin patches, unique BOs, heart problems vs head problems, red dots, are a few examples. Possibly related to this? "A newly discovered network of fluid-filled channels in the human body may be a previously-unknown organ, and it seems to help transport cancer cells around the body" (2018) https://www.newscientist.com/article/2164903-newly-discovered-human-organ-may-help-explain-how-cancer-spreads/
  • Via enema seemed more effective with certain donors. But I've heard feedback from other people that the oral route seemed more effective for them. I started doing both when possible.
  • Small amounts (less than 1 capsule) seemed as effective, if not more so, than larger amounts (2-6oz).
  • Nearly anything wrong with the donor can be transferred.
  • Nearly every donor had unique effects, but 1 and 4 seemed very similar in questionnaire, stool type and effects.
  • 0 lifetime antimicrobial use might be an important factor. Perhaps due to long-term damage, or perhaps due to a healthy/disease resistant gut microbiome never needing antimicrobials.
  • It seems very clear to me that high quality donors have something very important, that stimulates an immune system response, that low quality donors completely lack. So combining multiple low quality donors cannot equate to one high quality donor (what Taymount seems to be trying to do). I have a feeling this very important factor is severely damaged by antimicrobials. Maybe phages, maybe some immune system component.
  • Since stool testing (conventional & commercial 16s) is extremely limited you have to rely on an in-depth questionnaire, but even well-meaning people omit, forget, or downplay certain things.
  • Donors seem to majorly misjudge their stools. That plus the fact that intermittent soft stools seem to be dangerous means that you probably want to get multiple samples from a person over 2-3 days straight to judge the stool for yourself before using any of it.
  • I had no idea how important stool type/consistency was coming into this, but it seems high quality donors have identical stools, while low quality donor's stools are heterogeneous, thus it's one of the major ways to judge stool quality. This is based on my own experiences, and from experiences from numerous other people. And this Anna Karenina hypothesis supports this: https://web.archive.org/web/20230607102627/https://old.reddit.com/r/HumanMicrobiome/comments/6w43a7/a_grand_unified_theory_of_unhealthy_microbiomes/ This 2017 study saying otherwise is only for c.diff (which requires much less strict donor criteria): https://www.gastrojournal.org/article/S0016-5085(17)32233-3/pdf And it's quite likely that study completely lacked high quality donors (due to severe deficits in OpenBiome's donor selection), so they were only comparing average/low quality donors with each other. Also I believe it is a matter of "the highest quality donors all have type 3 stools, but not every donor with type 3 stool is high quality". At this point I would nearly bet my life on every single person in the "healthy" category/list above consistently having type 3 stools.
  • I think that continued FMTs (weeks/months) with donors 1 or 4 could result in sustained improvements if not cure. But they both made themselves unavailable. FMT from these two donors felt like taking 1 antibiotic pill when you're supposed to take 3x/day for 2 weeks. This (along with prebiotic experience below) might implicate phages as one of the most important components of FMT.
  • Prebiotics and other whole foods that harmed me prior to FMT also harmed me during & after FMT. At best, they had no impact. I do not think you should/can introduce these until you're pretty much in complete recovery. My experience with this says it is misguided to try and feed the new bacteria from the FMT. You shouldn't have to force these, but rather the right microbes from the right donor will allow you to reintroduce certain foods: https://www.sciencemag.org/news/2018/06/fecal-transplants-might-help-save-vulnerable-koalas + "diet" section of wiki.
Based on my experience & knowledge it seems soft stools are from one or more of:
  1. A low quality gut microbiome that lacks certain microbes needed in the digestion of certain foods.
  2. A pathogen that feeds off certain food items (iron for example: https://web.archive.org/web/20230610141727/https://old.reddit.com/r/HumanMicrobiome/comments/8c4x2h/no_effects_without_causes_the_iron_dysregulation/), and thus causes soft stools & other problems when eating those foods.
  3. Temporary upset from either mild food poisoning or poor hygiene/sanitary practices.
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Forum threads (in order):

HumanMicrobes.org, Donor UT-AW-1998. No improvement for IBS-D, CFS, mild Alzheimer's, severe food intolerances, and more. Tested fresh vs frozen. Tested double encapsulated delayed release capsules vs none. (2021)

HumanMicrobes.org, Donor FL-RS-1997. Addressing IBS-D, CFS, mild Alzheimer's, severe food intolerances, and more. Tested fresh vs frozen; upper and lower. Tested refrigerated for 7+ days. Mild improvements overall. Moderate improvements for IBS & food intolerances. (2022)

HumanMicrobes.org, Donor NY_BuddingBear_1994. No benefits. Worsened CFS, IBS, food intolerances, brain function/inflammation. (2023)

HumanMicrobes.org, Donor IA_SMJ_2010. Mild improvements for IBS and fat intolerance. Testing vacuum sealing and "stool type vs breastfeeding". Comments for regulators. (2023)

HumanMicrobes.org, Donor SD_ES_2015. Mild improvements to sleep, fatigue, hair, IBS. Major improvements to stool quality, and protein tolerance. (2023)

HumanMicrobes.org, Donor OR_JO_1993. Treating CFS, IBS, and more. Benefits to iron tolerance, prebiotic & legume tolerance, pathogen clearance, weight. (2023)

HumanMicrobes.org, Donor NY-KS-1998. Treating CFS, IBS, mild Alzheimers. Large improvements to skin, stool quality, IBS. Mild to moderate improvements to fatigue, sleep, sex drive. Time to focus on Step #3 (2024)
 
Included required info?
  1. Yes
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So reading this I'm assuming that on the other thread, where you stated that you had two donors who stood out as being by far the best but who each only donated once, that you were referring to Donors 1 and 4 in this summary, just because in the introduction you SAY that you would have liked to try more of these donors?

If my assumption is correct, then what is it about your responses to these donors that particularly stood out? Purely by reading your accounts of what happened after each donor, without that comment in the introduction, I would not have noticed these two donors as standing out in terms of benefit relative to harm. In particular, with Donor #1 you mention a lot about getting cramps as a side effect and only a tiny bit about improving food intolerance, that even the reader kind of needs to infer by your mention of trying new foods rather than it actually being spelled out. And Donor #4 you mention as a "mixed bag with a wider range of positive and negative effects". Nothing particularly "glowing" with either one, it doesn't sound for example as if you got all benefits and no side effects from these two but mostly side effects from the others.

I hope it's not that the mere fact that you only experienced one sample from each of these donors created room for wishful thinking. I.e. the other donors you could try more if you liked the effect so once you stopped improving you knew you'd hit a wall, whereas with #1 and #4 you didn't have a chance to hit that wall so possibly you imagined it not being there?

Oh... and... not exactly on topic but Elon Musk is supposedly not intelligent?
 
SFBayFMT5 said:
that you were referring to Donors 1 and 4 in this summary
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Correct.

SFBayFMT5 said:
what is it about your responses to these donors that particularly stood out?
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They both triggered a reaction followed by large overall improvement, particularly to fatigue.

Perhaps I downplayed it a bit but I went from laying in bed all day with eyes closed, feeling like I was dying/whole body shutting down, to being able to exercise and eat new foods without any symptoms.

It's not about a wall. These are the only two donors I experienced this with.

The Remission Biome guys recently ran a Twitter poll asking about remission triggers, and a significant portion of people said an acute illness and vaccination. These two donors triggered that same effect that appears to be "turning the immune system back on". I believe it can be a lasting improvement with more FMTs but I haven't been able to find another similar donor to test it. However, other donors I tried (8 and 11) had similar improvements to fatigue and food tolerance (and much longer lasting) without the immune reaction. And donors 8 and 11 were also the ones with stool most similar to donors 1 and 4.
 
That's interesting--I had no reaction/flare after my last (and only) FMT. I have absolutely no information about the donor, though I obviously very much wish I did.

Why then do you say that the donors who DID cause a flare are better than the ones who didn't, even though the improvements from the latter were similar yet longer lasting?

Of the HMorg donors who are on the donor list but not yet activated, which have stool most like 1/4/8/11? And which is least like those?
 
SFBayFMT5 said:
Why then do you say that the donors who DID cause a flare are better than the ones who didn't, even though the improvements from the latter were similar yet longer lasting?
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They were longer lasting because I did many more FMTs from them. The donors that caused the acute reaction had the strongest benefits, even though they were short-lived due to the single dose.

SFBayFMT5 said:
Of the HMorg donors who are on the donor list but not yet activated, which have stool most like 1/4/8/11?
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None. But I'm largely ranking them according to who has the most similar stool type to those donors.
 
How would you describe this stool type, other than just being type 3-4 on the Bristol scale (which, by itself, it would seem MANY donors would have)?
 
Hello @Michael Harrop,

Long time reading your work. Recently, my health issues have become severe enough that I am seriously considering a procedure that, for someone like me who is uneducated on the subject, seems almost unimaginable: a FMT.

From reading your extensive research, it is clear that you are incredibly knowledgeable in this field. However, I also sense some frustration in your writing regarding your personal healing journey. As someone who knows very little about this topic, it is somewhat discouraging to see that even someone as smart and dedicated as you has faced significant challenges in healing.

I am curious: have you been able to identify any specific factors that have hindered your healing process? Do you attribute your ongoing struggles to any particular cause? Despite these challenges, do you continue to have hope and keep trying new approaches?

I apologize if these questions are too personal or if I have misunderstood your situation, but I felt compelled to ask in order to better understand the magnitude of the issues that some of us have been suffering from for years or even decades. I greatly appreciate your time and any insights you can provide.

Thank you for your dedication to this important field of research.

Best regards,
Arturo.
 
I've been unable to find an ideal donor. There are more details and discussion about this in many places, including:
Strange that you're not aware of that if you've been following me for a long time.
 
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