WARNING: This article contains photos of shit, obviously. They’re pixellated, but just letting you know anyway.
I’m in a windowless room watching a near-stranger use a protein shaker to homogenise my poo. Back at home, I made my deposit into a two-litre plastic tub, put the lid on, completed all my normal ablutions then jumped on a tube to Westminster, rushing past tourists on the bridge. You see, I had two hours to arrive at Guy’s and St Thomas’ Hospital, because after that, all the bacteria in my poo would have started to die. And this bacteria is vital in my quest to find out if my poo is “super”.
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A faecal microbiota transplant (FMT) – where one person’s healthy poo is put into another person’s less healthy body, to improve gut health – was first undertaken in China in 300AD. More recently, FMT has been given its fancy name and approved for medical use by some western countries.
In 2014, the UK’s National Institute for Health and Care Excellence issued guidelines on FMT. In the US, the FDA has spent six years stalling on regulating the medical use of an arguably irregular substance. But FMT does work, according to Dr Simon Goldenberg, consultant microbiologist and infection control doctor at the hospital’s Viapath unit, where I arrive with my caddy of crap.
“Clostridium difficile is a bug that typically gets picked [up] by old people who’ve had lots of antibiotics,” he says. The antibiotics strip their gut’s good bacteria, making way for the bad stuff to turn up. “Patients get really severe diarrhoea and lose lots of weight. Usually, antibiotics will help them get better, but a few patients get recurrent disease. The key to getting those patients better is restoring their microbiome, and faecal transplants work really well for them.”
However, I don’t just want my turds to “work well”. I want to see if I have super-poo, something I first heard of in January, when microbiologists at the University of Auckland wrote in a health journal that someone, somewhere, will be capable of producing poo with such a diverse range of microbes that they will help “achieve clinical remission rates of perhaps double the remaining average”.
If having super-poo was as easy as eating lots of varied meals then taking a dump, surely I could be a candidate? Not necessarily. The antibiotics I took over the new year period following a bout of tonsillitis stripped my innards of all their bacteria, meaning any poo I donated in the three months that followed would be a crock of shit. So I bided my time, eating a variety of foods, willing the bacterial cultures of my gut’s messy loops to grow like wisteria on posh houses, for my belly to become a fetid Kew Gardens.
After three months, I was back in the game. A screening process involved stool samples, a survey and a blood test. For the screening – and this truly demonstrates the NHS’s diligence – Dr Goldenberg sent me some consent forms for my poo, a toilet-paper hammock for me to poo on and three tiny vials. Once I had scooped some faeces into each vial – who knew shit doesn’t yield like a Mr Whippy? – I flushed the toilet paper hammock and its inhabitant, before all necessary clean-up. I put the vials in the fridge overnight. Inside a padded envelope, of course.
The next morning, I took the envelope to Dr Goldenberg. It didn’t matter that the bacteria inside each vial had perished, because this poo was being used to test for other, more virulent stuff, like HIV and hepatitis and norovirus and MRSA and parasites like campylobacter and strongyloides.
He took some blood from my arm, then asked some questions which, in retrospect, weren’t as personal as him literally sifting through my shit. How much do I drink? Have I got tattoos? Had acupuncture? Been imprisoned? Travelled anywhere exotic? These checks and balances exist, Dr Goldenberg explained, because: “We’ve got to make sure [FMT] is effective, but it might be effective and give patients, who are transmitting, hepatitis afterwards, and that would be a massive scandal!”
I passed the survey and was sent away. Two weeks later, my poo’s test results came back all clear, and Dr Goldenberg agreed on a time and date for me to return with my donation. He has nearly a dozen donors, he said, “who tend to drop in at 8AM to 9AM, on the way to work”.
So here I am, back at the hospital, shit in hand. After discussing my recent bowel movements, including whether I’ve taken any trips to the larger numbers of the Bristol Stool Chart scale, Dr Goldenberg takes me into the room where he’ll toss my poo like a barman shakes espresso martinis.
He sits at a biosafety cabinet – essentially a glass box on a table with an extractor fan whirring at the top. He then tips my brown-beige nuggets and some saline into a protein shaker I’m far more used to seeing in shiny-haired influencers’ social media posts. “We just had the idea that, to homogenise and get the lumps out, to make it smooth, this does the trick!” he says.
The chunks tumble into the saltwater to become a bubbly, lukewarm consommé the same murky-brown colour of the Thames, and the extractor fan fights a brave losing battle. My milkshake-thick poo-saline is then filtered through a plastic sieve atop a plastic jug, and poured into a 200ml pot. Dr Goldenberg adds glycerine, “as an antifreeze, protecting bacteria”.
The pot will be frozen and kept at -80C, along with a raw sample – just in case they discover a new organism they’d never seen before.
Donations from Guy’s and St Thomas’ bank are licensed for use by King’s College Hospital, three miles down the road. Dr Debbie Shawcross, reader and honorary consultant in hepatology at the hospital’s Institute of Liver Studies, says using FMT to treat clostridium difficile “has an approaching 98 percent cure rate in this setting”. She is also the principle investigator on a medical trial attempting to work out if FMT can improve outcomes in patients with advanced chronic liver disease, who have a high mortality rate and will die without access to a liver transplant. Though the research isn’t finalised, they’ve had no significant concerns to date.
“We were concerned that the idea of having a faecal transplant might be ‘unpalatable’ to patients,” Dr Shawcross adds, “but this does not seem to be the case, and it’s probably the only study I’ve undertaken to date where patients are writing to me to ask if they can take part.” Pretty surprising when you consider that receiving a turd sounds more painful than the bureaucracy of donating one.
Within the next six months, then, when someone at Guy’s and St Thomas’ or King’s College needs FMT, my poo will be available to be couriered to the patient’s bedside. It will then be defrosted over three hours, before being inserted via “a nasogastric tube that’s up the nose and down into the stomach, or the nasojejunal tube, which goes through the stomach into the first part of the small bowel”, says Dr Goldenberg.
Can’t it go up the bum, I ask. “We can do it rectally,” he replies, but “you need sedation for the colonoscopy. You also need a bowel preparation, which involves taking lots of laxatives. It’s more uncomfortable to deliver to the colon, but it’s more effective.”
All that’s required for either nasal insertion, however, is a few days’ worth of antacids, to ensure stomach acids won’t kill off vital microbiomes.
Dr Goldenberg declares this entire process “super basic” in its current iteration – because until scientists find the perfect poo, they don’t even know what species of bacteria are good. “What we do know is that having a diverse range of bacteria seems to be associated with health,” he adds. “No one has characterised that yet, and each donor will have a different microbiome, and even the same donor on a Monday and Thursday will have variation.”
So while my body contains no bad stuff, and it’ll likely contain good stuff, it’s hard to tell if it’ll be super stuff. I do learn, though, that while Dr Goldenberg has kindly taken me through the process so I can get some photos, my donation is too small. At 43g, it is 17g shy of the minimum donation size of 60g. Some samples, Dr Goldenberg informs me, weigh in at over 180g, meaning “we can make three separate batches”.
Now I am embarrassed, and vow to return with a bigger and better load. Dr Goldenberg kindly provides me a new tub as I begin to mentally calculate how to get more fibre into my diet.
Elsewhere, the future of FMT is brighter. Recent studies are exploring whether the process could help alleviate the symptoms – or even existence of – conditions, diseases and syndromes as varied as autism, obesity, cardiovascular disease and mental health disorders such as bipolar disorder and anxiety disorders. And with the stigma lessening, more research is just around the bend.
Maybe my quest to become a super-poo donor would have been more successful if I’d been paid for my sample, like donors can be in the US, at about $40 a pop. But Dr Goldenberg assures me on my way out that, while all donors are reimbursed for travel, paying for donations “is riskier: if you pay people, they’re more likely to lie about their risk factors”. For now, at least, I’d rather live knowing that I drop a light load than exist as a medical shit-stirrer.
