So, a bit of background on fecal transplants. The idea is that you take the gut bacteria from a healthy donor, and put it in an unhealthy person's gut. This will make the recipient's metabolism/digestion more like the donor's. This has been found to work for weight loss; you give a normal-weight donor's microbiome to an overweight person, and they lose weight a significant fraction of the time.
So, when I read:
> the woman received a fecal transplant from her overweight but healthy daughter, via colonoscopy
I cringed. There are three things wrong with that. First: you don't need to use a relative, because fecal transplants don't have risk of rejection. Second, you wouldn't use a donor who's overweight. And third, it's normally done with a swallowed capsule, not with a colonoscopy, which adds risk and unpleasantness for no reason.
(Edit: The primary source says "With the occurrence of weight gain after FMT in this case, it is now our policy to use nonobese donors for FMT. The untoward consequences of using nonideal FMT donors are important, because patients may prefer to use a family member rather than an unrelated or unknown stool donor due to the perception that these sources are safer.")
Almost nothing you said is correct aside from your basic description of the procedure.
Weight loss is rarely the primary goal of FMT and its efficacy in that realm remains unproven. Nowhere did the article imply that any of the things that made you "cringe" are necessary. And oral administration isn't objectively better than the alternatives, nor is it always an option since many people understandably find the idea of swallowing a "poop pill" rather repulsive.
This donation occurred back in 2011, when it was still very unclear whether familial relations were important. We now know that there don't appear to be any additional risks for unrelated donations.
> This has been found to work for weight loss; you give a normal-weight donor's microbiome to an overweight person, and they lose weight a significant fraction of the time.
Do you have cite for this? I think there is some circumstantial evidence on this, but it's far from settled.
This woman was being treated for recurrent Clostridium difficile, not obesity. The weight gain was a side affect of the treatment, not the reason for it. Yes, people recently have started experimenting with fecal transplants to help with weight loss, but that's not what was happening here. The woman also picked her daughter because who wants a stranger's poop injected into their colon? No one... is pretty much the correct answer there. No one. Lastly, this was done in 2011, so... up the butt it went.
> Second, you wouldn't use a donor who's overweight.
Why? These transplants are so new and cutting edge that we don't know if taking from an obese person will be a bad or good thing, anecdotes like this might help us form an educated opinion, but it is too early to say for sure.
You certainly cannot say for sure if that was a mistake because few know that really...
If we're able to cure obesity using probiotics designed to wipe out existing gut bacteria and replace it with something designed to reduce the absorption of calories/carbohydrates/sugars, that would be a huge breakthrough.
As always, science doesn't happen via "Eureka!" but by "Well that's strange...".
> it's normally done with a swallowed capsule, not with a colonoscopy, which adds risk and unpleasantness for no reason.
Perhaps the patient opted for the colonoscopy the avoid the "unpleasantness" of swallowing a capsule of fecal matter. It may not taste like shit, but you know it is.
In high school we did an experiment where we caught different types of food on fire, and using them as fuel burning under a beaker, measured the temperature change of the water in the beaker.
Later I learned that cow-dung was used for fuel in some of the poorer places on earth.
I always assumed there must be some calories left in stool; and that this seeming-dogma about 'calories in calories out' was completely ignoring what could be a huge amount of calories getting shat out (or not).
She didn't gain weight because of the calories in the fecal transplant. She gained weight, it's suspected, because of the new gut flora from the overweight donor. Different flora may mean a different metabolism.
That said, the study of gut flora is just starting. Here's a summary of <Nature Article I read a while ago but can't seem to find> : When raising sterile mice (no bacterial whatsoever) they tend to do pretty badly. Low body mass, overactive immune system, etc. Taking these mice and then doing fecal transplants (method is for sure 'icky') from obese PEOPLE and thing PEOPLE (totally strange), the mice tend to be obese or thin. Now, they then just cage sterile mice NEAR transplanted mice, and see the same thing, the flora just waft over and find a home. Then they cage sterile mice near thin and obese mice at the same time. The sterile mice get obese, rarely thin, and NOT in-between, it's all or nothing. Flora, this one article I once read states, come in flavors (real icky ones) that like to be in certain relations to each other. Why the mice tended to get obese is strange, and needs more funding.
Real cool stuff, I guess, but then you get to be known as the 'rat poop eating' labs. So there is a detriment to the research.
There won't be one. Bigotry cannot be fought with facts.
While some forms of obesity have been linked to physical health and or genetic factors, even if you discount that the remaining research has suggested it is a mental health disorder not that dissimilar from e.g. alcoholism, exercise addiction, sex addiction, drug addiction, smoking, and so on.
Essentially food causes pleasure centres in the brain to fire, these make people feel less depressed, tired, or just happier in general. So food is often used to treat depression, which unfortunately as the person gains weight can cause both tiredness, lethargy, and depression to grow, so they need even more food to fight it (rinse, repeat).
But all this won't change perception, because perception isn't about facts. For example, homophobes don't hate gay people for any logical reason that you can fight with facts and evidence, it is deeper than that. You have to deal with the core of their hate, which is often self-hate, or fear.
Ultimately these are people picking on others with a mental health issue. It only makes the depression worse. But they rationalise their bullying as "helping" (even if there is evidence that it hurts, not helps), but really this all comes from a core of self-hate or fear, rather than any logical part.
>To treat ongoing CDI-related diarrhea problems, the woman received a fecal transplant from her overweight but healthy daughter, via colonoscopy.
One possible situation is that she was eating poorly but didn't gain weight due to diarrhea and when she had healthy stool she gained the weight. Also, 'fatty has no-self control' is a way to stifle opposition to your opinion. Ther is no need for that. The laws of physics apply to all people. Burn more calories than you take in, you lose weight. Clearly there will be factors that determine how many calories you burn (perhaps someone burns them much slower than the average person), but as far as I've read magic isn't real yet. The laws of the universe still apply to everyone. I've yet to see anyone eat well and exercise and not maintain a healthy weight. Ever. Not once.
> I wonder what the reaction will be if it turns out obesity isn't just about 'fatty has no self-control'
Since the scientific evidence for a variety of metabolic conditions, etc., contributing to obesity has been overwhelming for a long time without dispelling the popularity of this attitude, I'm going to say the correct answer is "people who are emotionally attached to the idea of 'fatty has no self-control' will continue to ignore the scientific evidence."
I believe in many cases it is well documented that obesity isn't caused by a lack of self-control. However that knowledge is simply not accepted by the general population. I would guess that it is difficult for people to accept this for the same reason that rich people have difficulty accepting that poverty is commonly not the fault of the poor. We may even be able to generalize these problems to all forms of victim blaming.
There may be special factors we haven't discovered yet, but a lot of people are overweight simply because they don't have the money or will to consume decent food.
imho the article is awful. There was 1 case study and it happened by accident. The title is just giving another excuse to people who are struggling with self-discipline.
There is an excellent New Yorker article on fecal transplants and gut flora.
The article spends considerable time talking about the donors, and the rigorous screening process to make sure the donated bacteria are good ones. Obviously, that procedure wasn't followed in this particular incident.
>>Her weight gain continued despite a medically supervised liquid protein diet and exercise regimen.
How is this possible? If they were supplying her with a certain amount of calories per day, she absolutely HAD to lose weight. Unless she was snacking, in which case the whole mystery is solved.
The number of calories that go into your mouth can be very different from the number of calories absorbed by your body. To give a simple example you'll absorb way more calories by eating a piece of bread with olive oil than if you eat the two pieces of food a couple of hours apart. And someone with intestinal parasites will receive notably less nutrition from their food than someone without. It would would actually be very surprising if intestinal flora didn't effect the ratio of calories consumed to calories absorbed.
[+] [-] jimrandomh|11 years ago|reply
So, when I read:
> the woman received a fecal transplant from her overweight but healthy daughter, via colonoscopy
I cringed. There are three things wrong with that. First: you don't need to use a relative, because fecal transplants don't have risk of rejection. Second, you wouldn't use a donor who's overweight. And third, it's normally done with a swallowed capsule, not with a colonoscopy, which adds risk and unpleasantness for no reason.
(Edit: The primary source says "With the occurrence of weight gain after FMT in this case, it is now our policy to use nonobese donors for FMT. The untoward consequences of using nonideal FMT donors are important, because patients may prefer to use a family member rather than an unrelated or unknown stool donor due to the perception that these sources are safer.")
[+] [-] DontBeADick|11 years ago|reply
Weight loss is rarely the primary goal of FMT and its efficacy in that realm remains unproven. Nowhere did the article imply that any of the things that made you "cringe" are necessary. And oral administration isn't objectively better than the alternatives, nor is it always an option since many people understandably find the idea of swallowing a "poop pill" rather repulsive.
[+] [-] jessriedel|11 years ago|reply
> This has been found to work for weight loss; you give a normal-weight donor's microbiome to an overweight person, and they lose weight a significant fraction of the time.
Do you have cite for this? I think there is some circumstantial evidence on this, but it's far from settled.
[+] [-] jnevill|11 years ago|reply
[+] [-] UnoriginalGuy|11 years ago|reply
Why? These transplants are so new and cutting edge that we don't know if taking from an obese person will be a bad or good thing, anecdotes like this might help us form an educated opinion, but it is too early to say for sure.
You certainly cannot say for sure if that was a mistake because few know that really...
[+] [-] toomuchtodo|11 years ago|reply
As always, science doesn't happen via "Eureka!" but by "Well that's strange...".
[+] [-] xtrumanx|11 years ago|reply
Perhaps the patient opted for the colonoscopy the avoid the "unpleasantness" of swallowing a capsule of fecal matter. It may not taste like shit, but you know it is.
[+] [-] frandroid|11 years ago|reply
Why did that make you cringe in particular?
[+] [-] eof|11 years ago|reply
Later I learned that cow-dung was used for fuel in some of the poorer places on earth.
I always assumed there must be some calories left in stool; and that this seeming-dogma about 'calories in calories out' was completely ignoring what could be a huge amount of calories getting shat out (or not).
[+] [-] jnevill|11 years ago|reply
[+] [-] Balgair|11 years ago|reply
That said, the study of gut flora is just starting. Here's a summary of <Nature Article I read a while ago but can't seem to find> : When raising sterile mice (no bacterial whatsoever) they tend to do pretty badly. Low body mass, overactive immune system, etc. Taking these mice and then doing fecal transplants (method is for sure 'icky') from obese PEOPLE and thing PEOPLE (totally strange), the mice tend to be obese or thin. Now, they then just cage sterile mice NEAR transplanted mice, and see the same thing, the flora just waft over and find a home. Then they cage sterile mice near thin and obese mice at the same time. The sterile mice get obese, rarely thin, and NOT in-between, it's all or nothing. Flora, this one article I once read states, come in flavors (real icky ones) that like to be in certain relations to each other. Why the mice tended to get obese is strange, and needs more funding.
Real cool stuff, I guess, but then you get to be known as the 'rat poop eating' labs. So there is a detriment to the research.
[+] [-] panzagl|11 years ago|reply
[+] [-] UnoriginalGuy|11 years ago|reply
While some forms of obesity have been linked to physical health and or genetic factors, even if you discount that the remaining research has suggested it is a mental health disorder not that dissimilar from e.g. alcoholism, exercise addiction, sex addiction, drug addiction, smoking, and so on.
Essentially food causes pleasure centres in the brain to fire, these make people feel less depressed, tired, or just happier in general. So food is often used to treat depression, which unfortunately as the person gains weight can cause both tiredness, lethargy, and depression to grow, so they need even more food to fight it (rinse, repeat).
But all this won't change perception, because perception isn't about facts. For example, homophobes don't hate gay people for any logical reason that you can fight with facts and evidence, it is deeper than that. You have to deal with the core of their hate, which is often self-hate, or fear.
Ultimately these are people picking on others with a mental health issue. It only makes the depression worse. But they rationalise their bullying as "helping" (even if there is evidence that it hurts, not helps), but really this all comes from a core of self-hate or fear, rather than any logical part.
[+] [-] chez17|11 years ago|reply
One possible situation is that she was eating poorly but didn't gain weight due to diarrhea and when she had healthy stool she gained the weight. Also, 'fatty has no-self control' is a way to stifle opposition to your opinion. Ther is no need for that. The laws of physics apply to all people. Burn more calories than you take in, you lose weight. Clearly there will be factors that determine how many calories you burn (perhaps someone burns them much slower than the average person), but as far as I've read magic isn't real yet. The laws of the universe still apply to everyone. I've yet to see anyone eat well and exercise and not maintain a healthy weight. Ever. Not once.
[+] [-] dragonwriter|11 years ago|reply
Since the scientific evidence for a variety of metabolic conditions, etc., contributing to obesity has been overwhelming for a long time without dispelling the popularity of this attitude, I'm going to say the correct answer is "people who are emotionally attached to the idea of 'fatty has no self-control' will continue to ignore the scientific evidence."
[+] [-] emodendroket|11 years ago|reply
[+] [-] radicaledward|11 years ago|reply
[+] [-] api|11 years ago|reply
[+] [-] Red_Tarsius|11 years ago|reply
imho the article is awful. There was 1 case study and it happened by accident. The title is just giving another excuse to people who are struggling with self-discipline.
[+] [-] sparkman55|11 years ago|reply
The article spends considerable time talking about the donors, and the rigorous screening process to make sure the donated bacteria are good ones. Obviously, that procedure wasn't followed in this particular incident.
Worth a read!
http://www.newyorker.com/magazine/2014/12/01/excrement-exper...
[+] [-] e40|11 years ago|reply
[+] [-] sarciszewski|11 years ago|reply
Please be careful not to read too much into one data point.
[+] [-] delecti|11 years ago|reply
> Correlation doesn't imply causation, but it does waggle its eyebrows suggestively and gesture furtively while mouthing 'look over there'.
There seems to be enough evidence that it's not unreasonable to believe your weight is strongly influenced by your gut bacteria.
[+] [-] hipcactus|11 years ago|reply
[+] [-] gambiting|11 years ago|reply
How is this possible? If they were supplying her with a certain amount of calories per day, she absolutely HAD to lose weight. Unless she was snacking, in which case the whole mystery is solved.
[+] [-] Symmetry|11 years ago|reply
[+] [-] jdminhbg|11 years ago|reply
It's weird how people talk about calories in/calories out as if they have a way to measure the second half of the equation.
[+] [-] task_queue|11 years ago|reply
Altered metabolism that allowed her to pull more nutrients from her food or store them easier?