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The Species in the Feces

I do not understand the interest many appear to have in their bowels and the movement there of.  But then, I pay little attention to most of my body functions as long they are functioning within  reasonable parameters, and as I get  older the definition of reasonable is increasingly flexible.

The elderly especially seem to obsess about their bowels.  My theory is that since they have often lost taste, smell, hearing and are alone with little direct human touch,  a good BM is the only remaining physical joy left, and when it is compromised they are understandably upset.

Still, the concept of colonics for ‘detoxification’  strikes me as more humorous than repellent, despite the lack of efficacy and documented complications of the procedure.  Under normal circumstances, when it comes to the colon it is probably better to be removing substances than to be introducing them.  I do not pretend to be expert in the human microbiome: the complex ecosystem of bacteria and other organisms that are in and on us. It is of interest but usually not a direct concern in the daily application of infectious diseases.  I spend most of my days trying to kill the odd pathogen, most of whom are not usually part of the human bacterial ecosystem.  There are 1000’s of species in and on us, and we can grow only a small fraction of them in the clinical microbiology lab. There are an estimated 10 to 100 times more bacterial cells in and on you than there are cells of you.  Take your colon. Please.

…it has been estimated that the cumulative human lower intestinal microbiota contains at least 1800 genera and 15 000–36 000 species (depending on a conservative vs liberal classification).

I tend to think that the conservative approach has a larger quantity of lower intestinal material associated with it.  You may think you are hot stuff, but really you are only a sentient transport and feeding mechanism for your bacteria.

A side effect of antibiotics is wiping out large swaths of the normal flora in and on us.  Early in my career it was taught that the benefits of the microbiome were simple: competition for adherence sites and nutrition with a little vitamin K production thrown in for good measure.  It turns out the interactions of the metabiome and the humans is much more complex than  suspected.  There probably is a core microbiome that we share, but the diversity of bacterial flora  is greater than the similarities.

At the national meeting I  last year I attended some lectures on the microbiome, and the two most interesting factoids from my notes were that microbiomes are more similar in people who are related.  My microbiome resembles  that of my parents and children more than that of my wife.  And even more interesting is that the microbiology found on the left upper canine tooth resembles the right upper canine, rather than the tooth below it or the teeth next to it.  Each tooth is a Galapagosian island of separate and sometimes parallel evolution.  Neat.

I mess with the microbiome of others on a daily basis wiping out billions of bacteria and upsetting the human ecology.  Not that I have much choice.  Most of the patients I see would likely die from their infection without antibiotics, although if there is karma for causing the deaths of other creatures, given the huge number of microbial deaths for which I am responsible,  I am destined to come back in the next life as a rabbit in a syphilis laboratory.

What little data exists suggests that the bacterial flora declines dramatically with antibiotics and is slow to recover, often taking months to return to pre-antibiotic diversity.  Each course of antibiotics is, to the bowel bacteria, an almost K-T extinction event.  There would be a less prolonged effect if we were more like mice and were coprophagic, but eating poo is not high on the human consumption list.  Except for those of us that love hot dogs.

The best known and more reliable effect of messing with the bowel flora is diarrhea, which comes in two flavors: antibiotic associated and Clostridia diarrhea.  Some antibiotics, like oral amoxicillin/clavulanic, are arguably better than most laxatives at cleaning out the gastrointestinal tract, and antibiotic associated diarrhea adds to discomfiture and cost of hospitalization, with the upside that you can get more reading done.

Probiotics are useful in prevention of antibiotic associated diarrhea, supported by reasonable studies in the literature.  In my institutions when we instituted yogurt for all our patients on antibiotics our testing for causes of diarrhea fell by half, a reasonable surrogate that the product was effective.

I recommend the yogurt over probiotic pills if possible, despite how unpleasant yogurt can be.  Yogurt has the advantage of a known quantity and distribution of bacteria since its production is overseen by regulatory agencies.  I suggest yogurt that has the more diverse and highest quantities of bacteria, the yogurt closest to stool, a slogan not likely to be used by Dannon anytime soon: “The yogurt that most resembles stool. ”Probiotic pills are problematic, since their contents are not regulated and the organisms can be dead or be species of bacteria other than what is listed on the label.

It is wrong to consider the organisms in probiotics to be ‘good’ bacteria.  They are not part of the normal flora and can incite an inflammatory response or  invade the blood stream in rare circumstances.  It is interesting, but not surprising,  that probiotics can prevent URI’s in children.

Regarding the potential mechanisms through which the reductions in respiratory symptoms and antibiotic usage could be explained, an immune-enhancing effect is a likely explanation, because numerous studies with various probiotic bacteria have demonstrated their ability to modulate immune responses through interactions with toll-like receptor.

As I have mentioned before, “immune-enhancing” is what ID docs call an inflammatory response, which, if activated in advance of a pathogen, primes the immune response against subsequent infections.  The inflammatory response, long term, is bad, being associated short term with increased vascular events (stroke, heart attack and pulmonary embolism) and long term with vascular disease.  Being immune-enhanced may, for example, prevent TB at the price of the metabolic syndrome. As far as I can tell, the immune system is best left alone if not under acute microbial attack

Bacteria are neither good nor bad, but more or less likely to be pathogenic.  Some are collaborators with the enemy, aiding and abetting pathogens in their invasion.  The normal flora, the so called ‘good’ bacteria, may enhance infection from polio,  some worms, and other bacteria.  Not a surprise, for even as we were evolving in tandem with our flora, our pathogens were certainly evolving along us and our microbiome.  Even the ‘good’ bacteria would be happy to consume you if given half an opportunity.  As would some of our pets as I think about it.

The utility of probiotics in the prevention and treatment of probiotics for C. difficile diarrhea is problematic, and the literature can be read either way, I tend to think the glass is half full (of stool) and is of little utility.  It is a problem as C. difficile can be a difficult disease to treat with antibiotics and has a high relapse rate.  Some patients go through multiple courses of different antibiotics without resolution of their disease, each antibiotic more expensive than the last.  The newest agent for C. difficile, fidaxomicin, has set a new record for price gouging with a 10 day course costing round $2800. Yep.  Two thousand eight hundred.

The best therapy, best being the highest cure rate,  for C. difficile is the stool transplant, and I get puky just writing about it.  The stool of spouse (although it should be the parents or children) is pureed and given either down a nasogastric tube or as an enema.  Efficacy is almost 100%.  There are worries about disease transfer, as some infections are spread by the fecal-oral route. Ick.  But most spouses, unlike other relatives, probably share most infections anyway.  I have yet to send a patient for stool transplant, but my partner and the  GI docs have done a handful with good results.

Imagine my surprise when the local weekly had  an article on stool transplants being used by a naturopath  as part of a 3000 to 7000 dollar treatment, depending on whether you want to do receive it at home or as part of a colon health retreat.  According to the Willamette Week, the practitioner is self taught and the stool is obtained from a 13 year old who was chosen as he had never had prior antibiotics.  The kid is paid for his donations. I had a paper route and it also was a …, no I’m not going there. Nope.

According to the web site,

FMT is over 90% effective at treating C. difficile infections, and is 50-90% effective at significantly decreasing or eliminating symptoms of ulcerative colitis and IBS-C.

The first number is legit, the second?  At best I can find a half dozen case reports for ulcerative colitis  and a similar number for irritable bower syndrome.

For non C. difficile bowel disease stool transplant is an intriguing idea, and given the interactions of the colonic microbiome and the gut, I would not dismiss the idea out of hand. How alterations in gut flora plays a role in IBS, UC, or even weight gain or loss are interesting concepts.  The understanding of these interactions is in their infancy and may be a fruitful therapeutic option someday.  I would be cautious since it is also reasonable that  that giving someone a strangers poo could conceivably  set them up for chronic inflammation with resultant stroke and heart attack, increase their risk for polio or even put them at long term risk for bowel cancer, given the curious association between toxigenic Bacteroides fragilis and colorectal cancer.

There are likely to be subtleties in different microbiomes and an individuals immune system’s interactions with that microbiome that will alter the risk or benefit of a random stool transplant.  At least with a kidney they try and match it to the recipient.  I would not be surprised if a similar process would optimize the benefits of a stool transplant, although a complication of organ rejection is infection, and how would you tell in a stool transplant.   While it is medicine that is accused of not treating the individual, it is often the SCAM practitioners who have a one size fits all in their treatments with no consideration of the potential ramifications of the practice.  In the practice of medicine you learn early that no good deed ever goes unpunished; everything has downsides.

I would be disinclined to recommend that a patient spend thousands of dollars based on an interesting idea.  I would not have though someone could beat out Big Pharma and charge more than fidaxomicin for a 10 day course for bowel therapy, but evidently I lack the imagination.  I also lack the insight to realize the importance of the colon for so many extra-colonic processes, except I will admit my health did improve markedly for the better when I had my colon removed.

…using fecal microbial transplantation for other health problems, including autoimmune disease, eczema, asthma, multiple sclerosis and depression… and detoxifies the body and improves mood.

Interesting. The comments write themselves.  To say there is even biologic plausibility to treating MS or depression with stool transplants requires a biology I was never taught and cannot imagine. The opportunity for placebo effects to predominate with stool transplant would be enormous. But there are those who, well, like that sort of thing.  To each their own.

I do not see why squirting another’s poo in your colon would not be, in the world of colonic detox, the equal to giving a toxin enema. If there is anyone with toxins in their colon, it would be a 13 year old boy.  I have seen what mine will eat if given half a chance.

As for performing an unregulated procedure as unproven therapy, Davis says, “The FDA hasn’t said not to.”

The FDA also hasn’t said not to jump off a bridge, and damn I am getting old resorting to that trope.  That’s how to choose interventions for patients: if the powers that be don’t say not to, it is OK.  That is the approach to life of my teenage kids and I have found it to be a reliable technique for them to learn from really stupid decisions.

The practice of medicine is always in flux* and off the wall ideas today are tomorrows standard of care.  For fecal transplant and some colonic diseases, it is an intervention that, outside of C. difficile, is still unproven, although a promising idea.   For diseases outside the colon, biologic plausibility makes stool transplant unlikely to have any benefit with real potential downsides.  Stool transplants are unlikely to be of widespread to benefit,  but when all you have to offer is crap, everything is a toilet.

* an old term for diarrhea.

Posted in: Basic Science, Naturopathy, Science and Medicine

Leave a Comment (35) ↓

35 thoughts on “The Species in the Feces

  1. windriven says:

    “In my institutions when we instituted yogurt for all our patients on antibiotics our testing for causes of diarrhea fell by half, a reasonable surrogate that the product was effective.”

    Astonishing. I wonder how much that saves the Legacy System in a year?

    “…using fecal microbial transplantation for other health problems, including autoimmune disease, eczema, asthma, multiple sclerosis and depression… and detoxifies the body and improves mood.”

    You have to be wired really oddly for a shot of somebody else’s poop to elevate your mood.

  2. passionlessDrone says:

    Hello friends –

    To say there is even biologic plausibility to treating MS or depression with stool transplants requires a biology I was never taught and cannot imagine.

    Depression, and MS (and lots of other CNS disorders) have a state of inflammation as participatory players, and altering the microbiome can affect the level of inflammation.

    As an example of scientists who can imagine such a biologic plausibility, from the proceedings of the national academy of science:

    Proinflammatory T-cell responses to gut microbiota promote experimental autoimmune encephalomyelitis

    Although the effects of commensal bacteria on intestinal immune development seem to be profound, it remains speculative whether the gut microbiota influences extraintestinal biological functions. Multiple sclerosis (MS) is a devastating autoimmune disease leading to progressive deterioration of neurological function. Although the cause of MS is unknown, microorganisms seem to be important for the onset and/or progression of disease. However, it is unclear how microbial colonization, either symbiotic or infectious, affects autoimmunity. Herein, we investigate a role for the microbiota during the induction of experimental autoimmune encephalomyelitis (EAE), an animal model for MS. Mice maintained under germ-free conditions develop significantly attenuated EAE compared with conventionally colonized mice. Germ-free animals, induced for EAE, produce lower levels of the proinflammatory cytokines IFN-γ and IL-17A in both the intestine and spinal cord but display a reciprocal increase in CD4+CD25+Foxp3+ regulatory T cells (Tregs). Mechanistically, we show that gut dendritic cells from germ-free animals are reduced in the ability to stimulate proinflammatory T cell responses. Intestinal colonization with segmented filamentous bacteria (SFB) is known to promote IL-17 production in the gut; here, we show that SFBs also induced IL-17A–producing CD4+ T cells (Th17) in the CNS. Remarkably, germ-free animals harboring SFBs alone developed EAE, showing that gut bacteria can affect neurologic inflammation. These findings reveal that the intestinal microbiota profoundly impacts the balance between pro- and antiinflammatory immune responses during EAE and suggest that modulation of gut bacteria may provide therapeutic targets for extraintestinal inflammatory diseases such as MS.

    The data that depression is characterized by a state of inflammation is so numerous it makes little sense to try to enumerate. The data showing that the microbiome can modify the immune state is nascent, but growing.

    - pD

  3. Mark Crislip says:

    After finishing the post I came upon a review on inflammation and depression; not part of my normal world. Interesting stuff.

    MS is often worsened with acute infection.

    Giving others bacteria or probiotics would cause a pro inflammatory effect and I would predict likely worsen, rather than help, the diseases.

  4. WilliamLawrenceUtridge says:

    Nasogastral tube is a better option than straight-up oral…but imagine the burps. Imagine the breath.

  5. daijiyobu says:

    This may sound gross but, in terms of gut bacteria, I’m quite convinced that soda fountains are quite populated incubators of various gut-disturbing bugs.

    CBS has this http://www.cbsnews.com/2100-500165_162-6071268.html

    I’ll even hazard to say personally experienced / suspected.

    -r.c.

  6. “MS is often worsened with acute infection.”

    Not to mention that since common treatments for MS (steroids, etc) typically suppress the immune system with the understanding that MS is an autoimmune disease, introducing microbes into the person’s system might not be the best idea in the world.

  7. DW says:

    “the local weekly had an article on stool transplants being used by a naturopath as part of a 3000 to 7000 dollar treatment, depending on whether you want to do receive it at home or as part of a colon health retreat. According to the Willamette Week, the practitioner is self taught and the stool is obtained from a 13 year old who was chosen as he had never had prior antibiotics. ”

    Holy hell.

  8. Janet Camp says:

    In an effort to try out some vegan recipes, I recently prepared some “Tofu Spareribs” and while the sauce was delicious, I have had better tofu dishes at the Chinese restaurant down the street. I didn’t think much more about it other than I would not be making that again soon–until I had horrible diarrhea all night long. Perhaps I only needed more poop going in than was coming out–like cures like anyone? My husband didn’t get the diarrhea, but only said, “never give me that crap again for dinner”.

  9. RedBear says:

    If laughter is the best medicine, my health improved enormously reading this post. I had to double-check my calendar to see if April 1 hadn’t arrived without me noticing. Thank you for the high lol content! I’m looking forward to using the term ‘stool transplant’ in casual conversation soon, especially with some of my probiotic pill popping pals. Poo vs prozac would make an interesting study…

    I had a natural history teacher years ago ask a class, “Where is the nearest wilderness?” After blank stares and shrugs he replied by pointing to his chest saying, “We have ecosystems within us that are little explored or understood.” That made in impression, but you have elaborated brilliantly.

    Your post may inspire a movement… Just imagine a rewrite of Mary Poppins “spoonful of sugar helps the medicine go down.” (ok I’ll stop)

  10. mousethatroared says:

    Very interesting article. Although I was suprised to hear I was soley feeding and transportation for bacteria. I thought I was solely feeding and transportation for my kids. I feel much more productive now.

    We’ve had a noroviris plague in our area….one bug I’d rather not receive (again) the normal way OR by transplant.

  11. Calli Arcale says:

    I recommend the yogurt over probiotic pills if possible, despite how unpleasant yogurt can be.

    Speak for yourself! I’ve recently developed a taste for Greek yogurt, and it is awesome. Plain, well, okay, then it basically tastes like sour cream. (So much so that part of me wonders whether it could be used in making a sort of Medditerranean rommegrot.) I like yogurt.

    It is wrong to consider the organisms in probiotics to be ‘good’ bacteria. They are not part of the normal flora and can incite an inflammatory response or invade the blood stream in rare circumstances.

    I’ve heard it described as razing a rainforest and then planting corn and expecting that to make up for the loss of biodiversity.

    Bacteria are a bit like weeds; for many of them, whether they’re good or bad is often context-dependent.

    To say there is even biologic plausibility to treating MS or depression with stool transplants requires a biology I was never taught and cannot imagine.

    “I can easily teach him. All it requires is a cunning imagination and a glib tongue.”
    – The Fourth Doctor, “The Masque of Mandragora”, Doctor Who

  12. tuck says:

    “Yogurt has the advantage of a known quantity and distribution of bacteria since its production is overseen by regulatory agencies.”

    You’re kidding, right? The regulatory agencies that allow the sale of illegal honey in the US, or have allowed farmers to wantonly dose food animals with antibiotics for decades despite having the opinion that this is harmful, or that allowed Jack DeCoster to move from state to state to produce eggs for food in conditions that led to the breeding of salmonella leading to a 550-million-egg recall? Those regulators?

    Intersting article, and fascinating point about yogurt in your hospital, but faith in the regulators is a pretty dicey proposition…

  13. EricG says:

    reminds me faintly of the Southpark episode where they all put food in…uh…backwards, and poo out their mouths. the U.S. surgeon general was quite gracious with his credit to cartman for finding this healthly alternative.

    @ Calli Arcale

    you’ve stumbled upon near magic. mix greek yogurt with a ranch packet (or piece together the herbs and spice yourself if you’ve got the time) for ranch that doesn’t start with “oil, water, sugar” or, since you would have nearly all you need anyway, lime, garlic, cucumber, salt, pepper, dill. tzaziki (sp?). that thick yogurt is amazing.

  14. Wait. A kid not yet at the age of majority gets paid money for his feces? Really? Do they regulate his diet so that it’s all-organic, locally-sourced, fair trade, vegan? Klismaphiliacs.

    From the Colon Therapy pamphlet I came across this weekend: freaking out about some sort of closed system whereby unnamed toxins are continually reabsorbed, leading to “auto-intoxication.” Food particles, parasites, what-have-you making you sick with liver imbalances or whatever. Colonic hydrotherapy is the obvious cure, and “…If you wish, you are able to observe what is exiting you body as it travels through a viewing tube…”

    I’m only half-kidding about the fetishism angle.

    I just started a Z-pak for sinus infection. Off to eat a yogurt.

  15. Zetetic says:

    Paying that kid for his feces? Sure to precipitate some sort of anal fixation!

  16. Lytrigian says:

    There would be a less prolonged effect if we were more like mice and were coprophagic, but eating poo is not high on the human consumption list. Except for those of us that love hot dogs.

    The best known and more reliable effect of messing with the bowel flora is diarrhea, which comes in two flavors…

    I see what you did there.

  17. Chris says:

    Dr. Crislip:

    I recommend the yogurt over probiotic pills if possible, despite how unpleasant yogurt can be.

    When you can get good local strawberries try a dip made with plain yogurt and a little bit of brown sugar. I also like a sauce made of yogurt, garlic, cucumber and mint.

    Warning, much gross crazy follows… do not be eating, sitting quietly at your desk or drinking any fluids when you read the following!

    Y
    O
    U

    H
    A
    V
    E

    B
    E
    E
    N

    W
    A
    R
    N
    E
    D
    !

    Now, for really gross: Sullivan at LBRB found some extra crazy on a web forum:

    Here is how this procedure was done by that physician in canada who does not practice anymore. you collect the stool from a healthy relative (mother, father , so on) for a week in a bucket, no preservatives or cooling. Then mix well, fill in a decorating cone (that cloth cone you use to decorate a cake). Use the cone as an enema to empty all the content in the patient’s colon. The patient needs to hold that as long as possible.

  18. weing says:

    So if you have a patient with C. diff colitis in the hospital, or even at home, would it be a good idea to have family members not wash their hands after going to the bathroom and preparing or feeding him/her? I can’t resist sharing a nugget I learned years ago. Diarrhea runs in families.

  19. weing says:

    I just had another thought. Why not have the family members not flush and leave the toilet seat up. Then have the patient go and flush after them. They’ll get aerosolized stool and bacteria that way.

  20. LMA says:

    All sh*tting aside, my own personal anecdotal experience definitively links depression and IBS; when I’m severely depressed, my guts get all messed up, and alternately, I can be feeling really good mentally, but as soon as something sets off my IBS, my mood plunges immediately. Both my gastroenterologist and my therapist say this is familiar to them, and that purportedly, your small bowel secrets serotonin which of course according to current theories of mental illness, is implicated in mood regulation. So yeah, it’s easy to laugh about someone else’s intestinal misery, but it’s really not funny when you’re the person home sick on FMLA Intermittent Disability Leave.

    Just sayin’

  21. weing says:

    @LMA,

    Your GI tract has the largest collection of nerve plexuses outside the CNS.

  22. BillyJoe says:

    At least Australian diarrhoea and faeces looks better than American diarrhea and feces but, although it’s a close call, still not good anough to eat.

  23. nybgrus says:

    I agree. Yogurt is amazing. I eat it plain and in every other way imagineable. But then again, I was born in the country that invented it and for which the l’il bugger is named:

    Bacillus bulgaricus

    So it would be absolute heresy for me to have a distaste for the stuff.

    One of my favorite applications is a topper for spicy (aka flavorful, not hot) ground meat dishes. In particular stuffed bell peppers and what we call surmi (pronounced SUHR-mee with emphasis on the second syllable). The Greeks call it dolmeh (and the middle Easterner’s something quite similar to that as well). However, instead of grape leaves, I much prefer it would pickled cabbage (aka saurkraut, but instead of making it julienned cabbage, you saur the whole head and then use entire leaves to wrap the delicious beef filling).

    Now I am hungry and need to call my mother to make some food.

  24. DavidRLogan says:

    Great post.

    @daijiyobu thanks for the link. Having worked at a restaurant with such a soda fountain I should say I’m less than surprised (gross face)

    Otherwise this is all very interesting. I don’t personally use yogurt much because of the lactate content (I also am slowly morphing into a Howard Hughes figure). But once in a while it’s delicious! Shame on anyone who doesn’t like it barring some sort of allergy/intolerance!!!

    As I say on almost every post I don’t find many probiotics that meet label claims (ok none…but I’ve only looked at a few since I don’t plan on taking them). Jeez I’m a loser for always typing that.

    Have a nice (hopefully warm!) afternoon everyone. Beautiful here in Lincoln.

    -David

  25. Apparently I need immune suppression. Just for cost comparison, the treatment technically known as “Blasting you with Prednisone” cost me a $40 Urgent Care co-pay plus about $4 at the pharmacy. I realize this ignores the buckets of money we send to our insurer each month, but even including that it’s still far, far less than the $3-$7k for the naturopathic stool transplantation. As an added benefit, no 13-year-olds were exploited in the process.

  26. pmoran says:

    Still, the concept of colonics for ‘detoxification’ strikes me as more humorous than repellent, despite the lack of efficacy and documented complications of the procedure.

    It is another example of how CAM meanders around in the tracks of the mainstream with its eyes on the ground, gathering up our leavings — those ideas and practices that we discard as better understandings of biology come along. (Within the last century they also include the use of vitamins as pick-me-ups, other kinds of “tonic”, the “septic” focus as a cause of obscure illness and Warburg’s anaerobic theory of cancer. )

    The colon IS a source of serious “toxins”, as is strongly evidenced when our livers fail, so that colonic toxicity has some solid basis in fact.

    As applied by CAM, however colonic theory panders to hypochondria and purity fetishes, providing a temporary endorphin rush in those feeling ever-so-much purer after a successful “cleanse” while not realizing that that within 24 hours or so their colon will be back to much the same state as it was before, even if it was effectively “cleansed” (which it will not be in most of those who have genuine constipation Dr Gorski will confirm that we surgeons were experts on this — we need a scrupulously clean colon for some of our purposes.)

    All colonic treatments should be severely discouraged. They carry undue risk, especially of anal injuries by poorly trained personnel. The time would be better spent on exercise. It can provide much the same sense of health accomplishment and general well-being.

  27. DW says:

    “CAM meanders around in the tracks of the mainstream with its eyes on the ground, gathering up our leavings ”

    That’s a great line.

  28. DW says:

    This is a very funny thread.

  29. DW says:

    Sorry still laughing over this:

    “CAM meanders around in the tracks of the mainstream with its eyes on the ground, gathering up our leavings”

    Or in this case, perhaps not so much with its eyes on what was left on the ground, as “what is exiting [the] body as it travels through a viewing tube…”

  30. Janet Camp says:

    I’m a huge fan of Greek style yogurt and I make the same yogurt/cucumber/garlic/mint sauce or dip mentioned earlier and everyone (even the junk foodies) loves it. I use yogurt for salad dressings and in place of mayonnaise in things such as pasta or tuna salad. I’ve never eaten sweetened or “flavored” yogurt, but I do stir in fresh berries and a tablespoon of granola for breakfast. Anyone who thinks yogurt is “icky”, really needs to try the Greek type and add seasoning or fruit, not sugar.

    If you don’t like the expense of the Greek yogurt, get the regular stuff and let it sit in the fridge overnight in a colander or strainer lined with cheesecloth or nylon netting. I used to do this all the time before the Greek stuff came on the market.

    When I had my colonoscopy, by the way, the doc said I had the cleanest colon he’d ever seen! I think, though, that this is because I followed instructions to the letter and many of my friends tell me that they “cheated” a little.

    I wonder if this CAM poop fixation stems from the same brain process as the Alien Abduction phenomenon where they always seem to have been “anally probed”?

  31. ccbowers says:

    “But then again, I was born in the country that invented it and for which the l’il bugger is named”

    I’m not sure where the claim that yogurt was invented in Bulgaria comes from, but it is my understanding that the invention of yogurt is one of those things that we simply don’t know. The consumption of fermented milk products goes back thousands of years in Central Asia, but perhaps the claim involves a more specifically defined ‘yogurt’ product.

  32. mousethatroared says:

    Hehe, I recently got a puppy, so I can sympathize with the CAM poop fixation. Not only am I fixated on where to poop goes (outside not in) and the content of the poop (please no worms). And of course there is the ongoing effort to keep the puppy from either eating or rolling in his or other animal’s poop. But now that our puppy has had some issues with his anal glands, I find myself tinkering with his diet in the hopes of influencing the consistency of the poop (a dog needs good solid poop to adequately express the anal glands). The dog food boards are filled with (contradictory) personal annecdotes on how particular foods effected dogs poops.

    Now I come to SBM and what do I see, more poop!

  33. Pman says:

    Thanks for the post Mark. VSL #3 is a standardized probiotic that has some data.

    It’s nice we’re having this conversation in 2012 – probiotics has been floating in the integrative medicine circles since the early ’90s (at least). Stool transplants have been around since the ’90s. Twenty years to gain traction for a modality that’s nasty, but life-saving, with sensational efficacy rates (and I don’t use that word lightly) begs the question: is this the best we can do?

    Integrative medicine thrives in this space.

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