11 ms·

Australia gives world-first approval for fecal transplants to restore gut health

109 points by ValentineC 4y ago

LinuxBender 4y ago
Out of curiosity, how does this compare to mixing diverse cultures of probiotics with short chained fatty acids and injecting them rectally?
- diamondo25 4y ago
  Not a doctor, but I suppose its because its a complete mix and easier to do, because theres almost no prep needed?
- polskibus 4y ago
  Probiotics mix would be orders of magnitude less diverse.
  - LinuxBender 4y ago
    I am also curious about that as well. How many strains of beneficial bacteria are in feces? The probiotics I use have 20 beneficial strains but the company won't send me a non-capsule pack of the powder. They also have one with 36 strains, 120 billion CFU so it takes a lot of capsules to get a meaningful amount and takes a long time to open all the capsules. Based on my limited research it appears stool has about 100 billion per gram of wet stool but it also contains a lot of other material some of which may be harmful.
    - iancmceachern 4y ago
      My understanding is that a lot of the beneficial organisms dining the presence of oxygen, making it challenging to collect, multiply, and package them into pills or powder. Perhaps this is why they only offer the pills, the powder form in a jar would render some of them ineffective?
      - LinuxBender 4y ago
        I was thinking a sealed Mylar bag with O2 absorbers but I can see the cost issue that may arise especially if only a few self experimenters like me were interested to begin with.
        iancmceachern 4y ago
        As soon as you open the bag it's all exposed to o2. In a blister pack each does is in its own little chamber so when you open one dose it doesn't impact the others. An interesting aside, they started doing this kind of thing in the last few years for inhalers. There are some medicines that come as a fey powder, and need to be inhaled as such. It's a challenge to keep a bunch of doses together in one container and dose doses out without impacting the rest, so they do the same thing. The inhalers have little blister packs with individual doses in them, each time you need to take a puff you rotate the inhaler which advances to the next dose, pops the blister pack, and then you inhale.
        LinuxBender 4y ago
        It's probably OK if a percentage of them are damaged by the O2. If I take 4 to 8 trillion each time it just means I would have to do it more often. The only alternative I know is the usual and incorrect in my opinion way people consume probiotics which is significantly worse. Most are destroyed by the hydrochloride acid, digestive enzymes and bile. Worse, some of them survive and have to pass through the small intestine which is absolutely the wrong place for bacteria to exist, especially if there is even the slightest amount of inflammation of the junctions and especially if some remain in the mucus layer and grow in numbers potentially leading to SIBO. With my current method they go straight into a container of short chained fatty acids which I understand they can feed off of for a while. The SCFA are also beneficial for the large intestine.
    - massaman_yams 4y ago
      Table S3 here[1] starting on page 9 appears to show nearly 80 different genuses within stool samples after filtering out "vegetative (non–spore form) bacteria, fungi, parasites, and viruses" [2]. No word on how many strains per genus, but reasonable to assume multiple, if not hundreds in some cases. [1] https://www.nejm.org/doi/suppl/10.1056/NEJMoa2106516/suppl_file/nejmoa2106516_appendix.pdf https://www.nejm.org/doi/suppl/10.1056/NEJMoa2106516/suppl_f... [2] https://www.nejm.org/doi/full/10.1056/NEJMoa2106516 https://www.nejm.org/doi/full/10.1056/NEJMoa2106516
      - LinuxBender 4y ago
        On nice! I will save that one and read up on each species. I think it would be useful to know which of those are beneficial and are missing from the 20 I utilize.
- stevenwoo 4y ago
  Not exactly your question, but my reading of The Gene: An Intimate History says any microbiome changes from eating fermented foods like yogurt/kefir/kimchi disappears when the food leaves ones diet. This was published in 2015 so could be superceded by subsequent studies in same field and I didn't bother researching the studies referenced in the book, either. The book also talks about successful uses of fecal matter transplants (FMT) for c. difficile treatment, and it worked about 90% of the time, but required a periodic refresh because none of the patients in the studies could maintain the healthy microbiome without the FMT after a year or so.
  - stevenwoo 4y ago
    correction, the first note about fermented foods came from Burn(2022).
omnicognate 4y ago
Is it possible, once scaled up and using an artificial biome as described in the article, that this could be used periodically by people without specific symptoms, as a prophylactic or to improve general health? Or are there reasons that would be a bad idea? Reducing diversity in gut flora, perhaps?
- PaulKeeble 4y ago
  Our understanding of the gut microbiome is really primitive, we really don't know what a great one looks like. More problematic is that quite a lot of the bacteria that are critical die in the presence of oxygen and are thus very hard to collect and reintroduce. So far no one has made a mechanism to keep them alive and reintroduce them into other people. I would not be quick to rush to a fake biome just yet, it will almost certainly be lacking in a whole range of areas.
  - akiselev 4y ago
    That’s the problem of unculturable species that pervades microbiology and anything related like agriculture. We have no idea what percentage of bacteria species can even survive long enough to be studied in the lab let alone industrialized. Even if someone manages to grow them accidentally, we’d never know it because if they don’t absorb any of the known stains, it’ll just look like agar on a plate under a microscope. Last I checked the “state of the art” was to use a freaking electron microscope and hope that the plating process didn’t destroy the sample.
- mumblemumble 4y ago
  Just shooting from the hip, I'm going to guess that deliberately destabilizing ecosystems that aren't known to be unhealthy is generally not going to make them more healthy. I wouldn't say that it's impossible to come up with some sort of microbial suppository that can take a healthy (for the host) microbiome and make it even more beneficial to the host. But, given the level of inter-person diversity in gut flora, I can't think of any particular reason to believe that it's likely that there's some universal treatment that would be beneficial to everyone regardless of their existing flora.
- 4y ago
jeffrallen 4y ago
I just saw a documentary on this the other night on Swiss television saying that CHUV in Lausanne is doing this. So maybe "first in the English speaking world that lazy journalists have access to" would be more appropriate.
- nyokodo 4y ago
  > first in the English speaking world I don’t know what regulatory regime CHUV is working under but the regulatory approval by Australia as a generally acceptable medical practice in the country is substantially different to the limited research scale programs employed elsewhere in the world.
- jjcon 4y ago
  The regulatory approval is a world first - they are happening all over the world already though
  - bombcar 4y ago
    I could have sworn I hear about this every 2-5 years it seems.
    - stubish 4y ago
      Research and trials. Successful enough to see the treatment approved for general use. No more popping placebos because you turned out to be in the control group.
lizardactivist 4y ago
If we set aside problems with storage and shelf-life, would it not be possible to cultivate these bacteria and offer the treatment in the form of capsule which would be swallowed and dissolved in the intestines?
- massaman_yams 4y ago
  It's not quite clear if this is cultivated or not but I know this MD was working on cultivation at one point. "SER-109 is composed of approximately 50 species of Firmicutes spores derived from stool specimens from healthy donors." https://academic.oup.com/jid/article/214/2/173/2572105 https://academic.oup.com/jid/article/214/2/173/2572105
- emmelaich 4y ago
  That is mentioned in the article! > oral delivery is expected to be available before too long. At last you'll be able to eat shit for breakfast!
spfzero 4y ago
Wouldn't an easier way to do this be to control diet? For one thing, it slows the process of change down which would ease any shock-related side-effects. Of course, it takes a lot of work from the patient to adhere, but if they are at the point that they are considering fecal transplant, they're probably ready. This also gives the biome a chance to adapt to anything particular about the individual, if possible (certain pharmaceuticals may not be able to be worked around.) Also, I would think if you did the transplant and never changed your diet, you'd often just go back to the old biome after a time, but I could be wrong about that.
- massaman_yams 4y ago
  Diet alone can't restore strains that don't exist in a patient's microbiome.
- Mountain_Skies 4y ago
  You're probably correct that keeping the same diet could kill off the transplanted biome but a better diet can't necessarily improve the gut biome if desired microbes have gone extinct in that person. And there are likely cases where a person had the proper diet but some of their gut biome was destroyed by some other factor like a broad-spectrum antibiotic.
  - zug_zug 4y ago
    Okay makes sense, but exactly how do these diverse bacteria get into our GI tract in the first place if we can't ingest them?
    - nanomonkey 4y ago
      Your mother, and through introduction from your anus and what you eat (a limited amount of bacteria can pass through your stomach, or are harboring in structures that don't fully break down in your stomach before being passed along).
- manmal 4y ago
  Many GI diseases correlate with loss of microbial diversity. That diversity can’t be recovered with diet alone - lost strains are lost. Even most probiotics are rather short lived in the GI tract.
dirtyid 4y ago
I can't wait for celebrities to start selling their poop. On serious note, mostly have followed this over years from weight loss literature, wonder if it will be applied in reverse, find the most efficient gut flora and get transplantees to hold on to calorise more efficiently.
- throwaway920102 4y ago
  I bring this up to friends like once a year. It's only a matter of time until there is the stool-transplant equivalent to a sperm bank. I often feel very fortunate to have had no mental health problems or struggles in my life, especially as I see depression and anxiety take hold in more and more of my friends in my 20s and 30s and for those who've tried literally everything else to no success I wonder what it would be like if I could be a gut microbiome donor to them. There have been studies showing reversal of mental health disorders after stool transplants. Feels like if your mental health is absolute garbage and you struggle with suicidality that rolling the dice on this couldn't get worse only better or do nothing.
  - tsol 4y ago
    There are already places where people who are healthy can sell their poop. They're apparently very selective. And some people do these things themselves at home out of desperation-- so there's also a sort of underground market for the stool of healthy people who never took antibiotics.
  - AussieWog93 4y ago
    >It's only a matter of time until there is the stool-transplant equivalent to a sperm bank. We've had one in Australia for a few years now! https://www.abc.net.au/news/2020-03-09/first-public-poo-bank-in-adelaide/12034138 https://www.abc.net.au/news/2020-03-09/first-public-poo-bank...
GutThing 4y ago
I have a gut problem. I don't really know what it is. It's been like 4 or 5 years since it started. Doctors don't seem to know what's going on but basically my stomach acid destroys my throat and I can even feel the acidity in my mouth but I don't have heartburn or any other common symptoms. I've been on omeprazole and other PPI and several more drugs without any improvement. In all these years it stopped for around 3 weeks when the doctor prescribed me 2 antibiotics and domperidone. Then it went back to "normal". They won't prescribe me antibiotics again because after being tested everything came as negative. Now they basically tell me to take more omeprazole, which doesn't change anything. All this made me realize that it could be a gut bacteria problem. Maybe the antibiotics killed it which made me improve and then it came back again. Maybe it was due a diet change. My only hope is that more research like this is done in the field and maybe one day I'll feel like a normal person again.
- sanjayio 4y ago
  Hoping you get well soon and figure this out. Have you heard of the inter abdominal pressure theory for acid reflux, which you’re describing or a theory like Chris Kresser’s? https://chriskresser.com/how-to-cure-gerd-without-medication/ https://chriskresser.com/how-to-cure-gerd-without-medication... It’s a fantastic write up, that I read through when going through something similar. For me, ultimately it was controlling my weight (I’m at 12% body fat now) and tons of fiber. I feel like my case was mild though.
  - GutThing 4y ago
    Thank you for the link, I'll read it. I've been told by my doctor that weight matters but I'm a fit guy, around 12-13% body fat, non smoker and rarely drink alcohol. I also take care of my diet. I cook my own food, don't eat anything processed (maybe once in a while yes, but it's not part of my diet), I drink a lot of water, no sodas. What do you consider "tons of fiber"? What do you eat in a day to accomplish it?
- aradox66 4y ago
  Hope you find some relief! It's frustrating how little is understood about reflux type symptoms. Can you explain why you say you don't have heartburn? It sounds like you're describing canonical heartburn symptoms.
ViceCitySage 4y ago
Weirdest headline that I have encountered here. Had to read it twice just to make sure.
- kzrdude 4y ago
  Then I guess you haven't heard of fecal transplants before
DocFeind 4y ago
oh the joys of medicine Down Under
cpeterso 4y ago
Here’s an interesting story and News York Times short documentary about Josiah Zayner, bio hacker and former NASA scientist, and his DIY fecal transplant to address his severe GI issues. https://www.kqed.org/futureofyou/384757/a-year-after-ingesting-someone-elses-feces-biohacker-feels-like-a-new-man https://www.kqed.org/futureofyou/384757/a-year-after-ingesti...
Auracle 4y ago
I did this myself at home when my IBS was getting out of control. My girlfriend at the time, now - unsurprisingly - wife, was the donor. I took a specific antibiotic to wipe out what I could and then we did the transplant. It helped significantly and pretty much instantaneously, though over the years I’ve regressed a bit. I took antibiotics for acne as a teen for years, so it’s no surprise that when I stopped those I started having issues.
mjh2539 4y ago
https://en.wikipedia.org/wiki/Xylospongium https://en.wikipedia.org/wiki/Xylospongium

109 points by ValentineC 4y ago

Out of curiosity, how does this compare to mixing diverse cultures of probiotics with short chained fatty acids and injecting them rectally?

diamondo25 4y ago
Not a doctor, but I suppose its because its a complete mix and easier to do, because theres almost no prep needed?
polskibus 4y ago
Probiotics mix would be orders of magnitude less diverse.
- LinuxBender 4y ago
  I am also curious about that as well. How many strains of beneficial bacteria are in feces? The probiotics I use have 20 beneficial strains but the company won't send me a non-capsule pack of the powder. They also have one with 36 strains, 120 billion CFU so it takes a lot of capsules to get a meaningful amount and takes a long time to open all the capsules. Based on my limited research it appears stool has about 100 billion per gram of wet stool but it also contains a lot of other material some of which may be harmful.
  - iancmceachern 4y ago
    My understanding is that a lot of the beneficial organisms dining the presence of oxygen, making it challenging to collect, multiply, and package them into pills or powder. Perhaps this is why they only offer the pills, the powder form in a jar would render some of them ineffective?
    - LinuxBender 4y ago
      I was thinking a sealed Mylar bag with O2 absorbers but I can see the cost issue that may arise especially if only a few self experimenters like me were interested to begin with.
      - iancmceachern 4y ago
        As soon as you open the bag it's all exposed to o2. In a blister pack each does is in its own little chamber so when you open one dose it doesn't impact the others. An interesting aside, they started doing this kind of thing in the last few years for inhalers. There are some medicines that come as a fey powder, and need to be inhaled as such. It's a challenge to keep a bunch of doses together in one container and dose doses out without impacting the rest, so they do the same thing. The inhalers have little blister packs with individual doses in them, each time you need to take a puff you rotate the inhaler which advances to the next dose, pops the blister pack, and then you inhale.
        LinuxBender 4y ago
        It's probably OK if a percentage of them are damaged by the O2. If I take 4 to 8 trillion each time it just means I would have to do it more often. The only alternative I know is the usual and incorrect in my opinion way people consume probiotics which is significantly worse. Most are destroyed by the hydrochloride acid, digestive enzymes and bile. Worse, some of them survive and have to pass through the small intestine which is absolutely the wrong place for bacteria to exist, especially if there is even the slightest amount of inflammation of the junctions and especially if some remain in the mucus layer and grow in numbers potentially leading to SIBO. With my current method they go straight into a container of short chained fatty acids which I understand they can feed off of for a while. The SCFA are also beneficial for the large intestine.
  - massaman_yams 4y ago
    Table S3 here[1] starting on page 9 appears to show nearly 80 different genuses within stool samples after filtering out "vegetative (non–spore form) bacteria, fungi, parasites, and viruses" [2]. No word on how many strains per genus, but reasonable to assume multiple, if not hundreds in some cases. [1] https://www.nejm.org/doi/suppl/10.1056/NEJMoa2106516/suppl_file/nejmoa2106516_appendix.pdf https://www.nejm.org/doi/suppl/10.1056/NEJMoa2106516/suppl_f... [2] https://www.nejm.org/doi/full/10.1056/NEJMoa2106516 https://www.nejm.org/doi/full/10.1056/NEJMoa2106516
    - LinuxBender 4y ago
      On nice! I will save that one and read up on each species. I think it would be useful to know which of those are beneficial and are missing from the 20 I utilize.
stevenwoo 4y ago
Not exactly your question, but my reading of The Gene: An Intimate History says any microbiome changes from eating fermented foods like yogurt/kefir/kimchi disappears when the food leaves ones diet. This was published in 2015 so could be superceded by subsequent studies in same field and I didn't bother researching the studies referenced in the book, either. The book also talks about successful uses of fecal matter transplants (FMT) for c. difficile treatment, and it worked about 90% of the time, but required a periodic refresh because none of the patients in the studies could maintain the healthy microbiome without the FMT after a year or so.
- stevenwoo 4y ago
  correction, the first note about fermented foods came from Burn(2022).

omnicognate 4y ago

Is it possible, once scaled up and using an artificial biome as described in the article, that this could be used periodically by people without specific symptoms, as a prophylactic or to improve general health? Or are there reasons that would be a bad idea? Reducing diversity in gut flora, perhaps?

PaulKeeble 4y ago
Our understanding of the gut microbiome is really primitive, we really don't know what a great one looks like. More problematic is that quite a lot of the bacteria that are critical die in the presence of oxygen and are thus very hard to collect and reintroduce. So far no one has made a mechanism to keep them alive and reintroduce them into other people. I would not be quick to rush to a fake biome just yet, it will almost certainly be lacking in a whole range of areas.
- akiselev 4y ago
  That’s the problem of unculturable species that pervades microbiology and anything related like agriculture. We have no idea what percentage of bacteria species can even survive long enough to be studied in the lab let alone industrialized. Even if someone manages to grow them accidentally, we’d never know it because if they don’t absorb any of the known stains, it’ll just look like agar on a plate under a microscope. Last I checked the “state of the art” was to use a freaking electron microscope and hope that the plating process didn’t destroy the sample.
mumblemumble 4y ago
Just shooting from the hip, I'm going to guess that deliberately destabilizing ecosystems that aren't known to be unhealthy is generally not going to make them more healthy. I wouldn't say that it's impossible to come up with some sort of microbial suppository that can take a healthy (for the host) microbiome and make it even more beneficial to the host. But, given the level of inter-person diversity in gut flora, I can't think of any particular reason to believe that it's likely that there's some universal treatment that would be beneficial to everyone regardless of their existing flora.
4y ago

jeffrallen 4y ago

I just saw a documentary on this the other night on Swiss television saying that CHUV in Lausanne is doing this. So maybe "first in the English speaking world that lazy journalists have access to" would be more appropriate.

nyokodo 4y ago
> first in the English speaking world I don’t know what regulatory regime CHUV is working under but the regulatory approval by Australia as a generally acceptable medical practice in the country is substantially different to the limited research scale programs employed elsewhere in the world.
jjcon 4y ago
The regulatory approval is a world first - they are happening all over the world already though
- bombcar 4y ago
  I could have sworn I hear about this every 2-5 years it seems.
  - stubish 4y ago
    Research and trials. Successful enough to see the treatment approved for general use. No more popping placebos because you turned out to be in the control group.

lizardactivist 4y ago

If we set aside problems with storage and shelf-life, would it not be possible to cultivate these bacteria and offer the treatment in the form of capsule which would be swallowed and dissolved in the intestines?

massaman_yams 4y ago
It's not quite clear if this is cultivated or not but I know this MD was working on cultivation at one point. "SER-109 is composed of approximately 50 species of Firmicutes spores derived from stool specimens from healthy donors." https://academic.oup.com/jid/article/214/2/173/2572105 https://academic.oup.com/jid/article/214/2/173/2572105
emmelaich 4y ago
That is mentioned in the article! > oral delivery is expected to be available before too long. At last you'll be able to eat shit for breakfast!

spfzero 4y ago

Wouldn't an easier way to do this be to control diet? For one thing, it slows the process of change down which would ease any shock-related side-effects. Of course, it takes a lot of work from the patient to adhere, but if they are at the point that they are considering fecal transplant, they're probably ready. This also gives the biome a chance to adapt to anything particular about the individual, if possible (certain pharmaceuticals may not be able to be worked around.) Also, I would think if you did the transplant and never changed your diet, you'd often just go back to the old biome after a time, but I could be wrong about that.

massaman_yams 4y ago
Diet alone can't restore strains that don't exist in a patient's microbiome.
Mountain_Skies 4y ago
You're probably correct that keeping the same diet could kill off the transplanted biome but a better diet can't necessarily improve the gut biome if desired microbes have gone extinct in that person. And there are likely cases where a person had the proper diet but some of their gut biome was destroyed by some other factor like a broad-spectrum antibiotic.
- zug_zug 4y ago
  Okay makes sense, but exactly how do these diverse bacteria get into our GI tract in the first place if we can't ingest them?
  - nanomonkey 4y ago
    Your mother, and through introduction from your anus and what you eat (a limited amount of bacteria can pass through your stomach, or are harboring in structures that don't fully break down in your stomach before being passed along).
manmal 4y ago
Many GI diseases correlate with loss of microbial diversity. That diversity can’t be recovered with diet alone - lost strains are lost. Even most probiotics are rather short lived in the GI tract.

dirtyid 4y ago

I can't wait for celebrities to start selling their poop. On serious note, mostly have followed this over years from weight loss literature, wonder if it will be applied in reverse, find the most efficient gut flora and get transplantees to hold on to calorise more efficiently.

throwaway920102 4y ago
I bring this up to friends like once a year. It's only a matter of time until there is the stool-transplant equivalent to a sperm bank. I often feel very fortunate to have had no mental health problems or struggles in my life, especially as I see depression and anxiety take hold in more and more of my friends in my 20s and 30s and for those who've tried literally everything else to no success I wonder what it would be like if I could be a gut microbiome donor to them. There have been studies showing reversal of mental health disorders after stool transplants. Feels like if your mental health is absolute garbage and you struggle with suicidality that rolling the dice on this couldn't get worse only better or do nothing.
- tsol 4y ago
  There are already places where people who are healthy can sell their poop. They're apparently very selective. And some people do these things themselves at home out of desperation-- so there's also a sort of underground market for the stool of healthy people who never took antibiotics.
- AussieWog93 4y ago
  >It's only a matter of time until there is the stool-transplant equivalent to a sperm bank. We've had one in Australia for a few years now! https://www.abc.net.au/news/2020-03-09/first-public-poo-bank-in-adelaide/12034138 https://www.abc.net.au/news/2020-03-09/first-public-poo-bank...

GutThing 4y ago

I have a gut problem. I don't really know what it is. It's been like 4 or 5 years since it started. Doctors don't seem to know what's going on but basically my stomach acid destroys my throat and I can even feel the acidity in my mouth but I don't have heartburn or any other common symptoms. I've been on omeprazole and other PPI and several more drugs without any improvement. In all these years it stopped for around 3 weeks when the doctor prescribed me 2 antibiotics and domperidone. Then it went back to "normal". They won't prescribe me antibiotics again because after being tested everything came as negative. Now they basically tell me to take more omeprazole, which doesn't change anything. All this made me realize that it could be a gut bacteria problem. Maybe the antibiotics killed it which made me improve and then it came back again. Maybe it was due a diet change. My only hope is that more research like this is done in the field and maybe one day I'll feel like a normal person again.

sanjayio 4y ago
Hoping you get well soon and figure this out. Have you heard of the inter abdominal pressure theory for acid reflux, which you’re describing or a theory like Chris Kresser’s? https://chriskresser.com/how-to-cure-gerd-without-medication/ https://chriskresser.com/how-to-cure-gerd-without-medication... It’s a fantastic write up, that I read through when going through something similar. For me, ultimately it was controlling my weight (I’m at 12% body fat now) and tons of fiber. I feel like my case was mild though.
- GutThing 4y ago
  Thank you for the link, I'll read it. I've been told by my doctor that weight matters but I'm a fit guy, around 12-13% body fat, non smoker and rarely drink alcohol. I also take care of my diet. I cook my own food, don't eat anything processed (maybe once in a while yes, but it's not part of my diet), I drink a lot of water, no sodas. What do you consider "tons of fiber"? What do you eat in a day to accomplish it?
aradox66 4y ago
Hope you find some relief! It's frustrating how little is understood about reflux type symptoms. Can you explain why you say you don't have heartburn? It sounds like you're describing canonical heartburn symptoms.

ViceCitySage 4y ago

Weirdest headline that I have encountered here. Had to read it twice just to make sure.

kzrdude 4y ago
Then I guess you haven't heard of fecal transplants before

DocFeind 4y ago

oh the joys of medicine Down Under

cpeterso 4y ago

Here’s an interesting story and News York Times short documentary about Josiah Zayner, bio hacker and former NASA scientist, and his DIY fecal transplant to address his severe GI issues. https://www.kqed.org/futureofyou/384757/a-year-after-ingesting-someone-elses-feces-biohacker-feels-like-a-new-man https://www.kqed.org/futureofyou/384757/a-year-after-ingesti...

Auracle 4y ago

I did this myself at home when my IBS was getting out of control. My girlfriend at the time, now - unsurprisingly - wife, was the donor. I took a specific antibiotic to wipe out what I could and then we did the transplant. It helped significantly and pretty much instantaneously, though over the years I’ve regressed a bit. I took antibiotics for acne as a teen for years, so it’s no surprise that when I stopped those I started having issues.

mjh2539 4y ago

https://en.wikipedia.org/wiki/Xylospongium https://en.wikipedia.org/wiki/Xylospongium