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  • 1. ARI: Everybody, I am so excited to be speaking with Glenn Taylor, who is a microbiologist at the Taymount Clinic in the UK. Hi, Glenn. GLENN: Hello, Ari. ARI: Thank you so much for speaking to me. Glenn is a microbiologist who’s become an expert in fecal transplants, which is really what I want to talk to him about. Glenn, how did you get to this point, first? Let’s start there. GLENN: First of all, exactly fecal microbiota transplants. I don’t use whole product; I just extract the bacteria from there. How did I get into this? Well, I’ve been for 10 years conscious of the fact that bacteria actually play a major part in digestion, and to try and improve the environment inside the gut, I was working with probiotics, trying the different strains, different groupings, trying to combine them together, different media that I was growing them in. In essence, we were basically trying to create sufficient bacteria that we hoped would colonize in a human gut and relieve many symptoms. It took years before I realized that probiotics, as good as they are when they’re present, are very poor at colonizing. So it was a phone call I received some three years ago – or at least my wife was the first recipient of the call; a young man came on and said “Please don’t put the phone down on me. I’ve got an unusual question, and so far everybody I’ve asked this thinks that I’m a bit strange. I’m looking to get a whole human gut microbiota transplant.” My wife said, “Sorry, I don’t quite – what exactly?” “I’m looking for fecal transplant.” Bless her, she thought the worst and was about to put the phone down until I practically vaulted the desk and I said, “Hold it, hold it, hang on a second.” I spoke to the young guy, and that was my road to Damascus. I suddenly realized that my work was broadly wasted, and that what I really needed to be concentrating on was how to find the right diversity of bacteria, how to harvest it, how to preserve it, and how to put it back in, how to implant it. So for three years, I’ve just been researching, working, putting it into practicing. Very quietly, I have to say, in possibly the smallest research clinic in the world. And then we found that one or two of my patients were talking on the internet, and the next thing, I get an avalanche of inquiries. I had no clue that people were out looking. I had spent my time thinking “This is a bit fringe, a bit out there. Perhaps one day, what we do might be looked at a little bit deeper and accepted as a possibility.” What I didn’t know was that there were a huge amount of people on a search trying to find anywhere where they could achieve a clinical grade of implant. The result is that we’re about to move. We haven’t been here very long before we have to throw up and put our bags in the back of the car and move off to a new facility that will give us four times as many treatment rooms and double the facilities of being able to treat eight patients a day per room. Just because it’s absolutely necessary now. ARI: This is so amazing to me. I don’t even – I almost don’t know where to start because I’m so excited to even talk to you about this. The first question I have is how did you know what you could treat with it? Because as someone who suffered with Crohn’s disease and overcame it, it
  • 2. seems like a lot of people – a lot of doctors, at least – don’t even consider the gut when looking at illnesses. So how did you know what you could do with fecal microbiota transplants? GLENN: I suppose it’s part of being a bit of a maverick and going out and looking. First of all, research told us clostridium difficile responds extremely quickly. In fact, the battle is over and done with in probably about an hour. We only continue here at the clinic to do another two treatments on top, because quite frankly, it’s not fair to let a clostridium difficile patient not have a reasonable amount of microflora. After all – I’ll continue on C. diff. C. diff is present in an alarmingly high number of people, a very small amount, kept under control by your commensal bacteria. It’s only when you interfere with the ratios that clostridium can get out of its box and can cause an infestation. This is why we hear cases classically in hospital when people have undergone antibiotic treatment that changed the relationship of the different species in the gut that would normally keep clostridium under control. They certainly are there, because the antibiotic used kills the preventative bacteria – boom, it happens. That’s very well known. We then went on to say we’ll do not just one, but three treatments, because these people have clearly got a problem in the first place with their microbiota, so we’ll do one to kill, two to make sure, three to start to decolonization process. I’ve heard horror stories from the C. diff federation that a lot of physicians are simply relying upon a single implant and expecting it all to happen from there. Believe me, fellas, it doesn’t. So from that point, we started to hear some stories that immune conditions responded, people were seeing a change in their symptoms, when they had implants. You have to remember that we realize that by changing gut flora, you can change fairly simple things, like constipation. So with patients who are experiencing severe constipation, what we do is we just wash out their existing bacteria and put in a whole new bunch and presto, suddenly these people are able to have a regularized bowel movement and feel comfortable, and all the other symptoms that went with their constipation seem to abate. Now, when you’re treating people for constipation and they’ve got an underlying condition, like IBS – constipation together with IBS – and they come back and say “Hey, all my other IBS symptoms seem to have gone” – I have a colleague in Australia I’ll be with shortly, a professor of gastroenterology who’s been a long-term proponent of this. He found that when he was asked to treat patients with Parkinson’s and autism and [inaudible 00:07:05] classically had got constipation. When he replaced the gut flora and gave them a broad diversity and they were handed back to their carers, the physician and carers responded by saying “What else did you do? We’re seeing neurological changes. What, you just changed the bacteria and now it’s getting neurological changes?” So at this point, you start to look a little bit broader. Autoimmune diseases. For example, when we treat patients and they report that they’ve got conditions like enteropathic arthritis, they go through a course of treatment and they say “What did you do to my arthritis?” “I did nothing.” “No, no, it’s all gone.” “Excuse me?” So now we have to start [inaudible 00:07:50] each time we treat a patient. We say “Do you have any symptom of arthritis? Can you watch and monitor
  • 3. during the treatment program and let us know what’s happening?” And people are saying the aches in the joints and the nodules on the fingers and the joints, “I’m starting to see improvements.” So this is all leading to autoimmune conditions being clearly affected by change in the gut microflora. So what do you do? You just then look at what’s the function of the colon in the human body? We know, for example, that many patients unfortunately have to have a total colectomy. You get to a point where doctors can do no more than remove a highly inflamed colon, because it’s close to perforation. These people can survive, just as people who have colon cancer survive after the removal of the colon. Now, that means the colon surely isn’t a primary organ of the digestive system. At that point, I started to question its role, and I started to do “what ifs.” If you’ve looked at the structure of the colon and you’ve seen that there are so many immune cells placed in the colon – after all, there’s a very high proportion of your immune system exists in the gut – could it be that we had created an additional organ at the end of our digestive system – because we do a pretty good job of making our own enzymes – have we created an additional organ where we’ve given house room to bacteria, where the bacteria now interact with the immune system? Could we be describing perhaps more accurately the possibility that the colon is an organ of the immune system? If that’s the case, what are the autoimmune diseases now need to be investigated? We should now be looking at Crohn’s, ulcerative colitis, anything where there’s a suggestive of an immune connection, to see if by replacing all the gut flora in someone who has very bad dysbiosis, a very poor diversity of bacteria, if we actually change it and give them a broad diversity, how does their immune system respond? What we’re seeing at the moment is extraordinary results. ARI: That’s right. This is just mind-blowing to me. First of all, my understanding is that the results are pretty quick when you do these. GLENN: They can be, yeah. Let’s put [inaudible 00:10:42] aside one second, because without sounding fatuous, it is actually as easy as falling off a log if you do it properly. ARI: Okay, and please, tell me a little bit about how the actual process takes place, because as you said, you’re not doing whole material; you’re doing the microbiota and stuff. Because there’s plenty of stuff on the internet about people with their do-it-yourself versions, which I think is kind of crazy. So how does the process of the actual transplantation take place? How do you identify donors? Tell me about that. GLENN: Okay, first of all, I’m not here to offend anyone who’s undergone the procedure at home who thinks that’s the only one available. I’m aware that people can’t work because of their condition, they can’t afford to go for a proper treatment. What I’m disturbed about is the stories I get – unfortunately, at this moment in time, I’m getting a number of stories in the United States where the process is so poorly understood, physicians seem to be trying to use it as an opportunity and don’t quite understand the biology that’s involved.
  • 4. You’ve got to go right back to biology. How do we select? We select donors based on lifestyle and their own understanding of what their own wellness and their health is all about. We have to kiss a lot of frogs just to find a few princes. What we’re looking for, people who have basically got an innate understanding of what’s good for them. They have little interaction with antibiotics in recent history. That they eat particularly well, that they understand the concept that food has on the body, that by eating the right foodstuffs, you get the right responses. They understand things like the Paleo concept, that this hominid has survived 1.5 million years on this planet by gathering, picking, plucking, digging, and throwing sticks at things, and those foods have allowed us to develop rather successfully, and the new foods that have turned up in the last few millennia – where, let’s face it, we’ve only been farming for 280 linear conceptions, if you think about that, 280 generations – what the level of change to our DNA have we managed to achieve in a mere 280 opportunities to exploit mutation? So we have to look back at the fact that we’ve survived so many thousands of generations and eaten the foods that we’re used to and that we can eat well – and the concept of the Paleo diet basically is we understand it, we are genetically engineered to be able to consume it; it’s going to take us many, many more thousands of years before we learn how to properly eat a pizza. ARI: Right, of course. GLENN: Sometimes, the convenience foods are the only things to hand. If you apply the 80/20 rule, then you’ll get better benefit. So yeah, our donors, back to that, because I do wander. I do apologize for that. We have to work with donors who eat very well, who have not suffered too much medical intervention, who are tested – and that’s the critical part to this – we test people with both blood and stool tests to make sure they have no communicable diseases they can hand over to anybody in any compromised state. So we’re able to be fairly sure that we’re not going to give a recipient something they don’t want. Our donors get paid to produce; they’re professionals, and they’re tested every three months. In essence, looking for a new donor, somebody contacts us and says “I think I eat well.” We start the test process. We take blood and stool and they go off to the lab. We do DNA profiling, so we’re using qPCR processes to be able to tell exactly what bacteria are and are not present. It’s the most accurate system to date. The old system of culturing is old school and very inaccurate. So we’re testing them. At the same time, we bank what they produce. I’ll go through that in a second. We bank what they produce. Then we go get the results of the first test. We decide whether we keep anything they’ve banked or we dispose of it and we look somewhere else. If they’re good on their first test, we continue to bank. After three months, we test again. If they’re still good, everything we collected between Day 1 and three months is clearly good to use. So we turn the box around in the ultra deep freeze to the “use” end instead of “fill,” and now we can start using their microflora.
  • 5. At this moment in time, the bank has five donors, which allows us to then choose from different donors on each day that we’re putting an implant into a recipient, a patient. That means that on different days, different donors eat different things and have a different structure of their microbiota. By utilizing five donors and then using different timed extractions, we have one on one day of the month and another on another day of the month. Then we mix the donors during the treatment program. So let’s say 10 day treatment; you get two treatments from each donor at a different time of the month when they gave the implant. That gives a much broader possibility of having a broader range of bacteria. Our diversity chances are increased, so that we can draw a straight line across the level of bacteria and say that you’re going to be receiving almost Olympic level bacteria. ARI: Right, it’s the crème de la crème of microbiota. And how are you getting it in? How is the implantation process happening? GLENN: Okay, the implant. You hear a lot of horror stories how it happens. The nasogastric tube is one favored method. I have to say that we don’t keep bacteria in our small intestine by some intrinsic systems that we engage to stop bacteria wandering around where they’re not wanted. We use bile acids that we recycle again and again in our digestive process to keep our bacteria away from our small intestine. And it’s very successful, which is why 99% of people walk around with a small intestine that does not suffer from small intestine bacterial overgrowth, because we basically sterilize it. That is a very well known procedure. Now, when you start using a nasogastric tube, why would you place bacteria in harm’s way by putting it into an environment that is likely to kill and discourage them? We go straight back in where it’s supposed to go. Two ways of doing that, either by colonoscope – you know, that big – for the listeners who’ve undergone this, they’re wincing at this moment. ARI: I know it too well. GLENN: There’s no comfortable way of inserting a colonoscope. It’s a big piece of equipment. You probably need sedation. It’s not without a degree of risk for perforation. It really is an unpleasant experience that you wouldn’t queue up and pay to do too often. So the object being you use the very small biopsy channel that runs down the colonoscope. A good operator boasts that he can get from daylight to the ileocecal valve in about 33 seconds flat. That is indecent haste. But if you look at the way that they do that, the speed that they go in, that’s got to add risk somewhere. But once they’re all the way in, they’ve scoped you with a camera and they said “We’re in the right place,” they then implant down through the biopsy channel, as they slowly withdraw the instrument. This allows them to leave a trail behind them. That says yeah, we’re going to get pretty good dissemination. Now, I use a pediatric rectal catheter, which allows me to put the implant into the descending colon. For those of you listening, put your hand on your left hip. The soft part just inside your left hip, just inside the bony bit, that’s your descending colon. That’s where I do the implant.
  • 6. Utilizing a couch that does some very clever trickery as far as gravity is concerned, and a deal of manipulation, I then disperse the implant completely around the colon, getting 100% dispersal. So I achieve the same thing without the invasive process, with a much lesser risk, and it’s just a successful. ARI: And no sedation, right? GLENN: And no sedation. In fact, I’ve had a number of patients say “Goodness gracious, is it in yet?” No, don’t, don’t, because that brings back memories of ex-girlfriends. So really, it’s not a painful process at all. Nobody knows that it’s there. Sometimes they go “Ooh, was that it going – is that the implant actually going in?” Yeah, because they feel a small amount of pressure as the colon has to accommodate the increase in the volume of the implant. But that very quickly then disperses. The process is about three to four minutes. That’s all. And then the patient then waits for 30 minutes, because we want an appropriate amount of inactivity whilst the patient then draws out the saline solution. They want to draw the water out, making the implant a little bit thicker so that it can then stick to the walls. Because this stuff really doesn’t know how to stick. There’s a delightful English expression; I won’t regale you with the involves. ARI: This is an explicit podcast, so you’re welcome to. GLENN: Well, it sticks like whatever it is to a blanket. And that’s what they do. The pili and the flagella have got a method of adhering that’s second only to I guess Araldite. It’s great stuff. So yeah, we get full dissemination, no problem at all, and 45 minutes, the patient is back on the road again, back to their hotel, back to their home. But we express that we want relatively little activity so that you have a chance for it just to settle down. ARI: Sure. One of the things that really makes me curious is – well, actually, you sort of said this too, because your donors, you’re looking for people who have this certain lifestyle. They eat a certain way or they have some awareness. It’s just like if you give an alcoholic with cirrhosis a brand new liver, they really shouldn’t go back to drinking because they have a new liver. How do you deal with that aspect? A lot of these illnesses are brought on by a lifestyle that differs from the Olympian level donors that you’re getting it from, so is there any advice that’s given to people on that front? GLENN: Absolutely, because once they get here, then our whole team moves into play. We’ve got to address a number of issues. Stress. Absolutely a mess. Never underestimate the damage that stress does. ARI: I’m glad you said that first. GLENN: We’ve even got therapists here who have to help people with their stress levels, including not letting people travel too far to get to us on a daily basis. They get accommodation locally so they don’t turn up completely strung out, because that will undo everything we’re going to do for the rest of the day. So yeah, stress we deal with.
  • 7. We have to make sure they’re getting adequate sleep, and the food. They really do need a lot of help with food, because let’s be honest: if you carry on doing what you’ve always done, you’re going to carry on getting what you’ve always got. ARI: Yep, absolutely. GLENN: So something has to change, and it’s the food. It’s amazing how open people are. Let’s be honest; if you’ve done this journey through life and it’s exposed to you exactly why you’re in the position you are, you generally take the advice that’s given, and that is that you’ve got to eat correctly to make sure that these little fellas get their food as well. After all, what’s the expression, you are what you eat? Well, I don’t know. I would say take that further: you are what you eat eats. ARI: Yes, absolutely. GLENN: So what your little guys – you’ve managed to get your little guys inside; now you’ve got to feed them. And you are the most extraordinary exotic pet shop. Let’s face it: if you went to a pet shop to buy a new pet, you walked up and down the aisles, found something that was really cute, went back up to the guy at the desk and said, “I’d like to take this home, please,” and if he said to you, “Did you get their food while you were down there?” and you go “No, no, I thought I’d just feed it scraps off the table or we’d take it down to McDonald’s every now and again,” and he said, “You just take that thing back, put it back where you found it. You’re going to kill it.” So the point is, your bacteria live off certain food groups. If you want them to stay, could I suggest respectfully that you feed them properly? ARI: I think that that’s an excellent point. Because you’ve made the process – it sounds pretty pain-free and pretty easy and pretty straightforward – it sounds like you could probably experiment with a whole bunch of complaints and illnesses that people might come in with. I mean, you’re going to have people coming in with the common cold getting an FMT and walking out feeling great, it sounds like. GLENN: We’ll draw the line at [inaudible 00:25:18]. ARI: Well no, I’m joking a little bit, but I’m being serious, yeah. GLENN: I do agree with you. We don’t know where this ends. Every single day is a new opportunity to find out just what else might happen. We get people sending emails saying “I got…” and they’ll come up with something I even have to go and have a look at the medical directory to find out what the heck it is. I say “What do you think? Are you willing to give it a go?” ARI: Yeah, try it.
  • 8. GLENN: What have they got to lose? I guess you’ve got to lose the fee. That’s something, if it doesn’t work. But every opportunity, we get to find out if it’s just the immune system, or what else? ARI: I know that you’re going to have people, I’m sure, coming to you with depression, anxiety, all that kind of – and autism, even, maybe has some effect. Are there any side effects? I mean other than – I mean, are there? Are there side effects? GLENN: Yeah, absolutely, there will be. If somebody turns up in an extreme, acute state of inflammation, where their mucosal level inside the colon is fairly exposed, they’re ulcerated, pustulating, bleeding, then I’m afraid that what bacteria do when they arrive in an environment is to test it to see if it tastes good. They basically flood enzymes onto a surface to see if they can break it down. That’s what enzymes do; they’re cleaving enzymes. They chop things up. And they will attack any surface they have access to. Normally, if you’re protected by your mucosal layer, then you’ll do minimal damage. But if it’s exposed, yeah, I’m afraid that you’re not going to do yourself a huge amount of good. Don’t think that you can take a flare into a clinic for treatment with FMT, because the flare has to be brought under control first. Otherwise, you’re likely to see it exacerbated. That’s one of the major side effects that we see. In biological terms, if I was to purely talk as a biologist, I’d say, so, you take all the necessary bacteria out of a fit and healthy person. You tested the person. They’ve got no infectious diseases. You take these bacteria and you put them into a gut of a person who’s lacking a lot of bacteria. For pity’s sakes, what side effects are you expecting to happen? Why would you even imagine that they would? Now, that’s taking a simplistic view. What I’m saying is, there are precious few. What we’re seeing is inflammation is a big problem, and you shouldn’t have to take FMT if you have a high level of inflammation. Otherwise, you’re just going to exacerbate the situation. But otherwise, it’s not a problem. ARI: Okay. Glenn, we’re almost out of time here, and I want to respect your time. I want to make sure that people know that if they want to send you an email saying “I’ve got this, can I try…”, how do they find out about the Taymount Clinic and what you’re doing? GLENN: Okay, very simple to find us. It’s Taymount, not “mont,” [inaudible 00:28:27]. We get people turning up at funny angles. But yeah, Taymount Clinic is at www.taymount.com. To go through the website first will answer a huge amount of questions. It will also show you how to get hold of us; if you can’t find the answer to the question you’ve got there, then admin@taymount.com will get you there. But I do beg you to go to the website first and to read everything. If you’ve got something really unusual, bring it to us. Like recently, TMAU, trimethylaminuria. That’s the “fish smell” syndrome. We’ve investigating to see whether some bacteria contain FMO3, the enzyme required, and see if that will help. So there’s lots of things that we are yet to investigate.
  • 9. ARI: Wow. Well, Glenn, thank you so much for your time. This is really eye-opening for me, and I know that for the people listening to this podcast particularly, this is going to be amazingly interesting. So Glenn, thank you again, and I hope to talk to you again soon. GLENN: Yeah, great. Thank you for inviting me along to talk. I hope I haven’t baffled people with too much science. I take it this is going out in the States, and you’ll get the accent, I hope, after a period of time. We take a slightly different view on it; you strangled ours. ARI: Well, I think it made for a very good delivery, so thank you. GLENN: Great.