Transplant what?

On the day after my four-month SCD anniversary, I thought I'd share some news on the latest possible treatment for IBS that's getting a lot of buzz these days.

It's known by several names.  Fecal Bacteriotherapy.  Fecal Microbiota Therapy.  Stool transplant.  Yep, you read right, stool transplant: you take someone else's poop and transplant it into your colon.

Although it might sound absurd at first, once you think about it, it makes a lot of sense: there's a very diverse little village of bacteria in your gut, and if some parts of the population overgrow and others are suppressed or removed altogether, the entire system can start malfunctioning.  Badly.  But if you repopulate the village with a bunch of happy bacteria from the well-functioning village down the road, everything starts working properly again.

So how is this accomplished?  Well, it's been done in a few doctor's offices as a treatment for stubborn c. diff. infections.  But because it's still a fairly new procedure and hasn't received FDA approval, it's more commonly done as a DIY project.  You get a blender, some poop from a sympathetic donor, a turkey baster, and... well, you get the picture.  There are several threads going right now in the forums at http://www.ibsgroup.org that were started by people who decided to give it a try; a couple appear to be unqualified successes for people who have suffered from IBS for years.

Recently, a doctor in Canada came up with a way to extract the bacteria from someone's poop and pack them into pills that can be swallowed, rather than having to insert them via the other end of the pipe.  The whole process is described in this article.  It's not much different than taking any of the bazillion commercial probiotics that are out there, these capsules simply contain a much more diverse population of bacteria.

Both approaches -- the procedure done by a doctor and pills created for a specific patient -- have given a lot of people some new hope.  It may be somewhat gross to think about, but most people who suffer from serious IBS symptoms for years or decades would be willing to try just about anything.  Unfortunately, regulatory approval takes a long time, so it's unlikely that either approach is going to be widespread anytime soon.  But there's always the DIY approach.

And what do I think about it?  Since the Specific Carbohydrate Diet has helped me a lot so far, I'm going to continue on this path for the time being.  My biggest concern isn't the "gross factor," it's the lack of data about which bacterial families/strains are necessary for proper gut function, and in what ratio.  And which of those families/strains I'm low on, or are missing from my gut completely.  I mean, if the bacteria that I'm missing are the members of the community who are in the book club, and my donor happens to have an overabundance of bacteria that belong to a motorcycle gang, well... I just don't want to accidentally make things worse, that's all.

But it will definitely be in the back of my mind as an option down the road.

The Nonsense That Is Homeopathy

A few days ago I ended up in a contentious exchange about homeopathy in a Yahoo! group that I belong to. This group is dedicated to the Specific Carbohydrate Diet, and I've gotten a lot of good information and ideas from several of the long-time members. Sometimes discussions veer a bit from SCD-specific questions and comments to more general health-related topics; in this case, someone had posted a question about whether or not anyone was planning on getting a flu shot. Someone responded that she didn't get a flu shot, and if she came down with the flu she'd take a homeopathic remedy named Oscillococcinum, and that prompted me to get on my homeopathy-is-nonsense soapbox.

I don't remember when I first became aware of homeopathy, though I'm guessing it was sometime in the 1990s: I became a vegetarian around 1990, and vegetarianism and veganism seem to go hand-in-hand with "alternative medicine" (sort of funny that I'm now following a diet that almost no vegetarians follow, yet many of the followers are very into alternative medicine!). In the late 1990s or early 2000s, I wrote this article for the Straight Dope website mailbag column on something called "color therapy." Towards the end of the article, I write, "It shouldn't take much research, however, to find treatments that are similar in that they a) look or sound as though they might have a beneficial effect, and b) are not supported by one piece of scientific evidence. Try typing 'homeopathy' into your favorite web search engine." That last sentence started a flame-filled thread in the Straight Dope forum dedicated to mailbag pieces that went on for a long time. But the article isn't dated, and I can't remember whether I wrote it before or after Cecil's main article on homeopathy, located here. In any case, by that time I'd read enough to be a firm non-believer in homeopathy.

Homeopathy was created by a German physician named Samuel Hahnemann back around 1800. The hypothesis behind it is "like cures like": the same substance that produces symptoms of disease in healthy people will cure similar symptoms in people who are ill. We're already starting off on shaky ground -- I mean, how many people who find out from a throat culture that they have strep throat are going to be willing to swallow a capsule full of streptococcus bacteria? -- but it gets better: the substance is diluted to make the remedy, and the more diluted the substance is, the more effective it will be. With that, I believe the whole concept moves into the realm of fantasy. In his article, Cecil mentions "one cold remedy with a dilution of 200C, which mathematically is less than one molecule per all the known matter in the universe." Far less, in fact: a 200C solution means that the substance has supposedly been diluted to one part in 10 raised to the power of 400 (that's a 1 followed by 400 zeros), and it's estimated that the number of atoms in the known universe is 10 raised to the power of 80. Now, to me, that estimate seems awfully low: the universe is a big place, right? But even if you simply think of it as one part per all the known matter on earth, the concept is still pretty absurd. It's generally understood that once something has been diluted past a point far below this, there's not much chance that even a single atom of the original substance is contained in the remedy dose. And guess what? Oscillococcinum is a 200C remedy.

It's my belief that Hahnemann's ideas were (somewhat) reasonable at the time. This is over 200 years ago, and the concepts of atoms and molecules were apparently just gaining ground. But given the problems with the genesis of Hahnemann's hypothesis when he ate some cinchona bark (described in the Wikipedia article on homeopathy), and given what we now know about the properties of matter and the mechanisms of disease, the system defies logic and, more importantly, the laws of physics.

So when the subject came up in this group, a group of people who are very concerned about their health and who I've gained some great insight from, I felt compelled to explain what I know about homeopathy in the hopes that these good people would not waste time, energy, and money on something so worthless. Because I've found that most people who take homeopathic remedies know virtually nothing about homeopathy, they simply know that it's "alternative" so it must be better than what the doctor would give you, and a friend told them, "it works." As they say, no good deed goes unpunished.

I concluded a post where I described the basic concepts of homeopathy with this: "I know that people will believe what they like about homeopathy, as well as other forms of treatment and other concepts. But I will continue to rail against homeopathy anywhere it's mentioned, because I find it unconscionable that homeopathic remedies continue to be marketed to good people, like the people who belong to this group, who are trying desperately to regain their health. I urge anyone who has used homeopathic remedies in the past to read up on the subject; the Wikipedia article is a good start, and there is a lot more material out there."

That garnered this response from the poster who brought up Oscillococcinum: "You may want to think twice before railing against something you have no experience with." But that's poor advice: I don't need to experience a car crash to know that it would be bad for me; I don't need to experience self-trepanation to know that it would be a bad idea.  My response was, "One needn't experience something in order to apply critical thinking skills and come to a negative conclusion."

Another group member went on a long rant about why the people of the group are sick and tired of traditional doctors.  I understand that, and to a certain extent I can say that describes me pretty well.  But he writes, "we really don't have time to decide whether homeopathic remedies work or not, we don't have time to wait for researcher's answers."  This is the attitude I find most disturbing, the "don't bother me with the facts, I'm on a mission" approach.  I get the frustration, I really do.  But ignoring well-established laws of the physical world won't get you closer to realizing your goal; it may even send you down the wrong path if you get what you think is a positive response.  Not to mention the fact that, in the case of homeopathy, you don't have to wait for researcher's answers: homeopathic remedies have never been shown more effective than placebo in all of the numerous well-designed, peer-reviewed trials that have been performed.

The Oscillococcinum poster had this to say about her experience (just before advising me to "think twice"): "It is impossible for me to believe that a 6 month old baby who is so sick that he cannot raise his head and who is suddenly transformed to a happy child playing merrily with his toys on the floor 10 minutes after being prescribed the correct homeopathic remedy is experiencing a placebo effect. This happened time and again with my children. If not for that, I might question it too. But I have seen it with my own eyes too many times to not know there is something there."  I responded that without knowing any of the variables in play at the time, I couldn't offer any explanation.  But of course, there are many possibilities: the flu wasn't the cause; the child was going to start playing with his toys in 10 minutes regardless; the remedy had inactive ingredients (as if it had any active ingredients!) like sugar that gave the child energy; the child had been fed 30 minutes earlier and the food was just kicking in; etc.  I didn't bring any of that up, because I didn't want to get into a long drawn out discussion of what caused a child I didn't know to perk up five or ten years ago after taking a homeopathic remedy with an ingredient list that I didn't have access to.  She wants to believe it was the homeopathic remedy, and I'm sure there's nothing I can say to change that; I'll never believe that something that has no trace of a substance that supposedly reduces flu symptoms could actually accomplish that (in ten minutes, no less), and there's nothing she can say to change that.  I simply explained that my intention in discussing the subject is never to offend or belittle, just to educate, and if sending my thoughts through the ether sounded like an attack at any point, I was sorry.  Then I said I'd get off my soapbox, and hoped she wouldn't be surprised if I got back on it in six months if the subject came up again.  And added a smiley.  You just can't tell how people will read things when their sacred cow is involved.

She got the last word with this bit of condescension: "Well you know, we all have our own little box from which we view the world. Some people, through experience, have expanded their box and it's a bit bigger in some areas than other people's so they have a more expanded view. This is fine. It's when someone tries to force others who have a gained a larger view through experience into their own more limited box because they cannot see anything else - that's when things become annoying."  At least I've got the laws of physics and good critical thinking skills in my box, little though it may be.  And "forcing" someone into my little box?  Really?  People get so wound up.  I've never tried to force someone to believe anything about homeopathy in all the times I've discussed it, verbally and with written text.  How would I even do that?  "You'll stop believing in homeopathic remedies or I'll come down this ethernet cable and MAKE you stop believing!"  Sheesh.

And finally, this: "if you cannot see the purpose of something, by all means you have a right to your view, don't use it. I ask that you give the same respect to others who have a different experience."  Respect?  Gee, I'm not sure I've got room for that in my little box.  I'm guessing that "respect" to this person means "not explaining the premise behind homeopathy to someone who mentions it," whereas I prefer to think of respect as "trying to educate someone about something that is a waste of their time and money."  But to each his or her own.  You just might want to give some respect if you expect some in return, and here's a hint, telling someone that their worldview box is smaller than yours doesn't carry any respect points.

I've already learned quite a few things from this poster about the Specific Carbohydrate Diet, both in response to questions from me and in response to questions from many others.  She posts frequently, and I'm sure I'll learn more, and I'm sure we can be civil.  I imagine if I ever met her in person I'd find her perfectly likable, and we'd have a perfectly friendly conversation.  The whole exchange was just really disappointing.

At least I got the homeopathy-is-nonsense word out there again.  I'd offer the same advice to anyone reading this: if you've taken homeopathic remedies in the past, do yourself a favor and read up on the whole system.  Or I might just have to come down this ethernet line and make you disbelieve.

What I Miss - And What I Don't

Sorry I haven't been posting.  I've been quite busy with house projects and other activities.

A brief update: I'm still doing quite well, though my symptoms have come back to a small degree.  I believe this was due to the introduction of peanut butter and nuts, but it's difficult to say for sure; I discontinued the use of both last week, and I'm giving my body a week or two to re-adjust.  Some SCDers have reported developing sensitivities to foods while on the diet, most notably dairy products.  I hope that's not the case with me, as I really think the homemade SCD yogurt has helped a lot, but if it is, I'll deal with it; when my current batch of yogurt is gone, I'm going to take a break from making yogurt for a week or two and see how my body responds.

I still believe that I'm better off than I was before starting the SCD, and I hope to continue improving.

A couple of weeks ago, Jenny and I went to see a movie.  We enjoyed the movie, but the movie theater experience isn't quite what it used to be for me.  I almost always had some popcorn at the theater, and usually some candy too: M&Ms were a favorite of mine, as were Reese's Pieces.  Looking at the options in the concession case, I realized that there is nothing that I can eat in movie theaters any more.  Popcorn is a complex carbohydrate, and as far as I know all of the candy that's available is sucrose-based.  When we went to a movie a couple of months ago I took some dates with me, and it was nice to be able to have a snack in the theater; but it's just not quite the same.

So that got me thinking about things I miss, now that I'm on the Specific Carbohydrate Diet.  Here are a few:

• Chips and hummus.  For some who know me well, this goes without saying, as I used to have some chips and hummus once or twice a day before the SCD.  Usually Mission brand corn chips, and just about any brand and flavor of hummus.
• Chips and salsa.  Who can resist Chevy's salsa?
• Subway Veggie Delite sandwiches.
• Dark chocolate.  Surprisingly, I don't think of this one very often; I thought every evening would be torture, since I used to have chocolate while watching TV on most evenings.  Still, every once in a while, I do crave it.
• Being able to go out to eat whenever I want.  It's not so much that I love restaurant food, it's just the ability to decide at the last minute that it would be nice to go out.

And thinking about things that I miss got me thinking about things that I don't miss:

• Pretty serious morning attacks of diarrhea.
• Not being able to eat breakfast, lest the morning attack continue all the way until lunch or later.
• Occasional worrying about whether or not I remembered my morning or evening dose of Loperamide.

I'm sure there are other things that fit into both categories, but those are what have been on my mind lately.