Your poop in capsules: Why this could be the key to solving your future health problems

Pardon the language but getting your shit together is quite literally what you can do to safeguard your health. Yes, we are talking about human faecal matter – the stuff that you wouldn’t think twice about when you press the flush button.

The same waste that your body produces can now be extracted, processed and banked – and used as a gut microbiome transplant, much like how an organ transplant is performed to replace a failing heart, kidney or liver.

The service that analyses and processes your gut microbiome is now available in Singapore and is offered by AMILI; cryopreserving it for future use is offered by Cordlife.

But why would you need to have a gut microbiome transplanted, you ask? Don’t you already have a microcosm of organisms living inside you, which is why you’re taking probiotics and gut-friendly food such as kombucha, yoghurt and kimchi to keep it balanced?

WHAT IS A GUT MICROBIOME?

To answer that, we’ll have to journey into the gut, where you’ll find 30 trillion to 400 trillion micro-organisms such as bacteria, fungi and viruses. These tiny bugs as well as their genes and environment (that is, your gastrointestinal tract) collectively make up the gut microbiome.

“Gut microbiome” is sometimes interchangeably used with “gut microbiota” but there is a difference. The latter refers to just the micro-organisms themselves, and doesn’t include their genomes and environmental conditions.

About 90 per cent of the microbiota in your gastrointestinal tract, which includes the mouth, oesophagus, stomach, small intestine, large intestine and anus, is made up of bacteria. In fact, there are three to 100 times more bacteria in the gut than there are cells in the human body.

The majority of these single-celled micro-organisms prefer to live in the lower portion of this real estate; it is less acidic and the pace of life is literally slower here than, say, the stomach and small intestine.

WHAT DO THESE GUT MICROBES DO?

Your overall microbiota may be tiny (they weigh about 200g in total; comparatively, your heart weighs about 300g) but don't let the lack of heft undermine its importance. In fact, the gut microbiome is regarded as a “supporting organ” because “it plays so many key roles in promoting the smooth daily operations of the human body”, according to Harvard TH Chan School of Public Health.

For one, complex carbohydrates such as fibre and starches need the help of the microbiota’s enzymes to get digested. Thanks to these guys’ help, the fermentation of indigestible fibres produces short chain fatty acids that play an important part in “possibly the prevention of chronic diseases, including certain cancers and bowel disorders”, according to Harvard TH Chan School of Public Health.

In addition, the same website noted that these fatty acids “may be useful in the treatment of ulcerative colitis, Crohn’s disease and antibiotic-associated diarrhoea”. A healthy gut microbiome will also protect you from harmful microbes that enter your body through eating or drinking contaminated food or drinks.

“Recent research suggests that microbiota is linked to not only digestive diseases, but also other diseases such as liver disease, cardiovascular disease, obesity, allergies, diabetes and mental disorders,” said Dr Jeremy Lim, the CEO and co-founder of AMILI.

The more diverse your microbiota (there are approximately 300 to 500 bacterial species in your gut), the better it is for you. In many studies, trouble typically arises when the microbiota’s diversity decreases. In patients with neurological diseases such as Parkinson’s disease and Alzheimer’s disease, research has found that their gut microbiome is not as diverse and rich as those from healthy individuals.

Another example is the link between the lack of gut microbe diversity and obesity. When scientists gave mice intestinal microbes from lean and obese human twins, and fed them the same amount of food, those that received bacteria from the heavier twins developed more body fat and a less diverse community of microbes in the gut. The lean mice, on the other hand, had gut microbiomes like the Amazon rainforest.

WHY DO WE NEED TO “BANK” OUR GUT MICROBIOME?

Like your fingerprints, everyone has a unique gut microbiome. But unlike your fingerprints, the tiny community in your gut can change – and sometimes, for the worse.

Your microbiome starter kit actually comes from your mother’s birth canal during your delivery (if it’s a caesarean section birth, it’ll be through skin contact) and her breast milk. As you grow and increase your interaction with more people and more environments, your personal collection of microbes expands. By age three, your gut microbiota would already be similar to an adult's.

But your microbiota doesn’t stay the same for the rest of your life. Your environment, diet and lifestyle all have an effect on these inhabitants. For instance, the use of antibiotics, eating more highly processed food and being more hygiene-conscious (especially during the COVID-19 pandemic) can affect your gut residents.

“The microbiome changes with time and is affected by medication, diseases and ageing,” said Tan Poh Lan, the group CEO and executive director of Cordlife.

This is where saving the best version of your microbiome for future use comes into play. It serves as insurance should you get an infection that requires antibiotics, which could kill off both the good and bad microbes in your colon, and create the opportunity for the bad ones to enter your body and take over.

WHAT DISEASES CAN A GUT MICROBIOME TRANSPLANT HELP?

Clostridioides difficile (C. difficile for short) infection (or CDI) gets a mention as it is the most common cause of infectious diarrhoea in healthcare settings globally. In Singapore, the incidence rate is 3.2 out of 1,000 admissions and is more common in males and patients above age 50, according to a study on patients from Singapore General Hospital.

According to the Mayo Clinic, "people not in care settings or hospitals also can develop CDI. Some strains of the bacterium in the general population may cause serious infections or are more likely to affect younger people". In fact, some individuals carry C. difficile bacteria in their intestines; they don't get sick but can spread the bacteria.

The potentially deadly CDI wreaks havoc on the colon. At its worst, it can lead to life-threatening sepsis in the large intestine; even at its mildest, the infection can give you "watery diarrhoea three or more times a day for more than a day", noted the Mayo Clinic website.

CDI often occurs four weeks after completing a course of antibiotics, when whatever infection the antibiotics were meant to exterminate, has also wiped out the gut microbiome. Without your body’s sentry, bad bugs such as Clostridioides difficile find their way in. What makes CDI a notable adversary is that it has a high relapse rate – about 20 per cent of cases, according to Harvard Health Publishing. “The risk of yet another relapse is even greater in the weeks following treatment for a recurrent CDI,” noted the website.

Since treating recurrent CDI with antibiotics would enable a relapse, gut microbiome transplant (GMT) or faecal microbiome transplant is used instead. “GMT is a widely accepted treatment for recurrent CDI, with cure rates of up to 90 per cent,” said Dr Lim, who added that GMT is only used on CDI patients currently.

“However, there are more than 290 clinical trials to establish the role of the gut microbiome in over 60 conditions, including allergy, immune system functioning, metabolism, autism and dementia,” he said.

HOW IS THE PRESERVED STOOL USED?

Your banked stool would be defrosted and prepared for use in a way best recommended by your doctor. And there are a few ways the GMT can be carried out: Via colonoscopy, nasogastric tube, enema or oral capsules containing the GMT material, said Dr Lim.

If colonoscopy is used, the endoscope is inserted to the predetermined section of the colon and the GMT material is then squirted around the walls of the intestine. “The actual stool transplant is usually completed in under 10 minutes,” he said, while the patient rests still for 90 to 120 minutes.

“GMT capsules are even simpler and can be taken in a clinic setting after which patients can simply go home. As the microbiota materials are encapsulated in pill form, they have no taste or odour.”

According to Dr Lim, it is optimal to use one’s own GMT but it can also be donated to a family member.

HOW IS THE STOOL PROCESSED? HOW MUCH DOES IT COST?

There are two rounds of assessment to clear. First, a health history questionnaire (those with certain infectious diseases or health conditions may not be eligible); then, stool and blood samples are taken for analysis.

After passing the screening, you will be given another stool collection kit – this time, a more elaborate one that prevents stool decomposition and allows for temperature control. This sample will be the one that is preserved, and it should be free of blood, mucus and urine. The Bristol stool score should be less than 5.

At the lab, the stool is filtered to remove any food debris, then concentrated and placed in a sterile bottle that can prevent freezing damage. Once done, the bottle's exterior is disinfected and the bottle is transported to the cryopreservation lab for preservation at around -80 degrees Celsius.

You can expect to pay S$5,500 (before GST) for 10 years of storage, inclusive of screening. “Once stool samples are banked and frozen, a person’s gut microbiome should be viable for a lifetime,” said Tan. “We are only offering 10 years of storage because this is a new service. We will review the number of storage years to offer as the service matures.”