 If you have an irritable bowel syndrome, IBS, should you undergo fecal microbiota transplant therapy or FMT? Hi, this is Dr. Rioscio and let's discuss this question. This is certainly something that patients, especially if they've tried a few different dietary changes or use probiotics, and still aren't seeing improvements in their IBS in their abdominal pain, in their constipation, or diarrhea, or gas, or bloating, are wondering, could FMT help? And what FMT is in case you have not heard of it, is essentially taking the stool from the healthy donor and then transplanting it into the colon, either through a colonic administration or sometimes through a tube down the nose or the throat, into the intestines. And the thinking here in the mechanism is that the tremendous amount of bacteria contained in the healthy donor stool functions like a super probiotic that contains a thousand-some odd bacteria and also fungus. And this can help to literally re-colonize the host, in this case a sick individual, with the healthy microbiota of a healthier donor. And there is great evidence for this being life-saving in a chronic infection clostridium difficile. And there's some emerging evidence that's hopeful and promising for inflammatory bowel disease, Crohn's and ulcerative colitis. So it begs the question, could this also be helpful for IBS? And the data here are unclear. There's some data that suggests that FMT can help IBS. There's other data showing that FMT cannot help IBS. And I'll share some of these juxtaposing opinions with you in a moment. Part of the reason this disagreement may occur is because there's not consensus on what is the best method of administration. Should we do this with fresh stool via an enema-like setup? Should we freeze this stool into these capsules that can be taken orally or use a tube that goes down the nose into the small intestines? How frequently should this be administered? Can it be done once? Does it need to be done serially? So because of this, even though there is some positive data, I think it's important to bridle the enthusiasm in how quickly IBS patients reach for FMT. And I have seen IBS patients here in the clinic that have gone off to do FMT. And some have been helped, but I would say it does appear, at least to my best recollection, that more patients seem to be not helped or only minimally helped from FMT who have IBS. Again, I think this is something that could be helpful, but we may have more to learn. But here are the conclusions from two high-level analyses, systematic reviews with meta-analysis, essentially saying opposing things. And I'll put the first abstract up here on the screen from the Journal of Elementary Pharmacology and Therapeutics, a systematic review. Essentially, they're concluding fresh or frozen donor delivered via colonoscopy or naso-digital tube may be beneficial in IBS, but larger, more rigorously controlled trials on FMT in IBS are needed. So this is suggested that IBS may be aided by FMT. However, going to abstract number two from the American Journal of Gastroenterology, ETs or randomized controlled trials does not suggest a benefit of FMT for global IBS symptoms. There remain questions regarding the efficacy of FMT and IBS, as well as the lack of clear explanations on the discrepant results among RCTs and subgroup analyses. So what we're seeing here is there may be benefit, there may not be benefit, and essentially more research is needed. So what did you do? What is my recommendation? My recommendation would be to exhaust all of the under available therapies before utilizing FMT. Now I should mention, oftentimes a patient will have tried a diet or two, tried some probiotics, potentially tried an antibiotic, antimicrobials, and seen a flicker of improvement. And what I've noticed is a common oversight for patients is they don't have an overarching process to organize how all these different therapies could be used in sequence and in conjunction with one another. And in many a case, the difference between success and failure is not just using a diet or a probiotic or an antibiotic or an antimicrobial, but rather having a process through which you work. And this is exactly what I lay out in Healthy Gut, Healthy You. There's essentially eight steps that can all be somewhat tweaked and personalized to the individual along each step that allows you to build a progressive supportive program for your gut and to cultivate the healthiest ecosystem and environment in the gut, thus allowing and favoring the health of healthy bacteria to grow. So I want to be careful to draw that clear distinction that if you've tried some of the stuff that's discussed in gut therapies, but you haven't done it with an overarching map and plan, then that very well may be the difference between success and failure. And I don't say that lightly. We've documented here on the website a number of patients who have been to other doctors, in some cases five other doctors, read other books and they only saw the results they were looking to obtain after going through the Healthy Gut, Healthy You protocol. And I think that's because I wrote the protocol not to be kind of an easy here's something that can help, which is all fine and good, but rather here is a real game plan and map to walk you through from A to Z a comprehensive approach for improving your gut health. I would start there or with a competent GI clinician far before you reach for FMT. Unfortunately, the new and the novel sometimes distract us from working through the tried and true. So I think there's a place for FMT and IBS potentially, but we're still very early. There are still some major discrepancies in the data like we just discussed. So again, I would start first with going through a well articulated plan for improving your gut health exhaust all the available options and then leave FMT as a last resort. And please, if you do FMT, work with the professional. Okay. This is Dr. Rishow and I hope this helps you get healthy and get back to your life.