Are you struggling with a C. Diff Infection? Often referred to as C. difficile or C. diff, Clostridioides difficile is a bacterium that can infect your large intestine. It is the most common bacterial infection in hospitals, and in America, between 450,000 to 500,000 people get C. Diff infections every year! In today’s episode, we are discussing the signs and symptoms of C. Diff, who can be affected by C. Diff infection, helpful probiotics, and more!
We answer these questions:
– What signs and symptoms should you be looking out for?
– How does C. Diff affect patients of different ages?
– Is C. Diff Infection related to Inflammatory Bowel Disease?
– How and where can you contract C. Diff?
– What is megacolon?
– Does the health of your microbiome affect your odds of infection?
– What probiotics can help?
– And more!
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Connect with Dr. Sahil Khanna:
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About Dr. Khanna:
Dr. Sahil Khanna is a Professor of Medicine in the Division of Gastroenterology and Hepatology at Mayo Clinic, Rochester, MN. He completed Medical School at the All India Institute of Medical Sciences, New Delhi; followed by Post Doctoral Research at University of California San Diego, CA; residency in Internal Medicine and Fellowship in Gastroenterology and Hepatology at Mayo Clinic, Rochester, MN before joining the Faculty. He also completed Masters in Clinical and Translational Sciences during his fellowship. He is directing the Comprehensive Gastroenterology Interest group, C. difficile Clinic, Fecal Microbiota Transplantation program and C. difficile related Clinical Trials at Mayo Clinic, Rochester, MN. He has over 120 publications, serves as reviewer on the editorial board of several journals, and has won numerous awards.
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Dr. Ann-Marie Barter is a Functional Medicine and Chiropractic Doctor at Alternative Family Medicine & Chiropractic. She is the clinic founder of Alternative Family Medicine & Chiropractic that has two offices: one in Longmont and one in Denver. They treat an array of health conditions overlooked or under-treated by conventional medicine, called the “grey zone”. https://altfammed.com/
Dr. Sahil Khanna: We have some data that is actually sobering and mind numbing that says that between 450,000 to 500,000 people get C-diff infection every year in the United States, it’s between the last five minutes of you and I talking to each other. Several people somewhere have been diagnosed with C. diff infection, and to think about that, it is the most common and bacterial infection in hospitals.
Dr. Ann Marie Barter: Are you struggling with bloating, gas constipation and fatigue, but don’t know what’s causing these problems? The Gut Health Reset podcast with Dr. Ann Marie Barter dives deep into the root causes behind these issues that start in the gut. This podcast will give you the knowledge you need to heal your gut and reset your health. Thank you so much for joining us on the Gut Health Reset podcast. I’m your host, Dr. Ann-Marie Barter, and today we are covering a topic we have not covered before we are covering C. diff infections and these were generally thought of as only being hospitalized infections. You could only get this in the hospital. But now we’re we’re coming to find out is you can actually come in contact with this pathogen in a lot of different arenas in your life and younger and younger people are actually contracting a serious infection. So we’re going to talk about some of the signs and symptoms where you’re getting it from, how to protect yourself, and also some new emerging treatments and see if one of those is fecal transplants. And we’re going to talk about the pros and cons of fecal transplant, some of the limitations and where it has been studied to know if maybe that’s a great avenue for you to potentially explore. So you do not want to miss this episode. It is a very good episode, but before we get into it, I just want to thank you for being here. You guys are just so awesome. Thanks for listening. Thanks for the comments. Thanks for the emails. Thanks for recommending guests. Please keep that up. We want to know what you want to hear more of what you want to hear about so that we can get that out to you. So feel free to do that and recommend guests. Also, we’re getting questions about supplements, so we are now trying to put them below in the show notes, as well as the Dr. Ann-Marie Barter website has been launched so you can find the supplements there, but you can also find all of the podcast there that we did with the Gut Health Reset podcast, as well as fearless health, and we’re trying to transcribe those for you. So if you don’t feel like listening, you can just read about the episode as well. Dr. Sahil Khanna is a professor of medicine and division of gastroenterology and hepatology at Mayo Clinic Rochester. His research and clinical interests include epidemiology outcomes in emerging therapeutics for C. diff infections, an arena where he has numerous publications and presentations. He is directing the comprehensive gastroenterology interest group C. Diff Clinic, Fecal, Microbiotic Transplantation Program and C. diff related clinical trials at Mayo Clinic. He has over 120 publications and serves as a reviewer on the editorial board of several journals. He has won numerous awards. Dr. Khanna it is such a pleasure to have you here with us today, and I’m super excited to dig into the amazing research that you have really done with gut infections that are pretty tough and will generally send people to the hospital and they don’t respond well to antibiotics. So today we’re going to dig into a little bit of C. diff and and fecal transplants, as glamorous as that sounds, but they work, right? So how in the world did you get into researching these topics?
Dr. Sahil Khanna: Dr. Barter, thank you for having me or the pleasure’s all mine. You could wake me up at two a.m. and talk about this, and I’ll be super excited. This is my jam and my wife tells me, “you like bacteria more than you like me sometimes.” That may be true, but I did get into research. I think a lot of times in our lives as physicians, as you also know that and health care providers, research and all of those opportunities come with mentorship. So I got into senior research after age nine residency here at Mayo Clinic, and it came to me from my mentor who had a project looking at the epidemiology and outcomes of C. diff infection in a population based cohort in Olmsted County here in Minnesota. Prior to that, during medical school, I did like bacteria, did like microbiology as a subject. This was a natural fit for me. More importantly, Dr. Dal Parti, who’s been my colleague and mentor for over 13 years now and we still worked together and we write papers together. You may have seen that a lot of work that we’ve done, we do it together is the one who held my hand and kind of guided me to the initial work. That’s how I got into it and ended the first project. I fell in love with the outcomes and what we saw in that project. And also I learned that my very first study that this is a very, very big and unmet issue that is affecting the population. So when we did our first study, there was a notion that C. diff infection affects the hospitalized elderly people who are sick and who have received antibiotics. That’s what was going on in the early 1980s, late 1980s. But a lot of us as. Americans had seen an observation that sea life is not only affecting the old people or elderly who are in the hospital, but every now and then you see somebody in an outpatient practice that C. diff infection. So what we found among one of the first studies in the United States was that about 40 percent, four zero, 40 percent of all see, this was affecting people outside the hospital. It’s not a condition that we were thinking before that. We also figured out that those people were about on an average 20 years younger than people who were in the hospital getting C-diff infection. And on top of all of that, sometimes you would get to see them outside like the hospital in a younger person who had not received even received antibiotics. So about one in five people who came to our clinics would see this infection had not received antibiotics. A whole different disease entity, the same bacterium, which about two or three decades ago, was infecting only people in the hospital. Now we seeing that’s migrating outside the hospital into the community, from older people to younger people, and from traditional risk factors to new risk factors, it’s always a cause for concern. So we went on a crusade over the last decade now trying to understand why this is happening. Risk factors. How do we optimally diagnose this? How do we test this? And then how do we optimally treat patients with C. diff infection? So we’ve gone through a whirlwind of research looking at epidemiology outcomes, new risk factors, testing strategies, looking at newer kind of antibiotic treatments, how do those affect people who have this dreaded infection? And then also looking at how do you stop the cycle? So that’s where we started doing a lot of this research, and that’s where we’re at and moving. Moving on from being epidemiological studies to my microbiome based therapies of fecal transplants, it’s been a journey. And let’s talk about that.
Dr. Ann Marie Barter: Yeah, like that. So, you know, we have a wide variety of different subsets of people. So how are they presenting differently into practices? What are you noticing from a young person that has a C. diff infection to somebody that is a little bit older and is currently hospitalized at contracts to C. diff infection now?
Dr. Sahil Khanna: So these are two different case entities. But even let’s take a step back and let’s when we talk about young people, old people, it’s always a good idea for us to know how many people are actually getting this in the United States. We have some data that is actually sobering in mind numbing that says that between 450000 to 500000 people get C. diff infection every year in the United States. It’s between the last five minutes of you and I talking to each other. Several people somewhere have been diagnosed with C. diff infection, and to think about that, it is the most common and bacterial infection in hospitals. Corbett is now the most common viral infection, but C. diff is now. He has been the most common bacterial infection in the hospital, a single bacterium that causes all these infections. Now that that battle to answer your question, the people who are in the hospital and who get C. diff infection on an average, usually over the age of 65, usually over 95 percent of them have received antibiotics for something, and the majority of them have some other comorbid condition that they were in the hospital for. And they will see that after that. The hospitals have improved. We’ve seen that the incidence of C. diff in the hospitals has stabilized in the last year actually gone down. Guess why? They’re washing hands better.
Dr. Ann Marie Barter: That’s funny, that is funny. But true.
Dr. Sahil Khanna: I mean, true, absolutely true. We’re washing hands better. Isolations better. Everybody knows about infection control because we now have a much more contagious illness that’s out there everywhere. Society from the hospital has stabilized a little bit. When you compare that to a person who is the outpatient setting about forty five years and an average age of about 20 years younger than the hospitalized person, about one in five not received antibiotics. But they have other risk factors like they may be on an acid reducing therapy like a bum inhibitor or members of our proposal. Like medications, they may have an underlying illness like inflammatory bowel disease, colitis, Crohn’s disease, those patients get seeded infection and then some of our chronic illnesses that we’ve seen over the years are getting more from older people to younger people. We’re seeing younger people with cancers. We’re seeing people on chemotherapy. So all those risk factors do affect around patients. One thing that we see differently is that the Hospital-Acquired population ends up being more severe illness than the community acquired population. We also see that Hospital-Acquired people, the population ends up being more fulminant and less C. diff, leading to an ICU admission or surgery. God forbid, that can also happen. And then finally, we do see that a subset of people who acquired C. diff in the outpatient setting in the community end up being hospitalized eventually for it. It’s a subset. Those are the older people or who have comorbidities. They’re not getting hospitalized, but there is a difference. The one thing that I would say like when you take all of that together, what can a person or a physician or clinician take out from that, that if you are an outpatient and you are developing or have developed chronic, unexplained diarrhea, chronic meaning lasting more than a few weeks, it’s not explained and you may not have received antibiotics. Still, C. Diff infection should be considered even in the outpatient population, which you are not considering more than two decades ago or a decade ago. You didn’t think about that, but now in today’s world, if you’re a patient and you have diarrhea and you don’t have an explanation for that. Talk to your doctor and say, Hey, could this be C. diff infection even if I’ve not been exposed to antibiotics because it can happen? And it’s important for it to be diagnosed and tested and treated well, unlike other causes of bacterial diarrhea in the outpatient setting. So let’s say somebody gets food poisoning or E. coli or campylobacter or norovirus treatment for that is supportive. People could get hospitalized, but you don’t need a specific treatment for that. And it goes away and most people. C. diff infection in most people. Once you get it does not go away on its own, it’s not a self-limited infection that goes away on its own and it’s got a sag off recurrences that I’m sure we’ll talk about today. Those are the big differences, but people should be aware of this condition not only because it leads to bad outcomes, but also you could get hospitalized for it. And God forbid, there are deaths that are associated with C. diff infection. Studies have shown that roughly about 9000 people may die of C. diff audits and complications every year, just in that it states.
Dr. Ann Marie Barter: Mm hmm. And do you believe that there is any possible evidence that it could potentially be a trigger for inflammatory bowel? Or do you think that’s related in any way, shape or form?
Dr. Sahil Khanna: It’s a very good question. Sometimes we don’t know the chicken and the egg story in this situation, although we all have seen and we’ve seen in our practice to some people who get diagnosed with multiple recurrent C. difficile infection and you end up doing a colonoscopy on them to treat C. diff. And you find de no inflammatory bowel disease wasn’t there before or was not diagnosed. One thing that we know for sure is that if you have underlying inflammatory bowel disease, positive colitis or Crohn’s disease affecting the large intestine, you are at a high risk of getting C. diff infection even without antibiotic exposure. Now it the other way around. What if you develop C. diff infection? Does that increase your risk of inflammatory bowel disease? We don’t know that for sure, but it needs to be looked for, especially if you have C. Diff infection and conventional treatments are not making you better. What’s the science behind it? We think we don’t know for sure. We think that maybe this was a person who was genetically programed to have could have developed inflammatory bowel disease. And then a second, it had happened. You got antibiotics. The microbiome changed. We know that the microbiome or the gut bacteria are the useful bacteria that live in the large intestine. They have properties to be in what we call as an anti-inflammatory state. They don’t let inflammation to happen. Their microbiome changes. You had the genetic predisposition to farm or developers of bladders in a second and happened, and you develop C. diff infection and then predisposed to developing colitis that you are not going to develop otherwise. So there it’s rare. It may happen, but it’s not that everybody who has different factions start wondering about, do I have ulcerative colitis or not? I think it’s a subset, and it’s those people in whom you think that the C. diff infection is not getting better just with antibiotics for seeded
Dr. Ann Marie Barter: the number one question. I feel like I get asked when there’s any questions about major pathogens is where did I get this? So when we’re looking at the younger population, when we’re looking at, oh, suddenly we’re presenting with inflammatory bowel, there might be a C. diff component where where are we getting C. diff?
Dr. Sahil Khanna: Back in the day until about 25, 30 years ago, we thought that this only lives in the confinements of health care facilities, hospitals, doctors offices, emergency rooms, dialysis centers kind of just lives there. And then if you get it. It lives in your bathroom. Once you get rid of it, it doesn’t live in your bathroom anymore. More recent studies have shown that this bacterium is also becoming ubiquitous. C. diff is a sport far more so. It can stay on surfaces for a while so people could pick it up from public bathrooms, would pick it up from grocery stores, could pick it up from food, could pick it up. We’ve seen that it’s been cultured from balls of meat processing plants. It’s kind of out there in your environment, everywhere. The one difference between C. diff, which is a poor farmer compared to some of the other bacteria, is that the alcohol and drugs that we use may not be a very effective killer for seed explorers compared to hand-washing with soap and water. So traditional teaching in hospitals is that if you have an outbreak of seeded hospital, you should think about using soap and water for hand-washing from bedrock on hand rubs. And I teach all of my residents and fellows is that they can get on to see the patient. And after that, they can give that, yes, you’ve got a hand sanitizer. Use that right away because your sink may not be right next to every patient room in the hospital. But then after that, find the sink and wash your hands with soap and water. Because we think that the mechanical action of washing your hands with soap and water and soap in itself is a much better way of getting rid of seeded spores. But it’s out there. It’s everywhere. It’s part of our environment
Dr. Ann Marie Barter: and is the only major symptom that you’re going to see in the younger generation has has been diarrhea in your experience or are you seeing other symptoms associated with
Dr. Sahil Khanna: diarrhea is the predominant symptom that is associated with C. diff. Those symptoms that we see more commonly are abdominal pain with the diarrhea that people get. And this is not your usual diarrhea. And this is not that I had food at the Minnesota State Fair, got picked up something, got diarrhea for a couple of days and went away. This is different. This is debilitating abdominal pain, causing cramping people feeling like they took their guts out. Kind of diarrhea. This is really, really bad diarrhea. A lot of people, we see abdominal pain. We see other systemic symptoms. People are not able to absorb the nutrients as well or have catabolic state where they just keep having diarrhea and lose weight. So weight loss is a symptom that we see quite a bit, too. And then a subset of people, a small number of people also end up developing upper symptoms, a significant bacteria that only lives in the large intestine. For the most part, we know that it’s not a stomach or food by itself because bacteria. But as a result of inflammation in the intestine, you end up seeing people developing nausea, vomiting, inability to tolerate oral intake. We see that quite a bit every now and then you see somebody develop strong stomach transiently because of that do. So this is what most people get. And then there’s a small subset of people very small, not everybody very small up of people who end up being in the intensive care unit for the colon tissue tends to die, becomes big called mega colon, and people end up being in symptoms of septic shock because of its infection. That population is very, very small, but it’s out there. It’s real. The one last thing that I also see is that diff is a gift, unfortunately, that keeps on giving. So you get it once it keeps coming back. And I have seen some people who develop anxiety disorder after they had C. diff infection just because of the anxiety of where the next bathroom. My life results on the bathroom. I’m homebound. I can’t leave. I’m locked down. I’m quarantined. So we’ve seen people who’ve been quarantining themselves the fear of infection, giving infection to others where before people are calling them. I see the patients have been practicing quarantine for much longer before the quarantine for it. It’s a true disorder, a systemic disorder, not only diarrhea, but eating from diarrhea symptoms, weight loss and unfortunately, anxiety, which I think is a very debilitating aspect of symptoms that happens to people.
Dr. Ann Marie Barter: And just just to kind of clarify, because I don’t know if everybody knows what mega colon is out there, I think that that’s pretty self-explanatory. But can you break that down for somebody that might not have a medical background?
Dr. Sahil Khanna: Thank you. Thanks for asking that. And then you have an infection and somebody has an infection of the large intestine, namely C. diff. Majority of people would be in the outpatient setting who got an outpatient setting. They take the medicine it resolves. Even in the hospital, you get some severity, you get a white gown response, you may get a kidney disease kidney injury response. It results in a small, small fraction of people, less than one percent in the hospital who may get a disease that stays where the cuts, producing a lot of toxin and then the large intestine or the colon, the inner lining tends to die because it’s shedding a lot of cells, and the toxin is what we call a cytotoxic. It kills more cells. When that happens, the Golden Ball in itself starts getting bigger and bigger and bigger. And when the world becomes bigger, you called it mega called the goal, and it’s like a balloon that is blowing up with it. It’s how I would think about it. And when you put too much effort in the wall can handle, sometimes it’s the risk of causing a whole lot of perforation, which is one of the most deadliest complications that we see in people with C. Diff infection doesn’t happen to most people happens to a small subset. And if you diagnose the disease early retreated early with guideline directed therapy, then this complication will potentially be avoided.
Dr. Ann Marie Barter: And do you think you know the severity of symptoms? Do you have some folks that are very, very severe with C. diff infections or very close to death? They’re hospitalized, and then you have people that maybe have less in the way of symptoms. Do you believe that the microbiome or the good bacteria has any impact on how severe somebody experiences? A. C. Diff infection?
Dr. Sahil Khanna: I think that’s a very good question about it. B And you don’t know the answer to that, but I’ll give you my speculations and how I think about it. We do think that the more severe an infection they have, the worse your underlying microbiome is. What we don’t know is that if you had an awesome like microbiome that led to the severity of the infection or the severe infection also kill the good bacteria and competed with them. What we do know is that about 80 percent roughly give or take will not develop severe infection, so people should not be scared about it for the most part. What about 15 to 20 percent will develop severe infection. Less than one percent will get permanent infection. We do know that there are some predictors of these severe infection episodes. Some of them include the sicker you are. Otherwise, some people have comorbid conditions like heart disease or other GI diseases or cancer or chemotherapy or immunocompromised. They are older. They are more likely to get the severe infection. We also know that these people underlying have a disrupted or dysbiotic microbiome, but I said disrupted our dysbiotic microbiome, meaning small numbers than other people and lower variety in other people. So conceivably indirectly, the worst your microbiome is you’re more likely to get a worse outcome from these infections in terms of severity. But more than the severity, the other debilitating aspect of seed of Zell is the recurrences that happen, and I think that’s where we know more. The more disrupted your microbiome is, the more recurrences that you’re getting. So even if somebody doesn’t end up not being in the hospital, even that cycle of recurrence that keep happening, it is actually more debilitating, more anxiety provoking, more quality of life than any other infections that people get
Dr. Ann Marie Barter: to speculate a little more. Have you noticed in your research any good bacteria that tends to be protective specifically by name, like the Befuddle family, the Lactobacillus Akkermansia, anything that has been very protective,
Dr. Sahil Khanna: so the bacterial entities are very protective against against this infection? We have seen that. So there is this family of the bacteria that you mentioned to the bacterial entities. Those are protected. But we’ve also seen that it’s not just the one family of bacteria that protects you. It’s the number of different kinds. It’s the whole colony of bacteria that live inside. It’s how they interact with each other because then you’ve got a good colony of gut bacteria. I kind of try to, in my mind, complete compared to what we call a good gut guard. So if you’ve got a good, highly lush green gut garden, maybe even multiple types of grass that you’re trying to grow in there, that’s not going to allow your weed or CBS or the weed plants to start growing in your backyard. That’s how I kind of usually think about think about it. What we do know is that if you if you have a lush green garden of gut bacteria but multiple different kinds of bacteria, just replenishing or replacing one or one of a kind of them is not going to be good enough to get rid of C. diff infection. So let’s say if somebody has said it and said, Can I just take a probiotic that has 10 different kinds? That’s not going to be helpful. Let’s talk numbers and you like numbers and look at the numbers there. And in a healthy person’s large intestine, there are 800 trillion. Not million, not billion, 100 trillion. Very useful back to that probably are living in John Kesselman mind this time. The other aspect of numbers is that we have about 500 to 2000 different kinds of bacteria that live in our large intestine, any monitoring. Everybody is different, but that’s the number that we’re looking for. The majority of these bacteria have not even been identified in medical science at this time. We are not that advanced or developed, even if the ones that we’ve identified, the majority of them have not been able to be cultured in a lab. And the majority of them, you don’t have enough technology to put them in a capsule by growing them in a lab at this time, we’re not there yet. We hopefully will be there at some point of time. But what nature gives us is not something that we can give to each other without taking help from nature. So if somebody asks me, what’s the best probiotic that I can dig for recurrent C. diff infection, I say healthy person stool is nature’s best probiotic for help. The second seeded to infection and I’ve been talking a lot about recurrent infection at some time during our conversations. I’d like to go into that as to why people get it and what can we do about it?
Dr. Ann Marie Barter: So many people struggle with bloating, bowel issues, brain fog, fatigue. You might not even have any gut issues, but did you know the cause of it could be food sensitivities or gut infections? What I have done is I have brought a talented functional nutritionist into my practice. We have very similar training in the nutritional world, and her name is Alexis Appleby. She is awesome. So you can head on over to our website Ult. Alti Fam Fam Med Med and have a consultation with her and schedule so that she can help you get to the root cause of your problems. I want to finish up with the probiotics and then I want to go into that a little bit. So, you know, the Lactobacillus in the pivotal family, very popular in probiotics, for example, and we are on the cutting edge of being able to get A. Mantia and, you know, is starting to I guess I don’t even know if they’re formulating a probiotic, but I know they’re they’re getting closer. We can actually have Akkermansia in our system. The the one thing that I’ve seen boost Akkermansia up, and I’m curious if you’ve seen the same thing or a few of the know has been grapes, the research says pomegranates. I haven’t noticed that. But do you have any comments on anything that could help boost some of these probiotics up to your knowledge other than the fecal transplant, which we’re trying to get into in?
Dr. Sahil Khanna: Just as I got transplants, different fecal transplants for recurrent Klebsiella infection or research settings, everybody should not be doing it on their own. It’s not a DIY thing, just not DIY.
Dr. Ann Marie Barter: Have you seen that first?
Dr. Sahil Khanna: Yes, I have. There’s a book that you can buy for DIY fecal transplants. It’s not a DIY. OK, let’s start there. Yeah, there is a lot of research, and I think in my mind, the best research has been done by Justin Thunberg’s group out of Stanford, and the reason wrote a book about the gut microbiome, which I have purchased not yet quite read, and how diet affects gut microbiome. So what can you and what can I and what can our listeners today do to improve their gut microbiome? It’s the age old stuff that my grandmother told me, and your grandmother probably told you don’t eat junk and eat the vegetables. Fruits, eat your fruits is one fruit or one vegetable better than the other? That’s not completely known because diet is hard to study, although we do know that if you take a diet that’s rich in because prebiotics sorts a prebiotic, prebiotic is food for a probiotic. So if we eat a diet that’s rich in fiber, if we don’t have any other contraindications to eating a high fiber diet 25 to 30 grams of fiber a day in diet, that is the number that you’re trying to strive for. Studies after studies have shown that kids of work and diet more than a decade of work on gut microbiome. What can you and I, and the average person who is healthy and wants to stay healthy wants to promote a good, healthy microbiome? What can you do? Eat a high fiber diet? That’s one studies have shown that. What else can you do? Drink a lot of non caffeinated nonalcoholic beverages, meaning water drink. If you don’t have any other contraindications stuttering and 64 ounces of water that gives a good gut health try to exercise. Studies have shown studies after studies exercise improves gut microbiome. What else can you do to stop smoking if you’re smoking? You’ve shown that smoking is not good for health overall. Well, it’s not for the good bacteria and then more importantly, try to avoid unnecessary exposures to things that alter the gut microbiome. Don’t go out seeking antibiotics, and you may not need an antibiotic or if somebody wants to give you an antibiotic to treat an infection, but is not sure. Is this a viral sore throat that you get or is this step sore throat but has an antibiotic just in case of Streptococcus causing or church? That’s the antibiotic question in a wide. Or if you get, God forbid, an infection that truly needs an antibiotic and that gives, please take the antibiotic, antibiotics are life saving. Studies have shown over years and years, and human lifespan has improved since. We have had antibiotics and antibiotics are and I’m not against antibiotics. I’m against unnecessary antibiotics. But if somebody tells you you’ve got an infection, you’ve got a sword in your hand that’s infected needs to be treated with an antibiotic. It may get better, but three days may get better with five days, but may get seven days, seven days because more is better. In that case, no more is not better. Less is better when it comes to antibiotic treatment. If less would be effective. So narrow spectrum antibiotics, short term antibiotics as long as those are going to be useful to treat the infection that you’re treating. All that will continue to help build your gut microbiome. Now do probiotics build the gut microbiome? I think that’s a question that I get asked all the time. I’m sure your listeners ask you all the time. I think it’s tricky. Probiotic products help some people in certain situations, but do they help build a gut microbiome? They may or they may not. We don’t know for sure. What we do know is that once you stop taking those probiotics, those particular strains are no longer in your stool. We know that now, then you’ve taken them. Have they helped to build your gut microbiome? I think it could help, but the trouble there is, we don’t know for sure. But I usually don’t recommend people take just probiotics and want them to take prebiotics and probiotics together to get their best bang for the buck.
Dr. Ann Marie Barter: Definitely. Wow. There’s just so much information there. Do you feel like stress depletes the microbiome? Do you feel like that’s one of the things that can deplete it from what you’ve seen from your research and your clinical experience?
Dr. Sahil Khanna: So I haven’t done, to be honest, I haven’t done research on the effects of stress on the gut bacteria myself. But I’ve read a little bit about the gut brain axis and there is a microbial brain axis that we understand. I think it’s probably both of catch. If your body’s under stressful situations, you probably see a decrease in the gut microbiome or the other way around is also true because we have seen that alterations of the gut microbiome with several neuropsychiatric illnesses such as autism, anxiety, depression, stressful situation. So we see a bidirectional association there. We don’t completely understand the cause and effect, but just for as for other illnesses, it’s important to try to improve a stressful situations as much as quickly as you can. Easier said than done. Meditation, psychotherapy. Whatever you can do to avoid stressful situations, it probably affects your health overall.
Dr. Ann Marie Barter: So now I want to get into the fecal transplant bit and recurrent infections just a little bit. I’ve heard a lot of folks recommending fecal transplants. And I do not know there was a DIY that is news to me who can benefit from it, from a fecal transplant and why.
Dr. Sahil Khanna: It’s a very good question, I think in today’s world, the way I think about fecal microbiota transplantation or fecal transplants, also known as microbiota restoration therapies. They in my mind to think about in two different categories broad categories. One category is people who have recurrent or refractory infection. In that situation, you can do that quite clinically and it’s allowed by the FDA not approved but allowed by the FDA to do that clinically for actually talk about risks and benefits. But you can benefit people with recurrent infection. So we’ll talk about those and there’s a other big group of fecal microbiota transplantation or microbiome based therapies for other illnesses. And if you go to ClinicalTrials.gov today, you’ll see more than 400 different studies for fecal microbiota transplantation, and a lot of them are for sale. But there are other diseases that are being studied, including obesity, inflammatory bowel disease, depression, anxiety, Parkinson’s disease and the like. And this is very, very long. So far, diseases other than C. difficile infection, it should only be done under research settings, it’s not clinical practice at this time. So let’s talk about selective infection. Let’s talk about where we do it in today’s world and why is important. And I think the reason the why is important is because for any ill illness in any medical therapy, especially if it’s new and experimental, it’s important for us to talk to our patients. The why so little the way? A little bit 100 trillion bacteria, 500 to 2000 different kinds when somebody takes an antibiotic does useful bacteria tend to decrease in numbers and then to decrease in the variety that you have, meaning that for some reasons, if you’ve got a backyard that’s full of green grass and you finally get a hole in there where the grass is not growing as well for one reason or the other, if you didn’t love fiber, fertilizer or somebody plucked out grass like an antibiotic and C. difficile is a weed plant that starts growing in your backyard or in your gut causes diarrhea. Now, the treatments that are used for C. difficile early on are also antibiotics. The most commonly used treatments are vancomycin on FedEx. Unless vancomycin is a broad spectrum antibiotic, meaning it’s going to kill not only C. difficile, but also is going to kill useful bacteria around in the intestines. Also, FedExCup mice until C. difficile, but does not kill as many useful bacteria as vancomycin does Orthodox medicine and stay more expensive? Limited clinical use at this time. Now, when you use vancomycin for some, let’s say, 500 people and you give them all vancomycin or medicine, but 80 of them, they’ll get better, but no recurrences, the rest 20 would probably get better with the seat of Zell will tend to come back. And the reason it comes back is because vancomycin and Fed-Ex myosin are not as efficacious against the spores of CW seed some of the spore form that has forms of vegetative form that makes toxin. So these medicines are not as effective against the spore form, and you stop the medicine of the sport from tends to grow back. And that’s where you start thinking about, OK, what do we do now? Said about 100 people, about 80 of them not get it back. When 20 of them, it’ll come back in, just like you said in your backyard, and it gives good grass around it and does not give the roots the weed. So guess what? The weeds? The weeds are going to start growing back after the first infection, when there’s a 20 percent chance of coming back for the second infection is going to 40 percent chance. It’s going to come back now for the third infection. Guess what, 60 percent chance. And fortunately, that’s going to come back. And the reason it keeps coming back is because you don’t have enough useful a good bacteria to fight against the spores. And that’s they’re replenishing the microbiome or giving somebody useful bacteria. And we can’t grow. All of those useful bacteria can grow that colony in a lab at this time, so it has to come from it. Healthy, well screened donor. And guess what? The number? That’s the best gut lottery you can win. Their chances of coming back are 60 percent, and they go down to less than 10 to 15 percent after fecal transplantation. So it’s a it’s been a magical therapy for patients with COVID infection. We’ve been doing fecal transplants here at our center since 2012. A lot of places have done that subsequently, and some places have been doing that for even longer than that. The first reports were in the 1950s, but it’s been in mainstream medicine since the early part of last decade.
Dr. Ann Marie Barter: What are you guys doing fecal transplants for? Is it? Is it? It’s C. Diff infections, are you doing? Inflammatory bowel, IBD, anything of that nature.
Dr. Sahil Khanna: So clinically, we’re doing them for people with the current infection, that’s the vast majority of people. Sometimes they do it for refractory C. difficile infection, meaning C. of Zell in the ICU, not getting better in the hospital, not getting better. We do every now and then have a research protocol for patients. Those to colitis recently finished a couple of smaller studies of some products that have been developed by industry. So we have some protocols for inflammatory bowel disease also. But that’s only strictly in the research settings and fecal transplant patients for conditions other than infection and or emphasize that further has to be done only under research settings.
Dr. Ann Marie Barter: What have you seen with inflammatory bowel? What what have your observations been from the research?
Dr. Sahil Khanna: I think the research right now has had mixed results. There have been some clinical trials of fecal transplantation, one from Australia, one from Canada that showed positive results from suppliers. There has been a negative study of fecal transplantation also. And then more recently, there was an industry sponsored product that had shown promise promises in early phase that even prevented that a receiver control study that didn’t see much of a benefit. I think inflammatory bowel disease in itself is a very heterogeneous disorder that has outstripped colitis as Crohn’s disease. There’s something called interim Gladys as mild, moderate severe illness. There’s practice, there’s partial clinical involvement that is full clinic at this early stage disease, there is disease and there’s multiple treatments that are out there for inflammatory bowel disease in itself. So trying to figure out which patient is going to benefit from fecal transplantation or a similar therapy in inflammatory bowel disease, we’re still trying to learn that. And then more importantly, for chronic diseases like inflammatory bowel disease, obesity, irritable bowel syndrome, fatty liver disease and the like, fecal microbiota transplantation may not be used as standard therapy. It probably should be used in my mind would be as an adjunct therapy. So usual treatments. Are there any working suboptimal? Can you do fecal microbiota transplantation to enhance your usual treatments for working? There’s actually been precedents. The cancer space. There are some earlier studies that have shown that you can improve the effects of your chemotherapy by replenishing the microbiome in a cancer. That’s very exciting.
Dr. Ann Marie Barter: And it’s amazing. That’s amazing. Have you? So, you know, you’re talking a little bit about obesity and the microbiome, and I’m not sure that people understand because there are some gut bacteria. That are very protective with with basically metabolic syndrome, obesity, et cetera, and so some people that have higher than normal levels of this tend to be trimmer. They tend not to struggle with obesity. So I’m assuming that’s what you’re you’re talking about when you when you’re speaking of about obesity, is that correct?
Dr. Sahil Khanna: Right? So there is an altered that mental profile that we see in people who are obese compared to people who are late. Not just people. You see that in mice, too. It was very interesting mouse work that’s been done over the years. If you take bacteria from an obese mouse and give that to a lean mouse that almost tends to become obese the other way around, which is probably where the holy grail is. Can I take bacteria from a super skinny person and give those bacteria to a person who is obese and see if that obesity improves? I think that’s the holy grail. That’s what we all want. We wanted a skinny bill. I want the skinny body.
Dr. Ann Marie Barter: Nobody wants it any better. Why not? One of the
Dr. Sahil Khanna: you think the research is not quite there as yet? To give you an example. There was a study that was presented at one of our national meetings. I believe in 2019, and this is a clinical trial where they took a bacterial product or a capsule based fecal transplantation or capsule based microbiome therapy from a super skinny person who could eat a high calorie diet and still not gain weight and use those capsules to do microbiome based therapy or fecal transplant like therapy in people who were obese and overweight. What they did notice at the end of their follow up period was that the people who got those bacteria did have a draft. I mean, it goes back to I started living in those people, but they didn’t lose a whole lot of weight. The drawback of that study, in my opinion, was that they were not very high on the diet and lifestyle, the intervention that that would come with it, and I think it probably is an adjunct would have in a next study. If I were to do a study with that, I would say, you do everything you exercise, you change your diet. You also then do a microbiome based therapy that we’ve done. We’ve seen studies a study that if you do a bariatric surgery on somebody to lose weight and the other person’s losing weight, their bacterial changes now, then you lose weight, your bacteria changes, all your bacteria changing. That’s making you lose weight. Or is it both? And I think it’s both of a positive cycle that you can you can establish where to start losing weight. You start getting the better mix of bacteria and then better mix of bacteria makes you lose weight. I joke around with some of my friends, this is completely joking around. Say when you go to a buffet table and you start looking at the cookies that are out there and the pasta and the salad, maybe it’s our gut bacteria telling your brain that I crave for the salad today rather than the cookie, or if I crave for the good gut bacteria that are trying to tell you that. And there’s some research that’s out there. But right now we’re joking about it. Maybe in a few years, we’ll know that. Yeah, what you’re craving for is your gut bacteria telling your brain are signaling your brain. What do you want to eat today?
Dr. Ann Marie Barter: Exactly. Yeah. What are you hungry for? The second brain, I guess, is how they they have generally put it is the second brain. So you mentioned a DIY book to do your own fecal transplants. What is the danger of doing this and what are the concerns and what have you seen that that this should be avoided?
Dr. Sahil Khanna: If there’s one thing today that we can all rest, there’s no please do not do this yourself. Please do not buy that DIY book. It is extremely, extremely, extremely critical that this gets done under the guidance of the provider who has experience with this. If I choose somebody who has to be a donor for fecal microbiota transplantation, they fill up a long, long questionnaire asking us as asking about all sorts of health problems that they may have had in the past. Everybody and anybody who may have had any kind of disease like irritable bowel syndrome, inflammatory bowel disease, obesity, diabetes, high blood pressure, anxiety, depression, they tend to be excluded from being a stool transplant donor. Then the next step is to make sure they don’t have any infectious diseases. So we check them for HIV acute and chronic hepatitis syphilis, about 25 to 30 different kinds of infections in their stool. Make sure they’re not carrying COVID 19 in India as well, and this is evolving over the years. Couple of years ago, we saw a donor who was healthy otherwise was unfortunately carrying a multidrug resistant equalizer or a superbug which infected a couple of recipients and one person died as a result of fecal transplantation. But then, out of Boston, demonstrated that of all comers who applied to be fecal transplant donors in a large stool bank out of Massachusetts, only 2.5 percent were eligible to be stool donors. So the joke there was it’s easier to get into Harvard and Boston than to get into the stool bank to be a stool donor. Sorry, but it’s true for most people. If they are trying to find a donor on themselves, they may not be able to find the donor who is healthy otherwise, and they put themselves at risk of getting an adverse event, transmitting a chronic disease, transmitting an acute infection. And then, more importantly, you want to make sure that the stool that you’re processing is being processed. An anaerobic facility is being processed cleanly, and then it should not be given to somebody without the direction of a care provider. In our practice, we do a lot of them by colonoscopy. Don’t do a class in yourself at home, but some people are doing enemas. It’s not the right thing to do because we’ve seen our practice and others and seen also some a lot of people who are trying to do fecal transplants on themselves at home, they’re not doing that perceived if they’re trying to get rid of some other health condition that we have. We don’t know if it works other health conditions. We’ve seen some people who tried to do this on their own and then develop another new chronic condition, which then go to your doctor and say, Hey, I thought of myself and I developed this guy to help me reverse this. He may not be able to reverse it for me. Mm-Hmm. Definitely. Maybe something that gets that happened and then the last thing you want is to get an infection from somebody and succumb to it, get COVID 19. Go with a bug that’s in people’s stools. There is no stool test for COVID that’s very readily available or widely accepted at this time. So it needs to definitely be done under the guidance of the provider. And for people for fecal transplantation or FMT for C. difficile infection. There are a lot of providers who do that. There’s a lot of research that’s happening. And if you’re someone who’s looking for a research protocol for a microbiome based therapy for a disease state that is not being clinically done, there are clinical trials available through clinical trials. So the job search for fecal microbiota transplantation in a particular condition, you may find a study that is that may help you out. Are you going to find that different microbiome based study? But please, please, please do not do this to yourselves. I’ll give you my exemplified, developed recurrent. She gets an infection. I do fecal transplants and others. I would not do one on myself without talking to my doctor and having my doctor directed for me. Mm-Hmm. And I would never do it for myself, for a condition other than an infection.
Dr. Ann Marie Barter: Mm hmm. He who has himself or a doctor has a fool for a doctor, right? Awesome. Well, is there anything that we didn’t touch on today? I mean, I could go on about IBD, but I’m just keep it with seeds and fecal transplants because I think that that’s just an amazing podcast episode.
Dr. Sahil Khanna: I think the one thing that I would say is that for people keep an eye on what’s happening with the gut microbiome. The gut microbiome is making headlines on major newspapers several times a year. There is more and more scientists that’s happening. Microbiome therapeutics in one form or the other is going to direct the future of medicine. We’re not there yet, but we will be there in the future for a lot of diseases other than seeded cell infection. It’s going to be critical to identify the. Correct donor. It’s going to be critical to identify the correct patient and what’s going to benefit. It’s going to be critical to identify the disease state that’s going to benefit from. It’s going to be critical to identify what therapies are using in addition to the microbiome based therapies. And I think the field is going to move very quickly to become donor independent. Can you have defined microbial consortia that are grown in a lab and that can be used to alleviate disease? We’re in the infancy of that at this time for CDC. So first of all, we know AFP’s work. There’s been phase three clinical trials. There are no products that have completed phase two clinical trials, one from serious therapeutics, one from torrent pharmaceuticals, prebiotics that are completed phase three trials. Everybody knows what phase three trials are now. That means they will be coming to market soon with FDA approval in the next year or two or something like that. Contrast that to products that have been grown in the lab for kids, an infection. One has completed a phase one trial. One has is currently in a Phase two trial. It’s the infancy for seed of seal, but the field will eventually hopefully move with some of those things work that we can grow things in a lab to treat C. difficile infection, meaning you know what’s in every capsule you’re giving somebody? And then I think once we learn from C. seals, then we’ll be learning for what we call a defined microbial consortia for other diseases as an adjunct to your usual therapies. We’re not there yet, but I promise we will be there soon. Shortly. In a few years, coming soon.
Dr. Ann Marie Barter: Coming soon. Well, this has been an absolute pleasure. It’s just so interesting to learn about this and to know because this is an episode that hasn’t been done on the podcast when we talked about that before you came on line. So thank you for just imparting knowledge and kind of setting us straight on the whole fecal transplant piece in c. diff infections, which I think it’s very important to cover. Where can people find you if they want to get in touch with you?
Dr. Sahil Khanna: People can find me on Twitter. I have a professional profile on Twitter. People, if they want to be seen as a patient at some point of time, they can reach out to us through the Mayo Clinic website. They can reach out to us through our appointment office. They’re always happy to see patients with team selection or always happy to interact with everybody or talk, but I also have to compliment you. We see a lot of information in the GI and the gut microbiome space that may not be completely accurate. I have to compliment on the podcast that you have to provide our patients with accurate health information.
Dr. Ann Marie Barter: Oh, thank you so much. That means a lot. That means a lot. We work really hard and I read PubMed on Friday nights and really appreciate it. Awesome. Well, it was a pleasure. I cannot wait until the microbiome. You have all the research with that, and we’re in a different place with people transplants. We’ll have you back on here to talk about the research.
Dr. Sahil Khanna: Thank you so much for having me today.
Dr. Ann Marie Barter: Thank you for listening to the Gut Health Reset podcast. Please make sure you subscribe, leave a rating and a review. More people can hear about the podcast and hey, take a screenshot of this episode and tagged Dr. Ann Marie on Instagram or Facebook at Dr. Ann Marie Barter. And for more resources, just visit Dr. Ann Marie Barter.com.