Feces consumption occurs throughout nature, from the dung beetle to the ringtail possum. Animals primarily nosh on stool for its nutrient content. Some eat the excrement of herbivores, whose inefficient digestive tracts leave nutrients behind, while others -- particularly non-ruminating herbivores -- eat their own droppings to give their bodies another pass at the buffet. Some young animals also gain valuable gut microbes by consuming their parent's feces [sources: BBC; Encyclopaedia Britannica; Hirakawa; Saylor]. Bon appetit!
Will It Blend?
Although something like it might have been practiced as far back as fourth-century China, modern fecal transplantation was pioneered in 1958 by Dr. Ben Eiseman at Denver General Hospital [sources: Allen; Brandt; Eiseman]. Fecal transplants saw only sporadic use for decades afterward, but began coming into their own around 2000 [sources: Allen; Brandt].
Here's how they work: After screening a donor for HIV, hepatitis and other disease-causing germs, the doctor dilutes a stool sample with saline or 4 percent milk, and then blends it into a milkshake-like slurry [sources: Allen; Bakken et al.; Floch; Silverman, Davis and Pillai]. The mixture is then fed into a patient's digestive tract via nasogastric or nasoduodenal tubes, through a colonoscope or via a retention enema [sources: Allen; Bakken; Hudson]. A nasogastric tube feeds matter through the nasal passage, down the throat and into the stomach; a nasoduodenal tube extends a bit farther.
The patient prepares for the procedure via the traditional take-no-prisoners, date-with-the-thunder-bucket ritual used by colonoscopy patients [sources: Allen; Stein]. Stool donations usually come from family members or spouses, but some facilities have tried unrelated, prescreened donors [source: Allen; Brandt].
If a fecal transplant sounds like a great DIY project, it isn't. First, stool is a level 2 biohazard; second, if you don't test fecal samples for communicable diseases, you could end up in a world of hurt; third, remind us to never drink frozen margaritas at your house [source: Bakken et al.; Floch; Silverman, Davis and Pillai].
As of October 2012, U.S. insurance does not cover fecal transplants, but some doctors believe billing codes for the procedure will exist by early 2013, with Medicare coverage following a similar schedule [sources: Allen; Brandt; Gewirtz]. Dr. Andrew Gewirtz of the Georgia State University Center for Inflammation, Immunity & Infection agrees.
"I would guess it might be insurable soon -- although it is possible that use of specific, defined bacterial cocktails may supplant it eventually," he says.
The procedure's legal status may pose a greater challenge. According to Dr. Lawrence Brandt of the Albert Einstein College of Medicine, the U.S. Food and Drug Administration (FDA) has declared feces for fecal microbiota transplants a drug, which makes transplants -- already a fringe therapy -- illegal until the FDA approves their use. While doctors are unlikely to do time for performing the procedure, its dodgy status could work against them should a malpractice suit arise [source: Brandt].
On the plus side, drug classification could move fecal transplants further into the mainstream. To become a widely accepted medical practice, the process must be subjected to large-scale clinical trials, but gaining funding for such trials from, say, the National Institutes of Health (NIH), hinges upon the FDA granting a substance "investigational status." Classification as a drug places feces in a category that the FDA recognizes for this purpose [sources: Brandt; Khoruts; McKenna].
Once they work the bugs out, bacteriotherapy and fecal transplantation could offer hope to a lot of sick people.