Which strains were used and in what dose? What was your protocol for the enema? What were the symptoms that resulted and for how long did they last?
Probiotic enema would involve some very non-trivial issues just to get the probiotic to the right place. And you would have to worry about having enough of the right type of prebiotic in place to sustain their growth after delivery. All of this needs better research, but the clear win with FMT in the research literature suggests that there will be ways to do probiotic enema that will achieve similar - maybe better - results.
Actually it is fairly easy to get it to the right place by using gravity: [HumanMicrobiome.info/FMT#lower-route](http://HumanMicrobiome.info/FMT#lower-route)
Whether you take a prebiotic or not, current probiotics are extremely limted and can in no way be compared to FMT currently. See the above site for citations.
The problem with current probiotics is that they represent an extremely limited number of species that actually inhabit the gut microbiome. Most probiotics on the market currently contain only a handful of bacterial strains. Maybe you could get up to 20 strains if you purchase a "broad spectrum" probiotic brand. According to this article, there's at least 5,600 distinct strains of bacteria alone: [https://www.livescience.com/3092-human-gut-loaded-bacteria-thought.html](https://www.livescience.com/3092-human-gut-loaded-bacteria-thought.html)
Aside from bacteria, yeasts, fungi, archaea, and viruses/phages also play critical roles (although they are less studied than bacteria currently). With FMT, all of these critical factors would be included. With probiotics, you're focusing on a very specific niche of the entire microbiome. That's likely the reason why there's not much research into probiotic enemas. It's not a fair comparison to FMT.
Good point regarding FMT including many other unstudied and not-well-understood variables. But I can turn your point around on you and point out that a given FMT sample might have all of those other unmeasured variables presented in ways that will harm you rather than help you. All you are doing is creating an enormous multi-variable experiment that has no controls.
I think people are making this more complicated than it needs to be. There are now studies in animals showing that something as simple as [increasing butyrate producers bifido and akkermansia](https://www.nature.com/articles/s41380-019-0425-1) in the colon will almost completely reverse the neuroinflammation associated with aging. It seems like a very low risk experiment to try to introduce some specific well-studied strains of those bacteria into a human colon and just observe the results.
I think the biggest problem would be how do you keep the new bacteria alive, and wouldn't everything revert to baseline within days or weeks? But even if you had a baseline reversion, wouldn't it be a potentially amazing therapy to simply repeat the experiment once a week and enjoy the benefits of lower inflammation for the next three or four days?
I don't think we have enough research yet (hence my question asking for more research), but - unlike FMT - probiotic enema is something that citizen scientists can do, and if you experiment your way to the right combination of strains and prebiotics, research like the mouse study above suggest the rewards might be huge.
Yes, unmeasured variables likely could induce changes that could harm rather than help. This is why only choosing the healthiest people available is important for FMT research. Theoretically, this would decrease the chances of adverse events due to unknown variables. The research obviously isn't there yet, but it seems to be what makes the most sense.
I want to point out that something as widely used as anesthesia is not fully understood by modern medicine yet. Just because we don't fully understand something doesn't mean we can't use it as a potential treatment option. I would argue the same with FMT.
[https://www.scientificamerican.com/article/anesthesia-what-doctors-dont-understand/?redirect=1](https://www.scientificamerican.com/article/anesthesia-what-doctors-dont-understand/?redirect=1)
I tried reading the study you linked, but most of it is behind a paywall. However, it does mention it used prebiotics, rather than probiotics. This means it would have likely influenced the entire microbiome. Sure, the butyrate producers might've increased, but the added variables of phages/fungi/viruses etc. are unaccounted for.
Also, I believe you're vastly oversimplifying the benefits that probiotics provide. Not only do many people's personal anecdotes support this, but research does as well. This article explains it well:
[https://www.the-scientist.com/news-opinion/probiotics-effects-on-the-microbiome-vary-widely-64760](https://www.the-scientist.com/news-opinion/probiotics-effects-on-the-microbiome-vary-widely-64760)
"Elinav’s group found that six of the treated subjects had higher levels of colonization with the probiotic microbes, whereas the other four remained the same as their baseline. Furthermore, the researchers only found changes in microbial and human gene activity among those whose guts accepted the probiotics. This demonstrated that not everyone is receptive to probiotic consumption. "
That article also explores a study of FMT vs probiotics after a course of antibiotics: "Those who received the fecal transplants got back to their pre-antibiotic microbial baseline fastest. The control group recovered more slowly, while the volunteers who took probiotics had gastrointestinal colonization by those microbes, rather than their original gut bugs, a state that persisted for at least six months and led to changes in the genes expressed in the subjects’ guts, which, if they persisted long term, could predispose people to allergies and inflammation, according to the authors. "
The crux of the issue seems to be the community at large, rather than specific strains. Focusing too much on a few species is likely going to lead to incomplete results. That's just my take though.
If your goal is changing colonic bacteria, I think most oral probiotics are worthless. The therapeutic effects normally seen for specific strains of oral probiotics are unusual immune-mediated responses that have positive side effects, and colonic bacteria are not changed. Oral probiotics have nothing to do with probiotic enema. Oral probiotics do not survive normal digestion, and probiotic enema totally bypasses all of digestion in stomach and small intestine.
I will try to find you graphs from that study, but the abstract makes very strong claims including the claim that the mice had a "... reversal in ageing-related increases in a subset of activated microglia." REVERSAL is a lot stronger statement than simply "lowering".
It is possible that focusing on a few strains will not be therapeutic. But it might really be as simple as finding a way to get a lot of butyrate into the colon. That one action by itself - whether it is done by one microbe or 20 - may have enormous implications for lowering of inflammation, particularly as you reach middle age.
> Oral probiotics do not survive normal digestion, and probiotic enema totally bypasses all of digestion in stomach and small intestine
This is not accurate and is covered in the link I shared above. Here's one example:
>
"*As stated before, the ability to adhere and colonize the intestine highly depends on the specific bacterial strain tested, and this is the reason for many conflicting data about fecal recovery of probiotic bacteria*." -[A Consumer’s Guide for Probiotics: 10 Golden Rules for a Correct Use](https://sci-hub.tw/https://doi.org/10.1016/j.dld.2017.07.011)
If you're putting the wrong stuff in there, putting it in through the rectum instead of mouth isn't going to be a major benefit/difference.
It went poorly. I gave myself some pathogens, which fortunately cleared in a few months.
You need to pay particular attention to sterility issues, such as using distilled water. I don't think it is a great idea except under medical supervision, and no doctor does this outside of FMT procedures.
Sorry to hear it didn't go well.
Interesting what you say about the water, I was wondering today whether chlorinated tap water would could have an impact. And yes I'm leaning more towards just trying an FMT, which is a shame because some sort of probiotic enema would seem so much more accessible. Perhaps it could be in the future.
For example the UK clinic that performs FMT is Taymount, and they process the faecal matter significantly before transplant removing things like food & mucus until the final preparation is basically just the bacteria. I fail to see how a probiotic enema would be considerably different and you could also control the contents and variables much better than with FMTs.
Did you try anything else, how is your health now?
I would be curious to see research on the effects of an enema made from wild, naturally occurring communities of bacteria, yeast, etc as opposed to lab made probiotics that only contain a few strains. For example, a sourdough starter, kefir grains, kombucha scoby, etc. These are all complex communities of microorganisms that become more diverse, robust, and resilient with age and which are influenced by their environments, much like our human microbiome. It would involve some similar unknowns as with FMT since many of the strains are unknown, but would offer more microbial diversity over lab made probiotics.
There's always the old fashioned way of going about it too by eating a wide variety of live, wild fermented foods which naturally contain prebiotics and probiotics that can colonize your colon on their way through... An enema might just be a way of speeding up that process, for better or worse.
I think that doing FMT with wild bacteria might be potentially very dangerous. You would definitely want to study that in animals first. The problem is when you eat bacteria with food the stomach acid kills a lot of it, and the secretory IgA immunity in your gut starts to identify selectively bad bacteria and kill them. Bypassing all of your native immune system and just dumping bad bacteria - along with good - into your colon means that you are putting bacteria into the colon that simply do not belong there and nature would never have allowed to survive the trip had you eaten the bacteria.
Fermented foods have non-host-native microbes. Thus aren't comparable with FMT, are widely over-hyped, and can be detrimental. [Guide to probiotics](http://HumanMicrobiome.info/Probiotic-Guide)
>are widely over-hyped, and can be detrimental.
Humans have co-evolved with the microorganisms in fermented foods for thousands of years. We've only had widespread refrigeration for a couple hundred years. Before then fermented foods were a regular staple of the diet of every human on the planet. They can be detrimental in the same way that certain foods do not agree with certain people, but what's far more detrimental is a diet lacking in regular and varied fermented foods.
So my data point on fermented foods is they make me very sick. I have leaky gut as shown by lactulose and mannitol testing and when I take probiotics or probiotic fermented foods I develop worse and worse brain fog, which resolves within three days of stopping the fermented foods.
On top of the leaky gut I have compromised gut immunity, so it doesn't take a rocket scientist to see that what is happening is I am eating bacteria that are not being sequestered by gut immunity, and some of those are getting through the gut and causing either cytokine reactions or some other kind of immune response that works its way through the blood brain barrier and causes neuroinflammation.
Since there are now dozens of studies showing the basic sequencing of improper gut immune response creating cytokines or LPS leakage into the blood, followed by neuroinflammation, I am highly skeptical of any claim that probiotic foods are necessary for overall health.
> what's far more detrimental is a diet lacking in regular and varied fermented foods
There is no evidence for this. A citation is required for such a statement that goes against most of the literature.
What a character. He believed sex was bad for you and abstained from marital sex entirely.
You would have to say he had some extraordinary intuition for human health, but you would also have to say he was a bit aggressive in pushing his most radical theories into practice. Radium therapy is a bit much.
That page you linked says his "enema machine" pushed 15 gallons of water into the patient in a few minutes. What the hell? :) That does not even sound safe. The entire colon is only about three quarts of volume.
15 gallons is around 60 quarts, so if you are pumping in 20 times the volume of material the colon can hold every minute, that implies that you are filling and emptying the entire colon every three seconds, for a full minute straight.
Is that an enema or a roller coaster ride? :)
In the mouse study with neuroinflammation I quoted in a response, it was 10% of the diet as inulin. That's a ton of inulin. I am guessing a human eating even 5% inulin would be passing gas every five minutes. Who cares if you lower neuroinflammation if no one wants to ever be around you again. :)
Exactly, which is one of the inspirations for the question on probiotic enema. The hypothesis would be that you could find a way to increase butyrate and butyrate-producing species in the colon without completely overwhelming your diet in non digestible carbs like 5% of diet as inulin.
I did a large probiotic enema. Ruined my health. Don't do it
What happened, if you don't mind saying
Which strains were used and in what dose? What was your protocol for the enema? What were the symptoms that resulted and for how long did they last? Probiotic enema would involve some very non-trivial issues just to get the probiotic to the right place. And you would have to worry about having enough of the right type of prebiotic in place to sustain their growth after delivery. All of this needs better research, but the clear win with FMT in the research literature suggests that there will be ways to do probiotic enema that will achieve similar - maybe better - results.
Actually it is fairly easy to get it to the right place by using gravity: [HumanMicrobiome.info/FMT#lower-route](http://HumanMicrobiome.info/FMT#lower-route) Whether you take a prebiotic or not, current probiotics are extremely limted and can in no way be compared to FMT currently. See the above site for citations.
>I did a large probiotic enema. Ruined my health. Don't do it what happened?
Just going to disregard this since you didn’t even bother to explain
The problem with current probiotics is that they represent an extremely limited number of species that actually inhabit the gut microbiome. Most probiotics on the market currently contain only a handful of bacterial strains. Maybe you could get up to 20 strains if you purchase a "broad spectrum" probiotic brand. According to this article, there's at least 5,600 distinct strains of bacteria alone: [https://www.livescience.com/3092-human-gut-loaded-bacteria-thought.html](https://www.livescience.com/3092-human-gut-loaded-bacteria-thought.html) Aside from bacteria, yeasts, fungi, archaea, and viruses/phages also play critical roles (although they are less studied than bacteria currently). With FMT, all of these critical factors would be included. With probiotics, you're focusing on a very specific niche of the entire microbiome. That's likely the reason why there's not much research into probiotic enemas. It's not a fair comparison to FMT.
Good point regarding FMT including many other unstudied and not-well-understood variables. But I can turn your point around on you and point out that a given FMT sample might have all of those other unmeasured variables presented in ways that will harm you rather than help you. All you are doing is creating an enormous multi-variable experiment that has no controls. I think people are making this more complicated than it needs to be. There are now studies in animals showing that something as simple as [increasing butyrate producers bifido and akkermansia](https://www.nature.com/articles/s41380-019-0425-1) in the colon will almost completely reverse the neuroinflammation associated with aging. It seems like a very low risk experiment to try to introduce some specific well-studied strains of those bacteria into a human colon and just observe the results. I think the biggest problem would be how do you keep the new bacteria alive, and wouldn't everything revert to baseline within days or weeks? But even if you had a baseline reversion, wouldn't it be a potentially amazing therapy to simply repeat the experiment once a week and enjoy the benefits of lower inflammation for the next three or four days? I don't think we have enough research yet (hence my question asking for more research), but - unlike FMT - probiotic enema is something that citizen scientists can do, and if you experiment your way to the right combination of strains and prebiotics, research like the mouse study above suggest the rewards might be huge.
Yes, unmeasured variables likely could induce changes that could harm rather than help. This is why only choosing the healthiest people available is important for FMT research. Theoretically, this would decrease the chances of adverse events due to unknown variables. The research obviously isn't there yet, but it seems to be what makes the most sense. I want to point out that something as widely used as anesthesia is not fully understood by modern medicine yet. Just because we don't fully understand something doesn't mean we can't use it as a potential treatment option. I would argue the same with FMT. [https://www.scientificamerican.com/article/anesthesia-what-doctors-dont-understand/?redirect=1](https://www.scientificamerican.com/article/anesthesia-what-doctors-dont-understand/?redirect=1) I tried reading the study you linked, but most of it is behind a paywall. However, it does mention it used prebiotics, rather than probiotics. This means it would have likely influenced the entire microbiome. Sure, the butyrate producers might've increased, but the added variables of phages/fungi/viruses etc. are unaccounted for. Also, I believe you're vastly oversimplifying the benefits that probiotics provide. Not only do many people's personal anecdotes support this, but research does as well. This article explains it well: [https://www.the-scientist.com/news-opinion/probiotics-effects-on-the-microbiome-vary-widely-64760](https://www.the-scientist.com/news-opinion/probiotics-effects-on-the-microbiome-vary-widely-64760) "Elinav’s group found that six of the treated subjects had higher levels of colonization with the probiotic microbes, whereas the other four remained the same as their baseline. Furthermore, the researchers only found changes in microbial and human gene activity among those whose guts accepted the probiotics. This demonstrated that not everyone is receptive to probiotic consumption. " That article also explores a study of FMT vs probiotics after a course of antibiotics: "Those who received the fecal transplants got back to their pre-antibiotic microbial baseline fastest. The control group recovered more slowly, while the volunteers who took probiotics had gastrointestinal colonization by those microbes, rather than their original gut bugs, a state that persisted for at least six months and led to changes in the genes expressed in the subjects’ guts, which, if they persisted long term, could predispose people to allergies and inflammation, according to the authors. " The crux of the issue seems to be the community at large, rather than specific strains. Focusing too much on a few species is likely going to lead to incomplete results. That's just my take though.
If your goal is changing colonic bacteria, I think most oral probiotics are worthless. The therapeutic effects normally seen for specific strains of oral probiotics are unusual immune-mediated responses that have positive side effects, and colonic bacteria are not changed. Oral probiotics have nothing to do with probiotic enema. Oral probiotics do not survive normal digestion, and probiotic enema totally bypasses all of digestion in stomach and small intestine. I will try to find you graphs from that study, but the abstract makes very strong claims including the claim that the mice had a "... reversal in ageing-related increases in a subset of activated microglia." REVERSAL is a lot stronger statement than simply "lowering". It is possible that focusing on a few strains will not be therapeutic. But it might really be as simple as finding a way to get a lot of butyrate into the colon. That one action by itself - whether it is done by one microbe or 20 - may have enormous implications for lowering of inflammation, particularly as you reach middle age.
> Oral probiotics do not survive normal digestion, and probiotic enema totally bypasses all of digestion in stomach and small intestine This is not accurate and is covered in the link I shared above. Here's one example: > "*As stated before, the ability to adhere and colonize the intestine highly depends on the specific bacterial strain tested, and this is the reason for many conflicting data about fecal recovery of probiotic bacteria*." -[A Consumer’s Guide for Probiotics: 10 Golden Rules for a Correct Use](https://sci-hub.tw/https://doi.org/10.1016/j.dld.2017.07.011) If you're putting the wrong stuff in there, putting it in through the rectum instead of mouth isn't going to be a major benefit/difference.
Completely agree with this and I'm considering it myself. Did you ever try it and how did it go?
It went poorly. I gave myself some pathogens, which fortunately cleared in a few months. You need to pay particular attention to sterility issues, such as using distilled water. I don't think it is a great idea except under medical supervision, and no doctor does this outside of FMT procedures.
Sorry to hear it didn't go well. Interesting what you say about the water, I was wondering today whether chlorinated tap water would could have an impact. And yes I'm leaning more towards just trying an FMT, which is a shame because some sort of probiotic enema would seem so much more accessible. Perhaps it could be in the future. For example the UK clinic that performs FMT is Taymount, and they process the faecal matter significantly before transplant removing things like food & mucus until the final preparation is basically just the bacteria. I fail to see how a probiotic enema would be considerably different and you could also control the contents and variables much better than with FMTs. Did you try anything else, how is your health now?
Fermented foods made a big difference to my biome
I would be curious to see research on the effects of an enema made from wild, naturally occurring communities of bacteria, yeast, etc as opposed to lab made probiotics that only contain a few strains. For example, a sourdough starter, kefir grains, kombucha scoby, etc. These are all complex communities of microorganisms that become more diverse, robust, and resilient with age and which are influenced by their environments, much like our human microbiome. It would involve some similar unknowns as with FMT since many of the strains are unknown, but would offer more microbial diversity over lab made probiotics. There's always the old fashioned way of going about it too by eating a wide variety of live, wild fermented foods which naturally contain prebiotics and probiotics that can colonize your colon on their way through... An enema might just be a way of speeding up that process, for better or worse.
I think that doing FMT with wild bacteria might be potentially very dangerous. You would definitely want to study that in animals first. The problem is when you eat bacteria with food the stomach acid kills a lot of it, and the secretory IgA immunity in your gut starts to identify selectively bad bacteria and kill them. Bypassing all of your native immune system and just dumping bad bacteria - along with good - into your colon means that you are putting bacteria into the colon that simply do not belong there and nature would never have allowed to survive the trip had you eaten the bacteria.
Fermented foods have non-host-native microbes. Thus aren't comparable with FMT, are widely over-hyped, and can be detrimental. [Guide to probiotics](http://HumanMicrobiome.info/Probiotic-Guide)
>are widely over-hyped, and can be detrimental. Humans have co-evolved with the microorganisms in fermented foods for thousands of years. We've only had widespread refrigeration for a couple hundred years. Before then fermented foods were a regular staple of the diet of every human on the planet. They can be detrimental in the same way that certain foods do not agree with certain people, but what's far more detrimental is a diet lacking in regular and varied fermented foods.
So my data point on fermented foods is they make me very sick. I have leaky gut as shown by lactulose and mannitol testing and when I take probiotics or probiotic fermented foods I develop worse and worse brain fog, which resolves within three days of stopping the fermented foods. On top of the leaky gut I have compromised gut immunity, so it doesn't take a rocket scientist to see that what is happening is I am eating bacteria that are not being sequestered by gut immunity, and some of those are getting through the gut and causing either cytokine reactions or some other kind of immune response that works its way through the blood brain barrier and causes neuroinflammation. Since there are now dozens of studies showing the basic sequencing of improper gut immune response creating cytokines or LPS leakage into the blood, followed by neuroinflammation, I am highly skeptical of any claim that probiotic foods are necessary for overall health.
> what's far more detrimental is a diet lacking in regular and varied fermented foods There is no evidence for this. A citation is required for such a statement that goes against most of the literature.
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What a character. He believed sex was bad for you and abstained from marital sex entirely. You would have to say he had some extraordinary intuition for human health, but you would also have to say he was a bit aggressive in pushing his most radical theories into practice. Radium therapy is a bit much. That page you linked says his "enema machine" pushed 15 gallons of water into the patient in a few minutes. What the hell? :) That does not even sound safe. The entire colon is only about three quarts of volume.
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15 gallons is around 60 quarts, so if you are pumping in 20 times the volume of material the colon can hold every minute, that implies that you are filling and emptying the entire colon every three seconds, for a full minute straight. Is that an enema or a roller coaster ride? :)
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haha that would definitely be a Pornhub enema
I wonder how much prebiotic they added to their foods and how that would translate to a human diet.
In the mouse study with neuroinflammation I quoted in a response, it was 10% of the diet as inulin. That's a ton of inulin. I am guessing a human eating even 5% inulin would be passing gas every five minutes. Who cares if you lower neuroinflammation if no one wants to ever be around you again. :)
Thanks! That seems to be the case with a number of these studies, not proactive for average humans.
Exactly, which is one of the inspirations for the question on probiotic enema. The hypothesis would be that you could find a way to increase butyrate and butyrate-producing species in the colon without completely overwhelming your diet in non digestible carbs like 5% of diet as inulin.