Those of you who receive my newsletter or watch my instagram stories likely know that I am in Nassau, Bahamas for two weeks to undergo an experimental procedure called fecal microbiota transplantation (FMT).
In a series of posts, I will be sharing about my experience and making recommendations to help those of you who decide to try this procedure.
First, I will start by telling you what brought me here.
My Digestive Health Story
My journey with irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) began a long time ago.
I remember digestive symptoms at least back to age 14 (that was in 2006), but have likely had them my whole life.
I was a super colicky baby and developed daily headaches in first grade that turned into frequent migraines by middle school. All of these conditions are believed to be rooted in digestive dysbiosis.
But I didn’t know that back then. I thought it was normal to feel unwell. Until my symptoms became severe.
I didn’t officially receive an explanation for my digestive symptoms until I started working with a naturopath. I was diagnosed with IBS in 2012 and then SIBO in 2014.
Getting My SIBO Under Control
In an effort to improve my digestive and immune health, I made some huge life changes. The biggest of these changes was abandoning the stressful (but financially promising) corporate career path I had chosen in college for one that would allow me to take better care of my health.
I began learning everything I possibly could about health, nutrition and SIBO. I went back to school for a Master’s in Nutrition degree and studied with top naturopaths in the SIBO and digestive health world.
Then I began applying what I had learned (along with working with a naturopathic doctor) to my own healing journey. It took a lot of trial and error, but by about 2 years into my SIBO journey, I figured out the right combination of diet, supplements, and lifestyle hacks to make me feel pretty healthy on a regular basis.
For about two years, I had a routine that worked quite beautifully for me. I used a combination of the probiotic VSL#3, a strong prokinetic called Resolor, and a diet I tailored to my unique needs. Occasionally, I used other supplements to get me back on track.
When symptoms would flare up a little, I could get them back under control in a day or two using one or more of the following:
- Ginger capsules (I like Nature’s Way brand)
- Vitamin C with Quercetin & Bioflavonoids (by Integrative Therapeutics)
- Colostrum (the brand I loved stopped carrying it)
I typically recommend purchasing supplements through a site such as Wellevate, rather than Amazon, when possible. That way you can ensure that the product you are getting is authentic and that it was handled properly (especially important for products that require refrigeration).
Diet For SIBO
I almost strictly avoided gluten, dairy, eggs, oats, and soy because those are foods that set me back for several days when I would eat them. I mostly avoided fruits, but would consume bananas and berries (strawberries, raspberries, blueberries) a few times per week or daily.
And then I would do something I call being “FODMAP conscious.” What I mean by this is that on days when I felt really well, I would consume more FODMAP containing foods such as onions, garlic, and other high FODMAP veggies. But when I would have a rough symptom day or series of days, I would ease off the FODMAPs.
I was super happy with the fact that I was able to reintroduce sulfur foods (I was once very sensitive to kale, spinach, broccoli, and other high sulfur foods). This happened about a year into my SIBO journey after taking the probiotic VSL#3.
Even though to the average person, a diet free from gluten, dairy, eggs, oats, soy, etc. sounds restrictive, it actually felt pretty lenient for me because during the worst of my SIBO journey, I seemed to react to nearly every food I ate (except meat, oils, and like 3 vegetables!). Being able to tolerate high sulfur foods made my diet feel more sustainable and nutritious for the long-term.
I told you what I wasn’t eating during my “maintenance diet”, but what did I eat? Vegetables, fresh herbs, and spices. Lots of them. Organic when possible- for all my food. I also aimed for high-quality meat and seafood, nuts/seeds, legumes, gluten-free grains (opting for whole grains over refined ones), and healthy oils like olive oil and avocado oil. I tried to keep sugar to a minimum, but definitely am one with a sweet tooth!
And Then I Had To Take Antibiotics…
And then in 2017, things took a turn for the worse.
I started trying to be a superwoman overachiever again. I wanted and tried to live a more “normal” life. I wasn’t getting enough sleep so my immune system wasn’t happy.
I ended up with a kidney infection that required me to take an antibiotic called nitrofurantoin. Within two doses of the antibiotic, I had symptoms of a vaginal yeast infection. It was only my second time ever having a yeast infection (and the first time it went away right away).
My doctor instructed me to discontinue the antibiotic and to take probiotics. I bumped up my dose of a strong probiotic called VSL#3 for a few days and it seemed to go away. So I thought the issue was resolved. But over the next several months, I began to develop mysterious symptoms (later found to be caused by vaginal yeast overgrowth):
- Sore throat, especially upon waking
- Extreme fatigue, especially in the afternoons around 2 PM
- Very low ferritin (9 and 14 ng/mL at the two times it was measured)- this occurred despite eating meat and not having any other obvious risk factors for iron deficiency
- Discomfort with urination- it was minor, but basically felt like early signs of a urinary tract infection (UTI)- but almost all the time…I went to the doctor multiple times for a urine test to check for UTIs, but the dipstick never showed signs of infection and the cultures came back normal (other than showing mucus which is a sign of inflammation).
I went to several doctors to try to get a diagnosis, but everyone was stumped. They tested for mononucleosis, cytomegalovirus, bacterial vaginosis, urinary tract infections (again and again because it felt so much like one), sexually transmitted diseases (by the way, did you know it is super easy to order STD testing online?), and a whole host of other tests that I can’t remember.
I was even referred to a urologist who wanted me to undergo cystoscopy as part of a work up that would likely eventually lead to the unhelpful diagnosis of “interstitial cystitis”. And that procedure would require taking another antibiotic…
It wasn’t until 5 months later during a routine women’s health exam (two weeks before I was scheduled for a cystoscopy that I then cancelled!) that my doctor connected the pieces of the puzzle. She said she could literally see the yeast (based on the type of discharge produced).
I was confused at first because the urologist had tested via a yeast culture and it was negative! But my doctor told me that test is not very sensitive and was likely a false negative. So she sent me for a more sensitive test called a wet prep or wet mount. It was quick and painless and sure enough, she was right- yeast was brewing.
It is my theory that because I was eating a nutritious diet that mostly avoided yeast’s favorite foods (dairy, gluten, sugar), the infection was slow to develop and didn’t present like a typical yeast infection.
So we began treating the yeast. And I started experiencing relief immediately. But I developed resistance to the first antifungal really quickly. And with each subsequent treatment we tried that were aimed at yeast, my symptoms improved, but only until the resistance built.
Here’s everything that helped me find relief from symptoms of vaginal yeast overgrowth (in order from most to least helpful):
- Tea tree oil suppositories (on Amazon)
- Avoiding sugar/fruit
- Thorne SF 722 (on Wellevate)
- Marshmallow root tincture (on Wellevate)
- Boric acid suppositories (on Amazon)
- Priority One Urinary Tranquility (on Wellevate)
- Nystatin (prescription)
- Ginger (Nature’s Way Brand on Wellevate)
- Plenty of rest
- Genestra Candicin (on Wellevate)
- Uva ursi tincture (on Wellevate)
- Diflucan (prescription)
- Monistat (at any pharmacy)
- Probiotic suppositories (I used a needless syringe, sauerkraut juice, and a “candlestick” yoga pose in the bathtub)
- Saccharomyces boulardii (Klaire Labs on Wellevate)
- Biocidin (on Wellevate)
- Priority One Biofilm Phase II Advanced (on Wellevate)
As you can see, I tried a lot of things. My doctor ran out of ideas. And I wanted a sustainable solution.
Frequently Asked Questions About FMT
I have gotten lots of questions about fecal microbiota transplantation (FMT) since sharing that I was undergoing the procedure, so I wanted to take a moment to answer them here for those who want to know more:
Q: How does it work?
A: Healthy individuals (in the UK) with diverse microbiomes donate stool. That stool is then concentrated so that it more closely resembles a super potent probiotic than poop.
Then, the FMT patient receives the implant through the rectum (bum) via a very small tube. This happens once daily Monday-Friday for 10 days.
The idea is that a diverse microbiome has been associated with a better state of health. But those with chronic health issues such as autoimmune diseases and digestive disorders often have poor gut microbial diversity. The critters in our guts are super important for regulating the immune system. So by introducing good ones, the hope is that the immune system, digestive system, etc. will function better.
Q: Why the Bahamas?
A: Well, my understanding is that, in the US, it is only legal for doctors to administer this procedure for individuals who have a C. dificile infection that has failed antibiotic treatment.
So, the Bahamas is the closest place to the US that performs the procedure. They are affiliated with the Taymount clinic in the UK so you could also go there.
Q: How much does it cost?
A: About $10,000..(yes, I am talking U.S. dollars). And that does not include lab fees for tests back home prior to treatment, airfare, lodging, food, or transportation.
Q: What are the risks?
A: The most pertinent risk is receiving a communicable disease (virus, bacteria, etc.) from the donor implant. However, the donors are healthy, screened thoroughly, and then the implant material itself is also screened.
Otherwise, the procedure is quite safe. In your initial appointment, you will have an opportunity to discuss risks with the doctor. They say it is safer than a blood transfusion!
Q: What is the success rate?
A: I wish I had taken notes from my initial consult (it was several months ago) because I am not sure I remember the numbers correctly.
But I think I remember them saying that the success rates (based on checking with patients 3 months after treatment) are different based on the condition being treated:
- Clostridium dificile (C. diff) infection: 90%
- Inflammatory bowel disease (IBD): 80%
- Irritable bowel syndrome (IBS): 70%
- Other disorders (such as MS, Parkinson’s, Autism, CFS, etc.): 50%
Seeking A More Sustainable Solution
Due to the high cost of FMT, it is not the kind of thing that you jump to right away.
I had thought about FMT earlier in my SIBO journey (when I was reacting to nearly all foods) and consulted FMT expert Dr. Mark Davis. He’s the one who recommended I try VSL#3 first!
And since I got so much better, FMT became less important. But FMT has always been in the back of my mind. One major reason is that I would like to be healthier before deciding to have children (since it is believed that the mother’s microbiota plays a big role in regard to what the baby gets).
But then at the beginning of 2018, a family member asked why I hadn’t already tried FMT. The big answer: financial risk.
But realistically, I have spent way more on health care costs over the past 4 years than the cost savings that a sustainable solution would provide. So FMT, while financially risky, could actually prove to be the best option financially in the long run.
That’s when my family member stepped in to help. And FMT became within reach. I scheduled an initial consult with the Bahamas Medical Center to determine whether I would be a good candidate.
My guess was that I would. And the doctor agreed.
Because the likely root cause of my various health issues is gut dysbiosis (I inherited a crappy gut and then took 15-20 rounds of antibiotics during my lifetime). I also LOVED sugar as a child and because I was skinny, everyone always told me it wasn’t a problem. But it was probably just destroying me on the inside.
So I took the leap. And I am now in the Bahamas. I’m hoping for the best, but also understand that it is not a golden ticket. All I can do now is relax, wait, and eat lots of nutritious food!
Stay tuned for part II & part III of my Bahamas FMT Journey. You can also find me on Instagram (I’m most active there!), Facebook, or sign up for my newsletter.
Tracie Koenig says
So exciting and best of luck. I am a fellow sibo who lives a very busy life. I have good weeks and bad. I wish I was more consistent with diet and supplements….
Thank you so much! I definitely understand how that can be challenging. Sometimes “balance” just isn’t possible.
So thankful, that you are sharing your SIBO journey. I’m a long time SIBO sufferer with sulfur intolerance as well. After little improvements from multiple antibiotic rounds – both herbal and pharmaceutical, pro-kinetics, low-fodmap diets, I have been considering FMT option in Bahamas. I landed on your website while researching this option.
My biggest concern with pursuing FMT route is its effectiveness with constipation. If the gut is not moving, will the new bacteria still be able to do their magic. At the same time, I’m out of all other options, so feel like worth a shot.
I know it is really early for you and results can take a few months, but I’m eager to hear about your early experience. I hope you are experiencing some relief, so we can follow your foot steps.
Good to hear from another sulfur SIBOer! I am sorry to hear that you haven’t had much success with treatments- I can imagine that would be really frustrating.
It is still too early to tell whether the FMT was helpful. Part of the reason for that is that I was taking antimicrobials (for chronic fungal overgrowth) and had to stop doing so a few days prior to my procedure. So I have gone almost a month without them and have experienced some troublesome symptoms because of it. I did have to remain on Resolor (strong prokinetic that works well for me) during the procedure and afterwards to help with constipation. I am still hopeful that the FMT will start doing its magic, but wouldn’t say I have seen anything miraculous so far.
Sorry to hear about your troublesome symptoms. I do feel that FMT has more of an upside to it, than the non-stop killing trail I have been on with the anti-microbials. Hopefully, you will start seeing benefits soon.
Based on my stool test, all prior anti-microbials have not been able to budge the bad guys – Citrobacter Freundii, E-Coli, Desulfurvibrio. Besides FMT, I’m also exploring phage therapy, since it involves a targeted approach towards pathogens.
A couple more questions:
1. Did your stool test prior to FMT show any specific pathogens, or Yeast, esp for explaining sulfur intolerance? Wondering whether they were similar to mine. BTW – my Doctor has put me on Bismuth besides Molybdenum. Apparently Bismuth helps bind the hydrogen sulfide. Hopefully, your stool test post FMT will show great diversity in microbiome.
2. What tests were helpful for you in revealing your fungal overgrowth? My stool tests have never shown any yeast issues, but my symptoms keep me guessing whether there are co-infections.
I couldn’t agree more- the idea of ongoing antimicrobials doesn’t quite sit right with me either.
That’s frustrating that the antimicrobials do not seem to budge the bugs on your stool test. Do they help you symptomatically though?
I have never had much show up on a stool test, other than being low in beneficial microbes and a bit of fat malabsorption.
I have heard about bismuth for H2S- would love to hear your experience with it!
As for fungal overgrowth, the only test that has ever revealed yeast for me is a vaginal wet prep. But when I went on an antifungal for vaginal candida overgrowth, it was my gut that improved quite a bit! So I wouldn’t be surprised if stool tests can miss it.
Bismuth can help with both sulfur reducing bacteria as well as Candida:
Bismuth can also help with motility issue due to sulfur reducing organisms
Personally, I haven’t experienced any measurable benefits, but I only started it two weeks ago. I plan to keep taking it since I haven’t seen any side effects either, and the research seems pretty convincing. The hard part of the intestinal dysbiosis is that there are several pieces of the puzzle. I’m hoping that the bismuth piece fits somewhere.
I never experienced even symptomatic benefits with the anti microbials (berberine, oil of oregano, cinnamon oil, eucalyptus oil, tee tree oil, dysbiocide), which makes me think that the critters are super resistant, have outnumbered the good guys, and I can’t just kill my way out of it. Let’s see how FMT fares in my case.
Initially in my journey, I was always doubtful about Candida, but the above anti-microbials help with both, so I never really focused on it, and the stool tests never picked it up.
1. Did you have burping / bloating issues, and did the pharmaceutical anti-fungals help with burping / bloating?
2. The FMT guys focus a lot on prebiotics. For me the hard point is deciding how long do you keep feeding the colon, before pulling the plug and again addressing the critters in upper GI. If anti-microbials have to be started again, I hope they equip you with enough tools that you can administer FMT with good efficacy at home.
Thanks so much for sharing those articles. I will check them out!
That’s super frustrating that you haven’t had any success with all sorts of antimicrobials!
No, I have never had issues with burping. I had some bloating, but it wasn’t my primary complaint- yes, it went down with anti-fungals.
I think that with prebiotics, they are great at feeding an already healthy microbiome, but may be a little more challenging when the microbiome is already messed up. I think more research is needed to figure out whether they are helping or hurting in the case of those with dysbiosis and how to fix the problem.
Alan Young says
Could you please let me know if your feel the FMT treatment has helped you now? Also what did you think of the level of professionalism at the Bahamas FMT Clinic?
I am Considering FMT at the Bahamas Clinic for Ulcerative Colitis. I may be going for Immunotherapy (for cancer treatment) and heard that FMT may help to avoid flares and also may enhance the results of Immunotherapy.
I’m sorry to hear that you are dealing with health concerns! I shared more about my experience in parts 2 and 3 of this series. Also be sure to check the comments sections as I answered more recent questions and updates there. Let me know if those still leave unanswered questions.
If you decide to go, I would love to hear about your experience as well!
Im not surprised you got yeast infection and urinary infection.i read so much microbiology that im sick of it.the way it works is like this. The colon microbiome is kind of the gatekeeper of the whole body.its the most diverse in count and population.you have many micriobiome sights in the body and when you kill the colon microbiome, the rest is affected. I did microbiome analysis of colon but you can tell how well you do it if you use bristool stool chart. So if you mess up your colon, your microbiome might be affectrd and not only vagina and so on…besides fixing your microbiome which you can do wirh PREBiotics and food, you have to heal livky gut:2 teaspoons of l-glutamine per day for 1 year.
Thank you for your insightful comments, Cristina! I luckily no longer suffer from chronic yeast infections and UTIs. I’ve also had success with prebiotics and am super grateful to no longer struggle with these issues!