Freakonomics Radio: The Power of Poop
The “Power of Poop”: Since the beginning of civilization, we’ve thought that human waste was worthless at best, and often dangerous. What if we were wrong?
I don’t know when most of you listen to our podcasts — probably while driving or running or hanging out at your desk. But here’s a fair warning: if you happen to listen to our podcast while eating, you might want to change your routine for at least this one episode. It’s called “The Power of Poop,” and while it’s got some mind-blowing science and stories in it, there’s also a bit of a gross-out factor. (You can download/subscribe at iTunes, get the RSS feed, listen live via the link in box at right, or read the transcript here.)
In a nutshell: throughout civilization, human feces has posed considerable health hazards; when it gets into the water supply, for instance, a lot of bad things can happen. But in recent years, a variety of medical researchers, many of them gastroenterologists, have pushed for a greater understanding of poop, and have made some startling discoveries.
To paint it with a very broad brush: it could be that many maladies — from intestinal problems to obesity to disorders like multiple sclerosis and Parkinson’s and Alzheimer’s and perhaps even cancer — are related to damaged or missing gut bacteria; the solution therefore may lie in transplanting healthy bacteria into a sick person.
How is this accomplished? (Okay, hold your nose for a moment.) A fecal transplant. Yes, you read right: taking the stool from a healthy person, mixing it with a saline solution, and injecting it into an ill person. The procedure resembles a colonoscopy; it’s a sort of combination of organ transplant and blood transfusion, which one doctor in our podcast calls a “transpoosion.”
Fecal transplants go back several decades, but momentum is unquestionably building, thanks largely to a rise in bench science looking into the bacterial environment of the gut — and that is due to the latest DNA technologies and computational techniques.
In this podcast, you’ll hear from two researcher/practitioners: Thomas Borody, a Polish-born gastroenterologist who works at the Centre for Digestive Diseases near Sydney, Australia; and Alex Khoruts, a Belarussian-born gastroengerologist and immunologist at the University of Minnesota. (Here’s one Borody paper on the topic, and here’s one from Khoruts; both are gated.) You’ll also hear from one of Borody’s patients, William Kostopoulous, who received a fecal transplant to treat his multiple sclerosis. According to both men, the treatment worked marvelously; Borody is currently setting up medical trials to try to establish proof.
Here are some key excerpts from the Borody interview:
BORODY: Fecal matter, I was brought up to believe, was waste. But we’ve now learned that it’s the largest organ of the body. It contains about nine times more living bacteria, bacterial cells, than the body contains human cells. So, in a manner of speaking, we are 10 percent human and 90 percent poo. …
When the stool is infected with a bug, when we changed the flora by implanting another person’s stool, that other person may contain bacteria which manufacture antibiotics. And this is the key: bacteria make molecules that kill other bacteria. In fact, most antibiotics come from bacteria, such as vancomycin for example. And you will remember, fungi produced penicillin. So it now physiologically makes good sense that when you implant flora from a healthy person into a person that’s got infected flora, that infected flora may be cured by that single implantation. …
Well, the feedback is very much like Barry Marshall‘s. I was initially ostracized. There was a program on our ABC Radio where a professor of medicine named me on television as being a charlatan for doing fecal transplants and he had no idea of the science behind it, very much like those people that initially criticized Barry Marshall, and initially Louis Pasteur was also criticized like this, and so was Edward Jenner with immunization for smallpox. [N.B.: see also Ignatz Semmelweis.] So I don’t expect anything different, but even now my colleagues would avoid talking about this or meeting me at conferences, although this is changing. I’ve just had an invitation to speak at an international conference about fecal transplantation. …? So I think we might be turning a new leaf, and I think we should, with poo especially.
And, from Khoruts:
KHORUTS: Well, part of me has not overcome that feeling [of disgust with human waste]. I think it’s universal. It’s evolutionarily put in there; we’re supposed to avoid the stuff. But I also realize that what it represents is shedding of our microbial organ. So I also think about all the functions that that entity has. It’s essentially like the elephant in the room for the gastroenterologist. We talk about all the other parts of the digestive tract, but we’re so ignorant about this component that most gastroenterologists and other scientists know very little about it. So our level of knowledge hardly exceeds that of a fifth-grader who just says, exactly as you said, “Eeewww.” … We have some understanding of how complex [the microbial organ] is. We have understanding of some of the basic components. We’re done classifying about 50 percent of different species that are there. We have some idea of how this organ is inherited, transmitted generation to generation. We have some idea of differences between individual species. We have some idea about the evolution of this organ. And we’re beginning to understand some of its functions.
And from William Kostopoulos:
KOSTOPOULOS: It wasn’t an overnight occurrence where I got better in like 15 seconds. But all I know now is, I’m 47 years old, I ride a custom chopper, I travel the world, I have a great time and I’m not in the bloody wheelchair, right? That’s all I know.
It’s a fascinating prospect: that for centuries, we’ve collectively looked at human waste as nothing but a frightful by-product of our existence, a source of shame and disease. Wouldn’t it be amazing if it turned out to be a health breakthrough rather than a heath hazard?
There are other goings-on in the world of poop as well: a poop-powered car; human waste used to heat homes in Oxfordshire; might it happen in New York, too? And, thanks to Flush Tracker, residents of some countries can find out where their poop goes when it isn’t being repurposed.