What do frozen yogurt and bacteriotherapy have in common? Good bacteria.
A few months ago I attended a presentation for families affected by pediatric IBD (Inflammatory Bowel Disease) at Seattle Children’s Hospital . The CCFA (Crohn’s and Colitis Foundation of America) and Seattle Children’s GI department presented a day-long seminar on several topics, including a new therapy and diet. I actually hesitated to go and finally dragged myself downtown. It turned out to be the one of the best decisions I’ve made in a long time.
So much good stuff came out of it, including an opportunity to find out more about bacteriotherapy (also known as fecal microbial transplant or FMT).
Seattle Children’s Hospital was the first research center in the nation to receive federal approval to test bacteriotherapy for Crohn’s and colitis. I’m honored that Dr. David Suskind, who is leading the study of bacteriotherapy at Seattle Children’s, has taken the time to answer some questions regarding this study and the work the team is carrying out. The team is also looking for funding to research the impact of SCD (Specific Carbohydrate Diet) for IBD.
At the end of the interview is a recipe for strawberry ripple frozen yogurt. I’ve been living on this treat ever since I first made it. The addition of lemon and salt make this lip-smacking good. I’m not a huge fan of froyo that even hints at the taste of yogurt, but this tastes like strawberry ice cream. And is it me or does it seem like strawberries are available almost year-round on the west coast of the U.S? We’re a bit spoiled over here. But in case you’re thinking of moving to Seattle, it does rain occasionally. And in the summer it rains sunshine and berries. Summer is good to us. And so are our research institutions. I’m grateful that the University of Washington and Seattle Children’s take good care of us.
And now for the interview…
I’ve been following the media’s coverage of bacteriotherapy/FMT for a few years in the hope that it might be an alternative therapy for IBD so it’s great to find out that its being studied. What inspired you to launch a study of bacteriotherapy in pediatric bowel disease?
I have always been interested in trying to improve treatment for inflammatory bowel disease while also bringing deeper insight into the disease. We have known for many years that our genes play an important role in the development of IBD but our genes, which we have inherited from our ancestors, have been the same for over a thousand years, while Crohn’s and UC (Ulcerative Colitis) are relatively new diseases of the 20th century. This means something has changed in our environment to bring about these disorders. The most likely culprit is the bacteria within our bowels. With the change in diet as well as increase use of antibiotics, the bacteria which have developed within us have changed significantly. It is this change which is likely a major trigger for IBD and by studying bacteriotherapy and fecal microbial transplant (FMT), we are able to test this hypothesis.
Besides the team at Seattle Children’s Hospital, are you working with other research groups, hospitals, or organizations, or is each study carried out independently?
We are working with a team at UW (University of Washington) to examine the changes in the microbiome that occur with IBD as well as changes which occur after fecal microbial transplant for our Crohn’s and UC patients. This will hopefully give us insight on which bacteria play an important role in potentially triggering the body’s immune system to cause inflammation within the bowels.
What are your goals for this study and for future IBD therapy?
This is the first study to examine bacteriotherapy or FMT in patients with Crohn’s and UC. We are getting very encouraging results. As this is the initial study, many questions still need to be answered such as how much stool do we need to transplant, how often we need to transplant, who would be the optimal donor, what type of pretreatment is best. This is the beginning of a very fascinating area in medicine.
Which patients would you recommend consider taking part in the study?
Any child with uncomplicated Crohn’s or UC aged 12 to 21 with active disease who would like to avoid steroids or increasing their immunosuppression.
How does this effort relate to the Human Microbiome Project?
The human microbiome project is an amazing project put forth by the National Institutes of Health to define what makes up the human microbiome. Over 100,000 separate samples from over 300 healthly men and women will answer the question what is “normal” for the human microbiome. This is important because we have over 100 trillion bacteria in and on us. These bacteria are active. They are communicating with each other as well as interacting with us. In our bowels they help digest our foods, produce vitamins, and help prevent pathogenic bacteria from infecting us. It is so very important to understand what the human microbiome encompasses as well as how it works to better our own health.
I’m intrigued by the recommendation that to sustain the therapy it might be necessary to follow dietary guidelines. Is there anything you can share regarding the use of diet as a therapy, either apart from this study or in step with it?
There is strong evidence that IBD is triggered by a dysbiosis or “bad” bacteria in the intestinal tract. This dysbiosis is likely caused by a number of things including antibiotics and diet. Although we don’t have studies to let us know what is the optimal diet for an individual with IBD, we do know that diet can have a dramatic affect in IBD. The research that has been done so far involves formula therapy in Crohn’s disease. We know that complete nutritional therapy in the form of formula is as good as steroids in achieving clinical remission in children. We also know that it is much better than steroids in achieving mucosal healing. This is extremely important because mucosal healing is associated with long term remission. There is also a large amount of anecdotal evidence to suggest that other diet therapies such as the SCD diet have a positive impact on disease activity as well. In fact we have recently submitted a paper for publication where we report the benefits of the SCD diet for 7 children with Crohn’s disease. This is another area of interest for me. In general, more resources and more research needs to be done in the area of nutrition and IBD.
Thanks to Dr. Suskind, Heather Vendettuoli, and the team at Seattle Children’s!
To find out the not-so-gritty details of the procedure which is surprisingly quick and odorless, go to Seattle Children’s website.
If you’re interested in helping support further bacteriotherapy (FMT) and SCD (Specific Carbohydrate Diet) research studies go to Seattle Children’s Foundation and earmark your donation to Pediatric FMT/SCD research.
Strawberry Ripple FroyYo
To make this dairy-free use a dairy-free yogurt and a dairy-free milk such as coconut or almond milk. If you don’t like the ripple effect or don’t like pieces of strawberry in your froyo, in step 4 you can place the ingredients in a blender and blend until smooth.
- 3 cups (420 g) sliced strawberries
- 3 tablespoons lemon juice
- 3/4 cup (180 ml) maple syrup or honey
- 1/4 teaspoon salt
- 1/2 cup (120 ml) almond milk or other milk
- 1 1/2 cups (360 ml) yogurt
- Add the strawberries, lemon juice, maple syrup, and salt to a medium saucepan and bring to a steady low boil.
- Cook for 10 minutes or until the strawberries begin to soften. Turn off the heat and cool for 10 minutes.
- Using a potato masher or fork, break up the strawberries so that most are at least somewhat mashed.
- Add the almond milk and yogurt to the strawberry liquid and blend well with a spoon.
- Chill the mixture in the refrigerator for at least 1 hour. The longer you chill it the better the consistency of the froyo.
- Place the strawberry yogurt mixture in your ice cream maker and follow the manufacturer’s directions.
- Place the froyo in a freezer-proof container and let it sit in the freezer for a few hours if it’s still a bit too soft to scoop.
- Serve cold. To soften it, remove it from the freezer a few minutes before serving. Store covered in the freezer for several weeks.
Makes 1 quart