If I were morbidly obese I'd rather have an enema with a thin, healthy person's feces than have a surgeon cut me up and put a band around my stomach to reduce the amount I can eat.
Am I the one that's weird? Or is it the doctors who see the fecal transplant as a last-ditch effort only after surgery?
Neither group is weird. It's totally reasonable for individuals to prefer a fecal transplant over surgery.
But doctors are part of a complicated system that prevents wild-ass medical experiments from being tried on humans. If you go in front of a review board [1] and say, "Hey, we'd like to try experimenting on live humans by giving them an unknown collection of microorganisms in hope that unspecified good things will happen", I can't imagine that it will go well.
Like it or not, the best currently proven treatment is the band. To prove that something else is better is a lot of work. I strongly share your suspicion that fecal transplants would be better, and if I were desperate that's what I'd try with my own body. But medical history is littered with treatments that looked promising but didn't work out, often because of hideous unexpected side effects.
Its also a system that sometimes takes forever to change even when there is evidence.
I read recently that it took 25 years to stop x-raying pregnant women after a British doctor found that it lead to birth defects.
And the unnecessary surgeries and medication and scans. I really find it hard to think of this as a conservative industry governed by "first, do no harm". These are all well-tested, according the establishment.
Fecal bacteria may not be well tested by the establishment, but its something we have been living with for millions of years. Many animals are constantly exposed to fecal matter. And so are you if you ride public transportation.
Maybe what this approach needs is someone like Craig Venter to sequence all the bacteria found in generally healthy people and people with specific problems. He did this in the oceans and found all this previously undiscovered genomes. That same tech could probably determine what strains of bacteria to start testing just from their absence in the unhealthy.
At the same time, their presence in the perfectly healthy indicates that the bacteria in question probably isn't dangerous. Of course, how specific individuals will react is always an unknown. But that remains an unknown even after something is well tested.
When I hear all the possible side effects of accepted drugs, which often include death, I have to wonder if there isn't some bias in favor of things created in a lab and where someone stands to make large profits. These drugs are recalled all the time and class action suits are common.
None of this inspires much confidence in how treatments are evaluated.
> Maybe what this approach needs is someone like Craig Venter to sequence all the bacteria found in generally healthy people and people with specific problems.
There are quite a few well-funded projects doing this on a large scale, see http://www.human-microbiome.org/index.php?id=30 for a comprehensive list. Not just the gut but other bacterial sites like skin, mouth, nasal cavity, urinary tract, etc.
It is exaggeration "by transplanting feces from thin people". It is for eye-catching. I believe scientists will strive to identify the bacterium or bacteria, grow and purify them in an emotionally-acceptable environment. The bacteria will be transplanted, mostly with some supplement for certain medicine purposes, not the feces.
I'm with you 100% -- many bariatric surgeries discard parts of the digestive system – there's no going back (at this point). Given some set of safety precautions (HIV, Hepatitis screening, etc.), I think a lot of people would gladly try the fecal enema instead. I definitely would.
Yes. 2000 calories can be starvation, complete with feeling like crap, reduced mental and physical capabilities and the body lowering its metabolism to keep itself from getting thin. Also, even if you do lose weight by starving yourself (which is inevitable if you do eat little enough for long enough and don't die from malnutrition), you can't go back to eating enough to feel satiated, because you'll get fat again. You'll need to feel like you're starving for the rest of your life.
For a 150 pound male who is sedimentary, approximately 2100 calories is required to maintain weight (American Cancer Society). While there are exceptions, most people who are overweight eat too much and exercise too little.
I'm a 155 lb male who does weight training 3 times a week with a personal trainer and if I eat more than about 1500 calories a day, I gain weight (mostly as fat).
When I was completely sedentary, anything more than about 1200 calories per day would cause me to gain weight (entirely fat). And this is with an extremely controlled diet of mostly fresh fruits and vegetables over the course of a year.
I wish I could eat 2100 calories per day. That sounds like such a luxury.
The thermic effect of various foods is so wide that you can have a 30% effective calorie swing based on what you eat. Protein for instance requires about 30% of the calories just to digest it. Fat? 3%
So then diet and exercise are a proven effective way for you to control your weight. Except for the fact that you wish you could eat more. But why do you want to eat more? You can't be feeling "like crap" as anonymous suggested or you wouldn't even be able to train. Maybe you just enjoy food and feel it would be nice to enjoy it more often.
I think that's really where most people are at. With varying degrees of consumption capacity. So the question is, do we want to "fix" ourselves so that we can consume more just because we like to eat? I don't really feel like that's a direction we should be trying to go.
You could eat 2100 calories a day without gaining weight if you expended 2100 calories a day on average.
Weight training does not necessarily burn a lot of calories, particularly fat calories. It primarily depletes glycogen reserves, which are quickly replenished in 1-2 meals and a good night's rest.
There is good evidence that people who seem "naturally thin" actually burn a lot more energy throughout the day by moving in small, maybe unconscious ways:
That's not what I want a citation for (but, yes - even that is not a trivial assertion, given that there is a nontrivial part of the population, perhaps even 10% who do not get fat regardless of the amount they eat)
I want a citation that "exercise and diet" are enough to convert a fat person to a thin person. Trivially, that's true - just stop feeding person until they starve and almost die, and then feed a little.
But the non-trivial question is: Given person X who is now fat (possibly a result of binge eating, but possibly a result of disease, some kind of pharmaceutical treatment, etc.) - can exercising and reducing intake alone make them thin, without damaging their psyche, without limiting their intellectual potential and mental well being?
There is NO reason to believe that the answer is a simple "yes". People who claim that the answer is definitely yes should be able to back their claims easily, if this is so trivial.
No, that's totally not what he claims, although that might be what he thinks he argues.
There are enough data points of (thin person, does not exercise or eat properly) and (fat person, exercises and eats "properly") to make that point basically wrong.
Perhaps the problem is with the definition of "properly". But the causation is not total (that is, there are reasons other than food and exercise that cause people to become fat, some known and some unknown), and the population correlation is time reversed to what you would expect (people stop exercising AFTER they gain weight, not BEFORE), to make this not a trivial matter at all.
Huh? There's a whole section about how the average person can go an entire month without eating at all because eating is not even entirely necessary. One guy went over a year with only water and vitamins and lost over 200lbs. And if I recall correctly from previous reading that guy actually kept the weight off for years. Nothing about a life of continuous starvation and suffering.
Holy Grand Poobah! I was just about to go out for lunch.
I don't think you're unique in your aversion to the knife (I know people who have risked serious long-term health issues by avoiding surgery), but maybe not many people are weird enough to prefer the fecal enema.
'"“I’m very excited about this,” he added, saying the next step will be to try using gut bacteria to treat obesity by transplanting feces from thin people.
“I have little doubt that that will be the next thing that happens,” Dr. Fischbach said.
But Dr. Flier said it was far too soon for that.'
I agree. It is far too soon - wait until you've named it something other than 'fecal transplant.' It's a branding issue.
Exciting news, though. I think our society uses shame as a motivator way too much. We judge each other far too easily. Thin people take the fact that they are thin for granted, and then accuse fat people of being lazy.
As someone who gained a bit of weight recently in the past two years inexplicably and suddenly, having been thin before, with no change in diet or exercise, I wonder how much of this is actually in our direct control, and about the quality of the simple answers we give to shame people into exercising or dieting.
I've got a zillion digestive problems running in my family so I'm actually super-excited by the fecal transplant tech. If I can steal your healthy bowel, I don't care if the idea's a little icky.
> wonder how much of this is actually in our direct control, and about the quality of the simple answers we give to shame people into exercising or dieting.
There's a contingent of people who find this attitude morally offensive. They worked hard for their health and are disgusted by those who want an easy way... and also people who didn't work hard to stay thin and are thin anyways like the self-congratulatory notion that they're doing something right.
Every time a new weight-loss tech appears you get people ranting about diet and excersize and the offensive nature of this "shortcut".
I'm reminded how Socrates was offended by the growth of writing because it was somehow morally inferior to memorization.
> There's a contingent of people who find this attitude morally offensive. They worked hard for their health and are disgusted by those who want an easy way... and also people who didn't work hard to stay thin and are thin anyways like the self-congratulatory notion that they're doing something right.
From my own experience, all the people that I know for sure 'worked hard' to achieve their fitness levels, are always the first to be the most understanding about the whole ordeal. Even the strong personality types. The vibe is always along the lines of: "yes, it can be incredibly difficult, and there are many paths to the same destination, but look at me -- it's possible!". I haven't seen many of of these people 'disgusted' at others who want an easier way, if anything they can probably sympathize cause they were probably there themselves at one point.
So that leaves the "didn't work hard" camp, and the "disgusted by an easy way out" bunch... Now, I'm not gonna draw any conclusions cause this is all anecdotal, and perhaps some people don't like to flaunt their successes or use them to inspire others, but it is tempting to make the correlation.
Yep. There will always be people complaining that technology makes us lazy. I think that's a good thing, because if there's no meaningful difference in our health, the time we spent trying to fend off the weight gain we could be spending doing other, less self-involved things thanks to technology.
I'm working hard to lose my extra weight. I run 3 miles every morning before breakfast. I've changed my diet and have been actively trying to eat less. Still, the pounds are coming off extraordinarily slowly. I'm not totally sure I'll ever be the weight I started again.
The Paleo Diet (or something similar) has also worked well for many people in losing weight and just feeling better overall. The culprit seems to be less about calories and exercise than about eliminating carbs, sugar and processed foods.
There is quite a lot of anecdotal evidence to support this, and I can just add that my wife and I started on it nine weeks ago and we have never felt better. I even dropped a few pounds although I didn't really need to. We also supplement with probiotics to ensure that we maintain good levels of healthy bacteria in the gut, which is where much of our immune system functions.
I'm currently doing a Keto diet (very similar to Paleo) and -at least for me- this is definitely the case. I'm addicted to carbs. I cut carbs and I immediately start losing weight and forget about constant hunger. Whenever I eat anything with carbs, my weight loss stalls and I start having cravings again, all the time.
Edit: Oh, and by the way, I've lost 40 lbs since I started :-)
I think one reason the paleo diet works for so many people is that most people are just bad at predicting the caloric content of food. So they think they are taking in about the same amount as before, but actually it has dropped significantly.
As an example: every single sandwich on the menu at Applebees, including the grilled cheese and the veggie burger, has more calories than the 12oz New York strip steak. The BLT has nearly 3x as many calories!
Another reason is that because it has such specific dietary guidelines, it tends to encourage people to prepare their own food rather than eat out. This alone drops more calories than people think, because of how most restaurants prepare food (with a ton of sugar, butter, fat, and oil).
I do agree that it delivers more nutrients than packaged food, which would improve health and make people feel better. It's easier to continue putting up with inconvenience if we feel better.
For those interested in recent research focusing on the interplay between bacteria and our immune systems, I recommend An Epidemic of Absence by Moises Velasquez-Manoff.
Hard to tell at a glance whether this "Hygiene Hypothesis" is legitimate science, or wishful thinking on the part of the journalist who wrote the book. I'm leaning towards being rather sceptical.
Some studies have shown parasites improve the symptoms of certain chronic illnesses, such as Inflammatory Bowel Diseases. Fecal transplantation has also been used to treat chronic digestive ailments. http://en.wikipedia.org/wiki/Fecal_bacteriotherapy
The premise, the logic stands on its own. We coevolve with other organisms and bacteria, not in a vacuum. So wether there is hard evidence for this or that, regardless it’s an interesting field of study right now and many are looking into it. Sometimes before you have evidence, you need a hypothesis.
I didn't say anything about the book, I haven't read it. You questioned whether the hygiene hypothesis was a real hypothesis.
According to my very casual glance at the evidence, it appears to be a hypothesis being actively debated by scientists. I'm not sure what else you might want for a hypothesis to be 'scientifically legitimate'.
" the part of the study that most surprised other experts was an experiment indicating that, with the right diet, it might be possible to change the bacteria in a fat person’s gut so that they promote leanness rather than obesity. "
Right. So back to the same common sense advice. It would seem wise to simply fix your diet first, maybe throw in a little exercise, and then see what happens. That is, before trying things like fecal transplants.
It's more complicated than that. First it's worth quoting the rest of that paragraph:
"The investigators discovered that given a chance, and in the presence of a low-fat diet, bacteria from a lean twin will take over the gut of a mouse that already had bacteria from a fat twin. The fat mouse then loses weight. But the opposite does not happen. No matter what the diet, bacteria from a fat mouse do not take over in a mouse that is thin."
Second, the context (described later in the article) is among co-habitating mice that eat each other's droppings, allowing their gut flora to commingle. When the mice were kept separate, the mice that had received gut flora from a fat human twin ended up 10-15% heavier even on the identical low-fat diet as the mice that received flora from a thin human.
(Aside, because it's personal: I have no trouble controlling my weight through diet and exercise. When I ate poorly and exercised little I was as heavy as 190 lbs. With exercise and being mindful about my diet I have no trouble maintaining 150 lbs. My wife, otoh, has struggled with her weight almost her entire life. To lose weight she has to weigh and track every ounce of food she consumes. It is a constant battle for her. Sadly, I see this dichotomy playing out in our son and daughter. My son will never struggle with his weight; I fear my daughter always may. And we eat well in this house. Real food, mostly plants, not too much.
So yeah, I think some people are thin almost no matter what they eat, some struggle with weight almost no matter what they do, and some are more in between. But a holier than thou attitude about being thin helps no one.)
It is clearly more complicated, but I don't see anything in your response that would indicate that one should not try fixing their diet as a first course of action.
I think js2 agrees diet and exercise is a good first course of action, but is responding to the subtle implication, intended or not, that diet and exercise are sufficient; that no further (more drastic) measures are needed. From his post he clearly agrees diet is the preferred course of action if it works on its own (as it does for him).
I was trying to imply that diet and exercise should be sufficient most of the time, but not always. That's why I said "and then see what happens".
Research is needed and more good research is always welcome but until we know how these things actually work, my bias is toward the simpler, more well understood options.
I think the problem with you being so glib about this is that the "common sense [...] diet and exercise" shtick has been treated as the last word. This pokes a major hole in that orthodoxy. And that orthodoxy is already pretty tattered.
That's important in this context because many people use the orthodox view as a club: if you're fat, then obviously you're a bad person, a lazy glutton who can't be bothered to take some simple actions.
Not only that, it completely overlooks the current obesity epidemic. If it was really such an open-shut case, we probably could've at least contained the problem by now.
If a theory depends on mass laziness and ineptitude from the same ingenious species that brought us all our modern innovations and wisdom, then something's not right. It's disingenuous to suggest that such behaviour should be so natural and prevalent amongst human beings; especially when it has only just exploded in the last few decades...
Why should we have contained the problem? It's not like coca cola and McDonalds are going out of business. The obesity epidemic correlates just fine with the notion that a poor diet leads to obesity. Diets are increasingly poor.
Correlation isn't necessarily causation and a group observation isn't necessarily applicable to individuals.
It frankly pisses me off when people tell me to stop drinking soda and eating fast food to lose the fat I have right now, and that going to the gym will fix it all. I don't drink much soda. I drink 95% water and unsweetened tea I make at home (jasmine or barley tea bag and one pitcher of water) and the other 5% being milk, juices and soda in that order - and this is a habit I've had for over half my life. Fast food and delivery is generally limited to 1x a week, and I may rely heavily on packaged foods (like trader joes frozen stuffs) but it's usually accompanied with a huge salad with only a little vinaigrette as dressing for a total of 1.5-2k calories a day most days. That's if I even eat much because I'm on Adderall _and_ Alli (the OTC version of xenical) quite literally pooping what little fat I'm eating. I have also gone to the gym anywhere from 2 to 7 times a week with workouts of all sorts, and at some point I even had a trainer looking after me for months as I spent 2-3 hours a day every day with him. And I. look. even. fatter. than. ever. even if I might be able to climb 10 flights of stairs without a sweat and I feel healthy - like how I'm on track to hit 100k steps (w/fitbit - 10k is about 5 miles) this week without much effort. The only thing that I can't do is getting out of my chair more often, and that's because I damaged a nerve after doing so a few months ago. For as long as that's lasted that hasn't done anything noticeable either.
A lot of my friends are in the same boat, and we're all sick of the same advice. There has got to be something in the equation that people are missing where fat is concerned. There are definitely people out there that eat junk food that need to stop, but not every overweight person is the same. The current advice being thrown out there and hammered into our heads isn't very helpful.
Since that doesn't work, you should try something different -
Seth Roberts' Shangri-La "diet" seems to work extremely well for about 80% of the people (and not at all for the remaining 20%). I quote "diet" because it involves ADDING 200-400 calories a day to your intake (albeit with some weird specific constraints).
It worked for me for a while, and then stopped. Other things worth trying are atkins style diets, Dave Asprey's BP diet (4500kcal/day, but with extreme attention to details) or even the Tim Ferriss advocated "slow carb" system.
It seems that no diet works for 100% of the people, and those that are not crackpot work for 80% but not more. I guess variance (biome or otherwise) is much larger than assumed - or there's a missing ingredient in diet that is being overlooked.
I think the idea would be that you could fast-track the process, with compounded benefits / amplifying the effects. I've not looked into this much, so not sure if that is a possibility.
This story really doesn't belong on HN, but I digress since it relates to a health issue I've seen a lot of software developers experience,
Making the assumption that the average obese person eat diets largely consisting of processed food (which though is not always high glycemic index is almost always accompanied by something which is), someone who is eating a diet of unprocessed foods should have a greater diversity in their gut bacteria.
One thing I have not seen mentioned is the use of anti-biotic medicine and gut bacteria. I now know of multiple friends who have undergone a regimen of heavy anti-biotic medicine, only to have digestive problems for anywhere from 6 months to well over a year and beyond.
I'm responding just to your first point that the story doesn't belong on HN.
From HN submission guidelines:
On-Topic: Anything that good hackers would find interesting. That includes more than hacking and startups. If you had to reduce it to a sentence, the answer might be: anything that gratifies one's intellectual curiosity.
Am I the one that's weird? Or is it the doctors who see the fecal transplant as a last-ditch effort only after surgery?