Chronic Inflammatory Illnesses Or Autoimmune Diseases?  Why Fmt Is The Most Important, Awesome, And Radical Treatment Option You’ve Never Heard Of!

Tuválkin “Beneficial effects of FMT have been described in case series or small prospective trials on a wide spectrum of conditions, including inflammatory bowel disease, gastrointestinal disorders, hepatitis, hepatic encephalopathy, and neuropsychiatric conditions, and in limiting antibiotic-resistant bacterial infections. Each of these proposed indications for FMT is associated with an underlying dysbiosis of the gastrointestinal microbiota and generally a clinical response is linked with a restoration of the gut microbiota.” From the September issue of Current Infectious Disease Reports (Fecal Microbiota Transplantation: Beyond Clostridium Difficile)

“Though new to the Western medical world, FMT has been described 1,700 years ago by an ancient Chinese researcher of the fourth century named Ge Hong, who first used what he called ‘yellow soup’ to treat his patients with severe diarrhea.”  From Dr. Liji Thomas’ (MD) article on News-Medical dot net, History of Fecal Transplant

“Gut microbiota is known to play a main role in regulating both health and disease in humans. Strategies for the therapeutic modulation of gut microbiota are therefore expected to give a relevant contribution in the management of disorders associated with its impairment. Among these options, one of the most renowned is fecal microbiota transplantation (FMT). Moreover, it was shown to be a promising therapy for the management of several noncommunicable disorders, including inflammatory bowel diseases and metabolic disorders.”  From next month’s issue of the Italian journal, Minerva Gastroenterologica Dietologica (Fecal Microbiota Transplantation: Past, Present and Future Perspectives)

“The microbiota-gut-brain axis (MGBA) regulates the reciprocal interaction between chronic inflammatory bowel and psychiatric disorders. This interaction involves…  antibiotic-induced dysbiosis. Perturbation of microbiota was accompanied by a general inflammatory state and alteration of some endocannabinoidome member in the gut [the endocannibinoidome is the system of neurotransmitters that bind to cannabinoid receptors found in both the central nervous system (including the brain) and peripheral nervous system, and known to regulate cognitive processes, fertility, pregnancy, pre and postnatal development, appetite, pain-sensation, mood, and memory, as well as mediating the pharmacological effects of cannabis]. Behavioral changes, including morphological rearrangements of non-neuronal cells in brain areas controlling emotional behavior were detected.”  From September’s issue of Brain, Behavior and Immunity (Antibiotic-Induced Microbiota Perturbation Causes Gut Endocannabinoidome Changes, Hippocampal Neuroglial Reorganization and Depression in Mice)

“The use of prebiotics as an aid for the development of a healthy gut microbiome is equally as important in maintaining gut homeostasis. Breastmilk, a natural prebiotic source, provides optimal active ingredients for the growth of beneficial microbial species. However, early life disorders such as necrotising enterocolitis, childhood obesity, and even autism have been associated with an altered/disturbed gut microbiome. Subsequently, microbial therapies have been introduced, in addition to suitable prebiotic ingredients, which when administered, may aid in the prevention of a microbial disturbance in the gastrointestinal tract.”  From an Irish study published in last month’s issue of Frontiers in Nutrition (Microbial Therapeutics Designed for Infant Health)

If SDJ and Frank Sinatra were alive today, I doubt they would be singing Me and My Microbiome (the title of today’s post), instead of ME AND MY SHADOW, but would probably find myself trying to talk them into it!  It amazes me how many people contact me via FACEBOOK, blog comments (many of them over at DESTROY CHRONIC PAIN), or by EMAIL, wanting to know what they can do for problem X; yet they’ve never bothered to look at THIS INCREDIBLE POST.  And for those who have looked at said post, it seems that most have not bothered to at least take a moment and scroll through the titles of my numerous articles on FMT (Fecal Microbiota Transplants).  Today I am giving you the straight scoop on poop. If you have CHRONIC PAIN (100 million Americans), CHRONIC INFLAMMATORY DISEASES (probably 90% of you reading this), or any AUTOIMMUNE DISEASES (best guess, half of you or more), then it is imperative that you understand why FMT could not only change your life, it could literally save your life.

Although there are any number of studies showing the benefits of PROBIOTICS for the same problems we will be discussing today, there are many others showing them to be not only ineffective, but actually causing side effects (HERE).  For chronically ill individuals, PROBIOTICS CAN’T COMPETE WITH FMT.  Why not? Feces contains the bacteria that make up most of your MICROBIOME — anywhere from a few hundred, to in some cases, a few thousand strains.  The very best probiotics have maybe 20 strains (most have no more than a handful).  What this means is that just like vitamins (HERE), probiotics are actually capable of causing DYSBIOSIS (abberations in the numbers of bacterial strains or ratios of strains to each other).  And if you have dysbiosis, you can almost assure yourself that you are going to have “THE LEAKIES” as well — leaky brain, leaky cord, leaky lung, leaky gut, etc, etc, etc.  In other words, this is a big reason that FMT is literally light years ahead of probiotics or thinking you can cure hardcore diseases simply by consuming fermented foods (HERE).

Today I am giving you yet another post on why it may behoove at least some of you to start looking into FMT.  FMT has been the medical standard of care for people who come down with C. DIFF infections (these are almost always picked up in a hospital setting by those who have had lots of ANTIBIOTICS — the number one cause of all the various forms of dysbiosis, as well as the treatment-of-choice for said infections).   But let’s forget about C. Diff for a moment.   Peer-review is so loaded with studies on FMT for things other than chronic C. Diff, I am going to go out on a limb and say that for at least half a decade, it’s the single most amazing treatment option out there.  Unfortunately, most of you have either never heard of it, or you’ve brushed it aside because it sounds “gross” (kind of like THIS, but not so funny).   Using the most current research available, allow me to show you why when it comes to FMT, you need to get up to speed.

For those of you who have not been on my site before, just days ago the journal Cell Host and Microbe (The Human Microbiome and Obesity: Moving beyond Associations), stated that “Mounting evidence indicates that the gut microbiome responds to diet, antibiotics, and other external stimuli with speed and high precision and in ways that impact a variety of metabolic conditions.”  The authors concluded with an info-gram showing that altered microbiomes are intimately related to (I am loosely quoting here and adding my own links) antibiotics, GENETICS / EPIGENETICS, EXERCISE, DIET, energy intake [what and how much you eat], ADIPOSE TISSUE, exposure to human touch (or a lack thereof), in-utero environment, social status, HPA-AXIS, AGE, STRESS, BRAIN, IMMUNE SYSTEM, HYGIENE, not to mention both MALE and FEMALE HORMONES.  Oh, inflammation was on the list as well.  Of all these, the buck stops with inflammation.  Figure out how to solve inflammation and at the very least, you have the potential to get better without living life stoned on THE BIG FIVE or something worse.

I’ve already mentioned the relationship between one’s microbiome and one’s level of inflammation — a big deal because inflammation not only always leads to fibrosis, fibrosis in its many forms just happens to be the leading cause of death in the US (HERE).  What can you do about this inflammation?  My grandfather, who was one of the smartest businessmen I ever knew, not only ran a large Kansas farm, but exposed me to some “interesting” home remedies, many of which, looking back on, were geared directly at resolving inflammation (not sure where the sixty year old ceramic jar of home-rendered skunk lard came from, but I can vouch for it’s efficacy in drawing out boils).  When he used to talk about the way his family treated a puncture-wounded foot when he was a kid (think stepping on a nail here), the “cure” was to go walk around in the cattle pen barefooted in order to prevent infection.  In light of the crazy-sounding nature of said treatment, microbiome is the only thing that makes sense.  Let’s look at one of the more “interesting” ways that people are purposefully transferring / receiving microbes.

BRAND NEW RESEARCH ON GUT HEALTH AND FECAL MICROBIOTA TRANSFER

GUT MICROBIOME MADE SIMPLE

DIY FMT MADE RIDICULOUSLY SIMPLE  

DISCLAIMER:  The information presented on this site (including this post), while directly cherry-picked from the most current peer-review available, is just that — cherry-picked information.  It is not intended to diagnose, treat, or cure diseases of any kind (God forbid anyone treats or cures their own diseases).  If you feel you may have a disease that needs diagnosing or treating, please discuss this post with your physician, despite the high probability they will look at you like a space alien who just flew in from Uranus.  WARNING:  Please do not try FMT at home, even though the safety profile for the procedure is on the high side of excellent (HERE).  Repeat; I am not advocating you try this at home, I am giving you some very cool information to pursue if you are really sick.

  • MICROBIOTA, IMMUNE SYSTEM DEVELOPMENT IN INFANTS, AND THE EFFECTS OF VACCINES ON SAID MICROBIOTA:  Listen folks; when you look at the number of children (let alone adults) who suffer with chronic illnesses, you should start to notice a pattern.  Unfortunately, we are screwing up our children’s internal ecosystems from the very moment they are born (HERE is one of the chief ways), which in turn can screw up almost anything you can imagine.  This month’s issue of MMBR published a study called The First Microbial Colonizers of the Human Gut: Composition, Activities, and Health Implications of the Infant Gut Microbiota, in which they discussed the importance of early-infant colonization by good bacteria since babies are born without a microbiome (their first exposure is via mom’s VAGINAL FLORA).  “Microbes colonize the neonatal gut immediately following birth. The establishment and interactive development of this early gut microbiota are believed to be (at least partially) driven and modulated by specific compounds present in human milk. Various studies have linked certain features of the microbiota/microbiome, such as reduced diversity or aberrant composition, to intestinal illnesses in infants or disease states that are manifested at later stages of life, including asthma, inflammatory bowel disease, and metabolic disorders. Thus, a growing number of studies have reported on how the early human gut microbiota composition/development may affect risk factors related to adult health conditions.”  When baby’s Gut is not colonized properly, bad things result not just in their present, but in their future.  Two months ago a study by ten Georgia State University researchers was published in the journal Brain, Behavior and Immunity (The Microbiota Influences Cell Death and Microglial Colonization in the Perinatal Mouse Brain) which revealed that the mammalian fetus develops in a largely sterile environment, and direct exposure to a complex microbiota does not occur until birth.  Our results suggest that direct exposure to the microbiota at birth influences key neurodevelopmental events and does so within hours. These findings may help to explain some of the behavioral and neurochemical alterations previously seen in adult mice.  This early-onset dysbiosis-induced MICROGLIAL ACTIVATION actually killed cells in specific parts of the brain.   The icing on the cake is that just last month, a group of Italian researchers, writing in Frontiers in Medicine, stated that, “Bacteria located in both colostrum and mature milk can stimulate the anti-inflammatory response by stimulating the production of specific cytokines, reducing the risk of developing a broad range of inflammatory diseases and preventing the expression of immune-mediated pathologies, such as asthma and atopic dermatitis.”   So, you’re not BREASTFEEDING for at least the first year of you child’s life?  Better rethink that decision.
  • FMT AND YOUR METABLOME:  Related to the microbiome, the METABOLOME is the sum total of the chemicals your body manufactures to keep you in HOMEOSTASIS — many of which are made by bacteria.  A study from this month’s issue of Mass Spectrometry Reviews (….Targeting the Crosstalk Between Gut Microbiota and Brain in Neurodegenerative Disorders) concluded that, “The emerging development in mass spectrometry technologies has shown promise in the discovery and quantitation of neuroactive small molecule metabolites associated with gut microbiota and brain. Significant progress has been made recently in the characterization of intermediate role of small molecule metabolites linked to neural development and neurodegenerative disorder, showing its potential in understanding the crosstalk between gut microbiota and the host brain.  These metabolic pathways allowed the microbiota to impact the regular function of the brain, which can in turn affect the composition of microbiota via the neurotransmitter substances. The dysfunctional interaction of this crosstalk connects neurodegenerative diseases, including Parkinson’s disease, Alzheimer’s disease and Huntington’s disease.”  For those of us who believe that MEDICATIONS are one of the chief ways people screw up their internal ecology, this study is a must-read, and particularly in light of the fact that I have previously written about FMT research on both ALZHEIMER’S and PARKINSON’S.
  • FMT AND SKIN CONDITIONS:  Although there are hundreds upon hundreds of studies linking everything from PSORIASIS, ACNE, ECZEMA, and many others (all are inflammatory, and many are autoimmune) to abnormal microbiome (dysbiosis), I could not find any ‘current’ studies on using FMT for these.  What I did find, however, were scads of testimonials on various sites from around the world (mostly message boards where commenters were not selling anything) telling how they “cured” (their word, not mine) skin problem X with FMT.  Just for you Mike L out on the East Coast; a study from this month’s issue of Experimental Dermatology (The Akkermansia-Muciniphila is a Gut Microbiota Signature in Psoriasis) discussed this strain of bacteria as associated with the TH-17 CELLULAR APOPTOSIS SYSTEM and psoriasis.
  • FMT AND pH (ACID BLOCKERS / PPI’S):  Speaking of drugs that among their numerous side effects are sure to foul your microbiome, PPI’s (Proton Pump Inhibitors) are one of the worst offenders.  Take a gander at the study in this month’s issue of Cancer Letters (Gastric Microbiota: An Emerging Player in Helicobacter Pylori-Induced Gastric Malignancies).  I’ve already shown you why it’s not only normal physiology, but critically important to have MEGA-STRONG STOMACH ACID (including the fact it keeps nasty critters like H. Pylori away (see link), but this new study goes even further.  “The complex diversity of nonpathogenic microbes that colonize the human body, known as microbiota, exert considerable effects on physiological homeostasis, and immune regulation. Helicobacter pylori (H. pylori) is a bacterium that frequently colonizes human stomach and is a major pathogenic agent for peptic ulcer diseases, gastric cancer, and mucosa-associated lymphoid tissue (MALT) lymphoma. Due to its acidic pH and peristaltic movements, the stomach has been considered a hostile environment for most microorganisms, however various commensal microorganisms are capable of colonizing the stomach. Recent pieces of evidence indicate that commensal gastric microbes or their metabolites influence the capability of H. pylori to colonize the stomach and directly modulate its pathogenicity and carcinogenic potential.”  And guess what decreases stomach acidity, while increasing whole-body acidity —- all while being a known cause of cancer itself?  That’s right folks, sugar and junk carbs (HERE).
  • MORE MICROBIOME AND HPA-AXIS:  One of the hallmarks of the majority of our population who lives in a state of CONSTANT SYMPATHETIC DOMINANCE is an inability to sleep, coupled with a constant fatigue or exhaustion.  Going back to Y-2K (The Sympathetic Nerve — An Integrative Interface Between Two Supersystems: The Brain and the Immune System in the journal Pharmacology Review) we see simply from looking at the study’s title that there is an intimate relationship here.  Bear in mind, however that the authors were not interested so much in manipulating the microbiome as they were in creating drugs.  “Pharmacological manipulation of the sympathetic-immune interface is reviewed with focus on new therapeutic strategies in the treatment of experimental models of autoimmune diseases, fibromyalgia, and chronic fatigue syndrome.” A study from the January 2017 issue of Nature Reviews (The Mucosal Immune System: Master Regulator of Bidirectional Gut–Brain Communications) bears out this relationship by revealing, “The messengers of this complex dialogue include neural, metabolic, endocrine and immune mediators responsive to diverse environmental cues, including nutrients and components of the intestinal microbiota (microbiota–gut–brain axis). We are now starting to understand how perturbation of these systems affects transition between health and disease.”  BTW, this study talks extensively about TREGS……. 
  • YOUR MICROBIOTA CONTROLS AND TRAINS TREGS (T-REGULATORY CELLS):  TREGS are T-Regulatory cells, previously known as T-suppressor cells (they prevent the immune system from running away with itself, which almost always leads to AUTOIMMUNITY).  This month’s issue of the Annals of Nutrition and Metabolism (Gut Microbiota in Health and Disease) concluded that “Intestinal regulatory T (Treg) cells are critical to maintaining immune tolerance to dietary antigens and gut microbiota.”  After discussing a number of things now known about the relationship between Tregs and one’s microbiome, the author goes on to describe several examples, saying that, “This cutting-edge method may lead to the evolution of an altered disease concept.”  Isn’t it interesting that I just wrote an article dealing with this very topic — microbiota as a common denominator in virtually all disease processes (HERE)
  • FMT AND INSULIN RESISTANCE, CARDIOMETABOLIC SYNDROME / PRE-DIABETES:  CARDIOMETABOLIC SYNDROME (aka Metabolic Syndrome, Syndrome X, or Pre-Diabetes) affects well over half our nation’s adult citizens (HERE), not to mention an exploding number of children and teens.  For instance, just two short weeks ago Molecular Metabolism published a study called Host-microbiota Interaction Induces Bi-Phasic Inflammation and Glucose Intolerance in Mice (in other words, the inflammation occurred both early and later).  Last month’s copy of Cell Metabolism (Improvement of Insulin Sensitivity after Lean Donor Feces in Metabolic Syndrome Is Driven by Baseline Intestinal Microbiota Composition) said that, “The intestinal microbiota has been implicated in insulin resistance…. Lean donor FMT in obese metabolic syndrome patients improves insulin sensitivity.  Insulin sensitivity at six weeks after FMT was significantly improved, accompanied by altered microbiota composition. We also observed changes in plasma metabolites [some of the “metabolomic” changes discussed earlier].  The beneficial effects of lean donor FMT on glucose metabolism are associated with changes in intestinal microbiota and plasma metabolites.”  This is why the body composition of your donor is such a big deal — something I will discuss at length later on.  There was also a study on dysbiosis being associated with coronary artery disease (hardening of the arteries otherwise known as arteriosclerosis).  This month’s issue of Beneficial Microbes (The Gut Microbiome Composition is Linked to Carotid Atherosclerosis) revealed that the amount of a bacteria named M. Racemosus, “had the same impact in the model as waist-to-hip ratio, high-density lipoprotein-cholesterol, fasting triglycerides or fasting glucose, suggesting that its relative abundance in the gut may be a relevant biomarker for cardiovascular risk.”  Did you catch that?  A certain bacteria is as good a marker of heart disease as all the stuff you are tested for in the clinic.
  • FMT HELPS RESTORE SEROTONIN PRODUCTION:  Fun Fact — MELATONIN (your sleep hormone) is made from serotonin, and a full 90% of your serotonin is manufactured in your Gut (HERE).  A study from September’s Scientific Reports (Dysbiosis Contributes to Chronic Constipation Development via Regulation of Serotonin Transporter in the Intestine) dealt with the fact that the neurotransmitter serotonin is much more than a chemical that affects only the brain.  “Chronic constipation is a globally prevalent functional gastrointestinal disorder with the prevalence 2–20% and is accompanied with intestinal dysbiosis. Mice which received fecal microbiota from patients with constipation presented a reducing in intestinal peristalsis and abnormal defecation parameters including the frequency of pellet expulsion, fecal weight and fecal water content.”  All this means is that what I showed you in my link on CONSTIPATION is true — the number one factor is dysbiosis.
  • FMT AND OBESITY:  The combination of DIABETES and obesity is not only so common that it is frequently called “Diabesity” in the scientific literature, there are hundreds of studies linking gut bacteria to your weight (it’s at least part of why ANTIBIOTICS MAKE YOU FAT).  In fact, I have covered this many times previously in my NUMEROUS FMT POSTS.  A study on the relationship between inflammation, obesity, and cognitive decline (Inflammation and Gut-Brain Axis Link Obesity to Cognitive dysfunction) was published in this month’s issue of Current Opinions in Pharmacology.  “Obesity prevalence is increasing steadily throughout the world’s population in most countries and in parallel the prevalence of metabolic disorders including cardiovascular diseases and type 2 diabetes is also rising, but less is reported about excessive adiposity relationship with poorer cognitive performance, cognitive decline and dementia. Inflammation may eventually spread from peripheral tissue to the brain, and recent reports suggest that neuro-inflammation is an important causal mechanism in cognitive decline. This inflammatory status could be triggered by changes in the gut microbiota composition.”  Let me give you another; when you think of neuro-inflammation, you had better be thinking of ALUMINUM — something that is found in almost every vaccine and antiperspirant.
  • FMT AND NEUROPSYCHIATRIC PROBLEMS:  Earlier this month, the journal Brain, Behavior, and Immunity (Microbes and Mental Health: A Review) stated that, “There is a growing emphasis on the relationship between the microorganisms inhabiting the gut and human health. The emergence of a microbiota-gut-brain axis to describe the complex networks and relationship between the gastrointestinal microbiota and host reflects the major influence this environment may have in brain health and disorders of the central nervous system (CNS). Bidirectional communication between the microbiota and the CNS occurs through autonomic, neuroendocrine, enteric, and immune system pathways. Perturbations of the gut microbial community have already been implicated in multiple host diseases such as obesity, diabetes, and inflammation, while recent evidence suggests a potential role of the microbiota-gut-brain axis in neuropsychiatric disorders, such as depression and anxiety.”  Another study, this one from Curent Neuropharmacology concluded the same thing — “The microbiota-gut-brain axis might provide novel targets for prevention and treatment of neuropsychiatric disorders” — before discussing FMT.  Believe me when I tell you that both DEPRESSION and ANXIETY are big deals in Western civilization.  Earlier this month and earlier this summer, the journals Neurotherapeutics (Anxiety, Depression, and the Microbiome: A Role for Gut Peptides) and BioPsychiatry (Harnessing Gut Microbes for Mental Health: Getting From Here to There) dealt with gut peptides, concluding that “The conceptual development of the microbiome-gut-brain axis has facilitated understanding of the complex and bidirectional networks between gastrointestinal microbiota and their host, highlighting potential mechanisms through which this environment influences central nervous system physiology. Communication pathways between gut microbiota and the central nervous system could include autonomic, neuroendocrine, enteric, and immune systems, with pathology resulting in disruption to neurotransmitter balance, increases in chronic inflammation, or exacerbated hypothalamic-pituitary-adrenal axis activity.”  I’ve already shown you that experts are doing FMT for these sorts of problems — much more in other countries than in PHARMA-RUN America.
  • MICROBIOME AND MULTIPLE SCLEROSIS:  The relationship between microbiome and MS is nothing new (HERE and HERE).  However, some brand new research has helped shed even more light on this issue.  About three weeks ago, ten Italian researchers publishing in Frontiers in Neurology (Immunological and Clinical Effect of Diet Modulation of the Gut Microbiome in Multiple Sclerosis Patients) concluded that “Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS) characterized by demyelination and mediated by an auto-reactive immune process directed against central neural tissues.  Pathogenesis of autoimmune disorders, including multiple sclerosis (MS), has been linked to an alteration of the resident microbial commensal community and of the interplay between the microbiota and the immune system. Dietary components acting on microbiota composition, could, in principle, result in immune modulation and, thus, could be used to obtain beneficial outcomes for patients.  Evaluation of clinical parameters showed that in the high-vegetable/low-protein diet group the relapse rate during the 12 months follow-up period and the Expanded Disability Status Scale score at the end of the study period were significantly reduced. Diet modulates dysbiosis and improves clinical parameters in MS patients by increasing anti-inflammatory circuits. Because Lachnospiraceae favor Treg differentiation.”  Paleo, Paleo, Paleo folks — Don’t be afraid of either the protein or FAT as long as it’s the right kind of fat.  Another study, this one from this month’s Neurotherapeutics (Intestinal Permeability in Relapsing-Remitting Multiple Sclerosis) dealt with MS and LEAKY GUT saying, “Recently the influence of intestinal permeability on brain function has greatly been appreciated. Previous works showed an increased IP that preceded experimental autoimmune encephalomyelitis development and worsened during disease with disruption of tight junctions. We found that an alteration of intestinal permeability is a relatively frequent event in relapsing-remitting MS.  The results led us to hypothesize that gut may contribute to the development of MS.”  This is not a surprise as virtually every single individual with chronic illnesses is going to have problems with barrier dysfunction — and not just in the gut, but in a wide array of tissues and organs as well (the “leakies” I discussed earlier).
  • FMT AND EPILEPSY:  Once you realize that MANY CASES OF SEIZURE DISORDERS, INCLUDING EPILEPSY are autoimmune, you’ll start to realize why FMT (along with the Ketogenic diet from last link in the previous bullet) might just be the cat’s meow. A study that was published just after our big flood (HERE) in the World Journal of Gastroenterology (Fecal Microbiota Transplantation Cured Epilepsy in a Case with Crohn’s Disease) talked about a young lady with a 17-year history of Crohn’s Disease (stick around — we’ll address Crohn’s in a bit).  Note that this is a case study.  “A 22-year-old girl, with a 17-year history of epilepsy, was referred to the Second Affiliated Hospital of Nanjing Medical University in May 2015 because of unsuccessful CD treatment. The initial presentation was at the age of 6 years, with generalized seizures of loss of consciousness and unexplained chronic diarrhea. The patient had more than 120 seizures every year between the ages of 6 to 13.  FMT showed positive response of more than 20 months seizure-free without using antiepileptic drugs.”  Say this sentence very slowly: They put healthy people’s poop inside of her and “cured” her epilepsy!   If you’ve ever known anyone with seizures, stop and let the magnitude of this wash over you for a moment.  I don’t care who you are, this is cool!
  • MICROBIOTA AND HEAD INJURIES:  What about people who have neurological issues, but they are the result of HEAD INJURIES instead of a “disease process”?  Interestingly enough, head injuries are highly related to the development of autoimmune diseases (HERE).  A study from the January 2018 issue of Nutrition (Head Injury Profoundly Affects Gut Microbiota Homeostasis), concluded that “Head injury induces a hypercatabolic state [your body is breaking itself down faster than it is building itself back up], dysimmunity [autoimmunity], and septic complications that increase morbidity and mortality.”  For the record, bear in mind that many of these infections (sepsis) are autoimmune — HERE is an example.  BTW, it only took four days for the rats used in this study to “profoundly” have their microbiome affected by their head injury.
  • FMT AND THE IMMUNO-COMPROMISED:  The brutal truth is that while some people have a disease process that leads them to be severely immuno-compromised, the most common reason for people whose immune systems are extremely suppressed is the drugs they are given.  This is because IMMUNE SYSTEM SUPPRESSION IS THE SINGLE MOST COMMON MEDICAL THERAPY in the United States!  The April issue of Frontiers in Immunology (Immune Responses to Broad-Spectrum Antibiotic Treatment and Fecal Microbiota Transplantation in Mice) concluded that “Compelling evidence demonstrates the pivotal role of the commensal intestinal microbiota in host physiology and the detrimental effects of its perturbations following antibiotic treatment.  broad-spectrum antibiotic treatment resulted in profound local (small and large intestinal), peripheral (mesenteric lymph nodes), and systemic (splenic) changes in the immune cell repertoire that could, at least in part, be restored upon FMT.”  This study is amazing and free to read in its entirety.
  • FMT AND THE HYGIENE HYPOTHESIS:  One of my favorite topics on GUT HEALTH is the HYGIENE HYPOTHESIS — the idea that in order to properly train a developing immune system (see earlier stuff on Tregs), it must be exposed to some germs — not just COLDS OR FLU, but real childhood diseases like people used to get before vaccination’s went HOG WILD (sounds crazy but stick with me).  Last month’s issue of Cell (Wild Mouse Gut Microbiota Promotes Host Fitness and Improves Disease Resistance) published a study by 14 NIH scientists that basically said that wild mice are different than lab-raised mice because of the amount of germs and diseases (not to mention SOIL AND OTHER ANIMALS) they spend their lives around.  What’s truly amazing is that this “advantage” can be transferred via FMT.  “Among 21 distinct mouse populations worldwide, we identified a closely related wild relative to standard laboratory mouse strains. Its bacterial gut microbiome differed significantly from its laboratory mouse counterpart and was transferred to and maintained in laboratory mice over several generations. Laboratory mice reconstituted with natural microbiota exhibited reduced inflammation and increased survival following influenza virus infection and improved resistance against mutagen / inflammation-induced colorectal tumor genesis.”  Why is this so critical to know?  We have a veritable explosion of ALLERGIES in this country, with no end in sight.  The European authors of the September issue of Nature Immunology (The Immunology of the Allergy Epidemic and the Hygiene Hypothesis) agreed, coming to some interesting conclusions of their own (and none too popular with most US researchers either — at least THOSE WHO VALUE THEIR CAREERS).  “The immunology of the hygiene hypothesis of allergy is complex and involves the loss of cellular and humoral immunoregulatory pathways as a result of the adoption of a Western lifestyle and the disappearance of chronic infectious diseases. The influence of diet and reduced microbiome diversity now forms the foundation of scientific thinking on how the allergy epidemic occurred. We propose that barrier epithelial cells are heavily influenced by [i.e. they are leaky leaky leaky leaky leaky leaky] environmental factors and by microbiome-derived danger signals and metabolites, and thus act as important rheostats for immunoregulation, particularly during early postnatal development. Preventive strategies based on this new knowledge could exploit the diversity of the microbial world and the way humans react to it, and possibly restore old symbiotic relationships that have been lost in recent times, without causing disease or requiring a return to an unhygienic life style.” So, thanks to vaccines, we have traded acute childhood diseases that everyone used to get (and AS HYGIENE IMPROVED, HAD LOW MORTALITY), and traded them for a veritable patchwork of chronic degenerative inflammatory and autoimmune diseases — diseases that don’t kill you outright, but they destroy you nonetheless, body and soul (HERE).
  • FMT AND ASTHMA:  Allergies and ASTHMA go together like beanies and weenies as verified by a study from the August issue of Allergologia et Immunopathologia (Future Prospect of Fecal Microbiota Transplantation as a Potential Therapy in Asthma), which concluded that, “There is convincing evidence from both human and animal studies suggesting that the gut microbiota plays an important role in regulating immune responses associated with the development of asthma. Certain intestinal microbial strains have been demonstrated to suppress or impair immune responsiveness in asthma experimental models, suggesting that specific species among gut commensal microbiota may play either a morbific [makes you sick] or phylactic [keep you from getting sick] role in the progression of asthma. The faecal microbiota transplantation (FMT) is a rather straightforward therapy that manipulates the human gastrointestinal (GI) microbiota, by which a healthy donor microbiota is transferred into an existing but disturbed microbial ecosystem. In this review, we provide several insights into the development of FMT therapy for asthma.”  The fact that between 8 and 10% of our entire population has asthma should not be lost on my readers.
  • FMT AND AUTISM:  As you  already know if you follow my site, I have a ton of info on AUTISM — particularly as it relates to Gut Health (HERE).  New studies continue to back this up, with several studies that I have already dealt with in other capacities this year leading the way (click the links).
  • FMT AND BLOOD & BONE DISORDERS:  When you read this, just remember that bones make blood, and that OSTEOPOROSIS is caused by inflammation.  Now, take a listen to the results of this study from a dozen Polish researchers (Fecal Microbiota Transplantation in Patients With Blood Disorders Inhibits Gut Colonization With Antibiotic-Resistant Bacteria) that was published in August’s Clinical Infectious Diseases.  “Patients with blood disorders colonized with antibiotic-resistant bacteria (ARB) are prone to systemic infections that are difficult to treat. Reintroduction of commensal bacteria can lead to eradication of enterococci.  Twenty-five FMTs were performed in 20 participants (including 40% who had neutropenia) who were colonized by a median of 2  strains of ARB. The primary endpoint [eradication] was reached in 60% of the FMTs and more frequently in cases in which there was no periprocedural use of antibiotics. Among participants 75% experienced complete ARB decolonization. There were no severe adverse events.  FMT in patients with blood disorders is safe and promotes eradication of ARB from the gastrointestinal tract.” Just one month earlier, the journal Calcified Tissue International (Gut Microbiota, Immune System, and Bone) concluded that, “It is well documented that the gut microbiome (GM) can interact with immune cells, dendritic cells [nerves], and hepatocytes [liver], producing molecules such as short-chain fatty acids, indole derivatives, polyamines, and secondary bile acid. The receptors for some of these molecules are expressed on immune cells, and modulate the differentiation of T-effector and T-regulatory cells [Tregs]: this is the reason why dysbiosis is correlated with several autoimmune, metabolic, and neurodegenerative diseases. Due to the close interplay between immune and bone cells, GM has a central role in maintaining bone health and influences bone turnover and density. GM can improve bone health also increasing calcium absorption and modulating the production of gut serotonin, a molecule that interacts with bone cells and has been suggested to act as a bone mass regulator.
  • GUT MICROBIOTA AND MUSCLE WASTING:  Exercise is good, but not all exercise is created equally.  If you go back and look at earlier links, you’ll see why I am such a monster proponent of adding at least a few minutes of strength training to whatever else you happen to enjoy doing (you will lose 10% of your muscle mass per decade after the age of 30 unless you are resistance training).  Last month’s issue of Calcified Tissue International (Gut Microbiota Contribute to Age-Related Changes in Skeletal Muscle Size, Composition, and Function: Biological Basis for a Gut-Muscle Axis) concluded, after revealing just how important lean body mass really is for a variety of purposes, that “Aging is associated with a decrease in muscle mass and function (sarcopenia) that is associated with a loss of independence and reduced quality of life. Gut microbiota, the bacteria, archaea, viruses, and eukaryotic microbes residing in the gastrointestinal tract are emerging as a potential contributor to age-associated muscle decline. Specifically, advancing age is characterized by a dysbiosis of gut microbiota that is associated with increased intestinal permeability, facilitating the passage of endotoxin and other microbial products into the circulation.”  So in some ways, FMT could almost be called a proverbial fountain of youth.
  • FMT AND ARTHRITIS: According to the NIH (Arthritis and Rheumatic Diseases) rheumatic diseases include everything from OSTEOARTHRITIS, POLYMYALGIA RHEUMATICA, TENDINOSIS/TENDINITIS, GOUT, BURSITIS, KNEE PROBLEMS, AUTOIMMUNE DISEASES (click for a list), RHEUMATOID ARTHRITIS, JRA, and a whole host of others.  Now listen to this; the September issue of Clinical Rheumatology (The Role of Gut Microbiota in the Pathogenesis of Rheumatic Diseases) revealed that “Rheumatic diseases refer to many diseases with a loss of immune self-tolerance [autoimmunity], leading to a chronic inflammation, degeneration, or metabolic derangement in multiple organs or tissues.  Over the past decades, emerging studies suggested that alteration of intestinal microbiota, known as gut dysbiosis, contributed to the occurrence or development of a range of rheumatic diseases, including rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, systemic sclerosis, and Sjogren’s syndrome.” The article went on to discuss the potential of microbiota-targeted therapies to prevent or cure rheumatic diseases, one being FMT
  • LIVER DISEASE, INCLUDING HEPATIC ENCEPHALOPATHY:  When the liver cannot DETOX / BIOTRANSFORM, toxins build up in the blood and affect the brain, causing something called hepatic encephalopathy (HE), with symptoms being forgetfulness, sweet-smelling breath (ketoacidosis, not to be confused with ketosis that people on the ketogenic diet work hard to achieve) as well as shaky upper extremities, disorientation, cognitive dysfunction, and slurred speech.  There are studies showing FMT to be beneficial for a wide array of liver problems, but HE is where these people will all end up if not dealt with properly.  The June issue of Hepatology (Fecal Microbiota Transplant from a Rational Stool Donor Improves Hepatic Encephalopathy) revealed that HE is a common reason for hospital readmissions (hospitals get severely docked financially for readmissions that occur within a certain time-frame) and then concluded that, “FMT with antibiotic pretreatment was well tolerated. Cognition improved. Model for End-Stage Liver Disease score transiently worsened post-antibiotics, but reverted to baseline post-FMT. Postantibiotics, beneficial taxa, and microbial diversity reduction occurred with Proteobacteria expansion. However, FMT increased diversity and beneficial taxa.”   A similar study, this one in last month’s issue of the World Journal of Gastroenterology (Fecal Microbiota Transplantation Prevents Hepatic Encephalopathy….) stated something quite similar.  “FMT enables protective effects in HE rats, and it improves the cognitive function and reduces the liver function indexes. FMT may cure HE by altering the intestinal permeability and improving the toll-like receptor (TLR) response of the liver.”  TLR’s are markers that help identify receptors on pathogens, and are handy for marking baddies for the immune system’s search and destroy missions.
  • FMT AND ALOPECIA (HAIR LOSS):  Before you get any wild ideas, understand that alopecia is not the same as male pattern baldness.  Also, the most common reason by far that people get FMT, at least here in America, is for C.Diff infections.  Writing for the September issue of the ACG Case Reports Journal (Hair Growth in Two Alopecia Patients after Fecal Microbiota Transplant) a group of five gastroenterologists saw alopecia cured (hair regrowth) in people being treated for C.Diff.  “Alopecia areata (AA) is an autoimmune, inflammatory condition of the hair follicle. It is classified as patchy, totalis, and universalis, depending on the degree of hair loss.  AA is one of the most common autoimmune disorders, affecting about 4.5 million people in the United States. Onset typically occurs in younger patients, with 66% presenting before age 30 and only 20% presenting after age 40. It is thought to be a T-cell-mediated autoimmune disease that attacks the hair follicle.  Notable improvement in AA was observed after FMT was performed for recurrent C. Diff infection.”  It is no longer uncommon to find instances of people having FMT for C. Diff and getting cured of something else (kind of like THIS).
  • FMT AND CANCER: I’ve got plenty of cool stuff on CANCER on my site, much of it (including OTTO WARBURG’S WORK) having at least in some way to do with the microbiome.  This relationship is also why ANTIBIOTICS ARE A KNOWN CAUSE OF CANCER.  How much does Gut inflammation caused by dysbiosis affect cancer?  That question was answered in the August issue of Seminars in Immunology (Microbiome, Inflammation and Colorectal Cancer), when the authors concluded that, “Chronic inflammation is linked to the development of multiple cancers, including those of the colon. Inflammation in the gut induces carcinogenic mutagenesis and promotes colorectal cancer initiation. Additionally, myeloid and lymphoid cells infiltrate established tumors and propagate so called “tumor-elicited inflammation”, which in turn favors cancer development by supporting the survival and proliferation of cancer cells. In addition to the interaction between cancer cells and tumor infiltrating immune cells, the gut also hosts trillions of bacteria and other microbes, whose roles in colorectal inflammation and cancer have only been appreciated in the past decade or so.”  Research that was published just a few short weeks ago in Science (Gut Microbiome Influences Efficacy of PD-1-Based Immunotherapy Against Epithelial Tumors) by a team of almost fifty researchers and physicians showed that when dysbiotic rats with cancer that were resistant to certain types of tumor-blocking medications were given FMT from rats that were not resistant, the medication (chemo) started working.  To sum it all up, August’s copy of Carcinogenesis (Microbiota in Digestive Cancers: Our New Partner?) concluded that, “There is much evidence about the gut microbiota’s contribution to carcinogenesis, involving proinflammatory and immunosuppressive signals. At the same time, it seems increasingly clear that commensal microbes can modulate cancer therapy efficacy and safety, in particular innovating treatments as immune checkpoint inhibitors.”  This is just one of the many reasons that it should be criminal for doctors — especially CANCER DOCTORS — not to be educating their patients about the importance of Otto Warburg’s work, and the importance of DIET IN GENERAL.
  • PRE & POST-FMT ANTIBIOTICS, AND WHICH METHOD OF FMT IS BEST:  There are many ways that different physicians and facilities do FMT.  There is the colonic route (putting it in through your rear end), the nasogastric route (a tube is run through your nose down into the top of the bowel), and the pill route (feces is freeze dried, capsulized, and taken orally).  Everything I have seen to date points to the colonic route as not only being the best, but probably the safest as well — more so than the nasogastric route.  August’s issue of the Journal of Hospital Infections (Comparative Effectiveness of Fecal Microbiota Transplant by Route of Administration) agreed by stating, “Overall, nasogastric delivery of FMT was less effective than lower endoscopic delivery. When patients were stratified by illness severity, nasogastric delivery achieved similar cure rates in healthier individuals, whereas lower endoscopic delivery was preferred for relatively ill individuals. Nasogastric delivery may be less effective than lower endoscopic delivery.”  Some doctors will want to clear out the dysbiosis prior to the FMT.  While one could probably achieve this with COLONIC IRRIGATION, researchers writing in the June issue of Frontiers in Microbiology (Preparing the Gut with Antibiotics Enhances Gut Microbiota Reprogramming Efficiency by Promoting Xenomicrobiota Colonization) concluded just what we see in the title — “These results suggest that FMT relied on the available niches in the intestinal mucosa and that preparing the gut with antibiotics facilitated xenomicrobiota colonization in the intestinal mucosa.”  I am always leery of antibiotics, but clearing out BIOFILMS can at times prove exceedingly difficult without resorting to this class of drugs.  Case in point of being leery of antibiotics, the August issue of Clinical Infectious Diseases (Early Antibiotic Use Post-Fecal Microbiota Transplantation Increases the Risk of Treatment Failure) also made some conclusions as seen in the study’s title — “Antibiotic use within the first 8 weeks post fecal microbiota transplantation (FMT) may disrupt microbial engraftment and limit FMT effectiveness.”  This, folks, is why I strongly recommend you do whatever needed to KEEP YOUR FAMILY OFF ANTIBIOTICS (fortunately, MY KIDS have never had to take them).
  • ETHICAL ISSUES; WHO MAKES THE BEST DONOR?  Yes, there are some big ethical issues here, the first being whether you should have the FMT done via COLONOSCOPY.  The second being what should the donor look like (this is absolutely critical and I cover it for you HERE).  Be aware that one of the things that the labs that do FMT are starting to do is pool donor feces.

INFLAMMATORY BOWEL DISEASE & FMT

Bruse Blaus “IBD is a group of chronic disorders characterized by relapsing inflammation of the gastrointestinal (GI) tract. The most common entities are Crohn’s Disease (CD) and Ulcerative Colitis (UC). While CD is characterized by a segmental transmural inflammation and granulomatous lesions of the whole GI tract, inflammation in UC is mostly restricted to the colon and the rectum. Both incidence and prevalence of IBD are currently increasing worldwide.  The mucosal immune system and the microbiota in the intestinal tract have recently been shown to play a key role in the pathogenesis of inflammatory bowel disease (IBD).  Finally, we address the current evidence of how this interaction (i.e., immune system–microbiota) can be modulated by food components, pre/probiotics, and fecal microbiota transplantation (FMT) and how these approaches can support intestinal homeostasis.”   From this month’s issue of Seminars in Immunopathology (Recipe for IBD…)

“We performed a systematic review and meta-analysis assessing the effectiveness and safety of FMT in IBD (Inflammatory Bowel Disease) through January 2017, with clinical remission established as the primary outcome.  53 studies were included. Overall, 36% of UC, 50.5% of CD, and 21.5% of pouchitis patients [due to colostomy, they have an artificial, surgically created rectum] achieved clinical remission. Sub-analyses suggest remission in UC improved with increased number of FMT infusions and lower gastrointestinal tract administration [as opposed to nasogastric infusions]. Most adverse events were transient gastrointestinal complaints [gas, bloating, discomfort, etc].”  From the October issue of Crohn’s & Colitis (Fecal Microbiota Transplantation for Inflammatory Bowel Disease: A Systematic Review and Meta-analysis)

“Inflammatory bowel diseases (IBD) represent a growing public health concern due to increasing incidence worldwide. The current notion on the pathogenesis of IBD is that genetically susceptible individuals develop intolerance to dysregulated gut microflora (dysbiosis) and chronic inflammation develops as a result of environmental triggers. Among the environmental factors associated with IBD, diet plays an important role in modulating the gut microbiome, influencing epigenetic changes, and, therefore, could be applied as a therapeutic tool to improve the disease course.”  From the September issue of Nutrients (Diet, Gut Microbiome and Epigenetics: Emerging Links with Inflammatory Bowel Diseases and Prospects for Management and Prevention).  The authors talked about the FODMAP diet here.

“Ultra-processed foods are ready-to-heat and ready-to-eat products created to replace traditional homemade meals and dishes due to convenience and accessibility. They could impact the prevalence of autoimmune diseases such as type 1 diabetes and celiac disease. Ultra-processed foodstuffs can induce gut dysbiosis, promoting a pro-inflammatory response and consequently, a “leaky gut”, associated with increased risk of autoimmunity. In addition, food emulsifiers, commonly used in ultra-processed products could modify the gut microbiota and intestinal permeability, which could increase the risk of autoimmunity. In contrast, unprocessed and minimally processed food-based diets have shown the capacity to promote gut microbiota eubiosis, anti-inflammatory response, and epithelial integrity.”  From this month’s issue of Foods (Old Fashioned vs. Ultra-Processed-Based Current Diets: Possible Implication in the Increased Susceptibility to Type 1 Diabetes and Celiac Disease in Childhood)

  • CROHN’S DISEASE AND FMT:  Back in July (PRIME TIME FOR THE CURRENT RIVER) the journal Scientific Reports (Multiple Fresh Fecal Microbiota Transplants Induces and Maintains Clinical Remission in Crohn’s Disease Complicated with Inflammatory Mass) concluded, “Crohn’s disease (CD) is characterized by a transmural inflammatory process, which may lead to the formation of intraabdominal inflammatory masses or abscess.  Twenty-five patients were diagnosed with CD and related inflammatory mass by CT or MRI. All patients received the initial FMT followed by repeated FMTs every 3 months. The primary endpoint was clinical response (improvement and remission) and sustained clinical remission at 12 months. 68.0% and 52.0% of patients achieved clinical response and clinical remission at 3 months post the initial FMT.  This pragmatic study suggested that sequential fresh FMTs might be a promising, safe and effective therapy to induce and maintain clinical remission in CD with intraabdominal inflammatory mass.”  BTW, almost 3 of 4 people studied improved their mass with FMT.
  • FMT AND ULCERATIVE COLITIS:  An August systematic review  and meta-analysis of 18 studies was published in the journal Alimentary Pharmacology & Therapeutics (Fecal Microbiota Transplantation for the Induction of Remission for Active Ulcerative Colitis).  “Despite variation in processes, FMT appears to be effective for induction of remission in UC, with no major short-term safety signals.  Clinical remission was achieved in 39 of 140 patients in the donor FMT groups compared with 13 of 137 in the placebo groups. Clinical response was achieved in 49% donor FMT patients compared to 28% of placebo patients.”  The July issue of Free Radical Biology & Medicine (Fecal Microbiota Transplantation Could Reverse the Severity of Experimental Necrotizing Enterocolitis Via Oxidative Stress Modulation) showed even better results for a form of IC known as NEC or Necrotizing Enterocolitis.  Right behind Respiratory Distress Syndrome (RDS), NEC is the next leading cause of morbidity in preemies (it causes the bowel to die due to lack of OXYGEN).  “Fecal microbiota transplantation (FMT) has been used successfully to treat a variety of gastroenterological diseases. FMT eliminated ROS (Reactive Oxygen Species) production and promoted Nitrous Oxide production in experimental NEC mice. FMT decreased the extent of  proinflammatory signalin in the intestinal mucosa tissue, and suppressed intestinal apoptosis [pre-programmed cellular death] and bacterial translocation across the intestinal barrier [Leaky Gut Syndrome], which was accompanied by decreased inflammatory cytokine levels [less inflammation], altered bacterial microbiota, and regulated lymphocyte proportions. FMT is effective in a mouse model of NEC through the modulation of oxidative stress and reduced colon inflammation.”  Super cool, but a similar study on children with UC was published in last month’s issue of the Journal of Pediatric Gastroenterology and Nutrition (Fecal Microbial Transplant In Children With Ulcerative Colitis) revealing that, “Remission or a 20-point improvement of PUCAI scores were seen in 60% of children receiving FMT versus 28% receiving placebo. More importantly, children receiving FMT did not require escalation of therapy in contrast to 71% receiving placebo. No serious adverse events related to FMT. Bloating and fever were adverse events that were considered related to FMT.”  Notice the “transient” side effects that most people get with FMT.
  • IRRITABLE BOWEL SYNDROME:  Irritable Bowel Syndrome is an Autoimmune Disease that is caused by inflammation, but is not “officially” part of the IBD family of diseases.  We do know that there is a huge connection between SIBO (Small Intestinal Bacterial Overgrowth) and IBS (HERE), that tends to respond like gangbusters to cutting FODMAPS out of the diet.  Back in June the World Journal of Gastroenterology asked a question via a study title, Can Fecal Microbiota Transplantation Cure Irritable Bowel Syndrome?  “IBS is the most prevalent functional GI disorder in developed countries. It is estimated that IBS affects 10%-15% of the adult population and strongly impairs quality of life, work productivity, and social function as well as inflicting substantial costs to health care systems.  Accumulating evidence indicates that the gut microbiota plays a significant role, and alterations in gut microbiota among IBS patients have been described frequently. IBS symptoms are characterized by chronic abdominal pain and altered bowel habits, including diarrhea and/or constipation, in the absence of organic or structural causes.  In the final analysis, treatment of 48 patients was evaluated. Treatment revealed an improvement in 58% of cases.”  Last month’s issue of Lancet Gastroenterology and Hepatology (Fecal Microbiota Transplantation Versus Placebo for Moderate-to-Severe Irritable Bowel Syndrome) concluded almost the same thing, with about 65% of the treatment group getting the results they were looking for.  “FMT induced significant symptom relief in patients with IBS.  No serious adverse events could be attributed to FMT.

Again, let me reiterate.  If you are chronically ill or overweight, as are the vast majority of American adults (as well as a huge percentage of our nation’s children), at least start researching what it is going to take for you to restore your Gut Health so that you can start the process of truly regaining your life.  Fortunately for you, I have lots of information on this topic completely free on my site (see below).

Share on facebook
Facebook
Share on twitter
Twitter
Share on linkedin
LinkedIn
Share on pinterest
Pinterest
Share on reddit
Reddit

Leave a Reply

Your email address will not be published. Required fields are marked *