Citation Needed - Fecal Microbiota Transplant

Episode Date: May 2, 2018

Fecal microbiota transplant (FMT), also known as a stool transplant,[1] is the process of transplantation of fecal bacteria from a healthy individual into a recipient. FMT involves restoration of the colonic microflora by introducing healthy bacterial flora through infusion of stool, e.g. by colonoscopy, enema, orogastric tube or by mouth in the form of a capsule containing freeze-dried material, obtained from a healthy donor. A limited number of studies have shown it to be an effective treatment for patients suffering from Clostridium difficile infection (CDI), whose effects can range from diarrhea to pseudomembranous colitis   Our theme song was written and performed by Anna Bosnick. If you’d like to support the show on a per episode basis, you can find our Patreon page here.  Be sure to check our website for more details.

It was it was like watching someone else play a video game badly. Oh brutal. It was Steven Spiel. I know disappointing Hey guys, what's up to you? I brought us barbecue. What I want some oh No guy. Oh ribs mine my mine. Oh Cecil Tom bit me. He does that. He does that. Come sit over here. There's plenty. There's plenty Mine dude, you gotta try the gravy. It's like tangy. It is so so good guys. Guys did any of you read On the calendar what my essay is about this week. No, no, I got I was caught up at work So I can't I can't anymore. No, I was caught up at work. I can't, I can't anymore. No. Okay, well, you see, it's about oh my God. I could drink this gravy. This is so good. You know what,

never mind. Yeah, so good. Right. I like the corn. Unexpected. Not unwelcome. Is that a peanut? Hello, and welcome to Citation Needed. The podcast or rejuice the subject, read a single article about it on Wikipedia and pretend where experts. Because this is the internet. That's how it works now. I'm Tom and I'll be the master of ceremonies because I like words to start with master. But unlike all the good uses of those words, I won't be doing this one alone.

Joining me tonight are two men whose collective beard could insulate a Jedi overnight, Cecil and Heath. They actually filmed a dig about training scenes in there. They're just jumping with, ahh, yod on his back. I think they prefer the term Italian-American. He's actually a pattern of behavior. Won't you throw it around anti-italian slurs on cognizance? Take it.

Unbelievable. You're a self-hating broadsray. And also joining us tonight are two men who represent the opposite side of the blood pressure spectrum, and Ela. You know, before I met Ela, I wasn't even aware that such a concept existed as an anger muse. Sorry. No, I know we're recording, but I meant to tell you, I accidentally sleep, bought eight

plane tickets last night back into Cleveland. So now I told you. It's just you and five babies. All right, before we start tonight, I want to thank our patrons. Thank you, patrons. For the money, we need that. And you should give us some. And if you're not a patron, you should be one. Because we need your money. So if you'd like to be one of the patrons that gives us money, as opposed to the deadbeats that don't stick around to the end of the show.

And we'll tell you how, Cecil, what person plays thing concept phenomenon or event? Will we be talking about today? You're not deadbeats, thank you for the download, Jesus Christ. But that's not chase away the four people who listen. Okay. Oh, God.

Today we're going to be discussing fecal microbiota transplants. Okay, is that really swap out your old shit for better shit? Yeah, we do that in post-tom. That's editing. They call that edit. Yeah, I actually, I do that in my personal life.

So you do. You know what? Oh, Chris, You picked this topic. Why did you pick this topic? I had recently seen I was trying to think of an essay topic and then I saw a ready player one. Got me to think about this. Two solid hours of me wishing I could hit the A and B button together and skip

past this part. solid hours of me wishing I could hit the A and B button together and skip past this part when you're fucking play. Okay. And so just to be official, because you don't want to see the amateur versions, what is a fecal microbiota transplant? Okay. Well, speak for yourself on those amateur versions, but Tom, as you've already hinted at, it is a medical procedure that involves swapping the fecal bacteria from a healthy individual into a recipient in an effort to restore healthy bacterial flora.

All right. You said that in a bunch of fancy science sounding words, but that's just like swapping out two people's poo, right? That's the right one. That's what I'm talking about. Well, no, it is, but if you want to charge for that, you need fancy science words. But yes, this whole essay is going to be about taking shit out of one person and then putting it into another. So we're just going to read the Republican talking points essay.

And that's another one. Another one. You can put my name right there. It's like it's Cousassese, so just put it right there. Oh no, whatever you do, don't stop listening to the entertainers. You disagree with terrible people who are temporarily brave enough to expose themselves. Anything that's not right. No, there are a number of ways to do a stool infusion. Wikipedia list, colonoscopy, anima, orogastric tube, or by mouth in the

form of a capsule filled with freeze dried shit. I've been saying this for years, astamouth is healthy. It works, but it's your own love for God. I love it. Is that line working? Not my mouth. I'm not. I'm not.

But it's your own. My crows. Wait, is it? Are you guys eating ash? Is that what we're trying to say? It's your work. No, we are. Sort of going to talk about, well, yeah, we'll get, let's slow down. Who's eating ash?

Like, it's a business. Wait, wait, wait, wait. Do you get to pick a method because like if you do who picks the poop capsule other than Germans, Eli who does pick. You seem to be pretty informed. I just, it seems quicker. I feel like before we dig in a ways to, you know, do the shit swapping, we should focus on the, the why.

That seems like an important question. Why did anybody ever bother coming up with a list of ways to swap people's poop? You know, that's a great question, Tom. And one I've never been asked in a more appropriate context. So it turns out that there are medical reasons for shit swapping. Okay, just real quick, you keep using the word swap. Does the healthy person have to eat the shit from the surface? Like, is it a is it a problem if you're empty? So you have to trade it's like conservation of energy and shit? Do you go first? No, you go first. No, you, okay, it would make me feel free. One, two, ah, you ate the shit. I know see the

so the shit swapping I should be clear is not the medical terminology. That's just a euphemism. I know, see the, so the shit-swapping I should be clear is not the medical terminology. That's just a euphemism I'm using. We're swapping out this shit, but no, that's, I'm glad you asked for that. Clear of a case, okay. So, okay, so a lot of your digestive health and just your health in general,

is determined by your microbiota, the ecosystem of microbes that live inside of you. Some medical conditions are caused or exacerbated by an out-of-wack microbiota, the ecosystem of microbes that live inside of you. Some medical conditions are caused or exacerbated by an out of whack microbiota. And by infusing you with a healthy person's shit, doctors can reintroduce a healthy balance of microbes to your body. Yeah, what sucks is in order to infuse it, you have to steep it in one of those T-Balls. Waiter, I'll have a cup of pool on, please. You can chance.

Kim, Poochah. Okay, I feel like they're overthinking this though with like the eating and drinking like tea and and pills are great. The bulk of you lost diet, but but the job is meant for supositor. It's like that's their destiny, right? I don't know guys. This poop swapping thing can go too far. For example, I know one of you has been swapping

my poop for blood these past few years, and you should stop, honestly, because everyone's like, go to the doctor, and I'm like, no, and they're like, seriously, it's a lot of blood, and I'm like, no. No. This is just, does anybody else just find it ironic

that Noah is doing a health-related episode? Well, if it was about good health, Tom, you know, maybe this is about being so unhealthy. They're shoving poop into you to see if maybe that'll work. That seems like right up my alley. So you want to try eating some shit? Yeah, I'll try. I mean, the only thing he eats this week, it's like they can't get worse is what we're saying.

You might as well. Just, okay. So before we go any further, I want to speak on behalf of the forgotten and undereappreciated microbe. Okay. Thank you. We have a tendency of thinking about microbes and going like, oh, yucky stuff that crawls on my face.

And yes, it is that, but the overwhelming majority of microbes are harmless or helpful. Like Keith. Okay. It's enough with the microbe aggressions. And... I'm not gonna judge it. Ash tag not all microbes.

So... So... But see, my point is that like, you know, you hear this, sometimes people will say, well, you know, it turns out they're on the same number of microbes on the outside of an M and M bag as there are on a toilet seat as though that makes them both equally healthy to lick, right? Go into the candy aisle with Noah got weird, man. Yeah, and chitting with him too. I told you guys, that was a bad idea. Go into the candy aisle. I mean, that was a way.

Who are you supposed to hold hands with? Not you, buddy. You squeeze, he squeezes, you both make eye contact. It's like felman Louise. We do a whole thing. We do a skit. All right, so I wanted to be clear, we do have an anti-microbias, but also I want to be clear that you can swing the pendulum too far the other way. Then you get these probiotic

idiots who think they can cure autism with yogurt. And we're going to talk a little bit more about them later. Don't want to spoil the ending. But if you've ever said, I bet you could get old medicine nuts to eat their own shit. I'm going to move that firmly outside the theoretical before this episode's over. Yeah, sounds about right. Juicing poop yogurt, J.A.D.A.G.s. It's all part of this balanced breakfast. And I only seriously believed in two of those in the last 10 years. So, and you know, your ass muscles got yoked. You're the loser. Yeah, it's the worst thing ever.

Yeah. Anyway, so my point is that microbes aren't bad. Each microbe should be judged on its own merit. And when you do that, you find a lot of good ones. No, the tiny teaky torches are adorable. I love that visual, though. Somebody draw that for us please. All right, so one of the good things about the good microbes is that they take up the space

that could otherwise be filled with the bad ones. Fingers crossed for 2018, guys. And there's another one star of you. Another one. Another one. Oh no, don't stop listening. Please, that's okay. You can listen to this hilarious list of right-wing comedians.

I'm done. The list comedians. I'm done. The list is done. I'm done. I'm doing good. Well done. It is. It is. It is.

It is. It is. It is. It is. It is. It is. It is. It is.

It is. It is. It is. It is. It is. It is. It is. It is. It is. basically a microbe vessel, honestly, like to be clear, the majority of the DNA in your body belongs to microbes, not your actual cells. You're getting a shit swap, a doctor's running an ass tube from your ass to some other dudes ass.

He's that GMO free though. What am I labeling? Oh shit. Gross. So the point being though, your intestines have 10 to the 14th power of microbes in them. Yeah, Avogadro's number two. That's a smart fucking joke. God damn it. That's the smartest of all the poop jokes. I get it. I deal with it. I's just look at all this stuff. And we'll have to pause if I do. Yeah, so I get it.

So I got my point though is that your intestines have like an order of magnitude more cells in microbes that you have in your entire body. Okay, so just to be clear, because I feel like I already got stuff wrong on this episode, 10 to the 14th power, that means you have 10 microbes with the power of a 14 year old, right? Each. No. We'll talk after the episode. We'll just keep.

We'll stay on. Also, without microbes, you couldn't eat or fart and you'd die. So to some extent, you and your microbes are a single thing. Needless to say, swap and bounce out of the good ones out for bad ones. It's going to fuck up all the eating and the farting Hence the need for the occasional microbiota transplant. Okay. All right. So just to be clear here After all that you've justified transferring microbiota, but Why does shit have to be the vehicle for this? Well, it's because it's cheaper than trying to culture a good mix of microbes

Honestly, okay, and this is an actual procedure that real doctors do, just like doctor human centipede is the one that says, no, I'm this, what's the fuck? I mean, legitimate doctors do this stuff. It's also something that dangerously stupid, non-doctor, stew from time to time again, we'll get to that. But yeah, there are genuine medical uses for the fecal microbiota transplant or FMT. For example, it's somewhere between 85 and 90% effective in treating

antibiotic-resistant cases of clostridium-difficial infection or C-Diff. Now, I gotta be honest, I didn't really know what C-Diff was, so I looked it up, and one of the complications it listed for it was toxic mega-colon. So, that's some pretty serious shit. Sounds like some pretty serious shit. It's also the name of my speed metal band. By the way, we're playing this Friday at the Y. There is a two drink minimum, but it's pool water. So please come. Toxic mega colon. I put up a poster. No, toxic mega colon is one of the creatures God's illa thought. He came from deep inside your, your ain your ain't, your, your, your, your, your, your, your mask, your mask, you can figure it out.

Uranus. That would be such a good Godzilla. It's worth noting that as antibiotic resistance, I'm totally going to do a fucking essay on Uranus now. Um, but I should know that as antibiotic resistance becomes more and more of a problem, more doctors are turning to FMT as a first defense against CDIs due to lower costs antibiotic over use and the fact that feeding people's ship pills is always. They got a whiteboard in the back with a scoreboard markup.

Another one. Yeah. What? It's bullshit. She had the flu. Come on, Dave. Can never be too careful. Put it on the flu. Come on, Dave. Okay, never be too careful. Put it on the board.

Championship. Um, no, also FMT has been shown to be effective against idiopathic colitis. There's some promising results that show it could be used to treat ulcerative colitis, although that's still speculative and there are good reasons to think it might not work, but it is legit. Try this poo. Okay, that didn't help, but hey, you still ate poo, so we're gonna go as you wanna win.

I feel like there's at least some amount of that, yeah. Now to my knowledge, those are the only proven uses of FMT medically, but a lot of studies are looking into a bunch of different intestinal problems or problems that have been associated with a whacked out microflour. So from what I've read, it seems that mainstream clinicians are hopeful that FMT

is going to yet be found effective against several other maladies as well. All right, I'm I feel like everybody's wondering. So I'm just going to go ahead and ask, who is the first person to think of this and where did they lock up? Well, a great question, but I did this person's way too useful to lock him up. This guy's amazing, right? It's like, okay, so I was thinking about this. Whatever you eat ends up in your shit, right?

Okay, hear me out. Eat this other guy shit right now. And it works. It would like this guy should be selling Islam in Israel, like best salesman ever. It's the shit whisperer. Well, actually, we don't know who came up with it first. There are records that show FMTB and used as far back as 1700 years ago to treat things like food poisoning

and severe diarrhea. centuries after that, a Chinese doctor named Lee Shin-jen used what he called yellow soup or when selling it to an aristocrat golden syrup to cure patients with persistent diarrhea. Of course, the fact that he was feeding people his own liquefied shit is all you need to know. And I'll why this didn't exactly catch on regardless of how effective it was. Honestly, I'm impressed more than anything else. This is there's literally nothing I could do with my shit to make it into anything you could call yellow soup or golden syrup. Yeah colors do you guys work in with? Yeah, I'll take in order of crab jacks with golden syrup.

Yeah, get in the area. I'll probably eat some poop. Little higher the dog. Last night was weird. Last night was weird. It's like drinking vomit the next day after. I don't think that's the same. I don't want to get sick. All right. Now, unfortunately, this was lost to history for a while, but the healing power of shit was recognized by veterinarians who were using

turds therapeutically as far back as the 17th century. And also apparently the Germans used camel dung to treat bacterial dysentery during World War Two. Just like, hey, Dave, do you remember how sick I fed before? I mean, so what? Hear me out. I heard a burn in a mule. I guess this is the ethnic cousin smoke at a camel. Well, tons, sir. But the treatment didn't really come into the attention

of Western medicine until 1958. When a team of surgeons in Colorado used it to treat four critically ill patients with foment pseudo-membranus colitis, which, that doesn't sound good. It sounds like your asshole just grew over. I'm not sure. I don't think it's bad. But they treated

them with fecal animals and all four of them recovered quickly. Okay. I have questions super curious about this. So first of all, why is it for them? Why were they finding each other? Who are these people like separate incidents or like did the assholes close over together in a related event? It's there's a lot of also does a fecal anima make any sense to you guys like like if a bidet just fired more shit How is that helpful? What does that mean? If you meet these guys at a bar you sit down they have a story So many questions. They need an episode.

So this was in 1958. Unfortunately, back then, doctors were pretty sure they hadn't reached the point of societal trust where they could just say, have you tried to eat and shit yet. So the practice languished in obscurity for another couple of decades. But that's when they started realizing how effective it was against C-Diff. And ever since then, the practice has been slowly gaining acceptance in the wider medical world. All right.

Well, I guess we've talked about the Y, we've talked about the what and we've talked about the when, so before we get to the unfortunate, how we're going to give you a second to finish whatever you're eating while we take a little break for an apropos and nothing. I say, Dr. Lee, ever since you gave me a golden syrup, I've been feeling in tip-top shape. Oh, glad to hear it. That's great. What? Why don't you have an Asian accent, Dr. Lee? Oh, because fuck Eli, that's why. Coward, get out of the scene. You're not in a scene, you get out of the scene. You're not in it.

Sorry about that. Anyway, anyway, Dr. Lee, me and the others from Cambridge just must know you'll see. Oh, well, I don't know. I couldn't possibly reveal. No, Dr. Dr. Lee, you must for the future of medicine would be ever so further by a contributions. Yeah, I just don't think that it's a good idea. And we need willing to compensate you one thousand pounds.

Thousand pounds, huh? That's quite a bit of wanton soup, eh? Okay. Racist. All right, well, I'm going to tell you. Huh? That's, that's quite a bit of wonton soup, eh? Okay, racist. Um, all right, well, I'm gonna tell you, I'm gonna tell you, but definitely money first. Smashing. You're gonna be mad. Maybe sit down.

[♪ OUTRO MUSIC PLAYING [♪ No, that's crazy. Just eat it. It's not crazy. It's a standard medical protocol. No, no, it is not's not crazy. It's a standard medical protocol. It is not. It is. It can help with C-Diff diarrhea, irritable bowel, Crohn's disease. I'm not disputing any of that. Then take your medicine. Tom, hold on. What's going on here, guys? Nothing.

Cecil, just a case of friends friends maybe caring a little too much you wouldn't understand you're right I would he didn't spend all morning on his squatty potty for, we're back. When we last left off, we were all playing along with the idea that eating shit can help your intestinal problems and the hopes that Eli would think we were serious. Or at least, that's what I'm assuming about all this. Keep going, Noah. He's almost there, buddy.

Alright, now I kind of wish that's what we were doing, but no, this is not the April Fool's episode anymore. This is actually all real stuff. Okay, well, jokes on you, I've been eating the shit of other people for years, and it always makes them sick. So, huh, that's awesome. Fun fact, if I could eat a single meal without feeling like I'd been stabbed by Hercules, I would eat the shit right out of your assholes and suck it down with a straw. We go home. That's far too much information. Noah, you were just about to tell us how people go about infusing new shit into unhealthy

people. So let's save heal. I don't think I can do this without too much information, Tom. Just warning you. All right. So the first thing you're going to need obviously is some good shit, right? No point in infusing Eli's gut biota with Cecil's turds, right, so you need a good donor.

No, if you're listening at home, you're thinking about monetizing your own shit, I should say the donor selection process is pretty rigorous. Donors have to be tested for a wide variety of bacterial and parasitic infections if they want their shit to pass mustard. Uh, question. Do you still get cookies after you donate? And if so, where do you get that?

I just really want to see this rigorous selection process for you're, you're saying there's shit applicants and they would have to. Right. Like I'm picturing like a dog show scenario. It's like a British guy in a bow tie. He's walking shit through an obstacle course. He's like checking its teeth and its balls and for heat and steam. And then like a montage of shit trying on outfits.

Right. No, I should pause here to emphasize the incredible success doctors have had at this point in not affecting the recipients with weird diseases. Cause I would think most people see this and they're like, all right, you're intentionally putting shit into me. My only hope is whatever weird disease that gives me kills the old one. But in more than 370 published report, there has yet to be a reported infection of transmission using clinical

FMT. Okay. All right. To be fair though, if you're so sick, you're shoving donated shit up your ass. I'm not convinced you'd be able to identify a new problem. Yeah. You're only feeling a little of that. Press a dry mouth.

That's probably probably unrelated, but maybe it's probably worth noting as well, that the lack of sufficient shit has started to become a problem as the, the procedure increases in popularity. That led researchers from MIT to open, that led researchers from MIT to found open biome, which is basically a shit bank. It provides clinicians with frozen, ready to administer stool samples. And if Heath ever gets a job there, he would starve to death as he would never stop thinking of good puns. Well, now I just want to hang out in the shitting version of the masturbation room. Yeah, I was like, I was throwing bags for shitting. That's the bad. Like, you think they

have shit porn? Like, does it make sense for shitting. That's the bad. Like, you think they have shit porn? Like, a mad guy, does it make sense? Or, I'm guessing a fancy coffee bar. Yeah, for sure, doesn't matter, already applied. Yeah. Someone there is like doing lines of metamusel off a mirror using a tightly rolled up piece of toilet paper. Just like,

yeah. Of course, I'm, use the tube. What, right now obviously, there you go. There you go. Both nostrils, same time. So, if you don't trust the... Nostrils, yeah.

So, if you don't trust the good people at MIT to decide what isn't good enough to go into your ass, you can trust with this particular question, does seem key to success. Yes, it's important. But you can also, apparently, be your own stool donor. Starting in 2009, a few clinics offered their patients a chance to deposit a healthy fecal sample just in case they get C diff in the future. Because eating shit's less gross if it's your own, I guess.

The idea here is that you basically hit the reset button on your microbiome anytime you want. See? This is crazy. I sat in jars as a kid all the time. And mom was like, you have to stop. Go to a doctor. Why is it blood? Blah blah blah. Turned out, I was a medical practitioner. Okay, know it. We all know that sometimes your own shit just won't cut it, but sticking random shit in your ass is a bad idea too. So how do I find out which shit is right for me?

All right, well, step one, you go find a good donor that isn't carrying around any weird diseases, and then you have them shit in a jar or a bag. To be honest, nobody went into any detail on this one and that's surprising to me. Like, shitting into something seems tough. You get used to it. You just quicker than you think. I mean, I'd say shitting, shitting into nothing seems hard. That's like a Zen Kowan. I'm not meditating. Shitting to nothing. I can see the, but more

than something small, but yeah, not a one-ass cheek shitting. So anyway, so the wiki just skipped straight from donor to having the stool specimen. So unfortunately, I have to do the same. Okay. Patreon reward. I will shit in a jar and pass into the end. It's not a problem. I know about this. I actually know how they do this, Noah, that you poop like normal, but a lab tech follows you around with a jewel bag wrapped like a glove around my hand. That's so cold.

Yeah. You like keeps faking them out, just like walking around in a circle, sniffing. No, moving on. Just checking that area. How many times do you have to pee? Geez. You're saying that exact same feeling when we were in Salt Lake City. It was never pee. You just tell people it's pee, so they don't ask questions. Sorry, I had a big soda. Oh, good. Not, I'm dying.

You can't just shove fresh poop up somebody's asking call it a day. Eat life, bear, bear. There. There's again, speak for yourself. Don't tell me. No, I mean legally, some people call them Thursday. There's a, but no, but there's a preparation process, which is half the fun I might add. That's part of the game. Don't skip, don't go skipsies.

So first thing we got to do is we got to measure out our dosage. Apparently, that varies between 200 and 300 grams, depending on the body weight of the recipient. That's about a half a pound of shit. Seems like a lot. Yeah, the thing is measured by weight and not volume, because you'd have to get a spatula and flatten off the top of one and a half cups of shit. You know, just to make sure it's all in there, you know. Right, just scrape the, yeah, I don't wanna use my finger

or whatever, I'm gonna move it. And you can never use that spatula for anything else. That is spatula, it has a one-use thing now. It's a fucking unit to ask her. Okay, but either way, that's somebody's job. Right. He's like, all right, give me a half pound of shit. Thin slice. Before his head. Yeah. Great. You want this free sample? No, it also says fresh shit is best. But in a pinch, I see what you did that use in a pinch.

best, but in a pinch, I see what you did that. You can use in a pinch. It's impossible not to in a set essay like that. Like every time you look, oh, like that's an also a shit, but you can use frozen turns. And then at this point, DeWiggy totally fell me. Okay, under the specimen preparation heading, it spends a few unsighted sentences describing what kind of solutions you can and can't dilute the turds in Somebody's job with a giant rack of shit jars on one side of their desk and like a rack of liquids on the other And they're just like all right orange juice no

Apple juice Yes, but then but then the wiki though it just skips over all the good stuff and says quote, the fecal transplant material is then prepared and administered in a clinical environment to ensure that precautions are taken. And quote, so the other than we just don't fling it around like the monkeys, they have no details here. In their defense, there was no description that was going to sound great, right? They were. So you know, you just like, if you get nugs and you will get nugs, you got to fucking it. You need one of the magic bullets, the original ones, not those rip offs.

You need to see grinder. That's important. But I did consult other sources, even though that kind of fucks up the idea of our show. And I learned that clinicians have the option of either shaking the diluted poop manually or using a blender. Okay. I bet no one drinks someone's lunch smoothie at that lab. I just want to see that lab the day the blender breaks. They're just like, are you fucking me? It's like when the credit card machine stops working at the restaurant.

Yeah, but with manual shit. That's the more that pastel guys, Jesus. Actually, the old time e-credit card machine might work. You can get carbon, you get carbon, you get shanked. Shanked everything. Shunk it. So okay, so one way or the other, you get your shit blended. Then you straight it through a gauze to remove all the particulate matter.

Obviously. The term I actually saw was that you want a multid milk consistency. Okay, we deserve that one star review. That one is okay. I think that multid milk you fold in a bunch of fat, you make a nice buttercream. But butter, butter, butter, the butter is in there. It's at the front. We are going to get so many emails now from the multid milk console.

Yes, this is it. And the big. It's not going to advertise with us. It's a whole thing. The Derrier Council is going to be pissed. Like I say, they just write them so. So, okay. Now that you've got your Multimilk Shake Derrier, you've got to get it into your patient. You've got several orifices to choose from, of course, uh, you can do it via Enema or colonoscopy and forgive me for thinking that's the same method with varying levels of commitment. It's like the photo from the roller coaster. Some people want to see me.

Right. You're never going to believe what was in my ass. Shit. Shadows are it never happened. So, but, um, but of course it can also be administered through a nasogastric or nasodewadendal tube. What? If you were where you'd miss out on the aroma, I don't see a lot of good options here. I'm not.

What would be a good option to you, Tom? I did not having pool from other people in there. Just less of that. Okay. Did you say naso gastric? Yeah. Like nose, tube. Like how the fuck do you land on a shit tube for the nose? Like who was watching the fecal anima or whatever they had before that?

Being like, hold on. We're not exploring face holes enough. Are you sure? Think outside of the box here. So, well, of course, now there is one other face hole that could be used for administration. And I kind of hope the preparation method is different on this one. I couldn't find anything definitive, but FMT can also be administered orally through a capsule full of poop.

Oh my gosh. The worst part is finding a capsule. They can fit 300 grams of poop. Oh my gosh, the worst part is finding a capsule that can fit 300 grams of poop in there. Might as well be a cocaine mule at that point. I'm not in Jesus. Now, up to this point, I'll admit that this whole episode has been decidedly pro-shitting. So in the interest of fairness, I should point out

that there are also a few downsides to consuming human feces. The extent of the microbiomes effect on your overall health isn't known exactly, and wherever there's an open question in medical science, there's some unscrupulous assholes exaggerating the fuck out of it to make money. For example, the microbiome of an overweight person is very different than that of an underweight person or a healthier person that might lead you to believe that an FMT from a thin person could help a fat person lose weight.

Okay, sure. Fine. But the heart of a thin person is different than the heart of an overweight person, right? Which is why I eat skinny people hearts to stay in shifts. Exactly. No. Well, but yeah, but I mean, that assumes the arrow of causality, right? It's also entirely possible that being overweight changes your microbiome.

And that's one of a bazillion examples I could have used because plenty of diseases and disorders result in or are caused by or are exacerbated by an abnormal gut biome. And that means that if you're a quack, you can pretend FMT works for any of them. Okay, well, I think we should also be exploring if thin people can achieve their fatness goals by eating fat versus that. Because, Judgy, I mean, lots of cultures fat is the better one. And I feel like you didn't mention anything like that. No, there's a shocking lack of research going in that direction.

Just a bunch of Hawaiians hanging around the bathrooms at ReasonCon. Fucking jackpot. No. What example I should throw out here? Autism definitely has a microbiome component. Okay, there's actually a lot of research that suggests FMT might be useful in the treatment of the various symptoms of autism. That being said, there's a big gulf between research suggesting something and putting that

into clinical practice. Of course, poop isn't exactly a controlled substance. So a lot of questionable clinics have hung out a shingle and advertised FMT is curing pretty much whatever you've got on you. Uh, if it was illegal, would it be sold on the brown market? What do you mean if you? If you can also, you can imagine the appeal of this kind of thing to alternative medicine It's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, alternative medicine plus they're used to having shit fed to them. So there are natural fit for overstating the promise of FMT. Yeah. And Guineph Poucher doesn't even have to change her website logo that much. She just has to change one letter. She saw this coming. So if the herpes is flaring up, you dip the wasp in the soft feces of a vegan Native American child and carefully sting yourself all along the lady.

That's what I'm saying. Yeah, so if this whole citation needed thing doesn't work out, I think we found Heath's new job. But of course, it's like what's the worst thing you can get Gwyneth Peltr to do to our vagina? That should be a game that we play. Oh, okay. I like that way better than when I was thinking.

I say when you get me out of the way. You're like, no. No, it's not what she has to do it to herself. Oh, okay, way better than when I was thinking I say when you get me know that me like no No, it's not what she has to do it to herself He that's a key that's a question correcting her as off the menu, okay Suggesting to kidnap celebrities on the show so speaking of which This is led to a movement of people who are getting pretty DIY with the shit swapping and This is led to a movement of people who are getting pretty DIY with the shit swapping. And I'm saddened by the fact that I have to live in a world where this needs to be said, but don't do that.

Don't force human feces down the throat of your autistic child without consulting with a physician first place. What if I consult a physician, but I ignore their advice? Or just be talking about something completely different. How would that be out of character for you, Eli? What would change? but I ignore their advice. We're just going to talk about something completely different. How would that be out of character for you, Eli? What would change? No, I should say though, the FDA and other worldwide regulatory bodies are starting to catch up

with this increasing interest in the procedure. In May of 2013, the FDA started regulating shit as a drug, which is the kind of thing that needs a whole essay's worth of context that to sound completely insane. Yeah. Yeah, keystering just got complicated. Like more complicated. Just drug dealers get all confused like, hey, okay, so are we still cutting this with laxative powder? Yeah. Pounder productive. It's just weird.

I don't know, thematically. Well, yeah, as you can imagine, this leads to a lot of really weird regulatory language where the storage of drugs has to carve out like very specific exemptions. But in the FDA's defense, we can't have a completely unregulated shit market. FMT is a remarkably safe procedure when it's done correctly, but you're still shoving poop into people. So the correctly part matters a lot. And I hesitate to ask this, but if you had to summarize what you've learned in one sentence,

what would it be? If Eli eats enough turds, he'll be healthy. I knew it. I knew it. I'm in. And are you ready to face a few questions from our panel? No, but they've been holding them in long enough, I guess. All right, I'm going to go first.

So that brown market is definitely real, which of the following is the best slogan for the fecal drug deal? Is it a welcome to the crack house and truth in the world? Also, is said, uh, B, we accept cash, shit coin and microbe Iota, my for my own, uh, craptocurrency. That was an amazing pun, whatever. Was it see the one plop shop we squat what you need. Needs with a K. Knie. Oh, needing the shit. Manually shaking the shit, like in the restaurant,

with the credit card machine. Or D, 100% laxative free. Nobody likes their shit, step down. Yeah. That's a three way point. Well done. To be honest, I don't know, but I feel like when it comes to shit questions, I can't go wrong by choosing number two. That is correct. Yes. Correct. They say

you know, uh, that a teaspoon of sugar helps the medicine go down, which food is the most popular vehicle for FM tea? A kung pu chicken with extra shiitake. Be a cappuccino with an extra square seat, see dumplings, or D New York style pizza. Boo, boo, boo. I'm here. I'm riding your style pizza, boo. I'm with you guys. Yeah. I'll go with secret answer. E Chicago style pizza. What's that? I'm right because I'm the only one who knows I can't hear you. You're breaking out. The Zencasters break out. No, I can't hear you.

You must have picked. You must have picked B. You're right. B. It's B. Definitely Chicago bedpan pizza. Absolutely. All right. Noah, what are some other innovative ways to use shit other than it's obvious medical benefits? Hey, Adobe style green housing, brown housing, red if you had beats. Yeah, outhousing. Burn it for fuel, 45 miles per gallon after Indian food. Yeah, that's good. Grind it for fuel 45 miles per gallon after Indian food. Yeah, that's good. Grinding

it up for fertilizer. It's preceded with corn. Oh, I don't know, man, I won't watch those videos, even I have my life. All right. So, it's hot. Yeah. All right. All right. I got 33% cheese. I'm going to go with a and hopes that my lifetime commitment to eating Ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha World of Podcasting can be hard to decide who. Who do we know who's healthy enough that I could eat their shit? Is it A? None of the above. That's it. That's it.

Well, you know, the thing is, is I kept writing different answers and Andrew kept crossing them out. So apparently I have to abstain on this one. That's it. All right, host the Nounces winner is Eli. Yeah. Did I?

That's it. Yeah, could I? Host, and I announce Tom as next week's essayist. Don't! Alright, now I'll toss it over to Sarah for last week's Twitter answer and this week's Twitter question. Thanks Tom. Last week's question was, what should be rule number one for dueling while inside a sarong with your opponent? The answer comes from Angry Science Guy on Twitter with this. After the second or third blow, the first party may beg their pardon for ejaculating on

the other party. This is to one higher degree if the person ejaculated upon is a lady in the care of a gentleman. This week's question is, if you were starting an FMT clinic, what would be your slogan? Just retweet our Facebook share this episode with your answer for a chance to be next week's winner. Back to you, Tom. Alright, well, for Cecil, Eli Heath, and Noah, I'm Tom, thank you for hanging out with us today.

We'll be back next week, and by then I'll be an expert on something else. Between now and then, you can hear more from Noah,, Heath and Eli on the Skating Atheist, got off of movies and citation needed. You can hear more from Cecil and me on cognitive dissonance. Neelyne has a blog that nobody cares about. If you'd like to help keep this show going you can make a per episode donation to patreon.com slash citation pod. Or leave us a five star review everywhere you can.

And if you'd like to get in touch with us, check out past episodes, connect with us on social media or check the show notes. Be sure to check out citationpod.com. Everybody go out and have a nice, delicious, no, don't eat ever again. We're all done eating. Yeah, forever. This is our weight loss episode, guys. Well done.

Well done. Jenny Craig would be proud!