It has been 6 months since my 10-day FMT treatment ended and I am in good health, despite having significantly reduced my medication. I was at a crossroads with my UC: to impede my immune system with expensive drugs that have serious side-effects, or battle what was causing my immune system to react. I obviously chose the latter. So far, so good!
In this post I will outline the protocol I followed. This is not to say that anyone should do exactly this, or even anything like it, only that this is what I did. There's nothing to say that some of this, much of this, all of this was unnecessary and I'd be feeling this well if I had done less or none of this. The purpose is to say what seems to have worked for me (so far), and so allowing correlations to be drawn from others who report what they did, and what their results were. The formal studies are slow and often have poor design, so anecdotes may provide hints in the mean time.
Age 56, diagnosed with UC 14 years ago and have been on various 5-ASA's since. No serious flare-ups until 18 months ago, when the 5-ASA became ineffective. For 6 months I tried steroid formulations. Budesonide (Uceris) reduced symptoms but flare returned when stopped. Same with hydrocort enema. Neither were long-term solutions, and during the 6 months of using those (on and off), I had flare symptoms of blood, mucus, diarrhea, urgency, many evacuations per day. That's the worst I've felt in my life with the roller coaster of symptoms and steroid side-effects. The 6 months following the use of the steroids I used the maximum dose of 5-ASA of 4.8g mesalamine (generic Lialda) in addition to about 1.3mg mesalamine in 20ml solution rectally. This kept symptoms under better control, but still had occasional symptoms. So going into the FMT, I was fairly healthy, but on the largest dose of 5-ASA and being careful about my diet. The fecal calprotectin test showed low inflammation at this time.
Throughout the one month run-up to the FMT procedure, I kept my diet about the same as usual, but on the conservative side by eating fewer different things. I tried to keeping things that worked for me and tried to reduce or eliminate things that did not work for me. This is difficult for me, since rarely does a food cause an immediate reaction, but rather multiple instances over weeks of some foods might cause problems.
28 days before the FMT was scheduled, I began taking osmotic laxative pills with a target of bristol#5. This was continued up to the start of the FMT treatment.
11 days before the FMT treatment, I began a antibiotic regimen (under the supervision of a doctor who was on-board with the FMT idea) that lasted 9 days: Vancomycin Hcl 1g/day, Metronidazole 750mg/day, Doxycycline Mono 100mg/day, Amoxicillin 1.5g/day.
7 days before the FMT treatment, I had a colon irrigation (colonic lavage)
http://www.crohnsforum.com/showpost.php?p=845588&postcount=322, and 4 days before the FMT treatment I did colonoscopy cleanse (
http://www.crohnsforum.com/showpost.php?p=844368&postcount=312). Between this cleanse and the FMT procedure, I ate normally, but on the light side (no large heavy meals).
Immediately before the first FMT infusion, I had another colonic lavage, then for 10 days I had human fecal probiotic from multiple healthy and screened donors introduced rectally (60ml centrifuged cells only, prepared in an anaerobic environment). During this time I stopped, then eased back into a low dose of the osmotic laxative in order to maintain a bristol#4/5. During the span of time of the FMT treatments, I ate slightly "worse" than my normal diet, since I didn't have a kitchen at the time. By worse, I mean more refined carbohydrates and fewer veggies. Also during the span of the FMT and every day up to today, I have been consuming a pre-biotic daily
http://www.crohnsforum.com/wiki/Prebiotics. During the span of the FMT, I maintained my dose of 5-ASA (4.8g mesalamine in addition to about 1.3mg mesalamine in 20ml solution rectally). During, and immediately after the FMT, fecal calprotectin and CRP tests showed very low inflammation.
Five weeks post FMT, I cut the dose of mesalamine in half, down to 2.4g. Nine weeks post FMT, I eliminated the rectal mesalamine. These changes did not seem to change symptoms at all, which, generally were one evacuation per day at bristol#4. None of the former notable UC symptoms were present.
My diet, post FMT has changed, somewhat. 1) I have reduced intake of foods containing gluten. Going completely gluten-free was advised, but I have not had the drive to do so. I have had the Cyrex 3 panel, which indicated I was certainly sensitive to 3 of the 24 things tested, so when convenient, I might go completely gluten-free for a couple of months, note how I feel, and then slam some gluten and see how I feel. 2) As I said before, I have added daily a pre-biotic (GOS). 3) I have started eating more organic raw and live foods. Examples of a live foods are sauerkraut and kombucha, both of which I make myself (but you can get both at health food stores). 4) Before and after FMT, most of my carbohydrate calories came from veggies, so very few refined carbs (except in my weekly trip to the craft beer establishment). So a large part of my diet has been and is fat and protein. The change is that now I'm eating more raw veggies than before (less Atkins-like and more along the lines of paleo).
