WEBVTT - Ep 87 C. diff: Fighting poop with poop 0:00:03.600 --> 0:00:09.080 Hi, I'm Laney. So in August of twenty nineteen, I 0:00:09.160 --> 0:00:14.360 started having wild bowel movements. That's about the only way 0:00:14.400 --> 0:00:17.239 that I can put it. I have celiac. I have 0:00:17.360 --> 0:00:23.200 irritable bowel. And these stools were nothing like I had 0:00:23.200 --> 0:00:27.720 ever encountered before. They were coming every hour to half 0:00:27.720 --> 0:00:32.320 an hour. Seemed like I couldn't be more than ten 0:00:32.360 --> 0:00:36.120 feet from my bathroom at any given time. I went 0:00:36.479 --> 0:00:41.000 to our little local first daid station kind of at 0:00:41.000 --> 0:00:44.240 my husband's job, and they had medical staff, and I said, look, 0:00:44.320 --> 0:00:49.519 something's not right, it's not okay. I intentionally withheld the 0:00:49.520 --> 0:00:51.839 fact that I had celiac disease, knowing that a lot 0:00:51.840 --> 0:00:54.400 of doctors actually like to just hang their hat on 0:00:54.440 --> 0:00:59.920 any GI symptom. And at the very end she had 0:01:00.040 --> 0:01:03.720 had gone through everything was gonna just basically say, if 0:01:03.760 --> 0:01:06.600 it's still not okay in a couple of days, come back. 0:01:07.280 --> 0:01:10.560 And somehow the word got out that I had celiac disease. 0:01:10.720 --> 0:01:13.600 And she said, oh, you must have just had gluten, 0:01:13.680 --> 0:01:17.080 that's all. And even though I was sure, she said, 0:01:17.760 --> 0:01:22.240 have some bananas, drink lots of water. Your stool should 0:01:22.240 --> 0:01:25.160 firm up and everything will be fine, and all I 0:01:25.160 --> 0:01:27.400 really wanted to do was go to my normal GP, 0:01:27.920 --> 0:01:30.880 but in rural Iowa, he was over an hour away 0:01:31.720 --> 0:01:35.759 and I could not make that trip to save my life. 0:01:36.080 --> 0:01:38.680 No bathrooms on the way, no gas stations. It would 0:01:38.680 --> 0:01:43.960 have been like me in a cornfield, So not an option. Finally, 0:01:44.080 --> 0:01:46.720 when I was having what I would consider a good day, 0:01:47.319 --> 0:01:49.840 I called my doctor and I said, I'm on my way, 0:01:50.200 --> 0:01:55.000 I need to come see you, and he submitted a 0:01:55.040 --> 0:01:59.640 test for SEDIFF. Sure enough, I came back positive. From there, 0:01:59.760 --> 0:02:04.320 we went through basically the standard first steps and I 0:02:04.360 --> 0:02:08.240 was put on a course of metronitisolar flagile. I saw 0:02:08.280 --> 0:02:12.800 a little improvement, but once the course of antibiotics was finished, 0:02:13.280 --> 0:02:16.040 it was all right back. So then he called in 0:02:16.520 --> 0:02:21.720 oral Vancomyasin. Thankfully that cleared it up. After the fact, 0:02:22.240 --> 0:02:24.600 we were trying to do a little research on how 0:02:25.040 --> 0:02:30.320 I acquired my seat of infection, and it wasn't until 0:02:30.360 --> 0:02:34.440 it was a long thought, afterthought that I had a 0:02:34.440 --> 0:02:37.960 bug bite before that and it had gotten infected and 0:02:38.000 --> 0:02:41.560 they had put me on superflexis in about two months prior. 0:02:42.480 --> 0:02:48.079 Fast forwarding to March of twenty twenty one, I am 0:02:48.120 --> 0:02:51.160 a vet tech and it was my third week on 0:02:51.200 --> 0:02:54.160 the job, we were still doing curbside because of COVID. 0:02:54.639 --> 0:02:56.519 I went out to go get a dog to bring 0:02:56.560 --> 0:03:01.320 it into the hospital. Somehow the dogs muscle slipped off 0:03:01.520 --> 0:03:04.400 when the owner was placing its lead on it, lunched 0:03:04.440 --> 0:03:09.800 at me, tackled me into a snow bank, and I 0:03:09.840 --> 0:03:13.720 had puncture wounds in my arm and had to go 0:03:13.880 --> 0:03:17.760 seek medical attention, where they put me on clintamyasin and zyperflexisin. 0:03:18.680 --> 0:03:21.880 I mentioned to urgent care, I have a history of cediff. 0:03:22.560 --> 0:03:24.880 Please help me. That's not what we should be doing. 0:03:25.160 --> 0:03:29.519 And instead of her directions for having a yogurt every day, 0:03:29.560 --> 0:03:32.320 she suggested a take to have two yogurts every day. 0:03:33.200 --> 0:03:38.720 That was a little insulting, to say the least. A 0:03:38.720 --> 0:03:42.960 few days later, my armhead absessed. I went to my 0:03:43.400 --> 0:03:48.240 current doctor's emergency room. I went in and they said, 0:03:48.280 --> 0:03:51.040 we need to admit you to the hospital. They started 0:03:51.040 --> 0:03:56.680 me on ivy vankamyasin, ivy metronitisol and ivy is trianam, 0:03:56.720 --> 0:04:00.120 which is a pretty kind of novel antibiotic that they 0:04:00.120 --> 0:04:05.120 only use in real serious cases. From there, my bite 0:04:05.120 --> 0:04:09.360 moom cleaned up. I was messaging my doctor like every day, 0:04:09.560 --> 0:04:11.560 at least a couple times a day, freaking out about 0:04:11.560 --> 0:04:14.080 having sea diiff again, sure that I was probably going 0:04:14.160 --> 0:04:17.120 to have it again, and he agreed that I was 0:04:17.160 --> 0:04:21.760 probably going to have seediff again from all of these antibiotics. Finally, 0:04:21.800 --> 0:04:24.320 when I was discharged from the hospital three days later, 0:04:25.000 --> 0:04:29.120 they don't have an oral version of as tree and am, 0:04:29.279 --> 0:04:33.159 so they put me on leva floxis, in another broad 0:04:33.200 --> 0:04:38.240 spectrum antibiotic. My heart kind of sank, knowing what the 0:04:38.279 --> 0:04:41.680 future held. It was about ten days after I was 0:04:41.680 --> 0:04:44.799 home from the hospital, had gone back to work, those 0:04:45.480 --> 0:04:48.400 urgent loose tools that when you feel it you need 0:04:48.440 --> 0:04:50.880 to sprint to the bathroom, but don't spread too fast. 0:04:52.400 --> 0:04:56.039 And I called my doctor and I said, look, I 0:04:56.080 --> 0:04:58.719 think I've got sea diiff. He ordered the test. I 0:04:58.760 --> 0:05:02.560 came down and I positive for SEEDFF. So they started 0:05:02.600 --> 0:05:08.320 me on oral vank commiasin right away, and finally, after 0:05:09.120 --> 0:05:13.040 it was a month on the bank commosin and doing 0:05:13.080 --> 0:05:16.760 a taper, things were starting to kind of finally feel normal. 0:05:17.440 --> 0:05:20.960 I finished my antibiotics and it wasn't three days later 0:05:21.040 --> 0:05:24.200 before I was at work and I realized, in the 0:05:24.279 --> 0:05:25.880 last hour and a half I've gone to the bathroom 0:05:25.920 --> 0:05:29.039 three times. I messaged my doctor while I was at work. 0:05:29.520 --> 0:05:33.000 I said, I need another test. I don't think it's gone, 0:05:33.480 --> 0:05:36.919 And sure enough I went over our lunch break, I 0:05:36.920 --> 0:05:40.520 took a longer lunch than we normally have and went 0:05:40.560 --> 0:05:43.240 down and by the time we were done. That night 0:05:43.279 --> 0:05:47.200 at work, I had my results that I had seediff again. 0:05:47.320 --> 0:05:51.520 I had a recurren seed if infection. That meant my 0:05:51.640 --> 0:05:55.039 doctor was calling infectious disease specialists and I spoke to 0:05:55.080 --> 0:06:00.200 infectious disease specialists and they referred me immediately to you 0:06:00.720 --> 0:06:04.480 a research trial for fecal transplant. They didn't even want 0:06:04.480 --> 0:06:07.119 to see me and they just sent me straight there. 0:06:07.600 --> 0:06:09.600 Then I get the phone call and I tell them 0:06:09.600 --> 0:06:13.359 my story. They said, you absolutely qualify for a fecal 0:06:13.400 --> 0:06:19.240 transplant with your recurrent infection. Will schedule you for. It 0:06:19.320 --> 0:06:22.279 was June thirtieth. It was my transplant date, and I 0:06:22.440 --> 0:06:26.520 had it circled and like starred on a calendar, but 0:06:26.600 --> 0:06:29.840 it was still a month out. So it was exhilarating 0:06:29.880 --> 0:06:32.760 but also a nerving knowing that I had to deal 0:06:32.800 --> 0:06:38.560 with this infection. So we started another Vincimizon taper. I 0:06:38.680 --> 0:06:42.840 stayed on the dose that basically kept my stools solid. 0:06:43.360 --> 0:06:47.520 From there, I waited until my transplant date. My transplant 0:06:48.200 --> 0:06:51.840 was colon ascapy guided, so they did a colonoscopy and 0:06:51.880 --> 0:06:56.800 then they came in and applied the fecal transplant matter. 0:06:57.279 --> 0:07:00.240 I remember wheeling it in to the colon ass could 0:07:00.240 --> 0:07:04.440 be room and seeing a jar with brown liquid in it, 0:07:04.800 --> 0:07:09.440 and I took a selfie with it. I was so excited. 0:07:09.720 --> 0:07:13.560 I screamed, that's my poop, that's my new poop, and 0:07:14.600 --> 0:07:18.840 the doctors laughed at me. I was just so excited. Thankfully, 0:07:19.880 --> 0:07:24.080 post transplant, things are going well. I have post infectious 0:07:24.120 --> 0:07:27.480 irritable bewel, probably on top of normal irritable bell, but 0:07:27.520 --> 0:07:31.840 they're still calling it post infection. So day to day 0:07:31.880 --> 0:07:36.520 life things are going pretty well. However, every time I 0:07:36.720 --> 0:07:39.240 feel like a little gas bubble or I get a 0:07:39.240 --> 0:07:42.600 funny little cramp, my heart sinks and I'm worried that 0:07:42.680 --> 0:07:45.960 the seed off his back because the doctors did notify 0:07:46.000 --> 0:07:49.640 me that my infection was relatively severe and that I 0:07:49.760 --> 0:07:52.600 might have to kind of get what they call little 0:07:52.640 --> 0:07:56.680 tune ups as far as just additional fecal transplants in 0:07:56.720 --> 0:07:59.679 the future, and so every time I get a funny 0:07:59.680 --> 0:08:04.640 little feeling I'm instantly worried, and my doctor even associates 0:08:04.640 --> 0:08:07.040 that with a little bit of PTSD. Honestly, from the 0:08:07.040 --> 0:08:10.320 whole event, it's interesting to think that I have more 0:08:10.880 --> 0:08:15.600 trauma from the medical fallout from my dog bite than 0:08:15.600 --> 0:08:19.680 the actual dog bite itself. Seed Iff has really stuck 0:08:19.720 --> 0:08:23.400 with me for anyone who's comparing it, because my mom 0:08:23.480 --> 0:08:26.000 was trying to put a label on it. She was saying, 0:08:26.400 --> 0:08:29.200 it can't be worse than kolonoscopy prep. It can't be 0:08:29.240 --> 0:08:33.800 worse than kolonoscopy prep. And I can officially say, after 0:08:33.880 --> 0:08:37.000 doing both that seed Iff is much worse. 0:09:23.600 --> 0:09:24.040 Wow. 0:09:24.080 --> 0:09:27.080 Thank you so much, Laney for taking the time to 0:09:27.080 --> 0:09:29.160 share your story with us. That's intense. 0:09:29.679 --> 0:09:31.040 Yeah, wow, thank you. 0:09:32.840 --> 0:09:33.040 Hi. 0:09:33.520 --> 0:09:37.160 I'm Erin Welsh and I'm Erin Alman Updike and this 0:09:37.400 --> 0:09:39.400 is this podcast will kill you. 0:09:39.520 --> 0:09:40.880 Welcome everyone. 0:09:42.240 --> 0:09:44.120 We're excited about this episode. 0:09:44.480 --> 0:09:49.560 As we are about all our episodes. It's genuine excitement. 0:09:50.040 --> 0:09:50.880 It always is. 0:09:51.559 --> 0:09:58.040 Today we're talking about Claustridium difficile a ka se diff Seediff. 0:09:58.040 --> 0:09:59.800 That's how I'm going to talk about it for the 0:10:00.240 --> 0:10:04.880 of the episode. But we're not talking just about this 0:10:05.080 --> 0:10:12.120 problematic pathogen. We're also talking about one of my favorite 0:10:12.480 --> 0:10:14.400 solutions to infection. 0:10:15.000 --> 0:10:18.480 Yeah, one of my favorite solutions to a problem. 0:10:19.040 --> 0:10:22.000 Yeah, yeah, I simply love it. And of course we 0:10:22.080 --> 0:10:26.680 are talking about fecal microbiota transplantation. 0:10:26.240 --> 0:10:30.720 Aka fecal transplant. We have talked about this like, we've 0:10:30.840 --> 0:10:35.800 dabbled in it and several other episodes and been like ooh, someday, ooh, someday, 0:10:35.880 --> 0:10:36.480 that day. 0:10:36.360 --> 0:10:37.680 Is finally here everyone. 0:10:38.360 --> 0:10:40.600 Yes, this is not going to be like a full 0:10:40.679 --> 0:10:43.200 takedown of the microbiome and all the impact that it 0:10:43.280 --> 0:10:48.240 has on different conditions or whatever in this associations, but 0:10:48.520 --> 0:10:50.559 we are going to do somewhat of a deep dive 0:10:50.800 --> 0:10:56.760 into fecal transplants or fmts, and we are very excited 0:10:56.800 --> 0:11:00.240 to bring on a special guest, an expert guest, to 0:11:00.400 --> 0:11:03.240 help us out with that. But that's jumping way ahead 0:11:03.280 --> 0:11:03.880 of ourselves. 0:11:04.000 --> 0:11:06.680 It is because first, it's quarantine. 0:11:06.679 --> 0:11:10.640 Any time, it is what are we drinking this week? 0:11:11.200 --> 0:11:14.560 This week we're drinking the slurry? 0:11:15.200 --> 0:11:21.760 This We're sorry is that when everyone wants to drink? Okay, 0:11:21.800 --> 0:11:24.400 So the thing is, it was either make a gross 0:11:24.480 --> 0:11:28.400 recipe or a gross name and not both and so 0:11:28.720 --> 0:11:31.240 one or the other had to happen. But yeah, exactly, 0:11:31.400 --> 0:11:37.400 I mean, like we are but human. So what is 0:11:37.440 --> 0:11:39.080 in the slurry? This? 0:11:40.480 --> 0:11:48.079 The slurry contains mango, pineapple, lime, tamarind, and tequila, all 0:11:48.120 --> 0:11:51.880 delicious things. And of course you gotta blend it up. 0:11:52.200 --> 0:11:55.480 You got to. You gotta blend it up. But it 0:11:55.559 --> 0:11:58.120 tastes good, right, and it's like yeah, so. 0:11:58.320 --> 0:12:01.000 I mean, it's like very fruity. It's a lot of flavors. 0:12:01.480 --> 0:12:02.560 We promise it's worth it. 0:12:03.360 --> 0:12:07.040 Yeah, yeah, And we will post the full recipe for 0:12:07.320 --> 0:12:11.040 this slurry quarantine as well as the non alcoholic place 0:12:11.040 --> 0:12:13.920 sy Burrita on our website this podcast will Kill You 0:12:13.960 --> 0:12:16.160 dot com, as well as on all of our social 0:12:16.240 --> 0:12:17.040 media channels. 0:12:17.280 --> 0:12:22.199 Yes, we will, Aaron, What other business should we tell 0:12:22.240 --> 0:12:22.960 everyone about? 0:12:23.960 --> 0:12:28.080 Well, how about our website? Okay, it's my turn to 0:12:28.080 --> 0:12:30.319 do the rundown of things on there. I'm nervous. 0:12:30.760 --> 0:12:32.000 You can do it. I believe in you. 0:12:32.679 --> 0:12:37.320 Okay, here we go. We have all of our references 0:12:37.360 --> 0:12:40.480 to all of our episodes on each episode page. We 0:12:40.679 --> 0:12:44.079 have transcripts. We have links to our bookshop dot org 0:12:44.120 --> 0:12:47.160 affiliate page, and our good Raids list. We have links 0:12:47.200 --> 0:12:51.960 to music Bloodmobile now on Spotify. We have links to 0:12:52.000 --> 0:12:56.559 our merch which we have very incredible merch. 0:12:56.679 --> 0:12:57.600 Please check it out. 0:12:58.920 --> 0:13:01.480 And we have a pro code page. I mean, I 0:13:01.520 --> 0:13:04.360 think that's that's got to be most of the things 0:13:04.400 --> 0:13:04.760 on there. 0:13:04.840 --> 0:13:07.520 It's most of the things. Definitely check it out. This 0:13:07.600 --> 0:13:11.320 podcast will kill You dot com. So does that mean 0:13:11.520 --> 0:13:14.480 we're ready to talk about C DIFF? 0:13:14.880 --> 0:13:15.120 Yeah? 0:13:15.120 --> 0:13:17.800 I think I think so. Thanks also to everyone who 0:13:18.040 --> 0:13:21.880 has requested this over the years. Yeah, and we hope 0:13:21.920 --> 0:13:22.760 you liked the episode. 0:13:22.880 --> 0:13:26.400 Yeah, so let's get right into it after this break. 0:13:52.320 --> 0:13:52.400 So. 0:13:52.600 --> 0:13:57.040 I don't know if anyone but me would notice this, 0:13:57.600 --> 0:14:00.040 but I think it's funny. I'm going to start this 0:14:00.080 --> 0:14:05.600 episode almost identically to Anthrax. I think, oh our Anthrax episode. 0:14:06.720 --> 0:14:08.760 I don't remember this, so this is good. 0:14:08.760 --> 0:14:12.520 It's fine, nobody will. But as I was typing it, 0:14:12.559 --> 0:14:14.880 I was like, this sounds familiar. And then I opened 0:14:14.880 --> 0:14:19.160 my Anthrax notes and I was like, ah, okay. Claustridium 0:14:19.400 --> 0:14:27.240 difficile infection is caused by an anaerobic gram positive rod 0:14:27.440 --> 0:14:32.800 shaped spore forming toxin producing bacterium. 0:14:32.880 --> 0:14:33.800 Yeah. 0:14:33.800 --> 0:14:37.960 Hold on, okay, a quick question already already? 0:14:37.760 --> 0:14:40.640 What then is that? Also? 0:14:40.720 --> 0:14:44.200 How you started the botulism episode. 0:14:44.440 --> 0:14:48.760 Ooh, probably, yeah, probably, Okay, I genuinely forgot that we 0:14:48.800 --> 0:14:50.040 ever did botulism erin. 0:14:50.120 --> 0:14:51.080 It was a long time ago. 0:14:51.680 --> 0:14:53.720 I loved that. I loved that it was. 0:14:53.640 --> 0:14:55.160 A good episode. I forgot. 0:14:55.400 --> 0:14:57.880 It'll also be probably the way that I start tetanus 0:14:58.040 --> 0:15:01.400 whenever we do that, so, you know, So for the 0:15:01.440 --> 0:15:04.040 remainder of this episode, like we said, I'm probably just 0:15:04.080 --> 0:15:07.280 gonna refer to this as sea diff because it's easier 0:15:07.320 --> 0:15:11.280 and shorter, and that's how I'm we're gonna say it. So, 0:15:11.640 --> 0:15:17.200 sea diff causes an infection that most of the time, 0:15:17.560 --> 0:15:21.920 very commonly is what's called a nosocomial infection, which means 0:15:22.040 --> 0:15:27.440 hospital or healthcare acquired. So the way that I've tried 0:15:27.520 --> 0:15:32.360 to organize this biology section is to first focus on 0:15:32.480 --> 0:15:37.320 the disease that Clusterdium difficiale can cause, how it's transmitted, 0:15:37.400 --> 0:15:40.120 how it makes us sick, and then take kind of 0:15:40.160 --> 0:15:42.760 a bigger picture view and talk a little bit about 0:15:42.760 --> 0:15:45.680 the microbiome as it relates to sea diff infection. 0:15:46.320 --> 0:15:48.640 Because as a spoiler. 0:15:48.600 --> 0:15:52.320 That Aaron, I know, you probably already know, and many 0:15:52.400 --> 0:15:58.760 listeners may know, but se diff doesn't always or necessarily 0:15:59.520 --> 0:16:00.520 cause infection. 0:16:01.520 --> 0:16:04.360 Yeah, it's it's like, uh, it's got to be one 0:16:04.400 --> 0:16:10.280 of our first besides MRSA maybe like opportunistic super opportunistic pathogens. 0:16:10.480 --> 0:16:13.560 Yeah, we haven't covered a lot of opportunistic pathogens on here. 0:16:13.720 --> 0:16:17.520 This is definitely one of them, but we'll get there eventually. 0:16:18.400 --> 0:16:22.120 First of all, transmission of sea diff at like the 0:16:22.120 --> 0:16:25.760 most basic level. The way that anyone in the world 0:16:25.800 --> 0:16:27.920 gets exposed to sea diff in the first place is 0:16:28.080 --> 0:16:32.800 fecal oral so poop in mouth. It's a common mode 0:16:32.800 --> 0:16:38.120 of transmission, especially for GI bacteria, and sea diff, like 0:16:38.160 --> 0:16:41.880 I mentioned, is a spore forming bacterium like our friend 0:16:42.000 --> 0:16:49.440 Bascillas anthrasis and Clusterdium tetani and also Botulinum and clusterdrium bochculainum. Anyways, 0:16:50.000 --> 0:16:54.560 see diff is also an anaerobic bacterium. Like a lot 0:16:54.640 --> 0:16:59.560 of our gut bacteria are either entirely or facultatively anaerobic, 0:17:00.000 --> 0:17:03.200 which means that they survive without oxygen. So what happens 0:17:03.240 --> 0:17:06.359 in the case of seedff is that on contact with oxygen, 0:17:06.600 --> 0:17:10.960 like when we poop out this bacterium, it forms spores, 0:17:11.480 --> 0:17:16.919 and these spores are very highly environmentally resistant inactive forms 0:17:16.960 --> 0:17:21.240 of this bacteria. They really can't easily be killed by 0:17:21.240 --> 0:17:25.560 heat or cold or alcohol, and they can persist in 0:17:25.640 --> 0:17:30.119 the environment, not dying or desiccating, just hanging out until 0:17:30.160 --> 0:17:34.680 they're ingested by another human or animal, because animals can 0:17:34.720 --> 0:17:35.640 also get infected. 0:17:36.119 --> 0:17:38.120 And then once we ingest them. 0:17:38.160 --> 0:17:42.000 These spores can easily survive the acidic environment of our stomach, 0:17:42.440 --> 0:17:47.440 travel through our guts, and then these spores are activated 0:17:47.560 --> 0:17:50.320 in our small or large intestine when they come into 0:17:50.359 --> 0:17:52.600 contact with our bile acids. 0:17:53.240 --> 0:17:55.360 Hmm, isn't that fascinating? 0:17:56.320 --> 0:17:58.840 Yeah, okay, I have a question about how long these 0:17:58.880 --> 0:17:59.879 spores can last. 0:18:00.080 --> 0:18:01.080 Oh, good question. 0:18:01.400 --> 0:18:03.800 I don't have an exact timeline, but definitely on the 0:18:03.880 --> 0:18:06.679 order of months, possibly years, depending on the conditions. 0:18:07.040 --> 0:18:11.720 I really hate that about these things. Yeah, it's very 0:18:11.800 --> 0:18:15.119 It makes it very scary and like it feels a 0:18:15.119 --> 0:18:17.480 bit challenging. 0:18:17.880 --> 0:18:19.800 Oh, very very challenging. 0:18:21.080 --> 0:18:21.480 Huh. 0:18:21.480 --> 0:18:24.720 Okay, So the bile acids, like, what about them? 0:18:25.240 --> 0:18:25.440 Yeah? 0:18:25.480 --> 0:18:27.360 What is bile acid I'm. 0:18:27.200 --> 0:18:28.560 So glad that you asked, Arin. 0:18:28.760 --> 0:18:34.400 Let me tell you so. Bile acids are basically cholesterol derivatives. 0:18:34.520 --> 0:18:40.360 Our liver makes bile and secretes it into our gallbladder 0:18:40.400 --> 0:18:44.040 where it's like stored, and then whenever you eat something, 0:18:44.119 --> 0:18:47.200 it sends signals to our gall butter to contract squeeze 0:18:47.240 --> 0:18:50.640 out the bile and that goes into our small intestine. 0:18:50.720 --> 0:18:54.800 And these bile acids help support digestion, especially the digestion 0:18:54.960 --> 0:18:56.720 and eventual absorption. 0:18:56.400 --> 0:18:58.800 Of fats huh okay. 0:18:58.960 --> 0:19:02.720 And it's a little bit more complicated. There's like multiple 0:19:02.800 --> 0:19:05.920 kinds of bile acids, and they're converted in our small 0:19:05.920 --> 0:19:09.959 intestine from like primary into secondary. And it seems like 0:19:10.320 --> 0:19:13.560 when sea diff spores come into contact with some types 0:19:13.600 --> 0:19:17.320 of these bio acids, especially in higher concentrations, that's when 0:19:17.359 --> 0:19:22.880 they very easily reactivate into a live, replicatable, mobile sea 0:19:22.920 --> 0:19:28.440 diff bacteria, which can then replicate and replicate and kind 0:19:28.480 --> 0:19:34.880 of beat out other bacteria in our guts and eventually 0:19:34.880 --> 0:19:35.560 cause infection. 0:19:36.560 --> 0:19:43.360 Are there other bacteria that are activated or inactivated by 0:19:43.600 --> 0:19:46.480 biole like do the bile acids kill a lot of 0:19:46.520 --> 0:19:50.879 potentially food born bacteria or are other food born bacteria 0:19:51.560 --> 0:19:53.400 resistant to bio acids. 0:19:53.560 --> 0:19:56.679 That's a good question I don't fully know the answer to, 0:19:57.680 --> 0:19:59.320 but I'm going to put a pin in it because 0:19:59.359 --> 0:20:01.720 I want to kind of get back to bio acids 0:20:01.760 --> 0:20:09.040 in a minute, okay, as it relates to our gut microbiome. Okay, 0:20:09.359 --> 0:20:13.640 So now the spores are activated, sea diff is replicating, 0:20:14.080 --> 0:20:17.680 and then somehow this leads to disease. 0:20:18.800 --> 0:20:21.360 How you may ask Aaron if you wanted to. 0:20:22.600 --> 0:20:26.840 I do okay, good, okay. Some species of sea diff. 0:20:27.359 --> 0:20:31.600 Not only do they form these spores in adverse conditions, 0:20:31.640 --> 0:20:35.479 but they also have the ability to produce toxins. And 0:20:35.520 --> 0:20:40.480 it turns out that it's these toxins, not the bacteria themselves, 0:20:40.800 --> 0:20:46.120 that are capable of causing infection aka sea diff colitis. 0:20:46.800 --> 0:20:52.960 So let's talk about what that actually looks like. Predominantly, 0:20:53.800 --> 0:20:57.679 se diff the toxogenic strains, the strains that produce toxins 0:20:58.280 --> 0:21:03.159 produce two major talks, very creatively named toxin A and 0:21:03.200 --> 0:21:07.840 toxin B. Keeps it easy, and essentially, what these two 0:21:07.960 --> 0:21:13.080 toxins do is they work together to ultimately disrupt the 0:21:13.280 --> 0:21:18.280 membranes of the cells that line your gut, and this 0:21:18.440 --> 0:21:22.240 results in little micro ulcerations of our gut wall, little 0:21:22.280 --> 0:21:26.720 little holes. It also disrupts the junction between cells which 0:21:26.720 --> 0:21:29.359 are supposed to be you know, a nice tight line 0:21:29.400 --> 0:21:33.720 of cells lining our gut. Basically, these toxins get in 0:21:33.760 --> 0:21:38.040 there and kind of shred the lining between them, leaving holes, 0:21:38.640 --> 0:21:43.240 which increases permeability, and that is what leads to watery, 0:21:43.600 --> 0:21:50.560 massive amounts of diarrhea. These toxins also then induce apoptosis 0:21:50.840 --> 0:21:54.200 and kill the cells that line our gut wall because 0:21:54.200 --> 0:21:57.000 of all of this disruption, and that leads to a 0:21:57.040 --> 0:22:00.320 lot of inflammation that can cause the formation of what 0:22:00.359 --> 0:22:04.840 are called pseudo membranes, which sounds gross and it looks gross. 0:22:05.600 --> 0:22:06.600 It's essentially just. 0:22:06.680 --> 0:22:11.040 Hordes of these dead cells mixed with bacteria and white 0:22:11.080 --> 0:22:15.159 blood cells and inflammatory gunk, and it forms this kind 0:22:15.200 --> 0:22:18.959 of membrane that then lines your gut, which even further 0:22:19.720 --> 0:22:24.080 prevents your colon from doing its job right of absorbing water, 0:22:24.320 --> 0:22:28.080 et cetera, which then leads to even more diarrhea. 0:22:28.720 --> 0:22:32.800 Okay, so I'm assuming that the benefit that seaediff gets 0:22:33.040 --> 0:22:36.520 from these toxins is that it can sort of wipe 0:22:36.520 --> 0:22:40.400 out the competition and even further and colonize as much 0:22:40.400 --> 0:22:42.760 as it wants to your intestines. 0:22:43.680 --> 0:22:44.800 Yeah, that's a good question. 0:22:45.840 --> 0:22:49.679 Maybe probably, I would guess, though, I mean, certainly it 0:22:49.720 --> 0:22:52.720 makes it hard for anything else to exist. Where these 0:22:52.720 --> 0:22:54.240 pseudo membranes exist. 0:22:54.600 --> 0:22:58.200 Okay, so it might not be necessarily helping with the colonization, 0:22:58.280 --> 0:23:00.600 but it helps clear the competition. 0:23:01.520 --> 0:23:04.639 Yeah, it's interesting because sea diiff is actually not a 0:23:04.760 --> 0:23:08.920 very good competitor to begin with, right, whether whether it's 0:23:08.960 --> 0:23:14.520 toxogenic or non toxogenic. So maybe these toxins are helping 0:23:14.520 --> 0:23:16.800 a little bit and making it a little bit more competitive. 0:23:17.240 --> 0:23:18.240 But I don't know for sure. 0:23:19.240 --> 0:23:24.320 Okay, toxins are costly to make m H, so you 0:23:24.320 --> 0:23:28.080 would think there'd be some sort of benefit from well toxins. 0:23:28.160 --> 0:23:29.960 I mean kind of like we've talked about in a 0:23:29.960 --> 0:23:34.800 lot of our bacterial pathogens that cause diarrhea. People who 0:23:35.040 --> 0:23:38.600 are having massive watery diarrhea because of sea diiff are 0:23:38.600 --> 0:23:44.760 spreading billions of spores, and spores, yeah, are very environmentally hardy, 0:23:44.880 --> 0:23:48.640 and so perhaps that's the major advantage, is that you're 0:23:48.680 --> 0:23:53.000 able to spread. Okay, I don't know if it's that satisfying, 0:23:53.080 --> 0:24:02.680 but but that's kind of the main and result. There's 0:24:02.720 --> 0:24:05.320 a lot more detail on these toxins. They're very interesting. 0:24:05.480 --> 0:24:09.200 There's also another toxin that is present in some strains 0:24:09.200 --> 0:24:15.359 that seems to when its present cause even more severe disease. Uh, 0:24:15.960 --> 0:24:18.240 But I'm not going to get into all of the 0:24:18.480 --> 0:24:22.800 specific biochemistry of it, because there's a lot more that 0:24:22.840 --> 0:24:26.199 I want to talk about with zetiff. But the end 0:24:26.320 --> 0:24:30.240 result of these toxins and the disruption that they cause 0:24:30.280 --> 0:24:32.840 in the lining of our colon, the death that they 0:24:32.920 --> 0:24:35.280 cause of the cells that line our colon, and all 0:24:35.359 --> 0:24:39.720 of this inflammation is what really causes the symptoms that 0:24:39.760 --> 0:24:40.320 we see. 0:24:40.880 --> 0:24:45.240 Is it only the toxogenic strains that cause disease? 0:24:45.480 --> 0:24:45.840 Okay? 0:24:45.920 --> 0:24:48.359 Yeah, And there are a lot of studies looking at 0:24:48.760 --> 0:24:51.200 do you have to have both of these toxins because 0:24:51.240 --> 0:24:53.640 it's toxin A and toxin B or could you have 0:24:53.800 --> 0:24:57.280 just one of these toxins. There's still some question as 0:24:57.359 --> 0:25:00.920 to that. It seems like in some models or in 0:25:00.960 --> 0:25:05.600 some clinical studies, they've seen that strains that only produce 0:25:05.640 --> 0:25:10.199 toxin B can still cause disease, so a might be 0:25:10.280 --> 0:25:14.640 kind of like a benefit but not necessary to cause disease. 0:25:14.880 --> 0:25:17.080 But then in other studies it looks like, no, you 0:25:17.160 --> 0:25:18.960 really have to have both, and if you only have 0:25:19.040 --> 0:25:22.440 one or the other, you don't really see disease from 0:25:22.520 --> 0:25:26.520 sea diiff, even though you might have colonization. So it's 0:25:26.520 --> 0:25:28.200 still a little bit I think up in the air. 0:25:28.280 --> 0:25:30.960 But it is really interesting the way that these two 0:25:31.119 --> 0:25:34.800 toxins kind of interact to then cause the actual symptoms 0:25:35.160 --> 0:25:39.120 that we see. Okay, so I've said the word symptoms 0:25:39.119 --> 0:25:40.760 like one hundred times, but I think the only thing 0:25:40.800 --> 0:25:44.120 I've said so far is diarrhea, and that is the 0:25:44.160 --> 0:25:50.119 hallmark symptom of a sea diiff infection, massive watery maybe 0:25:50.240 --> 0:25:55.960 mucis diarrhea. Generally, it's not overtly bloody diarrhea like we 0:25:56.040 --> 0:26:00.840 see with dysentery, and that's largely because seadift doesn't invade 0:26:01.119 --> 0:26:03.840 through our cells and it's very rare that it causes 0:26:03.880 --> 0:26:07.920 disease outside of the intestine. But because it is causing 0:26:07.960 --> 0:26:11.480 all of this inflammation and this damage to the lining 0:26:11.520 --> 0:26:14.840 of our gut, you can see like micro amounts of 0:26:14.880 --> 0:26:19.320