Anorexia is normally treated with therapy. Now a Canadian team is trying the gut

Anorexia is a life-threatening eating disorder that can manifest as an intense preoccupation on weight loss.

It's classified as a mental illness and normally treated with talk therapy, known as family-based therapy, but that's only effective for about half of the mostly women and girls who have it.

Those who don't improve may go to hospital and get locked into a relentless cycle of gaining weight and recovering from malnourishment, followed by weight loss and damage to organs, including changes to the brain from starvation.

Now, Canadian researchers are testing a new approach, tapping into the growing understanding of the gut-brain connection.

They're going to try treating teens with fecal transplants, to change the bacteria in their gut.

"We know that once the symptoms set in and the brain changes, it's really hard to change the course, so if we can intervene early in the adolescent years, we have the best chance," said Dr. Jennifer Couturier, a child psychiatrist and associate professor of psychiatry at McMaster University in Hamilton, Ont.

In fecal microbial transplants, a small sample of stool from a healthy person is purified to concentrate the beneficial bacteria minus the waste. The microbiome is then put in a capsule, which the recipient takes for therapeutic purposes.

Couturier and her team have Health Canada approval to run a randomized clinical trial in an initial group of 20 females aged 12 to 17 diagnosed with anorexia. They will either take oral capsules along with standard family-based treatment to stabilize nutrition and avoid the harmful effects of starvation or family-based treatment alone.

Fecal transplants have been tested in a small handful of adults with anorexia, including one who restored her weight.

In this trial, the McMaster researchers will use the university's own stool bank of donations.

Dr. Nikhil Pai, a gastroenterologist at McMaster and a co-investigator on the trial, credited the university's contributions for funding the research and starting the pediatric stool bank.

"This is not affiliated with any company," Pai said. "We developed this entirely in-house using carefully screened pediatric donors."

Pai said the screening checks for infectious diseases, similar to how blood donations are assessed. Staff at the stool bank then prepare the capsules, which can't be mass produced.

There are a few reasons Pai and some other doctors are optimistic participants will benefit.