Avoiding the Consequences of Antibiotics For years I have lectured to my patients about the often devastating effects that antibiotics can have on the gut flora. The billions of microbacteria, parasites and fungi which reside in our gut and on our skin are collectively termed our microbiome. Microbiomes are very personalized: each person’s is different and unique determined by our exposures and ingestions, as well as our history of antibiotic use. Our microbiome begins at birth with exposure to the maternal flora in the birth canal and in breast milk. Infants born via caesarean or who are not breast-fed are at a disadvantage immunologically. The greater the diversity of species in our gut and the ratios among species helps determine the integrity of our immune system. The greater the number of “beneficial” microbes, the better our capability of fighting disease. It is also more effective for keeping out opportunistic and dangerous microbes, a condition known as dysbiosis. Candida (yeast) overgrowth is extremely common if there is dysbiosis in the gut. For another example, C. difficile overgrowth following antibiotic use is now one of the leading causes of death in the hospital setting. It is not unusual now to hear, “The operation was a success but the patient succumbed to C. diff.” While it’s extremely important to avoid unnecessary antibiotic use, what about those who have carefully considered their options and decided that antibiotics are necessary in their situation? Is there no hope for recovering a healthy microbiome? It is estimated that the microbiome may take over 6-8 weeks to “recover” from prescription antibiotics. Need to take antibiotics? You need to read this article. While having to take antibiotics is never ideal, there are many cases where it is absolutely necessary, and don’t worry – the situation is far from hopeless. It will take some time and effort, but there are many things you can do both during and after a course of antibiotics to minimize the damage and encourage regrowth and diversification of your gut flora. Probiotics To some, taking probiotics during a course of antibiotics might seem contraindicated. After all, won’t the antibiotics just kill all of the probiotics anyways? First, keep in mind that probiotics don’t need to actually colonize the gut to be beneficial; even transient strains can have powerful therapeutic effects. There are quite a few randomized, placebo-controlled trials that have demonstrated the effectiveness of probiotic use during a course of antibiotics for reducing side effects and preventing gut infection. For example, a study on 135 hospital patients taking antibiotics found that only 12% of the probiotic-receiving group developed antibiotic-associated diarrhea, compared with 34% of the placebo group. Additionally, while 17% of the placebo group developed diarrhea specifically from C. difficile, nobody in the probiotic group did. One interesting study tracked changes in gut bacteria in three different groups of people receiving antibiotics, with one group receiving placebo, one group receiving probiotics beginning after the antibiotic treatment ended, and the third group receiving probiotics both during and after antibiotic use. The group receiving placebo had significantly higher levels of facultative anaerobes (read them as the” bad guys”) 20 days after finishing antibiotics compared with baseline, while the two groups receiving probiotics had no significant difference. But even though both of the probiotic groups ended up back at baseline levels, only the group taking probiotics during as well as after antibiotic treatment maintained stable levels of facultative anaerobes throughout the experiment. In the group who took probiotics only after completion of antibiotic treatment, facultative anaerobes increased significantly, and decreased only after beginning probiotic supplementation. This clearly demonstrates the importance of taking probiotics during antibiotic treatment, as well as after. Most of these trials used different strains of Lactobacilli, Bifidobacteria, or Saccharomyces boulardii. Lactobacillus and Bifidobacterium are two of the most common genera used as probiotics, so these supplements are readily available in most health food stores or vitamin shops. S. boulardii is actually a beneficial yeast rather than a bacteria, so it’s particularly useful during antibiotic treatment because the antibiotics can’t kill it. S. boulardii is also preferable under these circumstances because there’s no risk of it harboring genes for antibiotic resistance and later transferring those genes to pathogenic bacteria. As with anything else, the best probiotic to take will depend on a person’s particular circumstances (such as the antibiotic they’re on and the state of their digestive system), but the two supplements I recommend most often are Saccharomyces boulardii ( 5 billion CFU by Ortho Molecular) and Theralac (30 billion mixed strain with patented delivery by Master Supplements). The S. boulardii can be taken at the same time as the antibiotic. Take the Therlac 3 hours away from it. Prebiotics As I’ve mentioned before, prebiotics are much more effective than probiotics at promoting the growth of beneficial bacteria in the gut. Thus, prebiotics are an incredibly important part of any regimen to protect or rebuild a healthy microbiome. During and after antibiotic use, focus on getting plenty of soluble fiber, which feeds beneficial bacteria and is found in starchy tubers, squash, and peeled fruits. It might be best to avoid too much insoluble fiber while your gut is in a compromised state, since it can be irritating to the gut lining. However, one type of insoluble fiber that can be extremely helpful for supporting healthy gut flora is resistant starch. The easiest way to get a concentrated dose of RS is to use Bob’s Red Mill unmodified potato starch. As with any supplemental prebiotic, it’s a good idea to start with a small amount and work your way up. In this case, you could start with 1 teaspoon and work your way up to 2-4 tablespoons per day. My favorite prebiotic is TruFiber (by Master Supplements). It has 2 sources of soluble fiber plus 3 enzymes to enhance the activity of dietary fiber to further stimulate probiotics. If possible, introduce any prebiotic supplements before beginning the course of antibiotics so your body can get used to them. That way, you won’t have to deal with possible side effects from introducing the prebiotic on top of possible side effects from the antibiotics. Supporting diversity The main difficulty after a course of antibiotics isn’t recovering the number of flora present; it’s recovering the diversity. As we’ve seen, probiotic supplements can be incredibly helpful for preventing antibiotic-associated diarrhea and lowering the risk of a gut infection, and I recommend continuing with probiotic supplementation for a period of time after finishing your treatment. However, you can’t expect manufactured probiotic and prebiotic supplements to achieve the diversity of an ancestral microbiome on their own. One of the best ways to expose yourself to more diverse beneficial bacteria is by consuming fermented foods, so I highly encourage you to experiment with a variety of different ferments. These can include kefir, beet kvass, sauerkraut, kombucha, kimchi, and other fermented vegetables or fruits. Keep in mind that foods like yogurt and kefir will probably only have a handful of bacterial strains if you buy them from the store, so homemade is best. As far as prebiotics go, just try to get as much variety in your plant foods as you can, in addition to supplementation with resistant starch or another prebiotic formula. Some of the best sources of soluble fiber include carrots, winter squash, summer squash (especially peeled), starchy tubers, turnips, rutabagas, parsnips, beets, plantains, taro, and yuca. Green bananas and unripe plantains (which you can dehydrate to make chips) are good whole-food sources of resistant starch. This past year I had a patient, a very healthy 60 yr old woman, who had a cosmetic surgical procedure. She was given Keflex prophylactically for 7 days. Subsequently, she developed severe diarrhea and was hospitalized for C. diff. None if the antibiotics helped. Overall, she was in hospital for over 3 weeks and ultimately was given a fecal transplant which finally resulted in a cure. It is likely that this could have been prevented with a course of prebiotics and probiotics during and after the week-long course of antibiotics! So, avoid antibiotics whenever possible. If you must take them, please take prebiotics and probiotics during and after. Studies confirm this approach and it can save severe consequences and maintain your general health.
Posted on: Fri, 24 Jan 2014 11:42:14 +0000
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