Antibiotics: Decisions and Damage Control

We live a lot longer than our Victorian forebears. Largely thanks to the decline of infectious disease and our ability to treat it. Antibiotics have played a big part in this. And they continue to be very effective and life-saving drugs. That’s the upside. There’s also a downside, though. And it’s much bigger than most of us think. But there are situations where a course of antibiotics is the right answer. The good news is, we can limit the damage.

Let me be really clear. I’m not against antibiotics. I am resolutely for them. In the right circumstances. But, unfortunately, the risks they pose to our long term health are not acknowledged. (The NHS website lists some mild digestive symptoms and potential allergic reactions as the only side-effects). Consequently, antibiotics are prescribed (and taken) far too readily.

We hear a lot about antibiotic resistance. It’s very frightening. Let me put it in context for you: According to some microbiologists, if the current rate of antibiotic use continues, infectious diseases will once again become our biggest killers. Like in Dickens. This is bad. But there may be an even bigger issue. Antibiotics kill bacteria. Very efficiently. And indiscriminately. They are not, sadly, the laser-guided missiles of modern warfare. They are the carpet bombs of yesteryear. The Blitz, if you will. The aggressive targets are eliminated. But innocent civilians – our beneficial bacteria – are also wiped out. It’s nothing short of catastrophic.

Each of us has 100 trillion bacteria  – give or take a few billion – in our guts (our ‘microbiota’). 100 trillion. That’s quite a few. Our bodies are made up of only around 10 trillion cells. So, if you think about it, we’re only 10% human. Humbling, really. It’s a relationship that has evolved over millions of years. We provide them with food and shelter. They reciprocate with…well…we’re only just starting to grasp the enormity of their contribution. Immune function. Metabolism. Hormonal signalling. Nervous communication. That means our microbiota interacts with pretty much every organ and system in the body. And it’s a finely tuned machine. A delicate and highly diverse balance of different species. Any disruption can cause problems.

Antibiotics are more than an disruption. A single course of antibiotics can significantly alter as much as one third of our microbiota. And some of these changes are permanent. Populations of protective bacteria are reduced and overall diversity diminishes. Aggressive (potentially resistant!) species colonise and multiply. The health impacts of this are profound. Short and long term. And not just for us. Microbiota composition is passed on through the generations.

The most immediate problem is infection. A nasty bacteria called Clostridium difficile thrives in an antibiotic wasteland. Watery diarrhoea, fever and nausea are its house warming gifts. Oh, and colitis, if left long enough. It’s a bugger to shift too. But don’t worry. Conventional treatment is…oh yeah…more antibiotics. (The pharmaceutical companies really have cracked the customer retention game). When aggressive bacteria are allowed access to the intestinal lining, we have a more serious problem. E. coli  is a good example. It likes to attach itself to a gut cell, whereupon it burrows through the cell into the tissue. The alarm is raised and the immune system goes into combat mode. This inflammatory state is elevated further by other foreign particles seeping through the E. coli-created tunnels. It’s a mechanism that is now thought to be (at least partly) responsible for the development of asthma, food allergies and autoimmune diseases. And systemic inflammation is implicated in most chronic diseases. It doesn’t stop there, though. There is evidence linking an altered microbiota to a growing number of adverse health outcomes. From obesity and diabetes to Parkinson’s and Alzheimer’s.

That said, the immediate threat of uncontrolled bacterial infection may (and often does) take priority over longer term complications, no matter how serious. Antibiotics are, in many cases, the right course of action. And that’s ok. Because we can limit the downside.

Protect and rebuild the microbiota

The first step in this is probiotics. Supplementing with beneficial bacteria. Taking probiotics during and after a course of antibiotics has been shown to offset the negative effects. Most of the research has been on Lactobacilli, Bifidobacteria and Saccharomyces boulardii. (Saccharomyces boulardii is actually a yeast, rather than a bacterium). All were effective in keeping the invaders out and preventing diarrhoea. For Saccharomyces boulardii I use the Cytoplan brand, but there are many others. Lactobacilli and Bifidobacteria are the most popular probiotics. There are a boat load of options. VSL#3 is considered the best. It’s a super high dose supplement with eight different species. I haven’t actually used it yet, but I’m about to order some (it’s been shown to be beneficial for autoimmune diseases). Be that as it may, diversity is the key to a healthy microbiota. Supplementing with several species probably won’t rebuild the diversity lost to antibiotics. Prescript Assist is great for this. We take it as a daily supplement. A potent mix of 29 soil-based bacteria. Like the stuff our ancient ancestors “supplemented” with. Numbers and diversity can be also be boosted by eating fermented foods. We like sauerkraut. But there are many to choose from. Kimchi, kombucha, kefir to name a few. Being a bit dirtier will also help. Bin the antibacterial substances. Play in the woods. Wash less. And recolonise naturally!

For our bacterial friends to grow, they need the right food. That’s where prebiotics come in. That’s fibre to you and me. Specifically soluble fibre and resistant starch. We can’t digest it. But the bacteria lap it up. Some research suggests that prebiotics may be more effective than probiotics for recolonising the gut with beneficial bacteria. And, much like Slash and Axl, the real magic is in the combination. Supplemental prebiotics are available, and some probiotics include prebiotics. Prescript Assist does for instance. But the best source is real food. Vegetables and fruit. For soluble fibre, focus on starchy vegetables (sweet potatoes, squash, carrots, turnip, parsnips), bulbs (onions, garlic, leeks), and fruit. Green bananas are an excellent source of resistant starch. As we know, there are lots of other reasons to increase vegetable intake. Like vitamins and stuff. So it’s a win win.

Heal and sooth the gut

A permeable intestine is bad news. Repairing damage to the gut lining is essential during and after an antibiotic assault. We need glycine for this. It’s a type of amino acid, the building blocks of proteins. And it’s essential for the integrity of intestinal cells (as well as skin, bone and joint maintenance). We can make it in the liver, but only enough for vital functions. While we search for our next glycine-rich meal. One with lots of collagen. Bone, connective tissue or skin. Sadly, we don’t eat much of this stuff anymore. But you can change that. Bone broth is a good start. It’s the trendy name for stock! Easy to make, delicious and packed with glycine. I make a big batch every couple of weeks, and freeze it in mug-sized portions. Stewing meat for a long time also works. But it has to be the right meat. Cheap cuts with lots of bone and gristle. Collagen and gelatin (melted collagen) supplements are really helpful. We get the Great Lakes brand. Me and Gabriel start every morning with a mug of bone broth. With added gelatin.

There may, however, still be times when your guts feel a bit rubbish. For soothing a complaining bowel, few things work as well as ginger. Chop some fresh ginger (I cheat and buy frozen chopped ginger…from the Co-op) and simmer in water until the desired strength is reached. (Be careful with this. Ginger is strong. I made some a few nights ago and left it simmering far too long. It nearly melted my tongue). Add a teaspoon of raw honey to take the edge off.

Most of us will face infection again. While doctors are much more diligent than they used to be, antibiotics will often be prescribed. It’s up to you whether you take them or not. But that decision should include consideration of all the risks. Ultimately, the benefits may still outweigh the costs. They often do. In that case, do your best to protect your bacterial friends. You owe them a lot.

Own your health.

– James.

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