Antibiotics, Your Microbiome and Your Health

Microbiome_Pribootic_ProbioticIf you read my recent Seattle Times columns on the microbiome and antibiotic resistance, you might come away feeling like antibiotics are bad news. While it’s deeply unfortunate that antibiotics (especially broad-spectrum antibiotics such as the tetracycline often used to treat acne and the quinolones frequently used in both adults and livestock) can throw the ecology of your gut microflora into disarray, we are still lucky that we have antibiotics as a tool when we truly need them, because some bacterial infections can kill you.

And therein lies the rub. Antibiotics have the potential to save us, albeit not without some potential cost to our longer-term health, but by misusing antibiotics, we’ve not only done unnecessary damage to our microbiomes, but we’ve entered into an era when we can’t be guaranteed that antibiotics will work when we do truly need them.

As Steve Solomon, MD, former director of the CDC’s Office of Antimicrobial Resistance, said at the annual conference of the Academy of Nutrition and Dietetics back in October: If you have a bacterial infection, the benefit of taking antibiotics far outweighs the risk. If you don’t have a bacterial infection, there is no benefit but the risk is great.

Inflammation and Your Microbiome

The body of research on both chronic inflammation and the microbiome have been growing exponentially, and I think it’s fascinating (but not really surprising) that those two lines of investigation are converging. Both research (and common sense) have told us for eons that eating vegetables, fruits, nuts, whole grains and legumes is good for us, but pinning down precisely why those foods are good for us has been more elusive. Sure, they contain lots of vitamins and minerals, and more recently we learned that they contain health-promoting phytonutrients, but now it appears that it’s the positive effect of these foods on the microbiome, coupled with the fact that a happy microbiome contributes to a happy immune system and lowered levels of inflammation, that is the key to good health. Your gut is the mediator between healthy foods and, well, health. Again, not too surprising when you think about it.

I had a patient recently who had all kinds of things going wrong. She had a number of inflammation-based health problems, she had various gastrointestinal issues of uncertain origin (including constipation since childhood), she was upbeat, but a mess. As I gathered her health and nutritional history, I asked her if she had been put on antibiotics in her childhood. Not only had she been on antibiotics all during her adolescent and teen years (for acne), but from the age of 3 (she has a distinct memory of this), she was given “pink penicillin” liquid (I Googled this and was shocked that there are drink recipes named after it!) whenever she had so much as a garden-variety cold. Her poor microbiome!

Care and Feeding of Your Microbiome

So for your microbiome to have the best start in life, you would not be born via C-section, you would never taken antibiotics, and you would have grown up on a diet that was higher in fresh or minimally processed plant foods and low in highly processed foods. Does that mean that if your mom had to have a C-section, you had a raging ear infection when you were two that required antibiotics, and from ages 3-6 you refused to eat anything other than chicken nuggets and boxed mac and cheese that you’re doomed? Don’t throw in the hat yet.

From this day forward:

  1. Only use antibiotics when you truly need them. Remember that antibiotics do not treat viruses or fungal infections, they only treat bacterial infections. Talk to your doctor about what may happen if you don’t take them (for example, not taking antibiotics for acne may result in worse acne, but not taking antibiotics for a serious infection could cause serious complications or death).
  2. When you do need antibiotics, take them exactly as directed. Do not stop taking them “once you feel better.” That contributes to antibiotic resistance and superbugs.
  3. Eat more plants. The prebotic fiber in plant foods is what the health-promoting (probiotic) bacteria in your gut (in the large intestine, specifically) need to thrive. Remember that you can eat a plant-based diet even if you choose to also eat animal foods.
  4. Reduce your intake of highly processed foods. They tend to be lower in nutrients, higher in calories (calorie dense) and they don’t give the beneficial bacteria in your gut the right fuel.
  5. Eat fermented foods regularly. They provide probiotic bacteria and (in the case of fermented vegetables) provide prebiotics, too. Look for the “Live and Active Cultures” seal on yogurt you buy.
  6. Consider a probiotic supplement. If you already have a happy gut, don’t struggle with inflammation-based health conditions and have little-to-no history of antibiotic use, probiotics may not be worth your money, but if you are pretty sure your microbiome has taking a beating, it’s worth talking to your doctor about.