- Antibiotics, Microbiome Damage, and Your Health
- Antibiotic Resistance: What’s the Big Deal?
- Why Doctors Over-prescribe Antibiotics
- Is Your Doctor Prescribing Unnecessary Antibiotics?
- Antibiotic Stewardship: 6 Ways to Avoid Unnecessary Antibiotics
- Beyond Antibiotics – Other Medications that Damage the Microbiome
Each day it seems we’re learning more about the marvelous miracle that is our intestinal microbiome – the collection of bacteria, yeasts, and viruses that live in our gut and do an enormous amount of work to keep us healthy. Amongst the many accomplishments our microbiome could boast are manufacturing vitamins (they help produce Vitamin D and Vitamin K), detoxifying environmental toxins (they can even break down some heavy metals and help us eliminate excess estrogen), keeping our mind and mood steady, and keeping our weight down and regulating inflammation. We also know that what we put in our bodies, from foods to medications, has an impact on this precious reservoir of organisms.
The impact of antibiotics, and particularly the rampant antibiotic overuse that has become so prevalent, on our gut microbiome has become increasingly evident as research continues to emerge on the importance of our microbiome to our health. Disruptions in the microbiome have been associated with diabetes, weight problems, anxiety, depression, autoimmune disease, sugar cravings, fatigue, PCOS, fertility, immune health, adrenal dysregulation, and much more.
Did you know that:
- Antibiotic abuse in the United States is widespread. We have only 4.6% of the global population but we have 46% of the global antibiotic market?
- 95% of clinicians prescribe antibiotics even when they are not absolutely sure they are needed?
- 1 in 10 doctors will write a prescription for an antibiotic even though they know it’s not needed, just because a patient asks for it?
- At least 10% of doctors think that it doesn’t matter if antibiotics are given unnecessarily because they don’t cause any harm?
- Almost half of all doctors don’t counsel their patients against unnecessary antibiotic use?
Yet most of the antibiotics being prescribed doctors are unnecessary – and harmful to us personally – and globally. Learn what you can do to protect yourself from antibiotic overuse, and help reverse a very alarming and dangerous public health problem.
Antibiotics, Microbiome Damage, and Your Health
We’re going to continue to hear more as research into this fascinating intersection between our lives and the world of the microorganisms that live in, on, and around us evolves. What we do know already is that healthy communities of flora in our gut help regulate everything from our weight, mood and mental health to our immunity and hormones. A healthy micobiome contributes to how many calories we extract from our food – with too little of the good kind predisposing us to being fatter – and determines how well we detoxify excess hormones we produce due to dietary imbalances or that we pick up from environmental exposures.
One of the most certain ways to do damage to your gut flora, and along with it your health, is take antibiotics. Of course, an antibiotic is occasionally necessary and even life saving, but the hard truth is that most often they are unnecessary and even inappropriately prescribed.
In my medical practice so many of the patients I see with chronic health problems, and especially digestive, allergy, hormonal, and autoimmune problems, share the common denominator of having had a lot of antibiotics as babies, children, or young adults – the former usually for ear infections, supposed strep throat, and bronchitis, and as young adults for acne – sometimes for years at a time.
We know that damage to the gut flora from early exposure to antibiotics – or frequent exposure at any time – can permanently damage the microbiome. There is strong evidence showing that even a single course of antibiotics in the first year of life increases our risk of developing gut problems and autoimmune conditions including Ulcerative Colitis and Crohn’s Disease, to name just a very few. Leaky gut, a common reason for most food intolerances and many inflammatory health conditions, including autoimmune disease, can also be triggered by damage to the microbiome as a result of antibiotics.
Antibiotic Resistance: What’s the Big Deal?
Antibiotic misuse is a problem for more than just to our gut flora. We are experiencing a major global health crisis due to antibiotic resistance — the antibiotics we rely on for serious and life-threatening diseases no longer work because we’ve used them so much that the bugs we are treating have outsmarted us and can withstand exposure to them. We now have antibiotic resistant super bugs and increasingly, no effective treatments for many of them! At least 2 million people get infected with antibiotic-resistant bacteria each year, resulting in at least 23,000 deaths, according to the Centers for Disease Control and Prevention (CDC).
There are also immediate risks to taking antibiotics. They can cause allergic reactions, additional antibiotic resistant infections on top of whatever you are being treated for, and can cause a deadly diarrhea caused by the bacteria Clostridium difficile. Many antibiotics can cause additional serious consequences ranging from rupture of the tendons with common medications like ciprofloxacin used to treat urinary tract infections, to fatal cardiac arrhythmias. We take them like they are no big deal – but they really are!
Further, pharmaceutical companies are no longer developing new antibiotics because they “can't break even.” The last new antibiotic class for gram-negative bacteria was the quinolones, developed 4 decades ago.
Why Doctors Over-prescribe Antibiotics
There are 5 common common reasons that doctors over-prescribe antibiotics
- Fear of not treating a possibly serious bacterial infection
- Fear of malpractice should you have a serious infection that didn't get treated with antibiotics
- Patients requesting an antibiotic
- Lack of knowledge about antibiotic overprescribing and the importance of not contributing to it
- Lack of knowledge of antibiotic alternatives or time to teach patients about them if when they are knowledgeable.
Working with your care provider to directly address these issue can help you avoid being overprescribed to.
Is Your Doctor Prescribing Unnecessary Antibiotics?
Chances are that the answer is yes, your doctor is an antibiotic over prescriber, because most are. A study done looking at records from the Veteran Affairs (VA) system between 2005 and 2012 found that on more than 1 million visits to primary care, urgent care, and emergency room settings for upper respiratory infections, most of which are viral and never require antibiotic treatment, antibiotics were prescribed almost 70% of the time, and this number was trending upward. Perhaps the most concerning issue is that in studies of antibiotic use it has been found that over 10% of doctors surveyed believe that it doesn't really matter if they over prescribed, because the antibiotic wouldn’t hurt even if it wasn’t needed.
Antibiotic Stewardship: 6 Ways to Avoid Unnecessary Antibiotics
Stewardship means the activity or job of protecting and being responsible for something – antibiotic stewardship means taking responsibility for stopping the overuse of antibiotics.
Since it’s pretty clear that most doctors feel comfortable giving out antibiotics like candy, and aren’t going to tell us when they really aren’t needed, we have to take personal responsibility for avoiding unnecessary antibiotics treatment. Taking personal responsibility can also have an impact on ecological health and global antibiotic resistance. Antibiotic stewardship specifically refers to coordinated efforts to improve the appropriate use of antibiotics. Reading this article is your first step!
Here's how you can participate in reducing antibiotic overuse, while protecting yourself from the personal risks associated with taking antibiotics unnecessarily.
Express Your Preference to Avoid Antibiotics
If you don't want to be prescribed an antibiotic, let your doctor know. She or he may be prescribing one under the false impression that it’s what you want or expect. She or he may also feel so busy and harried that it's just easier and faster to write an antibiotic prescription than to have a conversation with you about why an antibiotic isn't necessary. So make your preferences known loud and clear. If the medical condition requires an antibiotic, then your doctor should respectfully let you know that this is the case and explain why. Then you can discuss what is safest and most appropriate for you. If it is unclear whether an antibiotic is truly needed, but there is a high suspicion that you have a bacterial infection, ask your doctor to check your procalcitonin level, a biomarker for infection. This test has been shown to be successful in nearly every well-controlled trial.
If an antibiotic has been prescribed and yet it’s not your preference to take one, ask your doctor how important it is for you to start taking it immediately, or whether a “watch and wait” observation period is appropriate, ask how long you can watch and wait for, and what you should look out for as signs of improvement or of things getting worse, and how long it should take for you to get better. Also, ask if there are any alternatives – for example, there may be nutritional or herbal supplements that you can try instead of the antibiotics. If an antibiotic is deemed to be necessary, ask your doctor about doing a short course, for example, 3-5 days instead of 10-14 days. Short courses of antibiotics are virtually always effective in well-controlled trials.
Get educated about the common health conditions that would bring you to the doctor for yourself or one of your kids and for which antibiotics are commonly misused, including ear infections, bronchitis, and even strep throat, so you can make wise and optimally healthful decisions. A great resource is called Get Smart, created by the Centers for Disease Control and Prevention (CDC) exactly for the purpose of helping you – and your doctors – avoid unnecessary antibiotics. You can refer to this site before you visit the doctor’s office and even bring information with you to help you avoid unnecessary antibiotics, you can visit the site with your doctor who might not even know about it, and visiting the site may even help you avoid a premature or unnecessary doctor’s visit.
Trust Your Body and Make the Time to Heal
My great-grandmother always said rest was the most important thing we could do when we’re sick – including time for convalescence after an illness. Unfortunately, most of us were never taught the simple types of wisdom our grandmothers knew, and most of us don’t (or feel we can’t) take the time to get well – whether getting a few days help with the kids or taking a few days off of work. So we ask for antibiotics in hopes that our symptoms will clear up faster – and sometimes antibiotics can make this happen. But the problem is that if we take antibiotics to hasten healing now, we might pay the price with chronic problems later. When we get sick what we really need to do is eat simply and well, take some time for R&R, and get some extra rest. In short: Pay now in time or pay later in health.
Learn About Alternatives to Antibiotics
Simply by changing your diet (clue: drop the dairy, sugar, and flour products for a few days) and adding in a few natural supplements including vitamins, minerals, and herbs, you can reduce the symptoms, severity, and duration of most common viral and many bacterial infections without having to use antibiotics. Sometimes, even more complex acute and chronic infections respond well to natural remedies without having to use antibiotics – but this might require you to see an integrative MD, a licensed naturopathic doctor, or a skilled herbalist for suggestions. On my website you will find an ever-growing body of resources on the natural treatment of common infections and many other of your health concerns.
80% of the antibiotic use in the United States is for growth promotion and disease prevention in farm animals – and these antibiotics make their way to us in what is know as the “farm to fork” phenomenon. Not only do antibiotics make their way to us, but so do resistant bacteria and bacterial resistance genes, which can be traced directly from chickens to the chicken meat in grocery stores to blood cultures in people. The practice of antibiotic use on farms was discontinued in some European countries many years ago, without economic or animal health consequences – and this is beginning to happen in our country as well. We can protect our health and the environment, and demand farming changes like this by voting with our dollars and purchasing only antibiotic-free meat.
If you really do need to use an antibiotic, it is not the end of the world, and it is important to be practical and open to the wonderful array of options both nature and science have to offer us for our health and well being. A healthy gut will usually repair itself perfectly if antibiotic use is rare or infrequent. The addition of fermented foods like sauerkraut, kimchee, and homemade yogurt (if you tolerate dairy, or if not, try coconut yogurt with live active cultures), as well as a probiotic and gentle gut healing herbs can also help restore your gut's natural health and flora.
Beyond Antibiotics – Other Medications that Damage the Microbiome
It makes sense that antibiotics would be harmful to gut bugs – after all, they don’t necessarily discriminate. They take out some of the good guys, along with the bad. But it was surprising to learn that antibiotics aren’t the only drugs that are doing some serious harm to the microbiome. According to research published in Nature, more than one in four non-antibiotic drugs – including over-the-counter acid-blocking drugs like Prilosec and commonly-prescribed drugs like the diabetes medication metformin, also used to treat PCOS, inhibit the growth of beneficial bacteria in the gut.
Those weren’t the only drugs to cause gut trouble. Certain antivirals, antipsychotics, and chemotherapy drugs also had “antibiotic-like” side effects in the gut, according to the data. The researchers were surprised by the number of ‘unrelated’ drugs that had a negative effect on the microbiome.
The study looked at over 1,200 drugs – 923 of which were non-antibiotics – and their effects on 40 bacterial strains often found in the gut, including 38 strains commonly found in healthy individuals. Over twenty-five percent of the non-antibiotic drugs suppressed the growth of beneficial bacteria.
The researchers also found that use of these drugs might promote antibiotic resistance, speculating that the medications cause the number of antibiotic-susceptible bacteria to decline – which makes room for antibiotic-resistant strains to flourish, reports the Center for Infectious Disease Research & Policy (CIDRAP).
I’ve written before about how taking NSAIDs (like ibuprofen) for as little as five days in a row can lead to gastritis, ulcers, and leaky gut syndrome – and how prescription pain medication can lead to constipation (along with far more serious consequences). Now, as we add to the list of medications that damage the gut (and in so doing lead to a whole cascade of other problems, including thyroid problems), we can see a whole modern-day system at work against our beleaguered intestines.
“Taking into account that abundant members of the human gut microbiome are impacted more by drugs,” the researchers write, “one could speculate that pharmaceuticals, used regularly in our times, may be contributing to the decrease in the diversity of microbiomes of modern western societies,”
This news is particularly important in light of the fact that women are disproportionately overmedicated, to the tune of 50% of women over 50 being on at least two daily pharmaceuticals, and that most medications have not been studied in women for safety and appropriate dosing. It gives us even more reason to restock our medicine cabinets with natural remedies, to use pharmaceuticals sparingly and only when necessary, and double down on our use of integrative and alternative therapies for preventing disease, and for treating our symptoms and medical conditions whenever possible.