ANTIBIOTICS and GUT FLORA

by drnieman on August 6, 2015

in Weekly

Around 1983 some North American doctors scoffed at their peers in Holland, who at that time did not treat all childhood middle ear infections with antibiotics. I specifically remember attending an Infectious Disease meeting where a well-respected professor from Dallas painted a grim picture of what can happen when ear infections are left untreated.

In addition, I remember sitting at a dinner with peers who ridiculed alternative medicine practitioners, because these clinicians put their patients on probiotics.

Fast forward to today and one can only marvel at how times have changed—for the better.

There is now much more wisdom when it comes to an appreciation of the vital role bowel bacteria play in keeping us healthy—starting in childhood.

We now have a better idea of why there appears to be a link, or an association, between antibiotic exposure and a later development of asthma, inflammatory bowel disease and childhood arthritis (JRA).
The hypothesis is that antibiotics destroy some of the good bacteria in the gut; disturbing the intestinal microbiome by altering the flora and thus causing a disregulated immune system. Inflammation becomes more prevalent as a result.

Gastro-enterologists have long been aware of the critical role the bowel system plays in regulating our immunity. Cardiologists and neurologists are now writing books and setting up conferences dealing not with the brain or heart, but the intestines. Psychiatrists are researching the possible link between depression and unhealthy gut bacteria.

More and more doctors are reducing their prescriptions of antibiotics, mostly because we are more aware of the dangers of antibiotic resistance. (In the USA the CDC reports that close to 23,000 people die each year as a result of antibiotic resistance—-the equivalent of the number of spectators at a NHL hockey arena)

But as a new report in Pediatrics (Aug 2015) explains, there is also a significant link between antibiotic exposure and the subsequent development of JRA. Authors report that children receiving antibiotics are twice as likely to develop JRA and the risk is the highest in six to 12 months following exposure.

They speculate that a disturbed microbiome is to blame. They admit that there is no direct cause and effect, but that more research is required. They also point out that the gut bacteria remain disturbed for as long as six months following exposure to antibiotics. (This information may prompt doctors to suggest the use of probiotics for far longer than a few weeks following antibiotic use.)

Penicillin was discovered by accident close to 90 years ago and there is no doubt that antibiotics have saved lives. I use my knife analogy when talking about this with peers, media and patients: grab a knife by the blade and it cuts you; use the handle and it helps you cut your juicy steak. In other words we are to use antibiotics extra carefully—personally I am more concerned about how it disrupts the bowel bacteria than how it causes other side effects.

Why this concern? Because of one single word: inflammation.

A disturbed bowel flora impacts the immune system adversely and it may go beyond that—some very preliminary research suggests it may even play a role in obesity. (We are told that artificial sweeteners disturb the bowel bacteria and this may explain research showing that diet sodas actually increase the risk of being obese)

One can understand that traditional medicine is leery to jump on “new” bandwagons; medical schools pride themselves in being directed by evidence-based research. Articles and commentaries such as the ones recently published in Pediatrics, suggesting a link between antibiotics and JRA, should be taught in medical schools. It may take some time for this to formally happen.

Meanwhile, when we read that fiber improves asthma it makes sense: fiber provides more healthy bacteria which in turn leads to a healthy microbiome and less immune dysfunction. Foods rich in DHA omega three’s also keep our gut bacteria healthy. The use of probiotics and prebiotics continues to grow in popularity. (For previous articles written for the Herald on this topic see www.healthykids.ca)

Breast milk is very rich in both probiotics and prebiotics and this may explain why prolonged breastfeeding modifies the risk of allergies and immune disorders. I encourage mothers of babies born via C-sections to intentionally add probiotics. Being born sterile, as opposed to getting colonized by bacteria during a vaginal birth, is a risk factor for later allergies. Once again, it all comes down to ensuring that our bowel bacteria remain healthy and undisturbed by certain foods or medications.

DR. NIEMAN IS THE AUTHOR OF A RECENT BOOK, MOVING FORWARD. HE CONTRIBUTES BI-WEEKLY TO CTV MORNING LIVE AND HOST A REGULAR BLOG ON WWW.NIEMAN.COM HE SHARES DAILY UPDATES ON NUTRITIONAL TOPICS ON TWITTER @DrPeterNieman

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