Dr. Sadeghi, our resident integrative health specialist, joins us to discuss the power and the plight of antibiotics in modern healthcare. This is an issue that can divide “conventional” and “alternative” circles and Dr. Sadeghi brings a balanced approach to the issue; one that reminds us that antibiotics have a place but it’s definitely not in day-to-day health issues or minor treatments.
If you feel you’ve been over-prescribed antibiotics in the past and are looking to restore your gut health, have an upcoming surgery that requires antibiotic support, or are looking for lifestyle choices to reduce the need for antibiotics in the future — then read on and get Dr. Sadeghi’s take on this and more.
Q: Firstly, can you tell us about antibiotics? How do they work?
A: Initially, the term antibiotic was used to refer to any substance produced by a microorganism that was harmful to other microorganisms. Molds and bacteria have long had an adversarial relationship. In this respect, it was the secretion of the mold penicillium rubens that was found to kill pathogenic bacteria, which we later came to know as the antibiotic penicillin. Most antibiotics in use today come from natural elements such as fungal, plant, animal, and other bacterial sources. It used to be that the term antibiotic was not used to classify substances that also killed bacteria but did not come from microorganisms or another biological source. An example would be hydrogen peroxide. This group, known as antibacterials, also included sulfonamides, synthetic sulfur-based drugs that disrupt the growth of bacteria. Today, any medication that is harmful to bacteria, regardless of whether it comes from a natural or synthetic source, is referred to as an antibiotic.
Antibiotics work in one of two ways. Most natural antibiotics kill the bacteria by attacking the wall or coating surrounding it. While this is good, the downside is that they don’t discriminate between pathogenic bacteria and the good bacteria in our intestinal tracts that help us absorb nutrients, support immunity, and provide us with vital nutrients like vitamin B12. Alternatively, synthetics work to inhibit bacteria growth and reproduction. Sulfonamides do this by disrupting the production of dihydrofolic acid in the bacteria so that it can’t make the necessary proteins to reproduce itself. The concern here is that human cells also use dihydrofolic acid, a form of folic acid, to make proteins and reproduce themselves.
Q: We’ve heard that we’re becoming resistant to antibiotics. Is this true and do you see a place for them in the future of healthcare?
A: Humans aren’t becoming resistant to antibiotics, however, some bacterial strains are. Through mutation they’re developing ways to overcome the natural compounds that dissolve their membranes or the chemicals that inhibit their reproductive processes. While “superbugs” as they’re called are a concern, I feel the media has generated a great deal of unnecessary fear about them. There are just three primary strains, all of which occur in people who are hospitalized or in nursing homes and either using catheters or mechanical ventilators, along with having weakened immune systems. The most common one we hear about is Methicillin-Resistant Staphylococcus Aureus (MRSA). Outside of a hospital or nursing home setting, where most of the deaths occur, healthy people will never come into contact with these bacteria. Even the staff members that work in those facilities virtually never acquire these infections, and the vast majority of patients overcome them. According to the CDC, although 2.8 million of these infections occur each year, only 35,000 people actually die from them. For context, over 52,000 more people die from kidney disease each year than so-called superbugs. So, while these bacteria are a concern to a specific group of hospitalized people, they’re not a significant threat to the vast majority of the population.
Antibiotics will always have a place in healthcare because of the speed with which they take effect and the fact that they’ve saved billions of lives worldwide since their creation. In fact, the CDC states that prior to antibiotics, 30% of all deaths in the U.S. were due to infections like pneumonia and tuberculosis. Antibiotics will always be the first course of action when an infection is acute or life-threatening, where the bacterial load is high and has already taken a stronghold in the body. The problem is that antibiotics are mostly prescribed for conditions that are nowhere near meeting those criteria. Unfortunately, 60% of patients with a sore throat are prescribed an antibiotic when in reality, strep throat (which does require antibiotics) only occurs in 10% of sore throat cases. At the same time, an abundance of evidence has shown antibiotics do not alleviate acute bronchitis and yet, 73% of patients with bronchitis receive an antibiotic.
Q: Can past courses of antibiotics have an impact on our current health? For example, is it possible that taking penicillin as a child could create side effects into our adult years? How can we tell?
A: The concern over antibiotics has far less to do with the evolution of superbugs than it does with over-usage and the consequences it has on our health. A healthy gut microbiome contains about 100 trillion microorganisms. That’s a staggering number when we consider there are 30 trillion human cells that make up the body. A small portion, perhaps 5% to 10%, of those microorganisms will be pathogenic, but as long as the good bacteria remain in the majority they can keep the bad ones in check. Killing off too many of the good bacteria along with the bad from long-term or frequent antibiotic use can cause an imbalance in the gut microbiome known as dysbiosis, allowing pathogenic bacteria to multiply and create health problems. One of the most common is known as C. diff or the proliferation of Clostridium difficile bacteria, which causes inflammation of the colon (colitis / Crohn’s disease), resulting in bloody stools, cramps, nausea, and dehydration. While 84% of infants are born with C. diff in their intestines, only about 5% to 15% of adults retain it. Even so, when C. diff gets out of control, it’s very difficult to treat because of its level of resistance.
Even before taking antibiotics, other actions early in life can predispose a child to dysbiosis as an adolescent or adult. In natural birth, a baby collects the mucosa that lines the birth canal in its mouth, nose, ears, and eyes on its way to being born. When ingested, this mucus, rich in probiotics or good bacteria, acts to populate the baby’s gut. This opportunity is lost in cesarean births. Breastfeeding is also crucial in boosting probiotic populations in the baby’s gut. In the absence of these two important things, unnecessary antibiotics early in life could lead to dysbiosis and disease. In the 2000s, the U.S. experienced a huge increase in children being diagnosed with Crohn’s disease (59%) as well as ulcerative colitis (71%).
As adults, other problems are more common such as poor digestion, constipation, malabsorption of nutrients, irritable bowel syndrome (IBS), recurrent yeast infections in women (Candida albicans overgrowth), lowered immunity, and frequent illnesses. Yet, most doctors and patients never suspect these problems are the end result of antibiotic use begun in childhood that has carried through to later years.
Because unnecessary antibiotics kill good bacteria along with the bad, the damage is cumulative overtime, weakening our immunity and making us more vulnerable to everything from colds to cancer later in life. A six-year study of three million people in Finland with no cancer history or risk factors found those who had 2 to 5 antibiotic prescriptions in that time period experienced a 27% increase in cancer occurrence, and those who had six or more prescriptions showed a 37% increase in cancer diagnosis than people who’d taken no antibiotics. Similarly, a study from the National Cancer Institute found that breast cancer risk doubled for women who took more than 25 antibiotic prescriptions or those who took antibiotics for 500 total days over a 17-year period.
In addition to physical health problems, frequent antibiotic use throughout life has shown to affect mental health, as well. The brain and the gut are connected by the vagus nerve, the largest nerve in the body that runs from the brainstem all the way down to the bottom of the intestine. It’s the neurological superhighway of information in the body. This is why medicine informally calls the gut our “second brain” because it’s directly connected to our thoughts and emotions, and why we get a “gut feeling” about something. With this kind of direct line access to the brain, it makes sense that research shows an imbalanced gut microbiome plays a major role in anxiety and depression. Most people suffering from depression don’t realize that they may need probiotic therapy instead of an antidepressant and should discuss the option with their doctor.
Because the gut is also an emotional center, chronic stress has shown to significantly reduce good bacteria and increase susceptibility to infections. Other research has shown that probiotic therapy can restore balance. Interestingly, researchers have found that there is a correlation between mental toughness or the ability to withstand stress and a strong gut microbiome. This is why we intuitively say someone “had the guts” to meet a challenge or was good in a crisis.
So, birth circumstances, breastfeeding or not, the number of courses of antibiotics taken over one’s life, stress levels from living or working conditions, quality of diet, and so on all factor together to shape our microbiome that profoundly affects our health later in life. It isn’t any one of those things, but the combination and frequency of them that really matters. The truth is all of us could stand to strengthen our microbiomes with occasional supplementation.
If you’re having any gut problems such as cramping, constipation, gas, bloating, loose or foul smelling bowel movements, you may have a gut imbalance. The easiest way to find out is to have a stool sample tested through your doctor. By isolating the microbial DNA, the lab can determine which microbes are present in the gut, what strains are dominant, the balance between good and bad, and the presence of various yeasts and/or parasites. Avoid the home test kits marketed directly to consumers. They usually exist to sell other products, and you’ll need a trusted doctor to interpret your results and provide any necessary treatment.
Q: If someone is battling an infection — are there alternative treatments prior to resorting to antibiotics?
A: That all depends on what kind of infection is occurring and how long it’s been going on. If you’re getting the feeling that a urinary tract infection might be starting, 100% cranberry juice has been shown to be very effective. Research shows that cranberry juice is very special in that it changes the thermodynamic properties of bacteria, creating an energy barrier that prevents the microorganisms from latching onto cells in the urinary tract. If sugar is a concern, taking D-Mannose, the active compound in cranberries, is also an option, as well as the herb, Arbutus uva ursi or mountain cranberry.
Echinacea comes from the cone flower and has shown to have powerful anti-inflammatory properties and compounds that bolster the immune system to help the body fight colds, infections, and even upper respiratory infections. Equally, echinacea not only helps fight colds but shortens their duration. Zinc supplementation has also been shown to reduce the severity and duration of colds, but it must be started early in the infection.
Your odds are always better if you can start a holistic intervention at the first signs of an infection. The type of infection and location in the body will determine what kind of treatment you’ll need. If an infection has been going on for more than a week or you haven’t felt improvement in that time, you should consult your doctor. Don’t take the chance of an infection spreading to other parts of the body and creating bigger problems.
Q: What about before an infection hits? Is there anything I can do to prevent taking them prophylactically? Many surgeries require a person to take antibiotics prior to or immediately after surgery to prevent an infection from forming; we know speaking in generalities is difficult — but is it possible to opt out of something like this?
A: Prevention is the best approach to infections. Taking supplemental zinc or D-Mannose/cranberry juice (if UTIs are an issue) daily can help with prevention. I wouldn’t recommend echinacea daily, only when you feel an infection coming on. You don’t want to keep your immune system aroused when you’re not sick.
Lifestyle habits can make a big difference in preventing infections. Eliminate as much sugar and simple carbs from processed and junk foods from your diet as possible. Bad gut bacteria thrive on these. When denied their food source, they die and the good bacteria can start to rebound.
Add fermented foods to your diet. Lacto-fermentation preserves certain foods by allowing good bacteria to proliferate in them, providing protection from bad bacteria that would cause spoilage. Some fermented foods include sauerkraut (uncooked), kimchi (a Korean form of sauerkraut using other vegetables besides cabbage), low-sugar plain yogurt, kefir, and kombucha (a fermented tea). You can even learn to make these at home.
Take a high-quality, food-based multivitamin every day, not synthetic. Nutritional deficiency lowers immunity.
Eat foods that fight microbes. Foods like garlic, coconut oil, oregano oil, lemon, and manuka honey have been known to have powerful anti-microbial and detoxification properties. They fight bad bacteria without harming the good strains. Manuka honey contains a powerful antioxidant called pinocembrin that’s been shown to kill MRSA in scientific trials. Interestingly, the high sugar content in honey renders the water within it chemically inert, making it unavailable for the growth of bad bacteria or fungus.
Eliminate as much stress as possible from your life, and learn to manage the rest in a better way. Chronic stress kills gut bacteria and weakens immunity, leaving us susceptible to infections and disease.
Wash your hands. When you come home from work or running errands, make it a habit to first wash your hands because you’ve been touching everything from door handles and gas pumps to checkout line keypads that have been touched by thousands of other people. While you’re out touching all those things, avoid touching your face and eating hand-held food like a sandwich, unless you have a way of cleansing your hands. Choose a knife and fork meal instead.
Clean your cell phone often. Wash your hands, then after unplugging all devices and turning the phone off, wipe it down with disinfectant wipes or spray a disinfectant solution of at least 70% isopropyl alcohol on a microfiber cloth and wipe the phone down, including the screen.
Take a daily probiotic supplement to support healthy populations of good gut bacteria. Be sure to choose a product that has at least 30 billion CFU (colony-forming units) or more containing at least 10 different strains with a minimum of two being from the Bifidobacterium classification, which is essential for colon health.
If you’re having surgery and going to remain in the hospital for a day or more, it’s best to follow your doctor’s orders and take the antibiotic. Ask your doctor about alternatives if you’re having the surgery as an outpatient. Don’t make the decision on your own.
Q: And for those that absolutely must go on a course of antibiotics — what steps would you advise to help restore their health once done? How long does it take to fully restore after a recent round of antibiotics?
A: There are two options. Get a high-quality probiotic of 100 billion CFU and alternate it with your antibiotic, taking them at least four hours away from each other. Otherwise, the antibiotic will kill all the probiotics in the supplement you’ve just taken. This will help continually restore the probiotics you lose while taking the course of antibiotics. Continue taking all the probiotics even after you finish the antibiotics. A full bottle usually lasts about a month. When that bottle is finished, take one additional bottle for a two-month course of high-dose probiotics for every course of antibiotics. Research shows that probiotic supplementation helps gut microbiomes return to near normal levels after antibiotics in 1.5 months. However, some original strains were still missing in stool samples after six months, so daily supplementation at lower doses (30-40 million) is important. It’s also a good idea to occasionally switch formulations so you’re regularly adding a good variety of different strains for gut diversity.
The other choice is to not start the probiotics until after the antibiotics are finished. This provides absolute assurance that none of the supplemental probiotics are killed off. Once again, you’ll need to take the high-dose probiotic for two months. Adding fermented foods to the diet will help, as well. Taking a collagen supplement can also work to restore the gut lining.
Q: We’ve heard a lot about the benefits of ozone therapy and its natural antibacterial and antimicrobial properties — would you say that consistently using ozone therapy and other natural medicines such as oregano oil on a regular weekly basis also disproportionately affects our gut microbiome by not supporting our good bacteria to thrive?
A: The assumption with ozone therapy is that because it’s oxygen, it doesn’t impact the good bacteria in our bodies because those strains are only aerobic. This isn’t true. Much of our good bacteria is anaerobic and is affected by hyper oxygenation, although not to the same degree as with antibiotics. Even so, long-term, regular ozone treatments aren’t recommended.
Q: How can we reframe our perspective of needing antibiotics or relying on them as a whole? Can infections still arise if we have a healthy gut?
A: Antibiotics are absolutely essential to modern healthcare, but we need to view them more as emergency medicine rather than typical treatment. They should be used when an infection is or could potentially become life-threatening. They are also important after surgeries, especially if the patient remains in the hospital where the risk of infection is higher. Outside these circumstances, doctors need to practice greater discretion when it comes to prescribing antibiotics.
Following the lifestyle recommendations I’ve provided here, along with a good daily probiotic goes a long way toward preventing infection so there is no need for an antibiotic in the first place. Prevention is 90% of good medicine. A daily probiotic is a good start, but isn’t enough. I can’t stress how important the lifestyle recommendations are for preventing infection, especially something as simple as washing your hands when you come home and not touching your face while you’re out. I have patients who’ve gone 10 to 15 years without getting sick following these recommendations. Because bacterial strains are always mutating, we certainly can get sick even if our gut microbiomes are healthy, however, infections will be rare, and the severity and duration will be much less.
For more health insights from Dr. Sadeghi, please visit beingclarity.com to sign up for the monthly newsletter or check out his annual health and well-being journal, MegaZEN here. For daily messages of encouragement and humor, follow him on Instagram at @drhabibsadeghi or tune into our podcast with him here.