Dynamic Duo: Antibiotics and Probiotics

Post on Dec 10, 2012 by Jennifer Huber from QUEST Northern California

Antibiotics work by killing bacteria or by stopping bacteria from multiplying. Each type of antibiotics affects different bacteria in different ways, although broad-spectrum antibiotics are used to treat a wide range of infections. Antibiotics quickly make you feel better because the drug kills the majority of the targeted bacteria very quickly.

However antibiotics also kill beneficial bacteria and induce negative side effects — most commonly diarrhea, upset stomach, and vaginal yeast infection. For instance, antibiotics cause about one out of three people to get diarrhea by disrupting the balance of the intestinal flora, a collection of bacteria and other microorganisms in the digestive tract. This can result in an overgrowth of the Clostridium difficile bacteria that causes diarrhea. Similarly, antibiotics can disrupt the vaginal flora and cause an overgrowth of Candidayeasts to cause a yeast infection.

Probiotics are live bacteria, yeasts and other microbes intended to maintain or restore the supply of beneficial bacteria in the body, particularly the stomach and intestines. Probiotics are found naturally in certain foods, including yogurt, aged cheeses, kefir, miso, tempeh, and fermented cabbage. Dietary supplements are another common source of probiotics.

Although probiotics have been widely promoted as a way to keep your body in balance, scientific evidence for these claims have been weakened by the small size of most research studies. However, the use of probiotics to reduce antibiotic-induced side effects is now becoming more widely accepted by the medical profession.

In a recent study  published in the Journal of the American Medical Association supports taking probiotics with antibiotics. A team of researchers from southern California combined and analyzed the results of 63 randomized controlled trials of probiotics for the prevention or treatment of antibiotic-associated diarrhea. The 11811 men and women included in this large combined study took a placebo or probiotics supplement along with their antibiotics. The people who took the probiotics were 42% less likely to develop diarrhea than those taking the placebo. This pooled evidence strongly suggests that probiotics can help populations of beneficial bacteria recover and more quickly restore balance in the intestines.

However, further research is needed to determine which probiotics are the most effective at preventing and treating antibiotic-associated side effects, as well as determine the optimal dose of the probiotics. Research is also needed to identify which antibiotics are most likely to induce adverse effects. Hopefully these further studies are underway.

Of course it is also important to limit your use of antibiotics, using them only for bacterial infections when necessary. Common cold and flu viruses don’t respond to antibiotics anyway.

Science

Are Antibiotics Making Us Fat?

Nov 2012

Paul Spector, M.D.

Founder, Pantheon Medicine; certified health and fitness specialist

Cleanliness may be next to godliness, but it might also do us in. A growing body of data suggests that a wide range of ills, from allergies and asthma to metabolic disease and superbugs, may be the consequence of our war on germs.

The territory in need of a cleansing now ranges from our garage to our gut, from our teeth to our toilet. Whether it's the surface of our kitchen counter or the surface of our face, cleaner is not just better, according to popular culture -- it's safer.

A kind of homeland security mentality has invaded the cosmos of clean. This is a two-front war, the world outside our bodies and the biosphere inside us. The axis of evil here is bacteria and all bacteria are bad. But nothing could be further from the truth. We can't live without bacteria.

The bottom line: Bacteria are an essential part of us.

Our bowels are a perfect example. There are way more bacterial cells living in our gut than the total number of our own cells in our entire body. We are, so to speak, colonized. These gut microbes turn out to be incredibly important. Anyone who has been on antibiotics, which kill many of these bacteria, can attest to the stomach misery caused by upsetting the balance of these little lodgers. Growing evidence suggests that a reduced diversity of these bugs is associated with inflammatory bowel disease, metabolic syndrome (prediabetes), asthma and even obesity.[1] So why would you want to "cleanse" a colon?

The first explanation for the proliferation of these disorders was the "hygiene hypothesis." This theory suggested that as we moved from rural to urban living, children were exposed to fewer bacterial strains that are essential to normal immune function. This has proven insufficient to explain the whole picture.[2] Now, the dominant paradigm in making sense of the explosion of these illnesses has less to do with external environmental exposure and more to do with the loss of our ancestral internal bacterial colonies as a consequence of antibiotic exposure.[1]

In the United States, the average child has received between 10 and 20 courses of antibiotics by age 18.[3] While there is no question that antibiotics have saved millions of lives, we are just beginning to appreciate the collateral damage. Without certain bacteria that we have experienced historically and that our bodies evolved to cohabitate with, bad bacteria are able to proliferate. This loss of "good bacteria" by antibiotic exposure appears to be linked to the huge increase in metabolic (diabetes, obesity) and allergic disease.

Let's look at obesity.

In the early 1950s, shortly after the discovery of antibiotics, researchers discovered that the administration of low doses of antibiotics to livestock dramatically increased their ability to convert food into biomass.[4] In other words, they grew much faster and reached a larger size. Between 1955 and 1995 (a before and after antibiotic-augmented feed comparison) the average broiler chicken changed such that it took 35 percent less time to reach market weight and had increased that weight by 50 percent.[5]

The way antibiotics enhance growth is poorly understood, but is presumed to be a consequence of their antibacterial action (rather than a side effect) because so many different types have this capacity. So antibiotics change the bacterial populations in these animals in a way that makes them grow bigger and faster. The younger an animal begins an antibiotic-augmented feed, the greater the effect.[1]

Are we fattening ourselves the same way we did our chickens?

It appears increasingly plausible that the widespread administration of antibiotics to young children is altering the bacteria in their intestines in a way that increases their ability to convert food into biomass, just like our livestock. In this way, antibiotics seem to be directly contributing to the obesity epidemic.

Let me close with a plea on behalf of the friendly bacteria that have taken up residence inside of us early in our development as a species. Antibiotics have rendered them an endangered species whose extinction threatens our future.

The ecology of our internal environment is no less important than our external one. We must be green inside and out.

What You Can Do

Make sure you use antibiotics only when necessary.

Try to avoid eating animals that have been fed antibiotics. (The use of antibiotics in livestock has been banned by the European Union due to the spread of antibiotic-resistant bacteria.)

Follow the advances in the use of probiotics.

When it comes to dangerous bacteria, we must cultivate the good bacterial part of us to survive them. Diversity is a good thing in man and microbe.

Huffington Post

Assessment of antibiotic resistance in probiotic strain Lactobacillus brevis KB290.

Assessment of antibiotic resistance in probiotic strain Lactobacillus brevis KB290.

J Food Prot. 2009 Sep

Fukao M, Tomita H, Yakabe T, Nomura T, Ike Y, Yajima N.

Probiotics Research Department, Research Institute, Kagome Company, Limited, 17 Nishitomiyama, Nasushiobara, Tochigi, 329-2762, Japan. Masanori_Fukao@kagome.co.jp

Our purpose was to investigate the safety of the probiotic strain Lactobacillus brevis KB290. The European Qualified Presumption of Safety (QPS) evaluation approach was applied to the strain. We determined the strain's antibiotic resistance, verified it at the genetic level, and determined whether it could be transferred to intestinal microflora. Of 14 antibiotics tested, 11 showed MICs within the limits of the QPS criteria. However, the L. brevis KB290 MICs of ciprofloxacin (a fluoroquinolone), tetracycline, and vancomycin were two, four, and eight times, respectively, the breakpoint MICs suggested by the European Scientific Committee on Animal Nutrition, and the MIC of tetracycline was eight times the breakpoint MIC suggested by the European Scientific Panel on Additives and Products or Substances Used in Animal Feed. Using analysis of gapped-genome sequences, we found no known transferable determinants for tetracycline or vancomycin resistance, and we found no mutations in the quinolone resistance-determining regions of the genes encoding GyrA or ParC for ciprofloxacin resistance associated with insertion sequences, integrons, or transposons. These data were confirmed by using PCR primers specific for the respective genes. We assessed the transferability of the resistance traits in conjugation experiments with enterococci and obtained no transconjugants, strongly suggesting that the resistance traits were not transferable. This study demonstrated that the antibiotic resistance observed in L. brevis KB290 was due not to dedicated mechanisms but to intrinsic resistance. According to the QPS criteria, these results provide safety assurance for the ongoing use of L. brevis KB290 as a probiotic.

PMID: 19777895 [PubMed - in process]

Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial.

Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial.
BMJ. 2007 Jun 29

Hickson M, D'Souza AL, Muthu N, Rogers TR, Want S, Rajkumar C, Bulpitt CJ.
Nutrition and Dietetic Research Group, Faculty of Medicine, Imperial College, London W12 0HS.

OBJECTIVE: To determine the efficacy of a probiotic drink containing Lactobacillus for the prevention of any diarrhoea associated with antibiotic use and that caused by Clostridium difficile. DESIGN: Randomised double blind placebo controlled study.

PARTICIPANTS: 135 hospital patients (mean age 74) taking antibiotics. Exclusions included diarrhoea on admission, bowel pathology that could result in diarrhoea, antibiotic use in the previous four weeks, severe illness, immunosuppression, bowel surgery, artificial heart valves, and history of rheumatic heart disease or infective endocarditis.

INTERVENTION: Consumption of a 100 g (97 ml) drink containing Lactobacillus casei, L bulgaricus, and Streptococcus thermophilus twice a day during a course of antibiotics and for one week after the course finished. The placebo group received a longlife sterile milkshake.

MAIN OUTCOME MEASURES: Primary outcome: occurrence of antibiotic associated diarrhoea. Secondary outcome: presence of C difficile toxin and diarrhoea.

RESULTS: 7/57 (12%) of the probiotic group developed diarrhoea associated with antibiotic use compared with 19/56 (34%) in the placebo group (P=0.007). Logistic regression to control for other factors gave an odds ratio 0.25 (95% confidence interval 0.07 to 0.85) for use of the probiotic, with low albumin and sodium also increasing the risk of diarrhoea. The absolute risk reduction was 21.6% (6.6% to 36.6%), and the number needed to treat was 5 (3 to 15). No one in the probiotic group and 9/53 (17%) in the placebo group had diarrhoea caused by C difficile (P=0.001). The absolute risk reduction was 17% (7% to 27%), and the number needed to treat was 6 (4 to 14).

CONCLUSION: Consumption of a probiotic drink containing L casei, L bulgaricus, and S thermophilus can reduce the incidence of antibiotic associated diarrhoea and C difficile associated diarrhoea. This has the potential to decrease morbidity, healthcare costs, and mortality if used routinely in patients aged over 50. Trial registration National Research Register N0016106821.

PMID: 17604300 [PubMed - as supplied by publisher]