Antibiotics eradicate pathogenic infections and save lives, they also disrupt the integrity of the intestinal microbiome. While many physicians recognise the need for restoring a patient's microbial balance following a course of antibiotic therapy, far fewer understand how to do this effectively. It can even help patients overcome the illnesses for which the antibiotics were initially prescribed.
Frequently Asked Questions
As antibiotics kill off infection-causing microorganisms, they also non-selectively destroy communities of beneficial gut bacteria, weakening the stability of the intestinal microbiome.
The degree to which these drugs damage intestinal microbiota depends on drug type, treatment duration, and frequency of use. Certain antibiotics trigger a greater release of endotoxins and cytokines than others. Higher daily doses are more impactful. Prolonged use of high-dose antibiotics can cause extreme damage to the microbiome that can take years of restorative therapy to reverse if it can be reversed at all.
Intravenous antibiotics can have the same negative impact on gut flora as oral drugs.
The timing of antibiotic delivery also makes a difference. Individuals who frequently use antibiotics early in life are more vulnerable to many types of illness as they age. Antibiotics have also been associated with obesity and weight gain in children as well adults. Researchers attribute these changes to the altered gut microbial composition.
Antibiotics can trigger the release of toxic lipopolysaccharides (LPS), large molecules found in the outer membranes of pathogenic Gram-negative bacteria. Some suggest that antibiotic-induced LPS release may contribute to the development of septic shock in patients treated for severe infections caused by Gram-negative bacteria. Others have demonstrated that LPS triggers an immune response by releasing inflammatory cytokines, a problem that worsens after antibiotic treatment.
The production of LPS is a survival strategy. These molecules interact on cell surfaces to form a barrier, preventing the antibiotics and other hydrophobic compounds from entering and allowing Gram-negative bacteria to live even in harsh environments.
Probiotics are a comprehensive strategy to restore gut flora following antibiotics. Looking at the microbial diversity of a healthy gut ecosystem, and when using products that contain many different species of beneficial microbes rather than "monocropping" with one or two single strains.
It’s recommended to use one month of probiotic treatment for every week that a patient was on antibiotics. Those who have been on prolonged continuous antibiotic regimens will need long-term restoration. For most people, there is no health risks associated with extended probiotic supplementation.
Patients receiving IV antibiotics should also take commensal probiotics. Some clinicians who are aware of this issue will start the probiotics as early as four hours after a dose of IV antibiotics.
People who have been on long-term or multiple courses of antibiotics typically show a severe erosion of the glycocalyx that normally coats the intestinal microvilli.
This is usually accompanied by a loss of brush borders and a marked reduction in secretory IgA production.
In some cases, these changes are caused by the effects of antibiotics themselves. In others, they reflect the impact of the infection for which the antibiotics were prescribed. Either way, the effect is the same: establishment of a microenvironment that is hospitable to opportunistic pathogens like Candida, but increasingly difficult for normal commensal bacteria.
Fungal infections are almost always accompanied by insufficient IgA production, as Candida consumes both glycocalyx and sIgA as fuels. It becomes a vicious cycle: low IgA begets Candida which further depletes IgA. Chronic urinary tract infections and mucosal infections like thrush are red flags for low sIgA production.
Without a healthy glycocalyx, organisms like Lactobacilli and Bifidobacilli have great difficulty establishing themselves. Supplementation with ordinary probiotics will usually fail.
Even if you recommend the best probiotics in the world, there’s’ no way for them to stick and colonise if the glycocalyx is eroded. You can actually exaggerate the GI symptoms by giving probiotics if the there's loss of ability to produce glycocalyx."
To restore a healthier microenvironment, you need to leverage the unique characteristics of Saccharomyces boulardii, an antibiotic-resistant, probiotic yeast originally isolated from lychee fruit in Indochina. It stimulates brush border enzymes, and promotes polyamine production, which feeds the intestinal microvilli and can be helpful for healing ulcerative colitis, Crohn’s disease, and irritable bowel syndrome.
It is important to be aware that in the first few days of taking S. boulardii, some patients may experience a noticeable "bowel flush" as the probiotic yeast displaces the Candida species. Candida die-off can also make people feel ill. It is best to advise patients of these possibilities beforehand, so they're not surprised if this happens.
In 9 out of 10 patients, four weeks of intensive S. boulardii supplementation is sufficient to restore a healthy glycocalyx layer and induce adequate IgA secretion. This then sets the stage for a much more effective round of restoration with a multi-strain probiotic.
Patients with irritable bowel syndrome or Crohn’s disease, however, may need longer-term support to rebuild a healthy microbiome after taking antibiotics.
Probiotics are just one part of the picture. If a patient cannot tolerate any type of probiotic, it’s a red flag that a patient's immune system is not functioning properly.
You first need to address any aspects of the nervous system especially sympathetic dominance that may be affecting the digestive tract.
Fish oil, zinc, vitamin A, and colostrum are to be of value in many cases. This is really good for restoring sIgA.
Glutamine supplements can also be helpful in some cases.
Plant-based medicines like oregano oil, tea tree oil, or pau d'arco extract may be helpful in ridding the GI tract of pathogenic yeast. These natural yeast-busters should never be used at the same time as S. boulardii; this "friendly" yeast is just as vulnerable to things like oregano and tea tree as the pathogenic yeasts.
A number of probiotic and prebiotic foods can aid the process of gut restoration.
When your gut has been compromised, you don’t want to tax your gut.
"Taxing" foods include wheat, dairy, sugar, unhealthy fats, and fried items. These foods, throw gasoline on the fire of a recovering intestinal system.
One should eat plenty of foods that promote the growth of healthy commensal organisms. Organic stewed apples, cooked until soft and shimmery, as one good option. Cooking apples releases pectin - a soluble fiber that provides fuel for beneficial bacteria.
The pectin present in stewed apples can also help to heal a damaged intestinal lining and seal off the tears in a leaky gut, preventing large food molecules from slipping through.
Collagen helps to seal a leaky gut. Patients recovering from antibiotic treatment are recommended to eat chicken bone broth, a good source of collagen, which also acts as a natural prebiotic, feeding the healthy bacteria in the gut.
Butyrate -- a natural substance made in the intestine -- is another important player in gut bacteria restoration. The cells lining the inside of the gut reproduce rapidly and that butyrate fuels the rebuilding of new cells. Insufficient butyrate production and a slow turnover of intestinal cells make the body more vulnerable to the development of cancer cells, resulting in a higher risk of colon cancer.
Probiotic fruits and vegetables, including foods bananas, sweet potatoes help to rebuild the gut microbiome, providing insoluble fibre that feeds good -- but not harmful -- bacteria.
Fermented, unpasteurized vegetables like sauerkraut, kimchi, and fermented beets, are another excellent source of natural probiotics. Every vegetable produces different families of beneficial bacteria during fermentation, encouraging patients to eat one forkful of fermented vegetables twice a day. The key to health in your gut is the diversity of your microbiome, pointing out that thousands of different families of bacteria live and interplay in the gut with wide-ranging impacts on our health.