Antibiotics, your gut and your weight!
In my early days of IC treatment, Ruth Kriz had put me on long term antibiotics for 9 months. Interestingly, I started to gain weight midway through my treatment even though my exercise and calorie consumption had not changed. However, I was eating the same foods every day and my stress levels were very high that year (I was in my first year of school teaching). I always wondered if the weight gain I experienced at that time was associated with negatives shifts in my microbiome while taking the antibiotics. In fact, most of my life I struggled with my weight; my IFM timelines indicates frequent antibiotic usage most of my life, thanks to chronic ear, nose and throat infections. The gut microbiota is identified as a key player in obesity, and changes in the gut microbiome have been correlated in the pathogenesis of obesity and other metabolic disorders (Zhang et al., 2017).
The gut microbiota consists of 4 phyla: Bacteroidetes, Actinobacteria, Proteobacteria, and Firmicutes (Baothman, Zamzami, Taher, Abubaker, & Abu-Farha, 2016). These enterotypes use different strategies to acquire energy from foods in the GI tract. For example, Bacteroidetes has the ability to metabolize carbohydrates and proteins and Firmicutes interacts with fiber (positively) and fat (negatively) (Zhang et al., 2017). “These strategies determine the incidence of obesity and related metabolic diseases” (Zhang et al., 2017). The composition of gut microbiota can influence a person’s ability to regulate their body weight. For example, a study examining the fecal samples of 416 pairs of twins revealed that the family Christensenellaceae is associated with a lower BMI (Zhang et al., 2017). Bacteroidetes is also associated obesity and is showing that it has the ability to alleviate diet-induced body-weight gain and adiposity by altering circulating amino acids (Zhang et al., 2017).
The effect of antibiotics on gut microbiota on body weight is well documented showing a long term reduction in bacterial diversity after use of antibiotics (Baothman et al., 2016). Antibiotic treatment in early life changed the gut microbial composition and the activity of genes associated with carbohydrate and lipid metabolism, as well as the level of special hormones, leading to the obesity (Baothman et al., 2016). The stronger, broad spectrum antibiotics are associated with more pronounced disruption on the microbiome, sometimes persisting as long as 4 years (Baothman et al., 2016). Numerous studies indicate that an increase in Firmicutes and reduction in Bacteroidetes phyla is associated with both increased energy absorption from food (hence less calorie burning) and increased low grade inflammation (Baothman et al., 2016). Two things I suffered from during the peak of my illness!
Interestingly, dietary changes can significantly shift the composition of these microbiota. For example, a high fat diet can reduce Bacteroidetes and increase Firmicutes, which dietary fiber can promote favorable effects on the microbiome. According to Baothman et. al, changes in the diet can account for 57 % of the variations in microbiota, while genetic variations in host that can only account for 12 %. “The dietary fiber-derived short chain fatty acids (SCFAs) and their receptors are recognized as one set of important mediator links of diet to gut microbiota-host homeostasis (Zhang et al., 2017). In addition, dietary omega-3 fatty acids were closely related to gut microbiota diversity by reducing the oxidative stress of intestines. A study conducted in 2017 with college students demonstrated that consumption of a single fast food meal was associated with transient biomarkers associated with risk of atherosclerosis (McFarlin, Henning, Bowman, Gary, & Carbajal, 2017). A “Western diet”, high fat and sugar, can significantly alter the composition of the microbiota in a single day! On the other hand, subjects fed a vegetarian diet, rich in dietary fibers, had lower counts of Bacteroidetes, E. Coli and other bacteria compared to the controls (Baothman et al., 2016). And finally calorie restricted diets can decrease Firmicutes to Bacteroidetes ratio (Baothman et al., 2016).
Recently, I decided to turn around my health and regain control of my microbiome. As a result of my efforts, I have been able to get off antibiotics and stop the vicious cycle of infections. What did I do to make this happen?
- I started to diversity my diet. The more diverse your diet, the more diverse your microbiome. I increased the diversity of my food choices by trying new foods. I focus on roots, tubers, cruciferous vegetables and leafy greens that are high in prebiotics. The prebiotics feed the good bacteria in the gut, which you want to encourage the growth. My next goal is to visit a different ethnic grocery store and try even more new foods my body has not been exposed to. This is going way beyond my comfort level, but it is something I realize I need to do to continue to enhance my health.
- Intermittent fasting and calorie restriction. There are certain microbes within that grow very well in a fasted state, such as akkermansia muciniphila, which is a healthy gut microbe for inflammatory bowel metabolism and leaky gut. In a paper dated in May 13, 2013, researchers at the University of Louvain, Belgium concluded that this strain of gut bacteria has the amazing ability to promote weight loss in humans (Silvers, 2017). In fact the study in 2013 states that “this human mucous colonizer can be used for the prevention or treatment of obesity and its associated metabolic disorders” (Silvers, 2017). This bacteria can talk to other bacteria in your body to help establish mutually beneficial relationship with you to stimulate and promote a number of beneficial physiological processes. I recently started water fasting, and it seems to have really exerted some interesting changes in my body. This is an area I would like to research further-the effects of water fasting on the gut microbiome.
- Probiotics-Right now I am experimenting with different probiotics. I currently take Megaspore biotic, Dr. Ohhira’s Probiotics and Femdophilus. The reason for taking the probiotics is purely theoretical. They are associated with promoting health in multiple different ways such as modulating inflammation, tight junction proteins in the GI tract and enhancing epithelial barrier function. Probiotics such as l. reuteri and l. rhamnosus (as found in Femdophilus) are found to modulate tight junction protein expression, while l. acidophilus can directly alter epithelial barrier function by influencing the structure of the tight junctions (Cui et al., 2017). Previous studies have demonstrated that just 4 weeks of treatment with Lactobacillus plantarum improved symptoms such as pain and flatulence in IBS (Lee & Bak, 2011). When my bladder was at its worst, so was my gut, as I had all the symptoms of IBS such as gas, bloating, and digestive issues. I take Dr. Ohhira’s to obtain a diversity of strains, such as Biofidobacterium. More recent studies demonstrate that bifidobacterium bifidum effectively reduced LPS-induced autophagy and can restore the integrity of the gut barrier that is diminished by LPS treatments in experiments conducted in rats (Cui et al., 2017). I have to admit, I do not currently eat much fermented food, and this is next on my list of things to do. However, I have started drinking raw camel’s milk and it’s quite tasting and the anecdotal reports look promising. Another item on my list of things to research!
- I eat a lot of prebiotic, fiber rich foods in my diet-My diet consists of about 80% fruits and vegetables. I also started to eat kiwis daily! Beneficial microflora strains like Lactobacilli and Bifidobacterium greatly benefit from regular kiwi consumption. One human trial found, acting to balance out these “good” bacteria while promoting healthy bowel movements and aiding the body in better assimilating nutrients from food (The Science of Eating, 2017). These prebiotics found in kiwi fruit help improve the overall functionality of the digestive system, while at the same time bolstering the immune system, a bulk of which resides in the gastrointestinal tract”(The Science of Eating, 2017). I also try to include a plethora of polyphenols (clover, ginger, star anise, spearmint, moringa, curcumin, schizandra, bilberry, blueberry, mexican oregano, thyme, rosemary). I also include flax seed meal, psyllium, vegetation, and hard fruit skins and cruciferous vegetables to get at least 32 grams of fiber per day. Polyphenols have been shown to increase the number of beneficial bacteria and decrease the number of disease causing bacteria (Lipski, 2013). Prebiotics are fermented dietary fibers have been shown to impact the host by specifically stimulating changes in the composition and/or activity of bacteria in the colon, increasing the number of Bifidobacterium and butyrate-producing colon bacteria/ “The proportion of butyrate in the intestinal microbiome was a key marker in the protection against obesity and type II diabetes, which indicated that the structure of the intestinal microbial community can be used as an effective environmental factor to prevent and diagnose these chronic metabolic diseases (Baothman et al., 2016).
I forgot to mention that I was given Orthobiotic while taking the long term antibiotics.
The strains in Orthobiotic are:
I now realize that perhaps the probiotics alone was just not enough to mitigate the negative effects of the antibiotics. It is clear to me it’s the synergy of the items I mentioned above that has really helped me repair some of the damage and restore my health.
Baothman, O. A., Zamzami, M. A., Taher, I., Abubaker, J., & Abu-Farha, M. (2016). The role of Gut Microbiota in the development of obesity and Diabetes. Lipids Health Dis, 15, 108. doi:10.1186/s12944-016-0278-4
Cui, Y., Liu, L., Dou, X., Wang, C., Zhang, W., Gao, K., . . . Wang, H. (2017). Lactobacillus reuteri ZJ617 maintains intestinal integrity via regulating tight junction, autophagy and apoptosis in mice challenged with lipopolysaccharide. Oncotarget, 8(44), 77489-77499. doi:10.18632/oncotarget.20536
Lee, B. J., & Bak, Y. T. (2011). Irritable bowel syndrome, gut microbiota and probiotics. J Neurogastroenterol Motil, 17(3), 252-266. doi:10.5056/jnm.2011.17.3.252
Lipski, E. (2013). Digestion Connection New York, NY: McGraw Hill.
McFarlin, B. K., Henning, A. L., Bowman, E. M., Gary, M. A., & Carbajal, K. M. (2017). Oral spore-based probiotic supplementation was associated with reduced incidence of post-prandial dietary endotoxin, triglycerides, and disease risk biomarkers. World J Gastrointest Pathophysiol, 8(3), 117-126. doi:10.4291/wjgp.v8.i3.117
Zhang, P., Meng, X., Li, D., Calderone, R., Mao, D., & Sui, B. (2017). Commensal Homeostasis of Gut Microbiota-Host for the Impact of Obesity. Front Physiol, 8, 1122. doi:10.3389/fphys.2017.01122