I have always stuck up for Western medicine. You can chew all the celery you want, but without antibiotics, three quarters of us would not be here. —Hugh Laurie
Last week, we learned that antibiotics are not as benign as they might seem. Even though they are miracle drugs, they can have an impact on our moods, our cognition — even our personality. This is because antibiotics disrupt our gut microbes, which can affect our brain via the gut-brain axis.
This week we look at some revealing paradoxes about antibiotics, what you should do when you take antibiotics, and what the future has in store.
The paradox of antibiotics
In third-world countries where infections are endemic, taking antibiotics while pregnant can increase the odds that the baby will have a healthy birth weight. But in high-income countries, antibiotic use during pregnancy is associated with low birth weight. That’s because mothers in high-income countries are more likely to get antibiotics regardless of infection. The net effect is thus negative, not positive.
Most mothers don’t know it, but they pass on more than their own genes to their children: They pass down microbes as well. When the mom takes antibiotics, it can affect this microbial heritage. Maternal infections and antibiotic use during pregnancy are associated with increased rates of schizophrenia, autism, anxiety, and depression later in the child’s life.
Antibiotics during pregnancy can save the life of both the mother and the baby, but it’s worth keeping in mind that broad-spectrum antibiotics may also damage the mother’s microbiota in a way that could have a lasting influence on her child. Some doctors recommend prophylactic antibiotics during the second and third trimester of pregnancy, but researchers are finding dwindling support for the practice, except in rare situations. Your doctor may not be aware of the recent findings on antibiotic side effects, so feel free to share this article.
How to take Antibiotics
Antibiotics will degrade some bacterial species, which will allow others to fill the gaps. In a balanced microbiota, these stand-ins are usually good neighbors. But in a poorly balanced microbiota, they can grow wild, producing dysbiosis. When you are taking antibiotics, you don’t want to encourage this overgrowth, so you can tamp down the weeds with a low-fiber diet. Eat simple foods like rice and bananas until the antibiotic treatment is over.
You may have heard that taking probiotic foods, like yogurt, can help with keeping your gut healthy. Sadly, it now appears that probiotics may not help, but rather hinder recovery. That is because a depleted microbiota can be overwhelmed by non-native bacteria, which actually slows the recovery of your normal microbes.
When you stop taking antibiotics, you will need to restore your friendly old neighborhood of microbes. Your best bet here is to eat a wide diversity of foods with lots of different colorful polyphenols and various types of fiber. A prebiotic blend could be a useful supplement if you can’t get enough diversity of vegetables and fruits. A Mediterranean-style diet is a great way to recoup from antibiotic treatment. It’s also delicious.
Alcohol can exacerbate a leaky gut, so use it sparingly. Sodas, candy, and other sweets will feed fungi. Bacteria and fungi have a complex relationship, but they tend to fight over resources. When antibiotics knock out bacteria, fungi enjoy a resurgence due to less competition. Fungal overgrowth can be tough to control, so don’t encourage it with sweets.
Can antibiotics be tamed?
A German study conducted by Lisa Maier, Camille Goemans, and colleagues from the European Molecular Biology Laboratory gives some hope for a better antibiotic outcome. The researchers looked at 144 different antibiotics and monitored how they affected specific gut bacteria. They discovered that several unexpected drugs could protect the gut microbiota against antibiotic damage. These include dicumarol (an anticoagulant), benzbromarone (a gout medication), tolfenamic acid, and diflunisal (anti-inflammatories).
These drugs allowed the antibiotics to attack their targets without killing beneficial bacteria. Maier says this novel approach, combining antibiotics with protective drugs, could reduce the harmful side effects of antibiotics, including psychosis. It will, however, take time to become a standard protocol.
Antibiotics are amazing drugs that have saved millions of lives, but in nature, nothing is black and white. The stories told here demonstrate that the gut-brain connection is vulnerable to antibiotics. That’s an important factor to consider the next time you get an infection.
References
Thinkhamrop, Jadsada, G Justus Hofmeyr, Olalekan Adetoro, Pisake Lumbiganon, and Erika Ota. “Antibiotic Prophylaxis during the Second and Third Trimester to Reduce Adverse Pregnancy Outcomes and Morbidity.” In Cochrane Database of Systematic Reviews, edited by The Cochrane Collaboration, CD002250.pub2. Chichester, UK: John Wiley & Sons, Ltd, 2015.
Suez, Jotham, Niv Zmora, Gili Zilberman-Schapira, Uria Mor, Mally Dori-Bachash, Stavros Bashiardes, Maya Zur, et al. “Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FMT.” Cell 174, no. 6 (September 6, 2018): 1406-1423.e16.
Maier, Lisa, Camille V. Goemans, Jakob Wirbel, Michael Kuhn, Claudia Eberl, Mihaela Pruteanu, Patrick Müller, et al. “Unravelling the Collateral Damage of Antibiotics on Gut Bacteria.” Nature 599, no. 7883 (November 2021): 120–24.
Essali, Norah, and Brian J. Miller. “Psychosis as an Adverse Effect of Antibiotics.” Brain, Behavior, & Immunity - Health 9 (December 2020): 100148.
Mostafa, Safinaz, and Brian J. Miller. “Antibiotic-Associated Psychosis During Treatment of Urinary Tract Infections: A Systematic Review.” Journal of Clinical Psychopharmacology 34, no. 4 (August 2014): 483.
Yousafzai, Zaland A, Qazi Kamran Amin, Wajeeha Qayyum, Azhar Saeed, and Nouman Anthony. “Ciprofloxacin-Induced Acute Delirium in a Young Female.” Cureus 14, no. 5 (n.d.): e25182.
Mohsen, Samiha, James A. Dickinson, and Ranjani Somayaji. “Update on the Adverse Effects of Antimicrobial Therapies in Community Practice.” Canadian Family Physician 66, no. 9 (September 2020): 651–59.