Monday, November 3, 2014

Resilience to antibiotic administration

If I’ve painted a bleak picture these last few weeks, don’t despair.  As I’ve said, antibiotics save lives—it’s the overuse of antibiotics that cause problems.  While I hope you never get into the situation where round after round of antibiotics is prescribed, if it does happen, there is still hope.

Gut bugs are extremely adaptable.[43] Even after many rounds of harsh antibiotics, it’s possible to regain the vigor of a healthy microbiome. In long-term studies, gut bacteria has been irrevocably mucked up for up to four years following a single antibiotic administration, although, of course, it may be different for each individual person.  During and after a prescribed antibiotic course is provided, there are immediate steps that should be taken to ensure your gut bugs are treated right and the stage is set for the beneficial microbes to out-pace the bad in the race that is soon to follow.

Probiotic supplements taken along with antibiotics provide relief from antibiotic associated diarrhea. Best practice guidelines from over 10 years ago were hesitant to prescribe probiotics in conjunction with powerful, broad spectrum antibiotics because the studies were rare and few.[44]

Two recent reviews suggest that with the heightened costs and debilitation associated with antibiotic-induced diarrhea and C. difficile-associated colitis justify use of targeted and proven probiotics.[46][47] One author Eric Claassen concludes,

"When given orally and in the right dose in combination with exercise and an appropriate diet, probiotics can give a clear healthcare system cost reduction for several forms of IBI [iatrogenic bowel irregularity] with notable examples like AAD [antibiotic-associated diarrhea], CDAD [C. difficile-associated diarrhea], and CDI [C. difficile-infection]. Probiotics are safe and reduce disease/antibiotic-related adverse events by at least 20%. Treatment dose and protocols are product- and strain-dependent.”

A recent study following 48 patients on long-term antibiotic treatment gained weight and had significant changes in their gut microbiota.  Nearly 25% of the treated patients gained from 5-30 pounds over the 18 months of antibiotic use, while none of the controls gained weight during the same time.
"Doxycycline and hydroxychloroquine treatment exhibited a reproducible effect on the community structure of the gastrointestinal microbiota, with treated patients presenting significantly lower concentrations of beneficial bacteria, Bacteroidetes, Firmicutes, and Lactobacilli."

Additionally, the researchers discovered that the subgroups at most risk of weight gain could be predicted by the composition of their gut flora prior to administration of antibiotics.

[43] Lozupone, Catherine A et al. "Diversity, stability and resilience of the human gut microbiota." Nature 489.7415 (2012): 220-230.
[44] Surawicz, Christina M. "Probiotics, antibiotic-associated diarrhoea and Clostridium difficile diarrhoea in humans." Best Practice & Research Clinical Gastroenterology 17.5 (2003): 775-783.
[45] Claassen, E. "Cost-benefit relation of diet and probiotics in iatrogenic ..." 2014. <>
[46] Lenoir-Wijnkoop, I. "Nutrition economic evaluation of a probiotic in the ..." 2014. <>
[47] Claassen, E. "Cost-benefit relation of diet and probiotics in iatrogenic ..." 2014. <>


  1. hello Tim,is it true that the appendix is a store of gut bacteria ready to re-colonize a damaged microbiome when the gut has been emptied because of a bad flu or food poisoning/

    1. Much speculation that is the case. It does seem perfectly designed to be a hidden little back-alley in your gut to preserve a portion of bacteria.

  2. I did a gdx2200 immediately prior to a 2 month abx stint. At the risk of sounding incredibly douchey, my body composition stayed great throughout and afterwards. I had AAD during but it it quickly went away after stopping. I took a lot of various pro-bx during and after. Maybe my results can help fit a few pieces of the puzzle together as to why some gain weight and others don't(as per your last paragraph)?
    Bacteroides 2.0 Clost 3.0 Prev 1.8 Fuso 2.8 Strep 1.5 Myco 5.1 Lacto 4.5 Bifido 3.2 Esch 4.0
    Firmicutes 77%
    Bacteroidetes 23%
    4 years ago, I did 4 months abx with no weight gain either

    1. You've probably heard the story, but when I was in the military, they gave us major antibiotics (cipro) for the 6-12 month stretches we spent in Iraq and Afghanistan to protect us in case of an anthrax attack.

      I think everybody was on the 'fat-boy program' when we got back. They blamed it on the, ahem, good food we had over there and lack of regular pt.

      But really, weight gain was the least of the problems. I had the worst heartburn you can imagine and lived on Tums and Prevacid. I was a wreck when I got back for a long time. Lots of PTSD, cancer, and metabolic derangement now blamed on "Gulf War Syndrome."

      But not everyone gained weight, some lost weight. Everybody's different.

      You were smart to take probiotics!