Antibiotics: The surprising truth about probiotics and what to do instead

if you were to ask me Dr B what is the antibiotic that increases our risk of a gut infection it's the antibiotic that you were prescribed Jonathan literally this antibiotic had wiped out 80 percent of these good bucks when you take out the good guys then what gets left behind is this bad guy he can now take over and dominate within that space to the point of actually causing a coal infection that can be life-threatening for people welcome to Zoe science and nutrition where World leading scientists explain how their research can improve your health [Music] now today's episode is a little different I recently fell victim to an unfortunate series of events but as they say every cloud has a silver lining and my incredibly painful accident means that today with the help of Zoe's microbiome testing technology and expert team I can show you what happened my gut microbes before and after taking antibiotics joining me to unpack this topic are two World leading gut experts Dr will bossowich and Professor Tim Spector Tim and will thank you very much for joining me today it's very exciting to have you physically in the same place well you know the drill are you ready to start with a quick fire round of questions yeah headers all right um maybe starting with will do antibiotics save lives definitely can antibiotics damage my gut microbiome definitely if my gut bike microbiome does take a hit after taking antibiotics can this damage be long lasting unfortunately yes will probiotics help my gut microbiome to recover after taking antibiotics unclear all right we're definitely gonna get into that last question Are there specific foods that can help my gut microbiome recover I believe so brilliant before we begin I have a favor to ask 63 of people that watch this podcast haven't hit the Subscribe button an 11 haven't hit the Bell to turn notifications on we want this podcast to reach as many people as possible as we continue our mission to improve the health of Millions doing us this small favor will really help so if you've ever enjoyed this podcast please hit the Subscribe button and turn notifications on thank you all right so Tim well I want to start we don't normally do this but actually telling a little bit of a story I went through as you both know rather an exciting start of the year so I was messing around in the house rushing from one meeting to another and I decided to quickly clean up clean up the kitchen and I knocked over this massive teak bench straight onto my toes I won't get too graphic but to say it was a little bit like uh sort of popping two grapes open so I don't recommend it to anybody who's listening at home uh luckily my uh my wife was nearby I called her up and said honey could you possibly come round and give me a hand uh she wrapped me all up and we went off to a hospital because I'd actually not just broken it but sort of smashed the whole thing up and open I ended up having to have a minor operation to like clean it all out and and sew it up and and the doctor um told me that the technical diagnosis was I had smashed my toes to Smithereens which I don't know if that's an American can uh diagnosis or only a British one well I think a translation will have gone true is pretty well yeah so um they did a fantastic job they cleaned it uh all out they sewed it all up and because it had been in operation I had been in um a operating theater uh they said you need to go on the course of uh antibiotics and rather luckily I have two of the world experts on the microbiome sort of in my my phone and I remember because I messaged both of you and will because it was still uh sort of um early evening in uh in the east coast you immediately replied when I explained um what had happened so I'd love to go back to that point and maybe tell me what you were thinking at the point that I explained what had happened and said like what do you think I should do part of the context that was really relevant and important to me as a gastroenterologist was you shared that you have a history of your old bowel syndrome and also that you've had issues with diarrhea in the past and so that sort of made me think this is a person with a gut that may be more vulnerable um and then you shared the antibiotic that you were on and I have to tell you that this I was not happy when I heard about it and you were taking I'm pleased to say you didn't really say that exactly to me at that point because I was committed yeah well I don't want to scare you so I mean I I I very directly gave you advice without sort of explaining the entire sort of logic behind what I was doing but let me just say that yeah unpack it for us now yeah let's let's unpack this specific antibiotic um because it kind of froze me in my tracks and made me go whoa okay hold on we have to make sure that we're handling this properly uh the antibiotic is called clindamycin and clindamycin just to explain this for people at home um the reason why you were prescribed this antibiotic is to protect you from skin infections and the specific type of bacteria that we want to protect against is staph aureus staph aureus can cause an infection in this area and if it did it would be catastrophic for you and this would be like a really bad thing to happen so we need something that's going to treat that um and clindamycin is one of the ones that does but there's unfortunately like clindamycin is a fairly broad spectrum antibiotic and can you explain what that means yes so what that means is that it's not just something that will destroy staph aureus it will destroy many many more microbes than that a very broad range of microbes when we say broad spectrum we're referring to the range of different bacteria that are vulnerable and susceptible to the antibiotic um clindamycin has this unique property where it can treat now I'm going to be a little bit nerdy for a moment so please I apologize because these are terms that I know Tim knows but I I think many people I don't even know Jonathan if you could have been exposed to this but there's these bacteria that we call anaerobes anaerobes means that they don't breathe oxygen they can't survive in an environment where there's oxygen but our body is actually filled with these types of bacteria and clindamycin is the antibiotic that you would use to destroy anaerobic bacteria now here's the problem the vast majority of the microbes in our gut are anaerobes so when we're trying to protect you from this one skin bacteria we are simultaneously gonna have this shrapnel this additional damage that takes place with the destruction of anaerobic bacteria with the recognition that our gut microbes are mostly anaerobic bacteria so uh this becomes very relevant because the reason why I have a as a medical doctor a knee-jerk reaction to this antibiotic that I don't like it makes me cringe is because this if you were to ask me Dr B what is the antibiotic that increases our risk of a gut infection called C diff clostridioides difficile this is a nasty infection I'm happy to unpack that in more detail but if you were to ask me what is the one antibiotic give me one name that's going to increase my risk it's clindamyce it's the antibiotic that you were prescribed Jonathan this often shows that the doctor that was treating you had a very short-term view of what he wanted to do right he wanted to get you out of there make sure that you weren't getting an infection he probably knew he didn't have to see you again just made to sure that you know you weren't going to die or get an infection he didn't really think about all the other things that might happen months down the line because that wasn't going to be his problem and that's generally the problem of short-term thinking uh within medicine and why he actually chose a a drug that as well says is designed to clear out your gut of anaerobic bacteria is often used in that way for people who want to you know reboot the gut in a way it's it's a it's a it's a bit of a block pretty heavy duty when you told me I was pretty uh shocked clindamycin wow that that's usually last resort you know that is something that you know or we know he's resistant to this you know this is a life-threatening illness not uh I've got a couple of squashed toes and I need to make sure you know that this one bacteria doesn't grow on there which you know before 1946 we didn't worry about we just cleaned it and uh hope for the best so it this it was a bit of a shock that done this as you know did you coax them into it Jonathan you say oh give me this most strong antibiotic you possibly can we know I'm keen on being in a like human guinea pig for science both of you so yeah I thought it would make a much better podcast if I don't know what happened that that perhaps you may want to share that's right so I told Tim that there was a suggestion that I might be allergic to penicillin um which was something that came about from 30 years ago and so he immediately said well you know I'm not I don't think we can should take any risk um and this was um I understand part of the the reason could you explain for a minute I think because I don't understand this and I suspect many other people don't like if you can in a very simple way like how does an antibiotic work and also how comes I can just swallow it and it will suddenly like kill bacteria in my toes as well as my my gut so it's sort of a bit magical yeah well antibiotics are these compounds that are produced by other microbes so the the first one uh came from an aspergillus which is a part of the fungus family and it it used all the microbes themselves produce chemicals to keep their Niche they're fighting their way so basically what we've done in nature is taken what uh by looking at you know various yeasts and fungi and other microbes what chemicals they produce and do they have some power against other microbes then we've magnified it used uh sort of genetically modified yeast to produce tons and tons of this stuff that we then synthesize chemically so we're using Nature's defenses in really big numbers to to attack these microbes we're we're unclean on but it's only recently we've started worrying about all the uh casualties if you like the bystanders that get wiped out at the same time and you've talked me through like let's say I'm swallowing the this antibiotic which you said comes from originally been made by like a yeast or something it could just talk me through what goes on inside my my body as a result so yeah so you you've got this compound which is in a capsule and it it goes beyond your stomach so usually it's not destroyed in in the stomach it passes through to the small intestine and some of that will be absorbed there and gets into your bloodstream and so this is where a lot of the most things get absorbed in the in the body end up in your blood so you'll start to get levels of that in the blood and so if you had a blood-borne infection uh so-called septicemia it would start to help there and then some of it is also staying inside your gut and goes down to the lower intestine where that chemical will start interacting with your gut microbe community and killing off the The Friendly guys and the ones the bit that's gone into the blood is also getting close to the skin and so would fight off any staphylococcus which uh this is the the one that for you they were trying to avoid that would get into your body through your skin through that wound so it's getting to your toe uh through this rather circuitous route and as a byproduct is going everywhere and and it sounds like it does a lot of it end up in in your gut as a result or is it sort of doesn't matter it's just like it's everywhere and it's powerful enough that it has its impact we know that the downstream effect that it's going to have on your gut because again if we go back to what is the likelihood of you having diarrhea associated with an antibiotic which of course the diarrhea like basically What's Happening Here is we're disturbing the balance within our microbes to the point that they actually are no longer functioning the way that they're supposed to right so if we look at what are the antibiotics that are putting us at the highest risk of developing antibiotic Associated diarrhea this is this is right at the top of the list and then if we look at what happens where someone develops this C diff infection that we've been describing basically what's happening Jonathan is in this C diff is is commonly associated with taking antibiotics basically the good microbes that currently reside in your gut are protecting you from this C diff the C diff may be there but it's not functional or capable of doing anything but when you take out the good guys then what gets left behind is this bad guy and the bad guy he can now take over and dominate within that space to the point of actually causing a coal infection that can be life-threatening for people in the last years so we're not talking about a trivial uh gut infection this C diff becomes recurrent C diff and normal antibiotics don't get rid of it so every time you give an antibiotic because it gets worse so it's actually caused by antibiotics the first usual old-fashioned treatment was more antibiotics and they only worked in about 20 percent of cases and it made worse and worse in people's lives you know it was often fatal I was as you can imagine sitting here feeling a bit paranoid thankfully will didn't give me all of this level of fear but I was feeling um uh a little bit paranoid about it and in part that was because I'd also had this fantastic experience over the previous four years with Zoe of like steadily improving my microbiome which you know I was in the unusual situation where I'd had a whole series of full shotgun sequence microbiome tests over the the previous four years and so we actually have some data which I'd love to to share and then get you to to help to explain a bit a bit more um so um I knew that when I'd done the very first test we did as part of our first sorry um predict studies my um my Zoe Hill school was about 50 out of 100 which put me sort of like in the middle of the population it's already much better than it would have been I think a decade earlier when you were talking about sort of the um the real digestive health issues I was having but still sort of middle and by the time I actually happened to have it tested literally four weeks before I broke my toes and my score got all the way to 78 out of 100 so I was basically sort of in the top 20 so it's sort of been getting steadily instead really better which I was really pleased about I'm feeling really good um and so I thought well one thing I'm definitely going to do is I'm going to start retesting very frequently and see what happens and I was nervous that after like all of this hard work it was going to be um to be smashed away so I think you've talked a little bit about the um like the immediate concerns about what might happen before I maybe share like what what did happen over the next week would you both just maybe share with me like what did you tell me to do at that point and why my concern was Europe you have this OBS history you have a history of diarrhea there's the family history with your grandmother to see diff Perfection I was worried about you potentially developing this infection C diff because of the fact that you're on the antibiotic that is so well known with this happening so my recommendation to you was that you take a very specific probiotic at a very specific dose and that was saccharomyces boulardii and uh at 500 milligrams once a day and the thought process there was to protect you from developing uh diarrhea instead of infection and my advice I think I asked you do you get uh bad problems after taking antibiotics and we talked about your penicillin problem I said it's likely to be complete nonsense you did the doctor should have just ignored that and given you you know the more standard uh less super strong antibiotic vast amount of people who think they have a personality don't when they're tested uh and I think that's important important lesson that you know as we're running out of antibiotics people don't exclude 80 of them um and the second thing I said you didn't get diarrhea after antibiotics I said well because you also do I take a probiotic and the evidence shows that probiotics do prevent uh post uh antibiotic diarrhea in randomized controlled trials there's quite a few of them if you take if you take them at the same time they'll reduce it but um I didn't recommend probiotics for you because of this um one Israeli study of only eight people but really thoroughly done and with mouse models and intensity that that showed that probiotics in in many people if given at the same time can actually make the recovery slower the reason we don't totally understand is that by having a sort of powerful induction of some extra new microbes it in a way stops your old Community getting back together again and I didn't want to have that and because there aren't any randomized controlled trials of people taking antibiotics to improve their gut microbes um I was saying at the moment the current evidence suggests you're better off not taking commercial probiotics but just taking fermented foods and so I I said to you take as many fermented foods as you possibly can a whole variety of them and hopefully that will do the trick so I was really struck by this is like I'm really lucky right I've got two of these World experts um uh available I thought you were both going to suggest me to take this really broad mix of probiotics and in fact um neither of you did maybe we'll starting with explaining why did you basically suggest this one particular probiotic and why not uh a broad thing and I think that's really interesting to um to understand yeah well and I think that first of all it's important to say that you know Tim and I were looking at the exact same literature and the cell study from 2018 from the Weitzman Institute is something that I was thinking about as well it suggested that surprisingly to all of us the use of probiotics may actually negatively affect the recovery of the gut one on the flip side a different a different question is risk associated with antibiotics in the short term the risks of developing diarrhea the risks of developing a C diff infection and these are different things it's not the exact same thing that we're talking about here where do you put your priorities with this because you're either going to give a probiotic or you're not in the vast majority of people and we can unpack this further if we want to in the vast majority of people I don't actually give probiotics anymore after antibiotics but in this particular case with your particular history and with the fact that this was this specific antibiotic it tipped the scale for me to feel more comfortable with you actually being on this specific probiotic and the reason why I chose the one that I did with uh protection from C diff protection from antibiotic Associated diarrhea the most evidence that exists is with the probiotic saccharomyces bilardia the one that I recommended in fact there are randomized controlled trials randomized controlled trials involving more than 100 people that convincingly show us that you can actually reduce the likelihood of developing antibiotic Associated diarrhea or C diff infection by about 60 percent by taking this probiotic to me that there's tremendous value with that and to make sure I've got that what you're saying is like potentially if I had just been on um uh something lighter uh you might have actually not even said that and only have sort of gone with what Tim was really talking about which is the the package of fermented foods a hundred percent that is 100 true and we don't know what would have happened all we know is what did happen and we're all just making the best uh using the best available information to make these choices so the only thing to add is to what Will's been saying is that there's the risks of antibiotic diarrhea and problems are much greater in young infants and the elderly and so the threshold for using say probiotics in those situations is much lower so if you'd be much older or it had been you know a young kid of yours uh Our advice would probably mean different as well so if it had been my grandmother you would have said not only that particular single probiotic which we will buy the way put in the show notes but also like a broader set of probiotics no I would use the probiotic that's evidence-based that has the randomized controlled trials to clearly demonstrate that we can reduce like this is a very targeted approach it's still just that one for you will like that is because it's not necessarily better so that's really interesting so ultimately what we want is we want to lean into where is where does the evidence exist that's the most profound and where we're confident and when it comes to probiotics I mean look like these probiotics they're not pharmaceutical drugs so they don't have the phase three clinical trials but thousands of people so when we get a randomized control trial with over 100 people we celebrate that that's and there's value that we find in that so with that I would still do this specific as the most powerful evidence for what we're trying to accomplish with the probiotic is actually behind this single strain it's a yeast actually that's not a bacteria you didn't say that it was but just making that queer for the audience so in you know with what Tim is saying you know in my mind as I'm clinically processing this I'm thinking about the antibiotic that you were prescribed but I'm also thinking about the specific patient and and what fits and you know what Tim's bringing up is people who are young people are old people who have other medical problems people who have inflammatory bowel disease or people who have a history of a C diff infection those are all like if you've had that infection in the past those are higher risk people and because they're higher risk it makes it more valuable to actually give them that enhanced level of protection so let me advance the story a little bit and and sort of tell you um you know where I was a week later so you know the antibiotics is actually only five days so it's almost like I think as everyone knows who does it it sort of happens incredibly fast so it feels I think as a lay person like Well it can't have had much impact right it's just a couple of days it does as much I think it's gone I was able to test my microbiome again and actually I started to test it every week from this point because it'll be really interesting to see what happens so when I got my results I was pretty shocked because actually this antibiotic had had a really big impact so I had got my uh my Zoe gut health score up to 78 on this first test which was just seven days after I had broken my toe seven days after I'd started the antibiotics that score had dropped to 40. so that was below where it was you know four years ago like overnight so there's like wow I've gone from like the top 20 to like the bottom 40 just by popping like 10 of these pills Pauling ears were hard work wiped out exactly so that was this I was pretty shocked by but on the other hand I knew that you know there could be a um you know you could have a knock and that sometimes said like maybe you get more of these bad bugs what was I think particularly shocking and I think also surprising I think even for you is we have this new um research study that's going on pushing to really identifying the individual you know microbes individual bugs that are that are viewed as good and bad and literally this antibiotic had wiped out 80 percent of these good books so I have to admit like I was shocked I shared this data with you guys what did you think I said well that's quite a big reaction but most people you know I would try and reassure you that actually this should improve there are a couple of studies where they've given volunteers antibiotics and every week they've followed their their microbes and by eight weeks most people have recovered they've all gone down as you did in those first couple of weeks most people recovered by uh eight weeks but both of these studies and I think between a dozen and uh 30 people so smallish studies but they've always been this other group so maybe a quarter of people have not uh got back to normal but I said okay chances are you'll be in that you'll be fine at eight weeks they're not dead completely you've just they've stopped replicating they've stopped having fun they've stopped eating and they've sort of gone into a little shell like this and they're hiding in your appendix and these little crevices uh you know and they've got nothing to eat and they're just hoping they can survive long enough to to come back up up again when you know and this is a story I was relying on as well I was like well I'm gonna go and like double down on eating the best possible way and it's all going to jump back in in a couple of months now before I sort of share I guess where I am uh today could we talk a little bit more about this fermented food so um if probiotics sort of I've been taking this one pill which I I took um for uh um I think about a month or something like that and then I was like full in on the fermented foods could we talk a bit about why fermented foods are so interesting fermented foods are basically probiotics live microbes but actually in food as opposed to in a capsule or in some synthetic version so these are things that have been we've had them for thousands of years in our in our diets and we're talking about uh the live cultures they're in yogurts they're in cheese they're in Cafe which is fermented milk we're talking um uh sakra which is fermented cabbage we're talking kombucha which is fermented tea kimchi miso etc etc all these ferments and compared to probiotics they generally have lower doses but um but most of them apart from maybe cheese and yogurt have there's many more species many more types many more diversity of microbes than you'd find in a probiotic capsule so the average yogurt has maybe three species but in once you get to cafes and kimchi's and kombuchas you can get anything between 20 and 40 different types of microbania bacteria but also some yeast 20 to 40 versus two or three so there's like enormously more different types exactly so my way of thinking is that probiotics when you take a capsule like you know saccharomyces it may be very individualized whether it's going to work for you or not depending on your community is it going to respond to that guy yes or no and that sort of we sort of see that in the results not every not you don't get 100 response because you know some people just don't have the gut Community that's going to be receptive to this new guy coming in and uh you know telling him what to do uh whereas my view is that fermented foods give you a much broader uh choice so that you've got all these different microbes that are quite happy living together in the food and collectively they're going to have a better chance of having an effect on on your gut and restoring it to health and we know from other studies randomized controlled Trials of fermented food that getting five or six little portions a day in a few weeks can actually reduce inflammation and boost your immune system so there is now science behind these these fermented foods so that was my rationale for saying to you get as many of these different ones you can go for diversity because that way you get different bugs in your kefir as your your kimchi and your kombucha and hopefully some of them are going to work right I was just throwing the kitchen sink at your problem and saying well you know we don't know which ones are the best or not we don't really know yet how to personalize it for you yet hopefully Zoe will sort that out in the future but we don't know that yet so that was the that was the thinking and there have been some and there are some studies showing that fermented foods do work in people with gut problems uh and and diarrhea Etc it's not as well documented as probiotics but there is there's some data so I immediately bulk ordered the kombucha and the kefir and the kimchi Tim that you recommended and I was in uh I was in London at the time how do you figure out um whether this is going to be something that is going to be full of these live bacteria or actually like it has the stamp on it and I know that sadly there's actually there's a lot of things out there that say for example kombucha on it but don't really meet the criteria Tim can how did how do you differentiate that and then maybe just tell me you know how did you advise me specifically what to use the first thing is to look at the label very carefully and if it's got um so say taking kombuchas or or water cafes which are generally or fruit cafes which are sort of similar uh you check there isn't huge amounts of sugar in it or large amounts of artificial sweeteners because we know artificial sweeteners have negative effect on the gut and the gut microbes so you definitely don't want anything with that in it and you also need to check that it hasn't been pasteurized and uh it might be in tiny little letters you know that that's been pasteurized so it may be perfectly done but to give it a long shelf life it's it's been just slightly pasteurized which means slightly dead and so the key thing is like you've got to make sure it's alive you said to me it's like there's a lot of ways that potentially stuff might and you can tell it shouldn't have a shelf life of two years for example um that will tell you it's definitely dead uh some of the kombuchas can have a shelf life of or on cafes and things and kimchi's for a couple of months usually it's shorter than that but that's the most you should ever get in and uh on kombuchas you should have often see a little sediment at the bottom showing that it's actually forming something live it's real it hasn't just been so filtered and processed that there's nothing left and the it shouldn't have lots of fruit and other stuff added to it as well because that also is a sign that's been Ultra processed and isn't real and often if you open it it should have Fizz I think the one I said oh I know Jonathan you like chuckling goat because it's really smelly and it's got a real F Fizz on it when you open it and so you really know it's live you know it's like and it's got a very pungent taste that's right so I had this experience you have to actually go and look at a video online for how to open it because when you open it it explodes so much that like a good chunk of it ends up sort of pouring around the side and you need to collect it so you don't lose it so again quiet and my my children thought I was mad but also thought this was really funny um and it was definitely stronger than the average uh kefir and I felt really good because it felt like it was definitely medicine this was definitely taking this properly uh and you also recommended I think a kombucha which again you'd seen made so you were like confident that's why it's the Momo Factory in London I'd seen what was done and they nearly all got a little sediment in it I know you're very skeptical of the kombucha's uh up to that point but um I was all in on anything that was going to help with me I was not worrying about my blood sugar at this point let's say this was like 100 focus on my gut you can be conned very easily in this game I think that's that's the message for people you know you could be taking the best intentions you taking saying it's pasteurized it's got so many artificial ingredients in it it's not useful it's too sweet um you know if you can't make it yourself really carefully and realize that if it's really cheap it's also unlikely to be the real thing because it has a shelf life of a year or so and they can Mass produce it the sauerkraut that I grew up on was in a a can and it was the second ingredient was vinegar and that that is not actually fermented sauerkraut when you make pickles or when you make sauerkraut it may surprise some people but what you want to look for in the store is that actually the ingredients are whatever the plant is plus water and salt water and salt is how you actually create fermentation so and again I feel more confident when it says live active cultures or live probiotics on it so I'd love to run forward just one month what has happened at this point and so the good news is that my number of good microbes have doubled at this point yeah I think if we were to conceptualize like where you started in the beginning what's what's use the term eubiosis eubiosis is the term that we we would um give to a microbiome that's in balance and the good guys are outweighing the bad guys that's what you had 38 good ones six bad ones right there the good guys are in control of that environment it's a stable healthy environment that is hard to shift but unfortunately the fastest way to cause a shift in this microbiome is actually antibiotics and antibiotics actually are medically inducing dysbiosis dysbiosis is the term that basically means a shift towards an unbalanced microbiome there's more vulnerability the microbiome is not able to do its job the way that it's supposed to so now the the problem is that when you reduce the good guys Jonathan you're creating a tremendous opportunity for the bad guys to take over where the good guys left space and so they will actually flourish that's quite depressing well and that's and that's to some degree we expect uh this sort of medically induced dysbiosis to occur after antibiotics the part that one that we did not expect that we're seeing with you is that this is lingering this is actually getting worse as you're doing serial tests now a month out your your measure a month out is worse than it was after a week um and I certainly don't like that I would have thought that we would be moving in the right direction by this point not necessarily back but at least moving in the right direction so to bring it up to to date which is like at this point um sort of three months afterwards my scores recovered a little bit I'm back up to 36. there's no more increase in the bad bugs in fact they're starting to Trend down a little bit I've got one more good bug so like a little bit better but the final summary you know for where I'm I'm standing today is this has been a like a really big shift and you know timing the way you describe it is like you know my previous stale micro a stable microbiome has been sort of smashed up and then this is sort of slowly progressing and I think um I guess the obvious question I have is beyond taking the fermented um products is there anything else that one should think about if I'm saying well you know what I want to get to this much healthier microbiome you know maybe I have to accept this is going to take some time what else can what else can I or anybody listening to well we know from a number of studies include include very careful Mouse studies that uh increasing your fiber is really important because that will directly impact the good guys and if you can get more of those good guys in they'll suppress themselves the bad guys and the bad guys are living off this inflammatory they they like inflammation they like a sort of slightly stressed gut and so the more you can put fiber and other good things in there and other plants it goes back to the general rules for our gut health so which are you know getting lots of fiber getting it through plant diversity and reducing as much as possible Ultra processed foods which are yeah which are stimulating the bad guys and I know I know you're already doing that but for you know other people who might not know about this so I think they're the other things you could try doing more time restricted eating give your gut a rest overnight because we do know that microbes themselves have a sort of inbuilt laundry service where they they they do the cleaning at night if they're if they're not having late night snacks and things so they can come in and really tidy up your mucosal layer on your gut so it's pristine in the morning and then that that seems to help gut health as well in your immune cells so I think it's a combination of those those gut things um and you've probably got some other tips as well I mean just to build off I think that's a great foundation and like the general concept that you're proposing which I completely agree with is you want to feed the good guys and you want to starve the bad guys right so this is how we restore the balance feeding the good guys with the high fiber foods and then with the bad guys we want to be cautious to the best of our ability in terms of the things that are feeding them and including refined carbohydrates like sugar the artificial sweeteners the ultra processed foods high levels of saturated fat intake um alcohol consumption we I think we want to be careful with all these things and then the other thing Beyond Tire restricted eating is we know that sleep is uh incredibly restorative to the microbiome so getting a good night's rest as much as possible spending time uh with exercise spending time Outdoors these are some of the strategies that can all help this is my one individual story and if people are listening to this like how should they think about taking antibiotics in general does this mean you should never take antibiotics like how common is this you know what would you be saying well I think that before we even go there your experience is is unique to you but also there is evidence in the in the medical literature to say that there are people that this similar thing happens to so there was actually a study that Tim and I have been looking at together where they they took a group of people very nice study and they found the vast majority of people as Tim alluded to they recover by eight weeks but there was a small subset of people that they could not explain why this was but these people their gut took a harder hit and it basically started to resemble resemble the gut of an ICU patient I'm guessing that's not a good thing that's not a good perk so in the depths of dysbiosis and then what they had to do is continue to look so you know we have the data up to three months well in this particular study these particular people they didn't really start to get back to their Baseline for about six months they did get back to that place so I think that's that's you know one of the points of encouragement but I think that the the takeaway here is that for some people it may take longer to make that recovery than others yeah and and there are some people that recover totally in two weeks so who just seem to have a microbiome that just bounces as often this is fairly trivial you know and they have no no real secretory but and this is where I think the exciting science is if we you know we at Zoe for example collect enough data in the future we can start personalizing this so you know you'd know that when you went to see your uh your surgeon you said listen I'm highly you know I'm highly likely to get a long-term reaction to these antibiotics you know give me something else or you know I'll take more of a risk or give me some topical cream to put on you know an antiseptic antibiotic cream on the on the outside rather than poisoning my gut so I think in the future we can see how hopefully we can pick whether you're a good responder medium responder a bad responder and and offer much more tailored advice but I think the other the other advice is um you know there is epidemiology data showing that overuse of antibiotics does uh increase allergies and to some extent weight can cause weight gain particularly in children and we know that in the US and the UK we're overusing antibiotics probably about two to threefold from what we actually do need to use them for and I wanted to ask a bit about that because you've I think made clear that I had a particularly heavy antibiotic right so it sounds like this is much stronger than average how would you think about um because and I've heard you talk about this sort of repeated antibiotic usage versus single antibiotic usage maybe something that is more you know not as strong as is how would you as people think about this like weighting the risk and I think we often think about this for example if you know with our kids and and things like that as as well as for ourselves so I think you know Jonathan from my perspective when I think about these things as a medical doctor you're thinking about benefits versus risks and when a person has an infection that requires antibiotics or in some cases like for example in your situation it's not to say that it was wrong to take antibiotics across the board when the benefit is there then we have to consider that there is and I don't think I mean hyperbolic when I say this the greatest invention in medicine in the modern times was the discovery of antibiotics there's no specific thing Beyond this that added more years to our life expectancy if you look at the top causes of death in 1900 they were all infections now they're not even close to being the top causes of death because we have these antibiotics but they we we have to be thoughtful about their use and so really what we're getting into here is do you need these antibiotics are they really required what is what is the appropriate antibiotic how how broad spectrum do they have to be you know it's just be thoughtful if we could with our medical doctors and ask questions what happens if I don't take this antibiotic is this the right antibiotic for me how long do I need to take it and by asking those questions we're trying to really sort of minimize our exposure yet get the benefits that we're looking for I have a personal story here because I've always suffered from sinusitis which is a nasty chronic infection of the sinuses started by bacteria and then it just becomes a long-term infection and each time I got a cold usually it would go to sinusitis and probably for 20 years every every time my cold lasted more than a week I would go onto antibiotics to try and clear the infection they were taking for two weeks so you would have taken dozens and dozens of courses yeah unlimited you know Supply had you know a big big supplies at Home in a valley a value pack of antibiotics did you often you know as doctors do self-medicating and uh not doing necessarily the right stuff and it was anyway I really got into the gut microbiome uh you know about 12 years ago I I you know that's when I stopped but I also the other reason I don't take them now when I get infection I still get infections is that if you look at the literature often the difference between taking them and not taking them for something like that is about one day of symptoms so yes statistically they work in Trials but the difference between taking them and not taking them might only be a day in symptoms and so this is true for many many conditions that do self-resolve not all and as well says they're often good reason to take antibiotics but there's many like this where it's a bit touch and go and anyone who now values their gut microbiome more than an extra day of respiratory or you know nasal symptoms I think needs to take notes so and the good news is that having taken many more antibiotics than you um in the last 10 years by improve my gut health you know I have a really good gut score so I think if there's a bit of optimism there it may not come back immediately but you know I'm hopefully you can get up there in the high 80s and beat me on I think it's a brilliant story so you're saying like even with all of the antibiotics you took when you started this journey around the microbiome you know like a dozen years ago actually managed to get to this um to this great Point well I think I think the shift is it's hard for healthcare to move away from what they sort of accept as their standard you know the standard is to sort of liberally use the antibiotics and not to see this risk because the the research on the gut microbiome is so new that it really hasn't gotten into the mind of the medical doctor who's conventionally treating a person who has sinusitis or whatever the issue may be they're not really thinking about that and I feel this happens a lot with children I and I'm particularly struck also in different I remember like I grew up in the states and my mother tells me about the amazing number of courses of antibiotics I had by the time I was like four years old and even contrasting with my my sister who was born 10 years later in the UK like many fewer um there's 20 courses on average by the time a U.S kid has reached 18. 20 courses of antibiotics and so presumably if this is my one experience even though this might be stronger you can sort of see that even if each individual course wasn't as bad if you do that like 20 times you're knocking it down and you're not eating all the foods that get it back it's not so surprising that we see in fact we see some we see basically the worst um microbiome scores in the US of anywhere we've we've tested right yeah and I'm sure that is a major contributory Factor not only in that but it's also in Foods as well and you know that's another source as well as the antibiotics you take it's in many meats and other products uh as it's used in agriculture interesting too fat and animals up yeah so that's why the interesting epidemiology shows that taking too many antibodies you know actually increase your weight there's lots of evidence from Farmers that pay lots of money to give their chickens and things uh antibiotics in order to make them put on weight fast because you can feed them the exact same amount of feed that's the fascinating thing about this is that you you can give them the same number of calories and end up with a with a larger animal and of course at the end of the day when you're selling that animal it's the number of pounds it's the weight of the meat that you actually sell it at but you know there was a study done in 2014 published in the journal Nature medicine where they put put people on five days of a plant-based diet versus five days of an animal-based diet and one of the big surprise findings is that on just five days of a completely animal-based diet they actually saw antibiotic resistance develop in the gut and that's not because of meat that's because there's residues of antibiotics that are existing within the meat that was being served and by the way the study was done in the United States extraordinary well I think that's um it's been a fascinating tour I think the good news is that um I've just done another uh just on another test so we'll have the results soon but I feel very optimistic that those numbers are going to be continuing to track up and I think you know Tim's story uh is really exciting so we will definitely share my upward trajectory I'm determined to beat Tim's score uh in the future but I recognize it may take a little while um let me just try and summarize and as always try and please keep me honest I think we started by saying look antibiotics are amazing they're probably the greatest life-saving invention in the last 100 years so we shouldn't be scared of never using them but we need to be thoughtful and we'd really like to make sure you know particularly for um for doctors who are thinking about prescribing this about understanding that there are these side effects and also I think as patients that you don't want to demand this if you don't need it because actually there you know there are downsides as well as upsides um we explained that there's sort of I guess two concerns with taking the antibiotics one is sort of the short-term situation where Azure actually taking the antibiotics what might might happen there's real concern about getting sort of horrible infections like C diff having diarrhea um and that for people who are at risk and I think you said in particular either sort of people who are really young people who are old or people who've had previous issues which is where I I fell into then actually there is one particular probiotic yeast not even a bacteria whose name I'm going to mangle even though I have bought it saccharomyces belardi and the good news is I didn't get any diarrhea so as far as I'm concerned Will's a genius and it worked perfectly um and we saw some traces of it in my um in my first few microbiome tests and then interestingly it fell away so again it's one of these things that's sort of transient and and doesn't live then we talked about like what do you need to do sort of a longer term to deal with this and that critically Probot there isn't like these magic probiotics you know even though there's shells and shells of them in the stores you know neither of you said take any of this actually it's all about this fermented food and the fermented food is packing maybe 20 times more different varieties than just a simple yogurt and even though that might sound less high-tech than getting these these pills actually this is a much better solution to actually improve our health than you talked about you know this magic things like kimchi and kombucha and kefir uh I've been trying the the lot and then on top of that I think what you what you said is like take the things that will really support your gut health in the long term so really thinking about lots of fiber because that's actually what's going to support the good bugs over time so even if you don't fix this immediately actually the right long-term diet Tim is talking about in his experience will mean you'll be able to support more and more of these good bugs over time and sort of squeeze down these um these bad bugs and then I think a couple of interesting additional ideas like time restricted eating to like really reduce the amount of time that you're eating so that you're having no food for 14 hours or 16 hours or something in a stretch is something else you can try and then I think interesting things just like sleep and exercise will you mentioned might also all contribute so I think the summary of that is there's quite a lot of things that you can do and none of this takes away from the fact that you know this antibiotic is like a huge sledgehammer and so you know if you've got something really bad it's going to be really effective but you've got to recognize that this is not a sort of precision targeted Pearl this is sort of having this big and nuclear bomb it's it's a nuclear bomb and I guess we all know you don't want to set them off unless you really need to exactly wonderful well look I love doing this in person thank you and uh we will I will keep everybody posted on the state of my guts good luck thanks you Tim and will for joining me on Zoe's science and nutrition today if you want to understand how to support your gut microbiome with the best foods for your good bucks whether you've recently taken antibiotics or not then you may want to try Zoe's personalized nutrition program you can get 10 off by going to join zoe.com podcast as always I'm your host Jonathan wolf Zoe science and nutrition is produced by yellow hewings Martin Richard Willen and Alex Jones see you next time

Channel: ZOE

Views: 948,264

Keywords: zoe, zoe podcast, gut health, ultra processed foods, tim spector, jessie inchauspe, gut health diet, ultra processed foods documentary, ultra processed food, antibiotics, probiotics, probiotics for gut health, probiotic foods, probiotics benefits, probiotic foods for gut health

Id: o6_6I5f_OEs

Length: 52min 43sec (3163 seconds)

Published: Thu Aug 17 2023