In pediatric medicine, antibiotics are among the most commonly prescribed medications, with more than 30 million prescriptions written each year. A recent study analyzed antibiotic prescribing patterns in outpatient visits in the United States between 2006 and 2008. Antibiotics were prescribed in 21 percent of visits. Respiratory conditions accounted for most of the prescriptions (72 percent).

Prescriptions for broad-spectrum antibiotics, those that target a broad range of bacteria, were prescribed in 63 percent of those cases, but they were prescribed for infections for which antibiotics were not indicated. That means they were inappropriately prescribed for conditions for which antibiotics don’t work, conditions like bronchitis, viral pneumonia, and influenza.

Though overall rates for antibiotic prescriptions in outpatient pediatric care have declined, it is obvious from this report that antibiotics are still being overprescribed. Certainly, antibiotics play an important role in helping to stop harmful, and even deadly, infections, but when they are prescribed for conditions for which they are not helpful, they only serve to increase antibiotic resistance, a considerable health threat to modern medicine.

Not to mention, inappropriate overuse of antibiotics can contribute to gut imbalance that can have health effects that extend throughout a lifetime. Remember that digestive health is the foundation upon which total-body health is built.

Share this Post...

antibiotic resistance, antibiotics, broad-spectrum antibiotics, bronchitis, childhood, Digestive Health, gut imbalance, Health, infections, influenza, medications, medicine, overprescribed, pediatric, pneumonia, prescriptions, total-body health

The hygiene hypothesis states that a lack of exposure to microorganisms—both beneficial and potentially harmful—during early childhood increases susceptibility to development of allergic diseases by creating an imbalance in immune system development. Brenda has blogged on the topic before, and I’ve blogged about immune balance.

A recent study published in the Journal of Allergy and Clinical Immunology has found that gut diversity in infancy helps protect against the development of allergies.¹ The study involved 40 children: 20 with atopic eczema, and 20 children with no health conditions. Stool samples were collected from each child at one month and twelve months of age, and the DNA of bacteria present in the infants’ guts was identified. The diversity of gut microflora at one month of age was significantly greater in the healthy children than in those children who later developed allergies.

The researchers suggested that in the absence of stimuli from a diverse array of microbes, the immune system may overreact against harmless antigens in the environment, such as food. I have blogged on the topic of food sensitivities, as well, highlighting the importance of maintaining immune balance with a good balance of gut bacteria.

So how do infants acquire gut bacterial diversity? First, by vaginal delivery, through which they are inoculated with protective bacteria from their mother (which works best if mom is on a plant-based diet, eating prebiotic foods, and taking probiotics throughout the pregnancy); second, by breastfeeding, which delivers yet more beneficial bacteria and prebiotics to feed the beneficial bacteria establishing in the baby’s gut; three, without the use of unnecessary antibiotics, which decrease gut bacterial diversity; and four, with a healthy diet consumed by the mother. When any of these factors cannot be optimized, probiotics formulated for infants can help build the beneficial bacteria in the gut.

References

1.  T.R. Abrahamsson, et al., “Low diversity of the gut microbiota in infants with atopic eczema.” J Allergy Clin Immunol. 2011 Dec 6. [Epub ahead of print].

Leonard Smith, M.D.

Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

Share this Post...

allergic, antibiotics, balance, beneficial, beneficial bacteria, childhood, Children, eczema, food sensitivities, gut, gut bacteria, gut bacterial diversity, gut diversity, harmful, healthy diet, Hygiene Hypothesis, immune balance, immune system, infancy, microbes, microflora, microorganisms, prebiotic, Probiotics

Atrazine is the most widely used herbicide in the United States. Over 75 million pounds of it are applied to corn and other crops, many in the Midwest. Atrazine is the most common pesticide contaminant found in groundwater, surface water, and rain in the United States. A recent study has found that women living in areas where atrazine water contamination is found are more likely to experience menstrual irregularities than women living in regions where there is no contamination.

I have blogged on the adverse hormonal effects of atrazine before. It has been found to turn male frogs into females, even at low concentrations. In 2009 atrazine was also linked to low birth weight in Indiana newborns, and menstrual irregularities have been found in women exposed to atrazine through agricultural work.

In this new study, women from two different cities in Illinois were compared with women from two different cities in Vermont. Illinois has the highest rates of atrazine water contamination, though the levels found in the study were still under limits set by the Environmental Protection Agency. The women in the Illinois cities were almost five times more likely to report irregular periods than the Vermont women, and more than six times more likely to go more time between periods.

Emily Barrett, a reproductive health scientist at the University of Rochester in New York stated, “These types of changes to hormone concentration and ovarian function could potentially lead to problems with fertility.” The study did not look at fertility, but hopefully more studies will address this.

Atrazine is sprayed on 75 percent of corn, as well as other crops. Corn is used in so many foods, and is used to make so many different ingredients in foods. This week, start reading your food labels to discover how widespread corn is. Then, take measures to replace the largest sources of non-organic corn with organic corn in your diet. It’s worth it. We’ve got to reduce our chemical exposure. Eating organic, when possible, is a big way to do that.

Share this Post...

allergic, antibiotics, balance, beneficial, beneficial bacteria, childhood, Children, eczema, food sensitivities, gut, gut bacteria, gut bacterial diversity, gut diversity, harmful, healthy diet, Hygiene Hypothesis, immune balance, immune system, infancy, microbes, microflora, microorganisms, prebiotic, Probiotics

In some people who take antibiotics, the uncomfortable side effect of diarrhea results. This happens because antibiotics disturb the gut bacterial balance. Antibiotics, aptly named as they are, work by killing bacteria—both good and bad bacteria. This alteration of gut bacteria can result in an imbalance that favors pathogenic bacteria, resulting in diarrhea. This is known as antibiotic-associated diarrhea (AAD). One of the most severe forms of AAD is Clostridium difficile-associated diarrhea.

A recent review of 22 studies, and a recent meta-analysis of randomized controlled trials, both sought to determine the effectiveness of probiotics on the prevention of antibiotic-associated diarrhea. In the review, the lead researcher stated, “Overall in twenty-two studies, probiotic prophylaxis significantly reduced the odds ratio of developing AAD by approximately 60 percent. This analysis clearly demonstrates that probiotics offer protective benefit in the prevention of these diseases.” A researcher presenting the results of the meta-analysis stated, “The preventive effect of probiotic use remained significant regardless of species used, adult versus child populations, study quality score and antibiotic administered.”

These findings were presented at the American College of Gastroenterology’s 76^th Annual Scientific Meeting in Washington, D.C. in late October. The acknowledgement of the beneficial effects of probiotics by such a group is encouraging. Certainly, the evidence is impossible to ignore. Next time you are prescribed antibiotics, ask your doctor about taking probiotics. If your doctor is not familiar with probiotics, educate him/her!

Share this Post...

AAD, antibiotic, antibiotic associated diarrhea, antibiotics, bacteria, Clostridium difficile-associated diarrhea, Diarrhea, Gastroenterology, gut bacterial balance, imbalance, pathogenic bacteria, Probiotics

Antibiotics are overused for conditions they do not treat, such as viral infections like cold or flu. Antibiotic overuse is leading to antibiotic resistance, one of the major challenges facing medicine today. But antibiotic resistance is not the only consequence of the average 10 – 20 courses of antibiotics children receive by the age of 18. An under-appreciated negative effect of too many antibiotics is the killing of beneficial bacteria, as highlighted in the recent Nature journal article, “Antibiotic Overuse: Stop the Killing of Beneficial Bacteria.”¹

From the article, written by Martin M. Blaser, head of the department of medicine at New York University’s Langone Medical Center:

“Early evidence from my lab and others hints that, sometimes, our friendly flora never fully recover [after antibiotics]. These long-term changes to the beneficial bacteria within people’s bodies may even increase our susceptibility to infections and disease. Overuse of antibiotics could be fueling the dramatic increase in conditions such as obesity, type 1 diabetes, inflammatory bowel disease, allergies and asthma, which have more than doubled in many populations.”

This gut microbiota alteration is likely a contributing factor to the increase in antibiotic resistance seen in such “superbugs” as Clostridium difficile and methicillin-resistant Staphylococcus aureus, Blaser further explained.

Studies by Les Dethlefsen, David Relman, et al, have also found permanent alterations in gut microbiota after antibiotic treatment. These researchers investigated the effects of ciprofloxacin on gut microbiota changes over a period of 8 to 10 months in two studies—one with two courses of antibiotic treatment, the other with one.^2,3 Each study involved extensive stool sample analysis by 16S pyrosequencing (one rDNA, one rRNA) in three subjects over many months.

In one study, gut composition closely resembled its pretreatment state four weeks after antibiotic treatment. However, several bacterial groups did not recover even six months later. In the second study, gut composition stabilized by the end of 10 months, but it differed from its original state. The study concluded, “Antibiotic perturbation may cause a shift to an alternative stable state, the full consequences of which remain unknown.”

Blaser recommends reducing antibiotic use during pregnancy and childhood, citing that between one-third and one-half of pregnant women receive antibiotics during pregnancy in the U.S. and developing countries. “Each generation could be beginning life with a smaller endowment of ancient microbes than the last,” he stated, “Particularly the 30 percent or so of infants born via Cesarean.”

The search for effective alternatives to traditional antibiotics is on, as researchers from all over the world are testing new possibilities in the hopes of heading off the antibiotic-resistance disaster at the pass. One recent study highlighted the use of a commensal E. coli strain which was re-engineered  by adding fragments of DNA to the bacterium that allows it to sense the presence of the pathogenic bacteria known as, Psuedomonas aerugenosa. Pseudomonas is a superbug responsible for infections in the lungs, urinary tract, blood, and on wounds and burns. Upon sensing the Pseudomonas pathogen, the E coli released a potent toxin which killed up to 90% of the pathogen.⁴ It will be exciting to see if this technology holds up in forthcoming animal and human trials.

I believe the future will likely include widespread use of large amounts of commensal bacteria, probiotic bacteria and prebiotics, as well as genetically altered bacteria, to manage bacterial infections. We may even have a whole armamentarium of slightly altered commensal/probiotic bacteria on hand for certain infections. Antibiotics are already assuming a lesser role, and the CDC has a major program to remind physicians to be more discriminating in antibiotic use.⁵ So perhaps the future of pharmaceutical antibiotics will be their judicious use, in combination with various bacterial therapies, and this will become the standard of care. It will be very interesting to watch the unfolding of all the new research.

References

1.  Blaser M, “Antibiotic overuse: Stop the killing of beneficial bacteria.” Nature. 2011 Aug 24;476(7361):393-4.
2. Dethlefsen L, et al., “The pervasive effects of an antibiotic on the human gut microbiota, as revealed by deep 16S rRNA sequencing.” PLoS Biol. 2008 Nov 18;6(11):e280.
3. Dethlefsen L and Relman DA, “Incomplete recovery and individualized responses of the human distal gut microbiota to repeated antibiotic perturbation.” PNAS. 2011 Mar 15;108 (Suppl 1):4554-4561.
4. Saedi N, et al., “Engineering microbes to sense and eradicate Psuedomonas aeruginosa, a human pathogen.” Mol Sys Biol. 2011 Aug 16;7, no 521. Online ahead of print.
5. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6034a1.htm

Leonard Smith, M.D.
Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.  

Share this Post...

allergies, antibiotic resistance, antibiotics, asthma, beneficial bacteria, childhood, Clostridium difficile, cold, flu, friendly flora, gut microbiota, inflammatory bowel disease, obesity, pregnancy, superbug, type 1 diabetes, viral infections

In a recent study published in the journal Clinical Infectious Diseases, meat and poultry samples were tested for the presence of Staphylococcus aureus, a bacteria associated with a wide range of human diseases, including MRSA infection, the most dangerous drug-resistant Staph infection.

In the study, almost half the meat and poultry samples were found to be contaminated with S. aureus, and over half of those bacteria were resistant to at least three classes of antibiotics. Antibiotic-resistant bacteria pose a major health risk, as doctors are running out of antibiotics that will treat these infections. That these bacteria are found on over half the meat at the supermarket is a scary thought.

The bacteria probably come from the food animals themselves, according to the researchers, and proper cooking should kill the bacteria. But cross contamination can occur when preparing the meat, so care needs to be taken during food prep.

A major culprit in bacterial resistance is the overuse of antibiotics in food production. “The fact that drug-resistant S. aureus was so prevalent, and likely came from the food animals themselves, is troubling,” said Dr. Lance B. Price, lead researcher of the study. These animals are exposed to constant low doses of antibiotics, which can trigger the development of antibiotic-resistance in bacteria.

As a matter of fact, consumer groups have recently sued the FDA over the excessive amount of non-therapeutic antibiotics used in animal-food production. The FDA has produced draft guidelines for the phasing out of non-therapeutic antibiotics in food production, but the consumer groups want to put more pressure on the FDA to act with urgency.

In the meantime, I recommend avoiding meats raised with antibiotics. Look for antibiotic-free or organic meat. Those animals are not given antibiotics unnecessarily, and so don’t contribute to the antibiotic-resistant bacteria that are haunting our hospitals.

Share this Post...

antibiotic-free, antibiotic-resistant bacteria, antibiotics, bacteria, contaminated, cooking, cross contamination, dangerous, diseases, doctors, FDA, food, health risk, infections, meat, MRSA, organic, overuse, poultry, resistant, S. aureus, Staph, Staphylococcus aureus

A recent study published in the journal PLoS Biology has found that Candida albicans forms two distinct biofilm types according to what form the Candida is in—the sexual or asexual form.¹ A biofilm is a protective polysaccharide matrix in which microbial populations exist and are able to hide from the immune system and antimicrobials. As it turns out, when Candida is in an asexual form, it produces a biofilm that is impermeable to antifungals, antibodies and white blood cells. This asexual form makes up the majority—about 90 percent—of Candida cells in the body. The other ten percent are sexually reproducing Candida cells that form a similar looking biofilm that behaves differently and is susceptible to antifungals and to the immune system.

Biofilms are formed by more than just Candida, however. The National Institutes of Health (NIH) estimates that nearly 80 percent of chronic microbial infections are due to biofilms.² Dr. Maria Usman, MD has developed, and is refining, a Biofilm Protocol for use in children with gut disorders on the autism spectrum.³ She is seeing some success with this protocol, though it must be tailored to the individual and can cause a “die-off” reaction, also known as the Herxheimer reaction. (When microbes are killed they give off microbial toxins that can cause sickness-like symptoms that can make the patient feel worse before getting better.)

Another approach that can help get Candida and gut issues under control is the 4R Model.⁴ The Institute of Functional Medicine promotes this model as the best way to evaluate and treat patients with gastrointestinal complaints. The 4R model asks four main questions:

REMOVE—What may need to be removed? This may be pathogenic or potentially pathogenic organisms like Candida, bacteria or parasites. It can also be foods or toxins to which the person is sensitive or allergic.

REPLACE—What may need to be replaced? In this step, the use of digestive enzymes and HCl should be considered to ensure that they body is properly absorbing necessary nutrients.

REINOCULATE—What may the body need to be reinoculated with? This considers intestinal microbes and uses probiotics and prebiotics to reestablish intestinal balance.

REPAIR—What may be needed to repair a healthy mucosal layer? The use of certain nutrients, such as L-glutamine, to repair the mucosal layer are useful here. 

One probiotic—the probiotic yeast Saccharomyces boulardii—may be particularly helpful for those with Candida problems. Candida often occurs in people who have been treated with antibiotics. Antibiotics target bacteria, both good and bad, but do not affect Candida because it is a yeast, leaving no competition for Candida. This is where S. boulardii can be helpful, because it is not killed by antibiotics like other probiotic bacteria. Futher, S. boulardii has also been shown to inhibit Candida albicans.⁵ S. boulardii produces capric acid, and both have been shown to downregulate (reduce) the expression of genes associated with Candida virulence. Thus, the capric acid secreted by S. boulardii inhibits C. albicans hyphal formation, adhesion properties and biofilm formation.⁶ Probiotic bacteria have also been found to be helpful for Candida by helping to reduce and inhibit Candida, and by stimulating immune response against Candida.⁷ 

Bringing the gut back into balance takes a multipronged approach.  The 4R program can help address the multiple issues that arise when faced with digestive conditions like Candida overgrowth. 

1. Song Y, et al., “Alternative mating type configurations of Candida albicans result in alternative biofilms regulated by different pathways.” PLoS Biology. Aug 2011;9(8): e1001117.
2.  http://grants.nih.gov/grants/guide/pa-files/PA-03-047.html
3. http://www.autismpedia.org/wiki/index.php?title=Protocols/Usman
4. Jones DS (editor), Textbook of Functional Medicine, The Institute for Functional Medicine, 2005, p. 462-8.
5. Krasowska A, et al., “The antagonistic effect of Saccharomyces boulardii on Candida albicans filamentation, adhesion and biofilm formation.”FEMS Yeast Res. 2009 Dec;9(8):1312-21.
6. Murzyn A, et al., “Capric acid secreted by S. boulardii inhibits C. albicans filamentous growth, adhesion and biofilm formation.” PLoS One. 2010 Aug 10;5(8):e12050.
7. Wagner RD, et al., “Biotherapeutic effects of probiotic cacteria on candidiasis in immunodeficient mice.” Infect and Immun. 1997 Oct; p. 4165-72.

Leonard Smith, M.D.

Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

Share this Post...

4R Model, antibiotics, antifungals, biofilm, biofilm protocol, Candida, Candida albicans, die-off, Digestive Enzymes, HCl, Herxheimer, immune system, intestinal balance, L-glutamine, microbes, Parasites, prebiotics, Probiotics, reinoculate, remove, repair, replace, Saccharomyces boulardii, toxins, Yeast

I recommend eating natural foods all the time because I know foods that don’t contain toxic ingredients are better for our bodies. If you eat meat, choose natural meats from animals that haven’t been treated with growth hormones and antibiotics.

Now there are even more good reasons to go all-natural. A recent study found certain strains of E. coli bacteria that were causing urinary tract infections (UTIs) in women were the same strains found on antibiotic-treated chicken at the local grocery store.

Yeah. Gross.

Are you wondering, “how the heck?” Well, antibiotic-treated chicken may actually harbor bacteria that are more resistant because some bacteria can survive antibiotic treatment. These resistant bacteria live on the raw chicken and can be consumed if cross-contamination prevention is not practiced while preparing and cooking food. The bacteria can pass through the digestive tract without causing an infection in the gut, but these same bacteria can migrate to the urethra where they are not as easily tolerated, triggering a UTI.   

What to do? Here are some tips:

• Buy chicken raised without antibiotics.  If you can get organic, that’s even better.
• Prevent cross contamination by cooking chicken thoroughly, washing your hands before and after handling chicken.  Thoroughly clean all utensils, cutting board and countertops with hot soapy water after preparing food (of any kind for safe measure).
• Do not use the same cutting board or utensils for raw vegetables that you used for the raw chicken
• To avoid UTIs, wipe from front to back, urinate after intercourse, and keep your gut balanced with a healthy amount of beneficial bacteria

Share this Post...

antibiotics, bacteria, bodies, chicken, cross contamination, digestive tract, E. coli, eating, food, foods, growth hormones, infection, ingredients, meat, natural, organic, raw, resistant, toxic, treatment, urinary tract infections, UTIs, women

Omega-3 fatty acids are wonder nutrients that offer many benefits to the body, from head to toe. Now, even the mouth is included in the long list of body areas that function better after intake of omega-3s.

A recent study found that a moderate, daily intake of the omega-3s DHA and EPA (found in marine sources, usually fish oil) was associated with up to a 20 percent decreased risk of gum disease (periodontitis).

Gum disease is an inflammatory disease that is caused by microorganisms like the bacteria Streptococcus mutans, Candida albicans and Porphyromonas gingivalis. Usually antibiotics are prescribed in an effort to eliminate these bacteria, but other treatments have been used that target the inflammation of gum disease, like scaling and root planing (ouch!) and in extreme cases surgery.   

Omega-3s are most known for their anti-inflammatory effects, so it is not surprising that they would help quell inflammation in the mouth. Additionally, this study also found that omega-3 fatty acids also demonstrated antibacterial activity against oral pathogens.

The mouth is the very beginning of the digestive tract, and the bacterial balance in the mouth is proving to be more important than previously thought. In fact, gum disease is also associated with the development of heart disease! Everything is connected, folks, and it all goes back to the gut!

Share this Post...

anti-inflammatory, antibacterial, antibiotics, bacteria, bacterial, balance, benefits, body, Candida albicans, DHA, digestive tract, disease, eliminate, EPA, fatty acids, fish oil, gum disease, gut, head, heart disease, inflammation, inflammatory, microorganisms, mouth, nutrient, omega-3, oral, pathogens, periodontitis, Porphyromonas gingivalis, prescribed, risk, Streptococcus mutans

The gut-brain connection is fascinating. It involves an intimate communication between the gut and the brain, and it goes in both directions—from the brain to the gut, and from the gut to the brain. I mean, isn’t it cool that what happens in your gut can affect your brain?

Yet another study looking at the gut-brain connection has found that gut bacteria are associated with anxiety. The researchers used an animal model to study this link, as it is easier to work out the details of these connections in animal models. Researchers found that antibiotic treatment altered the normal gut bacterial count, producing a change in behavior—the mice became anxious. They also experienced an increase in brain derived neurotrophic factor (BDNF), linked to anxiety and depression. When the antibiotics were stopped, behavior returned to normal.

To take this one step further, the researchers added gut bacteria from mice genetically prone to be passive, to mice prone to be more active and exploratory, and vice versa. They found that by giving the mice a different set of bacteria, the mice began to behave as the mice from which the bacteria were originally isolated. One of the researchers stated, “these results lay the foundation for investigating the therapeutic potential of probiotic bacteria and their products in the treatment of behavioral disorders, particularly those associated with gastrointestinal conditions such as irritable bowel syndrome.”

Like I said, the gut-brain connection is fascinating.  Did you know your gut had so much power over your health?

Share this Post...

antibiotic, antibiotics, anxiety, behavior, behavioral disorders, brain, Conditions, depression, gastrointestinal, gut, gut bacteria, gut-brain connection, Irritable Bowel Syndrome, Probiotic