Tag Archive for: antibiotics

Science at Work

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The challenge this week was to watch two video podcasts, think about what you heard, and then provide comments and questions. For those of you who did it, thank you. For those that didn’t, I recommend that you take some time this weekend and listen to them. I’m going to share my thoughts but there’s so much information, I’ll hit only the highlights. Suffice it to say, based on the questions, there are many subjects that will need to be explained. That will take months to research and present in Memos and Insider conference calls in a way that’s understandable.

The point of the interviews with Dr. Jay Lombard was to find out the relationship between the microbiome and pathogenic bacteria and neurodegenerative disorders (NDD). That includes everything from Alzheimer’s disease to depression to Parkinson’s disease. Here are the three things that stood out to me out of the many concepts presented.


Three Things I Learned

Leaky Brain Theory
The prevailing thought is that the blood-brain barrier prevents almost everything from entering the brain via a series of tightly packed blood vessels and cells. Nutrients are let through along with some medications, but bacteria are thought to be barred.

But evidently the toxins of some pathogenic bacteria are able to cross this barrier and affect the production of the proteome, an organism’s complete set of proteins. Remember the tau mice from last week’s Memos? The bacterial toxins impact the way the tau and other proteins are folded, which renders them unusable, thus resulting in misshapen structures that can contribute to NDD depending on which proteins are affected.

Antibiotic-induced Reduction in Fevers
In the treatment of patients with NDD, one characteristic that most seemed to share is the inability to get significant fevers with infections. The cause appears to be chronic use of antibiotics over a lifetime which somehow reduces the ability of the immune system to create high fevers. The rise in temperature is a natural part of the immune system when dealing with infections; without it, the immune system will not be as effective at combating viruses or bacteria.

Heat-Shock Proteins
Think of heat-shock proteins as the “cleaners” of the body. One of their functions is to collect the misshapen proteins and take them to the organelles inside a cell; that’s where they’re taken apart and the amino acids reused. If you can’t generate a fever that’s high enough, they can’t do that job as well.

There were several other items on my list, but those were the most profound. The first question in your mind is most likely “What can I do about these?”


How Science Works

The reason I chose to focus on Dr. Lombard with the purpose of showing how science works was two-fold. First, he asked good questions. Many physicians would think “How can I fix this?” and stop there. What Lombard and Hyman asked was “What caused this?” or “How did this happen?” You find that out only by asking the right questions of patients.

The second is that Lombard went to the current research to find out if there were any answers, and he discovered where he might have been incorrect because someone had tested it. Remember that in the first interview he was sure that the bacteria C diff was related to ALS; two years later he found that there was more than a single pathogen that could be related to ALS and other NDDs. He learned and adapted his hypothesis: that’s how science is supposed to work. Instead of spending time heading in the wrong direction, science guides the research he’s currently doing so that eventually he may discover effective treatments for these neurological conditions.


The Bottom Line

If you haven’t watched the video podcasts, I urge you to do that; you’ll learn much more than by reading my review. More than that, you’ll have more questions. One of the things both Drs. Lombard and Hyman agreed on is that “we know close to nothing.” I agree wholeheartedly. When you begin by asking the right questions, you have a chance of finding out the answers. Another point they agree on is that there’s no single cause of any NDD. There are multiple factors that contribute; finding out what they are may help develop effective treatments by focusing on a potential cause.

For those of you who want answers, whether about what I’ve written or about the many other things covered in the podcasts, I’ll write more as time goes on to satisfy that “What should I do now?” question. Obviously, you’ll want to keep your microbiome as healthy as possible (a search for the term microbiome on drchet.com will point you in the right direction); beyond that I have questions I need answers to before I can provide more answers for you. I’m on it and when I know, so will you.

What are you prepared to do today?

        Dr. Chet

Short-Chain Fatty Acids: DIY Nutrition

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Short-chain fatty acids (SCFA) are critical to your health and well-being, yet you may not really know where they come from or what they do. In my opinion, the most interesting thing about SCFA is that they’re not generally found in our diet; we make them ourselves! We do that when bacteria in the microbiome work to ferment digestible fiber.

By definition, SCFA contain less than six carbon molecules. The three you may have heard about are acetate, propionate, and butyrate. SCFA can provide us with up to 10% of our energy needs. They’re especially important to colonocytes, a type of endothelial cells of the large intestine that need energy to digest and absorb food that we use to produce the rest of the energy we need.

I’ll cover what else SCFA do on Thursday. In the meantime, one way to increase the production of SCFA is to get more fiber, whether from foods or supplements. It’s especially important after a course of antibiotics; research has shown that after the microbiome is upset by antibiotics, the production of SCFA can be impaired, which impacts many biological processes.

The monthly Insider Conference Call is tomorrow night at 9 p.m. Eastern Time. You can still participate by becoming an Insider by 8 p.m. tomorrow night. If you have questions about COVID-19 or any other health topic, this is your chance to get answers. I hope to talk with you then.

What are you prepared to do today?

        Dr. Chet

Reference: Benoit Chassaing, Andrew T. Gewirtz, in Physiology of the Gastrointestinal Tract (Sixth Edition), 2018.

MRSA at Home for the Holidays

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Meticillin-resistant Staphylococcus aureus (MRSA) is a threat to our health because the potential infections are severe and effective antibiotics to treat it are failing, yet it’s a strain of bacteria that exists just about everywhere, including in our homes. How can we limit exposure, and what can we do to prevent catching MRSA? That’s what a recent study attempted to discover.

A group of researchers recruited 150 healthy children who had been treated for a staph infection from 2012–2015 for a year-long study. All 692 people who lived in the house more than four nights per week were also recruited. That also included 154 dogs and cats. To establish a base line, cultures were collected from three anatomic sites of household members, two anatomic sites on dogs and cats, and 21 environmental surfaces to detect S. aureus. Interviews with household members were also done—no interviews with the dogs and cats. Data collection was repeated every quarter for 12 months.

The objective was to see how many new strains of S. aureus were introduced into the household and how many were transmitted between household members. Here’s what they found:

  • There were 510 introductions of novel strains into households.
  • There were 602 transmissions within households in a variety of ways.
  • Frequent hand washing reduced the likelihood that a new strain would be introduced.
  • Those who were exposed to S. aureus were mostly renters and those who shared bedrooms with strain-colonized housemates.
  • Transmission occurred more between household members who shared towels. I don’t think many people share bath towels, but hand towels are widely shared at home. Giving all family members their own hand towel could quickly become unwieldy in large families.
  • Finally, pets were most often the recipient of the transmission of bacteria, not the transmitters. (Who’s licking their dogs and cats?)

All kidding aside, this study illustrates how bacteria can be introduced into our environment and how it can be passed person to person or animal. It seems the best thing you can do to limit the spread of MRSA bacteria is to wash your hands regularly. With the holidays upon us, more people entering our homes, and more visits to family and friends, that seems to be the simplest solution to MRSA at home for the holidays.

Get yourself a gift of health this holiday season: the Optimal Performance program is on sale. Get prepared to have all the energy you need to achieve your goals in 2020. You can also shed that weight you’ve been wanting to lose. Order your copy today.

What are you prepared to do today?

        Dr. Chet

Reference: DOI:https://doi.org/10.1016/S1473-3099(19)30570-5.

More Reasons to Use Probiotics

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One of the most frequently asked questions I get is this: “Should I take probiotics when I take antibiotics? I don’t want to negate the benefits of the antibiotics.” Based on the summary of the Cochrane Review, I think there’s enough evidence to say that you should take probiotics any time you have to be on antibiotics. The research evidence is not perfect and the authors called for more and better research to confirm the results, but there appears to be no harm when taking probiotics during antibiotic use. If it doesn’t harm, then it’s a good idea to do it, even if the rate of C. diff is relatively low to begin with. But it’s a good idea to clear it with your doctor because reasons for taking antibiotics can be different.

There are a couple of things that we don’t know. What is the best type of probiotics to take? And how much should we take? In spite of those unknowns, when examining the data summary of all the studies, there was an overall benefit when probiotics were used. That means whether it was just one strain or several, in differing quantities, they all seemed to work. Whatever probiotic you typically use, take it during antibiotic use until we know more.

Another Review Paper

I’m currently going through a review paper on the brain-microbiome connection (3), and it’s one of the best reviews I’ve read in a long time. I’m still checking the background research; it’s complicated physiology and biochemistry. I can’t get it into the typical three Memos per week so it will be a new Bottom Line in the near future.

What I’ve taken away so far is that we should all be taking probiotics every day, unless there’s a reason you can’t. If you buy a quality product, they’re not inexpensive, but it’s still a good decision based on the potential benefits. In addition, it would be a good idea to add fermented foods to your diet every day: yogurt, especially Greek yogurt, kefir, sauerkraut, kim chi, and more. They all contain a variety of probiotics that can add to your microbiome.

You should also take a fiber supplement every day. Fiber supplements contain prebiotics that feed the probiotics—you’re feeding the good bacteria. In addition, eat foods with more fiber, and that means vegetables and fruits. Again, they can provide positive bacteria to help the microbiome if you eat them raw as well as the food the bacteria needs to thrive.

The Bottom Line

There is a long way to go until we have enough research that identifies the best strains and amounts of probiotics to take as well as the best sources. There’s always the possibility we’ll find a better way, such as eating specific varieties of fruit grown in a specific region of the world that has the right strains of bacteria. We just don’t know. But what we do know is that there are benefits to taking probiotics every day right now. I think that’s the path forward at this point for almost everyone.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. doi:10.1001/jama.2018.9064.
2. Cochrane Database Syst Rev. 2017 Dec 19;12:CD006095.
3. Cell Mol Gastroenterol Hepatol 2018;6:133–148.

 

Probiotics Can Cut C. Diff Rates

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The authors reported that there were 39 studies included in the Cochrane review; 33 on adults and six on children. They included studies that were in-patient, out-patient, and using varying strains and quantities of probiotics. Here’s what they found.

There was moderate evidence that the use of probiotics together with the administration of antibiotics did reduce the occurrence of C. diff. The risk of getting the C. diff infection was reduced by 60% when compared to control subjects or those who were not treated; typically about 4% of the subjects got C. diff when treated by antibiotics, and it was reduced to 1.5% when probiotics were given concurrently. The phrase “moderate evidence” is one I haven’t used before. It’s generally specific to Cochrane Reviews and is assessed using various factors, ending with a number that reflects the quality of studies included in the analysis.

There was also a reduction in abdominal cramping and diarrhea in those subjects who were given probiotics with their antibiotics compared to those who didn’t get probiotics. In this case, the quality of the research was considered of poor quality. Does that mean that the probiotics were ineffective? No. More than likely it was due to the subjective assessments of pain by individuals. You can test stool to see if C. diff is present, as would have been done in the other part of the research, but relying on people’s self-assessment of pain is less objective. (That’s why my website offers the pain scale developed by the Missoula Project; it has physical activity descriptors that make it easier to determine where you are on the scale. Look for it on the Health Info page.)

Where does that leave us? I’ll finish on Saturday with some recommendations for the use of probiotics.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. doi:10.1001/jama.2018.9064.
2. Cochrane Database Syst Rev. 2017 Dec 19;12:CD006095.

 

Can Probiotics Prevent C. Diff?

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Probiotic research is hot right now. Researchers are trying to figure out what these beneficial microbes can do for our health for a number of reasons. What types of infectious diseases can be prevented, whether food-borne or not? What are the best microbes to treat specific conditions? After all, there are estimated to be around 5,400 different bacteria, yeasts, and fungi. Which ones are best for an E. coli infection? Or salmonella? How about inflammatory bowel disease? Can probiotics benefit other organs in the body by not allowing negative bacteria to enter the blood stream? The questions are almost endless at this point.

We may be starting to get some answers. This week I’m going to focus on the role probiotics may play in preventing clostridium difficile, commonly known as C. diff, infections in people who’ve had to take antibiotics for different diseases. Antibiotics are beneficial when we need them but they do not discriminate; they kill microbes whether they’re beneficial or not. As a result, our gut bacteria—our microbiome—can be decimated. As a result, people who are on heavy doses of antibiotics are prone to C. diff infections. While treatable in most cases, it can have devastating effects on some people including severe pain, cramping, and uncontrolled diarrhea. Not fun!

The authors of a recent paper examined whether probiotics, administered with courses of antibiotics, helped to reduce the rate of C. diff in patients. A Cochrane Review paper examines all available studies from around the world, ranks the quality of the research, and analyzes all the data. Some of the authors of that paper published a summary of that review in JAMA. We’ll take a look at the results on Thursday.

DrChet.com

Tomorrow is the anniversary of the launching of the new DrChet.com website. This past weekend I was speaking in Texas, and several people who are Insider members said that the free monthly Insider Conference Calls were very informative and helped their personal health and the health of their family and clients. Think about becoming an Insider as we begin our second year of memberships.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. doi:10.1001/jama.2018.9064.
2. Cochrane Database Syst Rev. 2017 Dec 19;12:CD006095.

 

Health Headline: Antibiotics and Kidney Stones

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For this week’s Memos, I picked three health headlines from the past week and examined the studies behind them to see if they were headline worthy. Let’s begin with the use of antibiotics and the risk of kidney stones.

Researchers in the United Kingdom examined the incidence of kidney stones in over 13 million children and adults between 1994 and 2015. They examined the medical records of over 25,000 subjects with stones and compared them with over 250,000 matched-control subjects. The researchers wanted to compare the use of antibiotics with the onset of kidney stones.

The researchers found that there was a relationship between the use of five different classes of antibiotics and the onset of kidney stones. The relationship appeared to be stronger with younger subjects and the risk lasted longer: up to five years.

Headline worthy? In the abstract, the researchers wrote about the relationship between changes in the microbiome and kidney stones. Antibiotics can cause changes to the microbiome, but they did not test the microbiome of any subjects. Therefore, there’s a statistical relationship but nothing more. On top of that, the risk of getting a kidney stone over 21 years was just 0.19%.

Conclusion: not headline worthy. It’s worth researching further to establish whether there’s a cause and effect relationship along with the role of the microbiome in the process.

What are you prepared to do today?

Dr. Chet

 

Reference: JASN. 2018. doi: 10.1681/ASN.2017111213.