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 getting an intestinal infection, is it the antibiotic that you were prescribed, Jonathan, literally, this antibiotic had wiped out 80 percent of these good dollars, when it eliminates the good ones,

what

happens? Gone is this bad guy who can now take control and dominate within that space to the point of causing a carbon infection that can endanger people's lives. Welcome to Zoe Science and Nutrition, where the world's leading scientists explain how their research can improve your health. health 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 microbiome testing technology from Zoe and the team of experts, I can show you What happened to my gut microbes before and after taking

antibiotics

?

I'm joined to discuss this topic by two world-leading gut experts, Dr Will Bossowich and Professor Tim Spector Tim, and I would be very grateful if you would join me today. It's very exciting to have him physically in the same place, well you know the drill, are you ready to start with a quick round of questions? Yes, headings, okay, maybe starting

antibiotics

will save lives. Definitely, can antibiotics harm my gut microbiome? Definitely if my gut bike microbiome is affected afterwards. taking antibiotics, can this damage be lasting? Unfortunately, yes, will

probiotics

help my gut microbiome recover after taking antibiotics?

It's not clear, okay, we're definitely going to address the last question. Are there specific foods that can help my gut microbiome recover? I think it was brilliant before we started. I have to ask you a favor. 63 of the people watching this podcast haven't hit the Subscribe button and 11 haven't hit the bell to turn on notifications. 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 go a long way, so if you have ever enjoyed this podcast, hit the Subscribe button and turn on notifications.

Thank you. Alright, Tim, well, I want to get started. We don't normally do this. but I'm actually telling a little bit of a story that I had, as you both know, a pretty exciting start to the year, so I was playing around the house running from one meeting to another and I decided to quickly clean up, clean the kitchen and I knocked over this huge bench of teak directly over my toes. I'm not going to be too graphic, but to say that it was a bit like opening two grapes, so I don't recommend it to anyone listening at home, luckily, my uh.

My wife was nearby I called her and said honey, could you come and give me a hand? She wrapped me up and we went to a hospital because she actually not only had she broken it, but she had destroyed everything. Opening it up and opening it up, I ended up having to have a minor operation to clean everything up and sew it up, and the doctor told me that the technical diagnosis was that I had shattered my toes, which I don't know if that's true. can an American diagnose or just a British one, well I think a translation will have come true, it's pretty good yeah, so they did a fantastic job, they cleaned it completely, sewed it all up and since it had been running I had it .

I've been in an operating room, they told me you need to go on a course of antibiotics and luckily I have two of the world's microbiome experts on my phone and I remember because I messaged them both and I will. It was still early afternoon on the east coast. You immediately responded when I explained what had happened, so I'd love to go back to that point and maybe tell me what you were thinking at the time I explained it to you. what had happened and what he said: what do you think I should do? part of the context that was really relevant and important to me as a gastroenterologist was that you shared that you have a history of your old gut syndrome and also that you've had problems with diarrhea in the past and that made me think that this is a person with an old gut that you may be more vulnerable and then you shared the antibiotic that you were on and I have to tell you that I was not happy when I heard about that and you were on, I'm happy to tell you that you didn't really tell me that exactly at the time because I was engaged, yeah, well, I don't want to scare you, so I mean, I gave you advice very directly and without class. to explain all the kind of logic behind what I was doing, but let me just say yeah, let's unpack it for us now, yeah, let's unpack this specific antibiotic, um, because it kind of froze me in my tracks and made me go, "Okay, wait".

We have to make sure we are handling this appropriately. The antibiotic is called clindamycin and clindamycin just to explain this to people at home. The reason you were prescribed this antibiotic is to protect you from skin infections and the specific type of bacteria we want to protect against staphylococcus aureus. Staphylococcus aureus can cause an infection in this area and if it did, it would be catastrophic for you and it would be a really bad thing, so we need something that treats that, um and clindamycin. is one of those that does, but unfortunately clindamycin is a fairly broad spectrum antibiotic and can you explain what that means?

Yeah, so what it means is that it's not just something that will destroy staphylococcus aureus, but it will destroy many more microbes than that. a very wide range of microbes when we say broad spectrum we mean the range of different bacteria that are vulnerable and susceptible to the antibiotic and clindamycin has this unique property that it can treat now I'm going to be a little nerdy for a moment so please I apologize because these are terms that I know Tim knows, but I think a lot of people, I don't even know Jonathan, could have been exposed to this, but there are these bacteria that we call anaerobes. anaerobic means no If they don't breathe oxygen, they can't survive in an environment where there is oxygen, but our body is actually full of this type of bacteria and clindamycin is the antibiotic that would be used to destroy anaerobic bacteria.

Here's the problem: the vast majority of the microbes in our intestines are anaerobic, so when we try to protect you from this skin bacteria, we will simultaneously have this shrapnel, this additional damage that takes place with the destruction of the anaerobic bacteria, with the recognition that our gut microbes are mostly anaerobic bacteria, so this. becomes very relevant because the reason why, as a doctor, I have a knee-jerk reaction to this antibiotic that I don't like and I'm embarrassed about is because if you were to ask me, Dr. B, what is the antibiotic that increases our risk of a intestinal infection called C. diff clostridioides difficile.

This is a nasty infection. I'm happy to discuss it in more detail, but if you were to ask me what the antibiotic is, give me a name that will increase my risk. It's clindamice. The antibiotic he was prescribed, Jonathan, this often shows that the doctor who was treating him had a very short-term view of what he wanted to do. He wanted to get him out of there. He made sure he didn't get an infection. He probably knew that he didn't have to see you again, he just made sure you knew you weren't going to die or get an infection.

You didn't really think about all the other things that could happen months later because that was not going to be your problem and that's generally the problem with short-term thinking within medicine and why you actually chose a drug that, as you also say , it's designed to cleanse the intestine of anaerobic bacteria, it's often used that way for people I want to know reboot the intestine in a way it's a it's a pretty heavy block when you told me I was pretty surprised clindamycin wow, that It's usually the last resort, you know, it's something that you know or we know is resistant to this.

You know this is a life-threatening disease. No. I have a couple of crushed toes and I need to make sure you know that this bacteria doesn't grow there, which you know before 1946. Don't worry, we just cleaned it up and hoped for the best, so it was a bit of a shock that If you did this, as you know, did you convince them to do it? Jonathan, you say, oh, give me the strongest antibiotic you can. I know I'm interested in being a human guinea pig for science, so yeah, I thought it would be a much better podcast if I don't know what happened and maybe you want to share it, that's right, so I told them.

Tim said there was a suggestion that I might be allergic to penicillin, something that came up 30 years ago, so he immediately said, well, you know, I'm not, I don't think we can take any risks, and this was um, I understand part of it. of reason. Could you explain to me for a minute? I think it's because I don't understand this and I suspect a lot of other people don't like it if you can do it in a very simple way, like how an antibiotic works and also. How come I can swallow it and it suddenly kills the bacteria on my toes and in my intestines, so it's a little magical?

Yeah, well, antibiotics are these compounds produced by other microbes, so the first one came from an aspergillus which is part of the fungal family and uses all the microbes that produce chemicals to maintain their niche and are fighting in their own way, so basically what we've done in nature is take what, looking at, you know, various yeasts. and fungi and other microbes, what chemicals they produce and if they have any power against other microbes, then we have magnified that. We use a genetically modified species of yeast to produce tons and tons of this stuff that we then chemically synthesize, so we use nature. defenses in really large quantities to attack these microbes that we are not clean with, but only recently have we started to worry about all the casualties, if you like spectators who are eliminated at the same time and you have spoken.

Let's say I'm swallowing this antibiotic that you said originally comes from as a yeast or something, could you just explain to me what happens inside my body as a result, so yeah, so you have this compound that's in a capsule and it goes beyond that. from the stomach, so it's usually not destroyed in the stomach, it goes into the small intestine and some of that is absorbed there and gets into the bloodstream, so this is where a lot of the things that are absorbed into the body end up. in the blood, so you will start to have levels of that in the blood, so if you had a blood-borne infection, so-called sepsis, it would start to help. and then some of it also stays inside your gut and goes down to the lower intestine, where that chemical will start to interact with your gut microbe community and kill the friendly guys and those that the part that got into the blood is also getting close to. to the skin and thus it would combat any staphylococcus that, this is the one that for you they were trying to avoid, that would enter your body through your skin through that wound, so it reaches your toe through this quite a circuitous route and as a by-product, it goes everywhere and it seems that as a result a large amount ends up in the intestine or in some ways it doesn't matter, it's like it's everywhere and it's powerful enough to have its impact on we.

We know that the subsequent effect that it will have on your gut because again, if we go back to what is the likelihood that you will have diarrhea associated with an antibiotic, which of course is basically diarrhea. What is happening here is that we are disturbing the internal balance. our microbes to the point that they're no longer really working like they're supposed to, so if we look at which antibiotics put us at highest risk for developing antibiotic-associated diarrhea, this is right at the top of the list. the list and then if we look at what happens when someone develops this C diff infection that we've been describing, basically what's happening is that Jonathan is in this C diff that is commonly associated with taking antibiotics, basically the good bugs that currently reside in your gut is 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 eliminate the good guys, what's left behind is this bad guy and the bad guy who can now take over. They dominate within that space to the point of causing a carbon infection that can be life-threatening for people in later years, so we are not talking about a trivial intestinal infection, this C diff becomes recurrent C diff and normal antibiotics do not. get rid of it, so every time you give it an antibiotic because it gets worse, it's actually caused by antibiotics.

The traditional and usual first treatment was more antibiotics and they only worked in about 20 percent of cases and made people's lives increasingly worse. You know, it was often fatal. How can youImagine, I was sitting here feeling a little paranoid, luckily Will didn't give me this level of fear, but I was feeling a little paranoid about it and part of that was because I had also had this fantastic experience over the previous four years with Zoe of getting better. constantly my microbiome, and you know, I was in the unusual situation where I had undergone a whole series of full sequence microbiome tests over the previous four years and So, we actually have some data that I would love to share and then ask you to help me explain a little more.

So, I knew that when I did the first test that we did as part of our first. sorry um predict study my um myZoe Hill school was about 50 out of 100, which put me 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 the problems real digestive health. I was having but I was still in the middle and when I tried it literally four weeks before I broke my toes and my score came to 78 out of 100 so basically I was in the top 20 so it's Instead of that I've been constantly improving, which made me very happy.

I feel really good, so I thought, "Well, one thing I'm definitely going to do is start retesting really frequently and see what happens." I was nervous that after all this hard work it was going to be torn apart, so I think you've talked a little bit about the immediate concerns about what might happen before I maybe share what happened. will happen over the next week, could you both share with me what you told me to do at that time and why my concern was Europe? They have this history of OBS, they have a history of diarrhea, there's the family history with their grandmother to look at. diff Perfection I was concerned that you might develop this C diff infection due to the fact that you are taking the antibiotic that is so well known for this, so my recommendation to you was to 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 that was there to protect you from developing diarrhea

instead

of infection and my advice, I think I asked you if you have serious problems after taking antibiotics and we talked about your problem with penicillin I said it's probably complete nonsense, you did it, the doctor should have ignored it and since you know the most standard antibiotic, less super strong, a lot of people who think they have a personality, don't have it when they are tried uh and I think that's an important lesson you know since we're running out of antibiotics people don't exclude 80 of them um and the second thing I said, you didn't have diarrhea after the antibiotics, I said well, because you too I take a probiotic and evidence shows that

probiotics

prevent post-antibiotic diarrhea in randomized controlled trials, there are quite a few of them, if you take them at the same time they will reduce it, but I didn't recommend it. probiotics for you because of this um, an Israeli study of only eight people, but really done thoroughly and with mouse models and intensity that showed that probiotics in many people, if given at the same time, can actually make the recovery is slower, the reason we don't do it.

What I don't quite understand is that by having some kind of powerful induction of some additional new microbes, it somehow prevents your old community from coming back together and I didn't want to have that and because there are no randomized controlled trials of people. Take antibiotics to improve your gut microbes. um, I was saying that right now the current evidence suggests that it's best not to take commercial probiotics but just fermented foods, so I told him to take as many fermented foods as possible, a whole variety. of them and I hope that works out so I was really surprised by this it's like I'm really lucky I have two of these world experts um available.

I thought you were both going to suggest I take this really broad. probiotic blend and in fact none of you did, maybe we'll start by explaining why you basically suggested this particular probiotic and why not, a broad thing and I think it's really interesting to understand, yeah, well, and I think First of all, it's important to say that you know Tim and I were looking at the exact same literature and the 2018 cell study from the Weitzman Institute is something I was also thinking about and it suggested that,

surprising

ly to all of us, the use of probiotics they can actually negatively affect gut recovery, on the other hand, a different question is the risk associated with short-term antibiotics, 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 we're talking about here, where do you put your priorities with this?

Because either you are going to give a probiotic or you are not in the vast majority of people and we can analyze this further if we want. the vast majority of people I no longer give probiotics after antibiotics, but in this particular case, with his particular history and the fact that it was this specific antibiotic, it tipped the balance so that I felt more comfortable with it. you were taking this. specific probiotic and the reason I chose the one I chose with uh protection against C diff protection against antibiotics 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 convincingly showing us that you can actually reduce your chance of developing antibiotic-associated diarrhea or C. diff infection by about 60 percent by taking this probiotic.

What you're saying is that potentially, if I had been taking something lighter, you might not have even said that and just followed what Tim was actually talking about, which is the fermented foods hundred pack. percent that is 100 true and we don't know what would have happened, all we know is what happened and we are all doing our best, using the best information available to make these decisions, so the only thing we can add is what Will has been saying that there are risks of diarrhea with antibiotics and that the problems are much greater in young babies and the elderly, so the threshold for using probiotics in those situations is much lower, so if you were much older or had been so, you know. a child of yours, huh.

Our advice would probably mean differently too, so if it had been my grandmother, you would have said not only that particular probiotic that we will buy in the form indicated in the program notes, but also a broader set of probiotics. no, I would use the probiotic that is evidence based and has randomized controlled trials to clearly show that we can reduce in this way. It's a very specific approach. Still, it's the one you'll like because it's not necessarily better, so it's really interesting. So ultimately what we want to do is lean on where the deepest evidence exists and where we have confidence, and when it comes to probiotics, I mean, it sounds like these probiotics are not pharmaceutical drugs, so they're not.

We don't have phase three clinical trials, but thousands of people, so when we have a randomized control trial with more than 100 people, we celebrate that that's the case and there's value that we find in that, so with that I would still do this specific like The most powerful evidence for what we're trying to achieve with the probiotic is actually behind this unique strain, it's a yeast, it's not actually a bacteria. You didn't say it was, but it just makes it weird for the audience, so you know what Tim is saying. I know in my mind as I'm processing this clinically, I'm thinking about the antibiotic that was prescribed, but I'm also thinking about the specific patient and what fits, and you know, what Tim mentions is that people who are young are older people who have other medical problems people who have inflammatory bowel disease or people who have a history of C. diff infection, all of them are like if you have had that infection in the past, they are higher risk people and because they are higher risk it makes be more valuable to give them that enhanced level of protection, so let me fast forward the story a little bit and say, you know where I was a week later, so you know the antibiotics are actually only five days, so it's almost like I think everything the world knows who does it, it happens incredibly fast, so it feels, I think as a regular person, well, it can't have had much of an impact, right, it's just a couple of days, so long ago, I don't think it exists anymore.

I was able to test my microbiome again and I actually started testing it every week from now on because it's going to be very interesting to see what happens, so when I got the results I was quite surprised because this antibiotic had actually had a big impact . impact, so my Zoe gut health score went up to 78 on this first test, which was just seven days after I broke my toe, seven days after I started taking antibiotics, that score had gone down to 40 .so I was down from where I was, you know, four years ago, overnight, so it's like, wow, I went from being in the top 20 to being in the bottom 40 just by taking 10 of these pills. .

Pauling's ears were a hard job to erase exactly so that's what I was quite surprised about but on the other hand I knew there might be a um you know you could get hit and sometimes he said you might have more than these bad bugs, which was particularly shocking and I think also

surprising

. I think even for you is that we have this new research study that is pushing to actually identify the individual you know, microbes, individual insects that are considered good and bad and literally this antibiotic had killed 80 percent of these good books , so I have to admit that I was surprised.

I shared this data with you. What did you think? Well, that's a pretty big reaction, but to most people you know I would try to assure them that this should actually get better. There are a couple of studies where I've given antibiotics to volunteers and each week they've tracked their microbes and by eight weeks most people have recovered, they've all gone down like you did in those first few weeks, most of the people recovered within eight weeks, but both studies and I think between a dozen and 30 people, such small studies, but they've always been this other group, so maybe a quarter of the people are not back to normal, but I said, okay, you're probably at that okay at eight weeks they're not completely dead, they just stopped replicating, they stopped having fun, they stopped eating and they went into a little shell like this and they hide in your appendage. and these little cracks, you know, and they don't have anything to eat and they're just hoping they can survive long enough to come out again when you know, and this is a story that I trusted too.

It was like, well, I'm going to go and double down on eating the best I can and it'll all come back in a couple of months before I share, I guess, where I am today, could we talk a little bit? more about these fermented foods, so if there are probiotics, I've been taking this pill that I took for um, I think about a month or something and then I was completely focused on fermented foods, can we talk a little bit? A little about why fermented foods are so interesting. Fermented foods are basically probiotics, live microbes, but they are actually found in the food and not in a capsule or some synthetic version.

These are things that we've had for thousands of years in our diets and we're talking about live cultures they're in yogurts they're in cheese they're in Coffee which is fermented milk we're talking um uh sakra which is fermented cabbage we're talking about kombucha which is fermented kimchi tea miso, etc., all of these ferments and compared to probiotics, they generally have lower doses, but most of them, other than cheese and yogurt, have many more species, many more types, much more diversity of microbes from the ones you would find in a probiotic capsule. So the average yogurt has maybe three species, but once you get to coffees, kimchi, and kombuchas, you can get 20 to 40 different types of microban bacteria, but also some yeasts. 20 to 40 versus two or three, so there are many more different types.

Exactly, my way of thinking is that probiotics, when you take a capsule like Saccharomyces, can be very individualized, whether it works for you or not, depending on your community, it will answer that type yes or no and that type. Somehow we see that in the results not everyone doesn't get 100 answers because you know that some people just don't have the instinct ofcommunity that will be receptive to the arrival of this new guy and, you know, tell him what. do, whereas my opinion is that fermented foods give you a much broader choice, so you have all these different microbes that are very happy living together in the food and collectively they will have a better chance of having an effect on your gut and restore your health and we know from other studies, randomized controlled trials of fermented foods, that eating five or six small servings a day over a few weeks can actually reduce inflammation and boost your immune system, so now there is science behind these foods fermented so that was my reason for telling you to get as many of these different ones that you can go for diversity because that way you're going to get different bugs in your kefir like in your kimchi and your kombucha and hopefully some of them are going to work. good.

I was throwing the kitchen sink at your problem and saying, well, you know, we don't know which ones are best or not, we don't know how to customize it for you yet, but I hope Zoe solves it in the future, but we don't know yet, so that was the thinking and there have been some andThere are some studies that show that fermented foods work in people with intestinal problems and diarrhea. Etc. It's not as well documented as probiotics, but there is some data, so I immediately ordered in bulk the kombucha, kefir, and kimchi Tim that you recommended. and I was in London at the time, how do you know if this is going to be something that's going to be filled with these live bacteria or if it actually has the seal on it and I know that, unfortunately, there are actually a lot of things out there that say, for for example, kombucha, but they don't actually meet the criteria.

Tim can, how did 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 has something like that, for example, drink kombuchas or water coffees, which are generally fruit coffees, which are somewhat similar. Check that it does not contain large or large amounts of sugar. of artificial sweeteners because we know that artificial sweeteners have negative effects on the gut and the gut microbes, so you definitely don't want anything that has that in it and you also want to check that it hasn't been pasteurized and, uh, it could be in tiny fine print, You know it's been pasteurized, so it may be perfectly done, but to give it a longer shelf life, it's been lightly pasteurized, which means it's slightly dead, so the key is you want to make sure it's alive, said. to me it's like there are lots of ways things could potentially have it and you can say it shouldn't have a lifespan of two years for example, that will tell you it's definitely dead.

Some of the kombuchas can have a shelf life of or in cafes and things like that and kimchi for a couple of months is usually shorter than that, but that's the maximum you should have and in kombuchas you should often have seen a small sediment at the bottom that shows that something living is actually forming, it is real. not only has it been so filtered and processed that there's nothing left and it also shouldn't have a lot of fruit and other things added because that's also a sign that it's been ultra processed and it's not real and often if you open it up it should have Fizz I think than the one I said, oh I know, Jonathan, you like the laughing goat because it smells really good and it has a real F Fizz when you open it, so you really know it's live, you know it's and it's.

I have a very spicy taste, that's right, so I had this experience. You have to go and watch a video online to know how to open it, because when you open it it explodes so much that a good portion of it ends up spilling out. to the side and you have to pick it up so you don't lose it so again calm and my kids thought I was angry but they also thought this was really funny and it was definitely stronger than the average kefir and I felt really good because I felt like it was definitely a medicine, I was definitely taking this correctly, uh, and you also recommended to me, I think a kombucha that again you had seen made, so you were sure that's why it's the Momo factory in London.

I had seen what was done and Almost all of them have a little sediment. I know you're very skeptical about kombucha. Until that moment, but I was totally involved in anything that could help me. I wasn't worried about my blood sugar at this point. let's say this was like 100 focus on my guts, you can be fooled very easily in this game. I think that's the message for people that you know might be taking the best intentions, you say it's pasteurized, it has so many artificial ingredients that it's not useful, it's too sweet, you know, if you can't make it yourself very carefully and you realize that if it's really cheap, it's unlikely to be real because it has a shelf life of about a year and they can mass produce it.

The sauerkraut I grew up with was canned and the second ingredient was vinegar and that's not actually fermented sauerkraut. When you make pickles or 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 fermentation is actually created, so which time and time again I feel safer when it says live active cultures or live probiotics, so I would love to move on. In just one month, which happened right now, the good news is that my number of good microbes has doubled right now.

Yeah, I think if we were to conceptualize how you started at the beginning, what is the purpose of the term eubiosis? Eubiosis is the term we would give to a microbiome that is in balance and the good ones outnumber the bad ones, that's what you had, 38 good ones, six bad ones, right there, the good ones have control of that environment, it's an environment stable and healthy. It's hard to change, but unfortunately the quickest way to cause a change in this microbiome is actually antibiotics, and antibiotics actually induce dysbiosis medically. Dysbiosis is the term that basically means a shift towards an unbalanced microbiome.

There is more vulnerability, the microbiome cannot do its job. The way it's supposed to be now, 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 room and therefore really thrive, that It's quite depressing. and that is, to some extent, we expect this type of medically induced dysbiosis to occur after antibiotics, the part that we didn't expect that we're seeing with you is that this is persistent, it's actually getting worse as you do serial testing. now a month in advance, your measurement a month in advance is worse than after a week, um and I certainly don't like that.

I would have thought that we would be moving in the right direction at this point, not necessarily backwards, but at least moving in the right direction to update it, which is like at this point, about three months later, my scores recovered a little bit, I came back to 36. There is no further increase in bad errors in In fact, they are starting to trend down a bit. I have one more good bug, so I like it a little bit better, but the bottom line, you know, of where I am today is that this has been really great. change and you know, time the way you describe it is like you know my previous outdated microbiome, a stable microbiome, has been torn apart and then this is slowly progressing and I think I guess the obvious question I have is beyond of taking the fermented products um is there anything else one should think about?

If I say well, you know what I want to get to this much healthier microbiome, you know, maybe I have to accept that this will take some time, what else can be done? I or anyone who's listening well, we know from a number of studies including very careful studies with mice that increasing fiber is really important because that will directly affect the good ones and if you can get more of those good ones in, they will suppress themselves, the bad guys and the bad guys live off this inflammation, they like inflammation, they like kind of a slightly stressed gut and so the more you can put fiber and other good stuff in there and other plants, you're going back to the general rules for our gut health, so what are they?

Get plenty of fiber, get it through plant diversity and cut back as much as possible. Ultra-processed foods, yes, they stimulate the bad ones, and I know you're already doing it, but you know. other people who may not know about this, so I think it's the other things you could try to do, more restricted eating, give your gut a rest at night, because we know that the microbes themselves have a kind of service built-in laundry room where they do it. cleaning at night, if not, if they don't have late night snacks and things like that, so they can come in and really clean the mucosal layer of the intestine so that it's spotless in the morning and that seems to help gut health.

Well, in your immune cells, so I think it's a combination of those visceral things. And you probably have other tips too. I mean, just to build. I think it's a great foundation and I like the general concept you're proposing. What I completely agree with is that you want to feed the good guys and starve the bad guys, that's how we restore balance by feeding the good guys high fiber foods and then with the bad guys we want to be cautious. As best we can in terms of the things that feed them, including refined carbohydrates like sugar, artificial sweeteners, ultra-processed foods, high levels of saturated fat intake, and alcohol consumption, I think we want to be careful with all of them. these things and So the other thing that Beyond Tire restricts eating is we know that sleep is incredibly restorative for the microbiome, so getting a good night's rest as much as possible, spending time exercising, spending time outdoors free, these are some of the strategies that can help.

My only individual story and if people are listening to this, how should they think about taking antibiotics in general? Does this mean you should never take antibiotics? How common is this? Do you know what you would be saying? Well, I think before I even went there. your experience is unique to you, but there's also evidence in the medical literature that says there are people who have something similar happen to them, so there was actually a study that Tim and I have been looking at together where they took a group of people it was a very nice study and they found that the vast majority of people, as Tim alluded to, recover by eight weeks, but there was a small subset of people who couldn't explain why, but these people their instinct was given a hit harder and it basically started to look like an ICU patient's intestine.

I guess that's not a good thing, that's not a good benefit, so in the depths of dysbiosis, what they had to do is keep looking so you know we have the data. to three months, well, in this particular study, these particular people didn't start returning to their baseline for about six months, they did return to that place, so I think that's one of the encouraging points, but I think the bottom line here is that some people may take longer to recover than others, yes, and there are some people who fully recover in two weeks, which is why they seem to have a microbiome that bounces around so frequently.

This is quite trivial. you know, and they don't have a real secretor, but and this is where I think the exciting science is that if we know that in Zoe, for example, we collect enough data in the future, we can start to personalize this so that you know that you will know when I went to see your surgeon, you said listen, I'm highly, you know, I'm very likely to have a long-term reaction to these antibiotics, you know, give me something else or you know I'll take more risks or I'll give you I put some topical cream on. , you know, an antibiotic antiseptic cream on the outside

instead

of poisoning my gut, so I think in the future we'll be able to see how, hopefully, we can choose whether you're a good responder, a medium responder, a bad responder, and and offer advice a lot. more personalized, but I think the other advice is, you know, there is epidemiological data that shows that overuse of antibiotics increases allergies and to some extent, weight can cause weight gain, especially in children, and we know that in the US and in the UK we are overusing antibiotics, probably two to three times more than we really need to use them and I wanted to ask a little bit about that because I think you made it clear that you had a particularly strong antibiotic, so it seems like this is much stronger than average, how would you think?

Because I've heard you talk about this kind of repeated use of antibiotics versus using a single antibiotic, maybe something that's more well-known, not as strong as you as a people would do it. I think of this as weighing risk and I think we often think about this, for example, if we know with our children andthings like that, as well as with ourselves, so I think you know Jonathan from my perspective when I think about these things like a doctor is thinking about benefits versus risks and when a person has an infection that requires antibiotics or in some cases like e.g.

In your situation, it doesn't mean it was wrong to take antibiotics across the board when the benefit is there. so we have to consider that there is and I don't think it's hyperbolic when I say this the greatest invention in medicine in modern times was the discovery of antibiotics there is nothing specific Beyond this that added more years to our life expectancy yes Yes We look at the leading causes of death in 1900, they were all infections, now they are not even close to being the leading causes of death because we have these antibiotics, but we have to be thoughtful about their use and therefore really what we do .

We're getting into here: Do you need these antibiotics? Do they really need them? What is the appropriate antibiotic? How broad spectrum should they be? do not take this antibiotic, is this the right antibiotic for me? How long should I take it? By asking those questions, we are trying to minimize our exposure while still getting the benefits we are looking for. I have a My personal story here because I have always suffered from sinusitis which is a nasty chronic infection of the sinuses started by bacteria and then it just turns into long term infection and every time I got a cold it usually turned into sinusitis and For probably 20 years, every time my cold lasted more than a week, I took antibiotics to try to clear up the infection they were on for two weeks, so you would have taken dozens and dozens of courses, yeah, unlimited, you know.

Supply if you had known large supplies at home in a valley, a cheap package of antibiotics. Did you know that doctors often self-medicate and don't necessarily do the right thing? and anyway I really got into the gut microbiome, you know, about 12 years ago. I know that's when I stopped doing it, but also the other reason I don't take them now, when I get an 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 a day of symptoms, so yes, statistically they work in trials, but the difference between taking them and not taking them could be only one day of symptoms, etc.

This is true for many conditions that resolve themselves, not all and it also says that they are often a good reason to take antibiotics, but there are many like this where it is a little unstable and anyone who now values ​​their gut microbiome more than a extra day of breathing or nasal symptoms, I think I need to take notes, so the good news is that having taken a lot more antibiotics than you in the last 10 years to improve my gut health, you know I have a really good gut score, so I think if there is a little optimism, I may not come back right away, but I hope you can reach 80 and beat me.

I think it's a brilliant story, so you're saying that even with everything. of the antibiotics that you took when you started this journey around the microbiome, you know, a dozen years ago, they actually managed to get to this great point, well, I think the change is that it's hard for healthcare to move away from what they classify . To accept as standard, you know that the standard is to use antibiotics liberally and not see this risk because the research on the gut microbiome is so new that it hasn't really entered the mind of the doctor who conventionally When treating a person who has sinusitis or any problem, they're not really thinking about it and I feel like this happens a lot with kids.

It also particularly catches my attention in different aspects. I remember growing up in the United States and my mother tells me about the incredible number of courses of antibiotics she had when she was four years old and even in contrast to my sister who was born 10 years later in the UK as many fewer. There are 20 cycles on average at that time. An American boy has turned 18 years old. 20 courses of antibiotics and presumably, if this is my only experience, although it could be stronger, you can see that even if each individual course wasn't that bad if you do it 20 times you're bringing it down and you're not eating all the foods you're doing. they recover.

It's not that surprising that we see, in fact we see some, we basically see the worst microbiome scores in the US of any place we've tried. right, yes, and I'm sure it's a big contributing factor to not only that, but it's also in food and you know it's another source, in addition to the antibiotics that you take, that are found in many meats and other products , since they are used in agriculture. interesting, too fat and the animals gain, yes, so the interesting epidemiology shows that taking too many antibodies, you know, actually increases your weight. There's a lot of evidence of farmers paying a lot of money to give their chickens and things like that, antibiotics to get.

They gain weight quickly because you can feed them exactly the same amount of food. The fascinating thing about this is that you can give them the same amount of calories and end up with a larger animal and of course at the end of the day. when you sell that animal, it's the number of pounds, it's the weight of the meat that you actually sell it for, but you know there was a study done in 2014 published in the journal Nature Medicine where they put people five days a day. plant-based diet versus five days of an animal-based diet and one of the most surprising findings is that in just five days of a completely animal-based diet, they actually saw antibiotic resistance develop in the gut and that's not because to the meat, but to There are antibiotic residues in the meat that was being served and, by the way, the study was done in the United States, extraordinary.

Well, I think it's been a fascinating tour. I think the good news is that I just did it. Another one, just another test, so we'll have the results soon, but I feel very optimistic that those numbers will continue to increase and I think you know Tim's story is really exciting, so we will definitely share my upward trajectory. I'm determined to beat Tim's score in the future, but I recognize it may take a little time. Let me try to summarize and as always, try to be honest. I think we start by saying that antibiotics are amazing, they're probably the biggest life-saving invention in the last 100 years, so we shouldn't be afraid to never use them, but we should be thoughtful and we'd really like to make sure they know that. , especially for doctors who are thinking about prescribing this. about understanding that there are these side effects and I also think that as patients, they don't want to demand this if they don't need it because they actually know that there are disadvantages and advantages.

We explained that there's sort of I guess there are two concerns with taking antibiotics: one is the short-term situation where Azure actually takes the antibiotics. What could happen, there's a real concern about getting horrible infections like C. diff, having diarrhea, um, and that for people who are at risk and I think you said in particular any kind of people who are really young, who are older. or people who have had previous problems, that's where I fell, so there's actually one probiotic yeast in particular, not even a bacteria whose name I'm going to use. to destroy even though I bought it Saccharomyces belardi and the good news is I didn't have any diarrhea as far as I'm concerned Will is a genius and it worked perfectly um and we saw some traces of that in my um in my First some microbiome testing and then interestingly it disappeared, so again it's one of those things that is kind of transient and doesn't live on, then we talked about what needs to be done longer term to deal with this and that critically.

Probot doesn't exist like these magic probiotics, you know, although there are shells and shells of them in the stores, you know, neither of them said to take any of this, it's actually this fermented food and fermented food contains maybe 20 times more different. Varieties than a simple yogurt and although that may seem less technological than taking these pills, this is actually a much better solution to improve our health than what you mentioned. You know, magical things like kimchi, kombucha, and kefir. I've been trying everything and on top of that, I think what you said is taking the things that are really going to support your gut health long term, so really think about lots of fiber because that's actually what's going to support your gut health. the good mistakes over time, so even if you don't fix this immediately, the proper long-term diet that Tim talks about in his experience will mean that you will be able to endure more and more of these good mistakes over time and more or less . squeeze out these, um, these bad bugs and then I think of a couple of interesting additional ideas, like time-restricted eating, to really reduce the amount of time you eat, so that you're not eating for 14 hours or 16 hours or something like that. in one go is another thing you can try and then I think interesting things like sleep and exercise, as you mentioned, could also contribute, so I think the summary of that is that there are a lot of things you can do and none of this requires far from the fact that you know that this antibiotic is like a huge sledgehammer and therefore you know that if you have something really bad, it will be really effective, but you have to recognize that this is not some kind of precisely targeted Pearl. it's like having this big nuclear bomb, it's a nuclear bomb and I guess we all know that you don't want to set them off unless you really need to do it exactly wonderful, look, I love doing this in person, thank you and we'll do it.

I'll keep everyone updated on the state of my gut, good luck, thanks Tim and Will for joining me today on Zoe's science and nutrition if you want to understand how to support your gut microbiome with the best foods for your good money, whether you have Yes whether you have recently taken antibiotics or not, then you may want to try Zoe's personalized nutrition program. You can get 10 off if you join the zoe.com podcast as usual. I'm your host Jonathan Wolf Zoe's Science and Nutrition is produced by Yellow Hewings Martin Richard Willen and Alex Jones See you next time