Antibiotics and digestive problems

Effects of antibiotic use on the digestive system

Antibiotic resistance is perhaps the most well-known side effect of long-term use of antibiotics – a type of drug resistance, where a micro-organism can eventually withstand exposure to the antibiotic as a result of over-prescription and reliance.

However, there are actually many other side effects that can result from the long-term application and unnecessary use of antibiotics. Even short-term use (while often essential), can lead to issues.

One of the most significant effects is their impact on the digestive system, and the balance of microflora in the gut (a community of beneficial bacteria).

Can antibiotics cause digestive issues?

The simple answer is, yes they can.

Antibiotics work by either wiping out bacteria (bacteriocidal antibiotics) or by stopping bacteria from growing (bacteriostatic antibiotics).

Undoubtedly, they can be effective in overcoming bacterial infections. However, as mentioned above, the cost associated with such treatment is the risk of unwanted side effects and complications.

One of the main difficulties with antibiotic use is that, while they’re intended to destroy bacterial cells, they cannot be programmed to kill only harmful bacteria (i.e. the pathogen causing the condition). They also destroy friendly bacteria, which is vital to the proper workings of the digestive system.

As a result, antibiotics commonly lead to an imbalance of good and bad bowel flora (dysbiosis), which can in turn lead to symptoms such as constipation, diarrhoea, bloating, Irritable Bowel Syndrome (IBS), bad breath, nausea and upset tummy.

Perhaps, more worryingly, antibiotics can also have a direct and negative impact on the immune system. Good bacteria exist in their millions throughout the body – on the skin, in openings like the oral cavity, nose area and genitals and, arguably most importantly, in the intestines of the digestive system. They undertake essential functions in all of these areas, however their most important role is to protect our bodies against prospective pathogens. The antibiotics are therefore damaging our bodies’ natural ability to defend itself.

Imbalance of intestinal flora and immune function

Healthy intestinal flora is important for numerous functions in the body, including forming stools, sustaining a healthy digestive system and generating important vitamins (such as B vitamins). Yet, they’re most crucial to the ideal functioning of our immune systems.

You may be surprised to learn that the most important part of our immune system is located in the gut. 70% of all antibody-producing cells within the body are situated in what is termed “Gut Associated Lymphoid Tissue” or GALT. This represents the biggest group of immune cells in the body.

Imbalances of gut flora can have a number of unpleasant side effects and manifest itself in many ways. For example, fungi (like Candida albicans) and bacteria like pathogenic strains of Staphylococcus aureus (MRSA) and C difficile tend to make the most of the opportunity presented by the body’s reduced resistance, which means that they are then better able to grow more easily. This is a primary reason why antibiotic courses normally lead to thrush (a yeast infection caused by Candida overgrowth).

Similarly, C difficile infections have become prevalent in hospital wards and rest homes over the years. This is because, after antibiotic treatments, C difficile organisms can grow rapidly in the absence of the body’s natural defences. The bacteria produce toxic compounds that inflame and kill the cells that line the large intestine, which can in turn cause intense diarrhoea and internal bleeding. Several other digestive ailments and complaints are also quite typical, such as dysbiosis, toxic bowels and IBS to name just a few.

How to balance your gut bacteria

Research indicates that the damage caused by antibiotics to the gut can last for a far longer period than was previously believed.

In 2013*, Stanford University experts in the USA examined the friendly gut bacteria in 3 healthy adult women both before and after each of 2 cycles on an antibiotic. After the first round, they discovered that the medication affected the level of the women’s friendly bacteria in the gut drastically, perhaps even permanently. After the second cycle half a year later, they discovered that the impact was even greater.

As a result, it is advisable to take antibiotics only when absolutely necessary, i.e. when an infection is bad enough to cause discomfort and distress, or is life threatening or a risk to others. They should never be used as a repeated “quick fix” for small afflictions and lengthy programmes ought to be avoided wherever reasonably practicable.

If antibiotic intake is unavoidable, many individuals find it helpful to supplement their diets with additional friendly bacteria (probiotic supplements), before, during and after the programme of antibiotics is finished. It is believed that this will help to re-populate the digestive tract with the healthy bacteria that the antibiotics have decimated.

* https://med.stanford.edu/news/all-news/2013/09/scientists-show-how-antibiotics-enable-pathogenic-gut-infections.html

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How antibiotics affect the gut

Good health begins in the gut

Many health experts agree that good health begins with balance in the body, particularly in the digestive system.

Inside our bodies there are twenty times more bacteria than living cells, and maintaining the correct balance of good bacteria versus bad bacteria is a crucial part of avoiding illness and supporting long-term health and vitality.

Having the right kind of bacteria (so-called “friendly bacteria”), in sufficient quantities, is essential for everything from healthy digestion and nutrient absorption, to immunity and defence against infections.

What can disrupt the balance of gut flora?

The delicate balance of healthy bowel flora can be disrupted by a number of things, including excess intake of alcohol, a diet high in sugar, poor digestion, stress, as well as exposure to toxins and environmental pollutants. For the purposes of this article, we will look in more detail at one of the most common causes of bowel flora imbalance – the long-term or frequent use of antibiotics.

How do antibiotics affect the gut?

It is now generally accepted that antibiotics have historically been prescribed and used far more than they should be. While this is in the process of slowly changing, the result has sadly been an upsurge in antibiotic resistance – a type of drug resistance where a microorganism is able to survive exposure to an antibiotic.

What’s more, one of the most notable effects of antibiotics is their adverse impact on the digestive system and the balance of gut flora – they indiscriminately destroy both good and bad bacteria in the body. They work by either killing bacteria or by preventing bacteria from growing – obviously good in terms of bad bacteria, but bad in terms of friendly bacteria.

This is somewhat ironic, when you consider that people are taking antibiotics in the first place because they are ill, but their medicine is destroying one of the body’s primary lines of natural defence. In fact, what is arguably the most important part of the immune system resides in the gut – Gut Associated Lymphoid Tissue (special antibody-producing cells) work hard to prevent unwanted micro-organisms (such as bacteria and viruses) from entering the body.  

Of course, antibiotics have their role to play and can certainly be highly effective in resolving bacterial infections. However, it is important to use them sensibly, in moderation and to support your levels of beneficial bacteria both during and after a course.

Too many bad bugs

If your levels of good bacteria fall, you provide opportunistic ‘nasties’ (like bacteria, parasites and yeasts) with an excellent environment in which to thrive and spread.

An overgrowth of harmful gut flora (called dysbiosis), for example, increases gut toxicity and can result in a number of unpleasant symptoms and conditions, including:

  • bloating
  • constipation
  • diarrhoea
  • abdominal pains after eating
  • wind
  • Irritable Bowel Syndrome (IBS)
  • Leaky Gut Syndrome
  • and Candida overgrowth.

This is one of the reasons why antibiotic courses often result in thrush (a fungal infection caused by Candida overgrowth).

How to support the good guys

Research has shown that the damage done to the digestive tract by antibiotics can last far longer than was previously thought.

Stanford University researchers in America analysed the levels of friendly bacteria in three healthy adult women both before and after each of two cycles on the antibiotic Cipro. Following the first cycle, they found that the drug had altered the population of the subjects’ friendly gut bacteria significantly, perhaps even permanently. Following the second cycle, six months later, they discovered that the effect was exponentially greater.

As such, antibiotics should never be used as a regular “quick fix” for minor ailments and, wherever possible, long courses should be avoided. Where a course of antibiotics is unavoidable, you can support your levels of friendly bacteria through diet and probiotic supplements.

For instance, many cultures have observed the health-supporting effects of fermented foods (often referred to as “probiotic foods”) and so include them as a regular part of their diet. These foods include kefir, sauerkraut, miso, tofu and tempeh to name just a few. Including these foods in your diet on a daily basis is a good way to promote healthy intestinal flora.

However, it is worth noting that most of these foods do not contain strains of bacteria that can actually colonise the digestive tract. Instead, they do good work for a week or two and then pass through.

Supplementing with strains of good bacteria that can colonise the digestive tract (such as L. acidophilus, L. salivarius, B. infantis, B. bifidum, B. brevis and B. longum) is arguably a more effective and powerful means of supporting healthy levels of gut flora for the long term.

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Fibre for digestion

What is dietary fibre?

Dietary fibre, “bulk” or “roughage” (a complex carbohydrate) is the part of plant-derived foods that can’t be completely broken down by digestive enzymes in the human digestive system. Instead, it travels through the gut largely untouched, when it arrives in the colon where it may or may not be fermented by gut bacteria or micro flora. This is in direct contrast with most other nutrients, which are fully digested and used in other parts of the body during the digestive process.

Fibre is probably not something you think about too often, unless you suffer with chronic constipation or other symptoms of poor digestion on a regular basis. However, it plays a very important role in helping to maintain, not only a regular digestive system, but also a healthy body, for everyone.

As mentioned above, fibre is derived from plant sources, such as fruit, vegetables and grains, and contributes to digestive regularity, toxin elimination and is a key ingredient to a healthy, varied and balanced diet. Most people consume different types of fibre daily, without realising it. However, the quality of this fibre will vary greatly.

It is important to remember that fibre is about much more than just eating unprocessed bran, as is sometimes promoted by cereal companies. Bran has the potential to irritate many people’s guts, producing bloating, excessive wind and anal discomfort.

Soluble and insoluble fibre

Dietary fibre is often categorised according to its solubility, as soluble or insoluble fibre. In other words, whether it dissolves or not. Both types of fibre are found in different proportions in fibre foods.

What is soluble fibre?

Soluble fibre, essential for healthy digestion, is fibre that dissolves in water; a soft fibre that absorbs water as it moves through the digestive tract. It is made up of sticky substances like gums and pectin, which form a gel-like substance in the presence of liquid.

It is found in fruit, vegetables and other plant-based foods, and is probably best known for its cholesterol-lowering effects and ability to regulate blood sugar levels. When soluble fibre absorbs water, it turns into a gelatinous substance which is then fermented in the colon to produce short chain fatty acids. Soluble fibre is thought to bind with cholesterol and prevent it from being reabsorbed into the bloodstream. This helps to lower the amount of cholesterol in the blood, therefore reducing the risk of heart disease.

This type of fibre is a fermented source of nutrition, which means that it is acted upon by the normal bacteria in your intestines, which helps to break down the carbohydrates in your colon. One of the benefits is that your stomach stays fuller longer, providing a feeling of fullness.

Especially good sources of insoluble fibre include beans and other legumes, whole grains and certain fruit and vegetables (such as apples, citrus fruits and strawberries, and peas and lentils).

What is insoluble fibre?

Insoluble fibre, resistant to human digestive enzymes, is not digested by the body and it does not dissolve in water. It acts like a sponge, absorbing water and moving solid waste out of the intestines. In this way, it promotes regularity and softens stools

It is mainly found in wholegrain foods (such wheat bran, brown rice and couscous), root vegetables (such as carrots, parsnips and potatoes), celery, cucumbers and courgettes, fruit with edible seeds, beans, pulses and lentils, nuts and seeds. 

Constipation is a serious and chronic problem for many people of all ages in today’s fast-paced, fast-food society. Stress, low-fibre diets, lack of exercise, certain medications, very little insoluble fibre in the diet and dehydration all often result in continuous bowel problems. Toxic bowel material needs to be passed every day. Otherwise, if allowed to build up in the colon, it can lead to a range of bowel disorders and diseases.

Ironically, constipation can be a side-effect of a high-fibre diet if fluid intake isn’t also increased. This is because fibre acts like a sponge and absorbs water.

Why is fibre good for you?

Diets that are high in fibre have been shown to be beneficial in a number of ways, from supporting digestive health and regularity, to helping to eliminate toxins from the body. High fibre diets also help to regulate blood sugar levels, lower cholesterol levels and keep you feeling fuller for longer, thereby also supporting natural weight loss and a healthy heart.

Your daily diet should ideally contain between 25 – 30 grams of high quality fibre.

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