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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What is coeliac disease?

Coeliac disease (pronounced see-liac and spelled celiac in other countries) is an autoimmune disease, not an intolerance as is often assumed.

This means that the body’s immune system attacks its own tissues, through the production of antibodies. In the case of coeliac disease, this reaction is triggered by gluten.

Gluten is a protein composite found in wheat and related cereals, including barley and rye. If eaten by coeliacs, it inflames and damages the lining of the small intestine.

The primary functions of the small intestine are to breakdown and absorb the nutrients in food. In untreated coeliac disease, the cells lining the small intestine become flat and inflamed and their surface area significantly reduced. This results in a reduction in the absorption of nutrients from food and can lead to malnutrition and deficiencies in vitamins, iron, folic acid and calcium. Sugars, proteins and fats are often poorly absorbed as well.

Coeliac disease is closely related to dermatitis herpetiformis, which is an autoimmune blistering disorder associated with a gluten-sensitive enteropathy.

What causes coeliac disease?

The precise cause, or causes, of coeliac disease are not yet known. However, it is believed that there are three primary factors that underlie its development. These include:

  • an environmental trigger (in this case gluten)
  • a genetic susceptibility
  • an unusually permeable gut.

Occasionally, the stress of an operation, accident, intestinal infection or pregnancy can trigger the onset of the condition.

How is coeliac disease diagnosed?

Research shows that coeliac disease affects around 1 in 100 people in the UK, making it much more common than previously thought. Under-diagnosis is also significant problem, with it being estimated that around 500,000 people have not yet been diagnosed.

Coeliac disease can be diagnosed at any age. For example, even babies can be diagnosed – after weaning, when cereals containing gluten are first introduced into their diet. However, the most common age of diagnosis is currently between 40 and 60 years old.

What are the symptoms of coeliac disease?

The physical signs of coeliac disease vary from person to person and can range from mild to severe – it affects people differently.

Symptoms may present in the digestive tract, or in other parts of the body. For example, one person might have diarrhoea and abdominal pain, while another person may be irritable or depressed. In fact, irritability is one of the more common symptoms in children.

Some of the most common symptoms generally include: tiredness, anaemia, diarrhoea, abdominal discomfort, weight loss, vomiting and mouth ulcers.

Unfortunately, some people present no symptoms at all. While this may sound like a good thing, such people are still at risk of the complications associated with the disease. The longer a person goes undiagnosed and untreated, the greater the chance of developing malnutrition and other complications. Anaemia, delayed growth and weight loss are signs of malnutrition, because the body is just not getting enough nutrients.

In addition, increased incidence of rheumatoid arthritis, diabetes mellitus, autoimmune thyroid disease, sarcoidosis, vasculitis, pulmonary fibrosis, osteoporosis, infertility and other diseases of the gut have been reported in coeliac patients.

How is coeliac disease treated?

Unfortunately, there is currently no known cure for coeliac disease. However, the primary treatment, which is usually very successful, is to remove all sources of gluten from the diet. This approach is also effective in cases of dermatitis herpetiformis.

Concern has surrounded oats containing gluten (as some people with coeliac disease are also sensitive to oats), but studies have shown that consumption of a moderate amount of oats does not worsen dermatitis herpetiformis or celiac disease.

A gluten-free diet is a lifelong commitment, and adherence to a strict diet is difficult to achieve; gluten is present in various foods that are consumed on an everyday basis. Improvement of symptoms can also take several months and requires patience and staying-power. Having said that, a well-planned diet can deliver excellent results.

Nutritional supplementation, in conjunction with a well-balanced diet, is also recommended for patients on a strict gluten-free diet. This will help to ensure that they are receiving the broad spectrum of nutrients (such as vitamins and minerals) that they need. In particular, nutrients-fortified gluten-free meal shakes can be a safe, easy and effective way to achieve this.

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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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Is dairy bad for me?

Some people swear by dairy, claiming that it’s essential for strong bones and teeth and a generally strong constitution. Others feel that their bodies react poorly to dairy, with resulting increased mucous levels, stomach pains and congestion. So is dairy good or bad for you?

Well, as with most things, the answer depends on a number of factors, including the make-up of your own individual body, as well as whether you are consuming dairy in moderation. There is no denying the fact that dairy is, for one thing, acid-forming in the body, which can lead to inflammation and, as such, you should not be consuming dairy in excess. It is also high in saturated fat and, unless you are careful, can often contain contaminants (such as hormones and medication).

Dairy allergy

In this modern age of dietary awareness, many people may jump to the conclusion that they have a full-blown dairy allergy if they have a negative response to dairy. However, this may not always be the case. If in doubt, consult your doctor or an allergy-testing clinic.

A true dairy allergy is when the body goes into shock (or has an anaphylactic reaction) after ingesting dairy and is the response of the immune system to the proteins found in dairy products. Casein and whey are the two main components. Casein is the curd that forms when milk is left to sour, while the watery part that is left after the curd is removed is the whey.

A dairy allergy is an extreme sensitivity to these proteins and should not be confused with lactose intolerance.

Most symptoms of a dairy allergy (commonly hives, congestion and eczema) manifest within minutes after the person consumes dairy products. A dairy allergy can be mild or serious and varies among individuals. For example, the reaction can range from mild indigestion to anaphylaxis, which is an acute reaction.

Dairy allergies are a common problem, particularly amongst young children. Since children affected by dairy allergies are often too young to tell you when they are having a reaction, it is important for parents to be able to recognise the symptoms and have a proper understanding of foods and ingredients to avoid. Fortunately, it is one of the food allergies that has alternatives and is not always a permanent problem.

Lactose intolerance

A dairy allergy is commonly mistaken for lactose intolerance because they share similar digestive symptoms, but in actuality, a dairy allergy is very different to a lactose intolerance.

In contrast to a true dairy allergy (where there is an immune system response whenever exposed to cow’s milk proteins), people with a lactose intolerance can’t tolerate the sugar in milk (called lactose), because they don’t have the corresponding digestive enzyme – lactase – to cope with lactose sugar. An intolerance is not an allergy, because it does not involve the immune system.

A lactose intolerance is less threatening than an allergy. Triggered by the digestive system, the body can respond in a number of ways to the ingestion of lactose, but it usually involves a significant stomach upset. Symptoms can include extreme gas, bloating, diarrhoea, vomiting and stomach cramps, but not usually hives or breathing difficulties.

Living with a dairy allergy or lactose intolerance

The primary treatment for a dairy allergy is avoidance. Depending on severity, this will be either total elimination or limited consumption of dairy products.

However, there are a number of other techniques that can be used to live with both dairy allergies and lactose intolerances.

As with all food allergies and sensitivities, it is important to take allergy tests or go on an elimination diet to confirm that dairy is responsible for the reactions. Confirmation is extremely useful, because a wide array of foods can cause reactions and it is important to narrow down the true allergen.

Clearly, having a dairy allergy or lactose intolerance can present a very real day-to-day challenge in terms of ensuring a varied diet and optimum intake of nutrients. As with any restricted diet (for example, vegetarians, vegans and coeliacs) it is important to take proactive steps to ensure that the person with the allergy or intolerance is getting sufficient vitamins, minerals and other nutrients.

One of the easiest ways to do this is through careful dietary planning and supplementation. Dairy-free and lactose-free meal shakes and protein powders can be particularly beneficial, especially if they have been fortified with other nutrients.

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