Minimize The Harm Of Antibiotics

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In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

So, no question/request too big or small 😎

❝Am booked in for a hip replacement, and of course the doc wants to give antibiotics around the surgery, but I know that’s very bad. That being said, I’d also like to not die of sepsis, so is there any way to get the best of both worlds?❞

Not dying of sepsis is also one of our favorite things to do! Indeed, sometimes antibiotics are a necessary evil.

Let’s quickly recap for everyone why antibiotics really mustn’t be used unnecessarily.

• What most people know about: it creates antibiotic resistance, and thus helps breed dangerous pathogenic superbugs, à la MRSA et al. That’s a problem for everyone, including the person who took the antibiotics.
• What most people don’t know about: because it’s a “scorched earth” tactic that kills most bacteria, friend and foe alike, the problem isn’t just that it devastates your gut microbiome by killing helpful bacteria, it’s also about a secondary consequence of that, which is that it leaves the coast clear for pathogenic fungi which aren’t touched by antibiotics at all, being an entirely different kind of life.

Consider for a moment how bad that is: you just went scorched earth on your gut, killing everything good or bad… Apart from the fungus that likes to put its roots through your intestinal wall, make holes there, and interface with your nervous system, and is usually kept in check and stopped from doing that by friendly bacteria.

You wiped out the friendly bacteria that normally hold it back, and now the completely unbothered fungus is alone in there wondering “Did something happen? Oh well, free lunch!”

See for example: Candida albicans as a commensal and opportunistic pathogen in the intestine

And for that matter: Candida albicans-Induced Epithelial Damage Mediates Translocation through Intestinal Barriers

(That’s scientist-speak for “Candida puts holes in your intestines, and stuff can then go through those holes”)

And that’s just C. albicans, never mind things like C. diff. that can just outright kill you easily. This one’s not a fungus, it’s a spore-forming bacterium, but it’s also untroubled by antibiotics so it enjoys a similar launch into overgrowth when you kill its competitors.

For more details, see Four Ways Antibiotics Can Kill You

Now, how to minimize/mitigate that

First of all, of course, avoid antibiotics unless you really need them. Hip surgery is indeed a case of “really need them”.

By the way, in the US, most antibiotic resistance comes not from the direct use of antibiotics in humans, but from the heavy use of antibiotics in the farming of non-human animals (including fish, but cows and pigs are the biggest hosts) that are then eaten by humans, so that’s one more reason to skip the meat, too.

However, people do often errantly take antibiotics for things that antibiotics can’t really help with (e.g. most respiratory tract infections), so please consult with your doctor and only take them if they advise it’s truly necessary.

Secondly, IV is better than oral, unless your doctor has a very good reason to prescribe oral (e.g. “there is a pathogenic bacterial overgrowth in your gastrointestinal tract and we are going to kill it”), because:

1. better distribution through your circulation anyway
2. less impact on your gut than putting it directly into your gut (who would have guessed that?)

Thirdly, less is better than more, in the sense of: there’s normally a course of antibiotics, and for perioperative prophylactic purposes (i.e. what will be the case for your hip surgery), two or three days of IV is likely to be sufficient to avoid infection, and allows for a much better rebound of healthy gut bacteria than if you take seven days of antibiotics, for example:

❝The effect of antibiotics on gut microbiota is produced after antibiotics treatments over one week.

The recovery of gut microbiota to the state of pre-antibiotics may require over two weeks of antibiotics withdrawal.❞

Read in full: Assessment of the impact of intravenous antibiotics treatment on gut microbiota in patients ← this paper used data from heart surgeries, but the principle for your gut health is exactly the same

Lastly, prepare your gut in advance. By this we mean: the healthier your gut microbiome is when you go in, the more chance there is of a healthy rebound when you come out.

So, prioritize your gut health in the weeks (ideally, months, you really can’t start too early) before your surgery, and maximize your beneficial microbiota diversity, such as by:

• enjoying plenty of fiber (prebiotics)
• enjoying fermented foods (e.g. kimchi, sauerkraut, kefir, etc)
• taking probiotic supplements (but see the link below for how to not waste these by sabotaging them)

A lot of people do make certain common mistakes when taking probiotics, so here’s how to avoid those mistakes: Stop Sabotaging Your Gut

Want to learn more?

Here’s an in-depth guide to avoiding many all-too-popular contaminants of foods, including antibiotics:

Healthy Living in a Contaminated World – by Dr. Donald Hoernschemeyer

And, on a side-note, you might also like to check out:

Nobody Likes Surgery, But Here’s How To Make It Much Less Bad: The Insider’s Guide To Making Hospital As Comfortable As Possible

Good luck with your surgery!