Saturday, November 5, 2011

Pharmaceutical Antibiotics Probably Promote Obesity

We may add obesity to the long list of iatrogenic (medicine-caused) disorders.

Katie Moisse of ABCnews online reports that antibiotics may promote obesity.

Her article refers to research done by Dr. Martin Blaser of New York University Langone Medical Center.  Blaser studies the effects of antibiotics on Helicobacter pylori — a bacterium that lives quietly in most but leads to ulcers in some.

In his animal research, Dr. Blaser found that:

"...antibiotics for H. pylori trick the body into eating more by disrupting hunger hormone levels. Indeed, mice given antibiotics get fatter than their untreated counterparts despite having the same diet."
Blaser published his concerns in an editorial in the August 24, 2011 issue of Nature under the title "Antibiotic overuse: Stop the killing of beneficial bacteria."  

I don't have access to that full text article, but in April of this year a team including Blaser published the results of a human intervention study in which they tested their hypothesis that altering intestinal flora with antibiotics influences appetite-regulating hormones and body mass: The effect of H. pylori eradication on meal-associated changes in plasma ghrelin and leptin (full text).

They found that people treated with antibiotics had a 6-fold increase in post-meal ghrelin, a 20 percent increase in leptin levels, and a 5 percent increase in body mass index 18 months after completing the course of antibiotics. 

 Science Daily reports that ghrelin "not only stimulates the brain giving rise to an increase in appetite, but also favours the accumulation of lipids in visceral fatty tissue." [1]  So antibiotics promote central abdominal obesity, the type associated with metabolic syndrome and increasing the risk of diabetes.

Even if this treatment had spectacular success in treating the main complaints of the patients involved, they might not appreciate the side effect of increased obesity.  But it gets worse.  The text contains this passage:

"At baseline, the 38 H. pylori-negative and 44 H. pylori-positive subjects did not differ significantly in median pain, non-pain, and satisfaction scores (data not shown). Among the 21 patients from whom H. pylori was eradicated, there were no significant differences between baseline and follow-up pain scores [Median (IQR) 9 (2-23) vs. 6 (2-15); p = 0.86], non-pain scores [13 (12-16) vs. 10 (10-18); p = 0.28], or satisfaction scores [13 (10-23) vs. 19 (12-20); p = 0.29]. Thus, the observed increase in BMI following eradication (Figure3) was not correlated with diminished dyspepsia that could increase appetite."  [Emphasis added]
According to these authors, pain levels did not differ between people who were H. pylori positive and those who were H. pylori negative.  This might suggest to some people (like myself) that H. pylori does not cause of the problem.  Further, treatment to eradicate H. pylori did not result in any significant reduction in dyspepsia (stomach discomfort).  This again suggests that H. pylori does not cause the problems experienced by the patients.

So, the destruction of H. pylori didn't give the patients significant relief from their main complaint (stomach discomfort), but it did make them fatter.  How do you like that for an effective treatment strategy? 

I hypothesize that the gut flora reflect the diet, and that imbalanced nutrition causes both H. pylori overgrowth and dyspepsia.   If you change the food flowing through the gut, you will change the flora.  Overgrowth of H. pylori only serves as a marker for a particular type of diet, and does not the cause the dyspepsia.  Killing off H. pylori doesn't give people relief from their gut complaints because their gut complaints arise from dietary and stress factors that remain unchanged by eradication of H. pylori.  

How about holiday weight gain?  Many people report gaining weight over the winter, which may coincide with increased (misguided) use of antibiotics for upper respiratory infections.

Not Just Obesity?

According to another article on ABC News online by Mikaela Conley,  "Blaser hypothesized that the overuse of antibiotics may even be fueling the 'dramatic increase' in many illnesses, including type 1 diabetes, allergies and inflammatory bowel disease by destroying the body's friendly flora, or protective bacteria" in his Nature editorial.

Some cancers appear related to antibiotic use as well.

Tamim et al reported finding a dose-response relationship between antibiotic exposure and breast cancer in Canada, with the highest antibiotic exposure linked to a nearly doubled risk of breast cancer:

"The incidence of breast cancer was higher in subjects who had more antibiotic prescriptions during the 1-15 years prior to the index date (RRs = 1.50, 1.63, 1.71 and 1.79 for the four quartiles, respectively, p-trend = 0.0001). Similar results were found when a number of units were considered. We did not find any effect of the timing of antibiotic exposure on breast cancer risk. Similar patterns of increased risk of breast cancer were detected for the specific antibiotic classes."
Tamim et al also reported a dose-response relationship between antibiotic exposure and prostate cancer in Canada, with the highest exposure linked to an almost tripled risk of prostate cancer:
"Antibiotics exposure (number of prescriptions) during the period of 1-15 years in the past was significantly associated with an increased risk of prostate cancer; RR = 1.69, 2.61, 2.71, and 2.83 for the 4 quartiles, respectively, p-trend = 0.0001. When number of units was taken as the exposure definition, similar results were found. We did not find any effect of the timing or class of antibiotic exposure on prostate cancer risk. We found a dose-dependent association between antibiotics exposure up to 15 years in the past and risk of prostate cancer. However, the lack of temporal trends and the absence of class specific effects suggest a noncausal relationship."
Both of these studies suggested a noncausal relationship between antibiotics and cancer.  Since the relationship seems fairly strong on a statistical basis, I would guess that people who use antibiotics often have cancer-promoting lifestyles, whereas those who avoid antibiotic use have cancer-preventive lifestyles.  The habits that make people prone to infections also make them prone to cancers.

Prevalence of Antibiotic Abuse

Conventional physicians most commonly prescribe antibiotics for upper respiratory, sinus, or ear infections, despite the fact that most of these events involve viruses or fungi (sinuses), which are not susceptible to antibiotics. 

Apparently, according to Blaser, the average American child will receive 10 to 20 courses of antibiotics by the time he is 18 years old, and one-third to one-half of pregnant women will receive them during pregnancy. 

This means that the average American probably has disrupted gut flora and increased ghrelin levels before reaching adulthood.

The Herbal Alternative

I haven't used antibiotics for 30 years. 

If I, Tracy, or one of my patients needs help with an acute respiratory illness, I use acupuncture and herbal remedies.  Often the early application of the appropriate herbal formula can reduce the duration of a 'cold' or 'flu' to 3 days or less, compared to the 7 to 10 days typical for these challenges.

For my patients with chronic stomach discomfort associated with ulcers (or not), I use diet changes and if necessary, herbal medicines, with good results.

Evolutionary biology supports the use of herbal antimicrobials.  Plants need to defend themselves against viruses, bacteria, and fungi without pharmaceutical aid.  Natural selection favored the survival of plants that could fend off microbes, so those plants that could produce antimicrobial compounds survived evolution and those that could not, did not.

Plenty of scientific research shows various herbs have strong antimicrobial activities.  For example, following traditional Chinese medical practice, I use formulas containing forsythia fruit to treat sore throats and acne.  Qu et al reported on the antibiotic properties of forsythia components:

"Forsythiaside was found to possess strong antioxidant and antibacterial activity but forsythin was much weaker. Owing to these properties, the study can be further extended to exploit the possible application of forsythiaside as an alternative antioxidant and antibacterial agent of natural origin."
The "possible application"? Physicians trained in Chinese medicine have been using this herb for centuries!

Notice their reductionistic approach based on their limited knowledge.  They believe that forsythiaside is 'stronger' than forsythin because the former performed better in their test than the latter. 

This reflects the pharmaceutical approach, which so far focuses on taking one agent, isolating it and increasing the dose, hoping to find some dose of that one compound that will take down all of the cells in the microbial colony.  This ignores the variability of individual microbes which almost guarantees that no one compound will kill all individual microbial cells in a colony.

Its like thinking that 100 highly amplified violins will produce the same music (have the same effect) as a 100-piece symphony consisting of a dozen different instruments.  Using the example above, people who focus only on one plant compound like forsythiaside because it appears 'strongest' in some laboratory test forget that their test is limited by what they think they know.  They think forsythin is less important because it performed worse on their test. 

But forsythias produce 'weaker' chemicals like forsythin for some purpose, probably unknown to these researchers and to myself.  Not knowing the reason, we can't assume that the 'stronger' compound is the better one in a natural context.

I would wildly guess that in nature, some microbes will survive a huge dose of the 'strong' compound but die on contact with a small dose of the 'weak' compound.

The benefit of whole herbs lies in their provision of multiple antimicrobial compounds, each acting slightly differently from the others, resulting in a whole that exerts a greater effect than any single part--just like a symphony exerts a greater effect than 100 amplified violins.   The multiple angles of defense against microbes provided by a whole herbal extract increases the chance that it will weaken all microbes it contacts, and reduces the opportunity for the microbial colony to develop resistance to any one of the herbal compounds.  

Plants evolved their approach to controlling microbes over millenia.  Do we really think we can by dicking around with our limited intelligence improve on an approach that evolved by a process that we don't and will never understand completely?  

According to my copy of Chinese Medical Herbology and Pharmacology by John Chen PhD, PharmD, OMD, L.Ac., the essential oil of forsythia fruit (Chinese: Lian Qiao):

" ...has demonstrated a broad specturm of inhibitory effects against Staphylococcus aureus, Diplococcus pneumoniae, Bacillus dysenteria, alpha-hemolytic streptococcus, beta-hemolytic streptococcus, Neisseria catarrhalis, Salmonella typhi, E. coli, Mycobacterium tuberculosis, Bacillus proteus, Boretella pertussis, Corynebacterium diphtheriae, leptospira, and some dermatophytes and influenza viruses." (p. 175)
This provides only one example of literally dozens of antimicrobial herbs in the herbal pharmacopiae. 

With this knowledge, I just say no to pharmaceutical antibiotics.


Jack Christopher said...

Insightful post. What's your chronic sinusitis remedy?

Herbal medicine should be a basic part of our healthcare system:

Click "Category:Health" for P2P Foundation list of alternative healthcare systems.

BTW, PlantJourneys(blogspot/com) is a pretty good (women focused) herbal medincine blog

Ed said...

Dr Art Ayers writes about flora balance and health. In particular, a theme is that a healthy balance promotes regulatory T cells ("Tregs"), which prevent immune-system over-reaction. H Pylori eradication is shown to cause Treg imbalance (search on pubmed for reference). Insufficient Treg leads to inflammation. Inflamed hypothalamus leads to leptin insensitivity (see Guyenet). The chain of events is quite plausible to me.

It's not just H Pylori, Ayers writes that a healthful gut has ~150 species of microorganisms, in balance. Wired (of all magazines) wrote recently on the tremendous flora changes following antibiotics, and the difficulty re-establishing the original balance. I think our bodies are adapted to kissing (swapping gut flora) and not washing hands, eating dirty food -- but, of course, not modern industrial "dirt" ie pollutants -- to help maintain gut flora.

I think you should watch for adverse side effects from "natural" anti-microbials just as much as you would from man-made.

Ayers notes that you must carefully work to re-establish gut flora, through eating unwashed organic vegetables, but carefully, as there are very real risks of dangers in doing so.

Good start, Don. I would enjoy if you further explored the various areas of this topic. Dr Ayers doesn't blog enough for my taste!

Malibu said...

I like this post, wish you would have touched on the massive, extraordinary loading of depression medication done by doctors in relation to this as well. These pills seem to mess up systems and gut flora similar to antibiotics, when i wager a guess , dietary change & herbal/acupuncture would produce lasting similar natural results.

FWIW, i have 7 medication prescriptions sitting at the pharmacy from antibiotics i have been prescribed by doctors. i refuse to pick them up, because i refuse to take them. IMO, there is nothing good about them, and unless i am on my deathbed i dont plan to take them. a lot of feeling/being sick i think is in your head. i can run a fever as my body is fighting something off, but if i stay confident it's just something working its way out, it happens to pass on through me- plus a good dose of sunshine, broth and maybe an epsom salt bath!

i despise so much how dependent people are on doctors to fix and cure their every little ailment. it is soooooo annoying