For people in the ancestral health community, making the decision to take a course of antibiotics can be scary and discouraging. Many of us are aware that the overuse and misuse of antibiotics is a major public health issue that contributes to antimicrobial resistance. We may also know that antibiotics can significantly alter the diversity and composition of the gut flora in a way that might never fully return to its baseline. Before taking an antibiotic, you should carefully consider the advice of your prescriber to determine if it is truly necessary, and if so, if there is any additional testing that can be done to target the specific type of antibiotic prescribed. That being said, antibiotics can be lifesaving and if you need to take them, do so without unproductive guilt and fear. There are steps that you can take to restore your gut while taking antibiotics order to optimize your recovery. Probiotics: It is critical to supplement with probiotics while taking antibiotics. This is a common area of confusion as many people believe that there will be no benefit to taking probiotics because the antibiotics will simply kill them. However, there are numerous clinical trials that have demonstrated the benefits in taking probiotics along with a course of antibiotics to prevent side effects and gut infections (1, 2, 3, 4, 5). So, don't hesitate to take a probiotic along with your course of antibiotics, but know that the type of probiotic and the dosing is important to consider.
Type of Probiotics: The human microbiome is incredibly diverse and there is still much that we don't understand about ideal probiotic strains. What I can say with a great deal of certainty is that there is no probiotic supplement on the market that can mimic the diversity and complexity of the microbiome. Most of the studies that examine probiotic use during antibiotic treatment use a combination of Lactobacilli, Bifidobacteria, or Saccharomyces boulardii strains. Saccharomyces boulardii is a probiotic yeast that has numerous known benefits for health of the gastrointestinal system. It is particularly useful for supplementation during a course of antibiotics because yeast cannot be killed by an antibiotic. I generally prefer to recommend a professional brand, such as Klaire Labs, but if you are in a pinch, Jarrow is an over-the-counter brand that does not contain fillers. Lactobacilli and Bifidobacteria are common probiotic strains used in supplements, but again, I would recommend using a probiotic from a professional line brand.
There are no studies that evaluate the use of soil-based probiotics to address antibiotic side effects and related gut infections. Anecdotally, I have had excellent results with using a soil-based probiotic called MegaSporeBiotic for myself and my patients. Soil-based probiotics are able to colonize the gut, unlike other probiotics that are transient and unable to change the composition of the gut flora. Based on my clinical experience, the type of probiotics that I recommend most often for patients taking antibiotics are S. Boulardii, MegaSporeBiotic, and/or GutPro (which contains several Lactobacilli and Bifidobacteria strains). However, every individual is unique and if you are unable to tolerate these probiotics, you should work with a nutritional therapist to explore other brands and strains.
Dosing of Probiotics: You should dose the probiotics as far apart from the antibiotics as possible. If you are scheduled to take the antibiotic three times daily, take the probiotic 4 hours after the antibiotic. If you are taking the antibiotic twice daily, time the probiotic 6 hours after the antibiotic. For antibiotics scheduled once daily, take the probiotic 12 hours following the antibiotic.
How Long to Take the Probiotics: I have a conservative approach to supplementation, but I believe that most individuals benefit from long-term supplementation with probiotics. Most of us are dealing with damaged, or at the very least, less than ideal gut flora (for an explanation of some of the reasons why, see this post). Continue taking the probiotics after you finish the course of antibiotics.
Diet and Nutrition: Beyond probiotic supplementation, diet is essential for establishing healthy gut flora and restoring it after taking antibiotics. Following a real food template that eliminates processed foods and foods that are inflammatory and damaging to the gut flora is key. Prebiotics are the fuel found in fiber that nourish the probiotics in the gut. Prebiotic foods high in soluble fiber include Brussel sprouts, avocado, asparagus, turnips, carrots, squash, sweet potatoes, radishes, oranges, and figs. Resistant starch is also an important source of prebiotics, but caution is advised as it can sometimes be irritating to the lining of the gastrointestinal tract. Potatoes, green bananas, and unripe plantains are whole food sources of resistant starch and there are also resistant starch or inulin-based prebiotic supplements that you can take. If adding resistant starch, proceed slowly and listen to your body.
Although I don't believe that fermented foods can serve as a replacement for a therapeutic probiotic supplement, they are a good source of B vitamins and enzymes that are beneficial in healing the gut. The probiotics found in fermented foods may also contribute to the diversity of the gut flora. You can incorporate traditional fermented foods into your diet in the form of sauerkraut, fermented vegetables, kombucha, and kefir.
Bone broth is a traditional healing food that contains minerals and amino acids that soothe and heal the gastrointestinal tract. Glutamine is one amino acid found in bone broth that can assist with repair of the epithelial lining of the GI system. If you believe that your gut health is severely compromised, it may be prudent to supplement with l-glutamine. Glycine is another amino acid in bone broth that plays an important role in the inflammatory response. Antibiotics can stress the liver and glycine is also necessary for the body's natural detoxification process, so this is another reason to consume bone broth while taking antibiotics.
Other Considerations: When taking antibiotics, your health is likely not optimal and you may not be feeling your best. Adequate rest and sleep is critical when your body is fighting an infection. Focus on reducing your stress. Take as much time off work as you can. Enlist the help of your family and friends to assist with child care, errands, and daily activities. Get outside to soak in some natural vitamin D. Allow your body the time and space to recover.
Have you had to take a course of antibiotics recently? What tips do you have for recovering your gut health after antibiotics? I'd love to hear from you!