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Medication

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Could your medication be the cause of your weight gain or inability to lose weight? A recent study presented at the United European Gastroenterology week this year found that commonly prescribed medications significantly alter the gut microbiome, increasing the risk of infection, weight gain, obesity, and a host of other diseases and conditions related to gut bacteria imbalance (or dysbiosis). The study looked at stool samples from 1,883 individuals, some healthy and some with inflammatory bowel disease (IBD), and assessed the impact of single drug use as well as multiple drug use on the gut microbiome. Out of 41 drug categories analyzed, 18 were associated with significant alterations in the microbiome. These alterations varied depending on the medication, and included microbial changes such as bacterial overgrowth in the upper GI tract, alterations in fatty acid production, increased levels of E. coli and Eubacterium ramulus, and heightened antibiotic resistance within the…

Annette is a patient born in Argentina who I saw in consultation for Crohn’s disease. Like most people from that part of the world, she received the bacillus Calmette–Guérin, or BCG, vaccine against tuberculosis as a child. Since the vaccine is prepared from a strain of live tuberculosis that has lost its virulence in humans, one of the possible side effects is a false positive skin test for tuberculosis, which is exactly what happened to Annette when she was screened for tuberculosis in middle school. As a result of the positive test, she was treated for active tuberculosis infection with three antibiotics for a total of nine months, even though she never had any signs or symptoms of tuberculosis, and an X-ray of her lungs failed to show any evidence of the disease. In her senior year of high school Annette developed abdominal pain, diarrhea, and weight loss. She was…

Antibiotics disrupt flu vaccine success. A study published this fall found that in those who hadn’t had the flu shot or the flu in the last three years, receiving antibiotics just before the flu shot made it less effective. Cell Takeaway: This is the first human study of its kind, and illustrates the key role our gut bugs play in determining our immune response, as well as how our microbiome can impact the success – or failure – of medication. If you plan to receive the flu vaccine (and even if you don’t!), avoiding antibiotics is an important step in cultivating a strong, responsive immune system.

Proton pump inhibitor (PPI) use in infants increases risk of infection in certain populations. PPI’s (as well as other acid blocking drugs) are commonly prescribed to infants who suffer from gastrointestinal upset and reflux. A recent study found a significantly increased rate of infection in infants who take PPIs and have regular CYP2C19 gene function – a gene that plays a role in processing and metabolizing some commonly prescribed drugs. The rate of infection was significantly increased in those infants compared to ones who have heightened CYP2C19 function. Pediatrics Takeaway: Researchers who conducted the study concluded that CYP2C19 function should be assessed when considering PPI therapy in infants. PPI and acid blocking drugs are commonly prescribed in infant populations, yet studies show they are both ineffective and unsafe – and this study proves more of the same. Unfortunately, parents are often given prescriptions for acid suppression medications – a particularly…

Oral antibiotics are tied to colorectal cancer (CRC). Researchers matched over 28,000 patients with CRC found in the Clinical Practice Research Datalink database with controls. Results showed that CRC risk depends on antibiotic type and location in the colon, but overall, CRC risk was dose dependent with any antibiotic use. Antibiotics with anti-anaerobic activity, which disrupts the gut microbiome in a way that allows carcinogenic microbes to develop, posed the greatest risk, especially in the proximal colon. These antibiotics include penicillin (ampicillin and amoxicillin). Interestingly, antibiotics showed a protective effect against rectal cancers, specifically in doses of more than 60 days of antibiotic exposure when compared to no antibiotic exposure. While the study was funded by Johns Hopkins Fisher Center Discovery Center and Bloomberg-Kimmel Institute for Cancer Immunotherapy, the study reported indirect competing interests, including receiving financial support from pharmaceutical companies. Gut Takeaway: While these results do not prove a…

Hilary didn’t have a history of lots of antibiotic use in the past, but she was a picky eater in childhood who avoided fruits and vegetables like the plague. She was now in her thirties and in good health until a case of severe gastroenteritis, with nausea, vomiting, fever, and dehydration led to a five-day hospitalization. The cause of the gastroenteritis was never identified, but because she had a fever, while in the hospital she was treated with two different intravenous antibiotics and discharged on an additional ten-day course of oral antibiotics. Hilary felt better by the time she completed the antibiotics, but three months after the hospitalization she developed mushy stool that she described as having an oatmeal consistency, as well as severe bloating. Upper endoscopy and colonoscopy were unrevealing, and biopsies were negative for celiac disease, microscopic colitis, or any other abnormalities. A month later Hilary was prescribed…

…and this can really matter when we’re talking about cancer medication. Immunotherapy is a type of drug therapy used to treat cancer that focuses on boosting the immune system. Without the harmful side effects that come with chemotherapy, immunotherapy is the preferred method to treat many cancers today, yet positive response rates to this type of therapy fall somewhere south of 60%. Why so low? Because gut bacteria play a heavy role in metabolism and immunity, they can ultimately determine the fate of a medication’s effectiveness. And in those who suffer from dysbiosis (imbalanced gut bacteria), the likelihood of a positive response to immunotherapy is lower than those with a balanced, diverse microbiome. In fact, both human and animal studies show that taking antibiotics within a short timeframe before starting immunotherapy results in lower response rates. Researchers have also compared the microbiomes of those who respond well to immunotherapy and…

Glenn had been on various antibiotics for cystic acne for seventeen years. His skin would initially respond well, but after a year or two the cystic lesions would return, and his dermatologist would switch him to a different antibiotic. Ten years after he first started taking antibiotics Glenn began to have persistent loose stools and weight loss. He experimented with cutting out dairy and tried to increase his calories, but no matter what he ate, he still had diarrhea and trouble gaining weight. Evaluation of his digestive tract eventually revealed a diagnosis of celiac disease, and he was put on a gluten free diet (GFD), which he adhered to strictly. His doctor reassured Glenn that after a few months on the GFD his diarrhea and weight loss would improve, but two years later nothing had changed. Repeat evaluation showed the signs of celiac disease had completely resolved, and his small…

Antibiotic therapy disrupts the gut microbiome and results in a pro-inflammatory response that negatively affects bone health. Previous studies have uncovered the direct relationship between a balanced microbiome and healthy bone development. A February 2019 study took this relationship further and investigated the use of a broad-spectrum antibiotic in mice to determine if there were any microbiome-mediated alterations in skeletal formation on a cellular level. After administering antibiotic therapy during the post-puberty phase (this phase is responsible for 40% of our bone accumulation), researchers found that the antibiotics led to significant disruptions in gut bacteria that altered the communication between immune cells and bone cells. These alterations led to substantial changes to trabecular bone – the bone type that experiences high rates of bone metabolism. The American Journal of Pathology  Takeaway: Antibiotics, especially broad-spectrum ones, significantly alter the gut microbiome, which may have negative and lasting effects on skeletal health. Researchers hope to conduct…