On Health and Healing

Reflections on Wellbeing, Stress, and Contemporary Health Issuses

QUESTION: Should I Take Probiotics For MY GUt After a Course of Antibiotics?*

Answer: I always recommend getting a daily dose of fermented foods first. My favorite way is to garnish a meal with some kim-chee or sauerkraut. Food sources are always the most important foundation for getting vital nutrients. As for adding a probiotic supplement to support your digestive tract after antibiotics,* until recently I would have absolutely said Yes! However, I am no longer an unequivocal yes to GI probiotic supplements in this situation. Let me share with you why.

When we have a serious bacterial infection and need a course of antibiotics, the antibiotics not only take-down the “bad” or harmful bacteria, but they also take-down the “good” bacteria as well. By now it is common knowledge that we need the “good” bacteria in and around our bodies.

Kitchen-table wisdom tells us that replenishing our gut flora with probiotics will help us rebuild our gut microbiome. There are two good reasons to like this approach to health care. First, it recognizes the importance of gut flora for our health. The second is choosing to be proactive with self-care is a solid way to look after our well-being.

However the replacement model underpinning this advice doesn’t measure up to the complexity at work. In the deep-ecology of our guts, the math is something beyond that of subtraction and addition. It turns out the equation is more complex than that, dare I say algebraic!

Research into gut microbiomes suggests that what makes our gut microbiomes healthy is not mere abundance of the Good Bacteria, but a rich diversity in them. Having a complex web of good bacteria at work in a gut microbiome provides for checks and balances. Having checks and balances fosters a balanced and therefore healthy ecosystem.

It turns out then that supplementing with one or even a couple probiotic strains after antibiotics actually prevents a diverse population of flora from re-establishing itself. When the microbiome takes a hit, the digestive tract becomes vulnerable to one flora becoming dominant afterwards. In such circumstances, even typically healthy gut bacteria can turn problematic without good neighbors to keep them in check. In fact, according to recent research shared by Dr. Christopher Lowry from the University of Colorado, taking a probiotic after antibiotics can delay gut microbiome recovery by months. Oops!

(you can learn more here: deep-dive Cell Journal Paper or a BBC article)

In light of this updated understanding, it appears wiser to refine our goals in restoring gut-health in general and after a course of antibiotics in particular. The superior protocol at this time is to introduce a wide array of healthy bacteria that can re-establish themselves. This does not mean, and I emphasize this, that single strain probiotics don’t have a useful role in other health matters. Various strains are being tested for and found to have positive outcomes on mental health, IBS, IBD, obesity and more. You can reference some of those medicinal uses of microflora therapies here.

Back to our interest in supporting a healthy gut microbiome after antibiotics… are you wondering yet about what company makes a diverse, multi-strain probiotic and whether you should use that? If you are going to supplement, the obvious answer is Yes, multiple strains of probiotics are preferred over a single strain. But more to the point, this research reminds us that silver-bullet health solutions tend to grab our attention because they are shiny, yet everyday human health behaviors actually tend to stand the tests of time.

The deeper question sitting in the open now is what health behaviors foster a diverse microflora in the gut? The answer is shockingly simple: foraging.

Foraging connects us to an array of plant types and the highly diverse microbiomes each plant type has. In fact, according to research carried out by the American Gut Project, a notable factor that leads to a diverse gut microbiome is how many different plant types one eats in a week. Those in the project study that ate more than 30 plant types each week had more diverse microbiomes than those that ate less than 10 plant types. Kind of makes you rethink the salad bar, doesn’t it?

In Summary: On one hand, learning why diversity in the gut-microbiome is important invites us to pause and reflect on our assumptions about medicine and healing, particularly in relation to the invisible world of microorganisms we share the planet with. There’s a web of ecology beyond simplistic calculations that we are still learning to understand.

On the other hand, the magic of the natural world is nearly all of it happens without our full comprehension of all the ins and outs of the microbiome. We can do the right thing for ourselves and our loved ones simply by eating a diverse plant based diet.  We can increase the plant type diversity in our cuisine by adding many different plant types at the salad bar, how we shop the produce section, and even taking on new recipes from across the world which bring new and delicious plant types onto our plates. As we do, we can relax and trust that we are doing the best things possible to care for our microbiome, even if we find ourselves in a circumstance that requires additional care after a course of antibiotics.

*Note Well: This essay is solely focused on the gut microbiome after antibiotics and not other microbiomes (vaginal/oral) after antibiotics. Furthermore, introduction of single strains into a relatively healthy microbiome does have a therapeutic role under different circumstances.