Ask the DOC

Recent years have seen dramatic increases in the incidence of chronic diseases like diabetes, inflammatory bowel diseases, and obesity. Several months ago, a microbiologist from NYU Langone published an interesting theory to explain the rising disease rates. His theory is that the loss of diversity in the bacteria that live in our intestinal tract is to blame, and the cause is the use and overuse of antibiotics. More than 40 percent of U.S. adults are obese, and almost three-fourths are obese or overweight. In addition, childhood obesity rates are rising, going from 10 percent from 1988 to 1994 to almost 18 percent from 2013 to 2016.

His theory is that the bacteria that live in and on us are not random, but rather passed down from generation to generation. Interacting with each other and with us in complex ways, our bacteria form a diverse community called the microbiome. They are acquired in a standard, choreographed way and their composition in children comes to resemble that of adults by age three. Years ago, bacteria were transferred from mother to child during vaginal birth, from breast feeding and skin-to-skin contact, and from mother’s mouth by kissing. Today, with widespread cesarean delivery, bottle feeding, extensive bathing (especially with anti-bacterial soaps), and the use of antibiotics, the human ecology has changed, and the transmission and maintenance of ancestral microbes has been altered. More than 73 billion antibiotic doses are prescribed worldwide each year, or about 10 doses for each man, woman, and child on this planet, and the numbers are rising. U.S. children receive an average of 2.7 antibiotic courses by age two, and 10.9 by age 10. More than 50 percent of women receive antibiotics during pregnancy or perinatally. Repeated antibiotic exposure is common in early life and is often not medically justified. And, of course, many foods that we eat contain antibiotics.

For decades, the food industry has added antibiotics to animal feed to make the animals gain weight. Laboratory studies back this up. Mice exposed to antibiotics had more body fat at 10 weeks (32 percent) than control mice (22 percent). A single course of a macrolide antibiotic (i.e. Cipro) had long-term effects on the microbial population and on the host’s immune system. In non-obese mice, treatment with antibiotics early in life altered the gut microbiome, immune system, and accelerated the onset of Type 1 diabetes. In one Dutch study, the incidence of inflammatory bowel disease (IBD) in children increased with early-life antibiotic exposure, and the more antibiotics the child received, the higher was the incidence of IBD.

In a study done at VA hospitals, the top 10 percent of physicians prescribed 90 percent of all antibiotics. Physicians in Sweden prescribe 60 percent fewer antibiotics than U.S. doctors. Doctors are often put in a difficult situation by patients who seek an antibiotic prescription. If the doctor does not prescribe antibiotics for what he/she perceives to be a viral infection, the patient may feel put off and may complain or change doctors. For this reason and others, it is often simpler for the doctor to just prescribe them. So, the next time you have a scratchy throat or congestion, if your doctor feels that antibiotics are unwarranted, remember that the doctor is trying to do the right thing for you.

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