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Since the discovery of penicillin in the 1920`s, countless lives have been saved in fight with bacterial infections. Their use continues to be crucial in modern day medicine, and their role remains to be of utmost importance. More and more research studies continue to evaluate possibility of adverse events and negative impact this mode of therapy might  have on our overall gut health & microbiome diversity, it`s correlations with chronic disease when proper nutrition and lifestyle strategies are not being used hand in hand during and post their administration.

In 2018, the Federation of European Microbiological Societies (FEMS) reported administration of antibiotics to over 10% of European children, and accounted 25% antibiotic prescriptions to the pediatric population in USA per 2008 retrospective cohort study review(1). They also included a review of the effects of antibiotics on microbiome in children, correlating them to long lasting complications of obesity, behavior and neuro-development, allergies, autoimmunity, IBD, and weight gain.

Multiple studies have demonstrated the ability of antibiotic treatment to alter both infant and adult microbiome composition causing microbial imbalance known as dysbiosis, which in turn is correlated with impaired health and chronic inflammatory diseases if systematically left untreated. In a 2011 Nature Review Microbiology, looking at “how host genetics and environment shape the gut microbiota and how all of them may interact in the context of chronic disease”, are noted multiple disorders associated with altered gut microbiome.(4) The list includes, but is not limited to: IBS, IBD, gallstones, Colorectal Cancer, recurrent C.Diff infections, arthritis, asthma, autoimmune disorders, diabetes, eczema, metabolic syndrome, mood disorders, multiple sclerosis, obesity, etc. Hippocrates words” All diseases begin in the gut” might hold great truth after all.

Insight into what happens to gut microbiome after antibiotic therapy was published by Palleja et al in 2018. They followed 12 healthy adults over 6 month time period, after 4 day intervention with a cocktail of 3 antibiotics, commonly used in ICU (meropenem, gentamicin and vancomycin). (3) At ~ 45 days, shotgun sequencing –based metagenomics analysis showed gut microbiota has recovered near base line composition. At 6 month mark, 9 common species which were present in all subjects prior to the treatment remained undetectable. Study results confirm the hypothesis that broad spectrum antibiotics may alter the diversity and richness of gut microbiome. It is poor diversity, decrease in beneficial species, and subsequent increase in pathogenic ones that is associated with obesity, certain autoimmune conditions, metabolic disorders, and overall poor health. Even though researchers described the ability of antibiotic exposure to effect the gut microbiota of healthy young adults as“mild, yet long lasting imprint”, and noted the resilience of gut microbiome to regenerate, however, one might agree with the concern of what happens to the diversity and richness of our gut microbiome, after MULTIPLE exposures to antibiotics we might endure during our lifetime, and how that affects our overall health and well being and how is correlated to chronic disease?

The role and effect of probiotic intake during antibiotic therapy was published by Wieërs, Grégoire et al in 2021 in a randomized placebo controlled trial of 120 patients ,age median of 78 years old, with multiple co- morbidities. More specifically, they were looking whether probiotic intake during in-hospital antibiotic treatment will prevent colonization of gut microbiota with multi-drug-resistant bacteria. They were treated for 10 days with amoxicillin-clavulanate antibiotics comparing the effects of a 30 days treatment with placebo Saccharomyces boulardii and a probiotic mixture containing S. boulardii, L. acidophilusL.paracasei,  and B.lactis . Treatment was initiated within 48 hrs  within antibiotic administration. Stool samples were collected at the time of the inclusion of the trial, at the end of the antibiotic treatment and at the end of the study treatment. Results showed that taking probiotic mixture containing strains of  S. Boulardi combined with Lacto and Bifidobacterium “influenced the antibiotic treatment by counteracting the colonization of the colon microbiota with antibiotic- resistant pathogens”.(2)

This research study relays good news regarding gut health maintenance and antibiotic therapy.  Simply by incorporating probiotics with antibiotic therapy to assure integrity and maintenance of gut microbiome, and I would add from functional nutrition perspective, incorporating food and lifestyle practices to continue to feed and support diversity of gut microbiome would be an overall win-win scenario, in which one can enjoy the benefits and the therapeutic reason of antibiotic administration while protecting gut integrity. Following guidelines and nutrition recommendations sometimes tends to feel like a full time job which is quite easy to be non-compliant with. And so, how I like to remember and try to make it as a lifestyle pattern rather than a job to do would be by asking myself 3 questions, for there is no such thing as one intervention to fit and fix everything:

  1. Did I feed my gut today by recalling 3 P`s + S meaning Pre-Probiotic and Polyphenol rich foods + Soluble fiber.
  2. Did I avoid simple sugars?
  3. Did I invest time in self care?

Prebiotic & Probiotic rich foods -> aid in microbiome health and maintenance.

Oral probiotic-> look for mixture containing strains of  S. Boulardi combined with Lacto and Bifidobacterium. Given that supplement industry is not heavily regulated, on more tips and guidance on how to pick clean and safe supplements refer to another informative read ” The ultimate guide to buying safe supplements” article on ProjectofHealth.com

Polyphenols-> bioactive compounds found in colorful plant foods. Once ingested, depending on the degree of structural complexity and polymerization, may be readily absorbed in small intestine (5-10 %), or accumulated in large intestinal lumen where are subjugated to enzymatic activities of gut microbial community for extensive breakdown to metabolites which might be responsible for the health effects from colorful rich foods.(7) Researchers conclude “dietary polyphenols and their metabolites contribute to the maintenance of gut health by modulation of gut microbial balance through stimulation of growth of beneficial bacteria and inhibition of pathogen bacteria, exerting prebiotic-like effects.”

Soluble Fiber -> Increases beneficial SCFA’s (short chain fatty acids) known for their role in strengthening gut barrier, gut motility, immune-modulator role as well as being fuel for intestinal epithelial cells. (5) Food sources: oat bran, barley, nuts, seeds, beans, lentil, citrus fruits, berries, apples.

Avoid-> Simple Sugars: Recent 2020 study looking at mechanisms underlying the pro-inflammatory effect of dietary fructose showed that it is due to “changes in composition microbiota and metabolic function of resident enteric microbiota”.(6)Regarding food sources, my rule of thumb is: if it comes in a box or plastic bottle and has a vibrant beautiful artificial color, or is as white  as a sugar cube, it is a no no, for that is a route down a rabbit hole I truly do not want to partake.

Practice Self Care Daily: Lifestyle as Medicine: the reality of modern industrial times is the fact that we must put effort into strategies for self care that includes basic human practices that we have learned to sacrifice in order to keep up. And so, adequate Sleep; Movement and Physical Activity 30 min/5 days /week;  Stress-> coping; stress relief techniques such as breathing, singing, walking in nature etc would be some very common ones that we have taken granted for. For all these lifestyle modifications if not practiced, have been found not to only alter gut composition, but also play role in inflammation, immunity resilience, and pro-inflammatory cytokine production via multiple mechanisms. (8)(9)(10).

Bid you good health,

Biljana Sofronijoska Rece RDN, LD, IFMCP

This information is intended for informational purposes only. It is not supposed to be interpreted as specific medical advice. Regarding therapies, diagnosis and or health conditions please consult with your qualified healthcare provider

References:

  1. Hadar Neuman, Paul Forsythe, Atara Uzan, Orly Avni, Omry Koren, Antibiotics in early life: dysbiosis and the damage done, FEMS Microbiology Reviews, Volume 42, Issue 4, July 2018, Pages 489–499, https://doi.org/10.1093/femsre/fuy018
  2. Wieërs, Grégoire et al. “Do Probiotics During In-Hospital Antibiotic Treatment Prevent Colonization of Gut Microbiota With Multi-Drug-Resistant Bacteria? A Randomized Placebo-Controlled Trial Comparing Saccharomycesto a Mixture of Lactobacillus, Bifidobacterium, and Saccharomyces.” Frontiers in public health 8 578089. 8 Mar. 2021, doi:10.3389/fpubh.2020.578089
  3. Palleja, A., Mikkelsen, K.H., Forslund, S.K. et al.Recovery of gut microbiota of healthy adults following antibiotic exposure. Nat Microbiol 3, 1255–1265 (2018). https://doi.org/10.1038/s41564-018-0257-9
  4. Spor, Aymé et al. “Unravelling the effects of the environment and host genotype on the gut microbiome.” Nature reviews. Microbiology 9,4 (2011): 279-90. doi:10.1038/nrmicro2540
  5. Martin-Gallausiaux, Camille, et al. “SCFA: Mechanisms and Functional Importance in the Gut.” Proceedings of the Nutrition Society, vol. 80, no. 1, 2021, pp. 37–49., doi:10.1017/S0029665120006916.
  6. Montrose, David C et al. “Dietary Fructose Alters the Composition, Localization, and Metabolism of Gut Microbiota in Association With Worsening Colitis.” Cellular and molecular gastroenterology and hepatology 11,2 (2021): 525-550. doi:10.1016/j.jcmgh.2020.09.008
  7. Cardona, Fernando et al. “Benefits of polyphenols on gut microbiota and implications in human health.” The Journal of nutritional biochemistry 24,8 (2013): 1415-22. doi:10.1016/j.jnutbio.2013.05.001
  8. Matenchuk, Brittany A et al. “Sleep, circadian rhythm, and gut microbiota.” Sleep medicine reviews 53 (2020): 101340. doi:10.1016/j.smrv.2020.101340
  9. Molina-Torres, Guadalupe et al. “Stress and the gut microbiota-brain axis.” Behavioural pharmacology 30,2 and 3-Spec Issue (2019): 187-200. doi:10.1097/FBP.0000000000000478
  10. Mailing, Lucy J.1; Allen, Jacob M.2; Buford, Thomas W.3; Fields, Christopher J.4; Woods, Jeffrey A.1,5Exercise and the Gut Microbiome: A Review of the Evidence, Potential Mechanisms, and Implications for Human Health, Exercise and Sport Sciences Reviews: April 2019 – Volume 47 – Issue 2 – p 75-85 doi: 10.1249/JES.0000000000000183
  11. Anand Mohan, Siew-Young Quek, Noemi Gutierrez-Maddox, Yihuai Gao, Quan Shu, Effect of honey in improving the gut microbial balance, Food Quality and Safety, Volume 1, Issue 2, 1 May 2017, Pages 107–115, https://doi.org/10.1093/fqsafe/fyx015

Using Food and Lifestyle as Medicine

What a whirlwind year we have all been witnesses and part to. A year of unprecedented challenges that tested every possible aspect of our existence and well being, and has put to test our resilience to physical, mental and emotional challenges. An all around package filled with uncertainties and a lot of “what if” unanswered questions with so many possibilities. Year in which Mother Nature has put us in check, with a firm reminder  not only of the importance of optimal physical health but emotional, social and spiritual well being. The importance of our tribe, how well and how kind we are to ourselves, our neighbor, our family and friends. That being said, it is within this framework that I see confirmation of the importance of personalized medicine, personalized nutrition, personalized lifestyle and why it may be where the future lies in this mode of therapies. Therapeutic approaches in which each of us is being treated as a whole and specifically customized with targeted medical, nutritional and lifestyle interventions, rather than just symptom alleviations of some kind.

Multiple studies have confirmed positive relationships between metabolic syndrome and adverse SARS-CoV-2 outcomes providing us with pattern and importance of addressing metabolic health and chronic inflammation as a form of prevention and laying the field so to speak for better outcomes post infection.

Metabolic health is defined as optimal levels of waist circumference (WC <102/88 cm for men/women), glucose (fasting glucose <100 mg/dL and hemoglobin A1c <5.7%), blood pressure (systolic <120 and diastolic <80 mmHg), triglycerides (<150 mg/dL), and high-density lipoprotein cholesterol (≥40/50 mg/dL for men/women), and not taking any related medication. 2009-2016 NHANES survey has showed that the prevalence of metabolic health in USA is staggering 12 %, meaning that less than 1/3 of the US normal weight adults are metabolically healthy.(1) That means that 88 % of adult US population deals and or is taking some form of medication to address at least one of the previously defined parameters of metabolic health.

CDC National Center for Health Statistics Data Brief has reported that the prevalence of obesity in 2017-2018 was 42.4 %. Obesity alone, being recognized as chronic low grade inflammatory state compromises the immune system, suppresses its efficacy and therefore jeopardizes the ability to fight infections, and it this case Covid-19 with full strength.

In relation to the relationship between obesity and SARS-CoV-2 outcomes, a retrospective cohort study on Covid-19 only hospitalized patients at SUNY Downstate Health Sciences University Hospital in New York confirmed the hypothesis that obesity is a risk factor for Covid-19 complications. Results revealed that overweight and obese patients who had Covid-19 were at increased risk for mortality (higher in males) and ventilation compared to those with normal BMI. Obesity did not affect the rates of AKI, ACI, and ARDS. (2)

Systemic and meta analysis of twenty articles (4062 patients) with objective to review evidence for risk factors of Covid-19 patients progressing to critical illness showed that elderly male patient with high BMI, high breathing rate and a combination of underlying diseases (hypertension- HTN, type 2 diabetes – DM 2, cardiovascular disease-CVD, and chronic obstructive pulmonary disease-COPD) were more likely to develop severe Covid-19 infections. (3).

Multiple studies have confirmed the risk of adverse Covid-19 outcomes and elevated blood glucose(hyperglycemia).

Retrospective Pisa Covid-19 study in Italy, reported hyperglycemia as an independent factor requiring careful evaluation and proper treatment, and was associated with severe prognosis in people hospitalized for COVID-19.(4) They concluded that at admission high blood sugar, uncontrolled with medications was associated with poor prognosis in people hospitalized with Covid -19. Authors acknowledged study limitations the relatively small size of participants (271) and an incomplete set for some inflammatory parameters.

In a multicenter retrospective cohort study of 312 hospitalized patients with Covid-19 showed positive associations between impaired fasting glucose (IFG) and diabetes at admission with risks of complications and mortality among patients with COVID-19. Used end points- events in the study were mechanical ventilation, ICU admission or death. (5)

Another study looked at associations between high blood pressure (hypertension-HTN), obesity, and diabetes individually and clustered as Metabolic Syndrome (MetSy) in correlation with Covid-19 outcomes in patients which were hospitalized in New Orleans during the peak of the outbreak from March30th-April 5th, 2020.(6) They found that MetSy was significantly associated with mortality, ICU and ARDS(Acute respiratory distress syndrome when compared with non MetSy patients. Multivariable analysis showed no association of HTN, obesity and DM with mortality. Obesity was associated with higher ICU, ARDS, and invasive mechanical ventilation (IMV); Diabetes with ICU and IMV, while hypertension was not significantly associated with any outcome.

That being said it is of crucial importance we start being more aware and acknowledge the importance of our health, and well being on daily basis. Time to understand that being healthy does not entail just absence of disease and worrisome symptoms, but rather a state of well being on physiological, mental, and social scale. In this time of pandemic there are multiple approaches and interventions we can do form the comfort of our home to help our bodies recover from the stress of daily living. Each and every one of us must be aware of where we fall short in our optimal well being and start from there It is a project of health if you will, rather than just a quick fix. It might be we don’t sleep well or long enough or wake up restful. Or maybe we do not include movement and exercise daily, or weekly, or we eat out too often, and maybe just noticed that there is not enough color or variety of foods in our plates. All these possible variables, and behaviors add up over time, add more stress to our body and physiological machinery that keeps us going, that eventually tire our systems, and might result in the symptoms that are interfering our daily lives and optimal functioning, and or are just the fuel that keeps on adding to some of our chronic illnesses we have been dealing and managing so far.

What if we change our attitude, mindset regarding health, and well being? What if the strategy of controlling symptoms of chronic illness is not sufficient enough for living optimal life with vibrant health and social functioning? What if we by changing our mindset on what chronic disease and symptom management means to us and how it limits us in our daily lives, we shift from management of symptoms to hopefully, possibly reversing symptoms when and if possible resolution of symptoms by looking, and removing root causes of illness while using food and lifestyle as medicine in addition to disease management by medical practitioners.

As a functional dietitian, I thrive on using food and lifestyle as medicine. Below are some tips and general recommendations each and every one of us can consider in order to optimize our health and well being in these unprecedented times.

Use real whole foods and remember simple is better, variety and color even more so, moderation is key. Plant based foods with high phytonutrient components and nutrient density (vegetables, fruits, nuts, seeds, olive oil, legumes, and whole unprocessed grains), fish, pasture raised meats and eggs. Grocery shop by walking around the supermarket, avoid the middle aisle which contains prepackaged, premade, full with additives foods of any kind. Avoid eating food and food like items with names in the ingredient list you cannot pronounce.

In conclusion, when one realizes that only 12.5 % of US adults are metabolically healthy, the well known, and maybe less talked about epidemic of obesity on the US where it has been estimated that 2/3 of US adults are overweight-> meaning 3 out of 4 people are struggling with extra weight and all that comes with it , then maybe, just maybe this pandemic is not just about the virus and its ability to affect us on so many different ways, but also, a sober realization of how unhealthy, unbalanced we have become so that our bodies has lost the resilience and ability to properly fight foreign antigens. I believe I am not overstepping any toes and scope of practices by promoting healthy lifestyle and dietary patterns as one of the, I would say basic natural ways, to build and power back up the powerful machinery and work of art our bodies actually are, lay the ground so to speak, so they may do what they were originally designed to do. Strive for balance, homeostasis, and for optimal wellness and functioning, whether physical or mental . It is safe to assume that reaching this state of optimal health and well being, is not one type of intervention, change of behavior, type of breakfast we decide to have for the next couple of weeks, or eat this or that type of superfood, but rather a project of health, personalized, and long lasting that will encompass almost all aspects of our being, daily living and choices we make.

Bid you good health

Biljana Sofronijoska Rece RDN, LD, IFMCP

This information is intended for informational purposes only. It is not supposed to be interpreted as specific medical advice. Regarding therapies, diagnosis and or health conditions please consult with your qualified healthcare provider.

References:

  1. Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009-2016Metab Syndr Relat Disord. 2019;17(1):46-52. doi:10.1089/met.2018.0105
  2. Nakeshbandi, Mohamed et al. “The impact of obesity on COVID-19 complications: a retrospective cohort study.” International journal of obesity (2005) 44,9 (2020): 1832-1837. doi:10.1038/s41366-020-0648-x
  3. Xu, Lizhen et al. “Risk factors for 2019 novel coronavirus disease (COVID-19) patients progressing to critical illness: a systematic review and meta-analysis.” Aging 12,12 (2020): 12410-12421. doi:10.18632/aging.103383
  4. Coppelli, Alberto et al. “Hyperglycemia at Hospital Admission Is Associated With Severity of the Prognosis in Patients Hospitalized for COVID-19: The Pisa COVID-19 Study.” Diabetes care 43,10 (2020): 2345-2348. doi:10.2337/dc20-1380
  5. Zhang, Jiaoyue et al. “Impaired Fasting Glucose and Diabetes Are Related to Higher Risks of Complications and Mortality Among Patients With Coronavirus Disease 2019.” Frontiers in endocrinology 11 525. 10 Jul. 2020, doi:10.3389/fendo.2020.00525
  6. John Xie, Yuanhao Zu, Ala Alkhatib, Thaidan T. Pham, Frances Gill, Albert Jang, Stella Radosta, Gerard Chaaya, Leann Myers, Jerry S. Zifodya, Christine M. Bojanowski, Nassir F. Marrouche, Franck Mauvais-Jarvis, Joshua L. Denson. Metabolic Syndrome and COVID-19 Mortality Among Adult Black Patients in New Orleans. Diabetes Care, August 2020; DOI: 2337/dc20-1714
  7. Wright, Kenneth P Jr et al. “Influence of sleep deprivation and circadian misalignment on cortisol, inflammatory markers, and cytokine balance.” Brain, behavior, and immunity 47 (2015): 24-34. doi:10.1016/j.bbi.2015.01.004

Ruza S.

In my 60 + years of life, my ongoing struggle with headaches, stomach issues, and high blood pressure had resulted with daily long term use of medication after medication to the point that I was sick and tired by the site of a pill and eventually stopped taking them on a regular basis as instrstructed by my doctor. The tipping point for me to look into alternative ways to get better, was when after my stroke, feeling thirsty and dealing with dry mouth and insomnia for months, my primary doctor prescribed me even more medications and told me that he cannot officially diagnose me with type 2 diabetes because my A1c was not in the diagnosis range. I was told to stop eating sweets, and wait 6 months until my blood work would fit into the ranges for diagnosis so I can be officially diagnosed as a diabetic and get started on yet another medication for the rest of my life. It was frustrating that he never tried to help me stop the progression of the disease, or even ask me whether I liked eating sweets or not, but did assume none the less. I am happy that I took this journey to rediscover my health and well being with Project ofHealth. It felt quite liberating and empowering the feeling of taking control and actively participate in getting better. The dietitian worked patiently with me and my understanding of foods and their effect on my health. She guided me through the food plan she modified specifically to address my high blood pressure and blood sugar. Once my symptoms of high blood sugar started to improve, it was much easier for me to do all the changes that needed to be done so I can remain in this state of feeling well simply put. She introduced me to the concept of self-care, which I believe was very important in my understanding of getting better and living better, which I continue to follow even till today. I am happy to share, that after 5 months of work, my blood glucose levels are back to normal, and I am no longer in the pre-diabetic category. My weight has dropped, with some more space for improvement, of course, my sleep has been restful, my headaches decreased significantly, my dry mouth, thirst at night, and interrupted sleep symptoms are all gone. The empowerment, knowledge and new outlook on life I gained all these months, has helped me to live a very productive and quality life. I am very thankful to my dietitian Biljana, for her patience, willingness to listen, understand and help me deal with my struggles of trying to change my habits for better. The results I achieved are extraordinary in my opinion, and what makes the feeling even better is that I was actively participating in getting better and getting back some control of my health. I had a voice that was heard and learned a lot during the process. The knowledge that I get to use even today, for I know, even when sometimes I indulge in my pasta dish or have an extra piece of French bread, I do not have that feeling of regret, for I know, I am equipped to deal with whatever comes my way.

Thank you for everything, you saved me, or should I say per your recommendations, “We saved me”.

Mile S.

Although I must admit, in the beginning, I was sceptic thinking this would be a waste of time because she did not offer a cure but rather explained to me to that it will take some time until we see results, but that it will be worth it. She was asking me a lot of questions, was very engaged to listen to what I had to say and what I thought. It was refreshing to feel finally heard by a health care professional, without being rushed with some generic questions just so I an end up again waiting for a line at the pharmacy to collect my prescriptions. She understood my way of life, my food preferences and very little time I had to spend on myself due to my job requirements. I felt there was no judgment what so ever, but I felt she addressed my problematic lifestyle habits in such a way that at the end of the consult I was really ready and wanted to change them solely because I was finally aware of how they wreak havoc on my health. I was overweight, with a lot of stomach issues including acid reflux, pain, discomfort, bloating after meals, and very irregular bowel movements. I had a very Standard American Diet with allot of takeout food due to my work schedule. What became very challenging for me was that I was dependent on my antacids after literary every meal. My heartburn was getting out of control.
I started worrying when my antacids were not working anymore, and I had to increase my dose to 2 sometimes 3 Tums after a meal just to soothe my heartburn.
This was the reason that made me want to try to work with Biljana. As I said earlier, she asked a lot of questions, she listened to my story, and she explained my lab results and what they meant to my health struggle. I had a feeling that it was the both of us that made a therapy plan for me because she was recommending, but in the same time listening to what I am able and willing to do, and what I am not. She individualized her diet plan to my needs, and I must say, I was surprised to how it made it so easy for me. She introduced me to some roots and plants that I took instead of my antacids, for which it took some time getting used to, but the results were nothing short of a miracle.
I am happy to say my heartburn, my stomach issues and me going to the restroom have much improved with an occasional need for Tums depending on what kind of meal I decide to indulge on. I am happy and very grateful because she helped me with my stomach issues, taught me how to use food as medicine as she likes to say, and what I was not expecting, in the whole process I even shed some pounds, started sleeping better, am more interested in my health and well being, and even lost some pounds around my waist.
I recommend for whoever is trying to gain some control back over their health, is tired of having their health symptoms ruling their everyday life, to give it a try and work with her. I hope she can help you as much as she helped me.
Thank you thank you thank you Biljana,
Truly
Mile S