Dr. Eric Wood, ND, MA - Contributing Writer, Physician’s Choice
Having been in practice for more than a decade, I am still dismayed at how seldom individuals are provided medical guidance when taking antibiotics, particularly as it pertains to getting gut support with probiotics. A question I often get in practice: “Is it ok to take probiotics when I’m on antibiotics?”
This article is devoted to this issue, discussing the importance of supporting your microbiome, what antibiotics can do to gut health and why our health habits and practices need to adjust based on what else may be going on with our health.
The microbiome and the importance of gut replenishment
Our digestive tract really is a marvel of coordination and if you think about it, it really is a “highway,”, with the entrance being the mouth and the sinus tract, and then the exits being the anus and the urethra in the genitourinary area. There are several areas along that tract where there are substantial “colonies” of microorganisms devoted to different purposes to help protect and support our health.*
Our sinuses and mouth have various bacterial species that, when in good health, guard against colonization by pathogenic viruses and bacteria that could cause a variety of disruptions (as well as gum and dental diseases). The delicate balance of these bacteria, however, can be disrupted by the food we eat, certain exposures to microbes or environmental toxins such as toxic molds, which can then increase our risk for various kinds of infections and other symptoms.
When we travel downstream into the stomach and eventually the intestines, eventually we reach what is called the “microbiome,” which is a collection of bacteria, yeast, viruses and fungi that perform many vital functions. These include digestion, production of vitamins, detoxification, protection against pathogenic organisms and facilitating elimination through the bowel.
Unfortunately, this collection of microorganisms can be damaged in many ways nowadays. This includes but is not limited to:
- Pesticides including glyphosate (i.e. Roundup), which is commonly added to all non-organic grains to dry them more quickly (this includes children’s breakfast cereals and oatmeal!)
- NSAIDs and other pain meds including Tylenol, ibuprofen, aspirin, narcotics, opioids, Advil, and more
- Refined, sugar-laden foods of many types
Lay the foundation for good gut health with your dietary habits
Traditionally, we consumed much less of the above, and we included more foods that naturally replenished our microbiome regularly in the diet. But over the last several generations, much of this has changed for the worse. However, we can bring back many good foods and habits simply by improving awareness and incorporating them back into our routine. Foods that have naturally occurring probiotics include:
- Fresh, organic produce that hasn’t been thoroughly washed
- Raw sauerkraut, miso, kimchi, kvass and other fermented veggies/fruits
- Fermented dairy including yogurt, kefir, skyr and filmjolk
- Kombucha (be careful of higher-sugar varieties, however)
These foods have traditionally helped give us a “reinnoculation” of these good bacteria that over time naturally die and get damaged in the gut due to common exposures I mentioned previously as well as general age-related senescence.
In recent years, taking probiotics as a supplement has also become much more popular and medically accepted. So, is there any concern with taking them when you’re on a current antibiotic course?
What we do and don’t know about concurrent probiotic and antibiotic use
To begin, probiotics will not deactivate the antibiotic or make them not work. It is actually much closer to the opposite, where antibiotics will deactivate/kill probiotics when dosed too close together. The need and relevancy of taking probiotics when on an antibiotic is justifiably increased however, as antibiotics are typically not a very “discriminatory” killer.
That means that while antibiotics may kill off a lot of the “bad bugs” causing illness, they will also typically cause a lot of your beneficial bacteria to die and instigate a variety of potential side effects, including diarrhea. Probiotic supplementation can help to offset these potential issues.*
Timing the dosing of your probiotics
When I have a client on an antibiotic regimen, I typically suggest that to minimize the killing of the probiotic species, to take the antibiotics and the probiotics at least five hours apart. I have found that clinically to work well*. Unfortunately, there is very little research on this unique issue.
However, research does illustrate that starting probiotics at the start of an antibiotic regimen vs. waiting until later does minimize potential adverse side effects from the antibiotic regimen*. The time of day is not typically a big issue, but you’ll want to keep in mind what times your antibiotic will be dosed (commonly in the morning and sometimes before bedtime) as that will dictate the times you can optimally take your probiotic!
Support your liver
Antibiotics, like many medications, will often also stress the liver to some degree, as they require metabolization through phase I and phase II processes. This means that certain nutrients, like B vitamins, amino acids, glutathione and more may be used up at higher rates.
Because of this, it is more important than ever that individuals eat well and consider augmenting their healthy diet with appropriate supplementation such as a multivitamin and/or B complex, potentially a high quality protein powder, liver supportive herbs, antioxidants and nutrients such as milk thistle, glutathione, NAC, burdock and more to mitigate any such stresses.*
Probiotic considerations
Some important considerations when looking at probiotic options are: The number of strains, the species type and what research is available on that type of species pertinent to a particular health issue, the amount of colony-forming units (CFUs) and the type of probiotic (e.g. soil-based, non-soil-based). These considerations can matter a lot as to how much a specific probiotic may help to recolonize the gut, mitigate antibiotic side effects, yield long term colonization benefits, etc.
I typically suggest to clients to look for a minimum of 6-8 strains of lactobacillus and bifidobacterium with at least 15-20 billion CFUs per capsule. If possible, it’s even better to consider doing a spore or “soil-based” probiotic with good research backing, as selected spore-based probiotics better colonize the gut vs. traditional probiotic blends. Soil-based probiotics are also less sensitive to gastric acid, have less need for refrigeration and have shown good benefit in countering antibiotic treatment-induced side effects.*
Soil or spore probiotics are not technically “alive” when consumed. Like a seed or spore in nature, they lie dormant until the right environment prompts them to open up and become active. Because of this difference in their nature, they are less subject to environmental sensitivity and are less likely to be destroyed before they reach out microbiome to exert beneficial effects.
Research is limited, and thus there is need for more studies on both traditional as well as spore/soil-based probiotic benefits to give clarity on the most optimal types and dosages for various situations.
That said, beneficial effects on the bowels have been shown for both spore/soil-based and non-soil based probiotics with antibiotic regimens*. Also, as a general trend, research does suggest* that the spore or soil-based types compared to non-spore based types are harder to kill prematurely before they reach their desired target of the large intestine, where the microbiome is housed, thus resulting in superior long-term microbiome colonization.
For those in immunocompromised states however, it may be wise to supplement cautiously or avoid as it is possible they could cause health issues or complications, based on current research understanding.
In summary
Our modern habits and lives often do little to support the health of our microbiome. When we take medications for various symptoms or illnesses, this can often exacerbate gut health problems. As a good health measure for prevention and maintenance, it is wise to consider incorporating an array of fermented foods into the diet and probiotic supplementation. Moreover, when on antibiotics, consider increasing your dose of such foods and add even more probiotics at strategically dosed times to try and mitigate any negative impacts on your microbiome health.*
Not only will this help support your gut health, but it will support your immunity and over well-being. In this current time of much confusion and concern over immune function, it is hard to go wrong with taking steps to bolster good immune function! Look carefully at the strains, species, CFU counts and look for better quality brands such as Physician’s Choice that offer a variety of probiotic blend options to consider for optimizing your gut health. Consider getting started today to offer yourself the most protection and digestive support. Your gut will thank you for it!*