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8/3/2019 Necessary Pro Bio Tics

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Necessary Probiotics Might Be Permanently

Harmed by “Helpful” Antibiotics

Nathan Collins, Undergraduate Student, Brigham Young University; Provo, Utah

Abstract

Because probiotics contribute so significantly to the immune system, the effects

of antibiotics on the body's natural probiotics must be analyzed in order to maintain ahealthy level of probiotics. In comparing the prevalence of gastrointestinal diseases and

allergies against the use of antibiotics, those who used more antibiotics often had higher

occurrences of these diseases. Other studies demonstrate that a healthy level of probioticscan help reduce the frequency of gastrointestinal diseases and allergies. These studies

together show that overuse of antibiotics can result in long-term damage to the body's

microbiome, thus increasing the risk of various diseases.

Introduction

Probiotics are any “live microorganisms which when administered in adequate

amounts confer a health benefit on the host [1].” These probiotics mostly consist of lactic

acid bacteria in the human stomach and intestines which work to help digest lactose and

protect against pathogens that could harm the body [2-3]. The initial culture of these

helpful bacteria are given to a person at birth from the mother. Over the course of the

person's life, however, antibiotics prescribed to kill harmful bacteria also have the affect

of killing these beneficial bacteria. It had been thought that these populations of bacteria

would recover to their prior state after the immediate effects of the antibiotics had passed,

but another more recent view is that these bacteria populations never fully recover.

Instead, this view is that these probiotics continue to get weaker with every use of

antibiotics. While important correlations have been shown in support of a long-term

detrimental effect on the beneficial bacteria, conclusive evidence has not yet been shown.



Background

The magnitude of probiotics' role in disease resistance is not well known;

however, research has shown that those individuals with a compromised microbiome are

at more risk for gastrointestinal disease, asthma, allergies, diabetes, and other diseases.

These diseases are caused by many factors, so the significance that the presence or

absence of these probiotics has is relatively unclear with the current volume of research

on the topic. In addition, while the affect of antibiotics on the human microbiome has

been observed, there is insufficient data to determine how dramatically and lasting that

affects the probiotics. This innability to well predict the affect of antibiotics on the

microbiome and the microbiome on the immune system can be seen by one study to be

due to the large differentiability that exists between humans with regard to microbiome

content [4].

Results

Various studies have been done on beneficial bacteria and their role in our

immune systems. One such study looked to observe the relationship between the presence

of the probiotic, Helicobacter pylori, and the risk of asthma and allergy. In thousands of

patients, the presence of the Helicobacter pylori bacteria in their microbiome, asthma

status, and allergy status were measured. Results showed that having the cagA+ H pylori

strain was inversely related to ever having asthma with an adjusted odds ratio (OR) of

0.79 with a 95% confidence interval (CI) of 0.63-0.99 [5]. Having this H pylori strain

was also shown to be inversely related to having allergic rhinitis with OR 0.77 with a



95% CI of 0.62-0.94 [5]. In another study, probiotics have been shown to treat acute

diarrhea, especially in children, and pouchitis. Patients given the LGG probiotic had a

shorter mean persistence of diarrhea (58.3 ± 27.6 hours) when compared to those treated

for their diarrhea with a placebo (71.9 ± 35.8 hours, p = 0.03) [1]. In studying the

treatment of chronic pouchitis, 20 patients were treated with VSL#3 (a probiotic) and 20

others were treated with a placebo. All of the patients receiving the placebo experienced

pouchitis again within 4 months while only 3 of the patients receiving VSL#3

experienced a relapse (p < 0.001) [1].

In a different type of study, the compositions of microbiomes of various mammals

were measured by comparing the 16S rRNA gene sequences. Through this study, the gut

microbiota between members of the same species was shown to be more similar than the

gut microbiota between members of different species. However, within a single species,

large variance in the microbiota composition was measured as related to the diet of the

individual [4].

In a fourth and most recent study, Blaser showed the relationship between the risk

of juvenile inflammatory bowel disease (IBD) and the number of courses of antibiotics

that the child had taken. Based on his research, children are over two times more likely to

contract IBD if they have received three to four courses of antibiotics as opposed to zero

courses [6]. After receiving more than seven courses of antibiotics, the risk of getting

IBD has increased nearly threefold.

Discussion

These studies show that probiotics play major roles in our immune systems. The



presence of these helpful bacteria help to reduce the risk of not only intestinal diseases,

but also several seemingly unrelated diseases and conditions such as allergies and asthma.

In addition, effective use of probiotics is shown to be able to help cure conditions such as

acute diarrhea and chronic pouchitis. This is significant in that it shows the need for these

beneficial bacteria and the positive role that they play in our immune systems.

However, while probiotics are shown to be successful in treating and preventing

disease, the level to which probiotics are effective varies from trial to trial. This could

result form the large variance that exists even within members of the same species

because of differences in diet as shown by comparisons of the 16S rRNA between

humans who have different diets. More research must be done in order to show more

specifically how probiotics help the immune system as some probiotics will help one

individual but not another [1].

It is known that the use of antibiotics kills the good bacteria that exist in the

human body as well as pathogenic bacteria [7]. However, whether or not using antibiotics

results in permanent, long-term damage to our microbiome is still questionable. In

Blaser's study of number of courses of antibiotics versus inflammatory bowel disease in

children, a correlation was shown that suggests increased use of antibiotics results in

higher risk of IBD [2]. Blaser also notes the correlation between increased use of

antibiotics and the increasing prevalence of asthma and allergies. However in the case of

the relationship between IBD and antibiotics received, no note was made about the

amount of time between receiving antibiotics and contracting IBD. If in most cases IBD

was contracted just after receiving antibiotics, this could point to only a slight weakening

of the human microbiome and not a complete destruction like Blaser suggests. Research



in this area is very limited as of now, and as the relationship between the body and

microbiomes is so complex that more studies will have to be performed in order to isolate

environmental factors and show that the probiotics are being permanently damaged.

Though correlations seem to point towards permanent damage to the body's probiotics,

there is still insufficient data to make an accurate statement about the permanent damage

done to the body's microbiome by antibiotics.



References

1. Williams NT. (2010) Probiotics. American Journal of Health-System Pharmacy.

2010 Mar 15; 67:449-458.

2. Blaser MJ. (2011) Stop the killing of beneficial bacteria. Nature. 2011 Aug 25;

476:393-394.

3. Masood MI, Qadir MI, Shirazi JH, Khan IU. (2011) Beneficial effects of lactic

acid bacteria on human beings. Critical Reviews in Microbiology. 2011; 37(1):91-

98.

4. Ley RE, Lozupone CA, Hamady M, Knight R, Gordon JI. (2008) Worlds within

worlds: evolution of the vertebrate gut microbiota. Nat Rev Microbiol. 2008 Oct;

6(10):776-788.

5. Chen Y, Blaser MJ. (2007) Inverse Associations of Helicobacter pylori With

Asthma and Allergy. Arch Intern Med. 2007 Apr 23; 167:821-827.

6. Dillow C. (2011) Antibiotics May Be Permanently Altering the Guts of Humanity.

Popular Science. Available: http://www.popsci.com/science/article/2011-

09/antibiotics-may-be-permanently-altering-our-friendly-gut-microbes via the

Internet. Last accessed 30 Dec 2011.

7. Stark LA. (2010) Beneficial Microorganisms: Countering Microbephobia. CBE—

Life Sciences Education. 2010; 9:387-389.

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