ZOE Science & Nutrition - Recap: How to heal your gut health after taking antibiotics | Prof. Tim Spector

Episode Date: September 17, 2024

Today, we’re discussing Antibiotics. These incredible medicines target bacterial infections and save countless lives, but they don’t discriminate - killing off our good bacteria and impacting our gut health too.  Some experts suggest probiotics as a solution. But do they really help? And can fermented foods be the answer to reversing the damage to your gut microbiome?  Professor Tim Spector and Dr Will Bulsiewicz are here to help you understand what to do to boost your gut health after taking antibiotics. 🥑 Make smarter food choices. Become a member at zoe.com for 10% off with code PODCAST 🌱 Try our new plant based wholefood supplement - Daily30+ *Naturally high in copper which contributes to normal energy yielding metabolism and the normal function of the immune system 📚 Books from our ZOE Scientists: Food For Life by Prof. Tim Spector Every Body Should Know This by Dr Federica Amati Free resources from ZOE: Live Healthier: Top 10 Tips From ZOE Science & Nutrition  Gut Guide - for a healthier microbiome in weeks MenoScale Calculator - learn about your symptoms Have feedback or a topic you'd like us to cover? Let us know here Listen to the full episode here

Hello, and welcome to Zoe Recap, where each week we find the best bits from one of our podcast episodes to help you improve your health. Today we're discussing antibiotics. These incredible medicines target bacterial infections and save countless lives. But they don't discriminate, killing off our good bacteria and impacting our gut health too. Some experts suggest probiotics as a solution. But do they really help?

And can fermented foods be the answer to reversing the damage to your gut microbiome? Professor Tim Spector and Dr. Will Bolzewicz are here to help you understand what to do to boost your gut health after taking antibiotics. Fermented foods are basically probiotics, live microbes, but actually in food as opposed to in a capsule or in some synthetic version. So these are things that have been, we've had them for thousands of years in our diets. And we're talking about the live cultures. They're in yogurts, they're in cheese, they're in kefir, which is fermented milk.

We're talking sauerkraut, which is fermented cabbage. We're talking kombucha, which is fermented tea, kimchi, miso, et cetera, et cetera, all these ferments. And compared to probiotics, they generally have lower doses, but most of them, apart from maybe cheese and yogurt, there's many more species, many more types, many more diversity of microbes than you'd find in a probiotic capsule. So the average yogurt has maybe three species, but once you get to keffirs and kimchis and kombuchas, you can get anything between 20 and 40 different types of microbe, mainly bacteria, but also some yeast. probiotics when you take a capsule like saccharomyces, it may be very individualized

whether it's going to work for you or not, depending on your community. Is it going to respond to that guy, yes or no? And we sort of see that in the results. You don't get 100% response because some people just don't have the gut community that's going to be receptive to this new guy coming in and telling him what to do. Whereas my view is that fermented foods give you a much broader choice, so that you've got all these different microbes that are quite happy living together in the food, and collectively they're going to have a better chance of having an effect on your gut and restoring it to health. And we know from other studies, randomized controlled

trials of fermented food, that getting five or six little portions a day in a few weeks can actually reduce inflammation and boost your immune system. So there is now science behind these fermented foods. So that was my rationale for saying to you get as many of these different ones you can go for diversity because that way you get different bugs in your kefir as your your kimchi and your kombucha and hopefully some of them are going to work right i was just throwing the kitchen sink at your problem and saying well you know we don't know which ones are the best or not we don't really know yet how to personalize it for you yet. Hopefully, Zoe will sort that out in the future, but we don't know

that yet. So that was the thinking. And there are some studies showing that fermented foods do work in people with gut problems and diarrhea, et cetera. It's not as well documented as probiotics, but there's some data. So I immediately bulk ordered the kombucha and the kefir and the kimchi, Tim, that you recommended. How do you figure out whether this is going to be something that is going to be full of these live bacteria or actually like it has the stamp on it?

And I know that sadly, there's actually, there's a lot of things out there that say, for example, kombucha on it, but don't really meet the criteria. Tim, how do you differentiate that? And then maybe just tell me, you know, how did you advise me specifically what to use? The first thing is to look at the label very carefully.

So say you're taking kombuchas or water kefirs, which are generally, so fruit kefirs, which are sort of similar, you check there isn't huge amounts of sugar in it or large amounts of artificial sweeteners. Because we know artificial sweeteners have negative effect on the gut and gut microbes. So definitely don't want anything with that in it. And you also need to check that it hasn't been pasteurized.

And it might be in tiny little letters that hasn't been pasteurized. And it might be in tiny little letters, you know, that it's been pasteurized. So it may have been perfectly done, but to give it a long shelf life, it's been just slightly pasteurized, which means slightly dead. And so... So the key thing is like, you've got to make sure it's alive. You've got to make sure it's alive. It's one of the things you said to me. It's like, there's a lot of ways that potentially stuff might...

And you can tell it shouldn't have a shelf life of two years, for example. That will tell you it's definitely dead. On kombuchas, you should often see a little sediment at the bottom showing that it's actually forming something live. It's real. It hasn't just been so filtered and processed that there's nothing left. And it shouldn't have lots of fruit and other stuff added to it as well because that also is a sign that it's been ultra processed.

Often if you open it, it should have a fizz. I think the one I said, oh, I know, Jonathan, you like chuckling goat, because it's really smelly and it's got a real fizz on it when you open it. So you really know it's live, you know, and it's got a very pungent taste. That's right. So I had this experience. You have to actually go and look at a video online for how to open it because when you open it, it explodes so much

that like a good chunk of it ends up sort of pouring around the side and you need to collect it so you don't lose it. So again, my children thought I was mad, but also thought this was really funny. And it was definitely stronger than the average kefir. And I felt really good because it felt like it was definitely medicine. This was definitely taking this properly. And you also recommended, I think, kombucha,

which again, you'd seen made. So you were like confident. That's right. I've been to the Momo factory in London. I'd seen what was done and they nearly all got a little sediment in it. I know you're very skeptical of kombuchas. You can be conned very easily in this game.

I think that's the message for people. You know, you're taking the best intentions, you're taking something that's pasteurized, it's got so many artificial ingredients in it, it's not useful, it's too sweet. You know, if you can't make it yourself, work really carefully and realize that if it's really cheap, it's also unlikely to be the real thing because it has a shelf life of a year or so, and they can mass produce it. I often say live active cultures or live probiotics. And if it says that, then that gives you confidence that it has not been pasteurized.

Sometimes they'll actually list which specific microbes are present and what the doses may be. The other thing, too, to look for is not so much with kombucha, but more so when you're looking at fermented plant foods like a sauerkraut or a pickle. The sauerkraut that I grew up on was in a can and the second ingredient was vinegar. And that is not actually fermented sauerkraut. When you make pickles or when you make sauerkraut, it may surprise some people, but what you want to look for in the store is that actually the ingredients are whatever the plant is plus water and salt. Water and salt is how you actually create fermentation. So, and again, I feel more confident when it says live active cultures or live probiotics on it.

Beyond taking the fermented products, is there anything else that one should think about if one's saying, well, you know what, I want to get to this much healthier microbiome. You know, maybe I have to accept this is going to take some time. What else can I or anybody listening do? Well, we know from a number of studies, very careful mouse studies, that increasing your fiber is really important because that will directly impact the good guys. And if you can get more of those good guys in, they'll suppress themselves, the bad guys. And the bad guys are living off this inflammatory. They like inflammation. They like a sort of slightly stressed gut.

And so the more you can put fiber and other good things in there and other plants, it goes back to the general rules for our gut health, getting lots of fiber, getting it through plant diversity, and reducing as much as possible ultra-processed foods, which are stimulating the bad guys. And I know you're already doing that, but for other people who might not know about this. So I think they're the other things. You could try doing more time-restricted eating, give your gut a rest overnight,

because we do know that microbes themselves have a sort of inbuilt laundry service where they do the cleaning at night if they're not having late-night snacks and things. So they can come in and really tidy up your mucosal layer on your gut. So it's pristine in the morning. And then that seems to help gut health as well in your immune cells. So I think it's a combination of those gut things. The general concept that

you're proposing, which I completely agree with, is you want to feed the good guys and you want to starve the bad guys, right? So this is how we restore the balance, feeding the good guys with the high fiber foods. And then with the bad guys, we want to be is how we restore the balance, feeding the good guys with the high fiber foods. And then with the bad guys, we want to be cautious to the best of our ability in terms of the things that are feeding them, including refined carbohydrates like sugar, the artificial sweeteners, the ultra processed foods, high levels of saturated fat intake, alcohol consumption. I think we want to be careful with all these things. And then the other thing beyond time-restricted eating is we know that sleep is incredibly restorative to the microbiome. So getting a good night's rest as much as possible, spending time with exercise, spending time outdoors. These are some of the strategies that can all help. If people are listening to this,

how should they think about taking antibiotics in general? Does this mean you should never take antibiotics? There is evidence in the medical literature. There was actually a study that Tim and I have been looking at together where they took a group of people, very nice study, and they found the vast majority of people, as Tim alluded to, they recovered by eight weeks. But there was a small subset of people that they could not explain why this was. But these people, their gut took a harder hit and it basically started to resemble the gut of an ICU patient. I'm guessing that's not a good thing. That's not a good thing. So in the depths of

dysbiosis, and then what they had to do is continue to look. So these particular people, they didn't really start to get back to their baseline for about six months they did get back to that place so i think that's that's you know one of the points of encouragement but i think that the the takeaway here is that for some people it may take longer to make that recovery than others yeah and and there are some people that recover totally in two weeks so who just seem to have a microbiome that just bounces us off. And this is fairly trivial, you know, and no real sequelae. And this is where I think the exciting science is if we, you know, we at Zoe, for example, can collect enough data,

in the future we can start personalizing this. So, you know, you'd know that when you went to see your surgeon, you said, listen, I'm highly likely to get a long-term reaction to these antibiotics. Give me something else or I'll take more of a risk or give me some topical cream to put on an antiseptic antibiotic cream on the outside rather than poisoning my gut. So I think in the future, we can see how hopefully we can pick whether you're a good responder, a medium responder, a bad responder, and offer much more tailored advice. I have a personal story here because I've always suffered from sinusitis. And each time I got a cold,

usually it would go to sinusitis. And for 20 years, every time my cold lasted more than a week, I would go on to antibiotics to try and clear the infection that I'd taken for two weeks. So you would have taken dozens and dozens of courses? Yeah, unlimited. Often, as doctors do, self-medicating and not doing necessarily the right stuff. And it was only when I really got into the gut microbiome about 12 years ago, that's when I stopped. But also, the other reason I don't take them now when I get infections, I still get infections, is that if you look at the literature, often the difference between taking them and not taking them for something like that is about one day of symptoms.

And so this is true for many, many conditions that do self-resolve. Not all, but there's many like this where it's a bit touch and go. And anyone who now values their gut microbiome more than an extra day of respiratory or nasal symptoms, I think needs to take note. And the good news is that in the last 10 years, I improved my gut health. I have a really good gut score. Brilliant story. So you're saying like, even with all of the antibiotics you took, when you started this journey around the microbiome, you know, like a dozen years ago, actually managed to get to this great point.

Well, and I think the shift is, it's hard for healthcare to move away from what they sort of accept as their standard. You know, the standard is to sort of liberally use the antibiotics and not to see this risk because the research on the gut microbiome is so new that it really hasn't gotten into the mind of the medical doctor who's conventionally treating a person who has sinusitis or whatever the issue may be. They're not really thinking about that. And I feel this happens a lot with children.

I'm particularly struck also in different... I remember I grew up in the States and my mother tells me about the amazing number of courses of antibiotics I had by the time I was like four years old. And even contrasting with my sister who was born 10 years later in the UK, like many fewer. It's 20 courses on average by the time a US kid has reached 18. 20 courses of antibiotics. On average. It's not so surprising that we see, in fact, we see basically the worst microbiome scores in the US of anywhere we've tested, right?

Yeah, and I'm sure that is a major contributory factor, not only in that, but it's also in foods as well. And that's another source. As well as the antibody you take, it's in many meats and other products as it's used in agriculture interesting to fatten animals up so that's why the interesting epidemiology says that taking too many antibiotics you know actually increase your weight there's lots of evidence

from farmers that pay lots of money to give their chickens and things uh antibiotics in order to make them put on weight faster because you can feed them the exact same amount of feed. That's the fascinating thing about this is that you can give them the same number of calories and end up with a larger animal. And of course, at the end of the day, when you're selling that animal, it's the number of pounds, it's the weight of the meat that you actually sell it at. But there was a study done in 2014, published in the journal Nature Medicine, where they put people on five days of a plant-based diet versus five days of an animal-based diet. And one of the big surprise findings is that on just five days of a completely animal-based diet, they actually saw antibiotic resistance develop in the gut. And that's not because of meat. That's because there's residues

of antibiotics that are existing within the meat that was being served. And by the way, the study was done in the United States. Extraordinary. Thank you for listening to today's recap episode. I want to take 30 seconds to talk about something that's not talked about enough. Menopause. Over half the people on the planet experience perimenopause and menopause. Yet symptoms are often misunderstood or dismissed.

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