Back in 2000, my older son was 6 years old, and came down with what several pediatricians thought was Scarlet Fever. He had a rash, sore throat, and a high fever, couldn’t keep liquids down, and couldn’t seem to break the fever. He was given an antibiotic. For the next two days he went downhill rapidly, until I finally called 911 because he could barely breath. We landed in the closest ER the firemen could find.
They pumped his body with epinephrine and other drugs to open up his lungs. He gasped for air while he hallucinated. I’ll never forget one nurse leaving his bedside in the ER, mumbling that this is why she doesn’t do pediatrics. Coincidently, my husband was unreachable, in a closed-door meeting for the morning, and my younger son was in a pre-school class. I walked away for a moment as well, thinking that my son could die at any moment and I had to pull myself together quickly.
He was transported to Children’s Hospital for a week’s stay, lungs filled with fluid, unable to get out of bed to go to the bathroom. They filled his IV with antibiotic. When he finally crawled out of the hospital bed, I drove home as fast as I could, only to give him more antibiotic. We never did get a clear diagnosis of what he had- cultures came up inconclusive. It seemed like a cross between a bacterial and viral infection – that’s all we ever heard. A month later he developed a strange open wound on his face that wouldn’t heal for 5 months.
For several years pediatricians would prescribe antibiotics for many global and vague symptoms. Stabs in the dark. He was treated with antibiotics once he received his Crohn’s diagnosis. And we even gave antibiotics another shot recently when Dr. Wheeler suggested Rifaximin to control my son’s Crohn’s flare.
But I know, after so much time and experience, that what his body needs is lots of GOOD bacteria – from food, probiotics, any which way he can. And it’s going to take time to recover from this assault.
I tell you this story not to point a finger at antibiotics, although I do have some thoughts on that, as you can imagine. I think it is important that you consider the role of bacteria in your health.
In this next interview, Dr. Wheeler has once again graciously agreed to answer some questions for me, and for you, about bacteria and our health.
When is it a good idea to use antibiotics?
It is never a good idea. It is more of a necessary evil. The very word itself means “against life”. You have to weigh the risks and the benefits each time. Most importantly, you have to know exactly what you are treating.
The majority of antibiotic prescriptions are written without a culture and sensitivity test, meaning the doctors guess at what the cause may be and guess what may be effective in treating it – then prescribe their favorite standby med (usually a Z-pack or Cipro), something strong enough kill most any bug. Other times, doctors will prescribe antibiotics to assuage a patient’s fear that “nothing is being done”. It all stems from the loss of the concept of the “Vis medicatrix naturae” – the innate healing power of nature.
We’ve lost confidence in our body’s capacity for health. Medicine has forgotten how to identify and remove obstacles to cure. We want to get better (or get our children better) and we want it now. We no longer believe in patient convalescence. We do not give ourselves down time or take vacations just for our health. There is immense pressure for doctors to prescribe, and I have caved to this pressure myself occasionally. The bottom line is this: you must know what bacteria you are targeting, you must know what drug will kill it, you must determine if the body is incapable of killing it itself, and then you prescribe and actually make a profound difference in someone’s health.
Does the body recover from antibiotic use?
Yes, the body is very resilient and has an amazing capacity to detoxify and regenerate, but it needs the right environment. After taking antibiotics, you need to take probiotics, and then feed them with prebiotics. A good post-antibiotic probiotic is ABX Support by Klaire Labs. It contains the right blend of Lactobacilli, Bifidobacterium, and a special yeast called Saccharromyces that is very effective at preventing antibiotic associated diarrhea and complications due to a super bad bug called Clostridium difficile. Prebiotics are food for the probiotics, the most common being Fructooligosaccharides, also known as FOS. I also recommend taking milk thistle to help repair any liver damage and eating lots of colorful, antioxidant-rich fruits and veggies.
Do Rifaximin and other antibiotics help folks with IBD (Inflammatory Bowel Disease)? When is it a good idea to use an antibiotic?
First of all, it is important to understand the cause of IBD. There are two components: the microbial ecosystem and the immune system. Most IBD is an imbalance of both: the bad bugs trigger an immune reaction and the immune reaction becomes self-perpetuating. You can’t address one without the other.
With that said, there is some good evidence emerging that Rifaxamin can be effective for treating some cases of IBD. It has long been used “off label” for IBD and that is what they based the need for a formal study on – so many doctors were using it they had to do a study to see if it was actually effective. I think they kind of bungled the study (probiotics were not given), but there is still growing evidence for it.
Personally, I only use it for flare-ups when other means have failed. Some people use it for years, but it will lose its efficacy after a while due to bacterial resistance – and then you’re in trouble. If that fails, I will then move on to corticosteroids, which almost always do the trick, but, again, are not for long term use.
Rifaximin is very safe because there is almost no systemic absorption, so there is no concern about systemic toxicity. That is why it is my go-to drug when I need to clean the slate and start with a new gut environment.
Anytime I have to use any of these drugs I feel that I have failed a little, and I will always go back and reassess the treatment plan. There is no reason IBD cannot be controlled without them, but they are invaluable tools for when we can’t seem to get it right. The perfect plan, as you know, can be elusive and even then you often have a lot of poor patient compliance (it was just a little cake…I swear!).
How do I figure out which probiotics I need for my body type, and where do I get them?
Recent research has suggested that there are three common microbial ecosystems found in humans that vary with location and ethnicity. The science is too young to be able to give you an exact description of what you should have. What we do know is that certain bad players can be pushed out by certain good players. We also know that the preponderance of a certain strain of bacteria can push your immune system toward certain behaviors.
There are probiotics specifically for correcting autoimmune dysfunction and there are other strains specifically for reducing allergic response. There are also tests that can give you a really good idea of what you have in you at the moment, but finding the right balance of the two takes some skilled clinical judgment. You must know the pathology of the condition to know the right strain. It is beautifully complicated, a delicate dance of T helper cells and dozens of cytokines (chemical messengers) interacting with all these billions of bacteria. Just picking a probiotic off the shelf can have undesirable consequences and I definitely recommend seeing a qualified health professional to get you on the right one.
Is it necessary for a person to use probotics all their life?
It shouldn’t be, if you can create an environment conducive to a healthy gut ecosystem, you should be able to find a balance and keep it there with just diet, lifestyle, and prebiotic foods. That is easier said than done though, and often people will need a maintenance dose.
What’s your take on the environment and food affecting our bacterial “make-up”?
It is huge! Did you know that the antibiotics given to livestock are measured by the ton? It is a huge problem. Not only does this get into our food and create imbalance in our guts, it gets into the soil, water, and produce. This massive overuse of antibiotics destroys our ability to use them as effective medicine by effectively creating superbugs that cannot be killed. These resistant strains cause many deaths every year, all in the name of cheap beef and poultry. There is no way to measure the causal relation between industrial use of antibiotics and IBD, but it doesn’t take a genius to see the connection. Their use is directly correlated to the increasing prevalence of IBD, and it is a well known fact that antibiotic use in early life is correlated to IBD in later life.
Our water contains chlorine and fluoride, our food is full of simple sugars (which the nasty bugs love) and devoid of gut healthy natural fibers (which the good bugs love) – all this combined presents as an all out war against our gut ecology.
Can diets reverse or re-balance the bacterial make-up in our body? I’m thinking of SCD when I ask this, but you may have other thoughts as well.
I definitely think those diets can help immensely, and should be the foundation of any IBD treatment plan. The SCD diet is designed to do just that – restore and rebalance by starving the bad bacteria of the kinds of carbs they crave. Most of these diets are Paleolithic, or even elemental, in nature and quite effective. However, they are rarely stand alone treatments. It all depends on what is going on in the gut. There are some bugs that have to be killed with antimicrobials first. Then there is the issue of compliance, because these diets are hard to do and rarely enjoyable. That is why it is important to have such great resources like this blog. It takes a whole community working together to make the diets effective and enjoyable.
So when you say antimicrobials, are you talking about antibiotics?
I mostly use herbal products, and my favorite is ADP by Biotics. It is a potent oregano extract and it works wonders on dysbiosis (imbalance of good and bad bacteria). I also use digestive enzyme/botanical combinations like Candid-Away and, if things get tough, I will make an herbal tincture formula custom blended to a person’s stool analysis results. The tinctures taste awful and are pretty expensive, but work very well.
If I know what I am targeting and I know it is tough to kill I will use a targeted antibiotic. Rifaximin is a good example of this. Studies have indicated that a bug responsible for most cases of Crohn’s is a very hardy little beast called Mycobacterium avium paratuberculosis. It is most susceptible to Rifaximin, which is safe and non-toxic to humans, and the person obviously can’t clear it on their own, so it is a perfect case of proper antibiotic use. I still like to add herbal products to the treatment, as they prevent the development of resistance to the drug (bugs can’t resist herbs because herbs are actually dozens of different chemical compounds in one plant). Again, this may remove the bacteria, but you still have to address the immune side of things as well. Also, many people do not respond well to the die off of dominant pathogenic microbes and may actually feel very sick during treatment.
Any final thoughts?
I was recently at the Institute of Functional Medicine’s national symposium. The theme was “The Microbial Terrain”, and it was all about bugs. I really had my eyes opened to the power these organisms have over us and how deeply they are integrated with our systems. When they crave sugar, we crave sugar. When we take antibiotics, we wage war on ourselves. Bacterial infections have been indicated in almost every major disease: rheumatism, MS, autism, ADD, cancer, and the list goes on. The need for more studies, antibiotic regulation, and environmental clean-up is imperative.
The one factoid that struck me the most was this simple statement: we have more bacterial DNA in our body than human DNA. Not only does that make you think about the profound effect these organisms have on your health, it calls into question the very nature of the symbiotic super-organism that we now understand ourselves to be. As for me…it makes me wonder who is really in charge.
About Dr. Sage Wheeler
Dr. Sage Wheeler is a graduate of Bastyr University, the world leader in natural health sciences. After graduation, Dr. Wheeler was the recipient of the prestigious ITI-STAIR residency. During this additional one year of training and practical clinical experience he practiced under the mentorship of a conventional medical doctor as well as an experienced naturopathic doctor. This opportunity has given him a uniquely integrated perspective and way of practice.
Prior to attending Bastyr, Dr. Wheeler was afflicted with a genetic bowel condition that caused severe chronic pain which, for 5 years, was misdiagnosed as IBS. This experience led him to seek further training in functional gastroenterology as part of his medical training, and gives him a unique ability to genuinely sympathize with his IBD patients.
Dr. Wheeler enjoys frequently attending conferences and seminars to continually improve his practice and offer cutting edge knowledge and treatments to his patients. He is a member of the Institute of Functional Medicine, American Association of Naturopathic Physicians, and candidate of the Naturopathic Board of Functional Gastroenterology.
While Dr. Wheeler can’t answer your questions here, he is available for consultation. Visit his website, where you can find supplements, office hours, and more information on his growing practice.
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