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Gut Microbiome Disruptors

Part of the Clinical Practicum series on WholisticMatters designed to bring you clinical information for your practice.

 Gut Health

Antibiotics, medications, and drugs affect the microbiome in multiple ways. Following prescriptions per physician’s orders is necessary when prescribed, but many patients are over-prescribed and are facing a concern of superbugs and lack of a healthy microbiome. Antibiotics have come a long way in treating infectious diseases, but more action to repair the gut after antibiotic use is becoming more common. When taking antibiotics, the beneficial bacteria populations lining the gut are diminished, essentially creating openings in the gut. Commonly, these lesions are associated with “leaky gut,” which increases the viability of foreign bodies entering the bloodstream and causing digestive problems, inflammation, and imbalance. Therefore, when antibiotics are used, it is important to consider all of the impacts they can have on a patient’s microbiome, and a strategy to reestablish a healthy microbiome should be employed.

Use of non-antibiotic prescriptions to help patients manage acute and chronic health conditions can also influence the microbiome. These effects are not always detrimental, but they showcase how these prescriptions can be strong influencers of an individual’s microbial makeup and why a baseline microbiome footprint should be taken for patients put on regular prescription plans. Even the use of short-term antibiotics can affect the microbiome for up to two years. Broad-spectrum antibiotics can cause rapid and significant drops in taxonomic richness, diversity, and evenness. Treatments influence the growth of both beneficial and problematic microbes that do not exhibit resistance to the antibiotics.

A few examples include the common diabetes treatment drug, Metformin, and how it decreases intestinibacter and increases opportunistic pathogenic Escherichia species (E. coli and Shigella). Continued use of non-steroidal anti-inflammatory drugs (NSAIDs) has shown marketable increases in Enterobacteriacase using naproxen and increases in Enterococcaceae, Enterobacteriaceae, Erysipelotrichaceae, and Desulfovibrionaceae when using ibuprofen and celecoxib. Morphine usage in pain management has also demonstrated an ability to modulate microbial taxa makeup in humans. In a cohort study with 98 hospitalized patients, opioid use was positively associated with Parabacteroides, Propionimicrobium, Alistipes, Sutterella, Clostridium, Bifidobacterium, and Pyramidobacter. Pseudomonas, Candida, and Megamonas were decreased with the use of opioids.

Use of statins for managing a blood lipid profile has also shown microbial modification potential. Statin use has been positively associated with an increase in S. parasanguinis, Streptococcus vestibularis, Clostridium bolteae, Ruminococcus torques, Ruminococcus bacterium, and Coprobacillus. Statin use was negatively associated with Eubacterium ramulus, C. comes, D.formicigenerans, D. longicatena, and Ruminococcus lactaris. Antipsychotic medications have been found to have metabolic consequences associated to their use, and unsurprisingly also modify microbiome makeup. In a Dutch study with 1135 participants, antidepressants were positively associated with D. dorei and Coprococcus eutactus, and negatively associated with Eubacterium halili. Risperidone, a drug commonly used to treat schizophrenia and bipolar disorder, has been associated with an incensement in body mass index and a lower ratio of Bacteroidates to Firmicutes in psychiatrically ill male participants.

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