Antibiotics nearly double risk of developing IBD, doctors warn | Hacker News Reader

Antibiotics nearly double risk of developing IBD, doctors warn

studyfinds.org

139 pointsrajnathani56 comments

Makes a lot of sense. We know so little about the trillions of bacteria inside of us, and taking a nuke to them all is going to have consequences. There are probiotics tuned for IBD on the market, and one can only imagine the complexities of the ecological dynamics.

I personally believe that in 100 years there will be a real bacterial awakening in science understanding how much our microbiome affects so much about our health and happiness, and will look at antibiotics as a Neanderthal-like in their oversimplification.

Many antibiotics dont actually kill gram negative/positive bacteria, they merely prevent them from reproducing. Now if you want to kill bacteria, look to Russian phages, or swallow some sea water where a 1ml sample will contain billions of phages but its pot luck if any of them are right one's you need for your bacterial infection. One other little know fact about antibiotics, is the penicillin based one's get metabolised in the liver into penicillamine which is used to reduce copper levels in the body and ironically copper also helps to kill bacteria. https://www.nature.com/articles/151107a0 Considering what Penicillamine does to the body and how it affects Vit B6, you can see why you get pain in different parts of the body when you take too much Vit B6, however its also a good way to find out where bacterial levels are high in the body, dental fillings can be a common area. Creatine gets broken down into creatinine and happens to be one of the few things that can kill both gram negative and gram positive bacteria, of course you need to consume a lot of it though, but havent worked out why we get told to not consume creatine for more than a few weeks though. Anyone know?

One downside to phages is that they replicate. Once you stop taking antibiotics, there is no risk that the treatment will replicate and potentially mutate inside of you. Otherwise, I agree.

With regards to creatinine, I'm sure you'd want to generally suppress your bacterial load if you don't have symptoms or an active infection. That could leave the door open for a worst bacteria or fungus to come along and fill the niche.

My understanding based on an expert here in the UK is that Phages only replicate as long as there is the bacteria around that they were bred to infect and replicate in. As soon as the bacteria levels drop, phages die as there is essentially no food for them to consume. Considering the timescales to develop phages for a strain of bacteria (2 weeks), the ideal treatment is antibiotics, then phages to complete the job, because even Flemming stated when he discovered Penicillin, you need to keep taking these antibiotics until the infection is gone, but today many doctors just prescribe a course for 7-14days, and then you have to go back to get another course if they will prescribe another course, at least on the NHS its like that, and thats when you can get an appointment in my experience. Also bacteria can go into dormancy developing biofilms in different parts of the body and creatinine wont work then. As the immune system attacks the food we eat bar some exceptions like starch as the only sugar not attacked, when we do a water only fast the number of immune cells drop as the numbers are not needed to attack the food. So the lower number of immune cells concentrate on attacking pathogens and faulty cells. Considering Lent used to be 40days of water only fasting, and there was no modern medicine back then, it seems observation and trial and error over thousands of years highlighted a suitable way to keep religious followers healthy, a necessary requirement for religions back then. Today science can explain why water only fasting works for so many illnesses. It seems Herbet Shelton was good at observing considering what we know about Vit D https://web.archive.org/web/20110222200902/http://www.soilan...

However, one of the reasons why his Hygienist methods ie water only fasting were not popular is because some undiagnosed health conditions caused sudden deaths when on a water only fast, so this is why water only fasting is not popular in the medical industry, but Socrates called water only fasting the physician from within, so even the ancient Greeks had made their own observations of what worked way back then with their limited toolset.

The standard advice I have seen regarding Creatine as a fitness supplement is to basically just take 5g / day. I have never seen guidance to use it for a few weeks only. Creatine helps replace things that get used up during hard workouts and supports the cellular energy cycle. It wouldn't make sense to just take it for a few weeks because it doesn't do a one-time effect.

Creatine cycling has been a thing since I started lifting more seriously, at least 15+ years ago. There was often a loading period, where you would take more, and a maintenance period, both normally given as a g/kg or mg/kg value of creatine to body weight. I believe the idea was either your body became less responsive to the increase creatine in your system of time or your stores become saturated. I'm not sure what research now shows or how seriously cycling/loading not taken these as I'm not a trainer nor a nutritionist, but it something I did when I first started lifting and that's what I remember learning about taking it.

I always thought the old advice was to cycle creatine "Just in case" and that more recent advice was that there wasn't much research backed evidence that mandated the need to cycle it

For reference: https://supplementclarity.com/do-you-need-to-cycle-creatine/

Most antibiotics prescribed for UTI are bacteriocidal. Penicillins like amoxicillin and fluoroquinolones are probably the most popular.

Fluoroquinolones due to sequelae on connective tissue and retinas are not first line treatments for UTI anymore

https://blogs.bcm.edu/2018/07/25/antibiotic-ciprofloxacin-in...

https://www.acsh.org/news/2012/04/05/keep-eyes-open-using-ci...

https://sites.google.com/site/levaquininfo/

https://www.contagionlive.com/news/cdc-analysis-suggests-flu...

I agree. But the key is going to be that you can't easily classify most microbes as "good" or "bad" without talking about the host factors (genetic, diet, etc).

Uropathogenic E. coli are a good example of this:

Bacterial virulence phenotypes of Escherichia coli and host susceptibility determines risk for urinary tract infections https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653229/

One size doesn't fit all: unraveling the diversity of factors and interactions that drive E. coli urovirulence https://pubmed.ncbi.nlm.nih.gov/28217693/

We are already looking at the stomach in ways we never imagined.

Think about how powerful it is over our body. It controls mood, directs our behavior through pain, and is an amazing organ at capturing energy and nutrients from the world around us.

Important gut bacteria may have gone extinct and we did not even notice

Then it couldn’t have been that important.

Read _Never Home Alone_, ch 10 "Look What the Cat Dragged in (https://magazine.scienceconnected.org/2020/05/book-review-ne...) to learn about Toxoplasmosis gondii to blow your mind.

The whole book is excellent and there is supporting evidence therein about our personal biota impacting our health, especially around allergies.

Purely an anecdote: I wrote in a related thread about 5 years ago how I had an allergic reaction and my guts became a mess after taking antibiotics for the first time in my life (around age 23) [https://news.ycombinator.com/item?id=10555891]. I managed to get better by changing my diet. In 2017 I had another course of antibiotics, got very ill again and was hospitalized, diagnosed with IBD (UC), and spent nearly 13 weeks in hospital. Only thing that keeps me in remission now is Azathioprine. Had to cut back on the fibre too, now my diet is mainly meat. I also became lactose intolerant, where I'd been drinking milk all my life up to 2017 (age 30).

Have you looked into fecal microbiota transplants (FMT)?

This is a shot in the dark, but I had taken antibiotics to treat an infection twice last fall, then suddenly this summer have been having unexplainable (so far) stomach issues. Given the somewhat longer period after taking the antibiotics, is the length of time somewhat similar to yours?

Yeah, it could be similar. (Can't remember clearly first time as it was 10 years ago now).

Second time my stomach complaint got really bad, my doc assumed it was gastroenteritis and prescribed me more antibiotics. They were useless, and he figured it might be IBD a few weeks later and prescribed me some steroids (Prednisolone). The dose of steroids prescribed was useless as I already had severe symptoms by then, so I ended up hospitalized and pumped with a high dose of Hydrocortisone. If it were a few days later I probably would've been dead.

For a few months before my guts were bad, I was having pains in my chest (around the bottom of the ribcage). The doctor thought it was gallstones, but a UV scan came back negative. The pains in the lower part of the colon came afterwards, along with the diarrhoea.

I cannot wait until we discover a basic understand of the human microbiome. As a practice, gastroenterology is very good at diagnosing and dealing with cancer and very bad at dealing with anything else. IBS/IBD is basically a blanket diagnosis handed out when your doctor has no idea what's wrong with you.

I am not sure but it seems to me like:

-Medical establishment shrugs shoulders "Dunno. [Description-of-symptoms] Syndrome?"

then later:

-Medical establishment knowing look "Yeah we know that one. It is Name-of-cause/discoverer-of-cause disease."

Is this how it works?

Yes, except frequently they don't even have a name for the syndrome and won't believe it's real.

In the last 5 years there has been alot of progress in IBS research, namely the discovery that the low FODMAP diet can effectively treat the condition. This treatment method has been widely studied and confirmed. A dietitian is recommended to administer it properly because it eliminates alot of different foods and is far more complex than just avoiding gluten, for example.

The theory is that certain bacteria fermet FODMAPs into gas, water and other substances which cause the various symptoms of IBS.

IBD is very different from IBS. IBD is an autoimmune disease with a pathologic diagnosis (ie requires a biopsy and microscopic evaluation for diagnosis). It’s treated as almost autoimmune diseases are.

IBS is a syndrome (the S in the name) which usually implies a constellation of findings, but not a specific disease process. From the name you can know that the disease process hasn’t been clearly elucidated.

IBD is a catch-all for several different diseases, which are all poorly understood. There is still a debate over whether or not their cause is physical or psychological. There's a big gap between observing inflammation or related markers and actually understanding the disease. Even within the same subdiagnosis, people respond vastly differently to treatments, which more or less can all be described as intentionally crippling the immune system to stop inflammation. It's not uncommon for people with IBD to have tried a roulette of medications with questionable efficacy and dangerous side effects. If you talk to three different doctors you will get three different treatments and/or lifestyle change recommendations. I know several people who have quit all medications after this experience and turned to and alternative/holistic approach.

IBD shares this lack of understanding and heavy handed approach with many other autoimmune diseases. Being in this category is not a good thing. It's not unfair to lump IBD/IBS together; people who have these conditions share a lot of the same issues and struggles.

While I empathize with ibs sufferers, this is nonsense. Nobody with ibs poops large quantities of blood, needs their colon removed in many cases, or surgery because their bladder and bowel are now suddenly connected.

We don’t fully understand most disease processes, even those for which we have some effective treatments.

I don’t think lumping disparates diseases together simply on the axis of “understanding of disease process” is terribly useful.

I think there are many more similarities between IBS/IBD than the current understanding of disease process. People IBS/IBD (especially mild IBD) have more in common with each other than folks with other chronic illnesses. For instance, your sibling comments story about seeking treatment for IBS is very similar to many IBD stories as well.

IBD is itself a lumping of disparate diseases based on very minimal understanding of disease process, so I'm not sure what your point is.

My point is there is you’re providing very little of substance to show that IBS and IBD are related diseases. Just because we know little about either doesn’t mean much. IBS is unfortunately by its nature typically a diagnosis of exclusion while IBD of all forms is diagnosed strongly by both clinical history and laboratory/histopathological data.

3 years ago I got diagnosed with IBS after I landed in the hospital with a stabbing pain just right next to my belly button (sometimes I still feel it lightly) what they first thought was caused by kidney stones. Nothing turned up on the xrays or echoes. Since then things have only gotten worse as if it has spread upwards first causing constipation, then silent reflux (causing a constant burning sensation in my throat, mouth and nose), pain in my neck, foggy brain (which started recently) and so on. The GP, which in my country decides if I have to be forwarded to a specialist to relieve the medical system, keeps attributing everything to my IBS. Once I got the diagnosis IBS it is as if they stopped taking me seriously and act as if I am just being a hypochondriac so I decided to just let it be.

You might have success in managing symptoms by modulating diet and lifestyle. I personally find that a limited diet, no caffeine, and ample sleep help me a lot (I have Chrons), but every body is different.

Dealing with the medical system and outside advice in general can be very frustrating. Hope you can find a way forward! Good luck!

[IANAD] what you describe might as well be SIBO (as far as i understand in my limited non-professional understanding the bacterial overgrowth can cause the IBS symptoms too though fortunately i was spared that). It took some years in my case to stumble upon definitive test - the lactose based breath test - with all these years doctors dismissing it as "just take the antacid" (which is actually no-no for SIBO), and even with the definitive diagnosis confirmed by the test it is still a struggle to get a right doctor to correctly treat it.

Yes, they gave me different antacids and so far nothing has helped. I wish it was just like a regular acid reflux, but best way to describe it is as if there is a cloud of aerosolized acid being released from my esophagus 24/7 that is spreading and causing an non-stop burning sensation everywhere it gets inside my throat, mouth, nose, eyes and I think it is damaging my larynx. None of the usual advice seems to help. Days that I am feeling better I can eat an entire chocolatebar, mint tea, lay / sleep flat, everything I should not do and it does not get worse. Something I noticed though is that it disappears everytime I go on vacation and actually eat worse than usual (McDonald's etc.)

Never had any test done for SIBO I think. They did a stool test, sigmoidoscopy and found nothing. That is how I ended up being diagnosed with IBS.

I once had to take antibiotics like crazy for a long time because I had some pain in the ass strep that wouldn’t go away. It was quite the experience.

Afterwards, my breath was bizarre smelling, I had these horrible sulphuric burps for months, and I couldn’t digest ANYTHING properly. It was misery. I had such painful gas from indigestion so frequently that eating totally lost its appeal.

This stacks up right in my experience. I stay far from antibiotics as a rule, but if you need them, you need them. I hope I never need them again.

Sounds familiar to me. Had two big antibiotic treatments after dental surgeries last year. This did not feel right. How did you get rid of the problems? Change in diet?

This is insanely anecdotal and doesn't hold any scientific integrity, but:

I ate a lot of raw, sometimes fermented, vegetables and fruit. Generally high in fibre. I avoided foods I'd need to wash much because I was trying to fill my system with a diversity of bacteria. A bit of dirt was part of the goal. I ate stuff out of my garden, from a little local organic farm, foraged foods like berries and mushrooms, etc.

No idea if that's what helped, but I'm totally fine now. Whatever I did before wasn't working, or wasn't working quickly. Once I went to my mostly plant-based "dirty" diet, so to speak, the improvement was rapid. But it didn't happen in isolation, either. I also reduced my intake of animal proteins mostly, which would probably be a significant factor in digestion. Eggs would reduce the presence of sulphuric gases especially.

I'm not a believer in pro-biotics (they don't seem to support diversity, which seems essential), but I believe people should eat a lot of diverse bacteria in their foods. Things like wild mushrooms, plants grown in your yard that aren't extensively washed and peeled. Don't cook everything to death. Let some little critters into your system and let them do their thing. Assuming you don't get the particularly bad ones (usually easy to avoid if you know how the food is grown), I can't think of easier ways to introduce the diversity required to properly populate your GI tract.

Again though, I have no idea what I'm talking about. I'm just some guy who eats dirty carrots in his yard.

Some observations:

- I'm surprised they could find controls who had never received antibiotics. I assume this over some time period and not lifetime

- For each exposure to antibiotics, there was a stepwise increase in risk from 1.11 to 1.38 to 1.55

- When they matched them to siblings, the risk went down (1.35 versus 1.88) suggesting a genetic component to the overall risk

My guess is the control group wasn't made of people with no history of antibiotics. They just used the model to predict the risk difference between zero and one time of taking antibiotics. The control was people from the general population, and the "test" was people who had already developed IBD.

Though there are people, like me, who are allergic to many common antibiotics. Between some bad reactions in childhood and an emergency three years ago (over two decades), I never had antibiotics.

Taking another look, I think they are measuring antibiotic dispensations within the time period. Which makes a ton more sense because I'm imaging the number of people who have never been exposed to an antibiotic over their entire lifetime is pretty small.

How solid is the evidence that accutane causes IBD? Because most people who took accutane would have first taken antibiotics, which is a more common treatment for acne.

It's strange that these two drugs, with two different mechanisms of action, would both increase risk of IBD.

I took both and I have IBD. Stay away from this stuff unless you really need it.

I can raise your anecdata to two: I took lots of antibiotics as a kid for ear infections, then lots more as a prelude to acutane, and 15 years later I have proctitis.

For minor acne, doctors tend to prescribe topical antibiotics, and those are a lot less likely to interfere with the digestive tract than oral antibiotics. But you said accutane, and that's for severe acne.

Antibiotics cured my IBD. Had problems for years. A brief course of amoxicillin and some other, now forgotten, antibiotic (taken for unrelated reasons,) ended it almost immediately. It was amazing.

What wasn't so good was catching C. diff. soon after, almost certainly because of the aforementioned antibiotics.

Another treatment of yet another antibiotic dealt with that.

Net result; no IBD.

Related: Antibiotics cured, for about a year, my severe gluten and corn intolerance. Then the gluten intolerance ame back. Ive gone through a few rounds of eliminating the gluten issues in this fashion, but the symptoms always return 10-16 months later.

Can you describe what you mean by your intolerances here? I'm having a similar issue that developed after taking antibiotics and I'm curious if yours is similar.

You may have small intestinal bacterial overgrowth [1].

If you can't digest certain types of food, the bacteria which feed on this food grow out of proportion to their place in the microbiome. You'd often notice symptoms an hour or more after eating the food in question, which would give time for the food to hit the small intestine almost entirely undigested.

Taking antibiotics would kill off the overgrowth, but it would grow back over time unless you cut out the food or took supplementary digestive enzymes along with the food.

[1]: https://en.m.wikipedia.org/wiki/Small_intestinal_bacterial_o...

Honestly I thought that was pretty well known already. I knew a girl in college about 20 years ago who had been on massive amounts of anti-biotics, and it ruined her stomach & digestive system in some way. At the time she was having to slowly build up "good" bacterial through some type of specialty yogurts (might just have been probiotics, which were not as prevalent then). It was a multi-year process though, and she couldn't eat a lot of types of food in the meantime.

Why didn't she just get a fecal transplant?

Because you can't. They're reserved for c-diff infections and there isn't much risk data on use cases outside of that such that regular providers won't give it the OK.

This was 20 years ago. While not brand new at the time, it wasn't very common.

A lot of work on FMT has only taken place in the last decade. I don't think there was even a randomized trial for it as a treatment method until the last 10 years.

Let me explain my case here. 2 months back I was having stomach pain around the abdomen, it comes and goes, especially its a bit high after taking food. Consulted doctor, and he gave medicines assuming its gastritis, without antibiotics. Lipid profile was normal, SGPT was a bit higher (55 U/L)A Urea Breath test showed that I am positive for H-Pylori.

A USG abdomen showed a gaseous proximal colon along with mild wall thickening of sigmoid and adjacent descending segment around left lilac fossa (Radiologist assumed either spastic colon/ sequela of colitis). The Doc started treatment with antibiotics Amoxidin(Amoxicillin) + Flagyl(Metronidazole) for 14 days along with Gordex and Gaviscon for gastritis. After 14 days, the pain has drastically reduced, but I started having constipation, minor fissure. Consulted doc again, and he gave Flagyl(Metronidazole) for 7 days along with lactulose. Stomach pain actually went away when I started taking lactulose also H-Pylori was not detected on the next test(using H-Pylori antigen stool test).

When I stopped the medicines again, the constipation and occasional stomach pain came back. I started taking lactulose 2 times a day after the 14 + 7 days antibiotic course, everything was smooth, but when I stopped lactulose, stomach pain came back. I have then started reading about the symptoms and somewhere I read about gut flora and how antibiotics damages gut flora, on reading much I started asking my doc about probiotics.

He recommended a probiotic which said Colon support containing 20 billion CFU. The mix of probiotics was Bifidobacteria blend(18 billion CFU) (Bifidobacteria lactis, Bifidobacteria infantis, Bifidobacteria longum, Bifidobacteria breve, Bifidobacteria bifidum)) along with Lactobacillus Blend(1.5 Billion CFU) (Lactobacillus rhamnosus, Lactobacillus plantarum, Lactobacillus casei, Lactobacillus acidophilus, Lactobacillus bulgaricus, Lactobacillus helverticus) and Stephalococus Thermophilus (500 million CFU). Taking a probiotic capsule for 6 days has improved a lot, and I have a smooth stomach motion, and doesn't have the stomach pain or constipation anymore.

What I knew from Doc is, if we eat prebiotic (Food with good fiber), it is decomposed by good bacteria and they reproduce good. On the other hand, if you take high sugar, it usually helps the bad bacteria growth like H-Pylori or E Coli. I was taking this advice and taking a lot of salads in these days.

Ayurvedic practitioners always said stay away from western medicine, chemicals the rip out your gut and change your doshas.

Back in the day these good bacteria were found in milk, but now its homogenised and pastuerised they are killed off. THe reason we need to pastuerise the milk is to kill TB, but TB became more prominent after the industrial revolution.

Our demand for industralisation has created the mess we are in now.

To help make a "Map" of our gut bacteria, think about "benchmarking" your new Ryzen System with that ;)

https://www.worldcommunitygrid.org/research/mip1/overview.do

I got lactose intolerant for a few months after some antibotics. It went away again after a while.

Wouldn't the application method be a large influence here as well? I imagine that adverse effects from oral application should be more pronounced in the stomach and bowels than with IV use.

The next thing to test: Does a fecal transplant after taking antibiotics eliminate the increased risk of developing IBD?

I believe it

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