David PerlmutterPresident,, Perlmutter Health Center · Board-Certified Neurologist | Functional Medicine Pioneer | #1 New York Times Best-Selling Author | International Speaker | Host of The Empowering Neurologist Podcast

Countering Your Antibiotics with Probiotics

28 Jun 2015 · 2 min

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1:45

In this segment Dr. David Perlmutter answers a common patient question about how to manage probiotic use while on antibiotics. He explains that antibiotics remain in the gastrointestinal tract before systemic absorption, so probiotic supplements should be taken several hours apart from the antibiotic dose—ideally about six hours after a twice‑daily (12‑hour) antibiotic schedule. He recommends increasing (doubling) the probiotic dose during the antibiotic course and continuing the higher dose for roughly a week after finishing the antibiotics, because antibiotics disrupt the gut microbiome. Citing the book Missing Microbes, he notes that such microbiome alterations may promote weight gain and other health issues. He qualifies that these suggestions are based on his clinical practice and are not yet validated by formal studies.

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So the question I'm often asked is, I'm on an antibiotic. Now, I'm not personally, but you, the viewer, are on an antibiotic. You've been given for hopefully an appropriate reason, not just a sniffle or a cough, and you want to know what you should be doing with respect to the probiotics. So understand that the antibiotics are going to remain in your stomach and digestive system for a period of time, and then they're going to be absorbed into your systemic system. The first rule is to separate the probiotic from the antibiotic as long— for as long a period as you can. If you're taking an antibiotic every 12 hours, then after 6 hours, that would be when you'd want to take the probiotic. The other thing to understand is it's really not a bad idea to double up on your probiotics during the time you're taking antibiotics and even extend that period of doubling your probiotics for maybe a week or so after the antibiotics have finished. Because understand that these antibiotics that you're taking will have an effect on your microbiome. They will change the population of the bacteria that live within your gut. And what was recently described in the book Missing Microbes is that the changes to the microbiome, to the array of bacteria living within your gut, may actually be detrimental and may actually pave the way towards an array of gut bacteria that may favor even weight gain. So these are, I think, are good recommendations. I can't say that they've been validated in any study, but this is what I talk to my patients about.