Antibiotics Have No Downside?! The Most Damaging Dogma In Medicine

This whole idea of the hygiene hypothesis, not raising your child in say like a hyper clean environment so they get appropriate immune system development, is linked to something else that you talk about in the book.

The blind spot, I suppose you would call it again in medicine that there are little to no downsides to antibiotics. What's your take on that?

Look, this has been one of the most damaging dogmas in all of medicine and has harmed millions and millions of people with irritable bowel, unexplained chronic pain. We have these terms that are just wastebasket umbrella terms, Bacterial overgrowth syndrome, irritable bowel. But you know, many of these conditions didn't exist before the advent of antibiotics or were super rare. Ulcerative colitis, inflammatory bowel disease. Antibiotics, it turns out, are not totally safe and no medication is totally safe. Despite what you hear. They carpet bomb the microbiome that is the garden of millions of different bacteria that line the GI tract, that train the immune system, that digest food, that maintain an equilibrium and even produce serotonin involved in mood and GLP1, naturally the active ingredient in ozempic. So when we drop an antibiotic in there, we're undoing that balance. And we may, there may be overgrowth of bad bacteria like C. Diff, like pro inflammatory bacteria, increasing general body inflammation, but the microbiome has been this unrecognized area of the human body as if it has nothing to do with anything. Antibiotics save lives and it's important to take them many times. But 60% that are prescribed are unnecessary, according to several studies. And I think the most significant study of the modern era, in my opinion, was a study I found just a couple years ago that came out from the Mayo Clinic, comparing kids who got an antibiotic in the first couple years of life versus kids who did not. In this study of 14,000 kids, kids who got an antibiotic in the first couple years of life when that microbiome is still forming, had higher rates of obesity, 20% higher rates of obesity. By the way, farmers have been noticing that in animals for a long time. That's why they give them to animals. Learning disabilities were higher. Attention deficit disorder and other learning disabilities went up. These are all chronic diseases. New diagnoses that are have been skyrocketing in the modern era of antibiotic and microbiome sort of imbalance. And asthma was 90% higher. Celiac was nearly 300% higher. So when patients come in to see us as doctors and they have celiac or.

One of these other conditions and parents say, what Caused this. We've been basically telling them we don't know or we make something up. Here we have a strong signal in the data that changing the microbiome may cause or hasten some of these chronic diseases on the rise. And it's not just antibiotics, it's unnecessary C sections and other things.

Yeah, I was going to ask you and then you brought it up, this idea about antibiotics and obesity, because you briefly mentioned GLP1, which is of course on the tips of everyone's tongue these days. It seems like half of Hollywood and all the Silicon Valley tech entrepreneurs and billionaires are all using Ozempic or something like it. Do you think you could draw some kind of a correlation between antibiotic use and either a surgeon obesity or a diminished ability to resist the hyper palatable foods that are around us?

Well, it's hard to make a direct causal association, although in animal studies, the world expert on the microbiome who I interviewed for the book has made those direct associations. But it's hard to know which alteration of the microbiome is the one that's really causing this or is it all of the alterations. If you think about it, we're doing a ton of stuff in the modern era, in our lifetime. We're the first generation Ben that's had a massively altered biome from antibiotics, carpet bombing, some bacteria from C sections, ultra processed food, tons of refined carbohydrates, foreign substances that do not appear in nature, be it microplastics, pesticides or byproducts of seed oils. These are substances that do not appear in nature. And when they go down the GI tract, not only are they altering the bacterial balance, but the immune system lines the GI tract. And so the immune system may be responding and sort of fighting off some of these foreign particles that don't naturally appear in the environment. And you get a sort of not a major inflammation, but a mild and chronic inflammation. And that just makes people feel blocked, makes people, people feel sick. And that's why many people are taking a hard look now at the food additives and the diets in foods.

Right. You're describing a piece of the so called evolutionary or ancestral mismatch, the human body and brain being maladapted to this modern environment of not just the hyper palatable foods, but a large variety of synthetic compounds. And honestly, it makes me think that if I were not saying this is the case, but if I were a pharmaceutical company, it would actually be a very good move to encourage use of antibiotics. This is related to that other question I asked you a few minutes ago and simultaneously produce something like a GLP1 agonist. Those would seem like a match made in heaven based on what you're describing. Not saying that's the case. I don't know if it is, honestly, but it is very interesting. It's also interesting what you say about C sections. Um, you know, and I think a lot of people still aren't aware of this. I saw a figure. I don't know how accurate this was, but it's several years that it takes for the biome of a child born via C section to become as diverse as that of a child born vaginally. A process during which you, of course, collect a lot of your mom's flora. And as gross as this is to think about, you know, pick up some poop particles as you're coming, you know, through that canal and, you know, and basically having a little bit more of a natural delivery. So I would imagine C sections are also a pretty big part of this problem also.

I think you're onto something there, Ben, and I think that's a very important point. And just to sort of restate it a little differently, the microbiome, the gut of a baby in utero is sterile. There's no bacteria in there. The microbiome that is the garden of these millions of different bacteria is seeded from the bacteria the baby acquires from passing through the birth canal and augmented by breast milk bacteria and skin and kisses from grandparents. But when a baby is born by C section, a sterile baby is extracted from a sterile, operative field. And what may seed their microbiome and gut are bacteria that normally live in the hospital.

Oh, wow. Wait, wait, I need to repeat that. So my audience, I want to make sure they pick that up. Your biome would be seeded by the bacteria in the hospital rather than the natural floral environment of your mother.

That is a distinct possibility. That was. And that was a primary concern with all these C sections that the head of the Microbiome Research center at the NIH had explained to me in that very eloquent way. And so what are we doing now? C sections save lives and antibiotics save lives.

Yeah, I mean, my wife had a C section. She. Twin boys, tiny, petite woman. She would have been the type of gal who probably would have died in the wild, wild west 150 years ago trying to push a couple of boys out. And the C section probably did save her life or their lives.

Absolutely. Good point. C sections save lives, but they're overused. You know, there's a dogma that it doesn't matter. You get to choose. You can pick a date if you want to pick your, you know, grandmother's birthday to deliver your daughter or son. There are extremes on at every level, but the idea that there's no difference or that it's perfectly the same at Mount Sinai, they have a protocol now where if you're born by C section, they take some vaginal fluid and swab it on the baby's skin with the idea that they're going to promote the healthy seating of the microbiome. You're familiar with the rise of colon cancer in young people?

Yeah, I've been hearing a lot about that in the past year.

And everyone's scratching their heads. Even I'm a cancer surgeon myself, trained in surgical oncology and gastrointestinal surgery, and everyone's scratching their heads. Not many people are asking what's going on. But if we stop and look around, there's some pretty compelling data that's giving us some hints. A study just came out in JAMA Surgery. Remember, JAMA's the largest circulating journal in all of medicine. The JAMA Surgery sub journal just had a study that kids who were born by C section were more likely to have colon cancer before age 50, suggesting there's some role of the microbiome.

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