Probiotics after antibiotics: Building resilience in the face of resistance

Probiotics after antibiotics:

BUILDING RESILIENCE IN THE FACE OF RESISTANCE

Introduction

In recognition of World Antibiotic Resistance Awareness Week, let’s explore how to use probiotics after antibiotics, along with other diet and lifestyle measures, to help us build resilience against antibiotic-resistant bacteria.

For postmenopausal women, the frequency of urinary tract infections (UTIs), respiratory infections, and other bacterial infections can increase with age, raising the likelihood of needing a course of antibiotics.

We now know that the microbiome and antibiotics interact in ways that significantly impact both the type and number of bacterial species in the gut, potentially increasing the chances of antibiotic-resistant bacteria developing.

Using probiotics after antibiotics is one of many strategies that can help restore healthy bacterial diversity and support your microbiome.

This blog covers how antimicrobial resistance develops, why it matters, and practical lifestyle changes and dietary adjustments to build resilience in the face of resistance.

If you’re also interersted in supporting your immune system, then take a look at my other blog, “Supplements for the immune system: 15 most researched“.

Antibiotic resistance tests; the bacteria in the culture on the left are sensitive to the antibiotics contained in the white paper discs. The bacteria on the right are resistant to most of the antibiotics.

WHAT IS ANTIBIOTIC RESISTANCE AND WHY SHOULD YOU CARE?

Antibiotic resistance happens when bacteria evolve ways to survive antibiotic treatment. This change can occur in a variety of ways, for example when genetic information passes between different bacteria.

Over time, these resistant strains can become dominant, making infections harder to treat and increasing the spread of resistance between people and populations.

Common culprits, you may have heard of are:

• escherichia coli 🦠🌊
• klebsiella pneumoniae 🏥🧫
• methicillin-resistant staphylococcus aureus (MRSA) 💉🛡️
• enterococcus faecalis 🚽💧
• clostridium difficile (C. diff) 💩⚠️

They can cause urinary tract infections, respiratory infections, pneumonia, blood stream infections, peritonitis after surgery, sepsis and wound infections.

In recent years, antibiotic resistance genes have become a global concern, with the World Health Organization calling it a major threat to public health.

Diagram showing how genetic mutation causes drug resistance. Bacteria multiply by the millions. A few of these bacteria will mutate. Some mutations make the bacterium drug resistant. In the presense of drugs, only drug resistant bacteria survive. Drug resistant bacteria multiply and thrive.

MICROBIOME AND ANTIBIOTICS: IMPACT ON WOMEN OVER 50

The Role of Oestrogen

Women who have entered menopause and are not on hormone replacement therapy (HRT) experience a natural decline in oestrogen levels.

Oestrogen plays a protective role in the immune system, supporting the production of immune cells that help the body identify and fight off infections.

With lower oestrogen levels, immune responses may weaken, potentially increasing vulnerability to infections such as urinary tract infections (UTIs), respiratory infections, and skin infections.

Additionally, oestrogen has an anti-inflammatory effect on the microbiome and antibiotics relationship, helping maintain the delicate balance of beneficial bacteria in the gut microbiome.

The Risks of Frequent Antibiotic Use

Older women are more likely to have had several courses of broad-spectrum antibiotics over their lifetime and may not have replaced beneficial microorganisms by taking probiotics after antibiotics.

Frequent antibiotic treatment can lead to antibiotic-associated diarrhoea and disrupt the gut microbes, weakening the gut’s natural defences and increasing the chances of pathogenic bacteria multiplying.

Studies show that repeated antibiotic exposure reduces the diversity of bacterial species in the gut, impacting its role in supporting immunity.

Chronic Stress

Stress becomes more impactful on health with age, and chronic stress can disrupt metabolic pathways and weaken the immune system.

Chronic stress disrupts the gut, altering the microbial communities and increasing inflammation.

Sleep Disruptions

Many women don’t sleep so well post-menopause, which can impair immune function. Poor sleep reduces the production of immune cells and may contribute to a higher need for antimicrobial medicines to manage infections.

Nutritional Deficiencies

As we age, smaller appetites, nutrient-poor food choices, and declining digestion can all impact the intake of essential immune-supportive nutrients like Vitamin D, Zinc, and proteins.

HOW ANTIBIOTICS DISRUPT THE MICROBIOME

Disruption of Diversity

Antibiotics are designed to target harmful bacteria causing infections. Unfortunately, they do not discriminate between good and bad bacteria. When you take broad-spectrum antibiotics, they can significantly reduce the diversity of your microbiome by killing off beneficial bacteria alongside the pathogens. 

Overgrowth of Pathogens

With beneficial bacteria diminished by antibiotic treatment, there is often an opportunity for harmful bacteria or fungi to thrive and disrupt the delicate balance of gut microorganisms. 

Long-term Effects

Research has shown that some changes in the microbiome caused by antibiotics may be long-lasting or even permanent.

A study published in Nature indicated that certain individuals may never fully recover their original microbial diversity after antibiotic treatment. This alteration can contribute to chronic conditions like obesity, allergies, and autoimmune diseases.

Scanning electron micrograph of methicillin-resistant Staphylococcus aureus bacteria (yellow) and a dead human white blood cell (coloured red)

5 SIMPLE STEPS TO PREVENT ANTIBIOTIC RESISTANCE

#1. Practise Proper Handwashing

Regular hand washing is one of the most effective ways to prevent the spread of bacterial infections and avoid the need for antibiotic intervention. 

#2. Handle Food Safely

Pathogenic bacteria such as e. coli can be present in food, especially in raw or undercooked meat. Proper food handling, cooking, and storage can reduce the risk of infection and the need for antibiotics.

#3. Stay Up-to-Date with Vaccinations

Vaccinations for infectious diseases like flu and pneumonia are especially important for older adults. Reducing the risk of common infections can lessen antibiotic use, thus helping to prevent the development of antimicrobial resistance.

#4. Natural Immune Boosters

Certain foods and nutrients can naturally support the immune system. Garlic, ginger, and turmeric, along with vitamins such as Vitamin C, Vitamin D, Selenium, and Zinc, have shown potential in supporting immunity and helping the body combat infections. Similarly, taking probiotics after antibiotics is important – more on this a little later.

#5. Use Prescribed Antibiotics Responsibly

Only take antibiotics as prescribed by your healthcare provider, and avoid using antibiotics for viral infections, like colds and flu, which do not respond to these medications. Always complete the full course of prescribed antibiotics.

Do you need to test gut bacteria?

This is an important question you need to ask yourself. How do you know if you have imbalanced gut bacteria or harbour antibiotic resistant microbes?

Here are common symptoms of a dysbiotic gut (an imbalance of gut bacteria) that may harbor antibiotic-resistant or parasitic microorganisms:

1. Digestive Issues: Frequent bloating, gas, constipation, diarrhoea.
2. Food Intolerances: Increased sensitivity to foods that were once well-tolerated, particularly to gluten, dairy, or high-fibre foods.
3. Skin Problems: Eczema, acne, or other skin irritations, often linked to gut imbalance.
4. Frequent Infections: Recurrent UTIs, yeast infections, or other infections that indicate immune system strain.
5. Mood Swings and Anxiety: Altered gut bacteria can impact neurotransmitters, leading to anxiety, irritability, or depression.
6. Bad Breath: Persistent bad breath, which may indicate an overgrowth of certain gut bacteria.
7. Unexplained Weight Changes: Weight gain or loss that doesn’t correspond with changes in diet or lifestyle.
8. Cravings for Sugar and Carbs: Imbalance can cause cravings for quick-energy foods, often linked to certain strains of bacteria.

I’ve written this blog, “Microbiome Testing“. Please do read it, it’s full of useful information to help you decide. Or get in touch and I can help you.

HOW TO IMPROVE GUT MICROBIOME

The more gut-friendly species of bacteria you can grow and nurture the better. These beneficial bacteria reduce the amount of antibiotic resistance genes. 

Here are some natural ways to build this diversity:

#1 PREBIOTICS IN EVERYDAY FOODS

A prebiotic is a type of fibre that feeds the good bacteria in your gut, helping them grow and multiply to support your digestive health and immune system.

Great probiotic foods are garlic, onions, leeks, less-ripe bananas, chicory, asparagus, stewed apples, oats, Jerusalem artichokes (careful, don’t eat too many in one sitting!), flaxseeds, lentils, beans.

A study in mBio (2019) showed that prebiotic fibres can reduce the damaging effects of antibiotics on gut microorganisms and help your immune system recover.

Research published in Nature (2018) found that individuals with higher dietary intake of plant-based prebiotics had greater microbiome diversity, which helped to protect them against the spread of antibiotic-resistant bacteria. 

My advice is try to eat some foods containing prebiotic fibres at each meal and gradually build up the quantities that you eat, to give your digestive system time to adjust. Eating too many, too fast, can cause bloating, wind and digestive discomfort.

There are many probiotic supplements on the market (too many for me to evaluate here), however, if you are considering using prebiotic supplements, keep these tips in mind:

1. Start Slow: Begin with a small dose to avoid wind or bloating, as your body adjusts to the added fiber.
2. Stay Hydrated: Prebiotics need water to work effectively and reduce potential digestive discomfort.
3. Combine with Probiotics: Prebiotics support the growth of probiotics (good bacteria), so they work well together to benefit your gut health.
4. Look for Quality: Choose supplements with well-researched ingredients, like inulin, fructooligosaccharides (FOS), or galactooligosaccharides (GOS).

Enjoy prebiotic foods like garlic, onions, leeks, less-ripe bananas, chicory, asparagus, stewed apples, oats, Jerusalem artichokes, flaxseeds, lentils, beans.

#2 PROBIOTICS AFTER ANTIBIOTICS

Probiotics are beneficial bacteria that can help restore microbial balance in the gut. 

A balanced microbiome may lower the risk of recurrent infections and the need for additional antibiotic courses.

A meta-analysis in the Journal of Clinical Medicine (2018) showed that supplementing with probiotics, such as Saccharomyces boulardii, a beneficial yeast, can help reduce the risk of antibiotic-associated diarrhoea and Clostridium difficile infections.

The probiotic bacterium Lactobacillus rhamnosus helps to rebuild bacterial species diversity and prevents the overgrowth of pathogenic bacteria like klebsiella pneumoniae. 

Table to explain labelling terminology on probiotic supplements:

When choosing a prebiotic supplement, you can consider things like:

Strains

#3. Fermented foods

Fermented foods like yoghurt, kimchi, sauerkraut, kefir, miso, tempeh, kombucha, and fermented pickles are rich in beneficial bacteria that help maintain a balanced gut microbiome. Check your pickles are fermented in salt, not vinegar.

These foods introduce beneficial bacteria to the gut. Probiotic-rich foods help regulate inflammation and strengthen the gut barrier, which is essential for preventing harmful bacteria from entering the bloodstream.

A recent 2021 study published in Cell demonstrated the immune-enhancing effects of fermented foods. Researchers found that consuming a diet high in fermented foods significantly increased microbiome diversity, reduced levels of inflammatory proteins and increased resilience against pathogens – all of which indicate a strengthened immune response.

#4. A Balanced Diet

Eating a diverse range of foods is crucial for maintaining a healthy microbiome. Focus on whole foods rich in nutrients – fruits, vegetables, legumes – and avoid processed foods high in sugar and unhealthy fats that negatively impact microbial diversity.

Staying hydrated supports overall health and helps digestion by helping maintain the lining membrance  in your intestines where many microbes reside.

#5. A Perfect Immune-Supporting Meal

Try my super-easy immune-boosting meal.

Ingredients & Method:

• 1 serving of stewed Bramley apples & a few raisins
• A generous dollop of live yoghurt (dairy, soy, or coconut)
• A handful of blueberries & almonds (with skin)
• A indulgent blob of Manuka or raw honey
• 1 teaspoon of prebiotic larch arabinogalactans
• 1 opened capsule of Saccharomyces boulardii and your favourite probiotic

NUTRIENTS FOR IMMUNE SUPPORT

Supporting the immune system and gut microbiome is critical for building resilience against infections and managing the impact of antibiotic use. 

Here are some evidence-backed supplements shown to improve gut health and immune resilience.

Vitamin C

Vitamin C is widely recognized for its immune-supporting properties. A study published in Nutrients (2017) found that Vitamin C strengthens the immune system by stimulating the production of white blood cells, essential for fighting infectious diseases. 

Vitamin C acts as an antioxidant, reducing inflammation that can impair immune resilience.

A high intake of Vitamin C has also been linked to less respiratory infections in older adults, helping to reduce the need for antibiotic intervention.

Citrus, kiwi’s, Brussels, peppers, Goji berries, strawberries, blackcurrants – full of vit C

Vitamin D

Vitamin D plays a very important role in keeping the immue system balanced. Good levels of vitamin D has been linked to lower rates of antibiotic-resistant infections. 

A 2019 study published in Frontiers in Immunology found that Vitamin D enhances the immune system helping the body defend itself against bacterial pathogens.

Vitamin D is particularly valuable for older adults, as deficiency becomes more common with increasing age. 

Another study, published in The American Journal of Clinical Nutrition (2010), showed that Vitamin D supplementation in older adults reduced the incidence of respiratory infections by up to 42% – thereby reducing the need for antibiotics. 

Selenium

Selenium is a trace mineral.

Research from a study in the British Journal of Nutrition (2018) found that Selenium has a significant impact on immune resilience, especially in elderly populations. 

Numerous studies have shown that selenium deficiency can lead to ia  surpressed immune reaponse and greater risk of infection. Supplementation, therefore, may reduce reliance on broad-spectrum antibiotics by bolstering natural defences.

Zinc

Don’t forget Zinc! It’s fundamental to immune function and is required for the development and function of immune cells. 

According to a 2017 study in Advances in Nutrition, zinc deficiency is associated with a weakened immune response and increased susceptibility to bacterial infections. 

A meta-analysis in the British Medical Journal (2016) said that zinc supplementation can reduce the duration and severity of respiratory infections, potentially lowering the need for antibiotic treatment.

By supporting immune cell function and maintaining the gut’s lining, zinc helps ensure a healthier microbiome and a stronger defence against pathogens.

Immune supporting nutrients – Vitamin D, Vitamin C, Selenium, Zinc

LIFESTYLE WAYS TO SUPPORT YOUR IMMUNE SYSTEM

Many studies have shown that the combined effects of lifestyle changes, including sleep, exercise, and stress management really help improve microbial diversity and resilience, counteracting the negative impacts of antibiotics on the microbiome and supporting the immune system.

Here are studies that highlight the effectiveness of lifestyle changes in supporting the immune system and enhancing the resilience of the gut microbiome:

😴 Sleep and Immune Function 🛡️

A study published in Sleep (2015) found that quality sleep significantly improves immune response by boosting T-cell production and enhancing the body’s ability to combat infections. Participants with less than six hours of sleep per night were four times more likely to develop a cold than those who slept over seven hours, demonstrating how sufficient sleep strengthens immunity.

🧘‍♀️ Stress Management and Gut Health 🦠

Research published in Brain, Behavior, and Immunity (2017) shows that chronic stress disrupts the gut microbiota by increasing permeability of the gut lining cells and promoting inflammation – which weakens the immune response. Effective stress management, such as mindfulness and meditation, has been shown to reduce gut inflammation, promoting a healthy microbiome and bolstering immune function.

💪 Exercise and Immune Resilience 🛡️

A 2019 review in Frontiers in Immunology highlighted that regular physical activity enhances the body’s immune surveillance and promotes anti-inflammatory effects. Exercise is linked to an increase in beneficial gut bacteria, which supports gut health and resilience against infections. Moderate exercise, such as walking and cycling, was shown to lower the risk of respiratory infections, particularly in older adults.

CONCLUSION:

Reducing the risk of antimicrobial resistance is achievable through a few well-planned practices. While antibiotics play an invaluable role in treating bacterial infections, they can disrupt the balance in the relationship between the microbiome and antibiotics, often reducing diversity and promoting the overgrowth of harmful pathogens. Incorporating probiotics after antibiotics is one effective way to restore beneficial bacteria and support a balanced microbiome.

By fostering a diverse gut microbiome, practicing good hygiene, using antibiotics responsibly, and adopting a healthy lifestyle, we can strengthen our immune system, minimize the need for frequent antibiotics, and rebalance our internal ecosystems after treatment. Knowledge is power when it comes to protecting our unique microbial landscape – taking proactive steps helps safeguard our overall health while still benefiting from essential medical interventions when needed.

For a deeper dive into your gut health, especially if you know you have had multiple courses of antibiotics and experience the symptoms I discussed earlier, do browse the Gut Health Clinic and let me know if I can answer any of your questions.

Contact me today for a free 15 minute chat, and let’s start your journey toward better gut and immune health. 

References

https://pmc.ncbi.nlm.nih.gov/articles/PMC10449846/

https://doi.org/10.1038/s41467-018-07631-2

https://doi.org/10.1001/jama.2018.9064

https://doi.org/10.1016/j.cell.2021.06.019

https://doi.org/10.3390/nu9111211

https://doi.org/10.3389/fphys.2014.00151

https://doi.org/10.3945/ajcn.2009.29094

https://doi.org/10.1017/S0007114508006968

https://doi.org/10.3945/an.117.016593

https://doi.org/10.1136/bmjopen-2020-047474

https://doi.org/10.1001/jama.2018.9064

https://pmc.ncbi.nlm.nih.gov/articles/PMC4531403/

https://pubmed.ncbi.nlm.nih.gov/21040780/

https://pubmed.ncbi.nlm.nih.gov/31193280/