Antibiotics: Side Effects and Alternatives
About Kelly Brogan
KELLY BROGAN, MD, is a holistic psychiatrist, author of the New York Times Bestselling book, A Mind of Your Own, Own Your Self, the children’s book, A Time For Rain, and co-editor of the landmark textbook Integrative Therapies for Depression.
We use a lot of antibiotics. For coughs, cuts, urinary tract infections, and many times “just in case.” You could be considered reckless or ignorant if you opted to not use them. “But you could die of a deadly infection that could kill you!” chants the choir of voices entrained by a system that sees dangerous enemies lurking behind every life experience.
What may surprise you is that the real danger could lie in assaulting your body with an “anti-life” (the actual meaning of the word!) chemical that could very well be a Russian Roulette of unintended harms. Some of these harms are so significant that they could change the course of your entire life as you know it. Given that, I bet that if you knew that there were effective, safe “alternatives,” you’d seriously consider them.
To make your own decisions about health, you must inform yourself. Informed consent around medical interventions involves exploration of the risks, benefits, and alternatives. In our reactivity, however, we are accustomed to focusing only on the promise – knock that infection out and feel better quick! – without any meaningful information around the full breadth of scientifically-evidenced risks and treatment options.
The Benefits
Antibiotics obviously work, right? Well, we are learning that our dogmatic assumptions about the sacred cows of conventional medicine may be leaning on a house of cards. Or a house of placebos to be more exact. The reality is that infections have a natural course with an inbuilt capacity for robust recovery, so we may be giving undue credit to antibiotics. This appears to be possible based on the published literature. For instance, this study
[1]
on rhinosinusitis concluded: “…the risks of potential side effects need to be weighed against the potential benefit that antibiotics give to the patient. This is especially pertinent as usage of the placebo has shown to be almost as efficacious as using the antibiotic therapy, and also much safer.”
WIth rising rates of antibiotic-resistant infections (which have resulted from rampant antibiotic use), and fewer novel medications in the pipeline, it seems we are coming to a point of reckoning around our belief that the rampant extinguishing of life is a health-promoting practice.
The Risks
“Catherine, you have an upper respiratory infection. We aren’t sure whether it is necessarily bacterial, but you should go ahead and take that Z pack just in case…oh, and it’s unlikely, but it’s possible that you could be left bed-bound from neurological damage, develop a serious opportunistic infection, and possibly even a brand new psychiatric diagnosis like Bipolar Disorder. Hope you feel better soon!”
Microbiome-dependent risks
With the discovery of the microbiome, conventional medicine as we know it should have gone back to the drawing board. With the understanding that an inner ecosystem drives our epigenetic expression, ranging from nutrient production to metabolic health to hormonal balance to immunity and inflammatory response, the ‘body as machine’ model became obsolete. We need to better understand what makes a microbiome healthy and what hurts it.
So far, we have been left with many questions and few answers
[2]
. We have looked at super healthy modern hunter gatherers to try to quantify their gut health, we have studied the beneficial effects of probiotics, and we have learned that chemicals like Monsanto’s Roundup wreak havoc on our bugs. We have learned that the transfer of bacteria occurs well before birth, and continues throughout breastfeeding, setting the stage for adult health by age 2. And it has almost become common knowledge that the indiscriminate killing of bacteria through the use of antibiotics may come with a cost. But will the cost really be anything more than a yeast infection or a bout of diarrhea?
Perhaps. We have ample evidence that antibiotics take out the “good” with the “bad” bacteria and leave a trail of imbalance that leaves the patient more vulnerable
[3]
[4]
references the increased risk of foodborne infection, including antibiotic-resistant strains, in those who took antibiotics during travel, with unpredictable recovery rates that seem to get dismally worse with repeated antibiotic exposure:
“Even short antibiotic exposures disrupt the gut microbiome up to a year or more, and repeated exposures appear to attenuate recovery from ever occurring.”
Similarly, up to a one-third reduction in biome diversity can persist longer than 6 months, even after one short course of the popularly-dispensed antibiotic, Cipro.
[5]
This decrease in diversity can, itself, be a precursor to new illness. For instance, inflammatory bowel disease (IBD) is one of several chronic illnesses associated with low levels of beneficial bacteria
[6]
. Dysbiosis (imbalanced gut bacteria) is also a precursor to autoimmunity,
[7]
[8]
Yeah, we all should be using less antibiotics – but what if we have to take an antibiotic? Then can’t we just take a probiotic afterward?
There is, unfortunately, scant evidence to support this seemingly logical integrative medicine practice. While hamster studies suggest recovery of damage is possible
[9]
, the broad spectrum of antibiotic effects and probiotic options makes personalization of this support method challenging. Most probiotics contain only a few bacterial species, and our gut contains thousands.
Microbiome-independent risks
As if that weren’t enough to slow your pace to the CVS pharmacy counter, there is a growing body of literature focused on the non-microbiome-based risks of antibiotics. From slowed fracture healing
[10]
[11]
, antibiotics have effects at the cellular level beyond simply inducing dysbiosis. These include changes in up to 87% of gut metabolites
[12]
functional in the gut, injury and destruction of mitochondria (the energy centers of the cell), and damage to gut tissue.
Of significant interest to me are the known and well-documented psychiatric risks of antibiotics. I imagine there are few patients consented for acute onset psychosis or suicidality before being prescribed an antibiotic. An excellent 2017 review by Zareifopoulos and Panayiotakopoulos
[13]
suggests that patients should be told of these risks including irritability, confusion, encephalopathy, suicidality, psychosis, and mania. These researchers conclude:
“The neuropsychiatric effects of antimicrobial drugs are extensively documented in the literature. A number of antimicrobial drugs have the potential to exert CNS effects and many are associated with stimulant, psychotomimetic and epileptogenic properties, mediated by GABA antagonism (beta-lactams, quinolones and clarithromycin), NMDA agonism (D-cycloserine, aminoglycosides, and perhaps quinolones), MAO inhibition (linezolid, metronidazole and isoniazid weakly) as well as more exotic mechanisms, as in the case of trimethoprim, isoniazid, ethambutol, rifampicin and the tetracyclines.”
In fact, the term ‘antibiomania’ has been coined around the potential for antibiotics to induce manic symptoms. In a recent review, two-thirds of the mania-inductions were in male subjects
[14]
. The resolution of acute-onset mania with charcoal suggests that these psychiatric risks may be both microbiome-dependent and independent. Relatedly, data suggests that there is a dose-dependent risk of new-onset depression; the higher the antibiotic exposure, the higher the risk of depression
[15]
If you don’t know to connect these dots, then you could end up believing that your “mental illness” is an entirely new diagnosis requiring lifelong treatment.
The Alternatives
Fortunately, many alternative strategies exist that resolve bacterial imbalances without the side effects of pharmaceutical antibiotics. Even better – many of the plant-derived therapies can be easily incorporated in your everyday meals as a tasty preventative approach to resiliancey.
Colloidal Silver
Also called silver nanoparticles, colloidal silver has been used for over 2,000 years to resolve bacterial infections
[16]
. As such, silver is commonly used in intravenous catheters, dental fillings, wound dressings, and bone implants
[17]
. Though the exact antimicrobial mechanisms are still debated, colloidal silver generally works by damaging the cell membranes of pathogenic bacteria. Depending on the surface charge of the silver nanoparticles and the type of bacteria, bacteria can be killed by the formation of free radicals, accumulation of nanoparticles in bacterial cell walls, or depletion of cell membrane components
[18]
. Colloidal silver is effective both as a topical treatment for skin infections, like MRSA (methicillin resistant Staphylococcus aureus)
[19]
, as well as an oral antibiotic
[20]
Botanical Herbs
For centuries, botanical herbs have been used as antibiotics. Since there are countless herbal remedies for various types of infections
[21]
[22]
[23]
, I’ll just list a few common herbs that have been validated by modern research. For example, the herb Inula helenium, also called elecampane, was shown to be 100% effective against 200 isolates of Staphylococcus aureus (commonly known as “staph infection”).
[24]
Similarly, a study that evaluated Alpinia galanga, a plant in the ginger family that has been traditionally used in Asian countries, found that this herb was effective against Salmonella typhi and E. coli, as well as against other drug-resistant bacterial strains.
[25]
Extract from Nigella sativa, a flowering plant native to south Asia, kills MRSA,
[26]
while cinnamon and oregano are potent selective antibiotics against many drug-resistant species
[27]
. Similarly, easy-to-find spices like cumin
[28]
[29]
are powerful antimicrobials, as are child-friendly options like elderberry
[30]
[31]
. Many high-quality herbal products combine evidence-based herbs such as oregano
[32]
[33]
[34]
[35]
[36]
[37]
[38]
[39]
into an effective immune support formula.
Probiotics
A great way to prevent imbalances from making you sick is by strengthening your beneficial bacteria, also called probiotics. Incorporating probiotics improve your metabolic and immune functioning while also crowding out pathogenic bacteria. Probiotics can resolve bacterial infections ranging from oral gingivitis
[40]
to H. pylori-mediated gastric infections
[41]
[42]
. As one of the earliest and richest sources of probiotics is breastmilk, it isn’t surprising that breastmilk probiotics have been shown superior to antibiotics to treat mastitis, a common infection during lactation
[43]
(just another reason to breastfeed!). I recommend that people get probiotics through fermented foods like kimchi and sauerkraut
[44]
, as these contain many more complementary bacterial strains than supplements for daily prevention.
Garlic
‘Let food be thy medicine,’ decreed Hippocrates, the father of modern medicine – and he would have ranked garlic as one of the most medicinal foods. Numerous studies have shown the antimicrobial effects of garlic, including a report in which researchers tested garlic-water against 133 multidrug-resistant species, showing remarkable antimicrobial properties
[45]
. A randomized controlled clinical trial showed that garlic was more effective than a standard antibiotic, metronidazole, for bacterial vaginosis. Authors remarked that garlic provided both increased therapeutic efficacy as well as decreased side effects
[46]
. Garlic is an effective treatment for stomach infections caused by H. pylori
[47]
[48]
[49]
[50]
. Amazingly, consuming garlic not only protects against bacterial infections, but also lowers blood pressure
[51]
[52]
[53]
[54]
Manuka Honey
Raw Manuka honey is one of the tastiest ways to stay healthy. This honey comes from bees in New Zealand who pollinate the Manuka bush, and it has been used for thousands of years by various cultures to promote wellness. This high-antioxidant golden honey is a popular ingredient in high-end skin care products, as it is broadly anti-inflammatory and antimicrobial
[55]
. Inside the body, manuka honey can cure antibiotic-resistant C. difficile infection
[56]
[57]
[58]
[59]
[60]
[61]
. A bonus of eating honey is that it can include propolis, a mixture of bee saliva and wax known as “bee glue,” which contains over 300 therapeutic compounds that fight cancer
[62]
[63]
[64]
[65]
Here is where I recommend purchasing high quality supplements.
Make a Truce
It requires a mindset shift to stop fighting. Stop fighting each other, stop fighting nature, and stop fighting our own bodies. We need to break out of our patterned programs of control and domination and understand that this only strengthens our perceived enemies. We need to reconnect to the sacred complexity of pregnancy, birth, and breastfeeding as the origin of our health resiliency rather than a time to throw pharmaceuticals into the black box of undisclosed risks. The microbiome itself has taught us – through the poetry of biology – that we are inextricably connected to and dependent upon the web of the natural world. And that it is not possible to simply pull one thread of that web while leaving the rest of it intact. Remember that symptoms give us an opportunity, and perhaps the next time you have an antibiotic prescription dancing in your sights, you might see what it feels like to bring your body love and support rather than the detonation of grenades.
Visit the research dashboard on greenmedinfo.com to do your own exploration of risks, benefits, and alternatives to conventional pharmaceuticals.
Interested in more insights and tools to help you Own Your Self?
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