Your gut microbes on drugs

Is anyone surprised by this headline?

18 Common Drugs Tied to Altered Gut Microbiome

My reaction was more “What, only 18?”. Certainly there’s a general understanding that antibiotics affect gut microbes. After all, antibiotics kill bacteria, so you’d assume those drugs will play havoc with your gut microbe population. But this article describes effects of other types of prescription medications, many of them widely used.

The study looked at effects of 41 common drugs on gut microbe populations. The 18 medications linked to adverse changes included:

  • Proton Pump Inhibitors (PPIs), used for reflux diseasee
  • Antidiabetic, such as metformin, used by people with Type 2 diabetes
  • Antibiotics
  • Laxatives
  • Oral contraceptives
  • NSAIDs
  • Anti-depressants
  • Steroids

We associate antibiotic resistance with overuse of antibiotics, but this problem was linked to several other types of drugs, too, including PPIs, metformin, certain contraceptives, inhalers and laxatives. Bacterial changes linked to higher body mass index were linked to steroids.

The study only looked at the gut microbiome impact of one medication at a time. Unfortunately many people take multiple medications all the time. For example, what is the impact of taking anti-depressants, metformin and a PPI on a daily basis? Who knows? At best, the study authors admitted that prescription drug use is likely having a major impact gut microbe populations, which impacts disease processes, and we don’t know what’s going on. Great.

This is a big deal and I certainly don’t have an answer. I bring it up because, if you’re on one or more of these medications, you should take steps to ensure you’re eating a diet that promotes healthful microbes in your digestive system. The best strategy is to emphasize plant foods such as vegetables, grains, fruit, nuts and legumes. Gut microbes love plant foods; they live on carbs and fiber.

If you eat foods like yogurt that also happen to contain friendly bacteria, so much the better. However, simply adding yogurt or kombucha or a probiotic pill to your highly processed, low plant-food diet is the least helpful strategy. Gut microbes need to be fed; they don’t do well on a high protein, high fat, highly processed diet. They need fiber and carbohydrates, which are abundant in plant foods.

This isn’t the end of the story. There are plenty of other medications that could be impacting gut microbes: cancer drugs, cholesterol drugs, arthritis drugs, pain meds, other drugs for psychiatric diseases. Then there’s the massively complicated problem of how multiple drugs interact with each other in your gut. There will probably never be one cut-and-dried answer or maybe even a viable way to predict how one person’s list of medications will behave once ingested.

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