Recap: How to heal your gut health after taking antibiotics | Prof. Tim Spector

0:00Hello, and welcome to Zoe Recap, where each week we find the best bits from one of our podcast episodes to help you improve your health. Today, we're discussing antibiotics. These incredible medicines target bacterial infections and save countless lives. But they don't discriminate, killing off our good bacteria and impacting our gut health too. Some experts suggest probiotics as a solution. But do they really help? And can fermented foods be the answer to reversing the damage to your gut microbiome? Professor Tim Spector and Dr. Will Bolsiewicz are here to help you understand what to do to boost your gut health after taking antibiotics.

0:48Fermented foods are basically probiotics, live microbes, but actually in food, as opposed to in a capsule or in some synthetic version. So these are things that have been, And we've had them for thousands of years in our diets. And we're talking about the live cultures. They're in yogurts. They're in cheese. They're in kefir, which is fermented milk. We're talking sauerkraut, which is fermented cabbage. We're talking kombucha, which is fermented tea, kimchi, miso, et cetera, et cetera. All these ferments. And compared to probiotics, they generally have lower doses. but most of them apart from maybe cheese and yogurt have there's many more species many more types many more diversity of microbes than you'd find in a probiotic capsule so the average yogurt has maybe three species but in once you get to kefirs and kimchis and kombuchas you can get anything between 20 and 40 different types of microbe, mainly bacteria, but also some yeast.

1:58My way of thinking is that probiotics when you take a capsule, like Saccharomyces, it may be very individualized whether it's going to work for you or not, depending on your community. Is it going to respond to that guy, yes or no? And we sort of see that in the results. You don't get 100 % response because some people just don't have the gut community that's going to be receptive to this new guy coming in and telling him what to do. Whereas my view is that fermented foods give you a much broader choice so that you've got all these different microbes that are quite happy living together in the food and collectively they're going to have a better chance of having an effect on your gut and restoring it to health.

2:43And we know from other studies, randomized controlled trials of fermented food that getting five or six little portions a day in a few weeks can actually reduce inflammation and boost your immune system. So there is now science behind these fermented foods. So that was my rationale for saying to you, get as many of these different ones as you can, go for diversity, because that way you get different bugs in your kefir as your kimchi and your kombucha. And hopefully some of them are going to work, right? I was just throwing the kitchen sink at your problem and saying, well, we don't know which ones are the best or not.

3:23We don't really know yet how to personalize it for you yet. Hopefully Zoe will sort that out in the future, but we don't know that yet. So that was the thinking. and there are some studies showing that fermented foods do work in people with gut problems and diarrhea, etc. It's not as well documented as probiotics, but there's some data. So I immediately bulk ordered the kombucha and the kefir and the kimchi, Tim, that you recommended. How do you figure out whether this is going to be something that is going to be full of these live bacteria or actually like it has the stamp on it. And I know that sadly, there's actually, there's a lot of things out there that say, for example, kombucha on it, but don't really meet the criteria.

4:10Tim, how do you differentiate that? And then maybe just tell me, you know, how did you advise me specifically what to use? The first thing is to look at the label very carefully. So say you're taking kombuchas or water kefirs, which are generally, so fruit kefirs, which are sort of similar. you check there isn't huge amounts of sugar in it or large amounts of artificial sweeteners because we know artificial sweeteners have negative effect on the gut and gut microbes so definitely don't want anything with that in it and you also need to check that it hasn't been pasteurized and it might be in tiny little letters you know that it's been pasteurized so it may be perfectly done but to give it a long shelf life it's it's been just slightly pasteurized, which means slightly dead.

4:54So the key thing is you've got to make sure it's alive. You've got to make sure it's alive. It's one of the things you said to me. It's like there's a lot of ways that potentially stuff might... And you can tell it shouldn't have a shelf life of two years, for example. That will tell you it's definitely dead. On kombuchas, you should often see a little sediment at the bottom, showing that it's actually forming something live. It's real. It hasn't just been so filtered and processed that there's nothing left. and it shouldn't have lots of fruit and other stuff added to it as well because that also is a sign that it's been ultra processed often if you open it it should have a fizz i think the one i said oh i know jonathan you like chuckling goat uh because it's really smelly and it's got a real fizz on it when you open it so you really know it's live you know it's like and it's got a very pungent taste that's right so i had this experience you have to actually go and look at a video online for how to open it because when you open it, it explodes so much that a good chunk of it ends up sort of pouring around the side and you need to collect it so you don't lose it.

5:55So again, my children thought I was mad, but also thought this was really funny. And it was definitely stronger than the average kefir. And I felt really good because it felt like it was definitely medicine. This was definitely taking this properly. And you also recommended, I think, kombucha, which again, you'd seen made, so you were confident. That's right. I've been to the Momo factory in London. I'd seen what was done and they nearly all got a little sediment in it. I know you're very skeptical of the kombuchas. You can be conned very easily in this game. I think that's the message for people.

6:25You know, you're taking the best intentions. You're taking something that's pasteurized. It's got so many artificial ingredients in it. It's not useful. It's too sweet. You know, if you can't make it yourself, look really carefully and realize that if it's really cheap, it's also unlikely to be the real thing because it has a shelf life of a year or so and they can mass produce it. Often say live active cultures or live probiotics. And if it says that, then that gives you confidence that, that, you know, that has not been pasteurized. Sometimes they'll actually list which specific microbes are present and what the doses may be.

6:59The other thing too, to look for is not so much with kombucha, but more so when you're looking at fermented plant foods, like a sauerkraut or a pickle. The sauerkraut that I grew up on was in a can and it was the second ingredient was vinegar. And that is not actually fermented sauerkraut. When you make pickles or when you make sauerkraut, it may surprise some people, but what you want to look for in the store is that actually the ingredients are whatever the plant is plus water and salt. Water and salt is how you actually create fermentation. So, and again, I feel more confident when it says live active cultures or live probiotics on it.

7:37beyond taking the fermented products. Is there anything else that one should think about if one's saying, well, you know what? I want to get to this much healthier microbiome. You know, maybe I have to accept this is going to take some time. What else can I or anybody listening do? Well, we know from a number of studies and very careful mouse studies that increasing your fiber is really important because that will directly impact the good guys. and if you can get more of those good guys in, they'll suppress themselves, the bad guys. And the bad guys are living off this inflammatory, they like inflammation, they like a sort of slightly stressed gut.

8:18And so the more you can put fiber and other good things in there and other plants, so it goes back to the general rules for our gut health, getting lots of fiber, getting it food plant diversity and reducing as much as possible ultra-processed foods, which are stimulating the bad guys. And I know you're already doing that, but for other people who might not know about this. So I think they're the other things. You could try doing more time-restricted eating, give your gut a rest overnight, because we do know that microbes themselves have a sort of inbuilt laundry service where they do the cleaning at night if they're having late night snacks and things.

9:01So they can come in and really tidy up your mucosal layer on your gut so it's pristine in the morning. And then that seems to help gut health as well in your immune cells. So I think it's a combination of those gut things. The general concept that you're proposing, which I completely agree with, is you want to feed the good guys and you want to starve the bad guys. So this is how we restore the balance, feeding the good guys with the high fiber foods. And then with the bad guys, we want to be cautious to the best of our ability in terms of the things that are feeding them, including refined carbohydrates like sugar, the artificial sweeteners, the ultra-processed foods, high levels of saturated fat intake, alcohol consumption.

9:41I think we want to be careful with all of these things. And then the other thing beyond time-restricted eating is we know that sleep is incredibly restorative to the microbiome. So getting a good night's rest as much as possible, spending time with exercise, spending time outdoors. These are some of the strategies that can all help. If people are listening to this, how should they think about taking antibiotics in general? Does this mean you should never take antibiotics? There is evidence in the medical literature. There was actually a study that Tim and I have been looking at together where they took a group of people, very nice study, and they found the vast majority of people, as Tim alluded to, they recover by eight weeks.

10:21but there was a small subset of people that they could not explain why this was. But these people, their gut took a harder hit and it basically started to resemble the gut of an ICU patient. I'm guessing that's not a good thing. That's not a good thing. So in the depths of dysbiosis and then what they had to do is continue to look. So these particular people, they didn't really start to get back to their baseline for about six months. They did get back to that place. So I think that's one of the points of encouragement. But I think that the takeaway here is that for some people, it may take longer to make that recovery than others.

10:56Yeah. And there are some people that recover totally in two weeks. So who just seem to have a microbiome that just bounces as often. This is fairly trivial, you know, and no real sequelae. And this is where I think the exciting science is if we, you know, we at Zoe, for example, connect enough data, in the future, we can start personalizing this. So, you know, you'd know that when you went to see your surgeon, you said, listen, I'm highly likely to get a long-term reaction to these antibiotics. Give me something else or, you know, I'll take more of a risk or give me some topical cream to put on, you know, an antiseptic antibiotic cream on the outside rather than poisoning my gut.

11:40So I think in the future, we can see how hopefully we can pick whether you're a good responder, a medium responder, a bad responder, and offer much more tailored advice. I have a personal story here because I've always suffered from sinusitis. And each time I got a cold, usually it would go to sinusitis. and for 20 years, every time my cold lasted more than a week, I would go on to antibiotics to try and clear the infection that were taken for two weeks. So you would have taken dozens and dozens of courses? Yeah, unlimited. Often, you know, as doctors do, self-medicating and not doing, let's say, the right stuff.

12:20And it was only when I really got into the gut microbiome, about 12 years ago, that's when I stopped. But also the other reason I don't take them now when I get infections, I still get infections, is that if you look at the literature, often the difference between taking them and not taking them for something like that is about one day of symptoms. And so this is true for many, many conditions that do self-resolve. Not all, but there's many like this where it's a bit touch and go. And anyone who now values their gut microbiome more than next day of respiratory or, you know, nasal symptoms, I think needs to take note.

12:56So, and the good news is that in the last 10 years, I improved my gut health. You know, I have a really good gut score. So you're saying like, even with all of the antipose you took, when you started this journey around the microbiome, you know, like a dozen years ago, actually managed to get to this great point. Well, and I think the shift is it's hard for healthcare to move away from what they sort of accept as their standard. You know, the standard is to sort of liberally use the antibiotics and not to see this risk because the research on the gut microbiome is so new that it really hasn't gotten into the mind of the medical doctor who's conventionally treating a person who has sinusitis or whatever the issue may be.

13:37They're not really thinking about that. And I feel this happens a lot with children. I'm particularly struck also I remember I grew up in the States and my mother tells me about the amazing number of courses of antibiotics I had by the time I was like four years old. And even contrasting with my sister who was born 10 years later in the UK, like many fewer. It's 20 courses on average by the time a US kid has reached 18. 20 courses of antibiotics. On average. It's not so surprising that we see, in fact, we see basically the worst microbiome scores in the US of anywhere we've tested. Yeah, and I'm sure that is a major contributory factor, not only in that, but it's also in foods as well.

14:18And, you know, that's another source. As well as the antibody you take, it's in many meats and other products as it's used in agriculture. Interesting, too, fatten animals up. So that's why the interesting epidemiology says that taking too many antibiotics, you know, actually increases your weight. There's lots of evidence from farmers that pay lots of money to give their chickens and things antibiotics. In order to make them put on weight faster. Because you can feed them the exact same amount of feed. That's the fascinating thing about this is that you can give them the same number of calories and end up with a larger animal.

14:53And of course, at the end of the day, when you're selling that animal, it's the number of pounds, it's the weight of the meat that you actually sell it at. But, you know, there was a study done in 2014 published in the journal Nature Medicine where they put people on five days of a plant-based diet versus five days of an animal-based diet. And one of the big surprise findings is that on just five days of a completely animal-based diet, they actually saw antibiotic resistance develop in the gut. And that's not because of meat. That's because there's residues of antibiotics that are existing within the meat that was being served.

15:23And by the way, the study was done in the United States. Extraordinary.

15:29That's it for this week's recap. If you're listening to this, you're already on your way to living healthier through better nutrition. And at Zoe, we're doing everything we can to help you on your way. So we've developed Daily 30, a delicious dietary supplement to add to your meals. Because with Zoe, we ran a clinical trial testing Daily 30. The results were staggering. It's selling out in the UK and we're working hard to bring it to the US as soon as possible. Sign up to the waitlist at Zoe.com slash daily30.