I’m writing from the annual meeting of the American College of Nutrition, and I happen to be the co-Chair for this year’s meeting here in Orlando. I’m speaking on how medical providers can assess nutrient intake and cognitive function, and which nutrients improve brain performance.
The Gut/Brain Axis symposium of the meeting has captured my attention with compelling, new information. There is growing evidence that our gut bacteria (our microbiome) impact many aspects of our health, from weight control, to inflammation, to your risk for neurological diseases, like memory loss, depression, autism, and attention deficit disorder (ADD).
How can gut bacteria impact your weight? Well, antibiotics generally kill off many healthy gut bacteria and allow an overgrowth of bacteria that cause us to gain weight. Bad gut bacteria produce chemical compounds (like propionic acid) that induce cravings, hunger, and inflammation. Additionally, inflammation will decrease your calorie burn rate all day long.
This doesn’t just apply to people. This is why feedlots give animals antibiotics to fatten them up. Without any increase in food intake, feeding antibiotics increases weight gain in chickens, cows, and pigs. So don’t be surprised if you gain weight after taking an antibiotic.
As if a jump in body fat isn’t bad enough, people with bad gut bacteria are also much more likely to have neurological diseases, like memory loss, autism, depression, ADD, and Parkinson’s disease. Not only does bad gut bacteria increase brain inflammation levels, but bad bacteria release compounds that first make your gut lining leak, and can increase leaking between the brain and the blood stream.
As I am processing this microbiome information, it came to me that it is November, and we are on the verge of winter cold and flu season, and pretty soon people will start calling the office asking for antibiotic treatments for respiratory infections, and we’ll need to explain how harmful it is to use antibiotics inappropriately.
Likely the most common cause of a sudden change in gut bacteria is antibiotic therapy. Antibiotics don’t just kill bacteria causing an infection, but they also kill billions of healthy gut bacteria at the same time. I’m not suggesting that you skip treatment for a life-threatening infection like pneumonia, but the reality is that more than 90% of the time when doctors treat patients for upper respiratory infections (more than 90% are colds) they will get better whether they are treated with antibiotics or not. Give a cold 10+ days, treat your symptoms if need be, and it resolves whether you are treated with antibiotics or not. If you get sick this winter, ask your doctor if an antibiotic is absolutely necessary, or if you could safely wait and give it more time. Absolutely, don’t ask your doctor to treat you over the phone for an infection without even being seen.
What to do if you have a serious infection and you must take an antibiotic? At the clinic I founded, we offer a probiotic with Saccharomyces boulardii to help prevent bad bacteria from taking over during the week that you are taking antibiotics (S boulardii is a beneficial yeast that is not impacted by antibiotic use and will inhibit the growth of bad bacteria, such as C Difiicile. Then post antibiotic take a probiotic with at least 20 billion and up to 60 billion organisms daily for at least 8-12 weeks to help restore your gut microbiome with mixed species of Acidophilus, Bifidobacterium, and Lactobaccilus species.
What else can kill off your healthy microbiome besides antibiotics? Well, first and foremost is food. Surprisingly, consuming diet foods and diet sodas have been shown to cause weight gain over time. Why if they don’t have calories can they make you gain weight? Part of the reason is that many sweeteners kill healthy gut bacteria. So avoid artificial diet sweeteners.
Another clear cause for an overgrowth of bad gut bacteria is eating too much sugar and not eating enough fiber. Sugar and refined grain products feed bad gut bacteria. Eating more fiber from vegetables, fruits, beans, and nuts nourishes good bacteria. To maintain your microbiome, you should be eating at least 30 grams of fiber from these specific food sources every day. And this is the amount of fiber that also helps you lose weight and keep it off, decrease your blood sugar, blood pressure, cholesterol profile, and lower inflammation.
The other good news is that the healthier you eat, the less likely you’ll get sick, making it easier to stay active, productive, and feel fantastic.
I wish you the best of health!
Steven Masley, MD, FAHA, FACN, FAAFP, CNS
I’ve been on antibiotics off and on since last November, mostly on. No matter what I do, I can’t seem to lose weight. I’m taking a probiotic and a probiotic and watching my diet. This series of antibiotics will be done tomorrow. Do you think I’ll be able to shed some pounds then? I’m very frustrated with this weight gain.
Thank you.
You are correct that abnormal gut bacteria can cause weight gain, and occurs often with antibiotic use.
Sadly, prolonged antibiotic use does horrible things to your gut microbiome. Yes, there are some very serious infections that must be treated. But always ask your physician if the antibiotics are absolutely necessary, and what other options might be available.
During or immediately after a course of antibiotics I suggest a 30 day course of a probiotic that helps prevent serious bad bacterial overgrowth and medical emergencies (such a C dificil colitis) using saccharomyces boulardii, at least 5-10 billion daily for at least 30 days. In addition, I recommend a general probiotic with multiple strains to help rebuild your gut microbiome with at least 25 to 50 billion daily for 2-3 months.
I hope this helps.
Steven Masley, MD
I take 500mg of amoxicillin daily, and will likely do so for the rest of my life. I take an over-the-counter probiotic daily also. Are there better probiotics I should consider? I am SO frustrated at my inability to lose weight and specifically, my belly fat. Thank you.
I can’t think of a good reason to take amoxicillin every day. Please clarify, why are you doing this?
Steven Masley, MD
I took a seven day course of antibiotics for a skin infection. I already have a sensitive stomach and the medication made me feel very ill. Nausea, stomach cramps, irritated bowel, to name but a few. Now finished the course, I am left with a bloated stomach and feel I have put on weight. All in all, antibiotics really are difficult to put up with and in future I will be averse to taking any more.
There is no doubt the healthy bacteria in gut is eliminated while on antibiotics and very difficult to regain afterwards.
Taking 10 day course of antibiotics for a chest infection. First time ever taking antibiotics but after reading this I am concerned. I am a professional ballet dancer so can’t put on any weight. Is there a possibility that this small cause can cause a noticeable weight gain??
Emily,
If you are forced to take an antibiotic for a serious infection, be sure to take a probiotic for 2-3 months to help rebuild your gut microbiome diversity. Eating lots of prebiotic fiber from vegetables, fruits, beans, and nuts also helps to maintain a healthy microbiome.
I take azithromycin 3 times a week and have done for 5 years now and no sign of coming off due to my server asthma and prawn to chest infection are they part of my weight gain and if I stop them could it help e loose weight.
Joyce, You should only take medical advice from a medical provider who knows you well, not something I can provide via e-mail. At the very least, I would suggest that you seek a second opinion regarding your health care options. Taking antibiotics long term has a variety of side effects, including weight gain, and often promotes drug resistant bacteria as well.Steven Masley, MD
Hello Dr Marley.I have been on and off antibiotics for a year due to a serious fall and chronic cellulitis.I simply cannot shed the 3/4 kg and my stomach is so swollen it sometimes looks like I’m pregnant.I had no option but to take them because my leg was so infected it was very serious.But after all those antibiotics Manuka honey is what has treated it the best anyway!
I would suggest a second opinion as to why the infection keeps recurring. I would also recommend that you explore taking prebiotics daily, as well as diverse probiotic supplements to help boost your intestinal diversity. Honey is the only sweetener that provides some probiotic support, but by itself it typically isn’t adequate.
Steven Masley, MD
I have been on minocycline for years and have noticed an increase in my weight over the last couple of years and have always blamed it on my birth control. I am taking minocycline for my breakouts but try to only take it every other day. I still get pretty bad acne, I am seriously debating coming off of minocycline since it is not completely clearing up my face and just seeing if diet changes will help cure my break outs. What is your opinion?
Ashley, You are making a good point.
Talk to your physician about a topical antibiotic for acne. Topical erythroymcin is commonly used and effective with benzyl peroxide. When minocycline or doxycycline is the only drug that controls acne, topical doxycycline through a compounding pharmacy is also an option.
I have been diagnosed with cold and high temperature
While treatment my doctor injected me with antibiotics several times and also suggested me to take antibiotics course
But after 10 days of treatment m experiencing extreme weight gain
I have put on 5kg and experiencing hunger too
Do you have any solution for this??
If you have a life threatening infection, I don’t recommend avoiding antibiotics. But I would nearly always skip taking antibiotics for a cold. Once you have been treated, taking a probiotic supplement will help. Typically I like a combo approach. While on antibiotics, take sacchromyces boulardii (a yeast that protects you from bad bacterial overgrowth), I recommend 200 mg or 5-10 billion microbes daily for 30 days, and after the antibiotic course, a regimen of diverse probiotic bacteria, such as therbiotic (https://klaire.com/v775-06-therbiotic-complete) and take one capsule daily for 2 months. During this time, you want to eat lots of fiber to feed your healthy bacteria, plus you’ll want to eat 2-3 forms of probiotic food daily, such as sauerkraut, yogurt, kefir, miso, etc.
Good luck, Steven Masley, MD
My spleen was removed following a trauma last year. Due to this, I need to take antibiotics whenever I spike a high enough fever to prevent a serious infection. I had 4 fevers in 4 months, and had to take a 5 days course each time (so 20 days of antibiotics in all).
I am now experiencing a bloated stomach and weight gain. My family has told me I look bloated, and it doesn’t seem normal. One person said it didn’t look as if I was just getting fat, but rather that something else is going on.
What is your advice for my case?
Thank you!
Consider a second opinion with a physician you trust regarding having to take antibiotics 4 times per year. Yes you should be cautious, but you should not need to treat viral infections with antibiotics. You would to take a probiotic and prebiotics for months to recover from a single course of antibiotics. Bloating and weight gain are common with recurrent antibiotic use. Steven Masley, MD
My doctor gives me Minocycline for my acne (50mg pills twice per day) and I’ve been consistently taking it for almost a year now. I stopped taking it during the summer that resulted in a return of severe acne. I always have to frequent to the bathroom due to the medication. My doctor hasn’t given me a limit on the amount of time I’ll be on the medication so I assume that it will be forever since he says “it’s inexpensive and I respond beautifully to it.” Should I be considering other options? The last time I asked for other options he just gave me other antibiotics and variants of Minocycline. I’m only 17.
Abel,
At the least ask for a trial using a similar topical antibiotic. If it works it would be much, much easier on your GI system and your gut microbiome.
Steven Masley, MD
Hi i’ve been on minocycline 50mg tablets once daily for about 4 months now and have quickly gained 13kgs. I have booked an appointment with my docotor to talk about how to go about the weight gain. Does your body loose the weight naturally ? Or is it just some sort of retention because of the antibiotics
Angie,
You have to restore balance to your gut microbiome to bring your weight back to normal. You can take a probiotic supplement, and eat foods rich in natural probiotics. It takes several months to bring your system back into balance by doing this. The antibiotics don’t cause direct weight gain. They cause indirect weight gain by killing the healthy microbes in your gut that keep you healthy and slim. Steven Masley, MD
hey hi i took help me to azithromycin 3 times a week for almost 12 weeks for a skin treatment last year after this i have noticed quite a little change in my weight but with this i feel very fluffy .I tried working out but that doesnt help me loose my fluffiness . can you please help me????
Naveta,
I always prefer that you try a topical antibiotic for skin issues, prior to taking an oral antibiotic long term. Ask your doctor about your options, and be sure to take a good probiotic supplement and eat probiotic rich foods daily.
Steven Masley, MD
Patricia I have been on the antibiotic dicloxacillin since last August. I take 1000 mg a day. I have gain over twenty pounds since then. I am unable to lose weight. Is this due to the antibiotic?
Patricia,
In your case, there may be other causes for weight gain as well, but taking an antibiotic daily will disrupt your normal gut microbiome and make it more likely for you to gain weight. I’d double check with your physician if this is really needed long term. You might even consider a second opinion. I’d also start supplementing with a good probiotic and eating probiotic rich foods daily.
Steven Masley, MD, FAHA, FACN, FAAFP, CNS
I was on 5 or 6 different antibiotics for a sinus infection/mold overgrowth in my sinuses for 5 months. I have gained almost 10 lbs in that amount of time. I havent really changed my eating habits. I have been off all antibiotics for about 1 week and have not been able to kick the extra weight. How hard is it really going to be to drop the 10 lbs? I’m getting married in October. My dress needs to fit! Yes, i already take a daily probiotic and have for years due to reoccuring yeast infections.
Krista,
I hear your frustration. It will likely take you several months of taking a probiotic supplement with 30-50 billion microbes daily, eating 30 grams of fiber per day (10 servings of fiber daily), plus eating probiotic rich foods daily to bring your gut microbiome back to normal. This isn’t a quick fix.
Obviously other things you can do as well for better weight control are to: (1) Ensure you have regular exercise, both something aerobic 4-5 days and some strength training 2-3 days per week; (2)Eating at least 30 grams of fiber daily from vegetables fruits, beans, and nuts has been shown to decrease weight. (3) You can also add partial intermittent fasting and skip eating from 9 pm to noon 3-4 days per week. (4) Avoid all refined carbs sources (any foods with a high glycemic load) and sugar. (5) Avoid sweeteners, as surprisingly they can also cause weight gain. (6) Consider testing to see if you have any food allergies, such as gluten or dairy–an elimination diet can be very helpful to jump start a weight loss program.
Steven Masley, MD
I am on long term antibiotic suppression treatment of MSSA (staph aureus) of an infected hip implant. Surgery and 6 wks of IV Abx did not resolve the joint/ biofilm infection nor has nearly 2 yrs of oral: Cefdinir bid and Septra bid. The fear of sepsis and osteomyelitis keeps me from a trial of lowering or discontinuing these meds. I take high doses of probiotics a few hours before antibiotics twice daily. I have difficulty controlling my appetite and am gradually gaining weight. My docs have no guidance for me. I eat a mostly Whole Foods, plant based diet, exercise daily and previously was able to manage my intake, appetite and weight with little difficulty. Any suggestions would be most appreciated! Thank you.
That is a very challenging situation. Be sure that you are working with a skilled nutritionist to guide you as often most doctors won’t even address your concerns. I would look for either a CNS (certified nutrition specialist with the American College of Nutrition, or a nutritionist trained in functional medicine).
Steven Masley, MD
I have been prescribed Oracea for treatment of perioral dermatitis and I have already gained 10 lbs after only 2 weeks of taking the antibiotic on an empty stomach in the morning. I also take 3 mixed probiotic pills daily around 5 hrs after I take the Oracea but my stomach is still incredibly bloated and I have increased acid and flatulence. I also take 2 tbs of psyllium husk 2 hours after taking the Oracea. I am supposed to take it for at least 2 months – do you know if my weight will slowly get back to normal after I finish treatment?
Thank you so much Dr Masley.
It may take several months to bring balance back to your gut with probiotics, a mixture being a good idea, so yes with time you should be ok. You also need to eat lots of fiber, at least 30-40 grams daily. I would always recommend an elimination diet, and if needed topical antibiotics for acne first, but sometimes they don’t work, and you are stuck between a rock and a hard place.
Steven Masley, MD