 Welcome to the Dr. Gundry podcast. You know, they can live in vents on the bottom of the ocean, in caves deep below the Earth's surface, and even inside you and me. I am talking, of course, about bacteria, and they paradoxically are some of the most beneficial and harmful living organisms on the planet, responsible both for keeping you healthy and happy and for leading to dangerous illnesses like pneumonia, for example. Now in recent years, scientists have sounded the alarm about antibiotic-resistant bacteria. In fact, just last year, the World Health Organization said that antibiotic-resistant diseases could kill up to, get this, 10 million people every year by 2050. To help us make sense of how antibiotic-resistant works, I'm joined today by Dr. Mohamed Zaman. Dr. Zaman is a professor of biomedical engineering at Boston University and is an expert on cell biology. He's also the author of a brand-new book called The Biography of Resistance, The Epic Battle Between People and Pathogens. Boy, what a timely subject that is. On today's episode, Dr. Zaman and I will discuss the bacterial secret hiding in the guts of a long-lost tribe, the connection between the food we eat and antibiotic resistance bacteria, and whether you should worry about antibiotic resistance. Dr. Zaman, it's a pleasure to have you on the podcast. Thank you so much, Dr. Grandry. So let's start with this fascinating story that you tell in the book about antibiotic resistance deep in a cave in New Mexico. Wait a minute, deep in a cave, tell us about that. Yeah, so you know, this was a shocker for me as well. So two scientists, Dr. Wright from Canada and Dr. Hazel Barton from University of Acorn, and they teamed up together. And Dr. Barton is sort of an expert in bacteria living in sort of deep caves. And because bacteria, remember, Dr. Grandry, have been there from the beginning of time, billions of years old. And so they teamed up. And the idea was actually a very simple one, to go deep in the caves that have never been touched by any human activity, caves that have been there for millions of years, and see if the bacteria there that are not at all affected by human activity, by the use or abuse of drugs or bacterial products in the farms, and see whether they are resistant to any of the modern antibiotics. And what they found was just absolutely stunning. Deep in these caves, this is one of the largest cave system in the world. It's, I think, among the top five largest cave systems. It goes for miles and miles, really deep. And what they found was that the bacteria there on the surfaces were not just resistant to first and second line antibiotics, but some of the even most advanced antibiotics that we have developed. And that was surprising, right? So Jerry Wright and Dr. Barton together start to piece the puzzle. And it turns out that bacteria have been developing these mechanisms of coming up in new antibiotics and resistance mechanisms from the very beginning. Otherwise, there would have been only one kind of bacteria out there that would have been able to kill everybody else, right? That's not the case. The fact that there is such a diversity in the bacterial population tells you that this arms race is constantly going on. Somebody gets an edge a little bit here. Somebody loses the battle a little bit over there. But what is the problem here is that human activity has started to disrupt this equilibrium that has been going on for millions and millions of years. That equilibrium between producing new antibiotics and responding to those antibiotics that has been going on in soil and nature for a long time has been disrupted because of excessive use of antibiotics, because of antibiotics used in agriculture being used in situations and we don't need them. And that has what sort of tipped the balance. So we put the thumb on the scales a little bit in the favor of antibiotic resistant bacteria and hence the problem that we are seeing in hospitals and in patients all over the world. So let me back up for just a second. Most people understand the term antibiotic, I think, but the original antibiotics were derived from molds and funguses, yes? That's right. That's right. And this was literally a battle between bacteria and molds and fungi for space, for power. That's right. Absolutely. Absolutely. You know, one of the most potent sources of antibiotics has been, of course, bacteria. They are the original producers. They are these efficient machines and the best possible industry out there to produce antibiotics. Now, we figured it out that looking around what are some of the places where you'll find all kinds of bacteria. The most potent and the most sort of, I think, inexhaustible resource was your soil, all the way from your backyard to deep jungles of Indonesia and the Latin American countries and sort of all over the world, two mold found in bread and on cantaloupe. So as we sort of dug deeper and learned about bacteria and how they produced, we were able to sort of harness that capacity and produce new and new antibiotics. So and even to this date, sir, one of the most potent sources remains natural products to discover new antibiotics as well as natural environment, right? So if you want to look in our natural environment and the book goes in detail in several of these discoveries that come from soil that come from sort of a rotten cantaloupe that comes from sort of pristine environments or sort of soil samples in Borneo. So for the longest time, we have been able to mine these places for new discoveries. And I think scientists, myself included, believe that nature still has a lot of treasures to offer in terms of modern medicine and we continue to sort of learn and adapt and discover new things. So I'm on that front. I certainly am an optimist. I'm certainly an optimist. On other fronts, human behavior or less so. So you before I so rudely interrupted you, you were talking about how antibiotic resistance now just seems out of control because of the antibiotics we use in raising animals for slaughter and of course the willy-nilly that we give antibiotics for things that aren't bacterial infections. Can you elaborate on that? I think you certainly go into this in the book. Sure. So there are several dimensions of this. One dimension that you as a clinician are all too familiar with is the use and perhaps excessive use in hospitals and clinical settings. Some of it is being out of abundance of caution in hospital settings. Some of it is patient pressure on primary care physicians who want to get an antibiotic no matter what and the primary care doctors under tremendous pressure from parents and of children or patients themselves to get an antibiotic even though they may not need one. That's one aspect of it. The second aspect of it is consumers who would stop taking them after two days because they have started to feel better. The fever has gone whereas you would need it for five or seven days. That's the other aspect of the problem. And the reason both of these are important is if so for your listeners and for your audience, it's important to recognize that antibiotics taken for a short period of time would kill some bacteria, not all, and you start to feel better but the bacteria that were the most stubborn have survived and they will proliferate and they will grow and next time you get sick, the same antibiotic may take a lot longer to cure you or may not cure you at all because the ones that were the hardest to kill the first time are now the ones that are in majority. That's why it's important to finish the course. At the same time, when you take antibiotics for something that you don't need antibiotics for, for example, seasonal flu or common cold, what you end up doing is you don't do anything to the virus. What you end up doing is you start giving ammunition to the bacteria who are not causing the illness and are sort of just, again, some of the bacteria are going to die, the stubborn ones are going to survive and going to come back with the pensions. And not only that, you're also risking your neighbors and your family and others because you are helping create these bacteria that are resistant. So next time you are infecting them or infecting your neighborhood, well, they are the ones who are going to suffer. So there's a communal element here. So those are two aspects of it. There are other aspects which are under appreciated and important to recognize. The fact that there is an excess of antibiotics in the food production sector continues to be a problem because we have used and continue to use antibiotics in farm animals and as growth promoters, then there's absolutely no need. I am not somebody who says that if an animal is sick, you shouldn't give an antibiotic. I think that would be unethical. If there is an infection, you should give one. But if you're using it for fattening up your chicken or giving it as part of the feed in your cattle farm, then that's a problem. And that's something that they're not the right use for. And I think US, China, India, Brazil are often guilty of that because of having very, very large farms and poor regulations. So that's another dimension. On top of this, there are two other things that I talk about in the book, which are important. One of them is the fact that in many parts of the world, the quality of antibiotics is not what it ought to be. So you can be a good patient and take your course for all five or seven days. But if the drug was only 30% pure, then you're taking antibiotics for 30% of the time. So even though and that's an ethical issue because it's not the fault of the patient, but the system has failed you there. And I think that's important to recognize. Okay, so that's one other element. And the last and the final one, I think is global conflict makes people who are very vulnerable who are on the crosshairs of conflict get in situations where the hospitals are destroyed, health workers are not there, environment is contaminated and infection spreads very rapidly. And in these field hospitals, doctors don't have the capacity, ability or the resources to test each individual person to know what is the right antibiotic antibiotic you get is the antibiotic they have, not the one that you need. So increasing conflict, whether it is in the Middle East or in Crimea or elsewhere, makes people vulnerable to these things. All of us, Dr. Gandhi are really troubled by the sort of racial injustice in this country and all over the world. This is an issue that has gone on for way too long and is one that is so deeply troubling and depressing. One of the things we have to realize is any time these kind of injustices happen, any bit in the world, people who are on the losing end are also the ones who do not have access to good health care. So the problem of COVID or the problem antibiotic resistance is going to affect people who are socioeconomically disadvantaged. So there is every reason from the clinical or research side to address this issue, but there's also reason from social justice side, because the ones who are going to be most affected are the ones who have underlying conditions, who do not have access to good health care, who do not have access to good information. And all of these things I think are central as you want to build a better society that is fair and more just. And I think access to good health care, regardless of your color of your skin or socioeconomic status should be a fundamental pillar in all of our dealings. Couldn't have said it better. Let me let me ask you I'm I'm old enough to remember when the first broad spectrum antibiotics were available. And I was actually in medical school at the time. And we just thought it was the most wonderful thing that could possibly happen to us as clinicians because actually, I'll tell you a wonderful story from medical school. We got to rotate through private practice physicians offices and I had part of my pediatric rotation was in a pediatrician's office and he would take a swab for strep throat. And he would then have his nurse give the mother a prescription for penicillin or ampicillin before the culture even came back. And I said, Well, wait a minute, you took a culture, aren't you going to see if this is actually, you know, strep? And I said, Why'd you give him the antibiotics? He said, Because if I don't give mom the antibiotic, she will go next door down the street to my competitor, who will give her those antibiotics. And the mom's looking for something to do. And that's what I'm going to do. And it was just this blew my mind, you know, as a, you know, well meaning medical student going, Well, that's not what you're supposed to do. But speaking as a medical student when broad spectrum antibiotics came out. Now, you know, we didn't have to go. Oh, we got to wait for the cultures. We got it. We got to figure out what this bug is. Let's just shotgun everything. And we actually saw for the first time in the 70s, C difficile, we didn't even know what that was back then. We called it pseudo membranous center colitis. And I've written in my books, we actually gave patients fecal enemas from medical students, and to cure C diff back in the 1970s. So what, what has broad spectrum antibiotics done to us? I'm a sort of a strong believer in research. And I think the broad spectrum antibiotics offer the ability to treat both gram positive and gram negative infections. And I think there's, there's a value and a place for them. But I think they also offer to a certain extent, this false sense of confidence and false sense of comfort that has been abused, right? So they offered us sort of a sense of invincibility, saying that maybe the will always be ahead of the bacterial evolution. And I think that hubris, which I hope is now addressed, has not served as well. The hubris never serves you well anytime, any point in life. And that certainly whether it comes from the doctors or the patients, whether it comes from the public health profession of the politicians, is never a good idea. But what ended up happening was that there was this sense that, well, we will always have these antibiotics. And no matter what the infection is, we will always be able to address that. But we know now, and even at that time early on, we were able to see if he had paid attention, that resistance emerged almost immediately as using antibiotics. I'll give an example, very specific example here. And I talk about that in the book as well. So Cipro is something that many of your listeners and many of your colleagues are familiar with. We take it in the upset stomach. If you travel abroad, travelers diarrhea, Cipro is well known. Now Cipro is this sort of big hot commodity in mid and late 80s. As soon as it was rolled out, within a year or two, there were reports of resistance to Ciprofloxacin, which tells you that one, the resistance aspect can be pretty fast and dynamic. And two, that there is no really, I would say protection from resistance. And now we know that resistance is also natural. It's not surprising to expect resistance happening. And it has happened from the from the beginning of time. What can help us is to constantly extend that runway throughout behavior, and better practices so that we are ahead of the bacterial resistance process, they will always be resistance. But for it to happen almost immediately and happen in sort of that widespread sense is what makes people very vulnerable, who may already have higher risks. Yeah, the head of our department of urology has told me that only about 50% of people with urinary tract infections now respond to Cipro that it's absolutely. It's so so UTIs are sort of I would think are among the most commonly seen challenges in hospitals and places where you work and in Boston and elsewhere, which is sort of a real challenge, because the fact that on one end, you don't have new antibiotics coming to the market. On another end, you have more and more people who are not responding to therapies that only 10 years ago, were a lot more potent, should give us very, very serious cause for concern. And this is for people who are in the hospital, for people who are not coming to hospital and may develop infections at various levels is I think we don't even know how to count those numbers. So there, you know, when you go on the internet, they say, don't drink your municipal water because it's got antibiotics in it. What's what say you? Well, so I think I am not a fan of sort of people's claims without really backed up data. I think if there is reason that there are antibiotics either in full form or in residuals that I think that needs to be really taken care of. But I think there is a lot of danger out there in also creating this sort of a sense of unnecessary fear without backed up scientific data. And that's where I would draw the line. I think we know from from data all over the world that there are antibiotics in water in sewage systems, because most of the antibiotics that we would take part of it would be absorbed. The other part would be sort of excreted out of the system. So that is that itself is not scientifically disputed. But the fact is that somehow thinking that somebody is adding antibiotics to the system is I think a claim that seems bold, both bold and audacious and one that marriage scientific scrutiny. It's not to say that there aren't an antibiotics in our system. Of course, if you live any there downstream of a poultry or cattle farm, the amount of antibiotics in that environment are going to be high, largely because of poor regulatory infrastructure. But does that mean that your water is not safe to drink? I think that has to be done on a case by case basis, as opposed to one size fits all that creates the sense of conspiracy theory, which is very dangerous. And we're seeing some of those conspiracy theories play out also in COVID, which just sort of takes away from good public health practices, which are scientifically sound and are in public interest. So you brought up, you know, chicken and cattle farms. We're sometimes assured that no, no, no, it's illegal to use antibiotics and chickens anymore, or no, no, no, it's illegal to use these. And yet, correct me if I'm wrong, many of these products that claim to have no antibiotics when they're tested, have in fact antibiotics in them. What's with that? This is a great question. And unfortunately, the devil here is in the details. So the laws, the way they're written, they leave a lot of loopholes. So they would say they wouldn't give antibiotics for prophylaxis or growth control. But then they're lost saying, which are very weakly written about using antibiotics prophylactically to control infection ahead of time, which makes it gives some of our colleagues in the farming community an opportunity to use them, sort of not illegally, but in ways that are, I would say, not entirely consistent with what we ought to do. So I think there are regulations in places, Scandinavian is an example, Netherlands is an example, where there are stricter laws on when you can and cannot use antibiotics. So that's argument one. The second argument is, they would say we don't use antibiotics, and they would say, and that claim may also be true in some cases. And they would say we don't use antibiotics that have been sort of used or classified for exclusive human use. But they would use other antibiotics that may not be for human use, and maybe used only in sort of farms and animals. That doesn't mean that that takes away the problem. Because if you look at the mechanism, they may sort of lead to resistance anyway, even if they are not sort of approved for human use. So there, I think there's a slightly misleading approach, saying that we don't use any antibiotics, what they may mean is we don't use any antibiotics that are for human use, but maybe you may use for other animal use. And they may lead to resistance. And one of the things that we talk about in the book, which is important, and which is a big discovery in the 1950s, is how resistance can jump from one bacterial species to another, something that is called horizontal gene transfer. So up until 1950s, Dr. Country, the understanding was that it was only vertical, in other words, mutations from one generation of bacteria to the other. But we know from the late 40s into into 50s, that there was discoveries demonstrating that there's something that can jump from one species, for example, E. coli to Salmonella. And sort of in a form of you can imagine it's sort of kind of a bacterial mating, or sort of these little packets of DNA that can jump from one bacterial species to another, making it possible that you may be treating E. coli, but the resistance may be developing Salmonella. And that sort of really changed the field. And I think that is where we have to be concerned. Every now and then your listeners, your colleagues would hear the word plasmid, and saying that there are plasmids, plasmids are just a packet or a cassette of DNA that is basically mobile. These are mobile genetic elements that can go from one to the other, making it very difficult. So I grew up in Pakistan, and then the sudden part of the country, I grew up in the northern part, but in the southern part of the country, there's a typhoid outbreak, which is resistant to all drugs except two anymore, right? So every single drug doesn't work. Only two of them work. One of them is carbapenems that can only be given in the hospital. And the other one is isithromycin. And that emergence of this extensively drug resistant typhoid was because of these plasmids. I like the way you clarified that because I think what's amazing is that you're right, bacteria, for lack of a better word, can mate and transfer, you know, a resistance to an antibiotic that they may have the other bacteria has never seen it. But now that bacteria has has gotten that information. Absolutely. Absolutely. And that's why increased caution is important, along with better sanitation and hygiene. But assuming that I was only treating E. coli, and I'm not sure why Salmonella has it, would make an assumption that is just not accurate, because there is mating infusion of bacteria and transfer of genetic material from one to the other. Yeah. And we find that in the micro human microbiome research. That's this goes on constantly. There is constant talk between bacteria, constant exchange of genetic information. And it's actually, yeah, you know, like you say, who who would have imagined that this could happen? Absolutely. Absolutely. All right, I want to ask you about the Yanomani. Tell me about this tribe in the Amazon jungle in their microbes. What why why would you be interested in a tribe in the Amazon? So, you know, this was one of those serendipitous moments in science. There are tribes in Amazon that are uncontacted and have been there for thousands, perhaps tens of thousands of years. The Yanomami, one part of Yanomami is one of them. In sort of the first decade of 2000s, during the routine surveillance operation, the Venezuelan army spotted a group of people that they hadn't seen before. Now the international agreed upon ethics is that any time you see a group, it means that somebody else can also see that group. And if somebody else can see that group means that they do not have the same sort of immunization as you and I might, which means that if you and I might be carrying a disease that they're not protected against measles, for example, they may be wiped out in a matter of a few days. So care has to be taken to make sure that you are protecting them. You certainly want to leave them undisturbed. But the fact is that you have seen them means that other people can also see them and you have an ethical responsibility as humans to protect the people who are vulnerable. And that goes for everybody. Alright, so this is what happens. And so the Venezuelan Tropical Research Institute. And so ethically, they were I mean, their location is kept secret only a few people know. But a couple of researchers who were looking at antibiotics, decide, well, maybe this is an interesting question to understand, what is their microbiome? What exactly they have not certainly come in contact with modern hospitals, their diet is different, their lifestyle is different, their community structure is different. So what they did was before they gave them immunizations against sort of the routine, highly contagious diseases, they collected sort of the dead cells on the skin, and the the fecal samples, right? So both of these are non invasive, and were collected. And so then we have now tools to analyze what kind of cells are there, what's in there in these samples. And lo and behold, again, just like that sort of story in New New Mexico, sort of cave system, here again, you see that these skin cells and fecal samples have bacteria that are resistant to second third and even fourth generation products. Now that is just completely bizarre, right? So how could these group of people be resistant? And well, their microbiome may have bacteria. So so one of the things that I make this mistake often. And I want to tell you listeners is, people don't become resistant, it's the bacteria that are resistant, right? So we have to keep that in mind, there is no resistant individual here to antibiotic, it's the bacteria that's resistant, and we carry that bacteria or it may sort of cause an infection. Okay, so the Yanomamis are excluded from sort of the development of Brazil and Venezuela, they are a vulnerable group, they are certainly not coming in contact. So what's going on there, right? So this is just sort of completely bizarre and goes back against the notion that it's the human activity that is driving that. Well, it turns out that they're and we don't know all the answers. And this is one of the other things that I tell my colleagues and my students, certainly, that science is a process, it's a process of learning about ourselves. And what we want to be confident in is in the methods, the results can change and they continue to change and we learn, as long as we are certain and happy and rigorous in our methodology, that's the most important thing. The results, I mean, not too long ago, people believe that the Earth was the center of the universe. It wasn't very long ago and but but how you move forward anyway. So my point is that, so there are several reasons. One is it is possible that in the diet, as I mentioned earlier, and in the environment are bacteria that are producing antibiotics and also are developing resistance. One, two, we don't fully understand the microbiome and what may be happening there is something else. Or three, and these are these are concerning things, but then they're also positive and I think slightly encouraging aspects where there are antibiotics out there that we haven't really discovered yet. And they may be similar to ones we have made in the lab, but nature may already have made them hundreds of thousands or perhaps million of years ago. And of course, then you have to think about something that you mentioned earlier. The waterways maybe also have some contamination. So so as you look at sort of because while we may have not have come in contact with them, they certainly are coming in contact with the environment and the water. But the fact that they are resistant tells you something much deeper that there's a lot we don't know. And I think at some point we have to throw up our hands and say, well, there's a lot I don't know, and I need to understand and I need to think about that. There are things here that are concerning and the thing is here that are very positive and exciting. So actually at the start, we talked a bit about the soil and how the soil has changed. And the soil has its own microbiome. And so where when we've changed our soil, I've railed against this, you've spoken against this in the book. What does soil have to do with all of this? So so there are endless stories about both just absolutely fascinating stories about what soil has and how soil plays a role. Our environment is Dr. Gundry is who we are. And we have a tremendous sort of relationship with this environment, our microbiome and the soil plays a central role. Early on, scientists figured out that soil, both from our own backyards and our national parks and our sort of environment, as well as soil from far off lands, sometimes near even sort of these thick jungles or right around the graveyards has these bacteria that really are remarkable in producing unusual molecules. And I think as we change our environment, we are also changing our microbiome in tremendous ways. And as I said earlier, I think there's a lot that we don't know. And I think there is a lot we ought to learn. And they may be sort of hidden treasures that the earth has. About 10 years ago, there was sort of a discovery of new antibiotics again from soil samples. And I think as our methods become more and more sophisticated, we learn more about our environment and hopefully more about our ability to benefit from that environment in a much more, I would say, holistic manner. Okay, so we've touched on this, but everybody knows the word super bugs. And what are super bugs? Are the fears overblown? Is there anything we can stop these super bugs or we're just going to wait and they're going to take over us? So I think the fear is real. So again, it's one of those terms that is hard to define technically. And and and as scientists, you want to clearly define, but when something becomes a popular part of the common vocabulary, it changes its meanings, right? So super bugs are defined differently by different people. Broadly speaking, what it means is that there are bugs that we cannot fully fight with existing arsenal. We may have a diminishing number of antibiotics that might work. And they are super because they don't respond to one or two or perhaps three of our drugs. And we have to use really sophisticated drugs, but terrible, terrible side effects really get a hold of them. The fear is real country. I think even with the most conservative estimates, most conservative ones, the number of people dying because of antimicrobial resistance in this country every year is about 33,000. And the reason I say it's most conservative one is because there are a whole bunch of debts associated with sepsis, which is which is a big, big cause of debt that are not associated with antimicrobial resistance because they're comorbidities and other factors that are there, right? So so we don't count them as such. Certainly MRSA, another sort of infection that people like you see in hospitals all the time is a factor. And the reason I would be concerned about superbugs is because the curve is increasing, more and more people getting affected, more and more people not responding to your antibiotics and more and more hospitals having to recognize that this is a concern changing your hospital practice. Imagine a scenario where routine surgeries, even elective surgeries are becoming harder. People are having to deal with antimicrobial resistance, hospitals having to send people home soon because they're worried that if you stayed a little longer, you develop an infection that would be harder. People having to return to hospitals because the infection is so stubborn that it just doesn't go away with the first course of that antibiotic. So I think we have to think about how it really starts to impact the baby, seek health care. And as I mentioned earlier, people who are already suffering because of systemic issues, people who have multiple jobs, people who are underinsured or uninsured, people who are struggling financially, for them these kinds of challenges can be a knockout blow as we look at that issue. So I think that fear is real and one that is increasing. The other thing I want to say, and I think if one thing COVID should have told us, is that we are all in this together. You and me on different coasts of this country, me and my family on the other side of the planet. And antimicrobial resistance is no different in that regard. The book starts with the story of a woman who sort of slips and sort of has hip injury in another country and ends up dying in Nevada. And none of the 24 antibiotics approved by the CDC work. Right. So I think we have to recognize that this is not an abstract concept. It's an issue that is very real and certainly one that is in our own neighborhoods. But then I also want to sort of, I don't want to be sort of the only sort of bitter or bad news. There is. So the reason I wrote this as a biography is just as we have caused this problem through our action or inaction, therein lies the opportunity also by our behavior change, by better understanding and a very by not just better science, which is important, but also better policies by sort of having the sense of where the problem comes from so that our solutions can also respond and reflect on that. Good point. Now, you mentioned COVID, which is a virus. And to this day, I am impressed. So many people do not know the difference between a virus and a bacteria. And but I want you to tell me about viruses that attack bacteria, phages. You know, absolutely. This is this is another one of those sort of interesting dimensions people. So you're actually right. Many of my sort of friends wouldn't know the difference between a virus and a bacteria. And that's fine. I don't know a lot of things that either we all learn and it's good to learn. The tiniest of bacteria is way bigger than the biggest of viruses. The viruses. So we know that viruses need a living object to survive and thrive. That could be a blood cell. That could be a cell or an environment in your and my lung. I hope it is not the case. But that will also be bacteria. So the viruses can live in bacteria. So about 100 years ago, scientists realize that, well, some viruses can live inside bacteria and then basically hijack the bacterial machinery and kill it. And these are called bacteria phages. Now, that's really interesting because does that mean that can we use bacteria viruses to or program viruses or use viruses to target bacteria that are so stubborn that our drugs cannot work on them? The answer is yes. And it's a qualified yes. This therapy, Dr. Gunry is older than antibiotics. Back in the day, about 110 years ago or 105 years ago, this became the block busted. To the point that Pulitzer prize winning book, Aerosmith focused on bacteria phages. So for your listeners who have a taste for both history and literature, if they look at the book again, which is brilliant, they'll find sort of the story of this brilliant scientist and his therapy to save the world. And the book is called Aerosmith. And that's by Sinclair. Now, they became the hot commodity and they sort of faded because it was hard to really produce them for a number of different bacteria. Their potency was good, but not great. antibiotics came and they became cheaper. They were easily you could produce them in mass numbers. Also, again, in all of our lives, we cannot separate science from politics. Bacteria phages became the drug of the communist block, right? So the big Institute was in Georgia. Joseph Stalin was a patron of that Institute had a lot to do with that and that sort of that politics became part of the conversation as well, and sort of rejecting everything that was coming from the former Soviet Union. In 1980s, as the understanding of antibiotics and their limited potency became an issue, people started sort of to go back to the bacteria phages. And by early 2000s, people start saying, Well, they may be something out there for them. And I think now there is increasing awareness that there is a potential. However, I say that with a sense of caution that that potential comes from the fact of recognition that one, there's a lot we don't understand. For example, we do not have the same number of robust and rigorous clinical trials to demonstrate their efficacy. So there's some promising evidence, but not as much as you would like. So that's the first thing. The second thing is the fact that viruses being living organisms, we need to understand how they would change once they are in the bacteria inside the human body and what we would call sort of immune pathogen response, how our immune system react to this. And those questions are important as well. And finally, I think the reality is that for any drug to really reach the marketing stage and commercialization, you have to see what is the appetite of FDA? What is the appetite of the existing legal framework in licensing and all of that? And I think that also is in its infancy. It's getting there, but it's not quite there. So I would say promise yes, but with a caution that there's a lot we don't know. I think, correct me if I'm wrong, I think Eli Lilly, one of the big pharmaceuticals started as a bacteriophage company. Yeah, so there are some and I think they are increasing clinical trials. The companies are looking at that. Even when I spoke for the book US Navy was interested in looking at this, especially for its officers in the tropics who were increasingly concerned about various kinds of and a microbial resistant organisms. So I think there's, as I said, promise there's certainly a lot of discussion in the microbiology research community to understand what's going on. But as I said, I think it doesn't have the same broad sort of applicability right now as antibiotics do. And we also know that not all bacteria, I mean bacteria are not all the same. Even with antibiotics, you have a whole diversity on the mechanism of action. And I think the same would have to be thought through when it comes to pages that some diseases will be more suited to respond to it than others. Now, also in the news, there's word that pharmaceutical companies really aren't interested in developing antibiotics. What's with that? I mean, come on, there's got to be big money in this. Well, so that's the common assumption, Dr. Gundry. Unfortunately, let's do it. Well, okay, so let's do a thought experiment. You are you're a clinician. Imagine that you are a head of a publicly traded pharmaceutical company. And you have two options. You can invest in antibiotics that people would take for five, seven, 10 days, or you can invest in a drug for hypertension or cancer that people would take for a very long period of time. The numbers are not the same. That's the first thing, right? The second thing is let's say you are super successful and come up for an antibiotic against a stubborn gram negative infection that people have been struggling for decades. You market it and the government says, Dr. Gundry, great job. We're very proud of you, but we don't want you to market it to the public because we want to hold it for the worst case scenario. Right? So so because if everybody uses it, well, you develop resistance. We don't want that. That is like the biggest moot killer possible for any investor that you spend hundreds of millions, perhaps billions of dollars and you can market it. I mean, what do you mean? And here I'm neither defending the government nor the pharmaceutical companies. I'm laying out the reality of this thought experiment and sort of talk about why our marvel is broken and needs to be fixed in terms of a public good. Right? So those are two things. Third thing is people know that resistance is natural in a matter of time even with good antibiotics, you'll start to see some resistance. We've learned that. Fourth, in many parts of the world, including where I grew up in, antibiotics are available over the counter. You don't need a prescription. Prescription drug laws are not very strong in countries that have hundreds of millions of people. You market it there. Well, pretty soon you'll have resistance emerge in Pakistan or Nigeria or India or wherever. So this starts to really affect the mood. Whereas in cancer or in hypertension or in mental health or you name it or musculoskeletal disorders, the drugs are robust. I mean, the fact that in the last 10 or 15 years, we have only about 40, 43 drugs in the pipeline tells you how little appetite there is in pharmaceutical companies who instead of entering the market are actually leaving the market because the numbers are not adding up. Because we were talking about COVID, this is a statement from a friend of mine, Kevin Albertson. And so he works on economics of pharmaceuticals and he said that I'll say that to your listeners as well. If you had a COVID vaccine eight months ago, the value of that would have been zero dollars. Nobody would have been interested. So it tells you that the market dynamics are not well suited for these kinds of public pharmaceutical, sorry, public health challenges. And we need to create different incentives for pharmaceutical companies to come into that. Some of it is market entry. Some of it is other kinds of rebates. Those are being discussed. And but when I speak to my colleagues in public health, this is their concern because ultimately the work that happens in my lab doesn't reach your patients unless and until pharmaceutical companies are involved in making that drug safe, clear. My lab has no capacity, no, no training, no ability to make a drug. We can make all the discoveries we want, but it's a complicated sophisticated process and pharma companies have to be involved. And you have to create a mechanism by which for profit companies and the public sector can work together to do that. Otherwise we'll have the stalemate that we have right now. So is there any hope? There is some. And the hope comes from incentivizing medium to small biotech companies that are not as big as some of these giant multi billion dollar companies to come up with maybe one drug and being able to market it and take it to the level where it becomes attractive, right? So there's an NIH in the US, Welcome Trust in UK, and a few other agencies have partnered together to create this consortia. One of them is called Carb X that is incentivizing sort of small and medium biotech companies who have demonstrated early success to take them because that's called the value of death, so to speak. You have early success, but not commercialization. And few people are interested in investing in that value of death because great idea, good paper, good publications, but to take it through through the boring and laborious process of clinical trials, you have very few investors and they want to sort of bridge that gap there. And they incentivize by saying, look, we don't want any equity in this. You will maintain the equity. We just want to help you because this should be a public good. So there's hope in that. The other dimension of hope, which I think is absolutely important, is the fact that more people, including many of your listeners, will start asking these questions and thinking about behavior change and thinking twice before they tell their primary care physician. And the story that you told about the neighboring physician prescribing and hence all patients going to him or her is absolutely true. I've heard that I I can't even count anymore how many times I've heard that. So that awareness is important. And then of course, the fact is that we need better diagnostics, sir, which allow people to make a decision on how and which antibiotic to use as opposed to giving broad spectrum antibiotics that are one size fits all, but that size doesn't fit anything. Yeah, that's a great point. And some of that technology already exists. Yeah, it's just not utilized very much because that's right. Again, it's just so much more convenient to say here, you know, here's your prescription. Absolutely. And we've seen that that that that doesn't help anyone certainly doesn't help the patient, but doesn't help the community or their loved ones doesn't help the kids in that family doesn't help the elderly neighbor that they have. All right, before I let you go. What's exciting in bacterial science that gets you up in the morning? Well, there's a lot of things that are exciting. I think fundamental curiosity of how bacteria have been doing this for four million years for a billion years is absolutely fascinating. But I think my excitement also comes from the fact that as we know and understand more and more about bacteria, we'll realize that bacteria are not this little tiny bug that lives in its own world. It's modified and altered, and it's part of our community. And our behavior, individual and collective is affecting the bacterial behavior that is affecting our behavior in return. And that to me is a tremendously humbling moment. And I think as as we all should know, looking at COVID, humility is both in short supply and absolutely needed. So I think that sense of humility and how we're all connected is important. One of the biggest lessons for me, Dr. Gunry, was to appreciate that science is part of the solution, but not all of the solution. Human behavior, economics, policy, research in ethics, sociology, conflict and war, all of these things are interconnected in myriad ways that allow us to really be a better person, a better scientist, a better researcher, and ultimately people who would be able to help others in sort of combating antimicrobial resistance. I remain optimistic that window may be shrinking, but that that we can do, we can change things for the better. However, that would mean doing the hardest thing possible. And that is behavior change. That's true. And that's kind of what I what I do is try to change my patient's behavior in it. You're right, it's hard, but that's why we're doing all this. That's why we're doing all of this. All right, well, Dr. Simone, it's been a pleasure having you on the show today. Where do people find more about you? Obviously they can get the book wherever books are sold. Absolutely, wherever books are sold. This may be sort of my own personal feeling, but I am a strong supporter of going local. So if your local neighborhood bookstore is open, if they don't have it, they can order it. There are real people are neighbors who work in those bookstores. And you know, the best part about local book stores is that you can have a conversation about the book with the bookseller. And who knows what may come out of that. So if you can go local, please do. Yeah, I absolutely agree. We've actually got a bookstore that has been allowed to open and we're in there buying books. So that's excellent. That's excellent. All right. Well, thanks again for for being on this is fascinating. I know our listeners are going to love this. So good luck with the book and go go find some killers of bad bugs. Would you or something? Thank you. And I hope your listeners will get a chance to reflect on this. And I would love to hear from them through your advice. Thank you so much. Very good. Thanks a lot. Thank you. All right. So now it's time for the audience question. See shilling from Instagram. I just had a surgery for the removal of some stones and was on antibiotics for a long time. Boy appropriate question. How do I detox all the antibiotics and what pro biotics do you recommend to help? Okay, so you don't. You don't detox from antibiotics. They are not toxic in any way to human cells, but they are obviously designed to kill or at least maim bacteria. And sometimes just like we went on this program, bacteria have different resistance to being killed. And the point of all this is that many times, unfortunately, what we're infected with now is resistant to the first round of antibiotics, sometimes the second round of antibiotics. And we have to kind of get stronger and stronger antibiotics to have an effect. So those antibiotics we've unfortunately learned also kill off the microbiome, particularly if you were put on oral antibiotics. Now we're pretty convinced that IV antibiotics through your veins are not going to have the same effect on your gut microbiome as swallowing these antibiotics. So that's number one. So if you got IV antibiotics, you don't have to worry as much about the long term effects. What the long term effects of oral antibiotics are is we had no idea that these antibiotics not only killed all the bad bugs, but killed a lot of our good bugs, the probiotics. Now the problem is there are some studies that show a single five to seven day course of antibiotics may wipe out your entire microbiome or most of it for up to two years after that dose of oral antibiotics, two years. Now people go, well, I'll just take some probiotics, which are friendly bacteria, and I'll get all my bugs back. That's like saying we recently had forest fires here in Southern California that unfortunately destroyed a lot of our homes, including mine. But if we went out after that fire and the forest burned down and we planted little pine trees, our forest would not be back for 20, maybe 30 years, a complete ecosystem of forest, of a forest. And it's actually quite naive to think that we can swallow maybe 20 different strains of probiotics and expect that we would have 10,000 different strains of probiotics growing in our gut shortly. Unfortunately, that's probably just not going to happen. And that's what's so important to realize. As I talk about in my previous books, and I'm talking about in the energy paradox, the next one, if you look at the diversity, the number of probiotics, friendly bacteria, and bacteria in general and species in the gut of, for instance, a hunter gatherer, these tribes, the Yanomali, they have this incredible diverse ecosystem. And if you compare that to a typical western around the world, we have just a horrible, very tiny fraction of all the bugs we probably should have. So, yeah, do I think you should take probiotics after a round of antibiotics? Absolutely. But I think what's more important is that there actually are little nests of these friendly bacteria that live in all of our guts that are in the crypts. And what I think is far more important is you've got to give these guys what they want to eat to come out of hiding. And those are prebiotics. Those are the fibers that good bugs like. So, yeah, take your probiotics, but more importantly, give those bugs what they need to eat. And those are prebiotics. So, great questions. Okay, it's time for the review of the week. Stephanie Lamb on YouTube wrote in and said this, hi Dr. G, as a recently graduated PhD, congratulations, I greatly appreciate how you translate and transfer scientific knowledge to the public. This is very difficult for academics to do and you are a successful example of this. Thank you for sharing your knowledge with us. Well, I really appreciate that coming from a PhD. That's what I've tried to do throughout my career is make pretty complex stuff pretty easy to understand. And I I appreciate that you recognize my efforts and I'll keep doing it. So thanks very much. Appreciate that Stephanie. All right, that's it for the Dr. Gundry podcast. We'll see you next week. Before you go, I just wanted to remind you that you can find the show on iTunes, Google Play, Stitcher or wherever you get your podcasts. Because I'm Dr. Gundry and I'm always looking out for you.