 Hey everyone, this is Dr. Ruscio. Let's talk about if antibiotics actually damage your metabolism. Now if you haven't heard much about this argument, there is a concern, a hypothesis, that antibiotics by damaging or altering the bacteria in your guts can have a negative impact on your metabolism. And as we've been learning more about the world of bacteria in your gut called the microbiota, we are seeing associations between diabetes and obesity and alterations in these gut bacteria. So it's understandable to think that an antibiotic, something that alters and may cause a loss of some bacteria in the gut, may have a negative impact on those bacteria, which may then translate to a negative impact on diabetes, obesity, weight gain, what have you. So it's one thing to have a theory or a hypothesis or to show observation or correlation. It's another thing to show cause. So there was a study done that looked into and tried to answer the question of, does the administration of antibiotic therapy affect the bacteria in the gut and does that cause impairments in metabolism? So I want to read you a few quotes from this study. The name of this study, effective gut microbiota manipulation by antibiotics on host metabolism in obese humans, a randomized double blind placebo control trial. So this trial being placebo controlled controls for bias, controls for placebo effect and give us a much more true and representative answer to this question. It was also performed in obese subjects. So these are people who already have a predilection toward becoming overweight. So this is a very intelligent design of this study. And I want to read you a few quotes and we'll put these quotes up here on the screen. We investigated how gut microbiota manipulations by antibiotics, a seven day administration of amoxicillin, vancomycin or placebo affects host metabolism in 57 obese and prediabetic meaning having high blood sugar men. Vancomycin but not amoxicillin decrease bacterial diversity and reduced formicities. Formicities is a broad group of bacteria. So we do see an effect. So first thing we've seen, the antibiotics do cause an effect, more so the vancomycin. So we do see an effect. Second thing, adipose tissue, meaning fat tissue, gene expression of oxidative pathways was upregulated by antibiotics, whereas immune related pathways were downregulated by vancomycin. So what this means is we're seeing some mechanisms involved with fat cells, fat somatabolism and the immune system be affected. Okay, so we've seen bacteria be affected. We've seen some pathways be affected, but now here's the most important thing. Do these skewing of bacterias or skewing of certain pathways actually cause effect in human subjects? And this is a key thing as a healthcare consumer or as a doctor to be aware of. It's one thing to show stuff happens in the body. Stuff happens in the body all the time, right? If you open a postcard that says, hey, I love you from your mother, your cousin, you're going to have a flood of happy hormones in your body. That will cause an effect in your body. It doesn't necessarily mean that's something that's going to be super clinically relevant. Will that make you lose four pounds of weight? Probably not, right? So it's one thing to show there's an effect in the body, something measurable, but does that effect translate to something meaningful? This is the next quote. Sex did not affect tissue-specific insulin sensitivity, energy-substrate metabolism, postprandial hormones or metabolites, systemic inflammation, gut permeability, gut, excuse me, permeability, or fat cell size. So this is important. When we look at more clinical endpoint measures, true meaningful effects, we don't see much in the way of an effect. And the last point here, importantly, energy harvest, fat cell or adipocyte size, and whole body insulin sensitivity were not altered at the eight-week follow-up, despite there being an alteration in some of the gut bacteria, indicating that interference with adult microbiota by a seven-day course of antibiotics had no clinically relevant impact on metabolic health in obese humans. So what I'm trying to illustrate here, and what's important to bear in mind, is that you can have a theory that something is bad, and you can show that the something bad, in this case, antibiotics, causes changes in the body, as we saw there being some changes in the bacteria or the microbiota, and also some changes in certain pathways. But it's another thing to connect up all the way to the endpoint of this having a measurable, meaningful impact on a human and on their health. And in this case, a short course of antibiotics in obese and pre-diabetic men did not have a measurable negative impact on fat cell size, insulin sensitivity, even though we saw alterations in some pathways in the body. So what this means is, at least according to this study, antibiotics don't tend to have a major negative or any clinically relevant negative impact on metabolism. Why this is important is because while the overuse of antibiotics is certainly not doing anyone any favors and is a practice that needs to stop, using antibiotics for people to have legitimate infections that require care is important to undergo that treatment and not be fearful in thinking that if you're an adult, an antibiotic is going to cause a significant amount of weight gain. Now that being said, there is definitely literature showing that antibiotic use, especially early in life in infants, does put them at higher risk for negative metabolic consequences for the rest of their life. So this comes back to a theme of trying to use antibiotics discerningly and only when absolutely necessary. Now if a child has a life-threatening infection, of course, that's going to be a safe play. If a child has a head cold or the flu and you're thinking about just taking an antibiotic even though they're not indicated because you think it may help your child recover more quickly, then that's not intelligent because the flu is caused by a virus, not a bacteria, so antibiotics will not help. Now if the flu becomes prolonged and you end up with a secondary bacterial infection, then an antibiotic may make sense. So these are things that you want to discuss with your doctor for children. Coming back to the point at hand in adults that tend to have well-formed gut microbiotas and immune systems, there tends to be less of a deleterious or negative effect from antibiotics across the board. And this study quantified and showed that that effect on metabolism is not present, meaning there's no clinically relevant negative impact on metabolism in adults from antibiotics. I'm not saying that antibiotics should be used indiscriminately, they should be used when needed, but we should remain open to the use of antibiotics and not be feared into thinking that antibiotics are going to be a bad idea no matter what because that is a bit of an overinflated statement and we want to take from medicine what works, leave what doesn't. Let's leave using antibiotics because you have a head cold. Let's use antibiotics when they're clinically indicated and use them discerningly. So this is Dr. Ruscio and I hope this helps you get healthy and get back to your life. Thanks, bye.