Pretty much EVERYTHING we put in our mouths affects our gut microbiome. We are learning more and more about how food affects our microbiome + health by making byproducts such as short chain fatty acids and TMAO. But what about medications? Studies have looked at over 1000 drugs and found that 24% of them inhibited growth of at least one organism in your microbiome. Nexium + Crestor are on the top 10 most-prescribed and top-selling medications— I meet patients on these drugs for years + years without understanding all the side effects and what it may be doing to our most powerful organ- the microbiome. Lets break down what some of these common drugs are doing to your microbiome.
REMINDER: THE FOLLOWING INFORMATION IS TO INFORM YOU SO YOU CAN MONITOR, MITIGATE AND MANAGE THE SIDE EFFECTS OF MEDICATIONS. THIS DOES NOT MEAN YOU SHOULD STOP ANY OF THE FOLLOWING MEDICATIONS. ALL DECISIONS SHOULD BE DISCUSSED WITH THE PRESCRIBING DOCTOR.
The bad players:
ANTIBIOTICS. There’s enough information here for its own post. Protect your microbiome and only take antibiotics when absolutely necessary as determined by your doctor.
PROTON PUMP INHIBITORS (PPIs): Ex. Nexium, omeprazole
DYSBIOSIS: Decreased microbiome diversity
INCREASED INFECTION RISK: Decrease in the bacteria Clotridiales and increase in Actinomycetales, Micrococcaceae and Streptococcaceae, which are related to dysbiosis and increased susceptibility to Clostridium difficile infection. Usually stomach acid prevents overgrowth of bad infections but a reduction in the stomach acid by PPIs means more bacteria may survive. A less acidic environment may enable organisms in the oral microbiome to colonise the gut microbiome.
NSAIDs
PLAY POSSIBLE ROLE IN ULCER FORMATION: Studies have found that germ‐free rats were resistant to indomethacin‐induced intestinal lesions.
LEAKY GUT: Long term use of NSAIDs may lead to hyper‐permeation of small intestinal mucosa, and NSAID‐induced inhibition of prostaglandin may lead to decreased blood flow.
OPIATES
Small intestinal bacterial overgrowth (SIBO): opiates are associated with severe constipation, which is related to a disrupted gut environment leading to altered gut microbiota in the form of SIBO and microbial translocation.
INCREASED INFECTIONS: opioid use increases Staphylococcus and Enterococcus (Gram‐positive organisms) in the gut microbiota and enables their dissemination to organs.
LEAKY GUT: opioids induce interleukin 17A overexpression in a toll‐like receptor two‐dependent manner, which contributes to disruption of gut barrier function, in turn enabling further bacterial dissemination.
ANTIPSYCHOTICS
DYSBIOSIS
AN OBESE MICROBIOME: Decreased ratio of Bacteroidetes:Firmicutes, resembling the microbiome in obese patients.
INCREASED INFLAMMATION —> INSULIN RESISTANCE: Elevation of interleukin 8 and interleukin 1ß was observed in mice treated with olanzapine. These inflammatory cytokines are known to be associated with obesity and insulin resistance.
CHANGE IN HUNGER HORMONES: ie. leptin and ghrelin ratios.
BIRTH CONTROL PILLS (Exogenous hormones)
Exogenous estrogen is associated with changes in the vaginal flora, characterized by an increase in lactobacilli species with a concomitant decrease in vaginal infections
Oral contraceptives are also associated with an increase in certain Candida and Prevotella species in oral flora
STATINS
CAUSES SIDE EFFECTS: side effects of statins such as constipation or laxative effects could potentially arise from gut microbiota alteration.
DYSBIOSIS: statins have direct anti‐bacterial activity that may explain some shifts in the gut microbiome. Rosuvastatin affected bile acid metabolism and impacted the expression of inflammatory markers known to influence microbial community structure in the gut
ANTIDEPRESSANTS
ACTS AS A ANTIBIOTIC: Antidepressants have neuroprotective and antimicrobial effects. Major depression is associated with changes in gut permeability and microbiota composition. The antimicrobial effects of antidepressants could be related to the effectiveness of these drugs for depression treatment.
DYSBIOSIS: Antidepressants reduced richness and increased beta diversity of gut bacteria, specifically Ruminococcus. BUT a study showed supplementation with Ruminococcus lavefaciens decreased duloxetine-induced improvement in depression (A possible role for R. flavefaciens in treating depression??)
The ONLY good player: METFORMIN
Increased Akkermansia muciniphila! Metformin Increases inthe mucolytic bacterium Bifidobacterium bifidum and the mucin degrader Akkermansia muciniphila
Increases in several bacterias that make short chain fatty acids- Butyrivibrio, Megasphaera and Prevotella
Higher short chain fatty acid concentrations (especially proprionate)
Beneficial effects of metformin may be linked to an enhancement of the intestinal mucosal barrier
And let’s not forget that your microbiome also regulates how different foods and drugs are broken down. Stay tuned for more on that on the next post!
SOURCES:
https://onlinelibrary.wiley.com/doi/full/10.1111/apt.14451
https://www.ncbi.nlm.nih.gov/pubmed/27744123
https://www.nature.com/articles/nature25979