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RadioMD Presents:Healthy Talk | Original Air Date: June 3, 2015
Host: Michael Smith, MD

Anti-aging and disease prevention radio is right here on RadioMD. Here's author, blogger, lecturer and national medical media personality, Dr. Michael Smith, M.D. with Healthy Talk.

DR. MIKE: So, is giving antibiotics to infants safe? Or for that matter, babies and toddlers? Granted there are times when antibiotics are absolutely necessary. Bacterial meningitis, for instance, or pneumonia – bacterial pneumonia. There are times when antibiotics are absolutely necessary, but we also know we are overusing them. And not just in us, by the way, also in livestock where we eventually get our chicken and our beef. We are definitely over using them. So, what about when your child, your infant, baby or toddler, simply just has the sniffles--some sinus stuff going on, or weird stuff draining out of their nose? Does that automatically mean we need to be using antibiotics?

Some new research is showing that infant antibiotic use--and I think we can extrapolate this to babies and toddlers, but this study was focusing on infants, so I'm going to stick with that target population--infant antibiotic use is linked to diseases later in life, adult diseases. I am pulling this report from a publication called Vertical New Science and they are summarizing some research that was published in the Journal of Cell Host and Microbe from the University of Minnesota. What they found was a three-way link among antibiotic use in infants, changes in the gut bacteria and diseases later in life.

The change in gut bacteria, the term for that is called dysbiosis, and I might refer to that throughout this segment. Dysbiosis is simply where you have an imbalance in the gut flora. That is just another way of saying gut bacteria, even some healthy yeast species. That dysbiosis has been linked already, for instance, in adults to diseases, infections and allergies, autoimmune disorders, obesity.

Now, the question becomes, if we start to change the normal gut flora--that balance--really early in life, like in infants, is that dysbiosis we're creating there going to cause some of these same diseases? Or does it increase the risk for some of these adult diseases later in life? The answer to that is "yes". The purpose of this study--the methodology and the execution of the study--was put together by a graduate student. I don't have his or her name here. But again, the University of Minnesota, in the Biomedical Informatics and Computational Biology Program. Wow! So, things are getting really fancy in college.

When I was going through we had biology and microbiology. What this student did, of course, with the help of other researchers, I'm sure, is they developed a predictive model. The reason they have to say it that way is you can't really study infants like this.

So, you have to look at the information that is already out there. You've got to put it together in a mathematical formula that then can predict what would happen if you have dysbiosis in an infant.

So, they developed that model. They developed the math involved which definitely has a lot of clinical application, I think, in the future. They developed a predictive model that could measure how the normal gut flora develops and what antibiotics would do to that and, eventually, does that cause disease later in life. It is a really interesting study that they put together.

If you look at the hypothesis, they start off by reminding us that antibiotics are by far the most commonly prescription drugs given to children. They account for about one-fourth of all medication prescribed to kids with a third of these prescriptions considered unnecessary. That is a common statistic even put out by our own government that about a third of antibiotic prescriptions are not necessary. What

I mean by that is, you have a viral infection that is causing some sniffles and cough and cold, but the doctor wants to do something. Doctors, especially pediatricians, they don't like to tell parents, "Well just go wait it out. Lots of fluids. Rest." That is really hard for parents.

Parents want something to be done. I think we are all kind of responsible here. The parent wants something done, the doctor, knowing that this is probably a viral infection, still writes the prescription for an antibiotic. So, we are overusing these drugs. Studies have shown, over and over again, profound short- and long-term effects of using antibiotics when they are unnecessary and causing dysbiosis.

The question becomes, though, in this study, in this predictive model, that the researchers and this graduate student from the University of Minnesota were looking at was really: can we prove that using the antibiotics, especially when it is unnecessary, truly causes dysbiosis in the infant and that down the line increases the risk for adult disease? That's what they were studying. They developed this framework, this mathematical map of how antibiotics may be acting in the gut to cause disease later in life.

They took current knowledge linking antibiotics, dysbiosis and disease from thousands of research papers and proposed a framework for studying these types of questions. Like, if I give too many antibiotics is that really going to cause dysbiosis?

Is that going to increase the risk of allergies in this infant later in life? They put all of this information together in this new kind of framework – this mathematical framework. They discovered as they were doing this that there are four things or parts to dysbiosis that can happen when an infant is given an antibiotics. If you have one--just one--of these changes, that does increase the risk for disease later in life.

Four changes can happen to the normal gut flora when you have given antibiotic to an infant. Here's what they discovered. Number one, the loss of what is called "keystone taxa". These are really keystone species in your gut that are really, really important. You don't even need a lot of them. They are powerful, healthy bacteria, these species that protect you. When you can lose that in children and infants, you can lose the diversity of the normal gut flora. You can have shifts in metabolic capacity.

The gut flora is important to how we metabolize vitamins and minerals. You can also have blooms of pathogens. Basically, a disease can set in the gut. What they discovered by analyzing this in this mathematical framework is if you can show that at least one of those four things have occurred, you can then predict infant dysbiosis and the increase risk of adult diseases. The two main diseases that stood out – and I found this interesting. If you give antibiotics to an infant and they have one of those four changes, or maybe all four, or three out of four whatever.

So, you see the loss of the keystone species, diversity is down, pathogens – any of those things happen, you can predict adult diseases. Specifically, allergies and obesity. Interesting, huh? Allergies and obesity were the main links to dysbiosis in infants.

It is interesting that we are having an obesity epidemic in this country in adolescents, young adults, and that correlates well with the use of over use of antibiotics in those children. It is an interesting connection.

My take home message to you is if your infant has to have antibiotics, do things like continue to breast feed. Very important. There are infant probiotics you can use. You want to make sure they get the species bifidobacteria and lactobacillus acidophilus.

Those are the two most important species probably to a growing and developing child. You can even do something called kefir, for instance, but you have to make sure – kefir is a milk product that has a lot of natural probiotics that can be used.

But it's not really infants. That has to be babies at about year one. They have to be drinking milk already – normal, like cow milk for them to do kefir. There are things you can do if they really do need those antibiotics and I strongly suggest you do them.

This is Healthy Talk on RadioMD. I'm Dr. Mike. Stay well.