“Microbiota Can’t Recover Fully After Antibiotics”

Is it possible to lower risks while taking antibiotics? Do tablet probiotics work? Does dysbacteriosis exist? And how does it relate to stress? We have talked to a microbiologist about our second brain – our intestine.

For the last ten years, Karina Pokusaeva has been dealing with probiotics and studying microbiota. Her Ph.D. and doctor of science theses she dedicated to bacteriocins which are antimicrobial peptides produced by bacteria to protect themselves. They may become a safe alternative to antibiotics in future.

Karina studied Bifidobacterium at Baylor College of Medicine and found out that they produce gamma-aminobutyric acid, or GABA. It’s a neuromodulator in our nervous system which can reduce a stomachache. Now Karina is on maternity leave, she teaches at Houston Community College and shares her important knowledge concerning microbiota, prebiotics, and probiotics on her blog MyGutMetters.


CILANTRO: What is microbiota? Why is it so important to study it?

KARINA: Normal flora — about a kilogram of bacteria — inhabits our intestine. The majority have positive properties. They improve immunity, help digestion, and suppress undesirable microbes. As well as they “communicate” with other human body systems like immune, nervous, endocrine.

Where does microbiota come from, how does it develop?

Previously it was thought that amniotic fluid around fetus was sterile. Now scientists consider good microbiota to break through all barriers and to be formed during pregnancy. As well as pathogenic bacteria though. A child gets main microbiota “dose” from his or her mother passing through the birth canal and from breast milk then. ( How to help a child to obtain normal flora – here).

Is it true that big city inhabitants around the world have the same microbiota since antibiotics and fast food kill the diversity?

Yes. Western diet strongly influences the microbiota. Still, there are some nuances since the fast food can vary. However, the microbiota in villages and megapolises differs a lot. For instance, African kids have prevailing bacteria which can split dietary fiber while European ones don’t have these bacteria at all.


What are the problems related to microbiota?

There are lots of them but the most obvious ones are constipation and diarrhea. The second problem is frequent illnesses due to disorders of the immune system. Stress, depression and anxiety also refer to bad microbiota. And, contrariwise, a bad mood can influence our positive bacteria.

When you go deeper in any topic, you see that Mg deficiency brings on stress, stress aggravates Mg deficiency. Vitamin D deficiency leads to stress, and stress…

When we feel something described as stress, each cell has specific reactions. Our emotions look like K transportation interruptions at the cellular level, for instance.

Microbiota-Gut-brain axis is a very popular conception now. Michael Gershon, chairman of the Department of Anatomy and Cell Biology at Columbia University, introduced a concept of the ‘second brain’ referring to the enteric nervous system. It is autonomous, so can operate without the central nervous system. It has many more nervous cells than spinal cord has.

If the intestine is removed from the body, it can continue contracting. Brain and intestine are connected. Microbiota gives signals to nerve-endings; they send them to the brain, the brain to the intestine, the intestine to the microbiota. Some researchers admit the microbiota to be a separate body, a ‘forgotten’ one. It has so many bacteria, with each of them being a separate factory with its own task and program. Very interesting but hard to understand who is responsible for what.

We’re discussing microbiota and its role for us. Maybe we exist to serve it?

Yesss! Microorganisms living inside us are symbiotes. Our benefit is mutual. We feed them.

How can we harm our microbiota?

By a thin diet without vegetables, fruit, fiber, first of all. Microbiota diversity will be low then. Flora can’t recover fully after antibiotics.

Never ever?

Never. Even if you take probiotics, they will not give a 100% recovery. However, they will keep you close to the initial state.


How should we take probiotics (useful bacteria) and prebiotics (food appealing for our microbiota) while taking antibiotics?

The best way is to find probiotics including several bacterial strains. I usually recommend the cocktail. One bacterium will help one person and will not influence another. The more bacteria the higher chance to find the necessary one. It’s important to use prebiotics as well to feed bacteria, especially if your ordinary diet is far from being perfect.

How can you understand that the strain doesn’t work for you?

Probiotics mainly don’t have side effects. If the strain works you’ll easily see it. Taking antibiotics may lead to diarrhea. Appropriate treatment solves this problem in a day. It’s important to continue the treatment for a few weeks or even a month. While taking antibiotics, a double dose of probiotics is recommended since bacteria have lower chance to survive.

Before or after meals?

It’s better not to take probiotics on an empty stomach since they need food. You should take probiotics and prebiotics during or after meals, and antibiotics afterward.

If a person is sick, is there any chance to feed bad flora while taking prebiotics?

No. Pathogenic bacteria produce toxins. It requires a lot of genetic information, protein. Meanwhile, the major part of good bacteria’s genome produces enzymes necessary to digest complex carbohydrates like fiber, bran, oligosaccharides. The bad bacteria do not have reserves to eat prebiotics. They do not compete to get the same food. The only exception is glucose, it’s a simple molecule, and all microorganisms prefer it.

What are symbiotics?

It’s a probiotic and a prebiotic simultaneously. It can be both a drug and a natural product. Sauerkraut, kimchi, oatmeal kissel contain both fiber and bacteria.

Do probiotics survive in the intestine? Or there is the effect only while taking them?

It was thought 5-10 years ago that you could take them for a while and then quit. Now it’s recommended taking probiotics for a longer period, like several months. Then you can stop and observe if the problem is solved.

Which is a better form of probiotics if it’s a supplement? Many people say the liquid one is better than in capsules

Probiotics are probiotics if they survive in stomach acid environment. Drops are appropriate for kids, infants in particular. Adults need higher doses since the amount of a liquid probiotic will be too big. Furthermore, capsules dissolve slowly and transport probiotics to the intestine.

Is it enough for a healthy person, not taking antibiotics, to get probiotics from yogurt, kefir, tea fungus, sauerkraut, kimchi, and prebiotics from garlic, vegetables, fruit, greens? Is there any need to take supplements?

With the good immune system and a diverse diet, there is no need for supplements.

It’s said a lot that fruit is a natural candy. And it’s better to limit it. Is it true?

It’s ok if you eat one or two pieces a day. The fruit contains lots of fiber and prebiotics oligosaccharides which are easily ingested and feed our flora. It refers to healthy people, of course. In case of diabetes or prediabetes, it’s not recommended eating sweet fruit.

What is favorite fruit of our microbiota?

With a hard skin. Apples, pears. They contain much fiber, pectin. The more diverse diet the better. It’s not worth eating only pears. Berries with small seed like raspberry, blackberry, contain a lot of prebiotics, as well as A and C vitamins.

Probiotic drinks, like Kombucha and water kefir, are popular now. What are their benefits?

Water kefir is a drink cultured with water and sugar, not with milk. It’s produced with the help of microorganisms and fungus. Bacteria ferment sugar and release useful substances. It’s a refreshing drink. Water kefir can also be cultured with coconut water, juices.

And about sugar again. What is the solution for people restricting sugar consumption?

Кombucha may culture a drink for 30 days. In this case, it’s not sweet. The more you culture the less sugar left. Same with water kefir.

Illustration by Benjamin Arthur for NPR
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Олена Исламкина

Меня зовут Олена, и я предводительница кето-секты. Самопровозглашенная, конечно. А еще журналистка и биохакерша. В 2012 году я случайно отрыла для себя кето-рацион и вдруг сбросила несколько лишних кг, избавилась от мигреней, аллергии и акне, стала энергичной и продуктивной, уравновешенной и счастливой. Три года назад я завела cilantro.ru, чтобы рассказывать о том, что ЗОЖ не то, чем кажется. Но тема кетогенной диеты быстро вытеснила из моего блога прививки, ГМО и упражнения для крепких ягодиц, а я сама закончила несколько курсов и стала специалисткой по кето-питанию. Мне очень хочется, чтобы как можно больше людей знали: здоровая еда должна быть вкусной. А вкусная еда может быть лекарством и инструментом биохакинга. Потому что ЗОЖ не то, чем кажется.

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