The link between taking antibiotics and gut health

WWhile antibiotics are routinely prescribed to treat bacterial illnesses and even help prevent millions of deaths each year, certain risks come with their rewards. “Antibiotics are designed to kill pathogenic or potentially harmful bacteria,” says Sarah Greenfield, RD, a functional medicine dietitian who specializes in gut health. “However, in this process, the good or commensal bacteria are also killed,” including those found in the gut. A healthy gut is one that is diverse and has plenty of friendly bacteria, but what happens once antibiotics throw things off balance?

Below, we’ll cover the basics of strengthening your gut while on antibiotics. Plus: what you can do to further promote gut restoration in the weeks and months afterward.

How to protect your gut while taking antibiotics

Prioritize probiotics

Since antibiotics kill both good and bad gut bacteria, it’s common to experience digestive upset while taking them. “Studies show that taking a probiotic supplement can prevent upset stomach and diarrhea caused by antibiotic use,” says Bianca Tamburello, RDN, dietitian on behalf of FRESH Communications. However, both she and Greenfield advise taking the antibiotic and probiotic at least a few hours apart so that the latter has a better chance of survival.

Prioritizing foods with probiotics also gets a green light. “While taking an antibiotic, eating probiotic-rich fermented foods like kraut, kimchi, and yogurt can help preserve gut health,” Tamburello says.

…and prebiotics

While you’re at it, Greenfield also suggests consuming prebiotics, which feed friendly bacteria. “If you take probiotics and prebiotics while taking antibiotics, you can prevent some of the damage caused by the antibiotic, which can help with gut recovery time,” Greenfield explains. Fortunately, there are many healthy prebiotic foods to choose from, including but not limited to garlic, onion, and asparagus.

Beware of high-fiber foods

It’s important to not only add things to your routine while you’re on antibiotics, but also to consume a few others in moderation. For example, while fiber is beneficial for digestion and overall gut health, it’s best to save high-fiber foods for after you finish your recipe. “It is recommended to avoid high-fiber foods while taking antibiotics because fiber can interfere with how quickly the antibiotic is absorbed,” says Tamburello. (This can be a bit confusing since many, though not all, fibrous foods are also prebiotic. Some high-fiber foods worth saving for your post-antibiotic regimen include beans and legumes.)

make sure you relax

Last but not least, lifestyle factors will also play a role in your recovery. “Lowering stress and prioritizing rest while taking antibiotics will help make your gut more resilient,” adds Greenfield.

Reducing stress and prioritizing rest while taking antibiotics will help make your gut more resilient,” adds Greenfield.

Tips to restore your gut after antibiotics

Once your round of antibiotics is over, the standard gut health tips and tricks apply. “After completing an antibiotic regimen, eat foods rich in probiotics, prebiotics, and fiber to restore the number and diversity of good gut bacteria and fuel a healthy gut,” says Tamburello. “Probiotics increase the amount of intestinal bacteria and promote intestinal balance,” while the latter two “are especially beneficial for regaining intestinal health after a course of antibiotics.”

In fact, a 2019 study found that low-fiber diets exacerbated microbiota collapse and delayed recovery after antibiotic treatment, so be sure to ramp up your fiber intake through vegetables and staple foods alike. “Most high-fiber foods have prebiotic benefits,” reiterates Tamburello, which is why they typically offer two-for-one benefits.

Additionally, Greenfield recommends eating a colorful diet rich in whole foods to promote the health of your microbiome. “Sunlight exposure helps balance the circadian rhythm, which helps improve bowel function,” she adds. “Since vitamin D can decrease intestinal permeability, adequate vitamin D levels are important, ideally through sun exposure or supplementation.”

How long will it take to restore your gut after antibiotics?

Greenfield says that the answer to this question is not that simple to answer, since the research is not so clear. Results will also vary depending on the antibiotics you take, the specific strains of bacteria measured, and similar considerations. That being said, recent studies and reviews offer optimistic findings. According to a 2020 meta-analysis of 31 articles on the gut microbiota and antibiotic use, “after stopping treatment, gut bacteria recover, in most people, to baseline within a few weeks. Some studies suggested longer-term effects of two to six months.”

“After discontinuing treatment, intestinal bacteria recover, in most people, to their initial state within a few weeks. Some studies suggested longer-term effects of two to six months.”

In general, Greenfield says the state of your gut and overall health before taking antibiotics will have a big influence on how quickly you can restore your microbiome afterward. “If you already had good gut diversity, chances are the first round of antibiotics isn’t going to kill off entire species of bacteria,” says Greenfield. “But if you already had weakened bowel function or have taken a lot of antibiotics, the effects can be more damaging.”

Additionally, additional factors that influence gut diversity—that is, everything from your usual diet and lifestyle habits, pre-existing conditions, medications, and stress levels—will inform your timeline for microbiome restoration.

To gain clarity and make sure your gut health is trending in the right direction, Greenfield recommends getting a stool test with a functional health expert. “I like to wait 14 days after taking antibiotics to test microbiome diversity. This gives us plenty of time to see what the bacteria look like after taking the antibiotic,” she says. From there, personalized protocols can lead the way and promote a greater abundance of the beneficial bacteria your gut and greater health need to thrive.

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