My bones shuddered when I read that 270 million prescriptions for antibiotics had been issued in the United States in 2015 alone. That’s 838 prescriptions for every 1,000 people!(1) I shuddered because so many of my patients with osteoporosis have told me about their repeated use of antibiotics, especially when they were younger. Could they only now be seeing the haunting result of what has been smoldering within them for years as a result of an era of over-prescribing. No doubt, antibiotics can be lifesaving, but they are often used in excess. These medications have been around since 1928 when penicillin was discovered, and today they are a mainstay of medical treatment protocol. In fact, 50% of patients admitted to hospitals are prescribed antibiotics. These medications can work miracles, but they can also wreak havoc on the gut and, years later, cause disease. Antibiotics don’t just kill off the “bad guys”, they also kill off the “good” guys. In the process, the gastrointestinal lining becomes collateral damage.
The gut is home to 100 trillion bacteria encompassing over 1,000 species and 28 different phyla. Members of the Firmicutes and Bacteroidetes phylums are the most populous in the gut, and antibiotics, poor eating habits, stress, sleep disturbance, and even jet lag can disrupt their delicate balance. When the bacteria get sick and out of balance, we do too. (For more on this please refer to my book The Whole-Body Approach to Osteoporosis.)
When the gut’s microbiota composition is disrupted, immunological imbalance ensues creating dysbiosis, a condition that leads to intestinal permeability (leaky gut) and disease. Overgrowth of harmful bacteria and/or disruption of microbial family composition can cause symptoms such as stomach pain, bloating, constipation, diarrhea, and bad breath. This disruption can actually alter the genetics of the gut-lining cells forcing them to “accept” these “bad” bacteria as “normal” making it difficult for the body to regain intestinal health on its own. With these harmful bacteria essentially embedded into the gut it is not a surprise that so many conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), diabetes, cancers, obesity, and autism have been linked to dysbiosis.
Chronic poor gut health also causes bone loss and is a major factor in the development of osteoporosis. A failure to accrue bone when we are younger, a rapid loss of bone as we enter middle age, or the inability to form bone in our later years can all be the result, not just of compromised nutrient absorption, but from the immunological distress brought about by chronic activation of the immune system in response to dysbiosis. In fact, disruption of the immune system, we now realize, is one of the most insidious destructive forces to bone that we know.
To investigate the destructive forces on bone from dysbiosis and immunological dysfunction, and the beneficial effects of probiotics in the treatment of bone loss, Schepper, et al.(2) from Michigan State University and Baylor College of Medicine took a close look at post-antibiotic probiotic (Lactobacillus reuteri) treatment using mice in the lab.
We have known for decades that antibiotics cause long-term alterations in the gut’s microbiota composition and this creates intestinal permeability. Schepper, et al. explain that “under conditions of decreased barrier function (increased permeability), bacteria and their factors can translocate across the intestinal epithelium and move throughout the blood stream.” This not only causes inflammation in the gut but throughout the whole body and even the bones. Schepper, et al. found that post-antibiotic “dysbiosis significantly increases osteoclast markers and decreased osteoblast markers”, “has a detrimental effect on trabecular bone health” and “…markedly decreased bone density.” “We hypothesize that it is not the specific microbiota composition that regulates the bone health; rather it is the balance of “disease-promoting” versus “health promoting” bacteria.”
Schepper, et al. went on to report that “oral supplementation with the probiotic L. reuteri 6475 or direct inhibition of gut barrier leak significantly prevents trabecular loss and strengthens the role of the gut as a therapeutic target for bone health.” When the gut is unhealthy, oral probiotics help re-establish immune tolerance, reduce inflammation and the production of NF-kB (I explain NF-kB in depth in my book), and promote gastrointestinal health. Good bacteria not only heal the gut but can actually reinstate “normal” genetics to the gut-lining-cells.
With 70% of the immune system housed within the gastrointestinal track, improving gut health is one of the most important things we do to improve skeletal health. If you have osteoporosis and suspect that you have dysbiosis, talk with your doctor. He or she can do lab testing if necessary and help guide you to healing your gut and strengthening your bones. Every case is different, but therapy may include taking specific herbs or medications, making changes to life-style, reducing stress, eating a healthier diet, taking probiotics, and making sure your vitamin D levels are adequate (D encourages more “good” and less “bad” gut microflora).
OsteoNaturals’ OsteoStim® is a vital weapon for improving bone strength and does double duty when it comes to addressing dysbiosis. OsteoStim® not only has 1,000 IU of vitamin D in 3 capsules but also 250 mg berberine. This natural alkaloid not only limits osteoclastic bone resorption and boosts osteoblastic bone formation, but it is also anti-inflammatory and antimicrobial (killing harmful gut bacteria but encouraging of beneficial bacteria such as Bifidobacterium). The combination of vitamin D and berberine in OsteoStim® significantly benefits digestive health and microbiome. These, along with all the other ingredients in OsteoStim® make it a powerhouse for encouraging stronger, healthier bones.
1) Centers for Disease Control and Prevention, “Outpatient Antibiotic Prescriptions—United States, 2015,” accessed Jan. 25, 2018, https://www.cdc.gov/antibiotic-use/community/pdfs/Annual-Report-2015.pdf.
2) Schepper, JD, et al. 2018. Probiotic Lactobacillus reuteri Prevents Postantibiotic Bone Loss by Reducing Intestinal Dysbiosis and Preventing Barrier Disruption. JBMR DOI:10.1002/jbmr.3635. pp1-18.