Antibiotics

As much as I rant and rave about the excessive numbers of prescriptions written for antibiotics every year, there are, without a doubt, situations in which they are necessary. I experienced one such a situation lately.

I had a dental crown put in a molar more than 30 years ago that recently failed. The dentist advised pulling the tooth entirely and inserting an implant. I thought this was reasonable and proceeded. Those of you who have undergo a dental implantation know that it is a multi-step procedure with the initial procedure involving the drilling of a hole in the jawbone to allow insertion of a metallic anchor. This part of the procedure carries the risk of osteomyelitis, or bacterial infection of the jawbone, a potentially catastrophic situation. Antibiotics are therefore an essential part of the procedure, as they are, say, in sepsis, bacterial pneumonia, or a wound infection. As powerful as probiotics, fermented foods, and other microbiome strategies can be, no one has yet worked out a microbial workaround that allows us to avoid antibiotics in this situation. And recall that, after the colon, the mouth is the second most densely populated microbiome in the human body, teeming with trillions of species, both good and bad.

The periodontist performing the procedure, a refreshingly articulate and forthcoming practitioner, warned me about the need for periprocedural antibiotics. I was therefore dreading the 10 days of amoxicillin knowing that, in past, such a prescription would leave me with gastrointestinal (GI) distress, loose bowels, fungal skin rashes, and—worst of all for me—intractable insomnia. Despite decades of chronic insomnia, I’d lately been enjoying deep, mostly uninterrupted sleep due to the addition of Lactobacillus reuteri yogurt, providing hundreds of billions of counts of this microbe that provokes release of oxytocin from the brain. For me, the change in sleep habits has been profound, eliminating endless sleepless nights that previously caused me to take high doses of melatonin, tryptophan, or other sleep agents. With restoration of L. reuteri, I enjoy deep, restorative, dream-filled sleep. I feared that a course of antibiotics would promptly take me back to soul-wrenching nights of sleeplessness, since L. reuteri is very susceptible to antibiotics such as amoxicillin.

But, with this most recent course of antibiotics, I understand a lot more about the GI microbiome than I did several years go when I took my last course of antibiotics for a bacterial cellulitis (skin infection) that resulted from a minor skin injury I had incurred. I’ve made a habit of consuming several modest servings of fermented vegetables and meats every day, foods such as kombucha, kefir, kimchi, vegetables I fermented on my kitchen countertop, sopressata, salami. I also drink several small servings of Saccharomyces boulardii sparkling juice per day, a practice that is among the important steps you can take to protect your GI microbiome during antibiotics. Beyond the L. reuteri yogurt I had been consuming nearly every day, I was intermittently consuming L. gasseri yogurt, also yielding very high counts of this microbe that, like L. reuteri, colonizes the small intestine as well as large intestine, while also producing bacteriocins effective in killing fecal microbes in the small intestine.

I started the amoxicillin with trepidation, fearing that I would re-experience all the adverse effects I experienced in past. As the days passed, however, to my great surprise, nothing—nothing—happened. No GI distress, no abdominal discomfort, no sleeplessness. In fact, I continued to enjoy the deep dream-filled sleep that L. reuteri had been providing for me.

I had feared that, because L. reuteri dies in the presence of antibiotics, full benefit would not be experienced. Consistent with the original MIT mouse experiments, however, in which heat-killed L. reuteri still had the capacity to provoke oxytocin release, it appears–at least judging by my n =1 experience—that L. reuteri and oxytocin’s effects may persist despite antibiotics.