Antibiotics – Less is More

//Antibiotics – Less is More

I’m going to talk about something completely different than the usual obesity, insulin and type 2 diabetes stuff – antibiotics. This is another area where current medical teaching is completely logic-free. In many ways it reminds me of the entire ‘Type 2 diabetic patients have too much insulin. So, let’s give them more insulin and see if it helps’ argument. Logically it makes no sense. So, instead the medical establishment adopts a ‘I’m the expert so don’t bother trying to talk sense into me. Just do what I say’ attitude.Pills

Antibiotic treatment regimens are largely the same. Suppose you go to your physician for a bacterial infection. Viruses, like most common colds, are not affected by antibiotics, so therefore should not be prescribed. However, because many bacterial infections have the same symptoms, antibiotics are often prescribed ‘just in case’. This leads to antibiotic overuse.

Exposure creates resistance. High persistent levels of antibiotics lead to antibiotic resistance. In this case, the antibiotics kill off most of the bacteria, but there will always be a few that are resistant. Since everybody else is dead, these bacteria, which used to be very rare, are able to multiply, propagate and pass on their resistance to other bacteria.

These are transmitted by something called plasmids. Inside the bacteria, plasmids help the bacteria develop resistance. But these plasmids can be transmitted to other bacteria which means that resistance spreads much, much faster than otherwise. But the basic formula remains the same. Persistently high levels of antibiotic use leads to antibiotic resistance, just as high levels of insulin leads to insulin resistance.

Knowing this, the key would be to use less antibiotics. (Obesity is caused by too much insulin, so the key is to lower insulin). In many hospitals in the United States, antibiotic resistant ‘super-bugs’ have become a huge issue. Doctors in America love to use the latest and greatest medicine, and antibiotics are no different. Heavy handed dosing of the latest antibiotics has eventually led to tremendous problems with antibiotic resistance.

For example, MRSA (Methicillin Resistant Staph Aureus) rates doubled in academic American hospitals between 2003 and 2008. There are tuberculosis that are multi drug resistant. This has led to calls from the Infectious Disease Society to call for more antibiotics in their idiotic 10×20 plan. They want 10 new antibiotics approved by 2020.

Why do I call it idiotic? Let’s back up and think about their reasoning. Too many antibiotics causes resistance. Obvious answer is to use less antibiotics. Instead, the answer, according to these highly paid infectious disease specialists is to create even more antibiotics? Am I the only one who sees a problem? The problem is not the we don’t have antibiotics. We have lots of them. The problem is that we use them too much. If we simply create more antibiotics, but continue to use them heavily, then we will only get more antibiotic resistance. All that hard work of creating new antibiotics will have been wasted.

So the answer is not to create more antibiotics. That’s like giving insulin to patients with high insulin levels. The cause of the resistance is overuse of the antibiotics that we already have. So the answer is wary – use LESS antibiotics, not create MORE.

Alcoholism should not be treated by giving more alcohol. Cocaine dependence should not be treated by giving cocaine. It’s idiotic.

News story abound about huge funding for battling the ‘superbug’ problem. Here’s one, for example, about Harvard’s Dr. Grad researching new ways to ‘defend the wonder drugs’. Of course, millions of dollars are being spent for ‘new’ research into the tracking and treating antimicrobial resistance. He receives support from charitable organizations to do this work. Of course, since we already know the cause, the solution is bloody obvious. Heavy use of antibiotics creates resistance. Use less antibiotics. Case closed. Mischief managed.

So, when you go to your doctor for antibiotics, what happens? A typical prescription is ‘Take amoxicillin 500 mg three times a day for 14 days’ The question is this. How does the doctor know how long you should take antibiotics for? You might imagine that there are all sorts of studies that have compared short duration and long duration antibiotics. You would also be wrong.

Mostly, doctors follow an eminence based medicine standard. That is, somebody made up a regimen 14 days and that’s why they gave you 14 days. There are, in fact, virtually no studies to guide the proper length of treatment. It’s basically the WAG method (wild-assed-guessing). Most of medicine follows the WAG methodology, although doctors will try to convince you otherwise. It is standard to treat infections in 7 day increments – 7 days or 14 days. Why? Because somebody said so. In the year 1695!

Usually, with the antibiotics will come with the admonition that you should take all 14 days, even if you are feeling better by day 2. You might ask the question ‘Why should I take another 13 days of antibiotics if I’m feeling well?’ To which the only answer is ‘Because I said so’.

Mostly the reason given that you need to complete the full course even if you are feeling well is because you don’t want to cause resistance. Huh? Too much antibiotics creates resistance. So, we should take another 13 days of useless antibiotics to prevent resistance when we know that it will actually CREATE resistance? WTF?

WTF???

WTF???

Again, let’s consider this logically. If you are otherwise healthy, you have an immune system to deal with infections. It gets overwhelmed, so you need antibiotics. Within 2 days of antibiotic reinforcements, the war on bacteria has turned in your favor. Most of the enemy is dead, and the remaining bacteria are beating a hasty retreat. We can stop using the nuclear arsenal and let the immune system mop up. Is there any harm? No. What’s the worst that will happen? If the bacteria start to mount a comeback, then you can take more antibiotics.

But what happens if you slavishly take all 14 days? You will suffer much higher rates of resistance and future battles against bacteria will not go as easily. The risk of side effects is much higher. Any benefits? Not that I can see. The problem of resistance cannot be underestimated. It doesn’t simply affect you, it affects the entire health care system. A problem created for nobody’s benefit.

In my hospital, as with many others, there are Antibiotic Stewardship Programs (ASP) to accomplish this. They are specially trained pharmacists and doctors that will review antibiotic orders by physicians and make suggestions. Certain antibiotics are deliberately restricted from wide usage to prevent resistance. That way, when a truly horrible infection comes along, those antibiotics are still effective.

A recent paper published in JAMA makes the point that less is more. This paper reviews all the recent clinical trials in which virtually every single time, the shorter course of antibiotics is as effective as the longer one. In almost all cases, you can use 1/3 to 1/2 the dose of antibiotic and get the same result. That’s 1/2 to 2/3 less resistance, baby!

Which is kind of, obvious. Suppose you are washing your car. You wash for 10 minutes and it’s clean. Should you continue to wash for another 60 minutes and assume it will be more clean? Of course not. Well, if the bacteria are mostly dead (leaving the rest for the immune system to mop up), then what’s the point of taking more medications? None.

So, what’s the logical way to use antibiotics? Well, it’s pretty simple. If you don’t need them, don’t take them (viruses). If you need them, then take them. But you should take them only until you feel better. After that, you can rely on your body (assuming that you are otherwise healthy) to take care of the rest. If you need 3 days of antibiotics, then take 3 days. If you need 2 weeks then take two weeks. But don’t take 2 weeks of antibiotics if you only need 3 days.

Sometimes, I assume that the only place in medicine where there are obvious logical gaps is nutrition. Sadly, no.

2017-10-14T21:30:47+00:00 49 Comments

About the Author:

Dr. Fung is a Toronto based kidney specialist, having graduated from the University of Toronto and finishing his medical specialty at the University of California, Los Angeles in 2001. He is the author of the bestsellers ‘The Obesity Code’ and ‘The Complete Guide to Fasting’. He has pioneered the use of therapeutic fasting for weight loss and type 2 diabetes reversal in his IDM clinic.

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49 Comments on "Antibiotics – Less is More"

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Dan Donnelly
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My experience in the UK is that it is VERY difficult to get an antibiotic prescription from a GP … I think the message is well understood here.

Steve Summers
Guest

But when they are prescribed you are told to finish the 7 day course to prevent resistance.

Sue
Guest
Dr Fung, I know all of this to be true. I NEVER gave my children antibiotics unless I absolutely had to, which was few and far between. My “kids” are 27 and and 25 now and thank the good Lord above are in great health! When my kids were young I would see that many of their friends were constantly on some drug but they were constantly sick!!! I know that I was blessed with healthy babies and don’t take that for granted, but I do believe nursing, feeding them good and wholesome food and using antibiotics and all drugs… Read more »
Hm
Guest

your point make so much sense – scary to think there are no guides or studies on dosage + duration and we have been blindly following protocols with no basis. OMG!

David
Guest

I was on antibiotics for 2 years (about age 24 to 26) to fight acne on my upper back. I think it was 100 mg/day of minocycline, might have been doxycycline. I worry that it was a mistake for my overall health.

I’ve had more success fighting acne lately with weight loss, adapalene, benzoic acid, salicyclic acid, and a zinc oxide + castor oil cream, the ageing process … some combination of the above.

David
Guest

To add:

1) In my anecdotal observation, it didn’t help much.
2) Subsequent doctors suggested it as well but I opted against it.
3) I wish the natural stuff like castor oil, coconut oil, et cetera got a proper clinical trial at some point. There’s no money in properly evaluating herbal medicine.

KellyB
Guest

I don’t know if this is related or not, but as a child, I had frequent strep throat infections, and they were always treated with an intramuscular injection of penicillin (this was in the 1960s). Sometime since then, they stopped doing that, and everything was administered orally, over 7 or 14-day periods. Layman’s guess here, but I can’t help thinking that the shots were easier on my gut flora as well as being a very short course of medication.

Jin
Guest
Some people have said antibiotic treatment is half a treatment by which they mean after the antibiotics there should be a course of probiotics to rebalance gut flora. Last Saturday I finished a two week period of consuming 150 grams of sugar in 1 litre of water per day. This equated to 600 calories per day. Somebody asked me what was the point of doing this because it was obvious I was going to lose weight and have many favourable outcomes. Here are my reasons not in any particular order- 1. Although it was obvious to that person what was… Read more »
Jin
Guest

Just remembered the main thing concerning me was sugar causing me to have uncontrollable hunger pangs, didn’t happen.
I had pain in my right side upper and lower jaw which faded away.
I had pain in my right ear which slowly faded away.
I had no adverse effects on my teeth which was another concern to me.
My skin is the softest it has ever been my entire adult life.
I had improved eyesight.
I drank the solution heated up, it was like drinking highly sweetened tea.

BobM
Guest
I don’t know how to put this politely, so i won’t. The “study” you did on yourself was completely and utterly useless. When y;ou design a study, you design it to change the fewest number of variables possible. Otherwise, it’s impossible to know what caused the effects. For instance, assume you design a study trying to prove that olive oil is good. You eat more olive oil. However, if you eat the same amount of calories, that means you eat less of something else. Are the results you got from eating olive oil or NOT eating whatever it was the… Read more »
Jin
Guest
Hello Bob, Your post is a refreshing change from the “I eat low carb, I fast five days, I get diarrhoea” rubbish post you make every chance you get. In case you hadn’t noticed this is not somewhere filled to the rafters with scientists who are experts at doing studies, its full of lay people who want to learn different strategies for fasting and losing weight. Was it the eating of the sugar which gave me those results or was it the exclusion of something else that got those results? Who cares? The fact of the matter is some nice… Read more »
Determined
Guest

No need to insult people personally. Stick to the issues.

Valerie
Guest

Hi Jin,

Thanks for sharing your experience. I, for one, appreciate your openness and I think we can learn from indivudual experiments.

May I ask, how was your hunger during the experiment? Were you more or less bothered by hunger than during a water fast?

Jin
Guest

Hello Valerie,
Thank you for your kind comment, I can report I was less bothered by hunger. I would generally heat up a cupful whenever I normally drank tea. This would be four times per day.
On three separate days I mixed a teaspoon of salt into the water as “insurance” against low electrolytes.
Hunger was not really a problem. When I was on a water fast I would experience dizziness but no dizziness on the sugar water.

Mark
Guest
Jin, I appreciate your sharing your results with us. I share the concerns of others about the usefulness of the data, but you’re sharing it in good faith and I presume as accurately as you can, so we can all draw our conclusions on what it means. I have done two 14-day water-only fasts in the past year, plus one 9-day water-only fast. On each occasion I had similar results to what you describe with your sugar-water fast. I maintained some weight loss each time I fasted, though there was a significant rebound effect each time. I’m going to do… Read more »
Determined
Guest

This is a website dedicated to those people who are helped by a low carb high fat diet combined with intermittent fasting. I am happy that you lost weight on 600 cal per day.
That, of course, is a natural consequence of eating fewer calories than required for weight maintenance.
We have no need nor do we want you to proselytize your POV on this site. I hope that the moderators of this blog will block you from any further posts!

Jin
Guest

Hello Determined,
Can you show me where it says this site dedicated to low carb high fat diet intermittent fasters?
From my understanding Dr Fung recommends HFLC but he doesn’t think it’s the only way.

Sue
Guest
Jin, Even though Dr. Fung has said other “diets” can work, he clearly feels, for diabetes and weight loss LCHF + IF is the way to go. And Determined is correct, this site is really about supporting each other in embarking on this way of eating and living. As Dr. Fung said, all diets work, all diets fail. What is key is losing weight and keeping it off over a lifetime in a healthy and good way! There is no doubt in my mind that LCHF +IF is your best bet for life time success. And it’s not even just… Read more »
Jin
Guest
Hello Sue, You know I cheer for people who have success with HFLC. I have no issues with HFLC at all as long as its working. Some people can do HFLC for years and thrive, others have great success initially but then the benefits start wearing off and others for whom HFLC does nothing. Things always evolve nothing stays the same, HFLC will evolve as well. As Dr Fung himself said its good to shake things up once in a while if things are stagnating and that is all I have done, a way to shake things up if you’re… Read more »
Christopher Chadrick Hamilton
Guest
Christopher Chadrick Hamilton
That’s an interesting experiment, but I wonder if your conclusions are valid? The real issue with eating sugar is hormone imbalance, not weight loss. Theoretically you could fast six days a week and eat nothing but twinkies on the seventh day and end up with many health benefits including weight loss, but not nearly as many benefits as eating high quality food on that seventh day. A week of experimenting is not enough time to find out if something works as a dietary regimen. You can lose weight on a reduced calorie diet for nearly a month before your metabolism… Read more »
Sue
Guest

Thanks for sharing Christopher! And you are correct. Until you have long term success then you really can’t claim victory. I will say however, LCHF + IF has worked in every capacity for myself and my husband and I have a friend who has been on this “diet” for 10 years and continues to have great success. Enjoy the journey! Cheers!

Jin
Guest
Hello Christopher, First of all congratulations on taking charge of your health and moving it in the right direction. One minor correction, I did it for 14 days not 7. I did eat 150 grams of sugar everyday not just at the end. You are right about the real issue being hormonal imbalance. Millions of people are under the impression sugar is the root cause of diabesity. From what I have read lately on various blogs I had serious doubts about this and I wondered how I could convey those doubts to others. In the UK we had tv show… Read more »
Erin
Guest

Your results makes sense. I’ve done the master cleanse for 14 days on 2 different occasions. It involves drinking a lemonade concoction that has a lot of sugar (from pure maple syrup), though I don’t know the calorie content. I lost ~12 pounds both times.

Sue
Guest

Just curious, have you kept the 24 pounds off?

Erin
Guest

I went back to my prior unhealthy eating habits both times and gained the weight back. Now I believe if I had done IF afterwards I wouldn’t have gained it back.

Jin
Guest

Thanks Erin, I just wanted to focus in on sugar.

Elaine in Big D
Guest

Hi, Jin, thanks for posting your n=1. Very interesting. Don’t let the alligators get you down, as they say. The truth is not afraid of questions. We are all so individual in metabolism, your ideas could spark additional ideas that help someone down the road.

Emily
Guest

Jin’s experiment is very telling. I would wonder at years down the line if such a thing was followed regularly, even a few times a year.
Consequences appear after a life of toxic eating, not saying Jin’s experience would do that. Just wondering. But, Dr. Fung’s wisdom to shake things up are well taken.

Jerome Benthamite
Guest
Over and over again in my research on health related issues I find bad pharma as the cause. The answer is simple as to what is going wrong: Bad Pharma has taken over the production of information fed the doctors and public, through their KOLs (Key Opinion leaders). Think like a CEO of a pharmaceutical company who is fulfilling his fiduciary duty of maximizing profits: thus longer and higher dose is better, and of course new is better than older off patent. Claiming antibiotic resistance helps with sales thus its incidence is inflated. It is as Dr. Ben Goldacre writes… Read more »
Andrea
Guest
Dear Dr. Fung – I love all of your posts! I find them very inspiring. I love your common sense approach to these issues that seem to plague virtually every doctor I have ever seen. We have been bamboozled by the medical profession and the media about our health. We get bombarded with conflicting messages all of the time which leads to people feeling totally helpless about our own bodies and health. How did you manage to go through medical school and still come out with COMMON SENSE! I hope future doctors will be able to think for themselves with… Read more »
deirdra
Guest

Dr. Fung, did you come up with “eminence based medicine”? It is a fantastic way of describing it!

MR
Guest

I always thought that taking the full 14 day course was important to prevent resistance. The logic being taking only a few days exposed the bacteria to the medicine and allowed the survivors to adapt and propogate. By taking the full course, you ensure that there is not any around to propagate the adaptation. This seems logical to me. So you are saying this is not how it actually works?

Faith
Guest

This is what I have always thought too.

bachcole
Guest

Jason, I think that you will find that there are a lot of “logical gaps” in medicine, especially in the areas of degenerative diseases.

Chris S
Guest

It seems to me that over use of antibiotics may also contribute to the obesity problem in that we destroy a number of good things, not just the bad guys – rather like a scorched earth policy. Like many things, we seem to look for a simple, single factor, zoom in on it and then wonder why it didn’t pan out the way that we were hoping. Plenty of flaws to go around in any discipline.

bachcole
Guest

I also love “eminence based medicine” instead of “evidence based medicine”. It is sort of like Robert Mendelssohn’s (I think) “edifice complex” (Having impressive pieces of paper from impressive institutions of higher learning) on one’s wall.

Marie
Guest
Hi Dr. Fung, Thank you for this timely article. Right now I am on antibiotics (Cipro) and am having a difficult time with them. I have a problem with recurrent ear infections. Interestingly, the doctor at the medicenter told me that recurrent ear infections are common with diabetics. I was shocked, since this was the first doctor who ever told me this. He told me that diabetics have particular problems with fungal infections. Anyway, the culture that he took does warrant antibiotics in my case. Because I didn’t start “feeling better” in two days, I went back hoping that the… Read more »
Wenchypoo
Guest
So when are doctors going to realize that PRObiotics (much more positive-sounding, right?) can do the same job as ANTIbiotics? I recently had a go-round with my vet concerning my female cat’s pancreatitis. The cat threw up the prescribed antibiotic, and it was the one favored for her condition. A co-worker vet prescribed a course of probiotics, a prescription cat food, and a week later, the cat was back on the road to wellness. Probiotics and the right diet win again!! I seem to learn most of my health info through cat happenings, and usually end up resolving them with… Read more »
Marie
Guest
Hi Wenchypoo, Thank you for this reminder of probiotics. Over the years, I have tried so many different probiotic supplements, but have not had a lot of success with them. Do you know of any brand that actually works? I was trying daily yogurt for awhile; however, that only lasted for a bit. I’m wondering if there is a yogurt brand that is better for medicinal properties. This is something I would like to add to my daily diet on a regular basis. I, too, have found that I learn a lot for my own health in helping sick cats.… Read more »
Wenchypoo
Guest
Yogurt, unfortunately (in America, anyway), is loaded with sugar, so it’s no wonder it didn’t work for you. Try straight probiotic supplements from a health food store–yes, they’re capsules that may or may not have to be refrigerated,and yes, you have to take them first thing in the morning, and again 30 mins. before dinner, but you’ll find you have no gas, no bloating, and no more sickness (or so it seems). Yogurt in America is more a junk food than a medicine–turn a carton around to look at the hideously low fat content and high carbage (even the so-called… Read more »
Sue
Guest

Wenchypoo, you are entirely right!

Marie
Guest
Hi Wenchypoo, Yesterday I went to my local health food store and picked up a product by Renew Life called “Ultimate Flora”. It says it is ultra potent with 100 billion active cultures. I also picked up a new yogurt by Bles Wold that I have not seen before. On the lid it says that it is all natural farm yogurt. On the front of the container it says that it has active probiotic cultures. I will give these two products a try and see how it goes. I really think that I need to start thinking of my Vitamin… Read more »
seebrina
Guest

So true about vets. I avoid them unless its a traumatic situation. Every animal i ever adopted had issues I believe due to all the vaccines and medicines given, not to mention the wheat , corn based diet they wean them on. In contrast I aquired a kitten who had no intervention and was healthy as a horse his whole life and beautifully built to boot. He was kept inside all his life in case your wondering so away from others. I always intervene naturally whenever possible.

ANA
Guest
Hello everyone! – I’m from Brazil, I follow Dr. Jason Fung blog a long time and use of all the valuable information that he places here. I am not diabetic but had severe obesity, 127 kg in two years I with 104 kg and losing weight slowly but much health, making fasting and also removed all industrialized, gluten- and sugar. I had an accident and hurt his head with deep cuts and back injury had in the basin, made many points in my head. The doctor prescribed me antibiotics and recommended to take without fail for 7 days, I did… Read more »
Jin
Guest

Hello Ana,
Dr Fung has posted about the autophagy effect of fasting on this very blog. Type the word in the search box, it is a very interesting article

honeycomb
Guest

Dr Fung .. thought you might find this interesting ..

http://mobile.nytimes.com/blogs/well/2016/08/12/light-pollution-may-take-toll-on-muscles-and-bones/?_r=0&referer=http://www.drudgereport.com/

I know .. I know .. in rats ..

“During the study, the rats exposed to continuous light had less muscle strength and developed signs of early-stage osteoporosis. They also got fatter and had higher blood glucose levels. Several markers of immune system health also worsened, according to the report published in the medical journal Current Biology.”

Dorothée
Guest

It’s funny you use “less is more” as a title to talk about something else than fasting… As this is exactly the title of a book from Otto Buchinger, who was one of the physicians who developped fasting as a therapeutic method in Germany.

Maura
Guest

80% of antibiotics sold in the US are sold to the farming industry, what doctors prescribe is a nothing by comparison, this needs to be addressed as well as we are eating the antibiotics when we eat meat and they are probably also to be found in the environment

Ward
Guest

Could you people limit your comments to Dr Fung’s post. Enough with the unrelated hobby horse posts!

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