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Crohn's Disease Forum » General IBD Discussion » Could antibiotics contribute to IBD?


07-20-2013, 12:43 PM   #1
DLTooley
Could antibiotics contribute to IBD?

I have questions about antibiotics possibly contributing to some forms of IBD. I'm in the middle of being diagnosed and had a very negative experience with a round of flagyl that was given (unwisely) to rule out giardia - I'd definitely view it now as a 'flare' - though my blood sugars were also out of control as my diabetes was also just coming back. No vomiting, but I was bedridden for 2-3 days with fatigue and massive malaise. I also had my most serious extraintestinal episode start at this time.

My current situation has been going on six months, but I also had a round of flagyl last summer for a real case of giardia and in hindsight that also seemed to effect me similarly, though not as severely.

I am familiar with antibiotic use and the incidents last summer continued for awhile after use - most notably with some 'hawkwing' mushrooms that have the reputation of being tough to digest for some - and which knocked me out for a couple of days. This was about 3 weeks after finishing the flagyl. In general I spent a lot of time between 9,000 and 12,000 feet during that same period and was experiencing symptoms that made me think my sleep apnea machine was working at the altitude- primarily fatigue and related. We are testing that again this summer and the preliminary is negative on the apnea cause.

Last edited by DLTooley; 07-20-2013 at 12:48 PM. Reason: More detail
07-20-2013, 01:45 PM   #2
nogutsnoglory
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There is definitely a role between antibiotics and IBD activity but I have seen no conclusive studies indicating antibiotics can kick in this disease.

There was a study indicating children exposed to antibiotics were at increased risk
http://www.webmd.com/a-to-z-guides/n...ease-risk-kids

The medical community is not clear what causes IBD but it is thought to be a mix of genetics, poor immune function and environmental factors that contribute.

Broad spectrum antibiotics kill all bacteria in the gut, good and bad and have been used to fight inflammation and infections that occur due to IBD. On the flip side strong antibiotics causing GI distress due to upsetting the flora can also cause a flare up.

Here is some useful info on antibiotics from CCFA http://www.ccfa.org/resources/antibiotics.html
07-20-2013, 01:49 PM   #3
Kev
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My very crude knowledge (mostly anecdotal and extremely fallible) is that anti- biotics do not discriminate between good/bad intestinal flora... so, in use, they wipe out your healthy.. or pro.. biotics. Hopefully, they do similar damage to the bad bugs within your system. Now, what I've heard is... when you wipe out both good and bad, the bad are able to rebound faster than the good... and the loss of the good can play havoc on how you feel... and .. with the loss of the good... suddenly you have all this vacant space for the bad to rebound to. Like I said... that is my layman's take on what can happen with anti-biotics. If the anti-biotics permanently wipe out the bad biotics.. well, that's a best case scenario.. and your body will eventually return to feeling better (adding pro biotics to your diet may help). But, if it doesn't work completely (I once read that these colonies of nasty critters had.. inert, inactive, dormant members whose purpose was not immediately clear to researchers. But, when the colony is wiped out, these dormant ones would spring back to life.. and colony re-established). Possibly explaining the long held knowledge that, once you start anti-biotics, you stay on them until completed, else the rebound issue would kick in.. and possibly result in an anti-biotic resistant strain of the bug. Who knows? I don't. No medical training or expertise at all. I do know that my 1st GI put me on flagyl, but it knocked the stuffing out of me, but I toughed it out. Then, when it was apparent that it wasn't working, he admitted the success rate was only about 20%, but that it had to be tried anyway. Hmmm, who writes these rules?
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07-20-2013, 02:04 PM   #4
DLTooley
I'm pretty sure the antibiotic 'distress' did cause a flare, but I'm also still developing my awareness on those.

I made sure when I stopped the flagyl to eat a lot of good quality probiotic yogurt and it worked much better than it has otherwise. I was reading another thread on antibiotics and they suggested taking probiotics during your med course, but at a different time than when you take the meds so you aren't immediately killing all the good stuff. I am going to try that if/when it occurs again.

One point that the GI office made was that if you are eating too much yogurt you will counter act the positives, even if not lactose intolerant. That does seem to be the case with me.

Continuing on the yogurt tangent - I've been a fan of the good stuff for years and though it is still positive those benefits seem to have been reduced by whatever I've got. One piece of advice that I've heard is that it is better to buy plain as it has more pro-biotics than the flavored - then flavor it yourself prior to eating it. My favorites are Nancy's and the Stonyfield Whole Milk Plain. Greek Gods is also great as are the newer european varieties, Fage and Chobani come to mind. The honey 'greek gods' is luscious, super healthy, and not too expensive if you consider how rich it is.
07-20-2013, 02:09 PM   #5
nogutsnoglory
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Absolutely, I was doing relatively well and went on Avelox for bronchitis and spiraled into a horrible flare.

Studies show antibiotics coupled with probiotics reduce diarrhea. I definitely find that to be true. I also take the probiotic several hours away from an antibiotic to ensure that it is effective.
07-20-2013, 02:10 PM   #6
DLTooley
I just read those links from 'nogutsnoglory', it sounds like antibiotics are good for Crohns, which I'm pretty sure I don't have - but not UC - which is possible. FWIW, the WebMD link on childhood antibiotic use and IBD is broken, it looks like they moved or removed the article.
07-20-2013, 02:30 PM   #7
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I agree with Kev, your gut flora is part of your immune system, it's the first defense against pathogens. It's possible that if you deplete this flora, you allow a pathogen to prosper or enter into the submucosa, in fact that's how people get C Difficile.

Hmmm, what I don't think is happening is that dysbiosis alone is enough to cause any immune response, China has been abusing antibiotics for decades (they're abusers of antibiotics, not just users), and they have had very low rates of crohn's disease for decades, it's only very recently that they're catching up with the West, without anyone being able to explain why. They blame "Westernisation", well that doesn't really mean anything to me, it's a broad sweeping term that doesn't help explain why their crohn's disease rates are going up.
07-20-2013, 02:31 PM   #8
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The link works for me http://www.webmd.com/ibd-crohns-dise...ease-risk-kids
07-21-2013, 11:51 AM   #9
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I think probiotics are extremely important to take when you have any type of digestive disorder, and especially important to take when you are on antibiotics. I don't mean just eating a little yogurt, that is not enough. You need to take pretty high doses. I have to be on a low dose antibiotic( augmentin) daily to help keep the bad urinary infections I kept getting at bay. I take A LOT of probiotics and a few different kinds. I take one called 50 billion by renewlife. I take on capsule twice a day. I also take one called florajen3. I take another probiotic called florastor. This probiotic is a type of yeast that is suppose to keep the gut flora healthy. Antibiotics cannot destroy this one. When you are taking antibiotics I think it is best to take the probiotics while taking them. Just separate them by 2 hours at least. I also eat yogurt with active live cultures as well and try and avoid sugar as much as possible.

As far as to whether antibiotics cause IBD, well nobody really knows. I mean I think it all depends on the person and their body. No one really knows what causes Crohns or any of these diseases. Some say it has something to do with the foods we eat( GMO's and toxic preservatives that are put in our foods), some say it is environmental, and some say it is genetic. In other words, they have no clue. One thing I do think though is that there is some link in the foods we eat. I mean years and years ago crohn's was not even heard of,but then our foods were not being messed with and genetically modified either back in the days. In fact, everything was eaten in it's whole state. I myself try and eat as organic as I can and stay away from foods that have been processed or modified in any way.
07-21-2013, 06:19 PM   #10
Kev
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Well, probiotics are just a good idea all round. But, there is a catch. Or, at least a link to an article I read on the topic on here some years back. Seems that you shouldn't use a number of different strains of probiotics... Why? Well, if you take multiple strains of good biotics in yogurt. whatever... for some bizarre reason they end up competing with each other and NOT with your bad biotics. How, why, I don't recall reading. Maybe no theory was advanced. Maybe it was too deep for me to comprehend. And there is the chance that this theory has since been discredited. But, to be on the safe side for now, if you do take pro-biotics, find one you like, that works, and stick with it until you find evidence to the contrary. I guess, if one looks at it logically, in order to exist, bad biotics must be able to establish a toe hold within us and then out compete the gooduns
07-22-2013, 10:56 AM   #11
Ihurt
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Hmm, interesting theory. I know that when I was seeing a integrative medicine doctor awhile back she said it was important to take a probiotic that has many different strains of different bacteria. She said different bacteria work for different issues. She said the healthy human gut is filled with tons of different bacteria. Like for instance I take a probiotic by florajen that has high numbers of acidophilus in it as well as another bacteria that is good for women's health. Then I also take one by renewlife that has many different strains of bacteria in it. I was always told the more strains of good bugs, the better. But you theory is interesting too.

I really do not know what to think. I was talking to my gastroenterologist when I last saw him. I had a colonoscopy done in April and I know that the whole clean out prep Is very hard on the gut and wipes out a lot of the good flora. Well he knows I am on probiotics, but I asked him how I would go about getting them to re-establish faster ( I am on low dose antibiotics all the time to combat the nasty urinary infections I get which is why I take such high doses of probiotics). Well he said to eat high carb diet, he said this feed the bacteria. I found this odd because everything I read about Crohns and other digestive issues is to cut out most of the carbs as it feeds the bad bugs and helps them grow. I told my GI this and he said yes, this is true, but he then said when you starve out the bad bugs by cutting the carbs, you also starving out the good as well! So now of course I am confused by the whole issue. I do not eat many carbs anyhow because I am Gluten Free. But it just gets confusing with all the different theory's out there.
07-22-2013, 06:12 PM   #12
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Hey, wasn't my theory ;-) I was surprised when I read it.. but it made sense in a perverse sort of way. I recall there was a brand name yogurt whose advertisements focused on their having the most strains of biotics... then they ceased advertising.. and I can't recall their brand now.. or even whether they are still in business. It might have been coincidence.

Both good and bad feast on carbs and simple sugars... so if you starve one, you starve both, so it really is a no win situation. Now, here is a theory of my own making, and I've got absolutely no evidence to back it up with. These dormant members of the bad group that rebound AFTER anti-biotics wipe out the colony... what if this is some evolutionary response that has occurred as a result of anti-biotics alone. For decades now medical science has been trying to eradicate various/sundry bad bugs using A/B's. What if the bad bugs out there now survived to now because they had/fostered this dormant cell response? I mean.. doctors never targeted good bacteria... they were just collateral damage. How's that for formulating and expressing a theory while talking out my ass... As I was saying, nothing to back it up with. But I've heard from various sources that bad biotics do bounce back faster.. whether after being hit with anti-biotics in your gut, or even just with mouthwash and toothpaste in your mouth. Everything is wiped out, but the bad boys get back on their feet faster. It's a scary thought. Wish I hadn't thought it
07-22-2013, 06:31 PM   #13
kiny
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The first time they discovered the gut flora they actually tried to remove it from people, they thought it must be killing them...since up to that point, all bacteria = bad.

There's an interesting inverse between crohn's disease and tuberculosis. All places where TB is high, crohn's disease is low, places where TB is low, crohn's disease is high.

It might mean nothing, but it's interesting, bacteria are known to compete, not just in the body, in the environment too.
07-22-2013, 07:13 PM   #14
Ihurt
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Kev and Kiny,

Wow, pretty interesting stuff indeed. I have to agree that for some reason after antibiotics were invented, a lot of weird diseases started creeping up. It is like antibiotics are the blessing and the curse. They are great and have saved lots of peoples lives, but they have also causes lots of damage in some as well. Now there are infections that back in the day were easily eradicated. Now these same bugs have evolved and some are becoming impossible to kill and some have even began to form biofilms ( like a cloaking device sort of speak) where they cannot be detected or killed. Pretty scary stuff.

Kiny, it is very interesting about your TB theory. I think you may be on to something there. I mean look at some other diseases like Sickle cell anemia. People who have sickle cell anemia cannot get malaria. For some reason when a person has Sickle Cell Anemia and is exposed to malaria, the sickle cell grabs the malaria and prevents the patient from getting sick from the malaria. So I can see how TB may prevent a person from getting Crohn's.

These bacteria are resilient and are becoming more and more evolved. As scary as it is, I would not be surprised if we ever get a Plague type disease that will wipe tons of people out due to not having any meds that will counteract it. Scary to think about, but very possible. Bacteria are smarter than humans and they evolve very quickly and adapt very quickly which is why there are so many problems with antibiotic resistance now.
07-22-2013, 07:28 PM   #15
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These bacteria are resilient and are becoming more and more evolved. As scary as it is, I would not be surprised if we ever get a Plague type disease that will wipe tons of people out due to not having any meds that will counteract it. Scary to think about, but very possible. Bacteria are smarter than humans and they evolve very quickly and adapt very quickly which is why there are so many problems with antibiotic resistance now.
There will be a bacteria that kills thousands I'm sure, it's not a matter of if but when, there's too many people travelling and people in China live much too close to animals, there is zoonotic outbreak after zoonotic outbreak in China. China has a new outbreak every few months.

Governments have large quantities of new antibiotics that are ready for those cases but they might not even be effective.

I posted an article on antiadhesives to combat AIEC http://www.crohnsforum.com/showthread.php?t=53852 AIEC in crohn's disease are extremely resistant, they become resistant after 24 hours of introducing an antibiotic.

AIEC is an extremely advanced bacteria, it's one of the few that not only survives in an inflammatory environment, but manages to exploit it for it's own benefit, and does so better than any other bacteria.
07-23-2013, 10:10 AM   #16
DLTooley
Something seems to be 'opposing' my use of yogurt as a probiotic, something I've benefited from all my adult life. I've been tested for C. Dif., and that's not it. I'm pretty sure I don't have Crohns, so not sure if the AIEC might apply to me, but it definitely does to this topic.
07-24-2013, 03:10 AM   #17
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oooops i just started a new thread on this.
What i want to know is ARE there any people with crohns who never had anti biotics as a child?
Getting your gut healthy, loading it with good food, rainwater, yoghurt, probiotics, etc does help crohns. eating sugar, breads, grains, sweet fizzy drinks and smoking cigarettes is the worst thing you can do for any illness.
good luck everyone.
no fun having the shits...
07-24-2013, 03:42 AM   #18
kiny
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What i want to know is ARE there any people with crohns who never had anti biotics as a child?
Yes, plenty.

It's not like antibiotics are a major risk factor in developing crohn's disease, it's a small risk factor. The last studies I read about it were 7% of controls had used antibiotics in a 2 year period, and 12% of people with crohn's disease in a 2 year period before developing crohn's disease. It had about 2000 people with CD, and 20,000 controls.

In another study they used only 1 year data prior to diagnosis, and they found no correlation.

But because the studies that find a correlation, show it's dose dependent, people who take higher quantities of antibiotics..or for longer periods..have higher risk than those who take lower doses, there might be some truth to them. If it wasn't dose dependent I wouldn't believe them I think.


There's some issues when you would start to say that antibiotics actually cause crohn's disease I think. There's the abusive antibiotics use in China that has been going on for decades, and they have had, up till now, low rates of crohn's disease. Then there's certain demographics of people who use plenty of antibiotics, such as people with AIDS, and they actually have extremely low rates of crohn's disease. Africa is a big user of antibiotics too, very low crohn's disease rates.

Antibiotics might be a small risk factor, but it's not the cause of crohn's disease.

Last edited by kiny; 07-24-2013 at 03:57 AM.
07-24-2013, 03:54 AM   #19
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Also, another thing is, the first cases of which we can be pretty sure of were crohn's disease (since they could accurately distinguish it from intestinal TB) are from 1913, Dalziel described them. Antibiotics use came later.
07-24-2013, 07:39 AM   #20
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Yes very much so think mine triggered it off had only suffered with it for 5-6 months before I done anything about it. Got admitted October 29th 2011 they tried everything to try and stop the constant flare up. I was going the toilet 30-40 times a day eventually had to have a emergency life saving operation to remove my large bowel. I found out the next day my surgeon said it was the worst he had ever seen! It wasn't doing me any favours what so ever it could of burst at anytime which would of killed me. They had to give me a blood transfusion in theatre. I've just had my second op to remove my rectum 8 weeks ago still in pain and its open my surgeon said it could take 6 months to heal. My rectum was inflamed and still had the disease there. Not sure whether i have crohn's or colitis. but he said there is No sign of any more disease. If I had been joined up it could of come bk or been that bad that they'd have to remove it anyway. I made the right choice I'm happy apart from the pain. I could of hugged him on Monday when I went to see him. Gonna go bk to see him in 6 months just to check my bum wound.
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07-24-2013, 05:06 PM   #21
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thank you Kiny. I was interested to ask...as I had been bombarded with them as a child, but since i havent had them now for several years, i am feeling better and better as time goes by. it might be the Remicade though!!! Or the happy lifestyle, going surfing and living in the country with lots of fresh air and minimal stress. thanks again for your reply.
07-26-2013, 12:23 PM   #22
Ihurt
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That is interesting about China. I always was under the impression that China hardly ever uses antibiotics. I thought they used more herbal remedies and Chinese medicines when they get sick.....








Yes, plenty.

It's not like antibiotics are a major risk factor in developing crohn's disease, it's a small risk factor. The last studies I read about it were 7% of controls had used antibiotics in a 2 year period, and 12% of people with crohn's disease in a 2 year period before developing crohn's disease. It had about 2000 people with CD, and 20,000 controls.

In another study they used only 1 year data prior to diagnosis, and they found no correlation.

But because the studies that find a correlation, show it's dose dependent, people who take higher quantities of antibiotics..or for longer periods..have higher risk than those who take lower doses, there might be some truth to them. If it wasn't dose dependent I wouldn't believe them I think.


There's some issues when you would start to say that antibiotics actually cause crohn's disease I think. There's the abusive antibiotics use in China that has been going on for decades, and they have had, up till now, low rates of crohn's disease. Then there's certain demographics of people who use plenty of antibiotics, such as people with AIDS, and they actually have extremely low rates of crohn's disease. Africa is a big user of antibiotics too, very low crohn's disease rates.

Antibiotics might be a small risk factor, but it's not the cause of crohn's disease.
07-26-2013, 02:46 PM   #23
kiny
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That is interesting about China. I always was under the impression that China hardly ever uses antibiotics. I thought they used more herbal remedies and Chinese medicines when they get sick.....
Naw, they're major abusers of antibiotics, although they're trying to change it.

This reminds me of an article, Chinese kids attached to an IV in class to keep them awake when they study:

07-26-2013, 02:52 PM   #24
Ihurt
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huh, I had no idea. That is crazy about the IVs and trying to stay awake during class! I always assumed the Chinese did not use western meds as much, I always thought they used Chinese meds. They just seem more healthy over there than we do here for some reason... I did not know they abused antibiotics. Are they one of the countries that get them without a prescription over there? I know some countries you can actually buy antibiotics over the counter!
07-26-2013, 02:57 PM   #25
kiny
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They just seem more healthy over there than we do here for some reason...
http://edition.cnn.com/2013/05/28/wo...lages-mckenzie

It's mostly hospitals that prescribe the antibiotics, it's partly malpractice and partly cost, antibiotics are cheap, most medicine is not.
07-26-2013, 03:07 PM   #26
Ihurt
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Thanks for sharing that link. How awful for those people in that village to be exposed to that toxic environment. And I always thought China on a whole was pretty healthy. I mean I know they have issues with Led and other chemicals with not having any regulations with their foods really, but it is just that you don't hear of them having all these orphan diseases that are so wide spread here in the US and in Europe.....








http://edition.cnn.com/2013/05/28/wo...lages-mckenzie

It's mostly hospitals that prescribe the antibiotics, it's partly malpractice and partly cost, antibiotics are cheap, most medicine is not.
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