How long does it take the gut microbiome to ‘bounce back’ from antibiotics?
The last time I had antibiotics was about 16 years ago, when I was visiting a dear friend in the south of France. The reason? A terribly infected and neglected wisdom tooth. Yes, it was as awful as it sounds and it took multiple rounds of a very strong antibiotic to bring the infection under control (it also ultimately ended my European foray as a trip home was required for surgery!).
I was in my early 20s, and pre/probiotics and ‘gut repair’ were the last things on my mind. I was living on a tight budget and thought I was invincible! One thing I did feel though was gratitude. Gratitude for the antibiotics as they took away immense pain, allowed me to eat again and think about something other than my toothache!
The question is, how long did it take my gut microbiome to recover from these antibiotics to my pre-antibiotic state? It's hard to say exactly, but my guess would be that some beneficial microbes returned quite quickly (within a week or two), others took a bit longer (over months) and some probably never returned as I entered into a new and different 'stable microbial state'.
Allow me to explain further...
The time it takes for the gut microbiome to regain healthy bacterial diversity is highly variable. Factors such as the pre-existing health of the gut, a person’s dietary patterns (i.e., high or low fibre), a person’s age, whether they have an appendix or not, the type of antibiotic, the dose and duration of use, and environmental factors (i.e., hospital vs home environment) ALL impact how long it takes the gut to recover from antibiotics. Sometimes it's a relatively quick rebound back to a healthy microbial state, but in some cases, it can take years with a real risk of a permanent loss of beneficial species.For example, after short-term antibiotic use (5-10 days), studies have found that it can take at least one to two months for most bacterial groups to recover to pre-antibiotic levels. However, these studies have also shown that even after two to four years, some bacterial groups do not recover completely, and antibacterial resistance genes can persist at increased levels for at least one to two years following antibiotic use*. This means that even short-term use can have long-term effects on the gut microbiome.
As the treatment duration gets longer and multiple courses are used, there can be “deep demolition” of the microbiome which extends the recovery period even further. In some cases, there is permanent loss of some of our native and beneficial microbes. Our old friends can, and are, becoming extinct.One point I’d like to emphasise is that the gut microbiome after antibiotics is almost always different when compared to the pre-antibiotic state. The ecosystem itself, for better or worse, has changed to create a new norm. As one researcher stated,
“Antibiotic perturbation may cause a shift to an alternative stable state, the full consequences of which remain unknown.”
How much do probiotics help?
Taking probiotics during and after antibiotic use can reduce the risk of invasion by opportunistic pathogens and the development of antibiotic-associated diarrhoea; but it’s likely that different strains of probiotics have different levels of efficacy.
Interestingly, one study also found that certain probiotics may also inhibit the return of the native gut microbiota. The study found it took longer for the native gut microbiota to return in individuals who consumed probiotics for 28 days following antibiotic use compared to individuals who did not take probiotics.
What this means is that are pros and cons to taking probiotics or beneficial yeasts (such as Saccharomyces boulardii which are resistant to degradation from antibiotics) during and after antibiotics. For me, it’s about weighing up the risks vs benefits for each client. In many cases, the benefits outweigh the risks. The probiotic strains and products I recommend depend on an individual’s age, symptoms and diet.
If probiotics are not a silver bullet for recovery, what else can be done to support the gut to recover from antibiotics?
Include prebiotics in your diet before, during and after antibiotics through increasing intake of foods like onions, garlic, leek, globe artichoke, apples, green bananas and legumes; and/or taking a supplemental prebiotic such slippery elm, inulin or partially hydrolysed guar gum (PHGG).
Eat cultured/ fermented foods before, during and after antibiotics. Although the live bacteria they contain may be negatively impacted by the antibiotics, cultured and fermented foods like sauerkraut and kimchi still contain helpful enzymes, fibre and prebiotic actions which still protect and support the gut.
Eat a fibre-rich diet (over 25g/day). It’s abundantly clear that a low-fibre diet aggravates collapse of microbes from antibiotics and delays recovery. Aiming for a cup of vegetables or salad items with each main meal, and eating fruit, legumes, nuts and seeds throughout the day will ensure you’re ticking the fibre box.
For many clients with a history of urinary tract infections, I also recommend a female-specific probiotic immediately post-antibiotics which contains strains beneficial to the female urinary tract to reduce the risk of UTIs, candida or vaginal dysbiosis.
Get into nature as much as possible for exposure to beneficial microbes found in the air, soil and sea. For better or for worse, our environment has a huge impact on our microbial communities, both within and on us.
Stay active. Exercise can positively and powerfully enhance gut microbial diversity.
Get some sunshine. Safe sun exposure also positively influences gut microbial diversity.
And of course, only take antibiotics when necessary and indicated.
As you can see, there are plenty of things we can do to support the digestive system after antibiotics to ensure the emerging digestive ecosystem is as healthy as it can be. For more information on how to optimise digestion, click here.
