A new study has found that several types of common medications may have a lasting impact on gut health.
- The gut microbiome, comprising
bacteria, fungi, and yeasts, plays a crucial role in human health.
- Disruption of the microbiome is
associated with numerous chronic health conditions.
- It has long been known that
antibiotics affect the gut microbiome, killing both beneficial and
pathogenic bacteria.
- Now, a study has found that
other prescription medications also negatively impact the microbiome, and
their effects can last for some years after stopping the medication.
A
recent study has found that many prescription medications have a lasting impact
on the gut microbiome, which can persist for several years.
The study, published in
the American Society for Microbiology’s Journal mSystems,
found that, in addition to antibiotics, antidepressants, beta-blockers, stomach
acid reducers, and anti-anxiety drugs, these substances could
continue to disrupt the microbiome long after use.
Babak Firoozi, MD,
board certified gastroenterologist at MemorialCare Orange Coast Medical Center
in Fountain Valley, CA, welcomed the study, but urged caution when interpreting
the findings:
“The methodology was robust, and convincingly linked changes in gut microbiome to medication uses, but this was not a controlled trial. There are far too many variables that cannot be accounted for, such as environmental factors, diet, geographic location. The most surprising finding is how many classes of drugs appeared to have influence on the gut biome.”
Assessing the effects of many drugs
The researchers utilized
data from 2,509 adults in the Estonian microbiome cohort, a component of the Estonian biobank — a
population-based databank of volunteers in Estonia.
The
volunteers, who were ages between 23 and 89 years, provided blood, cheek swab,
and stool samples. The researchers then used
They
accessed details of participants’ current and historical prescription drug
usage from their electronic health records.
At
the time of the first sample, participants were using a total of 433 different
prescription drugs, and in the five years preceding it, they had used 507
different medications. Just over one-third of the participants (857 people)
were taking no medications at the time of the first sample, and those taking
medications were using, on average, three different types of medication.
The researchers did not assess the effects of antibiotics at the first time point, so they excluded anyone who had taken antibiotics within 90 days of the first sample, but the second sample was assessed for the effects of antibiotics.
Measurable changes in microbiome from 7 medications
In total, the
researchers analyzed the effects of 186 drugs. Of these, 167 affected the
microbiome in some way, and 78 showed long-term effects on the composition of
the microbiome.
Measurable
changes in the microbiome were seen in people who had taken the following
medications:
- Antibiotics — medications that treat
bacterial infections by killing bacteria or stopping them from multiplying
- Antidepressants — these increase
neurotransmitters in the brain to relieve symptoms of depression
- Antipsychotics —
medications that treat psychosis associated with some mental health
conditions, such as schizophrenia and bipolar disorder
- Beta-blockers — medications used to
treat cardiovascular symptoms, such as angina and high blood pressure
- Biguanides — metformin,
used to treat type 2 diabetes
- Proton pump
inhibitors (PPIs), which reduce stomach acid to treat acid
reflux, heartburn, and stomach ulcers
- Benzodiazepines, which are prescribed for
anxiety and sleep disorders.
What
medications had the greatest effect?
As well as
antibiotics, beta-blockers, benzodiazepine derivatives, glucocorticoids, PPIs,
biguanides, and antidepressants all had effects on the microbiome that were
seen many years after previous drug intake.
The
researchers found that the longer people took medications for, and the more
medications they took, the greater the effect on the microbiome. Multiple
medications appeared to interact and have a greater impact on the microbiome,
but for individual drugs, it was benzodiazepines that seemed to have the
greatest negative impact.
In
their paper, the authors warned:
“Given
that human-targeted drugs are often taken continuously throughout life, not for
short periods, which is the case for antibiotics, the physiological effects can
be even more profound.”
“Our
findings highlight that even past drug use can leave a lasting imprint. At the
same time, we found that even within the same class of drugs, individual
medications can affect the microbiome in very different ways. If two drugs work
equally well, doctors may opt for the one that has a smaller impact on the gut
microbiome.”
— Elin Οrg, PhD,
study co-author, head of the Microbiome Research Group at University of Tartu
Even
within drug classes, medications had different effects. For benzodiazepines,
which are commonly prescribed anti-anxiety drugs, alprazolam, sold as Xanax,
was found to have a much broader impact on the microbiome than diazepam
(Valium).
“The
noted difference in the effects on the microbiome by alprazolam versus diazepam
might be a valuable input for future therapy decisions and warrants further
investigation,” the authors noted.
How do drugs
affect the gut microbiome?
Since the
A
healthy microbiome is a stable community with high diversity of microorganisms
and high microbial gene richness that lives in balance with its human host.
However, factors such as diet, antibiotics and, age can change the gut
microbiome, often adversely affecting health.
Disruption
of the microbiome, or dysbiosis, is
linked to diseases including inflammatory bowel disease (IBD), obesity,
allergic disorders and asthma, Type 2 diabetes, cardiovascular diseases, and
autoimmune disorders.
Antibiotics,
particularly broad-spectrum antibiotics kill off beneficial bacteria in the gut
as well as the bacteria that they are intended to destroy to clear infections.
Other
drugs, however, act in different ways, as Firoozi explained:
“In
a broad sense, medications such as anti-depressants, beta blockers, and
benzodiazepines can affect intestinal motility which in turn likely has an
effect on gut bacteria by slowing transit through the intestinal tract. Proton
pump inhibitors have long been linked to affecting the gut microbiota mostly
through eliminating a key defense against bacterial growth, namely gastric
acid.”
He suggested that benzodiazepines might also impact a person’s gut microbiome by changing their eating habits, and diet is closely connected to the health of the microbiome.
How can you minimize negative effects of prescription medications?
While
emphasizing that people should follow their doctor’s instructions, Firoozi
recommended taking medications only as prescribed and only for as long as
needed.
“Particularly
with benzodiazepines, long-term use should be strongly discouraged, as it
easily leads to dependency and is linked to cognitive decline. For PPI
medications, the need to continue the medication should be discussed at least
every 2 months, with every effort to try and wean off the medication,” he
advised.
He
also recommended following a high fiber, low fat diet, minimizing red and
processed meats, eating fewer processed foods, and taking regular exercise to
promote overall gut health.
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