I was very pleased to receive my issue of ‘Your Bladder Health’ magazine from Bladder Health UK this month, because I had been struggling for blog ideas! I always get a bit panicky if I’ve not thought of a topic by mid-month. To be honest, I’m amazed that I keep managing to find stuff to write about – one of these days I will run out of ideas! Anyway, ‘Your Bladder Health’ arrived a couple of days ago and I thought I’d read through it and see if there was any inspiration to be found there. Thank goodness, there was!

On page 37, there is an announcement that the book ‘Cystitis Unmasked’ by Professor James Malone-Lee was released earlier this year. I wasn’t aware that he was writing a book, but I ordered my copy a few minutes before I began writing this blog and I very much look forward to reading it when it arrives, as his name has been mentioned to me by customers a few times over the years! In fact, I think some of you might be under his care. I know a lot of you will be aware of him already from previous issues of ‘Your Bladder Health’ and from online forums.

For those who are not aware of Professor Malone-Lee, I suggest you Google him. I don’t really want to write too much about him, because he is not the topic of this blog post and I don’t want to risk causing any kind of offence if I somehow misrepresent him. To the best of my knowledge and in very brief and simple terms, he specialises in treating lower urinary tract symptoms and he usually uses long term antibiotics to do this. Long term as in sometimes over a year, which is obviously well at odds with the three days of Trimethoprim you might get from a GP! He seems to have great success with this approach, as you can see in this article. Professor Malone-Lee believes that the thing we call interstitial cystitis is actually caused by embedded infection in the lining of the bladder and he treats it accordingly. He believes standard urine testing is unfit for purpose and is trying to change the way that GPs and urologists approach chronic bladder pain. I think we can all agree that that is a very noble cause and I hope his book will help with that!

Also featured in this edition of ‘Your Bladder Health’ is a piece about Candida albicans and recurrent thrush (pages 32 – 36). This, along with the announcement of ‘Cystitis Unmasked’ gave me a flash of inspiration for this month’s blog post! I am going to write about how to mitigate the negative effects of frequent or long term antibiotic use.

As ever, please note that I am not a doctor and nothing in this post is intended to constitute medical advice. These are purely my thoughts and opinions and are for entertainment purposes. Please always consult with a qualified healthcare practitioner before embarking on any treatments, or before making dietary or lifestyle changes. 

Although I am Tiny Pioneer and the daughter of a medical herbalist, I am by no means opposed to conventional medicine. I’m simply selective about how and when I use it. On my bedside table, valerian capsules, L-tryptophan capsules, passiflora capsules and mirtazapine tablets sit happily together (you know I don’t always sleep well!). They share the space with two torches, a candle, and a lava lamp, if you’re interested. If I get period pain I take a herbal tincture that works for me far better than paracetamol, but if I get a headache I take paracetamol, because I think they work better for ordinary headaches than anything else! And if I get a UTI or an ear infection, you had better believe I am first in the queue for antibiotics.

If it was the case that I had severe, ongoing bladder pain that did not respond to any natural approaches, I believe I would consider Professor Malone-Lee’s approach of long-term antibiotic use. It isn’t something that I’d want to try first, but if short term antibiotics and things like D-Mannose, high-potency aloe vera, marshmallow, quercetin, palmitoylethanolamide, dietary changes, natural antimicrobials and leaky gut protocols had all drawn blanks, then I would be willing to try long term antibiotics if the pain of the condition was rendering life too miserable to bear. In short, if the potential benefits outweighed the potential drawbacks and other avenues had failed, I would do it. I would also do it before I would consider more invasive approaches like instillations or cauterisations. Start with the least risky and move up would be my approach! That’s just me though!

Antibiotics are marvellous things and I definitely would not want to live in a world without them. However, their effect on gut bacteria is well-documented, as this article demonstrates. In its conclusion, the article says, “Antibiotics have an impact on the gut microbiota, causing rapid and diminished levels of bacterial diversity and increases and decreases in the relative abundances, leading to dysbiosis.” If you’re not familiar with the impact of gut health on general health, I suggest you check out my post on leaky gut and my review of Cambridge Nutritional Sciences before resuming reading this blog post.

As I understand it, Professor Malone-Lee favours the use of narrow spectrum antibiotics in his long term treatments. I might be mistaken about this, but that is my understanding. I am no expert in antibiotics and there are over 100 different types, so I certainly can’t tell you which types target which bacteria! What I can tell you though is that broad spectrum antibiotics have a sort of ‘kill all’ approach, whereas narrow spectrum ones are more selective and kill only specific target strains of bacteria. For this reason, it is likely that narrow spectrum antibiotics have a less devastating effect on the gut microbiome than their broad spectrum counterparts. Nevertheless, most chronic bladder pain patients are prescribed multiple courses of antibiotics before they even receive a diagnosis, so it is no surprise that many of them develop issues with thrush, digestive symptoms, or other symptoms indicative of a compromised gut.

Although I will certainly take antibiotics when I am unfortunate enough to need them, I always take extra care of my health during the course and in the immediate aftermath. If I needed to be on antibiotics long term, I would be all the more vigilant about this. I speak from experience when I say that a compromised digestive system and the wider health issues it can bring are no fun at all. However hard you subsequently try to repair things, I think it’s very difficult to achieve the same robustness as someone who is just born with favourable microbiota and durable guts! We all know someone who can eat whatever they like, drink more than is good for them, neglect any kind of supplement regime, pay no attention to not touching their mouth or eyes when out, and yet enjoy wonderful health all the time! If reincarnation is a thing, I’m coming back as one of those people – they’re usually enviably laid back about life as well!

Here are the things I would do if I were going through frequent or prolonged courses of antibiotics:

I would restrict sugar consumption, including from sugar-rich fruits, and would follow a lower carbohydrate diet than usual.

I already eat a fairly low sugar diet (and I don’t use sugar-free junk foods like diet fizzy pop or sugar-free sweets either), but because I view my way of eating as a permanent way of life and not a fad, I do allow myself some sweet treats. Don’t get me wrong, I’m not talking slices of cake or tubs of ice cream. I said goodbye to those years ago. But I do have a splash of maple syrup on my breakfast and I enjoy a Booja Booja chocolate most days. I’m also not as puritanical about hidden sugars as I was when I followed an anti-candida diet – for example, I will eat things like honey roasted ham or sweet chilli salmon as long as the sugar content is still reasonably low. I have three pieces of fruit daily and I eat carb-rich foods like gluten-free flours and sweet potatoes. I view my diet as a permanent lifestyle, not a short term fad, and so it is important to me that I generally enjoy the things I eat and have things to look forward to. During a course of antibiotics, I would cut down on fruit and would choose only low-sugar varieties. I would also reduce the size of my breakfast, which is my most carb-rich meal of the day (yes, nutritionists – I know that’s not ideal!) and would sacrifice the extra little sweet things and hidden sugars.

I would take a range of natural antifungals to kill off any bad bacteria that might attempt to beat the good bacteria in the growing back race!

Broad spectrum antibiotics can be a mixed blessing. They decimate the gut microbiome, taking both the good guys and the bad guys with them. If we’re careful, this affords us an excellent chance to ‘Build Back Better’ as world leaders are currently fond of saying! In the aftermath, if we’re not careful, it also affords less desirable bacteria the chance to gain a foothold before the good ones. I think I should write a dedicated post about antifungals at some stage, but things like capryllic acid, oregano oil, grapefruit seed extract, pau d’arco, garlic and berberine are a few common ones. I actually have antifungals in my daily regime, because I’m quite a stressy person with a lot of food intolerances – ideal conditions for candida! I always, always take extra varieties and in higher doses during and after antibiotics.

I would take extra gut healing agents like L-glutamine and collagen.

If you are not intolerant to casein, you could also use colostrum. Nutrients such as zinc, quercetin, vitamin C and PEA might also have roles to play in maintaining the integrity of intestinal tight junctions, so I’d be sure to take extra of those as well, although most of them are part of my daily routine anyway. I already take L-glutamine twice a day because of my history of IBS, leaky gut and food intolerances. I have occasionally stopped it for months at a time, but I feel more secure when it is part of my regular routine, and during/after antibiotics I would take more than usual.

I would take plenty of probiotics.

Again, probiotics are part of my daily routine anyway, but during and after antibiotics I would take extra to give my gut the best possible chance at repopulating with favourable strains of bacteria. Some people feel it’s a waste of time to take probiotics until after a course of antibiotics has finished, but I think it’s best to take them during the treatment as well. Even a broad spectrum antibiotic isn’t going to wipe out every single bacterium in the gut – it might wipe out a lot, but not absolutely all of them – so to me it makes sense to keep topping up the good ones! Certain strains of probiotics are themselves effective at reducing harmful bacteria, so I feel like if you take probiotics during antibiotic treatment, the bad guys are getting a double whammy! In some countries, it is normal for doctors to actually prescribe people a course of probiotics after they’ve had antibiotic treatment, but for some reason that doesn’t happen here. During and after a course of probiotics, I’d want to get at least 10 billion a day CFU – more if I could. Don’t ask me which strains – I’ve really no idea. It always takes me forever to choose a probiotic and I’m always riddled with doubt that I’ve made the right choice!

I’d eat extra raw fermented food.

I eat sauerkraut every day anyway, but it is delightfully low in calories, so there is no reason why I couldn’t really load up on it during and after antibiotics. I also eat kimchi and drink kombucha and jun. I don’t use any dairy based fermented foods, although you could do that if you are able to tolerate dairy (making sure not to choose brands with added sugar!). You could also use things like kvass, miso and tempeh if your dietary requirements allowed. Remember, raw and unpasteurised is the key. The reasoning is as for probiotics – I’d be loading up on good bacteria and hoping they’d beat the bad bacteria to the fresh new gut ground!

I wouldn’t drink alcohol.

I don’t anyway, but if you’re on antibiotics and for a while afterwards, I’d definitely recommend abstinence. It isn’t great for gut health and it depletes your immune system. (Be honest, you’re not really all drinking a single glass a night of exceptional quality red wine, are you?)

I’d incorporate prebiotic foods or supplements into my diet.

The bacteria in your gut – both good and bad – need food of their own to survive. And they eat prebiotics! Prebiotic foods include Jerusalem artichokes, garlic, onions, leeks and bananas. You can also buy prebiotic supplements – Lamberts FOS tastes like candy floss!

I wouldn’t eat processed food or junk foods.

Again, this is not something I really do anyway these days, but I’d certainly be very strict about it if I were taking antibiotics. No takeaways, no cheap bacon, no low-quality ready-meals, etc. if those are the sorts of things you do sometimes eat.

I’d keep my meat organic, if possible.

This is something I do anyway as much as I can afford, but I’d be especially strict about it during and after antibiotics.

I’d be extra vigilant about avoiding pathogens.

The gut plays a hugely important part in immunity and if the microbiome is compromised from antibiotic use, we are left vulnerable to other illness. We’re obviously already in a weakened state from some existing infection if we’re on antibiotics, so the last thing we need is another infection to contend with! Remember, antibiotics are only effective against bacteria, not viruses or fungi. I’d clean my food carefully, cook it thoroughly, would practise frequent hand washing, wouldn’t put my fingers in my mouth, would try to stay away from ill people, would try to avoid eating out, and would take extra vitamin C and D.

I’d try to avoid stress.

We can TRY, right?! Our immune system is already doubly weak from infection and a compromised gut microbiome. No need to drag it down even more by exposing ourselves to more stress than strictly necessary. Maybe delay a long journey, a serious discussion with a spouse, or working overtime all week until you are in a stronger position. And try to get enough sleep. Again, I know it isn’t always possible.

Okay, that’s everything I can think of for now! It’s never ideal needing to take antibiotics, but there are times when it’s necessary and like I said earlier, I’m very glad to live in a world where they exist. If any of you have had to use antibiotics on a regular basis, of if any of you are going to be on them for the foreseeable future, hopefully some of the things here will help you to emerge with a robust and healthy gut!

Until next time,

Tiny x

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