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Antibiotics Versus Probiotics

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Dr. Minocha  is a practicing gastroenterologist and author of "Natural Stomach Care: Treating and Preventing Digestive Disorders with Best of Eastern and Western Therapies"

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We are always concerned about everyone around us, not just the people, but animals and even bugs. Why? Because they can affect our safety and well-being!

Have you ever wondered about the world that you may be harboring inside your body? Did you know that the human body is comprised of billions of cells, most of which are actually bacteria? These "foreign" organisms include both the good and the bad variety.

There is a constant tug of war going on between these good and bad life forms. A shift in the "balance of power" in this "cold war" has the potential to affect your health and nutritional status at any given time.

Bowel microflora

Gut is sterile at birth. Bacteria start appearing as soon as the baby starts feeding. These bacteria comprise the bowel flora, which varies not only between different animal species but also between individuals of the same species. The composition of bowel flora also depends upon age, race and diet of the person.

The actual number of bowel bacteria varies in different parts of the digestive tract. The esophagus contains the bacteria swallowed with food, but very few of them survive the stomach acid. The first half of the small intestine thus has low populations of bacteria.

The numbers increase as we move further down the small intestine. There may be as many as 10 million bacteria per ml of fecal fluid in the last part of the small intestine. The populations of bacteria increase even more dramatically in colon.


Colonic food

Colon cannot be nourished by the nutrients in blood alone. It derives a significant proportion of its nourishment from food in the colon. Bacterial flora of the colon depends upon the "colonic food" ingested.

For example, the bowel bacteria of breast fed infants are different from those fed formula. The bowel flora of astronauts changes after an extended space visit. Our body system is intolerant of dramatic shifts in food intake. A change in the proportion of bacteria may allow the bad to overwhelm the good and cause disease.


The organisms that protect and enhance our life are known as probiotics. They may play a beneficial role in Traveler's diarrhea, antibiotic associated diarrhea, infantile diarrhea, inflammatory bowel disease, irritable bowel syndrome, and colon cancer etc. Certain beneficial yeast like Saccharomyces, not normally present in gut, are known as bio-therapeutic agents.

Probiotics produce important nutrients, eliminate toxins, protect food from putrefaction, destroy "bad" bacteria, and enhance the body's immune system. Certain fatty acids produced by bacteria are utilized as colonic food.

The bacteria synthesize vitamins for our consumption. They also produce antibiotics that can kill foreign species of bacteria invading our gut.

Lactobacillus organisms (some of the species are found in yogurt), have received much attention. Not all strains of this organism have beneficial effects. Lactobacillus GG (LGG) has proven to be particularly valuable in preventing intestinal problems. LGG produces an antibacterial substance that can kill several kinds of bacteria, including E. coli, Streptococcus and Salmonella etc.

In one study, LGG provided a 47% reduction in Traveler's diarrhea among subjects visiting developing countries. Children raised in the third world countries are especially susceptible to infections that cause diarrhea. Only about 10% of these cases benefit from antibiotic treatment, but widespread use of LGG prevents diarrhea in malnourished children.


In general, probiotics are more helpful in viral than in bacterial diarrhea suggesting immune enhancement as the mechanism of their action. Probiotics may also prove beneficial for preventing other bowel ailments. LGG has already been shown to reduce the incidence of chemically induced colon cancer in animals.


Appropriate use of antibiotics reduces morbidity and mortality due to infections. At the same time, they may have undesirable effects on our digestive system. The effect of antibiotic on the bowel depends not only upon the type of bowel flora present, but also on the age and the diet of the person.

Antibiotics may cause itching, diarrhea, and the inflammation of the tongue and stomach. They may also cause malabsorption of food components and ingested medications.

Antibiotics selectively kill some bacteria causing a disruption of the delicate balance between the good and bad organisms. When good organisms are lost, the protective barrier they create breaks down and the bad organisms are allowed to multiply.

As a result, the use of antibiotics increases the susceptibility to certain infections and may lead to a prolonged carrier state. Administration of ampicillin has been implicated in an extended outbreak of Salmonella infection amongst hospitalized infants.

Antibiotics lead to the development of resistant bacteria in the colon. These resistant bacteria can seed other tissues like skin, urinary system, and may spread to other patients in the hospital.

Farmers working on farms where antibiotics are used for cattle develop increased numbers of resistant bacteria in their colon. In fact, healthy adults living with patients getting antibiotics can develop resistant strains.


Restoring bowel flora

There is a difference in the gut flora during health and sickness. Metchnikoff, in 1905, introduced the concept of maintaining or restoring the bowel bacteria by introducing live organisms into the gut to stabilize the balance.

Bacterial enzymes break down "prebiotic" forms of food to produce nutritional products essential for the health of the colon. Commonly used prebiotics include fibre, especially oat and barley. They may be useful as vehicles for the delivery of probiotics, thus enhancing their efficacy.

In one study, investigators used the usual antibiotics plus probiotics or placebo for respiratory infections in children. Children receiving LGG had 17% incidence of diarrhea compared to 42% in the placebo group. Administration of probiotics to children in day care prevents dissemination of diarrhea among kids.

Is it safe to take probiotic bacteria as dietary supplements or to treat disease? The answer is yes. Probiotics have been used extensively in various societies and have been shown not to migrate from the gut to the blood, attesting to their safety.

The beneficial effects of probiotics in patients with HIV support their usefulness even among immune suppressed patients. However, one should not use an organism as a probiotic without scientific evidence that it is indeed safe and effective.


The imbalance of the "good" and "bad" bowel flora results in disease. Antibiotics decrease the incidence of sickness and death due to infections but alter the balance of bowel flora. The current challenge is to minimize the deleterious effects of antibiotics while maximizing their beneficial impact. A combination of probiotic and prebiotic therapy may provide an alternative to antibiotic treatments for intestinal ailments in the not too distant future.


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                                                                        Anil Minocha M.D.; FACP; FACG

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