The Problems with Antibiotics: Antibiotic Resistance
Allow me to preface this post series with a wholehearted acknowledgment of the beneficial role antibiotics have played, and continue to play, in fighting infections that might otherwise take limbs or lives. Before formal antibiotics, ancient and traditional cultures employed antibacterial herbs, tinctures, and even moldy bread, but regardless of the various methods’ efficacies, they were largely operating in the dark. They knew what worked, but not why it worked. When we use antibiotics today, we (mostly) understand what they are doing on a micro level, and we aren’t (ideally) just relying on hearsay, anecdote, and experimentation. This is a good thing.
So, how do antibiotics work, exactly? There are four primary routes taken by various antibiotics:
By crippling the microbe’s ability to fortify its cellular walls against external forces. Some antibiotics, like penicillin, prevent the target bacterium from manufacturing a substance called peptidoglycan that only bacteria use to construct cellular walls. Because animals don’t use peptidoglycan nor do our cells have “cell walls,” antibiotics don’t hurt our native cellular structures. Human tears actually contain lysozymes that also break apart peptidoglycan bonds in bacterial cell walls, much like antibiotics.
By binding to the protein synthesizing equipment inside the bacteria, gumming it up and interfering with its ability to arrange amino acids into proteins that perform vital roles. Tetracycline, a common antibiotic, binds to cellular ribosomes and interrupts an important step in RNA protein-sequencing. Luckily for us, human ribosomes don’t accumulate enough tetracycline to interrupt the sequence; bacterial ribosomes, however, accumulate enough to stop it altogether.
By preventing the bacteria’s synthesis of folic acid. Since all cells require folic acid and bacteria cannot absorb it from the environment, they must create their own. If something prevents its synthesis, the bacteria die. The sulfonamide class of antibiotics closely resembles para aminobenzoic acid, a critical component of the folic acid synthesis cycle. When bacteria mistake the sulfonamide for para aminobenzoic acid, they attempt to use the former to make folic acid. This doesn’t work and the bacteria eventually dies. Pretty devious, eh?
By targeting and interrupting the DNA replication process specific to bacteria. If a cell – any cell – is prevented from replicating its DNA, it dies. Ciprofloxacin is one antibiotic that targets DNA replication.
So, we’ve developed antibiotics that hit processes specific to bacterial cells while sparing human cells, and antibiotics that perform specific tasks and target specific species of bacteria. It all sounds pretty ironclad, yeah? There are some problems with antibiotics, though. Some very serious ones.
Foremost among them (at least in popular medical literature) is antibiotic resistance.
To understand antibiotic resistance, we must understand where most antibiotics come from. We derive pharmaceutical antibiotics from naturally-occurring bacterial weaponry, “natural” antibiotics manufactured and wielded by fungi, bacteria, and algae with the necessary genes in their ceaseless battle against other fungi, bacteria, and algae. Natural antibiotics and the bacteria the antibiotics are targeting have co-evolved over millions of years together. Just as the gazelle responds to the lion, and the lion to the gazelle, these microbes have also developed genetic counter-measures to enemy antibiotics. Written within their very genes are the tools to both produce and resist enemy antibiotics, and at least as far back as 30,000 years ago (and almost certainly many millions of years more, or for as long as bacteria have been battling each other), bacteria possessed the genes for antibiotic resistance. It’s been a lethal, ceaseless game of tit-for-tat against the backdrop of natural selection, with each side keeping the other in check.
Once we stepped in and began reproducing these antibiotics en masse, however, the delicate balance was tipped. Infectious diseases were hit pretty hard, and everyone hailed the great success of antibiotics. And they were a success, for the most part. The problem was the bacteria they were targeting kept evolving new defenses. And whereas “in the wild,” natural selection would usually produce a counter-counter-measure to the counter-measure and so on and so forth, we didn’t have that luxury. Our antibiotic pills weren’t going to adapt on their own. There was no selective force. We couldn’t just wait around for evolution to occur; we had to chemically alter the antibiotics to overcome the bacterial resistance. We had to laboriously and paintstakingly guide the hand of evolution ourselves. We had to engineer a selective force.
And so you have antibiotics like methicillin, which scientists created by modifying penicillin to get around bacterial resistance to penicillin. It worked, but only until bacteria like methicillin-resistant Stapphylococcus aureus (MRSA) emerged, and we had to start all over. Numerous other examples of resistant bacteria have surfaced as well:
- The infamous Clostridium difficile, commonly known as C. diff.
- Salmonella.
- E. coli.
- Certain species of Streptococcus.
- Certain species of Enterococcus.
- Certain strains of Mycobacterium tuberculosis.
Even those bacteria that do not endogenously possess the genes for antibiotic resistance can become resistant to antibiotics through a process called horizontal gene transfer, or HGT. HGT allows helpless bacteria to acquire genetic material from resistant bacteria that happen to be passing by. Through HGT, bacteria of one species can obtain antibiotic resistance from bacteria of another unrelated species. Acinetobacter baumannii, also known as multi-drug resistant acinebacter, is a common pathogen that obtained most of its resistances through HGT. In its cells, A. baumannii maintains multiple collections of foreign genetic material, kind of like a collector of weaponry from across the world. Oftentimes, the primary source of all this prime genetic material is a species of bacteria that poses no threat to humans but that wants to survive antibiotics just the same – and so develops numerous resistances which other, more dangerous species can pick up for free.
The big problem is that antibiotic resistance is a built-in feature of bacteria. It’s not going away. I mean, that’s what life does – it survives. And when the going gets tougher (when an organism is repeatedly subject to threats to its survival), that organism adapts and evolves and grows stronger. The more you produce the threat, the more you overprescribe antibiotics, the more you indiscriminately feed livestock antibiotics to promote faster growth, the quicker these resistances develop and spread.
Antibiotic resistance is a systemic issue, one that affects the global picture of health. It’s no doubt important, but there’s not a whole lot to do besides be aware of the issue (unless you’re a hotshot microbiologist actually working on new and improved antibiotics). There’s another problem with antibiotic usage, though, a hyper-local one that does impact us on an individual level and that we can hopefully successfully navigate. Next time, I’ll discuss that other unintended, but totally foreseeable, consequence of administering antibiotics in order to kill bacteria: the death of helpful bacteria living in the gut. And later, maybe in the same article if there’s enough time, I’ll go over strategies to combat the problems of antibiotics.
Thanks for reading this first part, and take care until next time. Let me know your thoughts in the comment section.
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Posted By: Mark Sisson
What about all the antibacterial hand wash, kitchen wipes, baby wipes etc? Totally unnecessary (if they are actually effective and not just a gimmick) and probably harmful for those who use them. You can never develop your own natural resistance to bugs if you try and kill them at every turn.
I prefer prevention over cure and if you do get ill, natural remedies over antibiotics. But ye antibiotics are extremely helpful but when people don’t finish their prescription, it can lead to antibiotic resistance.
This is one of my all-time favorite topics. Horizontal gene transfer in bacteria was the subject of a recent research paper:
http://web.mit.edu/newsoffice/2011/hgt-bacteria-1031.html
This wired blog covered research on how taking antibiotics can permanently destroy your good gut bacteria. Scary.
http://www.wired.com/wiredscience/2011/08/killing-beneficial-bacteria/
I’m currently kind of obsessed by the human gut biome, and wrote about it in a post on research about the gut biome and mental health here: http://www.gydlepublishing.com/blog/2011/09/about-that-gut-feeling/
and about fecal transplants as a possible solution for C. difficile and IBD here:
http://www.gydlepublishing.com/blog/2011/10/whats-the-poop/
Sorry for all the links. Mark, bravo for tacking a fantastic and super-important topic!! I can’t wait to read installment # 2.
Dear Mark,
Thank you for your interesting article. I’m looking forward to your article on the other side of the debate: antibiotic addiction/dependence. I’m not a doctor, but I believe that overprescription of antibiotics may at some point prevent the organism to fight the bacteria through its OWN defense mechanisms. From 2008 to 2010, I suffered from repetitive sore throats and had to take antibiotics about 10-15 times/year. In 2010 I had a tonsillectomy and since then (touch wood), not a single sore throat and no single pill of penicillin. However, I believe I could have avoided this operation if doctors in France didn’t prescribe antibiotics automatically for sore throat! Best.
Lexov
Expecting parents: don’t forget that the best way to keep kids off antibiotics when they’re little and grown is to breastfeed for 2 years (world health organization ). It wont prevent every case of needing antibiotics… but most. My 6 year old has never had antibiotic…. my 4 year old did once. Most of my friends who nurse that long have similarexperience… guys… encourage your wives/girlfriends to do this…. doesn’t get anymore primal than that!
I’ve recently read much about hydrogen peroxide and oxygen therapies.
They are supposed to cure colds and infections way better than anything a doctor can prescribe.
Google it.
I have been on and off antibiotics for years for different reasons. Most of the time my mom, who is a nurse, wanted to ‘help’ and that is how she saw she could. No parent wants to see their kid in pain. And in the 80′s and 90′s living a ‘primal’ like was out of the question.
Anyways when I moved away from home whenever I got sick I would break out leftover antibiotics from a previous bout of something (I had a little bit of everything, from seeing the DR so much) too help speed recovery. And it used to work.
Since I started eating primal foods I have been getting sick a lot less, like practically never, and the one time I have gotten sick this year, what previously would have turned from a cold into bronchitis, is just a cold and went away in 7 days.
Primal is beautiful. Don’t stop!!
Okay so I have a question… If antibiotics fatten up livestock, do they make humans fat too?
Are they the same kind of antibiotics? How do antibiotics work to fatten livestock or make them grow rapidly?
The antibiotic is used to keep the sick cow alive as they are filling it with grain. The grain makes it gain weight. Cows are rumins and are not adapted to eating grain but rather to eat grass and the like. The diet and close quarters stress the animal In several ways. Many would die before reaching the goal weight if not for the antibiotics.
I feel like too many doctors hand out Z-packs like they are candy. If you use Z-packs too often you open yourself up to much more threatening strands of viruses due to a weaker immune system that relied on Z-packs to bail them out.
I watched a documentary on phages as a much older (in terms of use) alternative to antibiotics. The doc was filmed in the country of Georgia where they had phages from over 100 years ago. They “grow” them and then use them whenever there are outbreaks in their hospitals. Apparently, the Georgian population uses very few antibiotics.
The doc was called, “Phages the Virus that Cures”. It was fascinating. (Apparently Time magazine did an article on phages a while back.)
For those looking at strengthen their immune systems using (semi-)natural approaches going beyond just food and foodstuffs, the information and referenced supplements in this Life Extension Foundation article may be of use:
http://www.lef.org/protocols/immune_connective_joint/immune_system_01.htm
My father recently contacted c.diff. while in the hospital. It came back after he went off the antibiotics. After he gets off this time I will be heavily dosing him with pre- and probiotics, and trying out some of the suggestions.
Ebook about antibiotics, mechanisms of actions, resistence, health associated resistnce
http://www.amazon.com/dp/B0050VQWXI?tag=widgetsamazon-20&camp=213761&creative=393545&linkCode=bpl&creativeASIN=B0050VQWXI&adid=1NQQEGYH6DGQGMCEXZNE&&ref-refURL=http%3A%2F%2Fwww.maysaaelsayed.blogspot.com%2F