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Do Antibiotics Raise Diabetes Risk via Gut Microbiota?

People who take multiple courses of antibiotics may face an increased risk of developing both type 1 and type 2 diabetes, potentially through alterations in gut microbiota, conclude US researchers.

The team, led by Ben Boursi, MD, a postdoctoral researcher in the department of gastroenterology at the University of Pennsylvania, Philadelphia, found that the risk of diabetes was increased by up to 37%, depending on the type of antibiotic and the number of courses prescribed.

“Overprescription of antibiotics is already a problem around the world as bacteria become increasingly resistant to their effects,” commented Dr Boursi in a statement.

“Our findings are important, not only for understanding how diabetes may develop, but as a warning to reduce unnecessary antibiotic treatments that might do more harm than good.”

The study was published online ahead of print March 24 in the European Journal of Endocrinology.

The More Courses of Antibiotics, the Greater the Risk

Dr Boursi explained that studies both in animal models and humans have shown an association between changes in gut microbiota in response to antibiotic exposure and obesity, insulin resistance, and diabetes.

Speaking to Medscape Medical News, he noted: “In mice, we know that germ-free mice are lean and, by fecal transplantation, we can transmit obesity to them. We also know that low dose of penicillin may induce obesity in mice models.”

He added that there have been several studies in humans indicating that exposure to antibiotics in early childhood is associated with an increased risk of obesity in later life, while other investigations have reported differences in gut microbiota between people with and without diabetes.

To investigate further, Dr Boursi and colleagues conducted a nested case-control study using data from the Health Improvement Network (THIN), a UK population-based database, from which they identified 1,804,170 patients with acceptable medical records.

As diabetes is associated with an increased risk of infection, the team wanted to exclude all cases with prediabetes or undiagnosed diabetes. To do that, they removed all patients diagnosed with diabetes within 183 days of starting follow-up and included only patients with exposure to antibiotics more than 1 year prior to the index date.

From the original cohort, they were able to select 208,002 diabetes patients and 815,576 controls matched for age, sex, general practice site, and duration of follow-up before the index date.

Conditional logistic regression analysis revealed that exposure to a single antibiotic prescription was not associated with an increased risk of diabetes, adjusted for body mass index (BMI), smoking, last blood glucose level, and the number of infections before the index date, alongside a history of coronary artery disease and hyperlipidemia.

However, treatment with two to five courses of antibiotics was linked to an increased risk of diabetes with penicillin, cephalosporins, macrolides, and quinolones, at adjusted odds ratios (ORs) ranging from 1.08 for penicillin to 1.15 for quinolones.

The highest risk for diabetes was seen among people who received more than five courses of quinolones, at an adjusted OR of 1.37. An increased risk of diabetes was also seen in patients who took more than five courses of tetracyclines, at an adjusted OR of 1.21.

Interestingly, the researchers were unable to find an association between diabetes risk and treatment with imidazole, antiviral drugs, and antifungals, regardless of the number of courses.

To account for further possible confounding factors, the researchers repeated the analysis only in individuals without skin or urinary-tract infections, which are more common among diabetes patients. This had no impact on the results.

Next Steps

When the analysis was restricted to type 1 diabetes, the risk was increased only following exposure to more than five courses of penicillin or two to five courses of cephalosporin, at odds ratios of 1.41 and 1.63, respectively.

Commenting on the findings, study coauthor Yu-Xiao Yang, MD, assistant professor of medicine and epidemiology, University of Pennsylvania, pointed out their investigation was observational in nature.

“We are not able to establish cause and effect necessarily, but it is actually pretty consistent with the experimental data, which is more definitive in terms of the animal data than in humans.”

Dr Yang said that the next step for the team will be to expand their focus, as the antibiotics data “provide indirect evidence suggesting the importance of gut microbiota on metabolic outcomes, including diabetes.”

Describing their findings as “important evidence,” he concluded: “Based on this indirect evidence and existing data in animals, we are planning to more directly investigate the effect of altered microbe environments in humans.”

The work was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences at the National Institutes of Health. The authors have reported no relevant financial relationships.

Eur J Endocrinol. 2015. Published online March 24, 2015. Abstract

via Do Antibiotics Raise Diabetes Risk via Gut Microbiota?.

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Antibiotics benefit farm animals, but at what cost?

Should we just say “no” to antibiotics for farm animals?

Your veterinarian hands you a bottle of antibiotics after treating your cat’s abscess. “Finish them all,” he urges. If you fail to comply, you’ll be contributing to the development of antibiotic resistance. In which case it won’t be your cat’s health alone that suffers, but potentially yours, too. All this because of a biological process in which bacteria mutate, deftly avoiding the mechanism by which antibiotics would see them exterminated.

Antibiotic resistance is an emerging threat that has accelerated in recent decades. The rise of the so-called “superbug” (think MRSA) has struck fear in the heart of anyone who would overprescribe, misuse or otherwise abuse antimicrobial drugs.

Physicians, veterinarians, patients and their families have all been put on notice: Overuse antibiotics at the public’s peril.

Still, that hasn’t stopped the animal agriculture industry from feeding hogs and chickens and cattle their daily dose of antimicrobial drugs. Aimed at promoting growth and preventing disease, the use of antibiotics in farm animals has been a boon to animal agriculture. Animals grow bigger, faster and healthier. They succumb to fewer diseases. They need less feed. For a farmer, the calculus is simple: Animals cost less when we spike their feed with drugs to prevent diseases.

If you eat most commercially produced meat, you’ve reaped the benefits, too. You spend less on your protein, and your food supply isn’t as likely to contain excesses of harmful bacteria. The public is well served by our modern methods, it would seem.

But at what cost?

That’s what the Obama administration has been pointedly asking over the past year in its quest to ban antibiotics from being used in healthy animals. These animals don’t need the drugs to treat their diseases. Feeding them a daily dose of drugs only accelerates the onset of a health care crisis the vast majority of the medical establishment agrees is looming.

Indeed, this issue has been decades in the making, meandering through public Senate subcommittee hearings and closed-door FDA sessions. Books have been written. Papers peer-reviewed and published. White papers authored. Commissions formed.

Much like climate change’s plodding progress toward more widespread acceptance, the science underlying modern industrial animal agriculture’s antimicrobial utilization methods has been increasingly questioned over the past few decades. Nonetheless, the findings have only recently gained purchase at the political level.

In large part, that’s thanks to the Pew Campaign on Human Health and Industrial Farming. Consider the following points for a taste of its findings:

1. Up to 70% of U.S. antibiotics go to animals raised on industrial farms that aren’t sick, to offset crowding and poor sanitation. The practice promotes the development of deadly strains of drug-resistant bacteria that can spread to humans.

2. Food-borne bacteria are more dangerous in their antibiotic-resistant forms, because they are harder to treat and may require multiple antibiotic treatments, longer hospital stays and other interventions before finally being eliminated.

3. Antibiotic-resistant bacteria cost the U.S. health care system an estimated $4 billion to $5 billion per year.

4. Each year, 300,000 hospitalizations and 5,000 deaths are caused by food contaminated by dangerous pathogens and bacteria such as salmonella and E. coli, which are increasingly becoming antibiotic resistant.

… among other frightening results.

But the AVMA (American Veterinary Medical Association), which traditionally supports animal agriculture, disagrees. Here’s an excerpt from its position statement (on the subject of Obama’s proposed ban on non-therapeutic antimicrobials in animal feed):

“This type of broad-based ban is contrary to the practice of veterinary medicine and is not risk-based. As legislation concerning the use of antibiotics in animal agriculture is considered by Congress, it is imperative that decisions be made based upon the science supporting the issue.”

Essentially, my profession’s leading organization says there’s little evidence to show that Point 1 has anything to do with Points 2 through 4. Correlation has been established, as it has for human misuse of antibiotics and the development of bacterial resistance. Causality has yet to be teased out —— something nearly impossible to achieve, whether for human misuse or animal overmedication. Yet it’s on this basis that we are asked to limit our enthusiasm for the obvious: Treat agricultural species like we treat ourselves and our pets. Give them antibiotics only when they’re sick.

Then we’re subjected to the most offensive argument offered by an animal-health-supporting body:

“The AVMA opposes this legislation because it would increase animal disease and death — an unfortunate and unintended consequence — without assurance of improving human health. As defined within the text of the legislation, elimination of “non-therapeutic” uses of antimicrobials would disallow disease prevention and potentially control uses.”

It’s true: The animal agriculture industry keeps infections at a manageable level by tamping them down with routine antibiotic use. If this kind of legislation is enacted, I have no doubt our agricultural animals that currently consume drugs daily will be less healthy in the short term. And, yes, that has implications for human health, animal welfare and the price you pay at the supermarket. (Check out the antibiotic-free meats if you care to compare.)

Nonetheless, I believe the Pew people have put their finger on the pulse of industrial animal agriculture and found it artificially strong. Like me, they see antibiotic use not only as a threat to human health, but as an animal welfare issue in and of itself.

After all, antibiotic use in animal agriculture makes sense primarily because of how we crowd and transport our creatures. Remove the antibiotics, and more animals will surely get sick in the short term. But long-term, that only means the industry will be forced to reform how it houses and ships its “widgets.”

Yes, long-term, I predict the trend toward voluntarily paying more at the supermarket (as some of us do now when we buy our antibiotic-free meats) will become mainstream as we’re forced to revert to meats raised in less intensive, drug-addled, hormone-laced environments — for the good of our public health.

Even if it does shrink the wallet somewhat, how bad can it be if it ultimately means Americans are persuaded to eat less of what we currently overeat?

via Antibiotics benefit farm animals (and people), but at what cost? – USATODAY.com.

Dr. Court’s Comments:

I always recommend that my patients eat as organic as possible.  This includes buying meats that are antibiotic free.  The meat industry in this country has become like every other large industry; it is dominated by large corporations who will stop at nothing to make more money.  This includes mistreating the animals and feeding them drugs and other chemicals so their when they are sold per pound they weigh more and collect more profit.

It is shameful, but it occurs everyday on farms and in slaughter houses around the country.  Let’s forget for a minute that what is done to these animals is not humane and consider the consequences on your health.

Do you want to consume the meat of an animal that has been injected with drugs and chemicals? Where do you think these chemicals go?  If you consume the meat, they go into you, that’s where.  While the antibiotics may reduce bacterial loads in meat it can create problems for you.  It can alter your gut flora causing you to absorb undigested proteins, fungus, parasites and other things that are not conducive with healthy living.

This is not just a question of animal welfare and treatment.  This is a major health problem in the US and changing it would change our meat supply for the better and result in healthier people across the country.

While free range, antibiotic, organic meat is more expensive, it is also much healthier for you.  Isn’t your health worth it?

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