We're slowly coming to understand that antibiotics are very unkind to our gut flora and are a prime suspect in subsequent weight gain. Post-antibiotic diet could be a critical intervention to keep patients from falling into the grasp of obesity.
A NY Times article earlier this year gives a background on how the rise of antibiotics has been accompanied by a rise in weight among animals and humans alike:
Kids in particular seem to be at risk. A recent study of 64,000 kids has associated repeated antibiotic exposure before age 2 with early childhood obesity:
It's good we're investigating diet-based therapy, so patients can someday hear their doctors say "after finishing this broad-spectrum antibiotic prescription, you [or your child] should eat like this for this amount of time to restore digestive health."
If you look at your JAMA article, you'll see that the connection between antibiotic use and childhood obesity is pretty small. My question would be, we've had broad-spectrum antibiotics around since WW2 (broad spectrum being the one the paper flags), yet obesity is a relatively recent phenomenon.
Also, they also found a connection between obesity and "Steroid use, male sex, urban practice, public insurance, Hispanic ethnicity, and diagnosed asthma or wheezing were also predictors of obesity; common infectious diagnoses and antireflux medications were not."
Cipro did wonders on my intestinal tract, effectively killing everything including the good. Had nine days of that to fight an under the skin infection/etc. Months after I started having problems with food, restrooms were becoming my second home and my commute was planned around easy access to them. You never want to experience life where one bit of food can send you off.
Six doctor visits, stool and blood tests later, the doctors found what moved in. New antibiotics and replenishment medicines, diet with lots of probiotics, and within a few months I was back to mostly normal.
My story is simple, if you end up on harsh antibiotics it can change your life. Plan for it.
Indeed, which adds to the argument that so called "mental" health problems are not actually mental. Many diseases cause some mental symptoms and get wrongly labelled as mental illnesses, when I dispute that there is such a thing.
Yes. The experiment proves that we are in astrology stage of development regarding mental illnesses. It doesn't mean that stars or planets do not exist. It just means that astronomy is yet to be born. Psychiatry awaits its Copernicus.
btw, I don't see how could you explain the second part of the experiment where were no fake patients at all as "gaming".
If a mere expectation of a fake patient screws the results so much; your methods are garbage. This and other counter-arguments are mentioned on the wiki-page.
Do you think if the same experiment were to be repeated today; the results would be different?
The link mentions related experiments with similar results as recent as 2008.
Anyway, judging by "The Diagnostic and Statistical Manual of Mental Disorders", Fifth Edition (DSM-5) (2013) there has been no paradigm shift in the last 40 years.
> Do you think if the same experiment were to be repeated today; the results would be different?
Yes. Big institutions have closed. Smaller hospitals replaced them and most people get treated in the community.
For example: my county has a population of about 600,000 people. About 4,500 people are on the books of the local MH trust at any time. There are only about 150 inpatient beds at any time.
People only go into hospital if they are a danger to themselves or others - hearing a voice that says "empty" or "hollow" or "thud" is not something anyone would be hospitalised for.
To get a diagnosis of schizophrenia you have to match the symptoms over a six month period and be assessed by the same doctor during that time. one of the benefits of the DSM / ICD is that doctors now use a set of standards when diagnosing mental illness.
The paper suggests that this is only a problem with psychiatry. This is something you hear from lot of people. "No test exists to diagnose a psychiatric illness, thus psychiatry is a sham. Look, I can get diagnosed if I lie to doctors!" This ignores the fact that there are a bunch of physical-health diseases you can get diagnosed with if you lie to doctors, but we don't call those a sham. Your link even talks about that:
> Many defended psychiatry, arguing that as psychiatric diagnosis relies largely on the patient's report of their experiences, faking their presence no more demonstrates problems with psychiatric diagnosis than lying about other medical symptoms. In this vein, psychiatrist Robert Spitzer quoted Kety in a 1975 criticism of Rosenhan's study :[5]
>If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behavior of the staff would be quite predictable. If they labeled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition.
Your link mentions RD Laing in the lead. RD Laing is now thoroughly discredited. (Although he did have some interesting ideas). You should read some of his books.
> Many defended psychiatry, arguing that as psychiatric diagnosis relies largely on the patient's report of their experiences, faking their presence no more demonstrates problems with psychiatric diagnosis than lying about other medical symptoms. In this vein, psychiatrist Robert Spitzer quoted Kety in a 1975 criticism of Rosenhan's study :[5]
If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behavior of the staff would be quite predictable. If they labeled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition.
> The link mentions related experiments with similar results as recent as 2008
No it does not.
There's a probable hoax from someone who can't provide any evidence, from 2004; and a totally different "experiment" (tv show) from 2008 where doctors were not allowed to interact with patients. You'd get similar results if the patients had physical health ailments.
How does the closing of big institutions improve the scientific rigor
of a psychiatric diagnosis?
The misunderstanding is probably my fault -- the message was too
short. Let's establish the basics: There can't be any science if you
can't measure. Reproducibility (replication): theory and experiment
(prediction <-> measurement spiral) are corner stones that support
each other and build on the language of math.
"the results" -- as the very first message I've posted on the topic
says -- are about the reliability of psychiatric diagnoses. If we
can't have that (an ability to measure) there is nothing to discuss.
On "150 inpatient beds" -- how many people are in jail instead? And
again, how does it relate to scientific foundations of psychiatry?
Both "lye to the doctor" excuse and "bleeding peptic ulcer" are
addressed on the very same wiki-page where the quotes come from.
"Your link mentions RD Laing in the lead. RD Laing is now thoroughly
discredited." Here's the only occurrence of the name in the
article:
"while listening to one of R. D. Laing's lectures that Rosenhan
wondered if there was a way in which the reliability of psychiatric
diagnoses could be tested experimentally."
Does "the lead" mean "an inspiration"? In what way precisely anything
about RD Laing changes the results of Rosenhan experiment?
I can go on pointing out imprecise statements but it don't see the
point. What would be nice to see is even a single reference to an
experiment that shows that yes we can reliably diagnose psychiatric
illnesses and here's what changed in out assumptions -- where is the
paradigm shift?
On 2008 experiment: the result: "The experts correctly diagnosed
two of the ten patients, misdiagnosed one patient, and incorrectly
identified two healthy patients as having mental health problems. If
you think that the result:
psychiatric diagnoses are unreliable
is invalid due to the way the experiment was conducted (some
methodological issues) then do point them out.
> doctors were not allowed to interact with patients.
Diagnosing a mental illness is a serious business with long term
consequences. Have any of the "experts" refused to diagnose on the
account of insufficient information? -- I don't know.
I'd like to be proven wrong and see psychiatry in the hard science camp.
Have I mentioned that psychiatric diagnoses are unreliable ;)
Eh, as a researcher at the periphery of the Human Microbiome Project and American Gut project this has been the accepted (and already shown, experimentally) conclusion for quite some time.
Those aren't particularly new things to study. We have tons of murine data on the subject and quite a few PhD students over the last 4-6 years have done their PhDs on microbiota and diet with themselves as the guinea pig, so to speak (2-4 year longitudinals).
There are a couple mouse papers out that don't directly address the issue in 2, but that permanence (or lack thereof) played prominent roles in their findings.
Study seems to follow common-sense - change the nutrients ingested and different gut bacteria will flourish.
What I'm really interested in is which types of bacteria create a feedback loop by releasing chemicals/hormones to increase hunger or cravings for specific foods. Definitely not an easy thing to determine given all the variables, but it seems very likely based on the other studies showing bacteria can promote fat or thin mice: http://www.scientificamerican.com/article/how-gut-bacteria-h...
Which means that a cure for obesity (or at least one of the components of a cure) can be as simple as an antibiotic that targets the "bad" gut bacteria. Very interesting.
Ask like this: Is it a mere coincidence that so many of poorest tropical and subtropical (hot and humid climate) populations traditionally use highly spiced food? Does it strictly a tradition of making a "poor" food taste hot, or there is a connection with bacteria population?
> Ask like this: Is it a mere coincidence that so many of poorest tropical and subtropical (hot and humid climate) populations traditionally use highly spiced food? Does it strictly a tradition of making a "poor" food taste hot, or there is a connection with bacteria population?
Tradition? Capsicums are a new world crop. They didn't make much of a dent in cuisines outside of the Americas until the 18th century.
Spicy food was historically used to mask food that had gone off (e.g. meat in hot climates). I doubt that has been a relevant consideration for many decades though, so I'd attribute it to culture/tradition.
> Spicy food was historically used to mask food that had gone off (e.g. meat in hot climates).
Spicing food has a preservative effect, which is probably a more important factor in the spread of the practice than masking food that has already gone off.
The second link is particularly interesting, as the Hadza hunter-gatherers have a lot of gut bacteria that cause disease in the west. So it seems that gut bacteria aren't the whole story. Something to complicate the story for people who want to cure mental illness or create skinny people via manipulating gut bacteria.
Can someone speak to my theory (that's based on limited knowledge), that if we wanted to "reset" the gut, we could deliberately take antibiotics to wipe out good/bad colonies of microbes and tailor a hyper-specific diet for sought after results. The hypothesis being that if certain microbes flourish for years and that if it is impractical to genetically map the gut biome to identify which are thriving in every patient, this could help us get to a clean slate before therapy is attempted.
IMHO, that seems like a bad idea. Two thoughts (these are only very overly generalized opinions, biology is a little bit complicated):
1) You might not get them all, and the ones that survive might transfer the traits of antibiotic survival and pathogenic-ability (if present) to the new population.
2) You would need to ensure that your hyper-specific diet contains the right mixture of microbes, say, you would need to avoid irradiated food, and a bunch of other things. "Bad microbes" coming into an empty gut seems to me like a bad thing.
Thanks, both are good points! I assumed there were downsides to if you weren't able to wipe out the robust bad microbes but that's even worse than I had expected. Perhaps I'll wait on self-experimentation. The possibility of nefarious and now genetically enhanced microbes reigning supreme in my body is not cool.
Antibiotics don't wipe out all the bacteria, just some of them. Its a bit of a problem because if some are effected less by the antibiotic, you can change the balance when the bacteria populations bounce back. The bacteria that are there do set up shop and don't like others crowding in.
We don't really enough enough about what should be the optimal mix of bacteria to make someone healthy.
They do "fecal" transplants to help people get back bacteria that are missing.
There was a graduate student talk (an hour) about some of this stuff last spring. slide decked linked to the right.
I've read a bit about fecal transplants and they apparently have good results. I just wanted to oversimplify and remove as many variables as possible before introducing new ones. No longer liking the idea...
Another option is to skip the antibiotic and use a probiotic to nudge your microbiome toward healthier regions. I am aware of two modern probiotics that might help you:
Both of them are designed thinking of ecosystems more than individual strains (repoopulate has 33 strains, equilibrium has 115). Of course, these aren’t an alternative to FMT if you’re treating a disease… but for general health/wellness I think they’re both quite good.
In it, the author tells a story of someone in a village in a less developed country who cannot afford pesticides. So he starts a war between two ant colonies in order to drive out the ants that are destroying a beloved fruit tree.
You can do the same thing for gut flora. You don't have to wipe things out first. Trying to wipe the gut clean is extremely hard on the body. It's much easier on the body to just feed the good flora and give them support so they start crowding out things you don't want. It's a gentler path. It just takes persistence.
As mentioned by acomjean, fecal transplant (FMT) is the typically how we restore "healthy" biota in the gut. Interestingly, only a handful of species play a large role in the regulation of gut microbiota and physiology/psychology of the host. Recolonizing the gut with these species alone is enough to restore a "healthier" mix.
So do we know yet what sort of diet cultivates a microflora biome that encourages healthy weight loss? I'm asking for a friend...
It's easy to find diets for losing weight in general, but I'm curious if we know enough to create a diet to make a microflora composition that can help the weight loss process along. I keep seeing mentions of the microflora factor influencing weight gain, so I'm assuming there's a way to cultivate it to help with loss as well.
The answer in humans does not quite match the answer in mice so far. Possible reasons to explain this discrepancy : might be the lack of a large enough group to study, or a local variation in the groups that does not generalize to mice.
It would be interesting to hear both why the chose a "high fat-high sugar" diet and to see further research that did more isolated tests in the vein of "high carb", "high fat" and "high protein" instead of combinations of them. Also, what are the implications of altered gut makeup after adopting these diets? Surely we could come up with experiments to measure metabolism and behavior as a result of the altered gut bacteria.
It will be fascinating to see how our understanding of nutrition and diet changes as science finally catches up. Studies like this are just the beginning.
It does seem like a very simple study, that we would have guessed the results. Seems like a study like this would be to help facilitate laws or actions rather than finding the really important answers you are suggesting. I hope one day we come up with a model to fund research for the people, and not wait for larger organizations to fund, typically for selfish reasons. I think if we could find this model science will not only catch up, but trail-blaze new findings.
I know that antibiotics are a significant factor in the loss of gut bacteria, but another factor is all of the preservatives that pervade the manufactured food most people eat every day. I've often wondered what percentage of the loss is from these substances.
Here is a case where the research is lagging the knowledge base. Every holistic MD has, for decades, preached eating foods enriched with healthy bacteria. What we need now is research that looks at outcomes.
> Every holistic MD has, for decades, preached eating foods enriched with healthy bacteria.
The problem with this is that they are frequently wrong. Many people respond poorly to these type of probiotic diets, and holistic medicine has observed outcomes in a small portion of the population and thus encouraged us to generalize them. All we really know about the gut is that it is extremely complicated and that in terms of gut conditions' ("IBS") relationship with gut microbiota they run the gamut. Many of them are either not directly affected by microbiota population (ie: nerve damage, circadian rhythm ), or gut microbiota are part of a multi-causal problem.
We need more science like this, that reaffirms what we "know," not more holistic bullshit.
Source: IBS sufferer who has spent years talking to GI specialists and reading research papers about this stuff. It's hard, and as soon as you think you have it figured out it smacks you in the face with another factor you haven't considered.
These results indicate that you can eat anything, not just foods enriched with bacteria like probiotic yogurt (which has questionable benefits in itself http://skeptics.stackexchange.com/questions/6180/do-probioti...), and observe a change in gut microbiota.
"Turnbaugh’s team found that switching mice to a high-sugar, high-fat diet reshaped the abundance of the community of microbes in the gut to a new, stable makeup within three days, in a reproducible manner that was largely independent of genetic differences among individual mice."
The real yogurt is the Bulgarian yogurt, not low-fat high-sugar ones sold at store in the States. Only an idiot will eat a probiotic "yogurt" with 30g of sugars in the small container and think they are doing good to their health! Fortunately, there are two brands [0] of the original sold at Whole Foods today (one, unfortunately, available only on the East Coast [1]), but they are too sour for the American to like. Does it have questionable benefits? Maybe you should try to research how yogurt got the attention of medicine. It was eaten by my predecessors for centuries and the benefits are without doubt.
When babies are born, their gut is sterile before it gets colonized from outside. The diet definitely can affect which strain will outgrow others, but all gut bacteria is exogenous.
This is true and might be surprising that Bulgarians are not accustomed to make their own yogurt, because stores are full of high-quality one that's cheap (unlike the $6-7/jar in the States). Kefir is also great and can also be made at home. My favorite is Lifeway [0].
Not sure I follow - is there a suggestion that you can only eat 'foods enriched with bacteria like probiotic yogurt'? I would think the less questionable benefits of eating yogurt would be calcium and protein, at the very least. This study didn't try to feed any sort of special 'probiotic' foods to the mice.
It's too bad you're being downmodded. I'll state what I think you're getting at: "holistic MDs have, for decades, hypothesized that the link between foods and gut bacteria is much more important than the scientific community yet realizes". Everything else they did from that point, yes you can call it "bullshit" because it was conjectural/anecdotal/etc, so downmod away for daring to suggest that such a morally bankrupt bunch as the holistic community might have had the faintest conjecture about something that turned out to be scientifically significant.
If you put a chip down on every number at a roulette wheel, you can experience the joy of winning with nearly every spin! Yet, strangely, the stack of chips dwindles instead of grows....
A NY Times article earlier this year gives a background on how the rise of antibiotics has been accompanied by a rise in weight among animals and humans alike:
http://www.nytimes.com/2014/03/09/opinion/sunday/the-fat-dru...
Kids in particular seem to be at risk. A recent study of 64,000 kids has associated repeated antibiotic exposure before age 2 with early childhood obesity:
http://archpedi.jamanetwork.com/article.aspx?articleid=19098...
It's good we're investigating diet-based therapy, so patients can someday hear their doctors say "after finishing this broad-spectrum antibiotic prescription, you [or your child] should eat like this for this amount of time to restore digestive health."