Medications that can impact your gut health

We are what we eat. But did you know that the medications we take can also have a significant impact on our gut health?

The term “gut” is synonymous with the digestive tract−primarily the stomach, small and large intestines. Our gut serves as host to approximately 1,000 unique species of bacteria, both good and bad, that regulate the immune system, aid in food digestion, produce certain key nutrients and protect us from toxins and pathogens. To maintain proper gut health, we need to maintain the proper balance of bacteria. But many of the common medications we use can upset that balance.

“A healthy gut is dependent upon a diversity of bacteria,” explains research assistant professor Sunil Thomas, PhD, who specializes in gastroenterology and infectious disease at Lankenau Institute for Medical Research, part of Main Line Health and located on the campus of Lankenau Medical Center. “Diversity is the key word here. Many of the common medications we use, such as antibiotics, kill bad bacteria, which is good. Unfortunately, they also kill good bacteria—or normal gut flora—which is bad. You need to be mindful of the medications you’re ingesting, and work closely with your physician to ensure appropriate usage.”

Some medications you should be mindful of and that can affect gut health include:

• Antibiotics – While antibiotics can be highly effective in treating serious bacterial infections, there is concern about misuse and overuse. Never take an antibiotic if it has not been prescribed to you by your physician, and steer away from antibiotic usage when an illness can be resolved on its own.
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) – NSAIDs (i.e., Motrin, Advil and Aleve) are America’s number one pain killer of choice. Unfortunately, they don’t just kill pain. They also disrupt the normal balance of the beneficial bacteria living in your gut.
• Proton Pump Inhibitors (PPIs) – These acid blockers—used to treat indigestion, peptic ulcers and acid reflux—are also known to reduce the diversity of gut bacteria. This can lead to an increased chance of infections like Clostridium difficile (also known as C. difficile or C. diff) and pneumonia, as well as vitamin deficiencies and bone fractures. Generic PPI names include omeprazole, pantoprazole, esomeprazole, lansoprazole, rabeprazole and dexlansoprazole.
• Antacids – Beyond PPIs specifically, all antacids neutralize the acid in our stomach, which is the body's first line of defense from harmful pathogens that we ingest every day. We increase our risk for stomach bugs and infections if we are taking antacids on an ongoing basis.
• Antidepressants – One of the most popular classes of anti-depressants are selective serotonin reuptake inhibitors (SSRIs). Scientists estimate that 90 percent of serotonin is made in the gut. Imbalances in serotonin have been linked to diseases including irritable bowel syndrome, cardiovascular disease and osteoporosis.
• Sleeping pills – Like antidepressants, sleeping pills are fat-soluble drugs. They can penetrate the gut wall and injure the natural balance of the digestive system.
• Laxatives – Laxatives can also affect the balance of gut bacteria. They should be used in moderation and only under the supervision of a physician or health care provider.
• Statins – Statins, or cholesterol lowering medications, are the most widely prescribed medications worldwide. Recent research indicates that statins may negatively influence the balance of gut bacteria. Further studies are pending.

“Always talk with your physician about any concerns about how the medications you take might be affecting your gut health,” says Dr. Thomas. “Never just stop taking a medication that has been prescribed for you. Only your physician can properly weigh the benefits of a prescribed medication versus the potential risks.”

In addition to being more aware of how medications can affect our gut health, Dr. Thomas reminds us of the significant impact our lifestyle can have.

“Treat your gut like a garden,” says Dr. Thomas. “Fill it with healthy and fiber-rich foods such as fruit, vegetables, whole grains and legumes to help grow beneficial bacteria, and stay away from processed meat, sugar and fatty foods that induce proliferation of bad bacteria. Regular exercise is also vital in maintaining a sturdy gut, as is plenty of water. I recommend seven to 10 eight-ounce glasses of water a day. There is so much we can all do to maintain the proper diversity of bacteria in the gut microbiome and in turn, support our good health.”