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Can Antibiotics Cure Hunger?

Health & Wellness  (tags: children, death, diet, disease, ethics, family, food, health, healthcare, illness, interesting, investigation, medicine, nutrition, prevention, protection, research, risks, safety, science, society, study, treatment, warning )

- 1932 days ago -
A pair of new studies offers further evidence that the bugs in our gut may play a crucial role in our overall health.

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JL A (281)
Monday February 4, 2013, 11:05 am

Mother Jones
Can Antibiotics Cure Hunger?
A pair of new studies offers further evidence that the bugs in our gut may play a crucial role in our overall health.

By Sarah Zhang | Mon Feb. 4, 2013 3:06 AM PST
A malnourished child with kwashiorkor. Lyle Conrad [1]/Wikimedia Commons

In the early 2000s, malnutrition got a squishy new peanut-flavored enemy. Kids fed a calorie-rich paste of peanuts, sugar, milk, and the whole alphabet of vitamins and minerals recovered at rates nearly twice [2] that for previous treatments. However, some 15 percent of the severely malnourished children still didn't recover on the ready-to-use therapeutic food (RUTF), puzzling and frustrating doctors. A pair of studies in Malawi recently published in the New England Journal of Medicine and Science suggest a clue: bacteria living in the kids' guts.

The first study [3], led by peanut-based food therapy pioneer Mark Manary, found that antibiotics plus RUTF cut mortality among severely malnourished children by 36 to 44 percent compared to RUTF alone. The WHO is now planning to recommend [4]wider antibiotic use for malnutrition, which kills a million kids each year.

"We were completely shocked," says the study's first author Indi Trehan. The researchers initially thought their study would prove cutting antibiotics saves money. The antibiotics were a holdover from the old milk-based malnutrition therapy that required kids to spend weeks in the hospital, which left them susceptible to hospital-acquired infections. RUTF, on the other hand, comes in packets easily distributed at home and should have eliminated that problem.

Why antibiotics helped these kids is still unknown. Trehan says it may ease chronic infections in these malnourished and immunodeficient kids. In addition, the intestinal linings of malnourished children break down, so bacteria normally harmless in the gut enter the bloodstream and cause trouble. Antibiotics could help those infections.
A mother feeding her kids peanut-based RUTF in Malawi. Indi Trehan

A second study in Science [5]suggests that imbalance in the gut microbiome causes kwashiorkor, an extreme form of malnutrition characterized by swelling. Identical twins could eat the same diet, the authors puzzled, but only one would have the bloated belly associated with kwashiorkor. So they looked at 22 discordant twin pairs in Malawi and found their gut microbes were markedly different. RUTF helped in the short term, but the kids with kwashiorkor reverted to abnormal microbiota at the end of treatment. And over time, the microbiota of kids with kwashiorkor didn't mature like their twins'a finding that suggests that kwashiorkor is a permanent condition.

Back in St. Louis, Washington University professor Jeffrey Gordon transplanted the Malawi twins' gut bacteria into sterile mice, a technique he's used before to study links between the gut microbiome and obesity [6] (PDF). These mice were then fed either a protein-poor Malawian diet or regular chow. Only the mice with both kwashiorkor microbiota and Malawian diets lost significant weight. This suggests that RUTF longer than the normal nine weeks may help correct the bacterial imbalance. An additional set of experiments looking at metabolites in mice urine and feces found that kwashiorkor microbiota messes with proper nutrient absorption.

This study solves some of the mystery of kwashiorkor and points toward a possible cure. "If you think of the microbiota as an organ, then repair requires microbes that can fill different 'professions,'" says Gordon. Thus, in addition to longer RUTF, treatment could directly target the bacteria, either in the form of probiotics to replace a missing microbe or a fecal transplant [7] that repopulates the entire community.

In light of what we know about the opposite problem, obesity, it makes perfect sense that antibiotics and the gut microbiome play a role in starvation. Obese mice [8] (and humans [9]) have altered microbial communities compared to their normal counterparts. And antibiotics in early childhood has been linked to higher body mass [10].

The antibiotics study may also echo the process that of fattening up animals with regular doses of antibiotics (which my colleage Tom Philpott wrote about here [10]), but Trehan cautions lumping against them together in one biological mechanism. The kids are given only one does of antibiotics, rather than continual doses over a whole lifetime. This also mitigates the problem of resistance, as the antibiotics are selectively doled out to malnourished kids rather than everyone in a particular town. "I spend half my time telling people to stop taking antibiotics as a pediatric fellow [in the US]," says Trehan, but "in an underfunded healthcare system, access to antibiotics is pretty rare."

Trehan's comment highlights the obvious gulf between healthcare in Malawi and St. Louis. The microbiome is one of the hottest areas in biomedicine right now, but research about its disease implications has focused on decidedly First World problems like obesity [9], high blood pressure [11], and autoimmune disorders [12]. An age-old and seemingly simple problem like malnourishment can benefit from cutting-edge science, too.
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Past Member (0)
Monday February 4, 2013, 11:45 am
This is very interesting, I just wish that this situation never has to occur in the first place!

Nancy M (197)
Monday February 4, 2013, 12:32 pm
Really interesting article. I am curious to find out the actual mechanism for this. I does highlight just how important our gut flora is in so many ways.

JL A (281)
Monday February 4, 2013, 12:35 pm
You cannot currently send a star to Garnet Jenny because you have done so within the last week.
You cannot currently send a star to Nancy because you have done so within the last week.

Terry V (30)
Monday February 4, 2013, 5:19 pm
What about over use of antibiotics? I am now allergic to most antibiotics because of high doses of antibiotics because of my mitral valve prolapse.

JL A (281)
Monday February 4, 2013, 5:22 pm
Excellent question Terry! We in the US have that issue while the starving may never have had any antibiotics in contrast. You cannot currently send a star to Terry because you have done so within the last week.

Kit B (276)
Monday February 4, 2013, 6:58 pm

Interesting study, so long as they don't over do the antibiotics leaving the children vulnerable. Since the introduction of the peanut butter "quick fix" a number of new all in one meals have been designed. Let's hope a small dose of antibiotics and more decent food will save some of these babes.

JL A (281)
Monday February 4, 2013, 7:42 pm
You cannot currently send a star to Kit because you have done so within the last week.

paula eaton (30)
Tuesday February 5, 2013, 3:27 am
This sounds too good to be true. Sounds like the drug companies are pushing this.

janice l (0)
Tuesday February 5, 2013, 4:43 am
I read that 50% of the food in the world gets thrown away. there should be some way to give the food to starving people instead of drugs. If we can send them drugs then you would think that there would be a way to collect and send them the food that is wasted every day.

Ro H (0)
Tuesday February 5, 2013, 5:06 am

Nancy M (197)
Tuesday February 5, 2013, 7:23 am
I think in this case, the antibiotics are short term to get rid of the bad microflora and help to establish better floor based on the food. I would not be overly worried here about resistance.

JL A (281)
Tuesday February 5, 2013, 7:35 am
You cannot currently send a star to paula because you have done so within the last week.
You are welcome Ro.
Thanks Nancy for addressing the antibiotic resistance concern with your expertise.
You cannot currently send a star to Nancy because you have done so within the last week.

Bruno Moreira (61)
Tuesday February 5, 2013, 9:44 am
noted thanks

. (0)
Tuesday February 5, 2013, 10:04 am
Interesting article. I suspect the antibiotics worked because this was the children's first time exposure to them.

JL A (281)
Tuesday February 5, 2013, 10:59 am
You're welcome Bruno. You may be right Michael. You cannot currently send a star to Michael because you have done so within the last week.

Past Member (0)
Tuesday February 5, 2013, 11:18 am

Natalie V (27)
Tuesday February 5, 2013, 4:52 pm

Sandy Nichols (0)
Monday February 11, 2013, 12:56 pm
J.L.A. Do you have to send a star to everyone? I sure have notice that you have the last few days. I agree with if we can send drugs why not send food? They will get so they won't be able to take antibotics. And sadly these mothers do not know the risk of taking too many antibotics. Sounds like the government is doing some test on them. Just a thought.

JL A (281)
Monday February 11, 2013, 1:53 pm
Interesting thoughts Sandy--thanks for sharing them (I'd send a star if I wasn't told it would be too soon).
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