Speaker 1 (00:00:00):
Welcome to the Dr. Gundry podcast, the weekly podcast where Dr. G gives you the tools you need to boost your health and live your healthiest life.
Dr. Gundry (00:00:16):
Welcome to the Dr. Gundry podcast. They can live in vents, on the bottom of the ocean, in caves deep below the earth’s surface, and even inside you and me. I am talking of course about bacteria. And they paradoxically are some of the most beneficial and harmful living organisms on the planet, responsible both for keeping you healthy and happy, and for leading the dangerous illnesses like pneumonia for example.
Now in recent years, scientists have sounded the alarm about antibiotic resistant bacteria. In fact, just last year, the World Health Organization said that antibiotic resistant diseases could kill up to, get this, 10 million people every year by 2050. To help us make sense of how antibiotic resistant works, I’m joined today by Dr. Mohammad Zaman. Dr. Zaman is a professor of biomedical engineering at Boston University, and is an expert on cell biology. He’s also the author of a brand new book called The Biography of Resistance: The Epic Battle Between People and Pathogens. Boy, what a timely subject that is. On today’s episode, Dr. Zaman and I will discuss the bacterial secret hiding in the guts of a long-lost tribe, the connection between the food we eat and antibiotic resistance bacteria, and whether you should worry about antibiotic resistance. Dr. Zaman, it’s a pleasure to have you on the podcast.
Dr. Zaman (00:01:55):
Thank you so much Dr. Gundry.
Dr. Gundry (00:02:00):
So let’s start with this fascinating story that you tell in the book about antibiotic resistance deep in a cave in New Mexico. Wait a minute, deep in a cave? Tell us about that.
Dr. Zaman (00:02:13):
Yeah, so this was a shocker for me as well. So two scientists, Dr. Wright from Canada and Dr. Hazel Barton from University of Akron. They teamed up together, and Dr. Barton is sort of an expert in bacteria living in deep caves. Because bacteria, remember Dr. Gundry, have been there from the beginning of time. Billions of years old. So they teamed up, and the idea was actually a very simple one, to go deep in the caves that have never been touched by any human activity. Caves that have been there for millions of years, and see if the bacteria there that are not at all affected by human activity, by the use or abuse of drugs, or bacterial products in the farms, and see whether they are resistant to any of the modern antibiotics.
What they found was absolutely stunning. Deep in these caves, this is one of the largest cave system in the world. It’s I think among the top five largest cave systems, goes for miles and miles, really deep. What they found was is that the bacteria there on the surfaces were not just resistant to first and second line antibiotics, but some of the even most advanced antibiotics that we have developed. That was surprising, right?
Dr. Gundry (00:02:13):
Right.
Dr. Zaman (00:03:47):
So Gerry Wright and Dr. Barton together started to piece the puzzle and it turns out that bacteria have been developing these mechanisms of coming up with new antibiotics and resistance mechanisms from the very beginning. Otherwise, there would’ve been only one kind bacteria out there that would’ve been able to kill everybody else, right? That’s not the case. The fact that there is such a diversity in the bacterial population tells you that this arms race is constantly going on. Somebody gets an edge a little bit here, somebody loses the battle a little bit over there.
But what is the problem here is that human activity has started to disrupt this equilibrium that has been going on for millions and millions of years. That equilibrium between producing new antibiotics and responding to those antibiotics, that has been going on in soil, in nature, for a long time has been disrupted because of excessive use of antibiotics, because of antibiotics used in agriculture, being used in situations and we don’t need them, and that has what’s sort of tipped the balance. Sort of we put the term on the scales a little bit in the favor of antibiotic resistant bacteria, and hence the problem that we are seeing in hospitals and in patients all over the world.
Dr. Gundry (00:05:06):
So, let me back up for just a second. Most people understand the term antibiotic I think, but the original antibiotics were derived from molds and funguses, yes?
Dr. Zaman (00:05:21):
That’s right, that’s right.
Dr. Gundry (00:05:23):
This was literally a battle between bacteria and molds and fungi for space, for power.
Dr. Zaman (00:05:32):
That’s right. Absolutely, Absolutely. One of the most potent sources of antibiotics has been of course bacteria. They are the original producers. They are these efficient machines, and the best possible industry out there to produce antibiotics. Now, they figured it out that looking around, what are some of the places where you’ll find all kinds of bacteria? The most potent and the most sort of I think inexhaustible resource was your soil. All the way from your backyard to deep jungles of Indonesia and the Latin American countries and sort of all over the world, to mold found in bread and on cantaloupe.
As we dug deeper and learned about bacteria and how they produced, we were able to sort of harness that capacity and producer newer and newer antibiotics. Even to this day, sir, one of the most potent sources remains natural products to discover new antibiotics, as well as natural environment, right? If you want to look in our natural environment… And the book goes in detail in several of these discoveries that come from soil, that come from a rotten cantaloupe, that comes from pristine environments, or soil samples in Borneo.
So for the longest time, we have been able to mine these places for new discoveries, and I think scientists, myself included, believe that nature still has a lot of treasures to offer in terms of modern medicine, and we continue to sort of learn and adapt, and discover new things. So, I’m on that front, I’m certainly an optimist. On other fronts, human behavior, less so.
Dr. Gundry (00:07:32):
So, before I so rudely interrupted you, you were talking about how antibiotic resistance now just seems out of control, because of the antibiotics we use in raising animals for slaughter, and of course the willy nilly that we give antibiotics for things that aren’t bacterial infections. Can you elaborate on that? I think you certainly go into this in the book.
Dr. Zaman (00:08:03):
Sure. So, there are several dimensions of this. One dimension that you as a clinician are all too familiar with is the use and perhaps excessive use in hospitals and clinical settings. Some of it is being out of abundance of caution in hospital settings. Some of it is patient pressure on primary care physicians who want to get an antibiotic no matter what, and the primary care doctor is under tremendous pressure from parents of children, or patients themselves, to get an antibiotic even though they may not need one. That’s one aspect of it.
The second aspect of it is consumers who would stop taking them after two days because they have started to feel better, the fever has gone whereas you would need it for five or seven days. That’s the other aspect of the problem. The reason both of these are important is if… So for your listeners and for your audience, it’s important to recognize that antibiotics taken for a short period of time would kill some bacteria, not all. You start to feel better, but the bacteria that were the most stubborn have survived. They will proliferate, and they will grow. And next time you get sick, the same antibiotic may take a lot longer to cure you, or may not cure you at all, because the ones that were the hardest to kill the first time are now the ones that are in majority, right? That’s why it’s important to finish the course.
At the same time, when you take antibiotics for something that you don’t need antibiotics for, for example seasonal flu or common cold, what you end up doing is you don’t do anything to the virus. What you end up doing is you start giving ammunition to the bacteria who are not causing the illness and are sort of just, again, some of the bacteria are going to die, the stubborn ones are going to survive and going to come back with a vengeance. Not only that, you’re also risking your neighbors and your family and others, because you are helping create these bacteria that are resistant. So, next time you are infecting them, or infecting your neighborhood, well, they are the ones who are going to suffer. So there’s a communal element here. So those are two aspects of it.
There other aspects which are underappreciated, and important to recognize. The fact that there is an excess of antibiotics in the food production sector continues to be a problem, because we have used and continued to use antibiotics in farm animals, and as growth promoters when there’s absolutely no need. I’m not somebody who says that if an animal is sick you shouldn’t give an antibiotic, I think that would be unethical. If there is an infection, you should give one. But if you’re using it for fattening up your chicken or giving it as part of a feed in your cattle farm, then that’s a problem and that’s something that they’re not the right use for. I think US, China, India, Brazil, are often guilty of that, because of having very, very large farms and poor regulations. So, that’s another dimension.
On top of this, there are two other things that I talk about in the book which are important. One of them is the fact that in many parts of the world, the quality of antibiotics is not what it ought to be. So, you can be a good patient and take your course for all five or seven days, but if the drug was only 30% pure, then you’re taking antibiotics for 30% of the time. So even though… and that’s an ethical issue, because it’s not the fault of the patient, but the system has failed you there, and I think that’s important to recognize. Okay, so that’s one other element.
The last and the final one I think is: global conflict makes people who are very vulnerable, who are in the cross hairs of conflict, get in situations where the hospitals are destroyed, health workers are not there, environment is contaminated, and infections spreads very rapidly. And in these field hospitals, doctors don’t have the capacity, ability, or resources to test each individual person to know what is the right antibiotic. The antibiotic you get is the antibiotic they have, not the one that you need. So, increasing conflict, whether it is in the middle east or in Crimea or elsewhere, makes people vulnerable to these things.
All of us, Dr. Gundry are really troubled by the sort of racial injustice in this country and all over the world. This is an issue that has gone on for way too long and is one that is so deeply troubling and depressing. One of the things we have to realize is anytime these kinds of injustices happen anywhere in the world, people who are on the losing end are also the ones who do not have access to good healthcare. So the problem of Covid or the problem antibiotic microbial resistance is going to affect people who are socioeconomically disadvantaged.
So there is every reason from the clinical or research side to address this issue, but there’s also reason from social justice side, because the ones who are going to be most affected are the ones who have underlying conditions, who do not have access to good healthcare, who do not have access to good information. And all of these things I think are central as you want to build a better society that is fairer and more just. And I think access to good healthcare regardless of your color of your skin or socioeconomic status, should be a fundamental pillar in all of our dealings.
Dr. Gundry (00:13:20):
Couldn’t said it better. Let me ask you, I’m old enough to remember when the first broad spectrum antibiotics were available. I was actually in medical school at the time, and we just thought it was the most wonderful thing that could possibly happen to us as clinicians because… Actually, I’ll tell you a wonderful story from medical school. We got to rotate through private practice physicians’ offices, and I had… Part of my pediatric rotation was in a pediatrician’s office, He would take a swab for strep throat, and he would then have his nurse give the mother a prescription for penicillin or ampicillin before the culture even came back.
I said, “Well wait a minute, you took a culture, aren’t you going to see if this is actually strep,” and I said, “Why do you give them the antibiotics?” He said, “If I don’t give mom the antibiotic, she will go next door down the street to my competitor who will give her those antibiotics. The mom’s looking for something to do, and that’s what I’m going to do.” And it was just this blew my mind as a well-meaning medical student going, “That’s not what you’re supposed to do.”
But speaking as a medical student when broad spectrum antibiotics came out, now we didn’t have to go, “Oh, we’ve got to wait for the cultures. We’ve got to figure out what this bug is.” Let’s just shotgun everything. We actually saw for the first time in the ’70s, Cdifficile, we didn’t even know what that was back then. We called it Pseudomembranous colitis. And, I’ve written in my books, we actually gave patients fecal enemas from medical students to cure C. Diff back in the 1970s. So what has broad-spectrum antibiotics done to us?
Dr. Zaman (00:15:29):
I’m a strong believer in research, and I think the broad-spectrum antibiotics offer the ability to treat gram positive and gram negative infections, and I think there is a value and a place for them. But I think they also offer, to a certain extent, this false sense of confidence and false sense of comfort that has been abused, right? So they offered us a sense of invincibility saying that maybe, we will always be ahead of the bacterial evolution. And I think that hubris, which I hope is now addressed, has not served us well. Hubris never serves you anytime, any point in life, and that certainly whether it comes from the doctors or the patients, whether it comes from the public health professionals, the politicians is never a good idea.
But what ended up happening was, there was a sense that, well, we will always have these antibiotics, and no matter what the infection is, we will always be able to address that. But we know now, and even at that time early on, we were able to see if we had paid attention that resistance emerged almost immediately as using antibiotics.
I’ll give a example, very specific example here, and I talk about that in the book as well. So Cipro is something that many of your listeners and many of your colleagues are familiar with. We take it with an upset stomach, if you travel abroad, travelers diarrhea, Cipro is well known. Now Cipro is this big, hot commodity in [inaudible 00:17:07], as soon as it was ruled out, within a year or two, there were reports of resistance to Ciprofloxacin, which tells you that, one, the resistance aspect can be pretty fast and dynamic, and two, that there is no really I would say protection from resistance, and now we know that resistance is also natural. It’s not surprising to expect resistance happening and it has happened from the beginning of time.
What can help us is to constantly extend that runway through our behavior, and better practices so that we are ahead of the bacterial resistance process. There will always be resistance, but for it to happen almost immediately, and happen in that wide-spread sense is what makes people very vulnerable, who may already have higher risks.
Dr. Gundry (00:18:03):
Yeah, the head of our department of urology has told me that only about 50% of people with urinary tract infections now respond to Cipro, that it’s-
Dr. Zaman (00:18:15):
Absolutely.
Dr. Gundry (00:18:16):
It’s-
Dr. Zaman (00:18:17):
So, UTIs are sort of… I would think are among the most commonly seen challenges in hospitals and places where you work, and in Boston, elsewhere, which is sort of a real challenge because the fact that on one end, you don’t have new antibiotics coming to the markets. On other end, you have people who are not responding to therapies, that only 10 years ago were a lot more potent should give us very, very serious cause for concern. And this is for people who are in the hospital, for people who are not coming to hospital and may develop infections at various levels is I think they don’t even think we know how to count those numbers.
Dr. Gundry (00:19:02):
So they’re… When you go on the internet, they say “Don’t drink your municipal water because it’s got antibiotics in it.” What say you?
Dr. Zaman (00:19:13):
Well, so I think, I’m not a fan of people’s claims without really backed up data. I think if there is reason that there are antibiotics, either in full form or in residues, and I think that needs to be really taken care of. But I think there is a lot of danger out there, also creating this sort of a sense of unnecessary fear without backed up, scientific data. That’s where, I would draw the line. I think, we know from data all over the world that there are antibiotics in water and sewage systems because most of the antibiotics that we would take, part of it would be absorbed, the other part would be sort of excreted out of the system.
That itself is not scientifically disputed. But the fact is that somehow thinking that somebody is adding antibiotics to the system is I think a claim that seems both bold and arduous and one that merit scientific scrutiny. It’s not to say that there aren’t antibiotics in our system. Of course, if you live anywhere down stream of a poultry or cattle farm, the amount of antibiotics in that environment are going to be high largely because of poor regulatory infrastructure. But does that mean that your water is not safe to drink? I think that has to be done on a case by case basis as opposed to one size fits all that creates the sense of conspiracy theory which is very dangerous and we’re seeing some of those conspiracy theories played out also in Covid which just sort of takes away from good public health practices which are scientifically sound, and are in public interest.
Dr. Gundry (00:20:52):
So, you brought up chicken and cattle farms. We’re sometimes assured that no, no, no, it’s illegal to use antibiotics in chickens anymore or no, no, no, it’s illegal to use these and yet correct me if I’m wrong, many of these products that claim to have no antibiotics when they’re tested have in fact antibiotics in them. What’s with that?
Dr. Zaman (00:21:20):
This is a great question and unfortunately the devil here in the details. So, the laws the way they’re written, they leave a lot of loop hole. So they would say they wouldn’t give antibiotics for prophylaxis or growth control but then they are laws saying which are very weakly written about using antibiotics prophylactically to control infection ahead of time which makes it… Gives some of our colleagues in the farming community an opportunity to use them sort of not illegally but in ways that are I would say not entirely consistent with what we ought to do.
So, I think they are regulations in places, Scandinavia is an example. Netherlands is an example where there are stricter laws on when you can and can not use antibiotics. That’s argument one. The second argument is they would say we don’t use antibiotics and that claim will also be true in some cases. And they would say we don’t use antibiotics that have been sort of use or classified for exclusive human use. But they would use other antibiotics that may not be for human use and may be use only in farms and animals.
That doesn’t mean that takes away the problem because if look at the mechanism, they may sort of lead to resistance anyway even if they are not sort of approved for human use. So there I think there is a slightly misleading approach saying that we don’t use any antibiotics. What they may mean is we don’t use any antibiotics that are for human use but maybe we may use for other animal use, and they may lead to resistance.
One of the things that we talk about in the book which is important, and which is a big discovery in the 1950s is how resistance can jump from one bacterial species to another. Something that’s called horizontal gene transfer. So up until 1950s, Dr Gundry, the understanding was that it was only vertical, in other words mutations from one generation of bacteria to the other. But we know from the late ’40s into ’50s, that there was discoveries demonstrating that there is something that can jump from one species. For example, E.coli to Salmonella, and in a form of… You can imagine its sort of kind of a bacterial meeting or sort of these little packets of DNA that can jump from one bacterial species to another making it possible that you may be treating E.coli but the resistance may be developing Salmonella.
That sort of really changed the field and I think that is where we have to be concerned. Every now and then your listeners, your colleagues would hear the word Plasmid and saying that they are Plasmids. Plasmids are just a packet or like a set of DNA that is basically mobile. These are mobile genetic elements that can go from one to the other making it very difficult. So, I grew up in Pakistan and in southern part of the country. I grew up in the northern part but in the southern part of the country, there is typhoid which is resistant to all drugs except two any more, right? So every single drug doesn’t work, only two of them work. One of them is Carbapenemase. It can only be given in the hospital, and the other one is Azithromycin. That emergency of this extensively drug-resistant typhoid was because of these plasmids.
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Dr. Gundry (00:25:17):
I like the way you clarify that because I think what’s amazing is that you’re right. Bacteria for lack of a better word can mate and transfer a resistance to an antibiotic that they may have… The other bacteria has never seen it but now that bacteria has gotten that information.
Dr. Zaman (00:25:38):
Absolutely. Absolutely. That’s why increased caution is important along with better sanitation and hygiene. But assuming that I was only treating E.coli and I’m not sure why Salmonella has it, would make it an assumption that is just not accurate because there is meeting and fusion of bacteria and transfer of genetic material from one to the other.
Dr. Gundry (00:26:00):
We find that in the human microbiome research that’s… This goes on constantly. There is constant talk between bacteria. Constant exchange of genetic information and It’s actually like you say who would’ve imagined that this could happen?
Dr. Zaman (00:26:22):
Absolutely. Absolutely.
Dr. Gundry (00:26:23):
All right, I want to ask you about the Yanomami. Tell me about this tribe in the amazon jungle and their microbes. Why would you be interested in a tribe in the amazon?
Dr. Zaman (00:26:38):
So, this was one of those serendipitous moments in science. There are tribes in Amazon that are uncontacted and have been there for thousands, perhaps tens of thousands of years. One part of the Yanomami is one of them. In the first decade of 2000s during a routine surveillance operation, Venezuelan army spotted a group of people that they hadn’t seen before. Now the international agreed upon ethics is that any time you see a group, it means that somebody else can also see that group, and if somebody else can see that group, means that they do not have the same sort of immunization as you and I might.
Which means that if you and I might be carrying a disease that they’re not protected against, measles for example, they might be wiped in a matter of a few days. So, care has to be taken to make sure that you are protecting them. Saying you want to leave them undisturbed but the fact is that you have seen them means that other people can also see them and you have an ethical responsibility as humans to protect the people who are vulnerable and that goes for every body.
All right. So, this is what happens, and so, the Venezuelan Tropical research institute… And, so ethically their location is kept secret, only a few people know. But a couple of researchers who are looking at antibiotics decide, well, may be this is an interesting question to understand what is their microbiome. What exactly they have not certainly come in contact with modern hospitals, their diet is different, their lifestyle is different, their community structure is different.
What the deal was before they gave them immunizations against the routine highly contagious diseases, they collected the dead cells on the skin and the fecal samples, right? So both of these are non invasive and were collected. And, so then we have now tools to analyze what kind of cells are there, what’s in there in these samples. Lo, and behold, again just like that story in New Mexico cave system, here again you see that these skin cells and fecal samples have bacteria that are resistant to second, third, and even fourth generation drugs. That is just completely bizarre, right? How could these group of people be resistant. About their microbiome may have-
Dr. Gundry (00:26:38):
Right.
Dr. Zaman (00:29:22):
A bacteria. So one of the things that I make this mistake often and I want to tell your listeners is people don’t become resistant, it’s the bacteria that are resistant, right? So, we have to keep that in mind. There is no resistant individual here to antibiotics. It’s the bacterial that’s resistant and we carry that bacteria would mean sort of cause of an infection.
So the Yanomamis are excluded from the development of Brazil and Venezuela. They are a vulnerable group. They are certainly not coming in contact. So, what’s going on there? Right? This is just sort of completely bizarre and goes back against the notion that it’s the human activity that is driving that. Well, it turns out that there are… And we don’t know all the answers and this is one of the other things that I tell my colleagues and my students certainly that science is a process. It’s process of learning about ourselves and what we want to be confident in is in the methods.
The results can change and they continue to change and we learn. As long as we are certain and happy and rigorous in our methodology, that’s the most important thing. The results I mean… Not too long ago people believed that the earth was the center of the universe. It wasn’t very long but when… But how you move forward anyway. My point is that there are several reasons. One is, it is possible in the diet as I mentioned earlier and in the environment are bacteria that are producing antibiotics and also are developing resistance.
Two, we don’t fully understand the microbiome and what maybe happening there is something else. Or, three and these are concerning things. But then there are also positive and acting slightly encouraging aspects where there are antibiotics out there that we haven’t really discovered yet. They may be similar to ones we have made in the lab but nature may already have made them hundreds of thousands or perhaps million of years ago.
Of course, then you have to think about something that you mentioned earlier, the water ways may be also have some contamination. As you look at sort of because while they may not have contact with them, they certainly have come with the environment and the world. But the fact that they are resistant tells you something much deeper that there’s lot we don’t know. And I think at some point we have to throw up our hands and say, “Well, there is a lot I don’t know and I need to understand, and I need to think about that. There are things here that are concerning and there are things here that are very positive and exciting.”
Dr. Gundry (00:31:46):
So, actually at the start we talked a bit about the soil and how the soil has changed. The soil has its own microbiome.
Dr. Zaman (00:31:59):
Absolutely.
Dr. Gundry (00:32:04):
We’ve changed our soil. I’ve railed against this, you’ve spoken against this in the book, what does soil have to do with all of these?
Dr. Zaman (00:32:15):
So there are endless stories about both. This absolutely fascinating stories about what soil has and how soil plays a role. Our environment Dr. Gundry is who we’re. We have a tremendous sort of relationship with this environment, our microbiome and the soil plays a central role. Early on scientists figured out that soil both from our own backyards, and our national parks and our environment as well soil from far off lands some times near even thick jungles or right around the grave yards has these bacteria that really are remarkable in producing unusual molecules.
I think as we change our environment, we’re also changing our microbiome in tremendous ways. As I said earlier I think there is a lot that we don’t know and I think there’s a lot we ought to learn and they may be sort of a hidden treasures that the earth has. About 10 years ago, there was a discovery of new antibiotics, of uniform soil samples that I think as our methods become more and more sophisticated, we learn more about our environment and hopefully more about our ability to benefit from that environment in a much more I would say holistic manner.
Dr. Gundry (00:33:54):
Okay, so we’ve touched on this but every body knows the words Superbugs. What are Superbugs? Are the fears over blown? Is there anything we can stop these Superbugs or we’re just going to wait and they’re going to take over us.
Dr. Zaman (00:34:15):
So, I think the fear is real. Again, it’s one of those terms that is hard to define technically. As scientists, we want to clearly define but when something becomes a popular part of the common vocabulary, it changes its meanings, right? So, Superbugs are defined differently by different people. Broadly speaking what it means is that there are bugs that we can not fully fight with existing arsenal. They may have a diminishing number of antibiotics that might work. They’re super because they don’t respond to one or two or perhaps three of our drugs and we have to use really sophisticated drugs with terrible, terrible side effects to really get ahold of them.
The fear is real Dr. Gundry, and I think even the most conservative estimates, most conservative ones, the number of people dying because of antimicrobial resistance in this country every year is about 33,000. The reason I say it’s most conservative one is because there’re a whole bunch of death associated with Sepsis which is a big, big cause of death that are not associated antimicrobial resistance because there’re comorbidities and other factors that are there, right?. So we don’t count as such.
Certainly, more so, another sort of infection that people like you see in hospitals all the time is a factor. The reason I would be concerned about Superbugs is because the curve is increasing. More and more people getting affected, more and more people not responding to [inaudible 00:36:01] antibiotics, and more and more hospitals having to recognize that this is a concern changing your hospital practice.
Imagine a scenario where routine surgeries, even elective surgeries are becoming harder. People are having to deal with antimicrobial resistance. Hospitals having to send people home soon because they’re worried that if you stay a little bit longer, you develop an infection that could be harder. People having to return to hospitals because the infection is so stubborn that it just doesn’t go away with the first course of that antibiotic.
I think we have to think about how it really starts to impact the way we seek health care, and as I mentioned earlier, people who are already suffering because of systemic issues, people who have multiple jobs, people who are under insured or uninsured, people who are struggling financially. For them these kinds of challenges can be another blow as we look at that issue. So, I think that fear is real and one that is increasing.
The other thing I want to say and I think if one thing Covid should have taught us, is that we’re all in this together. You, and me on different course of this country, me, and my family on the other side of the planet. Antimicrobial resistance is no different in that regard. The book starts with the story of a woman who slips and has a hip injury in other country and ends up dying in Nevada. None of the 24 antibiotics approved by the CDC work, right? I think we have to recognize this is not an abstract concept, it’s an issue that is very real and certainly one that is in our own neighborhoods.
But then I also want to sort of… I don’t want to be the only bearer of bad news, there is… So the reason I wrote this as a biography is just as we have caused this problem through our action or inaction, there in lies the opportunity also by our behavioral change, but better understanding in a [inaudible 00:38:26]. By not just better science which is important but also better policies. By sort of having the sense of where the problem comes from so that our solutions can also respond and reflect on that.
Dr. Gundry (00:38:39):
Good point. Now, you mentioned Covid which is a virus, and to this day, I am impressed so many people do not the difference between a virus and a bacteria. But I want you to tell me about viruses that attack bacteria, phages.
Dr. Zaman (00:39:01):
Absolutely. This is another one of those sort of interesting dimensions. People… So you’re actually right, many of my friends wouldn’t know the difference between a virus and a bacteria and that’s fine. I don’t know a lot of things either. We all learn and it’s good to learn. The tiniest of bacteria is really bigger than the biggest of viruses. The viruses… So, we know that viruses need a living object to survive and thrive, That could be a blood cell. That could be a cell or an environment in your, and my lung, I hope it is not the case. But that could also be a bacteria. So the viruses can live in bacteria.
About a hundred years ago, scientists realized that well some viruses can live inside bacteria and then basically high jack the bacterial machinery and kill it. These are called bacteriophages. Now, that’s really interesting because does that mean that can we use viruses to, or program viruses or use viruses to target bacteria that are so stubborn that our drugs cannot work on them. The answer is yes and it’s a qualified yes.
This therapy Dr. Gundry is older than antibiotics. Back in the day about 110 years ago, 105 years ago, this became the blockbuster to the point that Pulitzer prize winning book, Arrowsmith focused on bacteriophages. For your listeners who have a taste for both history and literature, if they look at the book again which is brilliant, they will find the story of this brilliant scientist and his therapy to save the world. The book is called Arrowsmith and that is by Sinclair.
Now, they became the hot commodity and they faded because it was hard to really produce them for a number of different bacteria. Their potency was good but not great. Antibiotics came and they became cheaper, they were easily… You could produce them in mass numbers. Also, again in all of our lives we can not separate science from politics. Bacteriophages became the drug of the communist block, right? So the big institute was in Georgia, Joseph Stalin was a patron of that institute, had a lot to do with that and that sort of… The politics became part of the conversation as well and sort of rejecting everything that was coming from the former Soviet Union.
In 1980s as the understanding of antibiotics and their limited potency became an issue, people started to go back to the bacteriophages and by 2000s, people started saying, “Well, they may be something out there for them.” I think now there’s increasing awareness. There is a potential. However, I say that with a sense of caution that, that potential comes from the fact of recognition that one, there’s a lot we don’t understand, for example, we do not have the same number of robust and rigorous clinical trials to demonstrate their efficacy. So there’s some promising evidence but not as much as you would like. So that’s the first thing.
The second this is the fact that viruses being living organisms you need to understand how they will change once they’re in the bacteria inside the human body and what we would immune pathogen response. How our immune system reacts to this and those questions are important as well. Finally, I think the reality is that for any drug to really reach the marketing stage, and commercialization, you have to see what is the appetite of FDA, what is the appetite of the existing legal framework and licensing and all of that. I think that also is in its infancy. It’s getting there but it’s not quite there. So I would say promise yes, but with a caution that there’s a lot we don’t know.
Dr. Gundry (00:43:13):
I think, correct me if I’m wrong, I think Eli Lilly, one of the big pharmaceuticals started as a bacteriophage company.
Dr. Zaman (00:43:22):
Yeah. So there are some and I think there’re increasing clinical trials, the companies are looking at that. Even when I spoke for the book US Navy was interested in looking at this specially for its officers in the tropics who were increasingly concerned about various kinds of antimicrobial resistant organisms. I think there’s as I said promise there’s certainly lot of discussion in the microbiology research community to understand what’s going on. But as I said I think it doesn’t have the same broad applicability right now as antibiotics do.
We also know that bacteria are not all the same. Even with antibiotics you have a whole diversity on the mechanism of action and I think the same would have thought through when it comes to phages that some diseases will be more suited to respond to it than others.
Dr. Gundry (00:44:23):
Now, also in the news there is word that pharmaceutical companies really aren’t interested in developing antibiotics. What’s with that? I mean come on, there’s got to be big money in this.
Dr. Zaman (00:44:36):
Well, so that’s the common assumption Dr. Gundry. Unfortunately, let’s do it well. Okay, so let’s do a thought experiment. You’re a clinician, imagine that you’re a head of a publicly traded pharmaceutical company and you have two options. You can invest in antibiotics that people would take for five, seven, 10 days or you can invest in a drug for hypertension or cancer that people would take for a very long period of time. The numbers are not the same. That’s the first thing, right?
The second is, let’s say you’re super successful and come up for an antibiotic against a stubborn gram negative infection that people have been struggling for decades. You market it and the government says, “Dr. Gundry, great job, we’re very proud of you but we don’t want you to market it to the public because we want to hold for worst case scenario, right?” Because if everybody uses it, well, you develop resistance. You don’t want that.
That is the biggest mood killer possible for any investor that you spend hundreds of millions, perhaps billions of dollars and you can’t market it. I mean what do you mean? Here I’m neither defending the government nor the pharmaceutical companies, I’m laying out the reality of this thought experiment and sort of talk about why our model is broken and needs to be fixed in terms of a public good, right? So those are two things. Third thing is people know that resistance is natural in a matter of time even with great antibiotics, you will start to see some resistance, we’ve learned that.
Four, in may parts of the world including where I grew up in, antibiotics are available over the counter. You don’t need a prescription. Prescription drug laws are not very strong in countries that have hundreds of millions of people. You market it there well, pretty soon you will have resistance emerge in Pakistan, or Nigeria, or India or [inaudible 00:46:31]. This starts to really affect the mood, well as in cancer or in hypertension or in mental health or you name it, musculoskeletal disorders, the drugs are robust.
The fact that in the last 10 or 15 years we have only about 40, 43 drugs in the pipeline tells you how little appetite there is in pharmaceutical companies who instead of entering the market are actually leaving the market because the numbers are not adding up. Because, if we are talking about Covid… This is a statement from a friend of mine [inaudible 00:47:06] and so he works on the economics of pharmaceuticals and he said, and I will say that to your listeners as well, “If you had a Covid vaccine eight months ago, the value of that would have been zero dollars. Nobody would have been interested.”
So, it tells you that the market dynamics are not very suited for these kinds of public health challenges and we need to create different incentives for pharmaceutical companies to come into that. Some of it is market entry, some of it is other kinds of rebates. Those are being discussed but then I speak to my colleagues in public health, this is their concern because ultimately the work that happens in my lab doesn’t reach your patients unless and until pharmaceutical companies are involved in making that drug safe, clear.
My lab has no capacity, no training, no ability to make a drug. We can make all the discoveries we want but it’s a complicated, sophisticated process and pharma companies have to be involved. You have to create a mechanism by which for profit companies and the public sector can work together to do that. Otherwise, we’ll have the stalemate that we have right now.
Dr. Gundry (00:48:23):
So, is there any hope?
Dr. Zaman (00:48:26):
There is some. The hope comes from incentivizing medium to small biotech companies that are not as big as some of these giant multi-billion dollar companies to come up with maybe drug and being able to market and take it to the level where it becomes attractive, right? So there is NIH in the US, Wellcome Trust in UK, and a few other agencies have partnered together to create consortia, one of them is called CARB-X that is incentivizing small and medium biotech companies who have demonstrated early success to take them. Because that is called the value of debt so to speak.
You have early success, but not commercialization. Few people are interested in investing in that value of debt because great idea, good paper, good publications but to take it through the boring and laborious process of clinical trials you have very investors and they want to sort of bridge that gap there, and they incentivize by saying, ” Look, we don’t want equity in this. You will maintain the equity. We just want to help you because this should be a public good. So there is hope in that.”
The other dimension of hope which I think is absolutely important is the fact that more people including many of your listeners will start asking these questions and thinking about behavioral change, and thinking twice before they tell their primary care physician and the story that you told about the neighboring physician prescribing and, hence all patients going to him or her is absolutely true. I have heard that. I can’t even count any more how many times I’ve heard that. So, that awareness is important.
And then of course the fact is that we need better diagnostics which allow people to make a decision on how and which antibiotic to use as opposed to giving broad spectrum antibiotics that are one size fits all but that size doesn’t fit anything.
Dr. Gundry (00:50:25):
Yeah, that’s a great point. Some of that technology already exists. It’s just not utilized very much. Because it’s-
Dr. Zaman (00:50:25):
That’s right. That’s right.
Dr. Gundry (00:50:35):
Again it’s just so much more convenient to say here’s your prescription.
Dr. Zaman (00:50:41):
Absolutely. And, we’ve seen that, that doesn’t help anyone. Certainly, doesn’t help the patient, but doesn’t help the community or their loved ones. Doesn’t help the kids in that family, doesn’t help the elderly neighbor that they have.
Dr. Gundry (00:50:54):
All right before I let you go. What’s exciting in bacterial science that gets you up in the morning.
Dr. Zaman (00:51:03):
Well, there is a lot of things that are exciting. I think fundamental curiosity of how bacteria have been doing this for four million years, sorry, billion years-
Dr. Gundry (00:51:15):
Billion years.
Dr. Zaman (00:51:17):
Is absolutely fascinating. But I think my excitement also comes from the fact as we know and understand more and more about bacteria, we’ll realize that bacteria are not this little tiny bug that lives in its own world. It’s modified, and altered, and its part of our community. Our behavior, individual, and collective is affecting the bacterial behavior that is affecting our behavior in return. And, that to me is a tremendously humbling moment and I think as we all should know, looking at Covid, humility is both in short supply and absolutely needed. So, I think that sense of humility and how we’re all connected is important.
One of the biggest lessons for me Dr. Gundry was to appreciate that science is part of the solution but not all of the solution. Human behavior, economics, policy, research and ethics, sociology, conflict and war. All of these things are interconnected in myriad ways that allow us to really be a better person, a better scientist, a better researcher, and ultimately people who would be able to help others in sort of combating antimicrobial resistance.
I remain optimistic. That window may be shrinking but that we can do, we can change things for the better. However, that would mean doing the hardest thing possible, and that is behavioral change.
Dr. Gundry (00:52:54):
That’s true and that’s kind of what I do is try to change my patient’s behavior. You’re right its hard, but that’s why we’re doing all of this.
Dr. Zaman (00:53:05):
That’s why we’re doing all of this absolutely.
Dr. Gundry (00:53:07):
All right, well, Dr. Zaman, it’s been a pleasure having you on the show today. Where do people find more about you? Obviously, they can get the book wherever books are sold.
Dr. Zaman (00:53:18):
Absolutely, wherever books are sold. This may be sort of my own personal healing, but I am a strong supporter going local. If your local neighborhood store is open, If they don’t have it, they can order it. There are real people, our neighbors who work in those book stores and you know the best part about local books stores is that you can have a conversation about the book with the bookseller, and who knows what may come out of that. So if you can go local, please do.
Dr. Gundry (00:53:49):
Yeah, I absolutely agree. We’ve actually got a book store that has been allowed to open and we’re in there buying books.
Dr. Zaman (00:53:59):
That’s excellent. That’s excellent.
Dr. Gundry (00:54:00):
All right. Well, thanks again for being on. This is fascinating, I know our listeners are going to love this. So, good luck with the book and go find some killers or bad bugs. Would you or something?
Dr. Zaman (00:54:14):
Thank you and I hope your listeners will get a chance to reflect on this. I would love to hear from them through you otherwise. Thank you so much.
Dr. Gundry (00:54:21):
Very good. Thanks a lot.
Dr. Zaman (00:54:22):
Thank you.
Dr. Gundry (00:54:24):
All right, so now it’s time for the audience question. C. Schilling from Instagram. I just had a surgery for the removal of some stones and was on antibiotics for a long time. Quite appropriate question. How do I detox all the antibiotics, and what probiotics do you recommend? Okay, so you don’t detox from antibiotics, they’re not toxic in any way to human cells but they are obviously designed to kill or at least maim bacteria.
Sometimes just like we went on this program, bacteria have different resistance to being killed. The point of all this is that many times unfortunately what we’re infected with now is resistance to the first round of antibiotics, sometimes the second round of antibiotics, and we have to get stronger, and stronger antibiotics to have an effect. So, those antibiotics we’ve unfortunately learned, also kill off the microbiome. Particularly if you were put on oral antibiotics.
We’re pretty convinced that IV antibiotics through your veins are not going to have the same effect on your gut microbiome as swallowing these antibiotics. That’s number one. So if you got IV antibiotics, you don’t have to worry as much about the long term effects. What the long term effects of oral antibiotics are is we had no idea that these antibiotics not only killed all the bad bugs, but killed a lot of our good bugs, the probiotics.
Now, the problem is, they’re some studies that show a single five to seven day course of antibiotics may wipe out your entire microbiome or most of it for up to two years after that dose of oral antibiotics. Two years. Now people go, “Well, I’ll just take some probiotics which are friendly bacteria, and I’ll get all my bugs back.” That’s like saying we recently had forest fires here in southern California that unfortunately destroyed a lot of our homes including mine. But if we went out after that fire, and the forest burned and we planted little pine trees, our forest would not be back for 20 maybe 30 years of complete ecosystem of a forest.
It’s actually quite naïve to think that we can swallow may be 20 different strains of probiotics and expect that we would have 10,000 different strains of probiotics growing in our gut shortly. Unfortunately, that’s probably just not going to happen and that’s what’s so important to realize. As I talk about in my previous books and I’m talking in the energy paradox in the next one, if you look at the diversity, the number of probiotics, friendly bacteria and bacteria in general and species in the gut of for instance, a hunter gatherer, these tribes the Yanomami, they have this incredible diverse ecosystem, and If you compare that to a typical westerner around the world, we have just a horrible very tiny fraction of all the bugs we probably should have.
So, do I think you should take probiotics after a round of antibiotics, absolutely. But I think what’s more important is that there are actually are little nest of these friendly bacteria that live in all of our guts. They’re in the [inaudible 00:58:39]. And what I think is far more important is you got to give these guys what they want to eat to come out of hiding and those are prebiotics. Those are the fibers that good bugs like. So yeah, take your probiotics but more importantly give those bugs what they need to eat and those are prebiotics. So, great question.
Okay, it’s time for the review of the week. Stephanie Lamb on YouTube wrote in and said this, ” Hi, Dr. G, as a recently graduated PhD… Congratulation. I greatly appreciate how you translate and transfer scientific knowledge to the public. This is very difficult for academics to do, and you’re a successful example of this. Thank you for sharing your knowledge with us.” Well, I really appreciate that coming from a PhD. That’s what I’ve tried to do throughout my career is make pretty complex stuff pretty easy to understand. I appreciate that you recognize my efforts and I will keep doing it. So, thanks very much. Appreciate that Stephanie. All right, that’s it for the Dr. Gundry podcast. We will see you next week.
Speaker 4 (00:59:53):
Thanks for joining me on this episode for of the Dr. Gundry podcast. Before you go, I just wanted to remind you that you can find the show on iTunes, Google play, Stitcher or wherever you get your podcast. And if you want to watch each episode of the Dr. Gundry podcast, you could always find me on YouTube at youtube.com/drgundry. Because I’m Dr, Gundry, and I’m always looking out for you.
