How Over-the-Counter Drugs and Chronic Stress Impact Gut Health and Type 1 Diabetes

We’ve gone over how damaging gut dysbiosis may be towards type 1 diabetes and diet’s influence over both of these conditions from our first two posts of this series.

Now, I’d like to bring to your attention how the long-term use of some medications and chronic stress may negatively impact your gut and diabetic health.

Ready?

Let’s roll!

Medications

Without question, medicine has played a vitally positive role in the evolution of the human race, let alone type 1 diabetes management.

Just before insulin’s discovery and its first administered dose in 1922, the average lifespan for a type 1 diabetic was less than 3 years (1).

Life expectancy has since risen dramatically among type 1 diabetics now that we’re able to immediately address their blood sugars (BGs) more quickly with prescription insulin.

However, other medications have been been associated with profound effects on the gut microbiome and overall health. You likely have heard of the variety of side effects from numerous TV commercials.

The two I’ll be going over in this post are antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs).

Antibiotics

Cartoon by Dr. Nick D. Kim, https://scienceandink.com/250dpi/nz083.jpg
Used by permission

Antibiotics fight bacterial infections, like strep throat and urinary tract infections, among other conditions.

In 1928, penicillin was the very first mass-produced antibiotic accidentally discovered by Alexander Fleming.

Initially, it was just some mold growing on a staphylococcus culture plate.

However, it quickly became the prime choice for medical physicians in treating previously life-threatening conditions such as gonorrhea, syphilis, and bacterial endocarditis.

Today, antibiotics have flourished and are commonly used in either the treatment or preventative measures for conditions such as ear and surgical infections and neonatal conjunctivitis (red eye caused by an infection in a newborn).

The short answers are hopefully but perhaps not without likely side effects.

Hopefully, in that if there is an infection of bacterial origin, the properly prescribed antibiotic should be able to eliminate it.

Perhaps not without potential side effects, in that most antibiotics are very generic and will eliminate not only the bacterial infection (assuming it’s there) but also beneficial, bacterial microbes, as well.

At this point, we already know how detrimental a low good gut bug count can be to our bodies, but let’s look at a specific case, shall we?

Standard Antibiotic Procedure Gone Wrong

In Dr. Martin J. Blaser’s book, Missing Microbes, he recalls the case of Peggy Lillis, who was a healthy and vivacious 56-year-old woman, who had some minor dental work done in March 2010 (2).

She was administered some antibiotics for the procedure.

Less than 2 months later she was dead.

Before her untimely death, she was diagnosed with a Clostridium difficile (C. diff) infection.

This particular strain of Clostridium is a bad microbe (most are good, however) that can be found in small amounts in the guts of healthy people.

It’s normally not deemed harmful due to the good microbes outnumbering C. diff to protect the body from it.

But if these beneficial gut bugs are wiped out, as they appear to have been from Peggy’s antibiotics, C. diff can spread quickly throughout the gut and colon.

It can then allow fecal matter to enter the bloodstream, as it did to Ms. Peggy, with drastic results.

Now, will this extreme circumstance occur in everyone who takes antibiotics?

It’s not very likely.

However, what is a consistent matter to be aware of is the significantly reduced amount of good microbes that normally result from the overuse of antibiotics (3).

Antibiotic Overuse

Antibiotics are commonly used to treat all different kinds of infections but should this be the gold standard of care?

For example, antibiotics are typically given for ear infections when up to half of the time it’s caused by a virus or food sensitivity (4, 5).

In 2016, the CDC estimated that 47 million antibiotics were prescribed for conditions that didn’t need them. This is equivalent to roughly 30% of all antibiotic prescriptions (6).

As you can see, the whole “overuse” argument does have some validity to it.

Incidentally, the ability of the gut microbiome to recover from a single antibiotic dose may take many months to occur (7).

And with chronic antibiotic use, there are instances when gut flora recovery may not even occur (8)!

But what if taking antibiotics is necessary for an upcoming procedure?

If so, the referenced article at the end of this sentence may help provide suggestions on how to buffer potential side effects when antibiotic use is medically necessary (9).

There are a great many benefits that antibiotics have and continue to provide us worldwide!

However, I do believe more careful assessment should be considered when it’s proposed to take them.

Especially if it’s for long-term use.

Now, what about NSAIDs?

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Many NSAIDs may be found as over-the-counter drugs (OTCs).

And these are highly profitable products for the pharmaceutical industry.

In 2019, OTC sales hit roughly 32.2 billion dollars (10)!

The most common OTCs are ibuprofen, aspirin, antacids, decongestants, antihistamines, proton pump inhibitors (PPIs), and acetaminophens.

Up to 70% of consumers that were studied with long-term NSAID use have been observed to express symptoms of gut distress, leaky gut, or nutritional malabsorption; 30% had signs of anemia and ulcers (11).

Studies show that chronic ibuprofen use may also alter gut microbiome composition while increasing potential disease-causing bacteria (12, 13).

The gut mucosa assists with gut barrier function and aspirin have been confirmed to compromise it (14, 15).

Antacids are commonly used to relieve heartburn, indigestion, or an upset stomach.

PPIs are used to treat acid reflux or gastroesophageal reflux disease (GERD).

Antacids and PPIs attempt to accomplish these goals by reducing the acidity level of stomach acid.

However, in doing so, this creates a more hospitable environment for bad microbes to reside and populate in greater numbers.

Though there’s not a lot of evidence correlating decongestants, antihistamines, and acetaminophens to gut dysbiosis, they have been associated with altered liver and kidney function, in addition to hypertension and dementia (16, 17, 18, 19).

Due to their associations with compromised health, it is recommended to avoid prolonged use of antibiotics and NSAIDs.

Next, let’s learn how chronic stress may compromise your gut health.

Long-Term (Chronic) Stress

We already know of the gut’s influence over nutrient absorption and immune function, but research has suggested it’s also able to modify mental and emotional conditions, as well (20).

The stress response in our bodies is highly adaptive and quick to restore balance after a “fight or flight” trigger presents itself and passes.

But how adaptive and quick it is in restoring balance also depends on the source of the stressor, the magnitude of the perceived stress, and how frequently it occurs.

More importantly, how stress is perceived/interpreted plays another big role, as well, but that information is too vast to cover in this post.

Though both of these scenarios are different in nature, they both can have similar impacts on our gut health that may alter our ability to cope with stress efficiently and vice versa.

The Enteric Nervous System and the Gut-Brain Connection

Second only to the brain and the nervous system, the gastrointestinal (GI) system is the next most important bundle of anatomy that our bodies possess.

The gut even has its own nerve supply called the enteric nervous system (ENS).

The enteric nervous system can function with near-independence without the brain’s help, as well.

The ENS is controlled by the autonomic nervous (“fight or flight” and “rest and digest”) system and is considered the second brain of the body (21).

This second brain has researchers adopting another name, also calling it the Gut-Brain Axis.

This Gut-Brain Axis exists because the ENS connects to our brain via a bundle of nerves called Auerbach’s plexus, which is all controlled by the vagus nerve, aka the 10th cranial nerve (22).

The vagus nerve is the longest cranial nerve in the body with the widest distribution among all the 12 cranial nerves.

It originates in the brain stem and extends down through the neck, thorax, and abdomen with nerve branches ending in the esophagus, stomach, and intestines.

When this Gut-Brain connection is altered, it has strong associations behind conditions such as anxiety, depression, mental impairment, IBS, and IBD (23, 24, 25, 26, 27).

This all may either be a cause or effect of gut dysfunction, chronic stress, or both.

Chronic Stress & Type 1 Diabetes

Many of us live in a stress-filled world.

These stressors can range from a variety of sources, such as work, family, insecurities, health, relationships, or ambitious projects, among many others.

And if you’re a type 1 diabetic pulling your hair due to ineffective BG management, this stress may be compounded!

Chronic stress appears to have mixed effects on a type 1 diabetic’s blood glucose levels (28).

Some experience no change in their blood glucose levels, while others experience abnormal blood sugars (dysglycemia).

Let’s connect these dots that likely cause another vicious circle of T1D annoyances (29, 30, 31, 32):

Make sense?

Our ability to combat stress is now another important variable that may be another cause or effect of altered gut health (33).

Hopefully, you’re starting to better understand the full magnitude of how gut health may impact many conditions that appear to be overlooked during current health assessments, especially for a type 1 diabetic.

Now, let’s take a look at specific cases from the research on stress and the gut.

Stress and Gut Microbiome Research

<>While the research indicates that gut health may alter mental health, it also points out that early-life exposures can also impact how well an individual may respond to stress via their microbiota as they age and mature (34, 35).

Early-life exposures specifically noted are that of vaginal births and infant diets (36).

Which, as we’re reading, may also influence the risk of Gut-Brain Axis dysfunction, as well.

Animal studies are a large portion of where stress and microbiome research is coming from.

One important study in 2004 was able to reverse a high-stress response in mice by transferring a large amount of a beneficial gut bug, called Bifidobacteria, into them (37).

Another study even took fecal (poop) microbiota from stressed-out mice and transferred them into germ-free mice that were lacking any microbes since birth (38).

Researchers found that when the germ-free mice were exposed to a particular infection, they displayed a decreased immune response, which increased inflammatory outcomes throughout their bodies.

There was another experiment with similar results, except the microbiota exchange was from depressed human patients to germ-free free rats (39).

One study was conducted that focused primarily on military stressors commonly experienced by its personnel and the effects on their gut microbiome (40).

It was first noted that stressors affecting the adrenals and sympathetic nervous system (“fight or flight” response) can alter immune and GI function.

Overall, the multiple stressors assessed ranged from psychological, physical, and environmental, which had, both, positive and negative outcomes on the microbiota.

Let’s briefly go over how these negative stressors may specifically impact our gut health.

Stress’ Influence on the Gut & Immune Dysfunction

Catecholamines are neurotransmitters, made by the adrenal glands, that help the body respond to stress.

Cells of the intestine secrete catecholamines in response to stress.

These neurotransmitters trigger the gut to not focus on anything unimportant during this stressful time, like urinating, defecating (pooping), sexual urges, or hunger (do you see a large GI theme, here?).

These catecholamines have been shown to alter microbial integrity in the gut, especially in chronic cases.

Stress is able to alter gut signaling, which can decrease peristalsis/gut motility.

Peristalsis is the wave-like motion of gut muscles pushing consumed contents through the GI system.

Its compromise is a common cause of gut dysfunction and may influence conditions such as gastroparesis and/or small intestinal bacterial overgrowth (SIBO).

Decreased blood flow to the gut also occurs during a stress response, which can create oxidative stress.

Stress is noted to alter immune function, as well (41).

Lastly, because your gut and brain are connected through the gut-brain axis, stress can directly impact your digestion.

One example is when you’re stressed, the neurotransmitter norepinephrine (part of the “fight-or-flight” response) can signal the growth of bad gut bugs, which may cause loose and more frequent poops (42).

As you can see, chronic stress can pack a punch beyond just mental and emotional responses.

And if you’re a type 1 diabetic who’s not seeing results with either the treatment you’ve been receiving or with your current BG management protocol, stress may be a missing link that needs to be addressed.

I believe the gut’s connection to stress (and vice versa) is too big of a variable to ignore in one’s overall health assessment!

Please also note that, currently, there is no direct connection between chronic stress and type 1 diabetes diagnosis.

However, under cases of long-term stress, the gut is likely to be compromised, which sets the stage for immune dysfunction to occur.

This is when genetics play a small part in what someone may be susceptible to.

I go over environmental and genetic triggers in more detail in part 5.

In part 4 you’ll be reading about the associations between chronic infections and lack of physical activity and their studied impact on gut, immune, and diabetic health.

Summary

Though antibiotics have been extremely helpful since its discovery, many argue its multiple uses in treatments that may be doing more harm than good
- Essentially, antibiotics wipe out as much bacteria present in the targeted area, both good and bad bacteria
- This can negatively affect the gut microbiome and its good gut bug population
NSAID overuse (like ibuprofen, aspirin, decongestants, antihistamines, proton pump inhibitors, acetaminophens, and antacids) have been shown to increase gut distress risk
Stress was never intended to last as long as it currently does today
There is a Gut-Brain connection where one can affect the other dramatically; many researchers label the gut as the “Second Brain”
Chronic stress tends to have mixed results among type 1 diabetics
- Some experience dramatic ups-&-downs with their blood sugars, where others do not during stressful periods
When stress is active, it impairs other gut functions in order to focus on the stress response (both cannot work efficiently at the same time; remember “fight or flight” vs. “rest and digest”)
- As a result, chronic stress may also impair immune function, as well

References

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