The genesis of my recent On Nutrition column, “FDA aims to halt antibiotic resistance at the source: your food,” came almost four years ago when I was working on getting my Master’s of Public Health from the University of Washington (let me pause here to say that I was rooting against the Huskies Saturday night…I was a Duck long before I was a Husky).
One of my required classes was Environmental Health. Let’s just say that I wasn’t 100 percent jazzed about the class, so I was determined to make it as relevant to my nutrition studies as possible. One of the course requirements was a term paper + presentation, and I don’t know why my brain latched onto the idea of writing about antibiotic use in livestock and the ramification for human health (I had probably just read something about it), but I was smitten with it.
When my professor said he didn’t think I should do the topic because students had tried–and failed–before to successfully connect the dots with available published research, I dug in my heels. Let’s just say I don’t like to be told “no.” He said that I could dig up a few research papers that convinced him I was onto something, he’d give me the OK. Well, I was like a dog going after a bone, and I found those research papers, and then some (hello, research rabbit hole, my old friend), and ended up getting an A on the paper (along with three of my Nutrition Science partners in insanity crime).
Antibiotics Misuse in Animals
Here’s a video from the Natural Resources Defense Council that gives a pretty understandable overview of how sub-therepeutic use of antibiotics in food animals contributes to antibiotic resistance:
With things getting serious this year on the topic of antibiotic resistance, with the White House holding a forum on antibiotic stewardship and issuing a national action plan (some good reading if you’re having trouble sleeping), and the Food and Drug Administration finally making changes to antibiotic use in livestock animals mandatory rather than (hah!) voluntary, I decided that I wanted to write about this important topic again, but not in an academic setting. And so here we are.
A few weeks ago, when I was at the Food and Nutrition Conference and Expo (FNCE) in Nashville, otherwise known as the annual national conference for the Academy of Nutrition and Dietetics, the fact that I was (at that time) in the process of writing my antibiotic resistance column came up in conversation several times. Most people said they hoped that I was also going to discuss how, when it comes to fighting antibiotic resistance, each of us as individuals also have a responsibility to use antibiotics responsibly–it’s not all on the farmers.
Although word count constrictions kept me from doing more than simply touching on the individual responsibility part, and at least half of the medically important antibiotics (read: used for humans, not just animals) used in this country are used in livestock, I have felt strongly for years that it is a travesty that so many people treat antibiotics in such a casual manner.
Antibiotics Misuse in Humans
I’ve known many, many people who will ask their doctors for antibiotics any time they have a routine ailment like a cold or the flu. Hello? Colds and flu are caused by viruses, and antibiotics do diddly squat for viruses. And then there are those who are only partway through their prescribed course of antibiotics (for legitimate reasons or not), and decide to stop taking them because they “feel better.” I’m not going to lie to you: this sort of thing drives me nuts. Everyone who has ever misused antibiotics is partially to blame for the current situation, in which more and more “superbugs” are becoming resistant to not just one, but several antibiotics.
Even worse, 90 percent of the cells in and on our body are bacteria (10 percent are human cells), and that includes the huge, diverse population of bacteria (most of them beneficial and health-promoting) in our intestines. This bacteria (along with smaller numbers of non-bacteria microbes) makes up our microbiome. Antibiotic overuse and antibiotic resistance disrupt our microbiome, and this sort of disruption contributes to a number of illnesses and diseases.
Data shows that antibiotic overuse in humans is rampant in every state in this country, but it’s dramatically worse in some areas, including much of the south. The problem isn’t all because of patients requesting antibiotics they don’t need, doctors are also overprescribing. Sometimes they may not want to argue with a patient, but there’s more to the overprescription issue than that.
In the talk he gave at FNCE, Steve Solomon, MD, former director of the CDC’s Office of Antimicrobial Resistance, talked about an intervention study where doctors received education about the perils of antibiotic misuse. While the study was actively underway, doctors did successfully modify how and when they prescribed antibiotics. But as soon as the educators and interventionists were gone, the number of unnecessary antibiotic prescriptions went right back to where it was. Solomon said that, clearly, education of health professionals and calls for voluntary reductions of antibiotic use in animals is not enough.
So Now What?
Solomon said that complacency contributed to our current antibiotic-resistance crisis, because in the early days of antibiotics, a new antibiotic was being developed every year or two, and we came to expect that. “[New] antibiotics are not coming to market and we are running out of options,” he said, adding that we need to protect the effectiveness of the antibiotics we have now, not pinning hopes on new drugs. He also said that simply trying to control the spread of infection with antibiotic-resistant bacteria among the human population is not an effective option.
“Antibiotic resistance is forever…even if the number of infections go down, the resistance is still there.”
Increased publicity about antibiotic resistance, and the adverse effects of antibiotic use on the beneficial bacteria in our intestines, has had the unfortunate side effect of prompting some people to refuse antibiotics when they truly need them. That’s a mistake, Solomon said. “If you have a bacterial infection, the benefit of taking antibiotics far outweighs the risk,” he said. “If you don’t have a bacterial infection, there is no benefit but the risk is great.”
