Before we really need antibiotics… What are the healthy alternatives?
Dame Sally Davies, England’s Chief Medical Officer, has labelled antibiotics as big a threat to our own species extinction as climate change, and is currently promoting the pharmaceutical equivalent of an Extinction Rebellion Style Campaign.
So how did one of our greatest saviours begin the transition into villain? The problem lies predominantly in profit before people, overuse and a lack of regulation, with both consumers and providers equally to blame. In the instant gratification culture, GPs feel increasingly pressured to provide quick fix solutions to illnesses like the common cold, whilst finding a distinctive lack of effective alternatives at their disposal.
“There is not the appetite [among pharmaceutical companies] to develop new medicines,” Sally Davies said. “There is a systemic failure. We need something similar to the IPCC.”
To add insult to injury, the farming industry has been rampant with its use of antibiotics on animals, including for ‘growth promotion’, as the drugs make livestock rapidly gain weight by disrupting their microbiome. Luckily these practices are less common in the EU and US but still remain an issue in other parts of the globe, along with antibiotic use in fish farming and the spraying of crops which we then consume.
A report by the UN’s Interagency Coordination Group on Antimicrobial Resistance (IACG) has made recommendations against the oncoming ‘silent tsunami’, saying we need tighter regulation, consumer education, improved sanitation globally and for pharmaceutical companies to accept market failure and develop new drugs – but lets face it, in the runaway train profit-driven system that we have, this seems unlikely. So what are the alternatives?
Amongst the greenery of Chelsea Physic Gardens, a group of medical professionals, herbalists and science journalists gathered for a topical discussion sponsored by Pukka Herbs. Led by Professor Michael Depledge, from the European Centre for Environment and Human Health at Exeter Medical School, and the College of Medicine, healthcare leaders gathered for an interactive conversation to develop user-friendly self-care approaches that would limit the call on antibiotic prescriptions.
There are many plausible and evidence-based alternatives for improving resistance to infections and managing the symptoms. There is also much emerging research, for example around the role of the microbiome and prebiotic intervention, both in improving recovery after a course of antibiotics, and to improve resilience to infections in the first place.
The first panel of the day was around the challenges in reducing antibiotic use, with talks from Dr Michael Dixon, social prescription lead at NHS England, Dr Amit Bhargava the GP clinical chief officer for Crawley, and Euan MacLennan, Pukka Herbal Director. Followed by research in alternative approaches presented by Rebecca Lazarou, Dr Elizabeth Opara, and Martin Logue.
We know that antibiotics don’t work for viral infections, which are the most common, that they mess with our gut flora, and then don’t work when we really need them. However the problem with many herbal alternatives is that they are seen as lacking in potency or efficacy. Research funded by Pukka Herbs sought to challenge this, along with an interesting discussion around the need for new lenses on evidence to supplement randomised controlled trials, including: weighted evidence and expert opinion to keep up to date with cutting edge developments and bring them into the mainstream faster, as well as to include the whole scope of holistic lifestyle experience and effects on individual health.
Here are some of the top recommendations with independence of benefit for colds and sore throats:
A flower which has traditionally been used for intestinal problems, respiratory ailments and wounds, owing to its astringent and antiseptic effects. Geranium oil is considered a relaxant in aromatherapy and in recent years has been sold in cold remedies in the EU and US. This is because systemic reviews of clinical research conclude that there is good quality evidence of its use in the common cold.
Clinical evidence suggests this can shorten the duration of the common cold, compared to placebo. This is a plant native to South Asian Countries such as India and Sri Lanka, where the lead and underground stem are used to make medicine. Active compounds such as diterpenes, flavonoids, xanthones and noriridoides have been isolated from the plant. Extract and pure compounds of the plant have been reported for their anti-microbial, cytotoxicity, anti-protozoan, anti-inflammatory, anti-oxidant, immunostimulant, anti-diabetic, anti-infective, anti-angiogenic, hepato-renal protective, sex hormone/sexual function modulation, liver enzymes modulation insecticidal and toxicity activities.
There are a number of placebo-controlled clinical trials that demonstrate that mushroom supplements (containing β-glucans and other immunoactive constituents) reduce the incidence and severity of respiratory tract infections. Medicinal mushrooms such as Lion’s Mane are becoming increasingly popular, and join a host of other trendy ingredients such as Adaptogens and Cannabidiol, for which there is emerging research.
There is quite robust evidence that polyphenol supplements shorten the duration of colds and viral infections. These are micronutrients that we get from plant-based foods. They’re packed with antioxidants and also found in red wine, although its recommended that healthier sources are sought after more regularly…
Although the overall evidence base is inconsistent there is enough clinical trial data that various probiotic supplements can reduce the frequency, duration and intensity of respiratory infections, especially in children. We are now beginning to understand that the gut houses our second brain, with the microbiome playing a vital role in everything from immunity to mood. Probiotics are supplements containing live bacteria designed to help repopulate the gut, whereas Prebiotics contain things like plant fibres designed to feed healthy bacteria in the gut.
Flu symptoms were relieved earlier in subjects taking elderberry syrup compared with placebo syrup. Elderberry is a type of flower which is a rich source of vitamin C, antioxidants and fibre.
The evidence base is mixed with the best evidence that echinacea may reduce the risk of catching colds. Some preparations may show more promise for actually managing the symptoms of cold. Commonly called Coneflowers, they are grown in the prairies and open wooded areas of North America.
Systematic reviews have found evidence that some proprietary preparations may both reduce the risk of respiratory infections and the symptoms when they happen. Raw garlic is the traditionally favoured option but there is no substantial research for this; it may temporarily upset the digestion in some people, and also has social consequences!
As a supplement there is some evidence that the equivalent of 15-13mg ‘elemental’ zinc can reduce the duration of colds in children.
Among a mixed record of clinical trials there are a few which point to doses of vitamin C of greater than 200mg shortening the duration and severity of colds. This benefit was most likely in people exposed to physical hardship of extremes of cold.
Controlled clinical trials of sage spray and proprietary sage products showed efficacy against viral pharyngitis. The latin word for sage Salvia, stems from the word heal, it has high antioxidant capacities and is part of the mint family.
As with any supplement, food or medicine, it’s important to know exactly what you’re buying. Many pills on the market are poor quality, and it’s important to do you research and to know what strengths you should be looking for, whether compounds work better as whole extracts or isolates, whether they should be in freeze-dried, in tablet or oil form, how often they should be taken to be effective and whether they interact with any medication you may already be on.
Another interesting point that was made during the discussion is that as a society we are sensitive and averse to the discomfort in ‘dis-ease’, seeking to instantly medicate away anything remotely negative – whether that be feelings or symptoms, even if there are longer term consequences. Where a healthy acceptance can be fostered, longer term benefits may manifest themselves such as a much needed rest and strengthened immune system.
It would be great to see more independent studies as well as meta analyses of results, of course having a herbal company like Pukka Herbs sponsor research into the medicinal benefits of herbs, is akin to a pharmaceutical company sponsoring research into the benefits of their own drugs. However many home and herbal remedies are often less costly, have fewer side effects and do educate the patient and practitioner about diet and lifestyle changes that work in synergy with both nature and the placebo effect (the power of the mind being around 30% of the effect of both conventional and alternative remedies).
The move towards a more integrative approach to health brings the best of both alternative and pharmaceutical worlds together, to provide a more wholesome view of health, the mind-body connection and the role of the individual in their own healing processes.
You can read more on the new College of Medicine online resource: Our Health Directory which already includes evidence-based self-care advice originally commissioned by the Department of Health and will also include the available evidence base for antibiotic alternatives.