GERM
00:00:09.120 – 00:00:11.080
Na nga def? My name is Germ.

WORM
00:00:11.080 – 00:00:11.920
I’m Worm.

GERM
00:00:11.920 – 00:00:26.560
Welcome to episode 110 of the Germ and Worm Travel Health podcast. The gut microbiome: I contain multitudes. It’s a big planet. See it in Good Health. I’m Dr. Paul Pottinger, also called Germ. I’m an infectious diseases specialist at the University of Washington in Seattle.

WORM
00:00:26.940 – 00:00:31.980
I’m Dr. Chris Sanford, also known as Worm Family Practice Doc, also at the University of Washington.

GERM
00:00:31.980 – 00:01:21.160
Well we’re talking about the human microbiome, especially the gut microbiome, Right, Chris. We’re going to answer all kinds of questions we’ve gotten from our listeners and other questions that we wish we had gotten, we will answer for ourselves. That includes the gut microbiome. What is it? How do we make it happy? How does travel affect the gut microbiome?

What are the implications of taking antibiotics for travelers? Diarrhea? If my gut microbiome changes when I travel, what does that mean for my health and care when I come home?

These questions and many a reminder to our listeners. Please contact us with your travel health questions, stories and your tips for success. Yes, we would love to hear those.

Just Visit our website, germandworm.com or send us an email, germanworm@gmail.com. Our medical disclaimer. This podcast is designed to inform, inspire, and entertain. But before you travel, please see a qualified healthcare professional for recommendations specific to you and your itinerary.

WORM
00:01:21.720 – 00:01:25.400
All right, Paul, start us off. What is the gut microbiome?

GERM
00:01:25.980 – 00:03:45.990
Well, the gut, we know that’s your intestines. So everything between your lips and your anus, that’s your gut. That’s how we’re going to define it here. But the microbiome, what is that? Micro means small, bio means life, and ome means the world, the study of it. So the gut microbiome is the study of all the small things that live inside of our intestines and our guts.

And there are other human microbiomes as well, right? There’s the skin microbiome, the female reproductive tract microbiome, the pulmonary microbiome.

There are other microbiomes, but the one that is so important, at least in the context of travel health, I think, is the gut microbiome. It contains multitudes.

There’s this very fascinating, actually, frankly, bewildering, complex community of microbes that lives inside of us here in 2026. We are still just beginning to understand what happens inside of us.

And I mean that from even the most very fundamental question, how many germs live in us? Actually, nobody knows there are too many to count.

We used to say that about 10 times the number of human cells that we are made of is the proper number of microbial cells. That’s prob. The number is probably closer to one to one. But honestly, nobody really knows. You can’t count them.

And by the way, if you take antibiotics, you will dramatically impact that number as well. The key here is that there are many, many microbes in us, the trillions of cells that make up our own body.

The same is true probably for the microbes that live in our intestines. And it’s not just their numbers. It’s the fact that they’re a very diverse group. At least in good health, there should be good diversity. Right, Chris?

This is a part of the body where we like to see a mixture of different germs. We’ll get into that in minute. But that mixture, it’s quite fascinating. It is probably individual for individual people.

My microbiome, Chris, is going to be different from yours, et cetera. At least we think that’s true.

People who are really studying this area, including Dr. Jonathan Eisen at UC Davis, Dr. David Relman in his lab down at Stanford, and many others, they’re trying to understand these patterns. So what microbes live in us? How many are there? How do they relate to each other, and how do they relate to our own health?

This science of microbial understanding, it’s not just infectious diseases. I mean, I think about germs and how to kill them. This goes way beyond that. This is about biology. This is potentially about health and wellness.

It’s also about staying savvy and avoiding scams. And we’ll talk about that, too. Important area, right, Chris?

WORM
00:03:46.709 – 00:05:38.600
Yeah, you bet. So this is stunningly complex, and I would say the research in this field is still very early.

But obviously, when you have billions of organisms of hundreds of different species in billions of different people, each one with a unique pattern of germ nerms in their gut, we’re still figuring out at a very rudimentary level what correlates to what. However, there are a couple large points I would make about keeping your gut biome happy with what we know about it.

My first two points would be, number one, fiber is good. And we knew that 50 years ago because it brings down your risk of heart attack and stroke, also brings down your risk of colon cancer.

But the bacteria and other organisms seem to have an optimal mix when you eat a lot of fruits, a lot of grain, a lot of vegetables, and wide variety. So fiber is good. Is one large meta point. The second one, antibiotics are to be minimized.

An antibiotic is like a freight train with a hundred boxcars roaring through your gut, and it just kills the bad bacteria.

Maybe you’re trying to kill because of your illness that you’re taking the antibiotic for, but it also kills a lot of what’s in your gut, and it takes a while, if ever, to get back to normal. So those are two of the larger points. There’s a lot of more subtle recommendations.

The role of probiotics and taking that we’re going to talk about in a little bit. It’s kind of nuanced and maybe not as helpful as a lot of people think it is.

Some other general things, the circadian rhythm that you have when you sleep, when you’re awake, that can affect things. So getting your good sleep is good. Alcohol tends to be bad. So I would minimize or not drink at all. Stress is bad. That’s not real actionable.

We can’t just wish our stress to be lower, but the gut microbiome changes with response to stress. Those are several things right there. Paul, anything else you would say that affects the microbiome?

GERM
00:05:39.320 – 00:06:17.780
There are probably all kinds of things where we can influence the microbiome and it in turn influences us. Indeed, we are they. So, yeah, there’s lots of things that go into that.

And, you know, in the state of normal health, if you have a healthy person, that person’s microbiome may be different from the next person next door. They can both be healthy. So that tells me a lot.

There is no single microbial ingredient that gives us fountain of youth, everlasting health, or sex drive or whatever.

This is about really humility, scientific humility, and understanding that although there are a lot of things we understand about this, there’s still a lot for us to learn.

WORM
00:06:18.260 – 00:06:28.980
Okay, Paul, this is a travel podcast. Suppose someone travels and both A, they don’t get sick, and B, they do get sick with diarrhea. What happens to the gut microbiome?

GERM
00:06:29.380 – 00:10:19.750
It’s such a good question, and I think it’s at the heart of the matter for this podcast.

As an infectious diseases doctor, one of the things that I’ll do with my patients is try to understand the patterns of antibiotic resistance that they keep inside of them. In other words, I see people who are sick more than I see people who are healthy.

So if someone comes to my practice and they have a urinary tract infection, for example, one of the things I need to understand, even before I have prescribed them A medication even before I have seen the results of their urine testing. I really want to get that history. Where have you been? Tell me about your life. Where have you traveled in the world? Who is part of your own community?

Because what we know, Chris, is that antibiotic resistance patterns differ in different parts of the world. If you travel to certain areas, you may be at much higher risk of being exposed to antibiotic resistant or partially resistant microbes.

And so I’ve seen this time and again. I cannot tell you how many times we have someone who should have a treatable form of bacterial infection.

And in fact, we are surprised to say, wow, this person’s bacteria actually is not particularly treatable.

And that’s an issue for us because unfortunately, it looks like they may have acquired and been colonized by a more drug resistant strain as they’ve traveled around the world. So what can happen when you travel? Look, when you travel, you gotta eat, you gotta drink, you gotta be around other people.

You’ve got to acquire the local microbes. You cannot avoid that. I mean, to do that, you’d have to live in a bubble. And then why would you, why would you travel?

So when people travel, they’re gonna eat and drink, and that food and drink will contain germs that are new and different. Just like we look for new and different experiences, our gut is doing the same. That’s not necessarily bad.

But what we’re coming to understand is that antibiotic resistance profiles may be substantially different and worse in some parts of the world.

So even if you’re healthy, even if you’re feeling fine, when you come home, you may have what ultimately might feel like a ticking time bomb in your colon, which is that if you ultimately get sick from some of those colonizing asymptomatic germs, they may be more difficult for me to treat as your doctor when you come to see me. That can happen in states of health and disease.

But for those patients who go overseas and get sick with, let’s say diabetes, diarrhea that requires antibiotic treatment, that can dramatically change the way the microbiome works. Look, even here in the good old domestic contiguous 48 states of the USA, you take antibiotics, you will profoundly impact the microbiome.

Fewer numbers of germs and less diversity of germs. When we alter that microbiome, other new germs can move in that germ warfare that they’re fighting with each other. We call these ecological niches.

A niche is just an ecological position that a germ can take inside the body. If there’s less competition. Something else could move in. Clostridium difficile or C. Diff is the classic.

But there are others like this that happens wherever we take antibiotics.

But if we happen to be overseas when we do so, the germs that move in may bring along with them some very nasty habits of being more and more resistant to antibiotics.

So anybody can get antibiotic resistant bacteria when they travel internationally and that risk is elevated for those people who take antibiotics for the treatment of travelers diarrhea, the implication is eat and drink and be merry, but wash your damn hands.

Be sensible about where you eat as we talk about here on German worm all the time, and recognize that if you are thinking about taking an antibiotic for, let’s say, traveler’s diarrhea, that might be the right move. But you need to have a clear plan about that because we’re trying to minimize the unnecessary use of antibiotics. So, Chris, let’s talk about that.

If we are trying to reduce the impact of travel on the human microbiome, let’s talk in a little bit more detail about the things we might be able to do or advise our patients to do before they travel.

WORM
00:10:20.150 – 00:11:08.210
You bet. And it’s an important topic and I’m loving all the research that’s coming out on this. One thing that’s coming out, which I think is fascinating.

There’s this thing called the gut brain axis, where basically chemicals in your body, neurotransmitters, go back and forth between your brain and your gut. And this is fascinating. So this may be one reason you feel fundamentally crummy when you have diarrhea.

Maybe all of that bad feeling does not entirely come from your gut, but the gut is putting out chemicals that go to your brain that affects your mood and your pain sensation and things like that. Things you can do to try to keep your gut microbiome maximally diverse and healthy.

One is, as I mentioned, is a high fiber diet before you travel for your whole life. And while you travel, if you’re just doing barbecued beef on a stick and red wine.

GERM
00:11:08.690 – 00:11:11.010
That sounds so good. That sounds so good.

WORM
00:11:12.610 – 00:13:17.620
It’s fun in the moment, but it’s kind of the opposite of a healthy diet. High fiber diet keeps the gut happy. Second thing is, minimize antibiotics. Now, antibiotics are beautiful.

They saved a lot of lives, millions of lives. But there are two tool. They’re a tool like a jackhammer. Jackhammer does what you want it to do, but it can do a lot of damage if you misuse it.

And I have to Say our threshold for using antibiotics is changing. A few decades ago we gave antibiotics out more liberally. Now we still give them out. But I would still stick with that four step plan for travelers.

Diarrhea, self treatment. Maybe take some antibiotics with you just in case you feel good. Don’t take anything at all. Mild diarrhea, don’t break out the antibiotics yet.

Do not take antibiotics at the first instance of diarrhea or stomach if you’re still able to do your activities.

Either take no drug and let it pass because it’s probably going to be self resolving, or take loperamide, brand name Imodium, which is a gut anti motility agent, no prescription necessary. And that is good treatment for mild diarrhea. When we start to consider an antibiotic, it’s when it’s severe.

We used to like count stools, which was kind of impossible, but now we more define it functionally if it’s definitely interfering with your activities, if you’re in bed and you can’t go back a tourist, then an option is to take an antibiotic. But you can also not take an antibiotic because even that diarrhea tends to be self resolving. And you can take the loperamide with that.

However, you don’t want to take, just as an aside, the loperamide, the gut antimotility agent if there’s signs of dysentery, which would be like fever or blood in the stool. And final part is if you get dysentery, fever or blood in the stool, maybe see a doc and don’t take the loperamide.

So anyway, that’s a long way of saying is yeah, take an antibiotic with you, but really treat it like a big intervention. Maybe contact your medical person back home and get his or her advice on if you should take it or not. So high fiber and low antibiotic is good.

And then just some of the other things I mentioned, try to get some sleep, go minimal or not at all, and alcoholic beverages. And that will in general keep a high diversity in your gut of bacteria and other organisms.

GERM
00:13:17.780 – 00:13:34.610
Although it’s difficult for us to quantify this and difficult to prove, I think it stands in good stead that if you’re smart about your food safety and you’re less likely to get diarrhea, you’re more likely to conserve those healthy germs you bring with you when you travel. So that’s about hand washing, that’s about sensible choosiness when it comes to what you choose to eat, right?

WORM
00:13:34.610 – 00:13:51.300
And boiling is a Beautiful thing. We talked in our last episode about Cyclospora and by the by that germ, and in fact, essentially all germs are killed by boiling.

So if you even take lettuce, which is dubious, if you boil the bejesus out of it, you’ve killed everything that can make you sick of an organization, organism, nature.

GERM
00:13:51.300 – 00:13:54.220
And that sounds like a great salad. A boiled lettuce salad.

WORM
00:14:00.700 – 00:14:05.420
All right, Paul, concerning the gut microbiome, what is the role of probiotics?

GERM
00:14:05.740 – 00:17:48.190
So what is a probiotic? I like, I like the word pro. It feels very positive. I’m probiotic, who wouldn’t be probiotic?

So this, I can’t actually tell you where the name comes from, but generally speaking, when we talk about probiotics, we’re talking about microbes, bacteria, fungi, parasites, anything that is microscopically small, but it’s given to people as an intentional dose to try to boost their microbial community in the gut. So probiotics is usually a mixture of different organisms. It’s usually bacteria, it usually contains Lactobacillus rhamnosus subtype gg, and it’s usually bogus.

I mean, there are some reasons to consider doing this and there’s even a little bit of evidence for some benefit, but there’s a lot of unsubstantiated claims that I have real concerns about. Is it possible to take a pill, a capsule, for example, and undo some of the damage that comes with antibiotics?

Well, maybe actually the risk of antibiotic associated diarrhea, which is something many of our listeners will have experienced personally, take an antibiotic, get diarrhea. Why does that happen? Because we’re killing off all the healthy germs in the intestine.

So it makes good sense that we would just put back what we have killed off. As we mentioned at the top of the show, it’s actually very difficult that. Right.

Because everybody’s community will be different in the gut and we don’t have an easy way to study that, short of pooping in a cup and making your own frozen crap souls and then taking your own poop again. I don’t know exactly how to do that, by the way. Is anybody out there interested in that topic?

Let me know, chat me up on the, on the socials, slip into my DMs. I’m interested in this topic, but anyway, no.

Can you go to a grocery store or a pharmacy, get something off the shelf that’s made by the millions and have that replenish what we’ve killed off in your intestines? No, that will not happen, but it does happen to a certain degree.

And in fact, when it comes to the risk of antibiotic associated diarrhea, there is a very modest, but I think consistently demonstrated benefit has been shown in a number of clinical trials. It’s not a dramatic difference, but there’s a slight difference.

In my own clinical practice, as somebody who prescribes antibiotics for a living, yes, I do sometimes suggest that people consider taking an over the counter probiotic when they take antibiotics. For those who don’t to do it, I have no hesitation.

For those who cannot because of very exotic, unusual gut disturbances where the mucous membranes are no good and I don’t want to give them a big dose of new bacteria. Occasionally I tell people not to. Usually I leave it up to the patient.

If there’s something that they’ve used before, something that they like, I’m okay with that. I do not know which brand is best and I don’t know because nobody knows.

We have really have not studied this in a way that can give us the great confidence that we would like before we recommend different products to different people. Is it better to take a probiotic that is live and frozen or refrigerated versus those that are on the, on the shelf and lyophilized?

They’re probably about the same. It’s a question of dose, right, Chris? Theoretically, you’ll get a higher dose with those that are kept in the fridge instead of on the shelf.

But the reality is I cannot tell you that taking a live, refrigerated version is any better than what we would take from the, from the shelf. So are there reasons to do this?

You know, if you’re going to take antibiotics and you want to do this during an antibiotic course, I think that’s perfectly reasonable. Would I give other health claims beyond that for these commercially available products, by the way, none of which are regulated by the fda?

No, I do not. They’re considered to be food supplements.

We don’t really fully understand from a quality improvement and quality assurance perspective what’s even really, truly in there. So it’s a bit of the Wild west when it comes to your colon and the pills that you could put into it from the shelf down at Walgreens.

WORM
00:17:48.190 – 00:18:03.910
And let me explicitly point out that there has been significant research on the role of probiotics in preventing traveler’s diarrhea, and it’s been real mixed. But the bottom line conclusion is there’s not evidence that taking a probiotic will reduce your risk of traveler’s diarrhea.

GERM
00:18:03.910 – 00:20:59.040
Sad to say, we wish there was. And you know, what about the ultimate probiotic experience? Fecal transplant. Yep. Somebody else’s poop up in your own intestines.

So fecal microbiota transplant, or fmt, that is a technique which we use in the hospital.

It’s in a very specific indication, and that’s for people who are suffering with severe recurrent refractory Clostridium difficile or C. Diff infection. C. Diff is a dysbiosis. The ultimate dysbiosis.

There’s nothing left except for C. Diff, which is okay, except C. Diff makes a poison, a cytotoxin that can cause terrible, terrible diarrhea in some cases even life threatening chr.

We know that if we can restore that microbial diversity almost instantly, these patients begin to feel better very, very quickly because of the competition in that new microbial community. So that’s fmt. You solve the problem of someone who’s nuked all of their healthy microbes by giving them antibiotics.

Well, what we do is we put back what used to be there. But how do you operationalize that? You know, for many years that was done usually spouse to spouse or sometimes child to parent.

You know, a lot of my patients who went through this process were really miffed that they hadn’t heard about this sooner. You mean I can take some of my husband’s feces and put it up in a milkshake and do a colonoscopy? Make me better.

I’ve been putting up with this shit for years. I’ll take a little more. Come on, bring it on. And so usually between married couples, this was okay.

The reality is it was the doctors who are more squeamish about it. You do have to take a donated stool specimen from someone who’s been screened for a whole, whole variety of infections which might be transmissible.

Hepatitis, hiv, you name it. And then they do what comes naturally.

Donate some poop, we strain out the food matter, make a very smelly looking brown tea, and then squirt that into the cecum during colonoscopy. It works. Well, it’s a hassle. Today in 2026, we have a couple of options that are FDA approved, which are standardized approach.

One of them is administered by colonoscopy or even by enema. The other is actually administered by capsules. We call them the crapsules.

And people take these lyophilized crapsules, you can repopulate, or as I say, repopulate the gut and make Things better and more natural that way. So it’s exciting times. But I just want to emphasize, folks, the indication for that is recurrent refractory, severe C. Difficile.

It is not for patients who want to lose weight or look better on the socials or max their appearance or anything else like this. So that’s something that you may read about, but it’s something that I think the promise we should really focus on is at the moment, quite limited.

So, Chris, let’s talk about the microbiome. We’re talking about why it’s this precious resource. Diversity is good.

I want you to give me your longtime physician’s opinion about what it really is, what we wish it could be. What are the realities of what the microbiome can. Can do?

WORM
00:20:59.040 – 00:22:49.480
You bet. And I’ll also touch on what are the realities of what we know through scientific research and what we’re ignorant about.

So it is these billions of germs in your gut. Okay, that’s normal. What it does, we’re still learning. It affects digestion, it affects your mental health.

So it affects, I think, your body and your mood and your health from head to toe. It may even have malignancy implications. We have a tremendous amount of information on it.

We know the different species, we know their predictions, proportions of different species. We know the different medical illnesses which are associated with different proportions of different species.

We know what travel does, we know what antibiotics does. Okay, but what is actionable? That’s a huge leap. And the answer is not that much.

Currently, as Paul just said, probiotics have not been shown to do much other than reducing the risk of antibiotic associated diarrhea. The microbiome does interact with your brain in some way.

It puts out these neurotransmitters, including serotonin and dopamine, but we don’t really know what combination is optimal. Now, this is opposed, say, to, let me talk about an older specialty that’s better quantified. Cardiology.

So in cardiology, we know that if your cholesterol goes up by a certain percentage, then your risk of heart attack and stroke goes up by a certain percentage. We know that exactly. Or if your blood pressure goes up by a certain amount, then your risk of heart attack and stroke goes up by a certain amount.

We have nothing close to that with the gut microbiome. Maybe in 20 years, I can tell you, oh, you should have 1,200 different types of bacteria and 21% should be this species of E. Coli.

And here’s how to make the changes to make that happen. And here are the benefits you will see statistically if we get that mix. We are so far from that now that I’m glad there’s ongoing research.

But I think all I can say now, now is it’s important. And eat your fiber, minimize the booze, don’t take antibiotics unless they’re really necessary.

GERM
00:22:49.800 – 00:24:00.900
But is there enough ongoing research? I mean, so the potential promise in this area is felt to be untold, right? Autoimmunity, obesity.

Boy, if you take the pellets of poop from a skinny mouse and give it to an obese mouse, the obese mouse gets skinny and vice versa. These experiments in animals have been done for a long time. Translating that into the human experience has yet to happen.

Is it possible that we can reduce inflammatory bowel disease, lupus, all kinds of disorders? There’s been all these promises about the gut microbiome. Look, today, in 2026, it’s just not true.

Is it possible that in 2036, 2046, this will come to pass? Maybe. I mean, theoretically some of that might be true, but the only way we can do it, as you said, is through research.

And as we slash and burn the American experience with scientific and medical progress by not funding these trials, by stripping NIH to the bone, it just sets us back and it sets up our competitors, by the way, in other countries to do that work. So I think there’s a lot that we can do in this area. But I would say that vision is one that’s going to be a long game.

And I think we need to invest in that research infrastructure.

WORM
00:24:00.980 – 00:24:34.270
And I think it’s premature to start doing things to yourself other than the small number of measures that I mentioned to affect your mix.

So if you read an article or see something on TikTok that you should, I don’t know, do something to your diet because that’ll increase the right species of bacteria, be very suspicious. We’re not near that research now, so I don’t think there’s much currently that is actionable.

However, I’m not a GI doc, I’m not a researcher in this area, I’m not a microbiologist. So please, if folks know about studies to the contrary, I’m all ears. Germandwormmail.com.

GERM
00:24:41.150 – 00:24:51.550
Chris, let me ask you a follow up question. If people are curious about their own microbial community, do you recommend that folks get an analysis of their feces?

WORM
00:24:52.350 – 00:25:17.950
If you have symptoms, yes, you should have your stool analyzed. If you’re just feeling good and want to continue to Feel good. I don’t see a benefit in that. Currently, more information is not necessarily helpful.

More information is just facts that are. We don’t really know what to do with. So if you’re asymptomatic.

No, personally I would not recommend that at the current time there’s any benefit to knowing exactly what your proportion is.

GERM
00:25:18.350 – 00:26:53.230
I agree.

And from just so our listeners understand, if you present to a medical doctor, let’s say you have a GI symptom, you’ve got diarrhea and it’s persistent, it’s not getting better, you’re worried that you may have acquired a treatable infection. We can look, even with a single test, we can look for more than 20 different pathogens. That’s a molecular test.

It immediately looks for a variety of things that we might choose to treat with antibiotics. That is very different from human microbiome analysis.

That’s not looking for one specific group of pathogens, that’s trying to analyze everything that’s in there. That is strict. In my opinion that is strictly for research use. And again, as I said before, we need to do more of this research.

But I have to tell you, I do have patients who have come to my practice with a variety of maladies or concerns and some well intentioned person has done the wrong thing, they have sent off that person’s poop for a full profile, a full analysis, trying to understand what’s in there. Is there a candida in there? Yes, there is. Candida’s always in the poop. It’s normal, it’s not a problem.

You know, what are the amounts of enterococcus and E. Coli? I, as a medical doctor, do not know what to do with that. I’m not saying it’s useless information.

I’m saying it’s useless to me because as somebody who has focused on states of health and disease for their entire career, I need that kind of information to be put through a clinical trial. We need rigorous study of this. At the moment, that’s totally lacking. If you are feeling well, please do not analyze your poop.

And if you’re feeling sick, please understand that you probably should also so not analyze your poop. And it would certainly not be to look at the microbiome in that way. At least not outside of a research context.

WORM
00:26:53.470 – 00:27:29.240
Right. I saw a patient not that long ago, nice man, visiting from Alaska. He had diarrhea. So I did testing and bang.

I did that one test that Paul mentioned that checks for 20 things. He had giardia. He got it probably from his. Well Water. I gave him the drug for giardia. He got better. He was happy, I was happy.

That’s a different case. He was symptomatic.

So, sure, if you have pretty much anything of a GI nature, chronic nausea, chronic abdominal pain, chronic diarrhea, chronic constipation. Yeah, see a doc and get some testing. But for the well person, does getting this information add value to your health status currently? I think not.

GERM
00:27:29.560 – 00:29:09.430
I think that’s right. And if we want to convert that kind of question from not helpful to helpful again, it is biomedical research that’s going to do that.

It’s possible that we could invest millions of US dollars of our blood, soil and treasure into this area. And it is a flash in the pan and nothing much comes of it. I doubt it. I actually think there is a lot that’s going on here.

The gut associated lymphatic tissue, the galt, it’s one of our biggest immune organs in the entire body. It’s constantly trafficking antigens, what we eat and drink, trying to decide what’s healthy, what’s nutritious, what’s dangerous.

It’s a very, very immunologically active organization, the intestines. And I think there’s a lot to learn from that in states of health and disease. So I really think. I’m not a GI doctor, not even a microbiologist.

I just slept at a Holiday Inn Express last night. But I’m telling you right now, this is important stuff. But we have to make that investment.

And that’s why I’m so eager for us to get a new administration that understands that science is the real thing and that we actually are willing as a society to say this is important. There could be long term benefits.

We’re going to make an investment, by the way, a very small investment to understand whether these great many fold health benefits may come thereafter. Chris, finally, just let’s bring it back home to the reality of someone who is traveling internationally. They do develop diarrhea.

It does not get better by itself. It’s not bloody, but these patients are having fever. Their illness has gone on for several days. They want to take an antibiotic.

To our listeners out there who may consider doing this, what antibiotics should they take and tell me what dose they should use?

WORM
00:29:09.830 – 00:30:29.190
The antibiotic we give most commonly now for traveler’s diarrhea is one called azithromycin. And there’s no one standard protocol or dose for treatment of traveler’s diarrhea.

If I have half a dozen books on tropical medicine, each one has a Bit of a different recommendation. One recommendation is 500 milligrams once, another is one gram once, a thousand milligrams once. Another is 500 milligrams once a day for three days.

Another is 500 milligrams Once a day for three days. Stop when better. So if you’re better after day two, stop, then the gut microbiome does best with single dose treatment.

And that actually is an important takeaway. So rather than two or three days, there’s a lot of evidence that single dose treatment is sufficient for traveler’s diarrhea.

Most books who use the single dose recommend 1 gram. That has a pro and a con. It has a slightly higher cure rate than 500mg once, but it has a significantly higher GI side effect rate.

People get abdominal pain, they get nausea doing one gram at once. There is increasing research that 500 milligrams once is sufficient.

And there’s not that many big a difference in cure rate between 500 milligrams and 1 gram. So bottom line, I think most people would do optimally well with 500mg once.

However, that’s not standard in every textbook and you’ll hear different things from different people.

GERM
00:30:29.270 – 00:31:08.130
And that’s what I do in my own practice and also in my own body. When occasionally I need to do this, that’s exactly how I would do it.

Remember, my perspective is that as an ID doctor and someone who’s been an antibiotic steward for near more than 20 years now. And so that is, I think, a wise word. Sometimes people get upset about this. What do you mean a single dose? Won’t that cause resistance?

Don’t I need to finish my course? Ladies and gentlemen of the jury, I submit to you that. No, please. In general, when it comes to antibiotics, less is more.

And these long courses of 7 days, 14 days, something that sounds like the days of the week or a football score. It’s been done traditionally and from custom, but it’s not usually biologically required.

WORM
00:31:08.520 – 00:31:12.680
Yeah, the fewer explosive depth bombs you drop into your GI tract, the better.

GERM
00:31:12.920 – 00:31:22.840
Speaking of explosive death bombs, if you are suffering from GI illnesses or diarrhea, we would love to hear from you and figure out why you’re sick, where you got sick. Please share that with us.

WORM
00:31:22.840 – 00:31:24.120
However, no photos.

GERM
00:31:24.600 – 00:32:00.330
You can send them. We will not look at. Everyone. That’s a wrap for episode 110 of Germ and Worm. As always, we really welcome your questions on travel Health.

Please send them to us or tips for travel success. Just send us an email germandworm@gmail.com or visit us online germandworm.com if you enjoy what you hear, please subscribe.

Rate us favorably right on your device and spread the word with friends, family and on the socials. Those are free ways to support this podcast. Podcast I’m Jer.

WORM
00:32:00.330 – 00:32:02.610
I’m Worm. It’s a big planet. See you in good health.

GERM
00:32:02.610 – 00:32:23.690
We look forward to seeing you next time.

This podcast is designed to inform, inspire, and entertain, but it does not establish a doctor patient relationship and so it should not replace your conversation with a qualified healthcare professional. Please see one before your next adventure.

The opinions in this podcast belong to Dr. Sanford and Dr. Pottinger alone and do not necessarily represent the opinions of the University of Washington or UW Medicine.