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In this article, we are going to talk about the link between antibiotics, C. Difficile infection, and anxiety. You may be familiar with C. Difficile as a common side effect of antibiotics, and a cause of severe gastrointestinal upset, but what you may not realize is that infection with C. Difficile is also a frequent cause of anxiety (even if you don’t have any gut symptoms).
Did you know that overcoming anxiety symptoms heavily depends on the microbiota in your gut? In fact, multiple studies suggest that there is a significant connection between gut health and mental health.
Scientists frequently use the term “gut-brain-axis”, when describing the bidirectional communication between the central nervous system (CNS) and gut microbiota (e.g., Clapp et al., 2017). According to research, inflammation of the gut is a common contributor to common mental health problems such as anxiety and depression. And the same happens and vice versa — anxiety also increases the chance of developing digestion problems.
While taking antibiotics has been considered an effective treatment to prevent some types of bacterial infection, it turns out that it can also result in the destruction of normal microbiota in your gut, which impacts the gut brain axis, and leading to a myriad of mental health symptoms such as anxiety, brain fog, and difficulties with sleep and concentration.
According to the literature, anxiety that is associated with prolonged antibiotic may be due to the release of a chemical called p-cresol, which is produced by the pathogen C. Difficile. Let’s take a look at the recent findings regarding Clostridioides difficile and explore how integrative and holistic medicine research and treatment can contribute to solving this issue.
A recent publication from the American Society for Microbiology, entitled “Clostridioides difficile Infection Dysregulates Brain Dopamine Metabolism,” explored the link between gut microbiota composition and the development of anxiety.
Clostridioides difficile (also known as C. diff) is a pathogen that causes diarrhea and inflammation of the colon. It usually overgrows in the gut as a result of extended antibiotic therapy.
Previous research about C. diff showed that this pathogen was associated with various digestive diseases such as colitis, sepsis, or toxic megacolon (e.g., Ofosu, 2016). But recent data suggests that this bacteria can also impact brain functionality and neurotransmitter release in the brain.
Certain strains of C. diff bacteria release a metabolite called p-crestol. P-Crestol is a toxin that blocks the conversion of dopamine into noradrenaline, resulting in excess amounts of dopamine in the brain.
Dopamine is a neurotransmitter in the brain that is associated with feelings of drive, pleasure, and happiness. However too-much dopamine can lead to paranoia, panic, and insomnia.
Infection with C. Diff may also lead to neurodevelopmental disorders (Vinithakumari, A.A., 2022), and according to Dr. Nicole Cain, a licensed naturopathic doctor who specializes in holistic medicine and mental health, elevations in dopamine promote the development of anxiety and panic disorders.
As discussed, excess levels of dopamine may lead to symptoms of paranoia, intense excitement, emotional eating, and even autistic behaviors (Cain, N., 2019).
To avoid anxiety following prolonged antibiotic use attributed to p-cresol release, it’s essential to conduct functional medicine testing to detect C. Diff in our bodies, specifically a stool test. My favorite stool test is the GI effects Comprehensive Stool Profile 3-day.
Functional medicine testing is a process that aims to identify biochemical and metabolic imbalances to find the root causes of complex diseases. This method is especially helpful to identify if anxiety is related to the interference of C. diff metabolites with dopamine metabolism.
In particular, the most effective functional medicine testing tool to assess C. diff species in your body is a stool analysis that includes pathogen testing. In order to detect Clostridia bacteria, tests include screening for the following 4 C. diff metabolites:
Other than using Organic Acid Testing and other functional medicine testing tools to assess your metabolic health, Dr. Cain also suggests specific treatments based on the integrative approach for getting more in-depth information about your metabolic health.
Here is a brief overview of the 3-pronged integrative approach to treating anxiety related to C. Diff.
One of the most effective ways to alleviate the effects of anxiety symptoms caused by C. diff is to replenish beneficial bacteria in your gut. Restoring gut microflora is possible using probiotics — live yeast and bacteria that can reduce the negative effects of antibiotics on your gut flora.
As studies show, probiotic supplements that contain strains of Lactobacillus rhamnosus and Lactobacillus plantarum restrict C. diff growth in your gut (Jeng & Yan, 2022) and therefore help in replenishing beneficial bacteria in your body. This means that probiotic supplements promote diversity in your gut microbiome after antibiotic treatment (Grazul et al., 2016).
The main reason why oral antibiotics are considered harmful to gut health is that they damage the natural balance in your gut flora by killing beneficial bacteria. However, according to (Mody et al., 2020, alternative approaches such as taking direct anti-clostridial agents such as curcuminoids are effective to eliminate the growth of C. diff without killing beneficial gut bacteria.
Curcumin is a herbal supplement that takes part in the management of inflammation and oxidative stress. Since it also has the potential to act as an anti-clostridial agent, it can also reduce the symptoms of anxiety associated with C. Diff.
Clostridium difficile infection is known for developing biofilms — microorganisms that usually come in a vegetative state, also known as the “spore” form (Hogan, 2021). Therefore, the third aspect of this integrative approach is focused on these spores.
As studies prove, biofilm formation can be prevented by the combination of berberine chloride and vancomycin. Berberine is a herbal supplement found in barberry, goldthread, Oregon grape, and goldenseal.
All in all, C. Difficile plays an integral role in promoting anxiety symptoms as a result of dysregulating dopamine metabolism in the brain. However, integrative treatment is an effective way to overcome anxiety due to extended antibiotic use as a result of p-cresol release by the pathogen C. Difficile.
Therefore, taking advantage of an integrative approach, using holistic treatment solutions, and taking probiotic supplements can help you restore the balance in your gut and naturally overcome the symptoms of anxiety.