Are antibiotics making us fat?

Jing Wei/The New York Times

Published: 14 March 2014 02:46 PM
Updated: 15 March 2014 10:37 AM
If you walk into a farm supply store, youre likely to find a bag of antibiotic powder that
claims to boost the growth of poultry and livestock. Thats because decades of
agricultural research have shown that antibiotics seem to flip a switch in young animals
bodies, helping them pack on pounds. Manufacturers brag about the miraculous effects
of feeding antibiotics to chicks and nursing calves. Dusty agricultural journals attest to
the ways in which the drugs can act like a kind of superfood to produce cheap meat.
But what if that meat is us? Recently, a group of medical investigators has begun to
wonder whether antibiotics might cause the same growth promotion in humans. New
evidence shows that Americas obesity epidemic may be connected to our high
consumption of these drugs. But before we get to those findings, its helpful to start at
the beginning, in 1948, when the wonder drugs were new and big was beautiful.
That year, biochemist Thomas H. Jukes marveled at a pinch of golden powder in a vial.
It was a new antibiotic named Aureomycin, and Jukes and his colleagues at Lederle
Laboratories suspected that it would become a blockbuster, lifesaving drug. But they
hoped to find other ways to profit from the powder as well. At the time, Lederle scientists
had been searching for a food additive for farm animals, and Jukes believed
Aureomycin could be it. After raising chicks on Aureomycin-laced food and on ordinary
mash, he found that the antibiotics did boost the chicks growth; some of them grew to
weigh twice as much as the ones in the control group.
Jukes wanted more Aureomycin, but his bosses cut him off because the drug was in
such high demand to treat human illnesses. So he hit on a novel solution. He picked
through the laboratorys dump to recover the slurry left after the manufacture of the
drug. He and his colleagues used those leftovers to carry on their experiments on pigs,
sheep and cows. All of the animals gained weight. Trash, it turned out, could be
transformed into meat.
You may be wondering whether it occurred to anyone that the powders would have the
same effect on the human body. In fact, a number of scientists believed that antibiotics
could stimulate growth in children. From our contemporary perspective, heres where
the story gets really strange: All this growth was regarded as a good thing. It was an era
that celebrated monster-size animals, fat babies and big men. In 1955, a crowd
gathered in a hotel ballroom to watch as feed salesmen climbed onto a scale; the men
were competing to see who could gain the most weight in four months, in imitation of
the cattle and hogs that ate their antibiotic-laced food. Pfizer sponsored the competition.
In 1954, Alexander Fleming, the Scottish biologist who discovered penicillin, visited the
University of Minnesota. His American hosts proudly informed him that by feeding
antibiotics to hogs, farmers had already found millions of dollars in slop. But Fleming
seemed disturbed by the thought of applying that logic to humans. I cant predict that
feeding penicillin to babies will do society much good, he said. Making people larger
might do more harm than good.

Nonetheless, experiments were then being conducted on humans. In the 1950s, a team
of scientists fed a steady diet of antibiotics to schoolchildren in Guatemala for more than
a year, while Charles H. Carter, a doctor in Florida, tried a similar regimen on mentally
disabled kids. Could the children, like the farm animals, grow larger? Yes, they could.
Jukes summarized Carters research in a monograph on nutrition and antibiotics:
Carter carried out a prolonged investigation of a study of the effects of administering 75
mg of chlortetracycline the chemical name for Aureomycin twice daily to mentally
defective children for periods of up to three years at the Florida Farm Colony. The
children were mentally deficient spastic cases and were almost entirely helpless, he
wrote. The average yearly gain in weight for the supplemented group was 6.5 lb while
the control group averaged 1.9 lb in yearly weight gain.
Researchers also tried this out in a study of Navy recruits. Nutritional effects of
antibiotics have been noted for some time in farm animals, the authors of the 1954
study wrote. But to date there have been few studies of the nutritional effects in
humans, and what little evidence is available is largely concerned with young children.
The present report seems of interest, therefore, because of the results obtained in a
controlled observation of several hundred young American males. The Navy men who
took a dose of antibiotics every morning for seven weeks gained more weight, on
average, than the control group.
Meanwhile, in agricultural circles, word of the miracle spread fast. Jay C. Hormel
described imaginative experiments in livestock production to his companys
stockholders in 1951; soon the company began its own research. Hormel scientists cut
baby piglets out of their mothers bellies and raised them in isolation, pumping them with
food and antibiotics. And yes, this did make the pigs fatter.
Farms clamored for antibiotic slurry from drug companies, which was trucked directly to
them in tanks. By 1954, Eli Lilly & Co. had created an antibiotic feed additive for farm
animals, as an aid to digestion. It was so much more than that. The drug-laced feeds
allowed farmers to keep their animals indoors because in addition to becoming
meatier, the animals now could subsist in filthy conditions. The stage was set for the
factory farm.
And yet scientists still could not explain the mystery of antibiotics and weight gain. Nor
did they try, really. According to Luis Caetano M. Antunes, a public health researcher at
the Oswaldo Cruz Foundation in Brazil, the attitude was, Who cares how its working?
Over the next few decades, while farms kept buying up antibiotics, the medical world
largely lost interest in their fattening effects and moved on.

In the last decade, however, scrutiny of antibiotics has increased. Overuse of the drugs
has led to the rise of antibiotic-resistant strains of bacteria salmonella in factory farms
and staph infections in hospitals. Researchers have also begun to suspect that it may
shed light on the obesity epidemic.
In 2002, Americans were about an inch taller and 24 pounds heavier than they were in
the 1960s, and more than a third are now classified as obese. Of course, diet and
lifestyle are prime culprits. But some scientists wonder whether there could be other
reasons for this staggering transformation of the American body. Antibiotics might be
the X factor or one of them.
Martin J. Blaser, director of the Human Microbiome Program and a professor of
medicine and microbiology at New York University, is exploring that mystery. In 1980,
he was the salmonella surveillance officer for the Centers for Disease Control and
Prevention, going to farms to investigate outbreaks. He remembers marveling at the
amount of antibiotic powder farmers poured into feed. I began to think, what is the
meaning of this? he told me.
Of course, while farm animals often eat a significant dose of antibiotics in food, the
situation is different for human beings. By the time most meat reaches our table, it
contains little or no antibiotics. So we receive our greatest exposure in the pills we take,
rather than the food we eat. American kids are prescribed on average about one course
of antibiotics every year, often for ear and chest infections. Could these intermittent high
doses affect our metabolism?
To find out, Blaser and his colleagues have spent years studying the effects of
antibiotics on the growth of baby mice. In one experiment, his lab raised mice on both
high-calorie food and antibiotics. As we all know, our childrens diets have gotten a lot
richer in recent decades, he writes in a book, Missing Microbes, due in April. At the
same time, American children often are prescribed antibiotics. What happens when
chocolate doughnuts mix with penicillin?
The results were dramatic, particularly in female mice: They gained about twice as
much body fat as the control-group mice who ate the same food. For the female mice,
the antibiotic exposure was the switch that converted more of those extra calories in the
diet to fat, while the males grew more in terms of both muscle and fat, Blaser writes.
The observations are consistent with the idea that the modern high-calorie diet alone is
insufficient to explain the obesity epidemic and that antibiotics could be contributing.
The Blaser lab also investigates whether antibiotics may be changing the animals
microbiome the trillions of bacteria that live inside their guts. These bacteria seem to
play a role in all sorts of immune responses, and, crucially, in digesting food, making
nutrients and maintaining a healthy weight. And antibiotics can kill them off: One recent
study found that taking the antibiotic ciprofloxacin destroyed entire populations of
certain bugs in some patients digestive tracts bacteria they might have been born
with.
Until recently, scientists simply had no way to identify and sort these trillions of bacteria.
But thanks to a new technique called high-throughput sequencing, we can examine
bacterial populations inside people. According to Ilseung Cho, a gastroenterologist who
works with the Blaser lab, researchers are learning so much about the gut bugs that it is
sometimes difficult to make sense of the blizzard of revelations. Interpreting the volume
of data being generated is as much a challenge as the scientific questions we are
interested in asking, he said.
Investigators are beginning to piece together a story about how gut bacteria shapes
each life, beginning at birth, when infants are anointed with populations from their
mothers microbiomes. Babies who are born by Caesarean and never make that trip
through the birth canal apparently never receive some key bugs from their mothers
possibly including those that help to maintain a healthy body weight. Children born by
C-section are more likely to be obese in later life.
By the time we reach adulthood, we have developed our own distinct menagerie of
bacteria. In fact, it doesnt always make sense to speak of us and them. You are the
condo that your bugs helped to build and design. The bugs redecorate you every day.
They turn the thermostat up and down, and they bang on your pipes.

In Blasers lab and elsewhere, scientists are racing to take a census of the bugs in the
human gut and even more difficult to figure out what effects they have on us.
What if we could identify which species minimize the risk of diabetes, or confer
protection against obesity? And what if we could figure out how to protect these crucial
bacteria from antibiotics, or replace them after theyre killed off?
The results could represent an entirely new pharmacopoeia, drugs beyond our wildest
dreams: Think of them as anti-antibiotics. Instead of destroying bugs, these new
medicines would implant creatures inside us, like more sophisticated probiotics.
Cho looks forward to this new era of medicine. I could say, All right, I know that youre
at risk for developing colon cancer, and I can decrease that risk by giving you this
bacteria and altering your microbiome. That would be amazing. We could prevent
certain diseases before they happened.
Until then, its hard for him to know what to tell his patients. We know that antibiotics
change us, but we still dont know what to do about it. Its still too early to draw
definitive conclusions, Cho said. And antibiotics remain a valuable resource that
physicians use to fight infections.
When I spoke to Antunes, the public health researcher in Brazil, he told me that his
young daughter had just suffered through several bouts of ear infections. Its a no-
brainer. You have to give her antibiotics. And yet he worried about how these drugs
might affect her in years to come.
It has become common to chide doctors and patients for overusing antibiotics, but when
the baby is wailing or youre burning with fever, its hard to know what to do. While
researchers work to unravel the connections between antibiotics and weight gain, they
should also put their minds toward reducing the unnecessary use of antibiotics. One
way to do that would be to provide patients with affordable tests that give immediate
feedback about what kind of infection has taken hold in their body. Such tools, like a
new kind of blood test, are in development and could help to eliminate the just in case
prescribing of antibiotics.
In the meantime, we are faced with the legacy of these drugs the possibility that they
have affected our size and shape, and made us different people.