According to recent research, most MC patients probably need more B12 than we realize. B12 is absorbed in the stomach, implying that anyone with compromised digestion is at increased risk of developing a B12 deficiency. And digestion is certainly compromised when MC or any other IBD is active. Interestingly, a B12 deficiency can cause many of the same symptoms as MC. A B12 deficiency can cause gastrointestinal symptoms such as bloating, constipation, diarrhea, gas, and nausea, for example. Is it possible that some of the cases where MC seems to be refractive to dietary treatment, despite careful attention to a restricted diet, might be associated with a B12 deficiency? That certainly appears to be a possibility. B12 deficiency seems to be associated with many autoimmune diseases. For example, B12 deficiency is common among diabetes patients (Kibirige, and Mwebaze, 2013).1 Published research has clearly shown that not only is neuropathy common among diabetics, but for patients who have diabetic neuropathy, the degree of neuropathy is inversely proportional to the level of B12 in their blood. In other words, diabetes patients who have the most serious levels of neuropathy. also have the lowest plasma levels of B12. New research questions the adequacy of adult B12 RDA. The possibilities discussed in the previous paragraphs gain substance in view of recent research led by scientists at the University of California, San Francisco (UCSF), 2025, February 19.2 The findings of the study challenge the long-held belief that maintaining vitamin B12 levels within the currently accepted "normal" range is sufficient to prevent neurological decline, particularly in older adults. Published in the Annals of Neurology, the study found that even individuals with B12 levels considered healthy by existing standards may be at risk for cognitive impairment and brain damage (Beaudry-Richard, et al., 2025).3 The study involved 231 healthy older adults with an average age of 71 years. Participants had an average blood B12 level of 414.8 pmol/L, well above the U.S. minimum standard of 148 pmol/L. Despite being within the normal range, individuals with lower B12 levels showed signs of neurological impairment and cognitive decline. Brain scans revealed the neurological effects of low "normal" B12 levels. MRI scans revealed increased white matter damage in participants with lower B12 levels. White matter lesions are associated with cognitive decline, stroke risk, and dementia. Participants with lower active B12 levels had slower reaction times and impaired visual processing speeds. Older participants were especially vulnerable, with age amplifying the negative effects of low B12. Elevated levels of Tau protein (a marker associated with neurodegenerative diseases like Alzheimer’s disease), were linked to high levels of biologically inactive B12 fractions (holo-haptocorrin). Vitamin B12 plays a vital role in:
A deficiency (even within the so-called normal range) may lead to brain damage through:
Notice that this research was based on measurements of active B12. B12 in food and cheap vitamins is in the inactive form (cyanocobalamin), which must be converted (by a methylation process) to the active form before our body can use it. About half the general population has one or more methylenetetrahydrofolate reductase (MTHFR) gene mutations which can limit our ability to convert vitamins into the active form. Some of us have major MTHFR gene mutations, which prevents our body from being able to use normal amounts of the B12 in our food, or most common vitamins. In such cases, a blood test may show our B12 level to be normal, or above the normal range, yet our body is screaming for the active form of B12. This deficiency can be resolved either by receiving regular B12 injections at our doctors office, or by taking an active form (methylcobalamin, for example) of B12. And according to the study cited above, our ability to absorb and/or convert B12 into the active form decreases as we age. MC depletes water-soluble vitamins. And since MC (and the other IBDs) deplete water-soluble vitamins, our chances of developing a B12 deficiency are much higher than someone who doesn't have a gastrointestinal disease that causes diarrhea. Considering our disease symptoms, and our general age bracket, it appears quite likely that B12 deficiency is common among MC patients. Long-term brain fog and fatigue are common symptoms of MC. Could a high prevalence of B12 deficiency be responsible for the brain fog and long-term fatigue associated with MC? Since the risk of deficiency increases with age, maintaining adequate vitamin B12 levels is particularly important for older adults. The decline is mostly due to a natural decline in the stomach’s ability to produce intrinsic factor (a protein required for B12 absorption from food). Disease-related malabsorption exacerbates the problem. For adults over 50, not only age-related changes, but diseases such as MC and other IBDs, lead to malabsorption of B12 from dietary sources. Low stomach acid (atrophic gastritis) or the use of medications such as proton pump inhibitors (PPIs) or metformin, can further reduce B12 absorption. As mentioned above, a deficiency in this vitamin can lead to serious health issues, including:
Fortunately, supplementation can help address this problem effectively. Instead of basing our B12 intake on the government's RDA guidelines, it appears that following the recommendations of the Linus Pauling Institute (LPI) may be more appropriate, especially for individuals such as us, who have MC, or some other IBD. Their recommendations state that adults over 50 should take 100–400 μg (micrograms) of supplemental vitamin B12 daily. These doses help overcome the body's natural decline in absorption by providing much higher amounts than would be possible through food alone. The good news is that most multivitamins already meet or exceed these recommendations, making it easy for most seniors to get the right amount through daily supplementation. The bad news is that a major caveat regarding multivitamins exists for MC patients, due to the fact that multivitamins tend to contain so many ingredients that most such products on the market pose a significant reaction risk for MC patients There are several forms of vitamin B12 available in supplements, although not all are equally effective for everyone:
These forms of B12 are available as:
Does a risk of overdose exist? No toxic effects have been associated with high vitamin B12 intake in healthy individuals, even at doses as high as 2,000 μg/day. This is because the body absorbs only a small fraction of large doses, with the rest excreted in urine. However, as is the case when taking supplemental magnesium, those who have compromised kidney function should consult their healthcare provider before starting high-dose cyanocobalamin (methylcobalamin bypasses this risk). In summary: For seniors, and especially those who have MC or some other IBD, the easiest and most effective way to maintain adequate B12 levels is:
This approach ensures that we can maintain healthy B12 levels, supporting brain function, nerve health, and energy metabolism well into our senior years. References: 1. Kibirige, D., and Mwebaze, R. (2013). Vitamin B12 deficiency among patients with diabetes mellitus: is routine screening and supplementation justified? Journal of Diabetes & Metabolic Disorders, 12(1), p17. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC3649932/ 2. University of California, San Francisco, (2025, February 19). 'Healthy' vitamin B12 levels not enough to ward off neuro decline: Experts call for new recommendations for older adults. Medical Xpress, Retrieved from https://medicalxpress.com/news/2025-02-healthy-vitamin-b12-ward-neuro.html 3. Beaudry-Richard, A., Abdelhak, A., Saloner, R., Sacco, S., Montes, S. C., Oertelm F. C., . . . Green, A. J. (2025). Vitamin B12 Levels Association with Functional and Structural Biomarkers of Central Nervous System Injury in Older Adults. Annals of Neurology, Retrieved from https://onlinelibrary.wiley.com/doi/10.1002/ana.27200
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A large-scale Swedish study analyzed data for over 900,000 women aged 50-58, including 77,000 hormone therapy users, to compare cardiovascular risks associated with different types of hormone therapy (Johansson, et al., 2024).1 The study assessed the risks of myocardial infarction (MI), ischemic heart disease, stroke, composite cardiovascular disease (CVD), and venous thromboembolism (VTE). The study showed that:
The clinical indications of the study suggested that: Transdermal estrogen has a better cardiovascular safety profile compared to oral estrogen, particularly for women with cardiovascular risk factors. Hormone therapy (oral or transdermal) remains a reasonable option for healthy women in early menopause with bothersome symptoms, but clinicians should prefer transdermal forms for those with increased CVD risk. Hormone replacement therapy and IBD. Research data show that hormone replacement therapy (HRT) may improve inflammatory bowel disease (IBD) symptoms, and reduce the risk of moderate to severe disease in post-menopausal women (Freeman, et al., 2023).2 Of course there are no official research data available regarding HRT and microscopic colitis (MC), but we can probably safely assume that the effects of HRT will be relatively similar for all forms of IBD (until proven otherwise). The research (published by Freeman, et al.) shows that postmenopausal women who took HRT were 82% less likely to have active IBD in the postmenopausal period, and the risk of surgery was reduced. Obviously, an 82% improvement with the use of HRT, is a huge advantage. There's no research comparing oral with transdermal HRT for IBD patients. Therefore, we can only speculate that in view of existing research showing the significant advantages of transdermal over oral HRT treatments, those advantages will almost surely carryover to IBD patients. It appears that the primary advantage of transdermal HRT is associated with its reduced impact on the liver, which likely lowers the risk of exacerbating IBD symptoms. Oral HRT can affect the liver during its first-pass metabolism, and potentially influence inflammatory processes in the gut. Our own experiences show that transdermal HRT is safer than oral HRT. And although the study cited above didn't consider any effects that hormone replacement theory (HRT) might have on IBD symptoms, our own experiences (as evidenced by the epidemiological data shown by the posts in the archives of the discussion and support forum associated with our website) show that transdermal patches are far less likely to trigger a microscopic colitis (MC) reaction, than oral HRT treatments. What about the sexual side effects? A Study of 670 healthy women aged 42 to 58 Years, within three years of their last menstrual period showed that transdermal estradiol significantly improved sexual satisfaction and the physical aspects of sexual function, compared with placebo (Taylor, et al., 2017).3 By comparison, oral estrogens modestly improved overall satisfaction, with the primary benefits seen in the physical aspects. All in all, transdermal delivery showed better results than oral treatments in the study. According to Dr Sharyl Magnuson (on our Board of Directors) the topical form of estrogen that's normally the most helpful for sexual functioning is the vaginal cream preparation (Premarin or Estrace creams). These help maintain a healthy vaginal mucosa, prevent vaginal atrophy and sexual discomfort. In conclusion: Research data show that transdermal HRT treatments typically provide more benefits and are less likely to create problems when compared with oral HRT treatments, especially for IBD patients. And the epidemiological evidence based on our shared experiences, recorded in the archives of the discussion and support forum associated with our website, agrees with those findings for MC patients. References 1. Johansson, T., Karlsson, T., Bliuc, D., Schmitz, D., Ek, W. E., Skalkidou, A., . . . Johansson, Å. (2024). Contemporary menopausal hormone therapy and risk of cardiovascular disease: Swedish nationwide register based emulated target trial. BMJ, 387, e078784. Retrieved from https://www.bmj.com/content/387/bmj-2023-078784 2. Freeman, M., Lally, L., Teigen, L., Graziano, E., Shivashankar, R., and Shmidt, E. (2023). Hormone Replacement Therapy Is Associated with Disease Activity Improvement among Post-Menopausal Women with Inflammatory Bowel Disease. Journal of Clinical Medicine, 13(1), p 88. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC10779540/ 3. Taylor, H. S.,Tal, A., Pal, L., Li, F., Black, D. M., Brinton, E., A., . . . Harman, S. M. (2017). Effects of Oral vs Transdermal Estrogen Therapy on Sexual Function in Early Postmenopause. JAMA Internal Medicine, 177(10), pp 471–1479. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC5710212/
A recent Medscape online article points out some interesting observations regarding the health benefits and risks associated with caffeine, based on recent studies (Spriano, 2024, October 11).1 And although the article doesn't mention how microscopic colitis (MC) patients might be affected by caffeine, we can certainly coordinate the information in the article with the vast amount of epidemiological evidence available in the shared experiences that have been posted to the database of our discussion and support forum over the last couple of decades in order to fill in the blanks. Looking at the chemical characteristics and pharmacokinetics of caffeine. Caffeine is a methylxanthine that is completely absorbed (within 45 minutes) and peaks in the bloodstream between 15 minutes and 2 hours after ingestion. Its half-life in adults is generally 2.5-4.5 hours, but several factors can extend or reduce this time, such as smoking (reduces half-life) and the use of oral contraceptives (doubles the half-life). Caffeine crosses the blood-brain barrier, where it blocks adenosine receptors, increasing alertness and reducing fatigue, but also having broader impacts on brain function. Caffeine has Cognitive and Neurological Benefits. 1. Caffeine is widely used to enhance alertness and work productivity by reducing fatigue and improving reaction times. 2. It may also have antidepressant-like effects by reducing the risk of depression in some populations. 3. Caffeine enhances the effectiveness of painkillers such as acetaminophen (paracetamol), aspirin and other NSAIDs, and opioids, in treating headaches and other types of pain. This effect is especially beneficial in treating headaches, migraines, and post-surgical pain, where combinations of caffeine and painkillers are sometimes used. It enhances the effectiveness of painkillers by: 1. speeding up the absorption of certain medications, allowing for faster and sometimes stronger effects 2. blocking adenosine receptors, which helps to reduce the perception of pain For us, boosting the efficacy of safe painkillers can be a huge benefit. The antidepressant-like effects (for some individuals) can certainly be considered beneficial for MC patients, considering that MC tends to be a very depressing disease. But the available options of safe painkillers are so very limited, with acetaminophen being the number one choice for most of us, when treating our routine aches and pains, that the benefits of boosting the efficacy of painkillers can be a huge benefit for most of us when our situation causes us to reach for a painkiller. Caffeine has cardiovascular benefits. Despite early concerns about its impact on blood pressure (BP), moderate coffee consumption has not been linked to increased long-term risk for hypertension and may even reduce the risk of developing it. Studies also show that regular coffee consumption is not associated with an increased risk of atrial fibrillation (AF) or cardiovascular events, and in fact, it may reduce the risk of AF in a dose-dependent manner. Caffeine reduces all cause mortality risk for type 2 diabetes patients. At least that statement is true for Japanese diabetes patients, since Japanese patients were used in the study. In fact, the study showed a dose response relationship for the reduction in all cause mortality. And the beneficial effects of caffeine were even greater when coffee was consumed along with green tea. These benefits must be weighed against possible adverse effects. 1. Caffeine can at least temporarily affect blood pressure levels. While caffeine can acutely raise BP somewhat after 200-300 mg), these effects are temporary and typically do not last longer than three hours. In patients who consume coffee regularly, this effect tends to diminish due to tolerance. Occasional coffee drinkers, however, may experience a more significant hypertensive response. 2. Caffeine can affect cholesterol levels. There's evidence suggesting that unfiltered coffee, due to its high cafestol content, can raise cholesterol levels, particularly LDL cholesterol and triglycerides. However, filtered coffee and instant coffee have much lower cafestol levels, thereby reducing this effect. Results from studies on coffee’s impact on cholesterol levels remain inconsistent. 3. Caffeine can increase anxiety and cause sleep disturbances. High caffeine intake (for example, 400 mg per day, or more) can lead to anxiety and sleep disruptions, although individual responses vary due to genetic factors and caffeine metabolism rates. Some individuals are more susceptible to these effects than others. 4. Caffeine overdose can lead to toxic effects. Caffeine overdose rarely occurs due to traditional consumption methods (for example,, coffee or tea), but it can occur when using caffeine tablets or energy drinks, particularly in young people, or those consuming caffeine along with alcohol, or engaged in intense exertion. The article referenced in the first paragraph points out that consuming large amounts of energy drinks (around 1 liter, containing 320 mg of caffeine, for example) can cause acute cardiovascular problems such as elevated BP, QT-segment prolongation, and palpitations. 5. Caffeine can be addictive. When consumed regularly, caffeine tends to cause users to develop a tolerance, which leads to a dependency, and therefore, suddenly avoiding caffeine can lead to withdrawal symptoms, including headaches, fatigue, decreased attention, and mood disturbances. 6. Caffeine can be a major concern for migraine sufferers. Because regular caffeine consumption can lead to dependency, if caffeine levels drop suddenly, the withdrawal symptoms can not only trigger headaches, but they can trigger migraines. For some individuals, even one missed or delayed dose of caffeine can lead to withdrawal symptoms. Caffeine can contribute to rebound headaches, particularly if used frequently in combination with pain relief medications, and this can make migraines more challenging to manage, possibly leading to a cycle of morning headaches. This can happen because caffeine constricts blood vessels, which tends to initially relieve migraines. But once the caffeine wears off, blood vessels may dilate again, which can trigger a rebound migraine. Note that in many cases, published research shows that magnesium deficiency (which is associated with MC) may be the cause of migraines, and for these patients, magnesium deficiency would probably be a much more likely cause of migraines than caffeine. But this is a two-way street. In small doses, caffeine can actually help stop a migraine in progress by constricting blood vessels and enhancing the effectiveness of painkillers such as aspirin, or in the case of MC and other IBD patients, acetaminophen. This is why caffeine is included in some over-the-counter migraine medications. Therefore, for some people, occasional caffeine intake can alleviate migraine symptoms, but it’s generally advised against regular use for chronic migraine sufferers due to the risk of dependency and rebound headaches. Certain consumer products are concerning. Energy drinks are particularly concerning due to their high caffeine content and potential to cause adverse cardiovascular effects when consumed in large quantities or combined with alcohol. Energy drinks also pose a risk due to the lack of tolerance developed from occasional use, making young people especially vulnerable to their stimulant effects. Many weight loss supplements contain high concentrations of caffeine along with other ingredients intended to boost metabolism. These products can be easily misused, especially given their easy availability and marketing claims, leading to adverse health outcomes. How do various products that contain caffeine compare? Coffee The average cup of coffee contains approximately 95 milligrams of caffeine. However, this amount can vary depending on several factors, such as the type of coffee bean, the brewing method, and the serving size. Here’s a breakdown of the typical caffeine content in different types of coffee:
These values serve as general estimates, but individual variations in brewing strength can influence caffeine content. And note that coffee contains more than just caffeine. Note that coffee contains over 1, 000 chemical compounds. So not just caffeine, but a huge number of other chemical ingredients contribute to its aroma, flavor, and effects on the body. And it's certainly likely that some of these other ingredients may contribute not only to coffee's beneficial attributes, but also to some of its negative attributes, such as withdrawal symptoms, anxiety risks, and possible sleep disruptions.. While these compounds may have negative health effects, moderate coffee consumption (usually 1-3 cups per day for most people) is generally considered safe. As is often noted in posts on our MC discussion and support forum, if coffee didn't bother us before we developed MC, then it's probably still safe to drink (in moderation) after we developed MC. However, individuals with specific health concerns, like acid reflux, high cholesterol, or kidney stone susceptibility, may benefit from moderating their coffee intake or choosing filtered coffee to minimize exposure to some of these compounds. Although we can't be sure, because there's no published research to back this up, it's likely that the gastrointestinal distress (sometimes referred to as "coffee gut") that sends some people to the bathroom soon after they drink a cup of coffee is probably not due to caffeine. It's more likely to be caused by some of the natural acids in coffee, such as chlorogenic and quinic acids. These acids can not only cause gastric discomfort, but they can also contribute to acid reflux, and heartburn, especially for people with sensitive stomachs or gastroesophageal reflux disease (GERD). Tea The average cup of tea contains approximately 20 to 60 milligrams of caffeine, depending on the type of tea and how it is brewed. Here's a general breakdown of caffeine content for different types of tea (per 8-ounce cup):
As with coffee, the brewing time and tea variety can affect the exact amount of caffeine in your cup. For example, brewing tea for a longer period can increase its caffeine content. Colas The average cola-type soft drink contains approximately 30 to 40 milligrams of caffeine per 12-ounce (355 mL) can. Here's a general range for some popular cola drinks:
In comparison with coffee or tea, the caffeine content in cola is significantly lower. However, many energy drinks or specialized sodas may contain much higher amounts of caffeine. Energy drinks The caffeine content in energy drinks varies widely, but it typically ranges from 70 to 300 milligrams per serving. Here are examples of popular energy drinks and their caffeine content:
The caffeine content can vary depending on the brand, serving size, and specific product line. Some energy drinks, especially those marketed for extreme energy or performance, can have significantly higher caffeine levels. It's important to check the label to know the exact amount. Guidelines for keeping caffeine beneficial, and minimizing the risks: Caffeine brings both benefits and risks, and understanding the context of use, dose, and individual susceptibility is critical in managing its impact on health. Moderation is the key. Most of the risks are associated with high doses of caffeine, particularly from energy drinks or caffeine tablets. Encouraging moderate consumption of coffee or tea can help mitigate these risks while still offering some health benefits. Specific patient considerations (such as hypertension, anxiety disorders, or pregnancy) should guide the decision on whether and how much caffeine consumption is advisable. And as MC patients, caffeine may convey a special benefit when we desperately need a painkiller. Since the safe choices of painkillers typically boil down to acetaminophen, taking the acetaminophen with a cup of coffee may help to make it a much more effective painkiller. And the antidepressant -like effects of the caffeine in that cup of coffee may help to provide another much-needed benefit for many of us as we continue to deal with this depressing disease. Reference 1. Spriano, P. (2024, October 11). Ready for a Jolt? Caffeine Brings Benefits and Risks. Medscape, Retrieved from https://www.medscape.com/viewarticle/ready-jolt-caffeine-brings-benefits-and-risks-2024a1000ilx
The first true antibiotic, penicillin, was discovered in 1928. But the prestige of that lifesaving discovery was slightly tarnished when the first case of penicillin resistance appeared in 1947. During the decade between 1950 and 1960, approximately half of the antibiotics in use today were discovered, earning this decade the title of the "Golden age of antibiotic discovery". Antibiotic resistance continues to increase. The growing problem of antibiotic resistance is a constant reminder that we need to find alternatives to antibiotics. And now, the recent research discovery that antibiotics increase the risk of developing IBD, adds another level of urgency to the dilemma. Precious few alternatives to antibiotics are currently available. Currently, there are very few practical alternatives to antibiotics, but there are a number of promising therapies under development that may prove to provide effective results to complete with current antibiotics, at some point in the near future. Here's a brief look at some of these possible future (in most cases) options. And please note that there are never any guarantees regarding developmental research, so the estimated availability times are little more than best guesses, subject to change, depending on the outcomes of laboratory procedures, treatment trials, FDA discretionary actions, and other influences. 1. Phage Therapy — Phage therapy uses bacteriophages, which are viruses that specifically infect and kill bacteria. Bacteriophages target specific bacterial strains without affecting beneficial bacteria or the body’s own cells, unlike broad-spectrum antibiotics. This technique has been researched for treating antibiotic-resistant infections such as MRSA (methicillin-resistant Staphylococcus aureus) and Pseudomonas infections. Phage therapy is highly targeted, reducing the risk of collateral damage to the microbiome and lessening the development of resistance. Phage therapy is in experimental stages in most of the world, with early clinical trials underway, especially in the U.S. and Europe. Some compassionate use cases exist for multidrug-resistant infections, but widespread regulatory approval is still pending. Regulatory approval, standardization of treatment, and creating phage banks for various bacterial infections are hurdles. Estimated Availability is 5 to 10 years. What will it cost? Considering the variability, the total cost of phage therapy (including medication, customization, and treatment) could range anywhere from $8,000 to $40,000 or more. The cost is likely to be higher in countries where phage therapy is not widely available or is considered experimental, requiring patients to travel to specialized clinics. 2. Antimicrobial Peptides (AMPs) — Antimicrobial peptides are small proteins produced by the immune system that can kill bacteria, viruses, fungi, and even cancer cells. AMPs disrupt the bacterial cell membranes, leading to cell death. They have broad-spectrum activity and are less likely to lead to resistance. AMPs are being developed to treat infections ranging from skin wounds to pneumonia and bloodstream infections. They have rapid bacterial killing activity and a lower likelihood of resistance. AMPs are in early stages of research and clinical trials. While they show promise, issues related to stability, toxicity, and effectiveness in humans still need to be addressed. Development of stable, non-toxic formulations suitable for systemic use and regulatory hurdles are the main challenges. Because they enhance cell growth and tissue repair, they're currently used in clinical treatment of pathogen infection, wound healing and cancer. Estimated Availability is 10 to 15 years. What will it cost? Considering the cost of medication, customization, and clinical treatment, the total for antimicrobial peptide treatments is likely to range between $12,000 and $50,000 or more, depending on the specific AMP used, the complexity of the infection being treated, and the region where the treatment is administered. 3. Probiotics — Probiotics are live beneficial bacteria that can promote a healthy gut microbiome by competing with pathogenic bacteria. By producing antimicrobial substances, and supporting the immune system, probiotics can prevent and treat infections. Probiotics have been used to prevent infections like **Clostridioides difficile** (C. diff) and to reduce the risk of respiratory and urinary tract infections, and they can support gut health without disrupting the beneficial microbiome, making them a potential alternative to antibiotics for preventing infections. Probiotics are already widely available as dietary supplements and are increasingly being used for gut health and adjunctive therapy in healthcare systems. Ensuring standardized and clinically effective strains for specific medical purposes remains an area of active research, but they are already part of healthcare treatments, particularly for gastrointestinal issues. What will it cost?
4. Prebiotics— Prebiotics are non-digestible fibers that serve as food for beneficial bacteria in the gut. By feeding the beneficial bacteria, prebiotics can help maintain a balanced gut microbiome, which can prevent harmful bacteria from overgrowing. Prebiotics are used to improve digestive health and may reduce the risk of gastrointestinal infections, and they support long-term gut health, and may help prevent infections naturally without the need for antibiotics. Prebiotics are available in food and supplements. Their role as part of gut health and adjunctive therapy is being explored further, but they are widely used already. Like probiotics, the challenge is identifying specific prebiotics that target particular gut bacteria for tailored therapeutic effects. What will it cost?
5. Herbal and Plant-Based Antimicrobials — Some herbs and plant-based substances have antimicrobial properties and have been used traditionally to treat infections. For example, garlic has broad-spectrum antimicrobial activity, and echinacea is believed to stimulate the immune system and may help in reducing the severity of infections. Cranberry is used primarily to prevent urinary tract infections. Tea tree oil is used topically for bacterial and fungal infections. These natural substances often have fewer side effects than antibiotics and may help in mild to moderate infections. Some plant-based antimicrobials (for example, tea tree oil, and garlic extract) are already used in alternative medicine and supplements. More rigorous research is ongoing to establish their effectiveness and safety for clinical use. Lack of standardization and clinical trials to prove efficacy and safety are major obstacles. Widespread medical use will require clinical validation. Estimated Availability is 5 to 10 years (for medical-grade applications). What will it cost?
6. Vaccines — Vaccines prevent infections by stimulating the immune system to recognize and attack specific pathogens. By introducing a weakened or inactive form of a pathogen, vaccines "train" the immune system to respond to future infections. Vaccines are a preventive measure against bacterial infections like pneumococcal pneumonia, tuberculosis, and bacterial meningitis, as well as viral infections like the flu and COVID-19, and they can prevent infections from occurring in the first place, thereby reducing the need for antibiotics. Vaccines are already widely available and an essential part of preventive healthcare. Research into vaccines against multidrug-resistant bacteria is ongoing, and such vaccines may be available in the next 5 to 10 years. Vaccine development for specific drug-resistant bacteria is complex, but current vaccines are integral to modern medicine. What will it cost?
7. Immunotherapy — Immunotherapy boosts the body’s natural defenses to fight infections. Some immunotherapies involve administering immune molecules like cytokines or interferons, while others stimulate the body’s immune cells directly. Immunotherapy is used in treating infections, particularly in immunocompromised individuals or those with chronic infections. It reduces reliance on antibiotics and strengthens the body's ability to fight infections. Immunotherapy is already widely used for cancer and some viral infections (e.g., COVID-19). For bacterial infections, it's still in experimental stages, with a focus on boosting the body’s natural immune response to fight infections. Translating success from cancer treatment into infection control will take time, as bacterial immunotherapies are still in clinical trial phases. Estimated Availability is 5 to 10 years (for bacterial infections). What will it cost?
8. Bacteriocins — Bacteriocins are antimicrobial peptides produced by certain bacteria that inhibit the growth of other bacteria (primarily similar or closely related bacterial strains). Bacteriocins can specifically target pathogenic bacteria, acting like natural antibiotics. They've been explored for use in food preservation and as potential treatments for gastrointestinal infections. They target specific bacteria without broad-spectrum effects, helping preserve a healthy microbiome. Bacteriocins are in early research phases for medical applications. They are already used in food preservation, but clinical use as antibiotic alternatives is still in development. Creating formulations that are safe, stable, and effective for medical use is a key challenge, along with large-scale production. Estimated Availability is 5 to 10 years. What will it cost?
9. Silver Nanoparticles — Silver nanoparticles have antimicrobial properties and have been researched for their ability to kill bacteria. They can disrupt bacterial cell membranes and inhibit cellular functions. Silver nanoparticles are used in wound dressings, coatings for medical devices, and other infection-prevention products. They have a broad antimicrobial spectrum and are less likely to lead to resistance compared to antibiotics. Silver-based treatments (e.g., silver sulfadiazine for burns) are already in use. Silver nanoparticles are in research and clinical trials for broader antimicrobial applications, including wound care and medical devices. Concerns about toxicity, long-term safety, and potential bacterial resistance are significant barriers to more widespread use. Estimated Availability is 5 to 10 years. What will it cost?
10. Monoclonal Antibodies — Monoclonal antibodies are laboratory-made molecules that can mimic the immune system's ability to fight infections. These antibodies bind to specific bacterial or viral proteins, neutralizing pathogens or marking them for destruction by the immune system. Monoclonal antibodies are being used to treat viral infections like COVID-19 and bacterial infections resistant to traditional antibiotics. They offer a targeted approach with fewer off-target effects compared with antibiotics. Monoclonal antibodies are already available for treating viral infections (for example, COVID-19) and chronic diseases (for example, cancer, and autoimmune disorders). Their use in treating bacterial infections is being actively researched, with some clinical trials already underway. Development of bacterial-specific monoclonal antibodies and ensuring cost-effectiveness for widespread use are key hurdles. Estimated Availability is 3 to 5 years (for bacterial infections) What will it cost?
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November 2025
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