Why do I keep getting sick every month? Brehan Crawford, L.Ac., in his video on the gut and the immune system

Why Do I Keep Getting Sick Every Month?

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    If you catch every cold that comes through, even though you look healthy, the germs are only half the story. The other half is the terrain they land in, and most of that terrain is your gut. Here is what the research says about the gut and immunity, what early antibiotics have to do with it, and how I rebuilt my own.

    The short answer

    Getting sick again and again is usually a terrain problem. Roughly 70 to 80 percent of your immune cells live in your gut, and the microbes there train them. If you have a dysfunctional gut, you also have a dysfunctional immune system. Antibiotics early and often in childhood leave the gut less diverse, and research links that to more immune problems later. The gut can be rebuilt. I did it with herbs, breathing exercises and cooked whole foods.

    The short version, on video.

    Why do I keep getting sick every month?

    Because your defenses are not holding, and exposure alone does not explain that. Everyone in the house meets the same virus. Not everyone goes down with it.

    Sleep is one piece. Researchers tracked the sleep of 164 healthy adults for a week, then gave them nose drops containing a cold virus. Those sleeping less than six hours a night had more than four times the odds of developing a cold compared with those sleeping more than seven.[1] If that is you, start with Gut Health Basics: Your Sleep.

    But if you sleep well, look healthy, and still get sick every two months, you might not be understanding what your gut needs. No one realizes this: most of your immune system lives there.

    Chinese medicine has never been very interested in the bug. It is interested in the ground the bug lands on. I call that terrain over warfare, and learning to tend your own terrain is what we do inside Gut Brain Synchrony.

    Is 70 percent of your immune system in your gut?

    Yes, as closely as anyone can count it. A 2021 review in Nutrients puts 70 to 80 percent of the body’s immune cells in the gut.[2] That makes sense when you look at the job. The gut lining is where the outside world, as food and trillions of microbes, meets the inside of you, all day, every day.

    Those microbes are not passengers. A 2014 review in Cell describes the microbiota as playing a fundamental role in the induction, training and function of the immune system. The same paper argues that overuse of antibiotics and changes in diet may have left many of us with a gut community that lacks the diversity and resilience balanced immunity depends on.[3]

    So if you have a dysfunctional gut, you also have a dysfunctional immune system.

    What happens to immunity when gut bacteria are wiped out

    Researchers at Stanford and Emory gave healthy adults broad-spectrum antibiotics around the time of a seasonal flu shot. Gut bacteria fell 10,000-fold, and diversity stayed down long afterward. In people who already carried antibodies to the flu strains, the vaccine response held. In a second trial, of people with low pre-existing antibody levels, the antibody response to the H1N1 strain was significantly impaired. In both trials the antibiotics also produced inflammatory signatures of a kind previously seen in the elderly.[4]

    Does the gut decide how often you catch a cold?

    The human trials say it has a hand in it. A 2022 Cochrane review pooled 23 trials and 6,950 people, from infants to the elderly, who took probiotics or a placebo. Those taking probiotics were 24 percent less likely to get an upper respiratory infection at all and 41 percent less likely to get three or more, and their infections ended about a day sooner. The reviewers rated most of that evidence as low certainty.[5]

    That is not a case for living on capsules. I have written about why probiotics are not the answer after antibiotics. What the trials show is the link: change what lives in the gut, and the nose and throat change with it.

    Do antibiotics weaken your child’s immune system?

    They can leave a mark on it, and I am one of the people carrying that mark. When I was two, I had an infection that almost took me out. Antibiotics ended up saving my life. They also wrecked my guts and my immune system in the process, and as a result I got sick very often.

    Both halves of that are true, and the research on children lines up.

    What early antibiotics do to a young gut

    The first years of life are when the gut community is built. Researchers at NYU followed 43 American infants through their first two years and found that antibiotic exposure was associated with delayed microbiome development and altered diversity.[6] A second team sequenced monthly stool samples from 39 children across their first three years, about half of whom had received multiple courses of antibiotics. The gut communities of the antibiotic-treated children were less diverse, in both species and strains.[7]

    What shows up later

    A Mayo Clinic study followed 14,572 children born in Olmsted County, Minnesota. Seventy percent received at least one antibiotic prescription in their first two years. Those children had a higher risk of childhood asthma, allergic rhinitis and atopic dermatitis, and the associations depended on the number, type and timing of the prescriptions.[8]

    A 2022 meta-analysis pulled together 160 observational studies covering more than 22 million children. Antibiotic exposure was associated with roughly double the odds of asthma, and with higher odds of eczema, food allergy, hay fever, juvenile arthritis and psoriasis. The effects were often stronger with more courses and with broad-spectrum drugs. The authors are clear that studies of this kind cannot prove cause.[9]

    Two studies get closer to the immune system itself. In a study of 560 young children, those given antibiotics before age two had lower antibody levels to several routine vaccines, and each additional course was associated with a further drop.[10] In a national cohort in Taiwan, 4,246 children who took antibiotics for at least seven days in their first two years were matched with children who took none. In the years before routine chickenpox vaccination, 23.45 percent of the antibiotic group caught chickenpox within five years, against 16.72 percent of the others.[11]

    That is my childhood in a data table. Kids who get antibiotics early and often end up with less diverse gut bacteria and more immune problems, with long-term consequences.

    What does Chinese medicine say about getting sick often?

    It says look at digestion first. In Chinese medicine the body’s outer defense is called wei qi, defensive qi. It is made from the food you eat, by the Spleen and Stomach, and spread to the surface of the body by the Lungs. Weak digestion means thin defenses.

    The Jin-Yuan dynasty physician Li Dongyuan built a school of medicine on this. His Pi Wei Lun, the Treatise on the Spleen and Stomach, names a weakened Spleen and Stomach as the root of many disorders and states the consequence plainly: when they are depleted, the defensive qi cannot protect the body from what comes at it from outside.

    The channel system makes the same connection: the Lung is paired with the Large Intestine. Researchers now call it the gut-lung axis.

    The classical formula for the person who catches everything is Yu Ping Feng San, Jade Windscreen Powder: astragalus, white atractylodes and saposhnikovia. In a double-blind trial at eight centers in China, 240 adults with COPD and a history of repeated flare-ups took Yu Ping Feng granules or a placebo for a year. The herb group averaged 1.15 flare-ups, against 1.55 on placebo.[12]

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    How to rebuild gut health after antibiotics

    Twenty years ago, when I started learning Chinese medicine, I finally understood the massive part the gut plays, and I started to rebuild my own health. I used herbs, breathing exercises and cooked whole foods. That gave my microbiome what it needed to repair itself. Here is why each one works.

    01 Cook your food. Chinese medicine asks a weak gut to do less work, so the food arrives warm and already partly broken down: soups, stews, porridge, cooked vegetables and grains. Cooking also changes what your microbes receive. In a study from UCSF and Harvard, the same plant foods served raw or cooked reshaped the gut microbiome in mice, through better starch digestibility and the breakdown of plant compounds, and the shift was detectable in humans.[13]
    02 Eat whole foods. Beans, sweet potato, squash and other cooked plants feed the bacteria you still have. Diet can shift immune markers within weeks. In a 17-week Stanford trial, healthy adults ate either a high-fiber diet or a diet high in fermented foods, 18 in each group. The fermented-food group steadily gained microbiome diversity and their inflammatory markers fell. In the fiber group, diversity held steady while the microbiome’s capacity to break down plant fiber grew.[14]
    03 Use herbs with a plan. Herbs feed the gut community as well as treating the person. A 2020 review describes Chinese herbal medicines as potential prebiotics and maps how they interact with Akkermansia muciniphila, a gut bacterium found at reduced levels in many diseases.[15] In Chinese medicine the formula is matched to the person’s pattern, not to the complaint.
    04 Breathe slowly, every day. Digestion and repair run on the rest-and-digest side of the nervous system. A meta-analysis of 223 studies found that voluntary slow breathing raises vagally mediated heart rate variability, a marker of that side at work, during a session, right after one, and after weeks of practice.[16]
    05 Give it time. A gut community does not rebuild in a week. Watch what shifts: your digestion, your energy, and how often you go down with something.

    Getting sick often: your questions, answered

    Why does my kid get sick so often?

    A young immune system is still learning, and a young gut is still being built. The gut community keeps changing through the first three years of life before it settles into an adult-like state.[7] That window is where my own story starts. When your kid is sick, here is how I think about it: slow down, watch closely, and support the basics. In Chinese medicine, the basics begin with digestion.

    How long does it take to rebuild gut health after antibiotics?

    Longer than most people expect, and the gut does not always find its own way back. When 12 healthy young men took a four-day course of three strong antibiotics, their gut bacteria returned to near-baseline composition within about a month and a half. Six months on, nine common species that every one of them had carried before were still undetectable in most of them.[17] That is why I think in terms of rebuilding, not waiting.

    Did Hippocrates say all disease begins in the gut?

    The line is credited to him wherever gut health is discussed. Whoever said it first, Chinese medicine arrived at the same place on its own, and the research above is a modern way of saying it again. I take it seriously, because I have lived both sides of it.

    In my late 40s, I rarely get sick and my guts work great. Start with your gut.

    — Brehan Crawford, L.Ac.

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    You are not unlucky. Your terrain needs tending.

    If you are sick every month or two and tired of hearing that something is going around, come learn how to rebuild the gut your immune system depends on. Courses, condition-specific programs and weekly live Q&A, inside Gut Brain Synchrony.

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    References

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    2. Wiertsema SP, van Bergenhenegouwen J, Garssen J, Knippels LMJ. The Interplay between the Gut Microbiome and the Immune System in the Context of Infectious Diseases throughout Life and the Role of Nutrition in Optimizing Treatment Strategies. Nutrients. 2021;13(3):886. doi:10.3390/nu13030886
    3. Belkaid Y, Hand TW. Role of the microbiota in immunity and inflammation. Cell. 2014;157(1):121-141. doi:10.1016/j.cell.2014.03.011
    4. Hagan T, Cortese M, Rouphael N, et al. Antibiotics-Driven Gut Microbiome Perturbation Alters Immunity to Vaccines in Humans. Cell. 2019;178(6):1313-1328.e13. doi:10.1016/j.cell.2019.08.010
    5. Zhao Y, Dong BR, Hao Q. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Syst Rev. 2022;8(8):CD006895. doi:10.1002/14651858.CD006895.pub4
    6. Bokulich NA, Chung J, Battaglia T, et al. Antibiotics, birth mode, and diet shape microbiome maturation during early life. Sci Transl Med. 2016;8(343):343ra82. doi:10.1126/scitranslmed.aad7121
    7. Yassour M, Vatanen T, Siljander H, et al. Natural history of the infant gut microbiome and impact of antibiotic treatment on bacterial strain diversity and stability. Sci Transl Med. 2016;8(343):343ra81. doi:10.1126/scitranslmed.aad0917
    8. Aversa Z, Atkinson EJ, Schafer MJ, et al. Association of Infant Antibiotic Exposure With Childhood Health Outcomes. Mayo Clin Proc. 2021;96(1):66-77. doi:10.1016/j.mayocp.2020.07.019
    9. Duong QA, Pittet LF, Curtis N, Zimmermann P. Antibiotic exposure and adverse long-term health outcomes in children: A systematic review and meta-analysis. J Infect. 2022;85(3):213-300. doi:10.1016/j.jinf.2022.01.005
    10. Chapman TJ, Pham M, Bajorski P, Pichichero ME. Antibiotic Use and Vaccine Antibody Levels. Pediatrics. 2022;149(5). doi:10.1542/peds.2021-052061
    11. Lin TL, Fan YH, Chang YL, et al. Early-Life Antibiotic Exposure Associated With Varicella Occurrence and Breakthrough Infections: Evidence From Nationwide Pre-Vaccination and Post-Vaccination Cohorts. Front Immunol. 2022;13:848835. doi:10.3389/fimmu.2022.848835
    12. Ma J, Zheng J, Zhong N, et al. Effects of YuPingFeng granules on acute exacerbations of COPD: a randomized, placebo-controlled study. Int J Chron Obstruct Pulmon Dis. 2018;13:3107-3114. doi:10.2147/COPD.S170555
    13. Carmody RN, Bisanz JE, Bowen BP, et al. Cooking shapes the structure and function of the gut microbiome. Nat Microbiol. 2019;4(12):2052-2063. doi:10.1038/s41564-019-0569-4
    14. Wastyk HC, Fragiadakis GK, Perelman D, et al. Gut-microbiota-targeted diets modulate human immune status. Cell. 2021;184(16):4137-4153.e14. doi:10.1016/j.cell.2021.06.019
    15. Bu F, Zhang S, Duan Z, et al. A critical review on the relationship of herbal medicine, Akkermansia muciniphila, and human health. Biomed Pharmacother. 2020;128:110352. doi:10.1016/j.biopha.2020.110352
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