• At least 1.27 million deaths per year are directly attributable to AMR (Antimicrobial Resistance), according to global AMR estimates released earlier this year by IHME (Institute of Health Metrics and Evaluation) and Global Research on Antimicrobial Resistance (GRAM) Project partners.
   
• The deadliest pathogen-drug combination globally was methicillin-resistant Staphylococcus aureus (MRSA), which caused more than 100,000 deaths attributable to AMR in 2019.
   
• MRSA can infect cuts or scrapes in the skin and then be passed through skin-to-skin contact or through items such as towels or clothing that have touched the infected skin.

There are several pathways converging on Anti-Microbial Resistance.

• Misuse and Overuse of antibiotics in raising meat, farmed fish, dairy, poultry and eggs
• Excessive use of antibiotics in Medicine
• Lack of clean water and sanitation in many poor countries
• Poor infection and disease prevention and control in health-care facilities and farms
• Poor access to quality, affordable medicines and vaccines
• Lack of awareness and knowledge

Emerging resistant strains include sexually transmitted infections (gonorrhea, syphilis, chlamydia), MRSA, tuberculosis, several bacteria that cause pneumonia, urinary tract infections and food poisoning.

Viral infections are also demonstrating antibiotic resistance including HIV (10% of cases in the majority of monitored countries in Africa, Asia and Latin America).

Malaria is also developing drug resistance and as global warming pushes this disease further north, soon greater parts of USA will be experiencing this mosquito vectored disease.

Drug resistant fungal infections (especially Candida which represents a major threat to immunocompromised individuals, especially in the hospital setting) are becoming widespread.

Antibiotic resistance in animal husbandry presents unique challenges.

Antibiotic resistance is of great public health concern because the antibiotic-resistant bacteria associated with the animals may be pathogenic to humans, easily transmitted to humans via food chains, and widely disseminated in the environment via animal wastes. These may cause complicated, untreatable, and prolonged infections in humans, leading to higher healthcare cost and sometimes death.

One of the problems with the RWA designation (Raised Without Antibiotics) is that it does not distinguish between overuse (used for prevention, growth and output) and use to treat infections. There should be a category of RWA that indicates that antibiotics are used only to treat illness in animals, not to prevent infections or foster growth.

RWA programs are intended to supply customers, such as restaurants, grocers and other food service establishments, with meat, eggs, and dairy products that can be labeled as having never had exposure to antibiotics.

Research in animal husbandry has demonstrated that pork, beef, chicken, dairy, and eggs raised without preventive antibiotics following simple sanitary protocols can decrease total cost in the long run. (Taking into account costs of antimicrobial resistance) Yet farmers continue to utilize antibiotics routinely to prevent rather than treat infections, due to habit, marketing (pharmaceutical industry) and fear of change.

This raises the issue of free-range economics vs raising animals in crowded environments. Regenerative agricultural practice incorporates free-range animal husbandry into crop management in a manner that utilizes animal waste for fertilizer instead of fossil-based nitrogen sources (reducing carbon foot print and creating rather than destroying soil), and eliminates crowded conditions, decreasing risk of infection. In addition there are many other potential approaches to help solve the problem of AMR.

Phytochemicals added to chicken feed represents a possible alternative to antibiotics to control antibiotic resistance in poultry.

Altering simple practices in the dairy industry (changing the rate at which a slurry tank is emptied) can delay the proliferation of multidrug-resistant bacteria.

There are many potential approaches to animal husbandry that can mitigate the growing problem of AMR.

The use of antibiotics to enhance profitability margins in the animal production industry is still practiced worldwide. Although many technical and economic reasons gave rise to these practices, the continued emergence of antimicrobial resistant bacteria is furthering the need to reduce the use of medically important antibiotics. This will require improving on-farm management and biosecurity practices, and the development of effective antibiotic alternatives that will reduce the dependence on antibiotics within the animal industry in the foreseeable future. A number of approaches are being closely scrutinized and optimized to achieve this goal, including the development of promising antibiotic alternatives to control bacterial virulence through quorum-sensing disruption, the use of synthetic polymers and nanoparticles, the exploitation of recombinant enzymes/proteins (such as glucose oxidases, alkaline phosphatases and proteases), and the use of phytochemicals.

Studies investigating various alternatives to antibiotics use in livestock show promising results. These alternatives include the application of bacteriophages and phage derived peptidoglycan degrading enzymes, engineered peptides, egg yolk antibodies, probiotics, prebiotics and synbiotics, as well as quorum quenching molecules

Simple sanitation techniques in raising poultry can achieve benefit without the use of prophylactic antibiotics.

Keeping strict biosecurity in segregation, traffic control, cleaning, and disinfection, helps prevent a large proportion of harmful bacteria and viruses from entering poultry barns (Segal, 2013). Apart from good management practices, there are many alternative approaches proposed and explored by researchers worldwide to overcome bacterial infections in birds.

Likewise, eliminating antibiotics from pig feed does not reduce growth measured at the end of finisher stage, and eliminates the cost of antibiotics in the feed.

At the consumer level, purchase animal products raised without prophylactic antibiotics. This will protect your family and send a message to the marketplace. The more we demand food raised without preventive antibiotics, the more producers will be forced to change old-unsafe habits.

Buying meat, poultry, dairy and eggs from local farmers that do not utilize preventive antibiotic usage and practice regenerative agriculture, is a great way to shift the marketplace towards a safer and more sustainable food system that improves health and safety while addressing loss of soil and carbon footprint.

If you prefer watching documentaries there are several that address issues related to regenerative agriculture. Here are a few:

https://www.thepollinators.net/

https://www.biggestlittlefarmmovie.com/

https://www.bbc.com/future/bespoke/follow-the-food/

https://www.sacredcow.info/about-the-film

In the context of the COVID 19 pandemic I will close with the usual summary.

1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
2. Get plenty of sleep (without adequate sleep your immune system does not work well )
3. Follow good sleep habits
4. Exercise, especially out of doors in a green space, supports the immune system
5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml, >40ng/ml arguably better.
6. Eat an anti-inflammatory diet rich in micronutrients.
7. Practice stress reduction like meditation and yoga which improves the immune system
8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
11. Drink water filtered through a high quality system that eliminates most environmental toxins. (Such as a Berkey or reverse osmosis filter)
12. HEPA filters or the home-made version (Corsi-Rosenthal box) used in your home or workplace can reduce circulating viral load by 80%. This works for any respiratory virus transmitted by aerosol and this winter we have the triple threat of RSV, Influenza, and SARS-CoV-2. It also decreases indoor air pollution.
13. If you are eligible for vaccination, consider protecting yourself and your neighbor with a few jabs. Age > 50 and/or risk factors (Diabetes, pre-diabetes, insulin resistance, hypertension, obesity, heart disease, COPD, asthma, cancer treatment, immune suppression) suggests benefit from a booster. Risk for complications of boosters in adolescents, especially males, without risk factors, may equal benefit. Previous infection with Covid can be considered as protective as a booster. Discuss risk vs benefits with your doctor.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob