He’s a physician, mathematician, and researcher in the field of antibiotics and tropical medicine. On many occasions he has treated many high-ranking world leaders. Professor Wolfgang Graninger is well known in specialist circles for his marvellous university lectures. However, most Austrians know him for his sometimes rather sharp public critique when a development displeases him. Mag. Anita Frauwallner interviews the internationally renowned infectiologist.
Anita Frauwallner: What connects the two of us is our shared passion for research. Our company is currently working on 25 different studies which aim to find new fields of application for probiotics. During the course of your life you have conducted ground-breaking studies concerning antibiotics – the exact opposite of what we’re working on. What is your stance on the development of probiotic medicine?
Wolfgang Graninger: The first probiotics consisted of only one strain, e.g. Enterococcus faecium or Escherichia coli. But even if great amounts of this one germ type are given, how should one strain replace hundreds of different useful gut bacteria? Acceleration and braking reactions are constantly taking place in the gut, similar to a nuclear reactor. This is the only explanation for the exceptional bacterial diversity one finds in the gut. When it comes to antibiotic associated colitis, caused by Clostridium difficile, one pathogenic germ manages to gain the upper hand and drives out the rest. This causes injury to the gut followed by a total failure of the gut’s natural regulation mechanisms. Finally, this results in a “total meltdown” inside the gut. That’s why I have always said: an appropriate probiotic should always contain several different strains – 5, 10 or in the future maybe even 50 different species. These would be capable of repopulating the gut and would so create a normal gut flora. How could one germ do that all by itself? I disapprove greatly of such preparations! It’s also important in which way the probiotics are administered to make sure that their capabilities can fully develop in the gut. I don’t generally reject probiotics, it’s just that I have high demands.
Anita Frauwallner: When it comes to that, we definitely see eye to eye. The highest possible quality is barely good enough when it comes to our health. You have done lots of research overseas and in the field of tropical medicine. That’s why I’m sure that many of your patients ask you for advice when it comes to what they should watch out for when travelling abroad. What should one be wary of, especially now, when many are fleeing the cold and taking a vacation in exotic countries.
Wolfgang Graninger: Make sure you only eat food that is steaming hot. Oftentimes the food there isn’t quite fresh, that’s why germs must be killed with an adequate amount of heat. This also applies to drinks, which is why drinking tea or beer is advisable. Nowadays good protection against insect bites is widely available. There are mosquito nets, insect repellents or even substances that can be applied to the skin which keep the insects away. However, when outdoors the most important protection is clothing. Always make sure to wear clothes which cover arms and legs. Even the colour of the clothes is significant: Khaki for example is the colour which diurnal insects don’t like. Whereas grey and black clothes are a definite no-go. The main host of the tsetse fly is the gnu, and they are dark grey!
An appropriate probiotic should definitely contain several different strains – 5, 10 or in the future maybe even 50 different species.
Anita Frauwallner: Oftentimes, physicians will advise their patients to take antibiotics preventatively during trips abroad, as protection against pathogenic germs. What’s your take on this?
Wolfgang Graninger: I disagree with that completely. The prophylactic intake of antibiotics is pointless when it comes to travel diarrhoea. In this case the intake of probiotics would by far more appropriate.
Anita Frauwallner: I’m very happy to hear that! You are an antibiotics-specialist, and despite this you take a critical stance concerning the prescription of antibiotics. For which reasons did you develop this opinion? In your opinion, under which circumstances would the application of antibiotics be appropriate?
Wolfgang Graninger: Of course, antibiotics can be appropriate; but only when one knows exactly what one is using them for. When it comes to flu-like diseases or urinary tract infections antibiotics are often given before one really knows which germ is responsible for the complaints. Over the years, this has made many pathogenic germs resistant to antibiotics. This leads to a massive increase in health care costs. When it comes to infectious gut diseases, diarrhoea, and infections in general, antibiotics are still considered a cure-all remedy, when in reality they aren’t. What really has potential to cure everything is a physician who really listens to their patient. Let’s look at it from another perspective: all physicians have sworn the Hippocratic Oath. But Hippocrates didn’t have any clinical diagnostic devices or laboratories; he only had several questions: Where are you from? What did you eat? What did you drink? Did others do the same?
The prophylactic intake of antibiotics is pointless when it comes to travel diarrhoea. In this case the intake of probiotics would by far more appropriate.
Anita Frauwallner:So, did I understand that correctly? It’s important to thoroughly examine one’s patients and to not automatically prescribe antibiotics. Instead, one should only use them for specific indications! Especially during the approaching flu season, many parents will come to you for help because their child has a fever. And most likely, mainly out of habit, they will insist on an antibiotic. What would your answer be in such an instance?
Wolfgang Graninger: First I would interview the parents to assess whether a different pathogen might be causing the fever. If it turns out that it’s most likely a viral infection, I will proceed by explaining to the mother that her child doesn’t need antibiotics; no matter how long it takes to convince her. I would argue that in this case it would even be harmful to give antibiotics. Otherwise I would have yet another patient with a damaged microbiome on my hands. Regenerating the microbiome of Patients who regularly take antibiotics is a truly cumbersome process. By using stool analysis data from a massive number of patients, Martin Blaser (the head of the Human Microbiome Project) has analysed what happens to the gut if someone takes antibiotics as little twice a year. In just a few years the gut flora is reduced from roughly 500 bacterial strains to only 250. As an 80 year old, one only has few bacterial strains left in one’s gut flora. It goes without saying that at this point the gut is in dire need of some support.
Anita Frauwallner:We are facing the problem that, due to modern therapy methods, the gut flora is becoming increasingly rarefied! If it’s possible to fight the pathogenic bacteria with an armada of useful ones, then that’s an approach with real potential! And we have proved just that in one of our recent studies. The administration of a probiotic led to an alteration of the gut environment, which in turn allowed many useful bacteria to colonise and drive out the pathogenic bacteria. Of course, we find this highly exciting. But it means far more to us that in our last study with OMNI-BIOTIC® HETOX, we were even able to drastically improve liver function. As an infectiologist, I’m sure you have come into contact with a great deal of liver cirrhosis patients over the years. What are your thoughts on this new therapy option?
Wolfgang Graninger:The liver is a real power plant. It has the capability to constantly process and detoxify everything that is absorbed via the gut. The normal gut flora modifies everything that reaches the liver via the gut. This means that a healthy gut flora can relieve the burden on the liver far more effectively than a damaged one can. We know that patients who are suffering from hepatic coma no longer have an intact gut flora. In such cases I am confident that a probiotic can improve the situation.fectively than a damaged one can.
*Professor Graninger is one of the world’s leading infectiologists and an emeritus professor at the Medical University of Vienna. He was the head of the clinical department for infectious diseases and tropical medicine at the AKH Vienna. At the moment, he is the director of the department for infectious diseases at the Karl Ladensteiner Institute.