Today's awful overselling of the microbiome - Robynne Chutkan on libido

Well, this is just plain awful Are Antibiotics Ruining Your Libido? - The Daily Beast.  In this article, Robynne Chutkan argues that people's sex drives may be being ruined by antibiotics.  And she presents zero evidence for this other than handwaving.

Some things in this article that are inaccurate:

We’ve spent most of the last century figuring out how to eradicate our microbes, and we’re just now realizing that the vast majority are friends rather than foes that actually play a vital role in keeping us healthy.

No - the "vast majority" of microbes are not known to be our friends or to play a vital role in keeping us healthy.  Certainly, microbes and microbiomes do contribute to our health and well being.  But to say the "vast majority" are beneficial is, well, just silly.

How about this section:

Most of the patients I see suffer from manifestations of an imbalanced microbiome—a condition known as dysbiosis. Some of the signs and symptoms are localized to the GI tract, like bloating and gas; but others, including yeast infections, brain fog, fatigue, rashes, joint pain, anxiety, food cravings, allergies, and autoimmune disorders, reflect the universal role our microbes play in preventing disease

Well, based on this statement I would certainly recommend nobody see Dr. Chutkan for any of their medical treatment.  What exactly is the evidence "brain fog" is caused by dysbiosis?  Or fatigue?  Or anxiety?  Or food cravings?  (Yes, I agree that some of the other things listed have been shown to be affected by the microbiome, but each of these (e.g., allergies) is influenced by many many factors and as far as I know there are no scientific studies that show that one can look at people suffering from any of these ailments and determine if their microbiome has caused their problems or not.

And then there is the discussion of microbiomes, antibiotics and sex life:

And what’s more, a healthy, balanced microbiome is essential for a healthy, satisfying sex life.

and

But there’s another alarming, but hidden epidemic of dysbiosis that’s occurring, and it may be wreaking havoc on your sex life. It’s the common practice of taking antibiotics after intercourse to prevent urinary tract infections (UTIs).

She then goes on to discuss issues in cystitis and UTIs and infections and the vaginal microbiome.  Yes, the vaginal microbiome is important.  And yes, antibiotics and affects the vaginal microbiome, both in positive and negative ways.  So - I do think we should be concerned with overuse of antibiotics and how that affects microbiomes.  And we should be concerned with overuse in the context of UTIs.  But does that concern allow us to oversell the science?  I don't think so.  The worst part of this whole story relates to this issue:

If you’ve been using antibiotics to prevent post-coital UTIs and you’re finding that sex is less enjoyable than it should be, your vaginal microbes might be in need of some rehab. I recommend a three-pronged approach of avoidance, encouragement and repopulation

and

It may take some time before you see meaningful results, but this approach offers the possibility of real and lasting relief, rather than an antibiotic quick fix that ultimately ends up being ruinous to your sex life. 

The problem with this is that she presents no evidence that alterations int he microbiome affect libido or sex life and no evidence that her recommended solutions (e.g., probiotics and prebiotics) help with such symptoms.  So, yes, overusing antibiotics is a risk we should limit as much as possible.  But no, lets not glorify microbiomes and overcritique antibiotics by making people worry about their sex drive and sex life without evidence.  That is not helpful and could be harmful.  For this I am giving Robynne Chutkan a coveted overselling the microbiome award.

For more on this award see here.