What is being “floxed”?
When we think of the side effects of antibiotics, we usually think of digestive disturbances and upset stomach. What doesn’t come to mind is tendon rupture, tendonitis, nerve damage and pain, chronic fatigue, nightmares and even hearing loss.
In April 2018 I watched my husband barely get up in the morning suffering from “burning knees”, extreme fatigue, nerve pain, and ringing in the ears.
He even got golf elbow (diagnosis from his doctor) despite not playing golf or doing repetitive action using his elbow.
Funny, this cleared up after he started recovery from the initial onset of systematic tendinitis.
In 2016, the FDA issued a black box warning on just these side effects on a class of antibiotics known as Fluoroquinolones often prescribed for urinary tract infections and upper respiratory infections.
What are Fluoroquinolones?
They are broad-spectrum antibiotics whose generic name ends in -floxin, oflxanin or -lox.
Hence the term, “floxed” or being floxed is used to refer to people who are suffering from the negative side effects of this class of antibiotics. Some people refer to this as “fluoroquinolones toxicity”.
Whereas there are many different symptoms that occur with this “toxicity”, the most frequently reported are:
- Tendon Rupture, Achilles.
- Debilitating Chronic Fatigue
- Hearing Loss, Tinnitus
- Nerve Pain
- Induction of Type 2 Diabetes
- Histamine Intolerance – Mast Cell Activation
- Gut Dysbiosis
- High Oxlalates
- Iron Toxicity
- Electrolyte Imbalance – Magnesium Deficiency
- Food Sensitivities/Intolerances
The most commonly prescribed antibiotics in this class are Levaquin (Levofloxacin), Cipro (Ciprofloxacin) and Moxifloxacin (Avelox). There are many others in this class but the key is to look for the generic name ending in -flox.
Who are the most vulnerable for these negative side effects?
It is still pretty rare to have these negative side effects but it is known that certain people are more vulnerable. Children, men over 65 years of age especially men who are athletic are more vulnerable. In addition, people who have thyroid autoimmune conditions like Graves or Hashimoto’s.
There are also genomic variants that would make someone more likely to suffer from using these antibiotics. Genomics is the science of slight variants in our genes that can impact our health.
For instance, variants in the thyroid hormone can a very big impact on how the body will respond to these antibiotics. These variants usually impact how your body metabolizes and produces thyroid hormones.
Other variants include your ability to produce the powerful antioxidant known as glutathione. Glutathione plays a major role in managing oxidative stress. Fluoroquinolone toxicity creates large amounts of oxidative stress which is the main reason for the pain and tissue damage that occurs.
How do fluoroquinolones cause these symptoms?
These broad-spectrum antibiotics are designed to destroy bacteria by damaging their DNA. This is very effective at eliminating the bacteria and making sure it does not survive. However, it has been shown that also can do the same to our DNA. Oops…
During this process, our bodies will also be releasing compounds known as reactive oxygen species (ROS). These compounds are usually converted to water and safely eliminated.
But we do not have enough antioxidants to the job, this creates what is known as oxidative stress. Oxidative stress leads to more inflammation, pain, and damage to the body.
What is oxidative stress?
What is oxidative stress? It is where the body does not have enough antioxidants to manage reactive oxygen species (ROS) leading to tissue damage. It also leads to chronic inflammation which is one of the key causes of most chronic diseases.
Vitamin A, C, E, and Zinc are powerful antioxidants that our bodies use to manage oxidative stress. But our bodies also produce antioxidants which are 100 more powerful than dietary antioxidants. This includes the king of antioxidants, glutathione.
The mitochondria are the powerhouse of our cells and flouroquiones actually change the DNA/RNA gene expression causing the production of “faulty” mitochondria. This damage mitochondrial also causes high levels of ROS leading to more oxidative stress.
This is one of the reasons why the damage and symptoms can last up to one year or more after taking the antibiotic as the body continues to produce faulty mitochondria. This can lead to chronic fatigue, tendinitis, and muscle pain.
People who have genomic variants in what is known as SOD2 will be more vulnerable to this damage greatly affecting their body's ability to produce energy. This variant is also the enzyme that protects your mitochondria from damage.
What are high oxalates and dysbiosis?
Abrupt decline in diversity causes major shifts in the microbe community composition. Research shows that it can take over 6 months for the microbiome to recover from most antibiotics. However, it takes even longer to recover a healthy gut microbiota with the use of these antibiotics.
When the diversity of microbes is reduced, it can lead to high oxalates Oxalates are anti-nutrients commonly found in plants that help to protect from insects and bacteria. One of the foods highest in oxalates is spinach and kale often touted as a superfood! It may not be a superfood for everyone.
High oxalates can eventually lead to the formation of crystals and those crystals can settle into our joints, muscles, and our kidneys. This can lead to muscle and joint pain as well as kidney stones.
The dysbiosis that occurs es wipes out the gut microbial known as oxalobacter formigenes which plays a major role in the removal of oxalates.
People who are deficient in vitamin B6 are more vulnerable to form oxalates. In addition, there are genomic variants in vitamin B6 metabolism that would make them more likely to form oxalates crystals.
The best test to test for oxalates and your microbiota is the organic acid test. Removing the oxalates requires an extensive nutritional support protocol and therapeutic diet. Simply removing high oxalate foods from your diet can lead to what is called “oxalate dumping” which can cause everything from nerve and joint pain, severe IBS, and chronic fatigue. Exactly what you are trying to overcome with being floxed.
As a functional nutritionist, I worked with many clients with high oxalates walking them through how to lower their oxalates through supplementation and dietary changes. And, I always have my client retest to make sure that they lowered their oxalate levels.
Are there drugs to helps with the symptoms?
What is the prescription or drug to turn this around? Medically there are no medications that really address these symptoms however antidepressants and pain medications are prescribed or recommended to get help with the side effects.
Why? Because common lab blood work comes back, “everything normal” therefore they can really cannot prescribe any medications.
And, the usual response beyond dealing with chronic fatigue, depression, and pain is that you “will just have to get through this”.
Physical therapy is sometimes prescribed but even physical therapists don't really know how to deal with nerve pain, muscle fatigue, and tendinitis.
Current research is showing some promise with nutritional therapy – nutrition and targeted supplementation. Everyone is different in their response, as this is a complex condition with many different variables.
How you can get started on your road to recovery from being floxed?
Getting started on your healing journey can be a challenge, as being floxed affects everyone differently. Because of this, integrative and genomic testing is a significant first step in helping to develop a personalized plan that will you speed up your recovery.
Whereas most integrative testing is not covered by insurance and is an investment, it will, in the long run, save you money and make your recovery much quicker. That is why I include integrative testing in my Floxie Solutions packages.
Along with integrative testing like organic acid testing, you will receive laser-focused recommendations and get on the right food plan for you. There is no one size fit all dietary food plan that works as the impact of being floxed affects everyone differently.
Learn more about my Floxie Solutions Packages or book a Discovery Chat appointment to learn more.
- Antimicrobial Use, Human Gut Microbiota & Clostridium difficile Colonization and Infection
- Understanding Sulfation and Oxalate – MTHFR Support
- Diminished Ciprofloxacin-Induced Chondrotoxicity by Supplementation with Magnesium and Vitamin E in Immature Rats
- Treatment of the Fluroquinolone-Associated Disability: The Pathobiochemical Implications
Eileen Schutte, MS, CN, FMN – One of my biggest passions is to help clients overcome food intolerances like histamine intolerance and sensitivities so that they can enjoy food again. My other passion is nutrigenomics, speaking to your genes through nutrition with focus on digestive health, autoimmune conditions, and skin health. I hold a master's degree in functional nutrition from the University of Bridgeport, Connecticut graduating Summa Cum Laude. After completing my masters I went on to get my certification in Functional Medicine Nutrition, and am a Certified LEAP Therapist (food sensitivities program). In addition, I am pursuing advanced education in Nutrigenomics through the American College of Nutrition.