Photo: Carol Yepes / Getty

Keep your gut health in check, even when you're under the weather. 

Jamie Vespa MS, RD
July 20, 2017

Zithromax (azithromycin) is most familiar to the public as the "Z-Pak," a convenient five-day pill regimen used to treat bacterial infections. Containing half the dose of many other popular antibiotics, patients take a "megadose" on the first day, followed by a normal dose the remaining four days.

Like all broad-spectrum antibiotics, Zithromax does not discriminate between pathogenic bacteria and healthy bacteria. Hence, when you take antibiotics to fight an infection, many of the bacteria in your gut are killed too (think of it as collateral damage). As a result, one of the more common side effects of taking a Z-pak is diarrhea, due to a disruption in your gut flora. The good news is there are ways to possibly mitigate this common side effect, and it starts with your diet.

Probiotics are live cultures that help repopulate the gut with favorable species to replace those killed by the antibiotic. To maximize the beneficial effect of probiotics, medical professionals suggest taking them at least 2 hours apart from your dosage of antibiotics. Probiotics are naturally found in foods, such as yogurt, kefir, miso, or kimchi. For individuals who either dislike probiotic-rich foods, taking daily probiotic supplements may help.

A 2013 Harvard-led study found that diet could alter the population of human gut bacteria within just one day. Try these delicious, nutritious recipes to ensure your gut stays strong and healthy on your road to recovery.

Day 1 of taking a Z-Pak:

Breakfast: Overnight Oats with Kefir, Berries, and Toasted Coconut
Kefir is a liquid yogurt that's cultured five to eight times longer than yogurt, giving good bacteria more time to multiply. It contains as many as 12 strains (versus about two in yogurt).

Lunch: Whole grain pasta tossed with grilled chicken and Dandelion Greens Pesto
Dandelion greens are a top source of prebiotics, a specific carbohydrate that feeds probiotics.

Snack: Fresh fruit with nut butter and kombucha on the side
Kombucha is a fermented beverage made by adding a culture of probiotic-rich bacteria and yeast to lightly sweetened tea. It is naturally low in calories and sugar, and ultra refreshing.

Dinner: Tempeh Reubens
Tempeh is fermented soybeans packed into cakes. Not only does tempeh have anti-inflammatory properties, but it's also a great source of plant-based protein.

Meal ideas for days 2-5 of taking Z-Pak:

Breakfast:
1. Yogurt with fresh fruit and granola
The active cultures in yogurt not only help with digestion but also help us better absorb nutrients from our food. The FDA requires at least two strains of bacteria in all yogurt (L. bulgaricus and S. thermophilus), though manufacturers can add more.

2. Sunshine Smoothie
Just one serving offers about one-third of the day's vitamin C and vitamin A, and about 10 percent potassium in a low-calorie package.

3. Toast with Greek Yogurt and Blood Orange
A tasty hit of probiotic-packed yogurt and vitamin-C loaded citrus.

4. Banana Breakfast Smoothie
Yogurt lends creamy texture and an array of gut-healthy probiotics.

Snacks:
1. Raw veggies dipped in Kimchi Yogurt Dressing
Kimchi is a spicy, fermented Korean vegetable side dish that's created by mixing cabbage and other veggies with garlic, ginger, chili peppers, and fish sauce. Try this probiotic-rich yogurt dressing on salads and sandwiches, too.

2. Orange-Banana Smoothie
Packed with vitamin C, probiotics, fiber and protein, this smoothie is a great midday pick-me-up.

3. Whole-Grain Apple Cake with Yogurt Cream
With 4 hearty grams of fiber per slice, and a silky-smooth yogurt topping, enjoy a slice of this probiotic-rich cake for breakfast or a snack.

4. Pears with Yogurt and Almond Butter
Protein, probiotics, and heart-healthy fats – what more could we ask for in an easy, 5-minute snack?

Lunch or dinner:
1. Grilled salmon salad tossed with Miso Citrus Vinaigrette
Miso is made out of fermented soybeans and is rich in probiotics. The concentrated salt content helps protect these good bacteria from contamination.

2. Miso Chicken with Brown Rice
Chicken and rice is a comfort food staple. We've amped it up with umami-rich miso to satisfy both your taste buds and gut flora.

3. Tempeh and Green Bean Stir-Fry with Peanut Sauce
A 30-minute meal with rich depth of flavor and plenty of fermented goodness.

4. Miso Soup with Tofu
What better way to utilize probiotic-packed miso than in a warming, cozy soup? Guaranteed to warm you up from the inside out and bestow healing powers.

5. Brown Rice Noodle Bowls with Tofu, Pork, and Kimchi
Warming and comforting noodle bowls rich in protein and probiotics.

Keeping your gut flora healthy influences more than just digestive health. A healthy gut plays a role in your immune system in ways that help protect you from future infection by pathogenic bacteria. Research also suggests a strong tie between gut health and mental health. Don't wait to grow your community of good gut bacteria until you're sick or taking antibiotics. Start today with these probiotic-rich recipes.