Hacker Newsnew | past | comments | ask | show | jobs | submitlogin
Surfers three times more likely to have antibiotic-resistant bacteria in guts (eurekalert.org)
238 points by fern12 on Jan 21, 2018 | hide | past | favorite | 84 comments


No coastal surf break that's close to civilization is safe from bacteria infestation but it is manageable.

BUT sewage regulation can go a long, long way - take a look at the San Diego bacteria report http://www.sdbeachinfo.com - the regularly sampled coastal water is in general pretty good even though there was rain in SoCal last week.

Meanwhile less than 30 miles away the surf breaks next to Tijuana, Mexico are extremely high bacteria - that's about par for the course - really sad to see:

http://www.sandiegouniontribune.com/news/environment/sd-me-t...

https://www.youtube.com/watch?v=WEyeCm0GVKg


That sewage is gross but the waves that break right near the outflow look ass kicking https://youtu.be/gcMqr_vbInI


Imperial Beach is supposed to have one of the best beach breaks in San Diego county besides Black’s, but even the mayor got sick from surfing it. Major bummer.

http://www.sandiegouniontribune.com/news/environment/sd-me-t...


> even the mayor got sick from surfing it. Major bummer.

You'd think those damn bugs would know better than to get the mayor.


Bodysurfing Imperial Beach on a big day is some of the most fun you can have in San Diego, if you're into that sort of thing.


Unfortunately, I do not need to see a study to know that the waters near Lima (Where I live & surf) are full of crap.. That said, the healthy effects of the exercising on the sea must counteract the bacteria, because I don't know a healthier group than the surfing community around here.


> The healthy effects of the exercising on the sea must counteract the bacteria, because I don't know a healthier group than the surfing community around here.

You're making a conclusion about cause and effect. It might be the case that the majority of people who take up surfing are extremely healthy since it's a physically demanding sport.


Exactly, the only people who’d continue surfing would be the ones whose immune systems could cope with the shock. If you kept getting sick after surfing you’d probably quit pretty quickly.


It's not that physically demanding. I've seen 3-4 year olds in Hawaii do it. Like in any sport, it depends on how far you want to push yourself.


I've seen kids run, doesn't mean it's not physical demanding to run.


It's not, if you don't want it to be. Old grandmas run.


Are you saying surfers don't in general take surfing to physically demanding limits? If not, then I'm not sure what your point is. That you could dial it down if you wanted to even though surfers don't, but they could if they wanted to?


Physical demand on the body is relative to the person. Kids paddling into small waves is much more demanding for them than for an adult. Same for grandmas.


Yes, they do 20cm white water waves, which is very easy. Difficulty increases by 5 if you go to the 2 m green water waves, where it usually takes you 10-20 mins of constant paddling through 2 m waves until you're behind the break.


> because I don't know a healthier group than the surfing community around here

Most of the serfers I know are just generally active people, they were like it long before becoming serfers, most did not become healthy because they are serfers, instead they become serfers because they like active healthy lifestyle.



To be fair, managing serfs is probably quite physically demanding also.


Surely people who do the same amount of exercise as surfers but in the absence of harmful bacteria are even better off?


The ones who get really sick silently disappear from the surfing community.


That said, the healthy effects of the exercising on the sea must counteract the bacteria

That was my initial thought as well, basically.

Cystic fibrosis is a deadly genetic disorder that makes one vulnerable to infection. Last I checked, the life expectancy was about 37 in the US, though someone on HN recently said it is now age 40.

People with CF who surfed had such a better prognosis than average that it led to development of a non drug treatment where they inhale nebulized saline solution as a treatment.

I think a better solution is just consume good quality sea salt. That's what I did to good effect. But everyone tells me that's anecdotal, whereas the existence of hypertonic saline solution as a medically prescribed treatment for my deadly condition is sciency or something. (There is probably a better way to say that, but I can't think of it at the moment.)


>But everyone tells me that's anecdotal

Most people have NO idea/sympathy for what its really like to have a disease/condition that medicine doesn't totally understand yet.. including doctors.

The bar for a certain treatment to be scientifically accepted is rightly pretty high - studies/research etc. that takes decades to do.

But as a patient, when medicine has no real treatments to offer you, of course our own bar should be lower! Even if sea salt hasn't been studied in a million people with double-blind placebo-controlled blah-blah studies, this kind of experiment has zero downside and potentially a very high upside - you would have to be crazy not to try it.

Anyways, just want to offer my sympathy and ranting as someone with a rare and ill-understood disease. Tim Ferriss and the whole "bio-hacking" movement also have this idea of "you are an N of 1" - we don't need permission to do basic experiments on ourselves. And for many millions of people for whom medicine has no answers, this really is the best we have.

Please keep talking about what works and what doesn't work for you regardless of haters - anecdotes can help others and the right anecdotes will someday become experiments, which will one day become well-accepted "science". Maybe in a 100 years medicine will recommend sea salt for CF, it will be just as effective then as it is now, and all that will have changed is it will have the "REAL SCIENCE TM" stamp of approval.


I appreciate the vote of support and sympathy, but I will note that I was just trying to agree with someone else's thought that surfing must do things that are generally beneficial. I think the established fact that it is known to improve the prognosis of people with CF, who are particularly prone to developing antibiotic resistant infections, is pretty strong evidence that this thought has merit.

As is often the case, the point I was trying to make has been completely ignored while multiple people jump on the personal angle of whether or not I actually know something medically useful and most comments are coming from an assumption of no, she can't possibly know anything medically useful, she is merely crazy. This is always a personally frustrating experience for me.

I'm human. I slept 14 hours last night and I am still tired and it is aggravating that the entire world wants me to either scientifically prove my personal opinions about my firsthand experience or be condemned to never, ever mention them at all. Sheesh.

So it might be time for me to just step away from this derail of a discussion because a. It is off topic and b. Most of it is openly and unnecessarily hostile and dismissive.

I'm not trying to prove anything here. I'm just human and don't always know how to separate my firsthand experience of life from some point I am trying to make and for whatever reason the world at large is often excessively interested in talking about that personal piece, whether the topic is my health or something else. And it is frequently a very negative experience for me.

TLDR: Thanks, but that wasn't the point and if I step away from this discussion it is not an admission that other people are right and I am wrong. It is just evidence that this discussion is off topic, not a positive experience for me and I don't feel like continuing it.


I would not just assume that sea salt has zero downside: http://www.pbl.nl/sites/default/files/cms/publicaties/650010...

"In the Netherlands a considerable part of PM10 is of natural origin. On a yearly average basis we have quite a large contribution of sea salt: 4 - 7 μg/m3. ... It would be wrong to conclude that this natural contribution does not have any associat- ed health effects. "


...because patients with CF have hypotonic secretions in the lungs, resulting in mucous plugging, and the inhalation of a hypertonic solution into the same space would cause a fluid shift that would dilute the aforementioned mucous... which is to say, it’s an empirically-verified intervention with a solid grounding in the underlying pathophysiology. Whereas just eating sea salt has absolutely nothing to do with any of that.

Which is to say, it’s anecdotal -and- not grounded in an underlying reasoning that makes sense in the context of the disease.


It is a mental model that assumes that CF is something in the lungs. This is not true. It is throughout the body, but especially impacts epidermal tissue, which includes both lung tissue and skin. Surfers are not just inhaling salty sea air. They are immersed in salt water and absorbing it through their skin. Plus people with CF are medically prescribed a high salt diet, so your assertion isn't really accurate. Consuming enough salt is a known treatment modality for CF. The only real difference here is that I felt the quality of salt mattered greatly. Furthermore, mucus is mostly salt and water, which is why you need to consume more of both when taking things like mucinex.


It’s not a mental model that CF is something in the lungs; it’s a treatment aimed at the pulmonary manifestations of the disease. No one is positing that saline inhalations are going to preserve pancreatic function, but that’s not because they forgot about the pancreas.

People with CF get a high salt diet because the same transporter defect causes an inability to reclaim sodium from sweat. This results in an inability to regulate water content, causing a hypovolemia. It’s not a “treatment modality” in that it directly treats the CF. It mitigates one consequence of CF: losing excess salt in sweat. That has nothing to do with dietary salt intake affecting the course of the disease generally.

And I don’t know where you got the information that surfers are absorbing salt through their skin. As far as I know (https://www.sciencedirect.com/science/article/pii/0167273892..., https://ac.els-cdn.com/S0022202X15470599/1-s2.0-S0022202X154..., http://www.comprehensivephysiology.com/WileyCDA/CompPhysArti...) that’s not a thing, but if you have any sources to the contrary I’d be interested in reading them.


What can be absorbed through the skin depends on various factors: https://en.m.wikipedia.org/wiki/Absorption_(skin)

People with CF are prone to aquagenic wrinkling. In layman's terms, they get extremely pruney when they bath. This suggests they absorb the water at a higher rate than is normal due to their genetic disorder impacting epidermal function.

https://jamanetwork.com/journals/jamadermatology/fullarticle...

No one is positing that saline inhalations are going to preserve pancreatic function, but that’s not because they forgot about the pancreas.

What I recall reading is that when people with CF surfed, their general prognosis was overall better. So if no one is positing that it has any impact on pancreatic function, then it seems to me they are viewing the data in highly selective terms and assuming it only impacts lung function and nothing else when the data does not suggest that.

Granted, I haven't dug deeply into the original data because it wasn't important to me. I was only trying to understand the positive results I was getting for my own edification. My recollection is the study was done in Australia if you want to try to find it.

I will add that it isn't actually necessary to prove people with CF absorb it through the skin. The article we are discussing states that surfers swallow a great deal more sea water than swimmers, 10x iirc. So surfers are, in fact, consuming sea salt.


> What I recall reading is that when people with CF surfed, their general prognosis was overall better.

Why would you think of sea salt as the relevant factor instead of the very well known positive effects on breathing and lung capacity caused by swimming?


Firsthand personal experience. I was consuming sea salt to great benefit and looking for studies that might cast light on the relationship between sea salt and cystic fibrosis.

Exercise also has played a significant role in my improvement. I am not discounting the impact it has. I just am baffled that they found that surfing benefits people with CF and their primary takeaway is that it must be beneficial to breath damp, salty air. There is a lot more going on when you surf than breathing damp, salty air. But that's the piece they turned into a medically prescribed treatment.


Exercise in conditions that involved inhalation of hypertonic saline during a period of increased tidal respiration, in a setting that reduces the amount of sweating typically experienced during exercise.

It’s not baffling.


>Quality of salt

It's not on its face impossible for sea and rock salt to differ in trace minerals, but be aware that the salt itself is the same in both. From the medical stuff you mentioned it sounds like it's the salt itself that's having the beneficial effect and not the other minerals.

Although, I do see an oft-overlooked wrinkle to it: the costs of these minor changes are so small that the odds that there might be something going on unknown to medicine might be worth taking.


I think the other trace minerals matter. But I also think simply consuming kosher or canning and pickling salt is better than consuming standard table salt.

Standard table salt typically has iodine added. It also has a chemical added to make it pour easier. This may not have a notable impact on a healthy person, but if you genetically misprocess various things and are medically prescribed a high amount of salt, that double whammy seems significant to me. You are consuming a lot of these extra chemicals and no one is questioning what that does to an already wonky physiology.

I no longer purchase Celtic Sea Salt. It is no longer necessary. But I still avoid standard table salt and favor brands that list sea salt as an ingredient.


Adding iodine has generally been a huge success.

Wikipedia: "Worldwide, iodine deficiency affects about two billion people and is the leading preventable cause of intellectual and developmental disabilities."

Wikipedia also lists sources for this claim.

Edit: if anybodys doctor told them to be careful with iodine then they should listen to their doctor instead of listening to random strangers on the internet. I'm just pointing out that there is good reasons why we started adding iodine to salt.


I am not talking about the general case. I am talking about two things: 1. The impact on me in specific, and I personally do not tolerate iodine well and 2. The impact on people with CF, who are told by their doctors to consume a high salt diet and there is zero commentary on the quality of the salt or the additives in it.

As far as I know, there are no studies on how consuming those additives in high quantities impacts this population with a genetic disorder that causes them to misprocess a number of different things.


Counterpoint: here in Hawaii, my friends and coworkers who surf are some of the most frequently bacteria infested people: frequent nose and ear infections, plus occasional staff infections.

These infections are usually confirmed by doctors for the people in their 50s or older, but us younger people are frequently under the weather from what I might now guess is bacterial infections.


*staph infection


I'm also living in Lima, learning to surf and bodyboard, and was getting pretty excited about it.

Two weeks ago the water was dark brown. Point taken, but... shrug? Like you said, seems like the merits of the exercise outweigh the downsides.


They're physically fit, but if those resistant bacteria end up in a part of their body other than their gut it will be a lot harder to remove. They could be more likely to die in those cases.


Yea same. Anecdotal but my surfer friends and I are seemingly never sick but other people I interact with are sick more often.


It seems possible that exposure to bacteria in the water in small doses builds the bodies immune system to deal with those making subsequent problems less likely.


When I was a little boy in New York City in the 1940s, we swam in the Hudson River and it was filled with raw sewage okay? We swam in raw sewage! You know... to cool off! And at that time, the big fear was polio; thousands of kids died from polio every year but you know something? In my neighbourhood, no one ever got polio! No one! Ever! You know why? Cause we swam in raw sewage! It strengthened our immune systems! The polio never had a prayer; we were tempered in raw shit! -- George Carlin


Like a multi-source fecal transplant, but without the rigid screening before donation.


Its crazy. I surf at a spot next to a sewage outflow known to be dirty after rainstorms and have never gotten sick, even though I definitely swallow tons of water from there. There are probably other negative effects I dont realize are happening to my body though im sure.


"The Beach Bums study asked 300 people, half of whom regularly surf the UK's coastline, to take rectal swabs" Good double meaning there.


I always remember when I first started surfing at the age of 10 in the North Sea. I was always sick and off from school with stomach bugs.

My anecdote is hardly scientific proof but this article certainly supports my thinking that I've now got a stronger stomach than most due to surfing at such a young age in terrible water conditions.

Over a period of a few years it just stopped and I was never ill again (after a surf)...apart from the dreaded and incredibly painful ear infections.



For me, the most surprising bit was in the Conflicts of interest section:

"Professor Hawkey [from the Institution of Microbiology and Infection, University of Birmingham] reports grants and personal fees from Eumedica, grants and personal fees from Pfizer, personal fees from Merck, personal fees from Novartis, personal fees from Magus Communications, personal fees from Bio Merieux, personal fees from Wyth, from Becton Dickinson, personal fees from Novacta, personal fees from Novolytics, outside the submitted work."

Wow, I'm in the wrong business. /s


Amazing that doctors can get away with NOT disclosing any of that information when prescribing any medicine to patients. I would certainly want to know what they get from X when they prescribe a certain drug with other alternatives around.


I agree, but at least the data is out there.

> The Open Payments Search Tool is used to search payments made by drug and medical device companies to physicians and teaching hospitals.

> A federal government website managed by the Centers for Medicare & Medicaid Services

https://openpaymentsdata.cms.gov/


> I agree, but at least the data is out there.

Not in every country...


As I understand it, they don't get paid for prescribing stuff. Rather, they get paid for persuading other physicians to prescribe stuff. Through speaking fees, payments for putting their name on favorable publications, and so on.


In Brazil they are forbidden by regulation to take money directly for prescribing stuff but pharmaceutical companies are allowed to sponsor their trip for a medical conference in Hawai and other subtle bribery. How they know who deserves that? There are companies devoted to gather this kind of information - source: used to be IT manager for a pharmaceutical company.


> As I understand it, they don't get paid for prescribing stuff.

Yes, this kind of practice has now been outlawed in many developed countries, but there are tons of indirect ways a doctor can get "favors" from a company. Free lunches, invitation to seminars, scholarships, speaking fees as you mention (which can be pretty, pretty generous), publications, reviews, advisory boards, etc...

So, let's not be naive. Patients should be aware of all this kind of things because they can clearly influence doctors in their choice of drugs.


Somewhat interesting: My sister is a PA and she said the ethics at the clinics she's worked at at forbid you from taking the lunch offers. Apparently those sort of ethics are more and more common.

So instead they invite you out to expensive dinners which is of course during off hours.


And free lunch from drug reps


I couldn't really figure this out from the article: What's the link between antibiotic-resistant bacteria, and manure run-off/sewage? It's obvious that there'd be more bacteria, but what's the deal specifically with them being antibiotic-resistant?


Antibiotics are heavily abused to help the survival of farm animals that are kept in really bad conditions. One horror story from big farms around here where I live is that in summer they spray cows with water to cool them in overcrowded boxes that they're kept in. But problem is that those cows are then left all wet and will often catch a cold and develop a pneumonia if untreated, so farmers give them antibiotics regularly to prevent this. I know this for cattle farms first-hand, but I've heard that pig farms are even worse offenders.


My understanding is that the primary use of antibiotics in farm animals is for more rapid animal growth, not to prevent visible symptoms of infection. (It's not clear why antibiotics promote growth, but it's possible they are suppressing minor asymptomatic infections that sap calories.)

In any case, the article is slightly misleading since the overlap between important human antibiotics and the widely used animal antibiotics is modest.

http://animalantibiotics.org/antibiotics-used-farm-animals/


> the overlap between important human antibiotics and the widely used animal antibiotics is modest.

The overlap may be modest, but the evidence clearly indicates that the resistances as a result of them do impact important human antibiotics:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194830/

> Increased virginiamycin use in Danish broilers during the mid-1990s correlated with a rise in resistant E. faecium prevalence, from 27% to ∼70% (7). Following the ban, resistance declined to 34% in 2000. Likewise, in Denmark, the 1998 ban on the use of tylosin in swine resulted in a decline in erythromycin (a structurally related macrolide) resistance, from 66% to 30%

> The finding of bacterial cross-resistance between NTAs used in food animals and human drugs was aptly demonstrated with avoparcin (an AGP) and its close relative vancomycin (an important human therapeutic) when vancomycin-resistant enterococci (VRE) emerged as a serious human pathogen. A connecting link between resistance in animals and humans was revealed when Bates et al. found avoparcin- and vancomycin-coresistant enterococci in pigs and small animals from two separate farms. Ribotyping methods showed that some of the patterns from farms and sewage exactly matched those of Enterococcus spp. from the hospital (24). The structures of the two drugs are similar: they are both members of the glycopeptide family


a lot of people are going to blindly say 'antibiotics used on animals'. that's probably not the case. the ocean has a high salinity as we all know. The same mechanisms that bacteria evolve to deal with that make it ideal for fighting against antibiotics.


I was wondering "isn't the salt water anti-biotic?"


Probably something to do with the fact that cattle are given loads of antibiotics, and are therefore more likely to host resistant bacteria.


I wonder what the p value is. 9% vs 3% in a sample of 300 doesn’t sound that compelling.


Yeah, it would be interesting to do the same study in California and see if the percentage was higher or lower, they could even break it down by closest major city, San Diego, Los Angeles, San Francisco, etc.


I couldn’t find 9 vs 3 in any of their published papers. Their most recent has 6 v 1.5 (p of .04) from a review of existing epi data, and not an original collection (https://www.sciencedirect.com/science/article/pii/S016041201...)


Exactly my thinking. It's 0.0256 using a chi-squared test, which is definitely below the standard threshold.



Totally worth it.

Just your periodic reminder that Surfing is one of the most fun things that a person can do on this planet, as evidenced by the fact that so many people have essentially dropped out of society and dedicated their lives to doing it every day.

If you live in a place near the water such as, say, the San Francisco Bay Area, and you have never tried surfing, you owe it to yourself to head down to Santa Cruz this weekend and give it a try.

Minor warning, though, you'll likely end up wearing your own personal groove into that highway over the next several years as you find excuses to sneak in a quick one every single morning once you get hooked.


Tried surfing last summer when I was at Bali. It was one of the best experiences of my life. In the next few days I also started scuba diving which I like even more.

It's a shame I currently live in a landlocked country.


some even go on heists to fund their surfing habit, I saw a documentary about it once.


Point Break was a documentary?? I'll be damned...


LOL. Made my morning. Thank you.


at least you got it :)


If instead you're near the mountains you can get into climbing (or even if you have a climbing gym nearby). Also highly addictive.


Climbing is a different type of addiction. In the mountains, I'd think that paragliding or snowboarding are better alternatives to surfing.


Good point actually. I even like to ski in winter. I'm just addicted to climbing so I didn't even think of snow-surfing.


>>as evidenced by the fact that so many people have essentially dropped out of society and dedicated their lives to doing it every day.

Sorry what? I hear people who do hard drugs that ruin their lives do the same thing. You know, drop out of society and dedicate their entire life doing it.


Drugs are also some of the most fun things that a person can do on this planet


Remember that terrible career advice they used to give saying "do what you love"?

Well, I always interpreted that as "arrange your life so that you can do what you love as often as possible", so I program computers for a living. It has the perfect combination of paying you four times as much as anything else for each hour you put in, and letting you hop from short term gig to short term gig. That gives you lots of free time that you can spend doing what you love.

Including, for instance, dedicating your life to climbing rocks and surfing.

I'm sure you could also dedicate your life to sitting in your mom's basement or on the beach in Belize smoking weed, for much less. But that's not what we're discussing here.

The reason I mentioned Surfing above is that, until you try it, you might not realize that you want to re-structure your lifestyle to prioritize it over, say, contriving to lease the flashiest car your bank will give you credit for. Most people are doing that second thing most of the time. And lots of them could benefit from a bit of real fun in their lives.


If the surfers are swallowing that much water why aren't more of them carries? Is it possible some of them for some reason have a natural "immunity"?

Also, it's at least possible (in theory) it's not the water at all. What if, just an example, many of them have the same weed dealer? Perhaps not the ideal example. But life is complex and surfing might not be THE common tread for this situation.

Or what if they ate ice cream? (Note: I know the difference between bacteria and virus. The link is simply to suggest the possibility of some other "trigger.")

https://arstechnica.com/science/2018/01/the-curious-case-of-...


Then I had better stop surfing Hacker News ;)


I bet open water swimmers have more - i remember doing open water and you always took a few mouthfuls of water by mistake during swims


Anybody checked the original study? Having a group that fights against sewage pollution in the interest of surfers recruit the surfers sounds.. sketchy at least.


I wonder how many of them cook for themselves and buy only organic meat.




Guidelines | FAQ | Lists | API | Security | Legal | Apply to YC | Contact

Search: