ANTIMICROBIAL resistance is steadily shaping up to be one of the greatest health threats of the 21st century. While conversations often focus on hospital infections or the misuse of antibiotics in clinical care, a critical dimension remains underexplored: the deep, intricate link between antimicrobial resistance and our food and nutrition systems. From the farm to the family dining table, the choices we make individually and collectively are now influencing how rapidly drug-resistant microbes evolve and how severely they impact communities.
In Bangladesh and many other low- and middle-income countries, where food production systems are under strain and healthcare infrastructures struggle with high disease burdens, the relationship between antimicrobial resistance and nutrition is particularly complex. Food is supposed to nourish, strengthen immunity and support growth. Yet in a world where microorganisms are outsmarting medical science, food can also become a silent vehicle for resistant pathogens and a reflection of the socioeconomic inequalities that worsen the threat.
Antimicrobial resistance occurs when bacteria, viruses, fungi, or parasites no longer respond to medicines that were previously effective. This resistance develops not only through inappropriate antibiotic use in humans but also through misuse in agriculture particularly in livestock, aquaculture and crop production. Across the globe, antibiotics are routinely used to promote animal growth, prevent infections in overcrowded farming environments and enhance yields. This overuse creates selective pressure, enabling resistant microbes to proliferate. These microbes then spread through food, water, soil and human contact.
The consequences are far-reaching. When people consume food contaminated with resistant bacteria, they may develop infections that are much harder and often more expensive to treat. Children, older adults and individuals with malnutrition are especially vulnerable. For them, a simple foodborne infection can escalate into a life-threatening condition because the usual treatments fail.
Bangladesh demonstrates this challenge vividly. The country’s booming poultry and fish industries rely heavily on antibiotics, often without adequate regulation or veterinary oversight. At the same time, densely populated urban areas depend on informal markets where food safety standards vary widely. Raw and cooked food frequently share space, hygiene practices differ and antibiotic residues in food items often go undetected. As a result, antimicrobial resistance does not remain confined to farms; it becomes a public health reality affecting everyday diets.
Nutrition itself acts as both a shield and a vulnerability in the antimicrobial resistance landscape. People with balanced diets, rich in micronutrients, have stronger immune defenses. Vitamins A, C, D, zinc and iron contribute significantly to immune function. Adequate protein supports the production of antibodies and immune cells. But when individuals, especially children suffer from undernutrition, their bodies lose the ability to fight off infections effectively. This leads to more frequent illness, more antibiotic use, and increased chances of resistance developing. In low-resource settings where malnutrition and infectious diseases are common, this becomes a dangerous cycle.
The food system also influences gut health, which plays a crucial role in antimicrobial resistance. The gut microbiome, a diverse community of bacteria in the digestive tract helps regulate immunity and protect against harmful pathogens. When people consume foods contaminated with low-dose antibiotic residues or resistant bacteria, the natural microbiome becomes disrupted. This disruption, known as dysbiosis, allows resistant organisms to colonise and spread more easily. Over time, the gut becomes a reservoir of resistance genes, which can transfer between bacteria and move across population groups.
One of the lesser-known aspects of antimicrobial resistance in food is environmental contamination. Agricultural run-off carrying antibiotic residues and resistant bacteria can enter rivers, lakes and coastal waters. This is especially relevant for countries dependent on aquaculture. When fish farms use antibiotics excessively, residues accumulate in the surrounding water, affecting not only farmed species but also wild fish and the broader ecosystem. These resistant microbes travel through water channels, irrigation systems and food chains, blurring the boundaries between agricultural and public health concerns.
Addressing the antimicrobial resistance-nutrition connection requires a multi-layered strategy. First, food safety systems need substantial strengthening. From farm-level practices to market hygiene and household handling, every step must be designed to reduce the spread of resistant microbes. Farmers must receive proper training on antibiotic stewardship and be provided with alternatives such as probiotics, vaccines, improved farm management and biosecurity measures.
Second, policy enforcement must become more rigorous. In many countries, including Bangladesh, regulations on veterinary antibiotic use exist, but monitoring remains weak. Antibiotics are often sold over the counter without prescriptions, and small-scale farmers rely on informal advice rather than trained veterinarians. Strengthening surveillance systems, requiring prescription-only sales and introducing routine testing for antibiotic residues in food items are essential steps to curb misuse.
Third, nutrition programmes must integrate antimicrobial resistance awareness. For decades, policymakers have approached nutrition and infectious diseases as separate domains. However, the evidence is now clear: malnutrition increases infection risk, infections increase antibiotic use and excessive antibiotic use accelerates resistance. Public health interventions particularly in schools, maternal care settings and community nutrition projects, should include education on hygiene, safe food handling and responsible antibiotic practices.
Consumers also have an important role. Urban populations are becoming increasingly aware of food safety, but awareness does not guarantee access. Many people simply cannot afford to buy antibiotic-free poultry or organic vegetables. This makes the antimicrobial resistance problem not only a health issue but also an economic and social one. Ensuring affordable safe food is crucial. Investments in regulated, hygienic wet markets, cold-chain transport, and farmer education can create safer environments for all consumers, not just those with higher incomes.
International cooperation is another vital element. Antimicrobial resistance does not respect national borders and contaminated food products can travel across continents. Surveillance networks, data sharing and regional guidelines help create a cohesive response. The fight against antimicrobial resistance has been recognised globally by organisations such as the World Health Organisation, Food and Agriculture Organisation and World Organisation for Animal Health. Their ‘one health’ framework emphasises the interconnectedness of human, animal and environmental health. Integrating nutrition into this approach strengthens public resilience against antimicrobial resistance.
Research and innovation also offer promising solutions. Scientists are exploring plant-based antimicrobials, bacteriophages (viruses that target bacteria) and advanced food processing technologies that reduce contamination without harming nutrient quality. Nutrition researchers are studying how probiotics, fermented foods and dietary fibre can help restore microbial balance in the gut and reduce the spread of resistance genes. Meanwhile, advancements in precision agriculture can lower antibiotic dependence by predicting livestock disease risks through data analytics.
Educational institutions have a unique opportunity to shape this narrative. Young professionals in nutrition, public health, veterinary science and agronomy must understand that antimicrobial resistance is not just a clinical issue it is embedded in the food systems they study and the communities they serve. Future dietitians and nutritionists will increasingly need to advise families not only on calorie intake but also on safer food choices, food hygiene and the implications of antibiotic residues.
The public conversation around antimicrobial resistance has often been dominated by clinical voices, but a shift is underway. Food and nutrition professionals are beginning to speak out, highlighting how dietary patterns and food safety influence the trajectory of antimicrobial resistance. Their insights remind us that antimicrobial resistance is not an isolated phenomenon; it is woven into the fabric of our everyday health practices.
As the world grapples with climate change, rapid urbanisation and growing food demands, the challenge will only grow. Without urgent action, antibiotic-resistant infections could become the leading cause of death globally by 2050. Safe, nutritious food is humanity’s first line of defence. Protecting that food from invisible threats requires collaboration, leadership and sustained awareness.
The connection between antimicrobial resistance and nutrition deserves far more attention than it currently receives. Food can either fuel resistance or fight it. The path we choose will shape the health of future generations. The stakes are high, but the solutions are within reach if nations, industries and individuals commit to safeguarding the integrity of both our food systems and the medicines that protect human life.
Antimicrobial resistance is no longer just a medical crisis. It is a food systems crisis, a nutrition crisis and ultimately a societal crisis. Understanding its roots in our daily meals is the first step toward building a safer, healthier future.
Raisa Mehzabeen is founder & CEO of Nutrition For Change.
