Infant Nutrition and Lifelong Immunity: Science into Support

[MUSIC] When a baby is born by C-section, they're at increased risk for asthma because their microbiome is sort of perturbed. So people have lower socioeconomic status. In many countries, yours and mine included, they are less likely to breastfeed or more likely to stop sooner. Parent wants to breastfeed, but they have to go back to work that is a very big barrier. So paid leave. Welcome to the final installment of our Deep Dive series. I'm your host, Dr. Catherine Glass, and it's time to wrap off our conversation with today's guest. What are the biggest challenges in translating microbiome discoveries into public health guidance in your mind? I think part, like we mentioned, it's complicated. It's not that there's one best microbiome that everyone needs to strive for. It might depend on your context. So since we don't know what we're striving for, it's hard to translate and give guidance if we don't even know what the target is. So the science is still evolving. But I also think more generally, when we think of public health, it's not unusual, and it's true for microbiome too, that the public knowledge is lagging behind the science. So there's still, I think for many people, this idea that microbes are bad. They make a sif. And maybe there's some acknowledgement that like, oh, we shouldn't use too many antibiotics, but mostly people are thinking because that might cause resistance to antibiotics, which is a very big problem in the world. But they're not thinking about their microbiome and the idea that, no, not all microbes are bad. A lot of microbes are really good. They're helpful to us. We have to protect them and foster them. And with antibiotics, it's not just that we might cause resistance, it's that we might be harming our good microbiome. So I think that knowledge is still behind the science. As part of a group in Canada through the CFAR network, we made a series of courses, modules about the microbiome, specifically targeted to public health programs. So there's like one module on the diet and the microbiome. There's one on breastfeeding. There's one on antibiotics. So trying to teach health practitioners and public health practitioners early during their training. Like, what is the microbiome? Why should I care to it? How does it link into public health, I think, is something in one of the reasons that it's been a challenge? Yeah, absolutely. There's a study in the UK that's starting around Codon Cancer in the young and how it's globally, you know, that is really increased in number. And I think the, there's a team in London who have collected Codon Cancer samples over 100 years and they're going to look at those samples and see how the cancer evolved and see what these factors are. And I'm definitely expecting the microbiome to be in supply linked to this surgeon, Codon Cancer in the under 50 years. What an amazing resource. Absolutely. Absolutely. As the sample is going back 100 years, yeah. Absolutely. I'm pretty sure I've seen, I did a sabbatical in the UK back in 2018. And one of the things I learned and was really impressed when I was there is that there is some sort of like advisory committee to parliament on the microbiome. For at least there was that. And I was like, that is very cool. I would love to see that happening in Canada. So I love to see that it's like on the minds of people who make decisions. Absolutely. Of brilliant. I hope it's still there. I need to, we'll come back on that. And fine. So thinking about that kind of critical window in early life, is there one where breastfeeding and infant nutrition appear most protective for chronic diseases? Yeah. So I'd say it's tricky. There's not like a magic cutoff, but certainly there is evidence to suggest that that early period is really critical. We often talk about the first 100 days. That's a nice round number, but it's evidence-based. You know, we see that in those first few months, that's when the immune system is developing in this timely structured way. And the microbiome is informing that. It's also when the gut is most sort of permeable and trainable. So we do see that it's perturbations in those first few months, whether it's spicy section by antibiotics, something else that can really trigger downstream impacts. So I do think those first few months are very critical. But with that said, there is no magic cutoff. It's not that, oh, after three months, you're good. And that's what I picked in the, here's the rapid fire. Like what's a myth? And I feel partly responsible for this. We had a really big paper last year and it showed like if you weaned before three months, you have that that that, but that three months was really because that's when we happened to ask and that's when we happened to collect our samples. So I don't think that means it's the magic like three months in your good. We talked about the fact every additional month is helpful, but yes, I do think those first few months are critical. And even honestly, the first few days we talked about colostrum being this immunotherapy, like it is chock full of antibodies. It's almost not even milk. Like if if you look at it, you'll see that it's this gooey, sticky, yellowy thing as opposed to what we all think of as milk like this white fluid. And that's because it is so compositionally different. And we see that that's really important for immune protection to babies and to kick starting things like cardiovascular development. So if you focus on the first few days, I think that is really critical for a few months, but you know, it goes beyond that kind of depends what outcome, what's your question, right? So for asthma, for obesity, you talked about longer is incrementally better. Whereas for this blood pressure study, it was really just like one day and you're good. Which of course doesn't mean like stop after one day because there's all these other outcomes with other benefits, but depends what you're asking. Yeah, absolutely. And to your point about frozen breast milk, does the same stand true for colostrum and freezing? Is that kind of a difference in frozen colostrum versus not or not? This is a great question. I'm really fascinated by colostrum and how a couple studies like starting up or I'm going now to address questions like this because the truth is there hasn't been that much research on colostrum because it's so like hard to come by, right? It's only produced for a couple days and it's so precious that most people don't want to give it up for research. They don't want there maybe to have it understandably. So we now have some really great technologies that from a tiny drop, we can analyze a lot of things. And the idea of freezing comes to there's this growing trend to do antinatal expression of colostrum, meaning before the babies even born to start hand expressing and getting little drips of colostrum. And this again fascinates me. It comes from research in people with gestational diabetes because it's known that they tend to have difficulty with getting going on lactation. So some of the metabolic changes that happen in diabetes can also affect lactation. So the idea was, well, if we can get them expressing milk, late in pregnancy before they even deliver, maybe they'll have a better time getting going with breastfeeding and the evidence there shows that that seems to be true. But it's sort of taken off from there to like, now everybody's doing it. And I personally wonder as a milk scientist, like, well, what is in that antinatal colostrum? Is it the same as what you would get postnatally? Because like a lot goes on in childbirth that probably triggers a lot of pathways that are going to affect the colostrum. And so is it different? And therefore, if you do express it, should you freeze it and should you still feed it to your baby? I would, my hypothesis is it's better than formula. Like, so the idea that if the baby is born and the mom can't breastfeed right away, rather than giving it formula, you'd give it this frozen colostrum. Probably that's good. Obviously, no one studied it. So we have a project going on right now to understand that better. Again, thinking about population groups. Are there population groups where breastfeeding rates are lower and asthma risks higher? And if so, what can be done in your mind to close that gap? Yeah, absolutely. So, sea sections are one. We touched on this a little bit earlier, but when a baby is born by sea section, they're at increased risk for asthma because their microbiome is sort of perturbed. Those babies are also less likely to get breastfed because moms just been through this major surgery. So I think therefore, really supporting those moms with everything they need to get going with breastfeeding as soon as possible is extra important. Another group is lower SCS groups. So people of lower socioeconomic status in many countries, yours and mine included. They are less likely to breastfeed or more likely to stop sooner. And their kids also are more likely to have asthma. Those reasons can be on the same pathway because they breastfeed less. They get more asthma. They can also be kind of separate in that low socioeconomic status brings a lot of risks to health, often less nutritious food available, less toxic activity, other disadvantages and inequities. But breastfeeding may be one way to address this. And so we see that in Canada for sure in the US, these are also the populations that are most likely to have to go back to work sooner. If they don't have the economic needs to take a nice year long maternity leave, then they have to be back at work that interferes with breastfeeding. So in a way, they're the groups that need the help the most because their children are already at higher risk for adverse health outcomes. And yet they are going to struggle the most with breastfeeding if we don't have systems in place to support them. Yeah, absolutely. Great. And then finally, what emerging interventions nutritional microbial or policy level are most promising for long-term child health? So I mean, I think the first one to mention, which you already asked about is paid leave. So this is a no-brainer if a parent wants to breastfeed, but they have to go back to work that is a very big barrier. So paid leave is very important for supporting breastfeeding, as well as many other things. It's not the only reason we should have paid leave, but it's so important in those first months, first year to be with your baby. And that's going to facilitate. breastfeeding. So that's one for sure. Other policies though, we're thinking about locally in Nantatoba, where in Chrome and Canada support, so insurance coverage for lactation support. So if the mom needs a breast pump or needs to see a lactation consultant, currently those things are not covered by many insurance programs. And they really should be, that's essential to health. It's also like a great long-term short-term investment, long-term gain, right? If you're presenting all sorts of chronic diseases. So we're trying to advocate for that because there are countries, so the US being an example, they don't have paid leave, but they do have insurance coverage for these things. So we kind of want the best of both of those worlds. And then in terms of microbial interventions, I mentioned I'm sort of cautious, but optimistic that the science is moving in the right direction that we will get to a point where we can have personalized microbiome targeted interventions. So first understanding what is wrong with a person's microbiome, and then going in and fixing it in a targeted way. So I think that's on the horizon. These examples of fixing microbial damage. So after antibiotics or after a C-section, promote breastfeeding, but if that's not possible, can we do other ways of fixing the microbiome, especially early in life when it's so so critical? I think environmental intervention, so there is evidence too that things like being more in your green spaces is good for your microbiome. We're also interested in the built environment, so are their aspects of your home that can be healthier for your microbiome. So those are some things to on the horizon too, but of course the best intervention is breastfeeding. And so if that's an option, that would be number one before all of these other things. Fantastic. And finally just have to interest. Sometimes committed ponte is try breast milk. Are there any benefits to add also breast milk? You know, like in some of the questions, there's not many studies, but and they're like, there's sort of a black market for breast milk in the bodybuilding community, because it has grown centers and it's like, I'm not endorsing that. But I do think there's actually a lot to be learned from breast milk that could be applied to people of all ages and preventing or treating different diseases. I can eat example of this is we talked about HMOs shaping the gut microbiome. So if you think of gut diseases like Crohn's disease or inflammatory disease, these are like big perturbations of the gut microbiome. So there is research going on like could we use these HMOs from breast milk to help fix the microbiome of adults with Crohn's or IBD. And it's actually quite promising. You know, there's other examples too of immune conditions. So probably not drinking the breast milk. And if you're a healthy person, probably not much to begin. But I think there is a lot to learn from breast milk to treat diseases in adulthood. And that's one of the reasons that we need more research. There we are. Fantastic. As I thank you so much for your time, Alex Patiz, on Infant Nutrition Human Biology and Infant Mibrary Bime. It's a real pleasure to have you. Hopefully we'll be meeting you again in the future. Thanks again. Absolutely my pleasure. Thank you so much for having me. And that concludes our deep dive series. Thank you for listening to the EMJ podcast and we hope you've enjoyed this conversation. Until next time, I'm Dr. Catherine Glass. Stay safe. Stay well. Stay curious. [Music]