The Panel Discussion, held in May 2021, was a unique combination of various experts in the field of the microbiome. They discuss factors that impact the microbiome of a newborn through to toddler age, and the evidence that suggests the microbiome is linked to immunity from a range of diseases. They also talk about the impact the microbiome can have on fertility prior to conception. To watch the discussion, and for full disclaimers head here: https://www.mothersbabies.org/evidence-based-science/
Dr Dani Susic, Obstetrician, Gynaecologist and Microbiome Researcher
Dr Steven Leach, Paediatric Immunobiologist and Microbiome Researcher
Leah Hechtman, Naturopath and Natural Fertility Expert
Matthew Evans, Farmer, Broadcaster and Food Commentator
And convenor, Kristy McSweeney, PR Counsel
Kristy: I’m Kristy McSweeney, and welcome to the very first MothersBabies discussion. We’re here to raise awareness and empower women to transform the health of their baby in pre pregnancy, pregnancy and during birth to ensure the gut health and the microbiome of both mums and babies is optimised for life, setting children up for the healthiest childhood possible. We want to start the conversation around what women can do and some of the science and research and lifestyle changes that women can make to ensure children are as healthy as possible. Welcome to the inaugural discussion of MothersBabies, and you’re all here because we all have a common interest in empowering women around how to prepare themselves for pre pregnancy, during pregnancy and after birth to ensure the health of their child is the optimum that it can be. And we’re going to talk about how that can be optimised through understanding and learning about microbiome today. We have a wealth of experience here today, Dr. Daniella Susic, Matthew Evans, Dr. Steven Leach, and naturopath Leah Hechtman. Dr. Daniella Susic, perhaps could you explain to us what is the microbiome and how do you explain it to patients of yours, to women who are about to give birth or are thinking of giving birth in your work as an obstetrician?
Dani: So the microbiome is the genetic material of all of the bugs that we have on and in us. The microbiota are the actual bugs. So, I think that’s an important thing to understand. So when we’re talking about the microbiome, we’re talking about the genetics of the bacteria, the viruses, the fungi that we have within our bodies, and they’re a natural part of us being human.
Kristy: I’m going to ask you Leah Hechtman, now, you’re a naturopath. You have been understanding the microbiome and how it prepares women for pregnancy for many, many years. What’s your definition when you talk to your patients?
Leah: I think it’s very much around preparing our bodies so that we can be as healthy as we can be. And when we’re incredibly healthy, then every aspect of our body is in health, which includes the microbiome or the microbiota, because then there’s harmony between everything that’s present. And we know that when we’re unhealthy or there’s a state of illness or disease, that there is a disruption in the bugs that are within us and around us. And so the preparation for women before they conceive, both themselves and their partners, is all about making them as healthy as they can be so that they can flourish. And it includes their environment around them. So the soil that they’re exposed to, their homes, their cleaning products, etc, as well as everything they put in their mouth and everything that they wear and everything that they do. But ultimately, you know, the microbiome at the heart of it is all around health and optimal health and harmonisation between the inner and the outer.
Kristy: And do you find there’s a lack of understanding or lack of awareness when people first come to you and you explain to them how to make changes in their life that could be positively affecting the microbiome?
Leah: Absolutely. I think the biggest challenge is we don’t realise how much power we have over our own health and how much power we have over the next generation and power in a positive way. We can make dramatic changes to the next generation just by making simple changes before we conceive them, as well as during our pregnancy. And those changes might be as simple as changing our cleaning products so that we’re not being overly antibacterial to our environment or having some soil time; eating organic fruits and vegetables and certainly having a really optimal diet makes a huge difference.
Kristy: Matthew, I want to ask you now, you are the way we talk about it now, the farm-to-plate man, and we’re looking at how food impacts the microbiome. But what’s some of your research or some of your undertakings from working in the food space for so long and the changes that you can see in microbiome when people really take that seriously, being conscious of food and where food comes from?
Matthew: We used to think of germs as bad. You know, all bugs are bad and they’re going to make us sick. And we had this attitude that we have to kill everything with our cleaning products, with antibiotics, you know, that everything was out to kill us. And then we suddenly realised that more than half of the cells in our body, our microbes, half of our bodies isn’t us. And all those things that live in and on us are doing us good. But as we’ve separated ourselves from natural food and from natural ways of doing things, we know that we’ve decreased the number of bugs, but also, more importantly, possibly the diversity of bugs that live in and on us and all of those things, they have a purpose that can help us to reduce inflammation or to make us better. And so my emphasis, I guess, is looking at, has been looking at, the role of soil, you know, our contact with soil and how our separation from the earth that existed before we existed -the separation has made us less healthy in some ways. And our separation also from the variety of foods and the wholesomeness of the foods that we want site has also lowered the the diversity and the ability of the things that live in us to help protect us from disease.
Kristy: Dani, I want to ask you a question just based on what Matthew is saying, you obviously have done a study with one hundred women, your MUMS study. How do you think women in your study have potentially got a changed microbiome to women in generations past and the interplay with food, diet, lifestyle and a lot of chemicals and products that we use now that we didn’t before or perhaps that we used before that we don’t now?
Dani: I think we’ve got a trans-generational effect of microbes generally diminishing over the last, you know, take it 20, 30, 40, 50 years. Some big studies have come out of the US looking at this and that our increase in reliance on antibiotics, which when used clinically, appropriately, are lifesaving and have saved many lives. And what you’ve said is that, you know, we’re kind of in that war of microbes. So there’s been a big shift in our understanding and our appreciation that we need our little team players that are part of our body to do some of the hard work for us. There are certain vitamins we can’t make by ourselves. Our bugs make them. That’s really important to know as well. And I think in terms of the food industry and how it’s changed, we are exposing our bodies to emulsifiers and preservatives because the food industry is probably financially driven. And so they’re making products that are more robust, that are able to be preserved with longer shelf lives. And I think we’re looking after a cohort of women now in today’s society that look very different from the society that my grandmother grew up in, for example. I think the wide use of antibiotics for farming, for animals in terms of meat productivity and percentage of, you know, bang for your buck from an animal from a farming point of view has also changed everything so that the widespread use of antibiotics in that sense has changed what we then are able to put into our bodies. If we don’t have that consciousness and awareness that Leah is talking about, that we are part of our environment, and that that is integral to who we are.
Kristy: Leah, I want you to comment on that point as well. And a lot of people might be listening to this thinking, wow, it’s really expensive to eat organic. It’s really expensive to make active choices around what products are used in the home. How do you talk people through that conversation before they put up a wall and say, look, this isn’t for me?
Leah: Look, I think I’m in a privileged position. Generally, by the time people come and see me, they want a baby, so they’ll do anything. And I think it’s a particular type of patient that will come and see me, because when it’s about another and it’s about a life that you’re creating, I think it motivates us very differently. So I guess when I’m speaking with a person, it’s very much around, what are the simple strategies that you can do at home that don’t cost very much, that won’t be very labour intensive, but bring you back to a simpler life that connect you to nature, connect you to the the cycles and the rhythms of the weather changes, of the seasonal eating patterns that your body naturally craves. Because when we’re more connected with our body, we’re more connected with all the bugs that we’re made of. And the cravings that we have in Winter are obviously very different to Summer. And similarly, simple things like cleaning products and skincare and toiletries and those sorts of strategies. There’s always actually a very cost effective strategy. There’s a very expensive version, and there’s a cost effective one as well. So it’s just about helping them feel empowered with the decision and recognising that ultimately their driver is about improving the health of the next generation.
Kristy: And Matthew, a lot of what you talk to people about is really getting back to nature, looking at the source of food. And I’m sure you agree with both Leah and Dani, that that makes a significant difference to the microbiome and how people pass that on generationally.
Matthew: You know, 50 percent of the people in the world live in cities and most Australians live in cities. And that generally, if you’re separated from soil, is not a very good thing for the diversity and the benefits of beneficial bacteria that live in and on us. But it’s not that hard to get in contact with soil. You just have to maybe buy some fresh vegetables that are grown organically and not sprayed with everything under the sun or even easier, just grow some herbs. You know, especially when you’ve got young children, you know, the benefit for them in those first few months and years of being in contact with soil. We had this you know, all germs were bad. The germ theory, all germs are bad. They’re all going to kill us. And then then we swung around to this idea that we had the hygiene hypothesis that if you sat in the gutters and, you know, swam in open sewers, it might give you some kind of immunity. And now we’re sort of in this beautiful in-between space where we realise that most of the bacteria that exist in the world and, you know, some of the other fungis and and viruses, most of them are old friends. We evolved in a world that already had them. And our bodies are designed to have them in and on us. And we can expose ourselves to them very easily by just touching soil. Not eating it, you don’t have to, you know, it’s not about you know, you’re trying to make yourself sick. It’s about just being around the stuff that humans have been evolved around, and that’s around plants that haven’t been completely sanitised of everything that’s on them before you eat them, and eat them fresh, and perhaps even tending some patch of soil yourself. And immediately you’re boosting your ability to be exposed to these beneficial bacteria that are going to you, your baby, your child benefit.
Kristy: Steven, I wanted to talk to you about that. Now your core research is the interplay around microbiome and how that may or may not contribute to the incidence of disease in early childhood or infanthood. What are your thoughts on how we’ve changed over the years and how perhaps some of these immunodeficiency diseases or conditions have become more or less prevalent?
Steven: So when you’re eating, I guess, fruit and vegetables, the type of bacteria on fruit and vegetables are the type of bacteria that break down so the materials that the vegetables are made up of. The cellulose and things like that, your body isn’t made up of cellulose. So those bacteria are designed to break that down. When that goes into your gut, those bacteria are helping breakdown the vegetable matter and they don’t react with your body. So they don’t initiate that inflammatory response. So when you’re talking about how the gut microbiome has changed, it really sort of comes down to that. And it’s the reduction in those types of bacteria, that break down the fruit and vegetables, that your body doesn’t react to. And it starts to become overwhelmed with different types of bacteria, the types of bacteria that your body will respond to in inflammation. So that’s really, I guess, core of what we’re talking about, change. And what has initiated that change? Well, there’s lots of things that’s gone on. We’ve already touched on it – change in diet, change in the cleaning products, change in our environment, and also change in medical practices. These seem to be the things that are driving this change from our gut being made up of inert so-called good bacteria to something that’s causing us to be more unhealthy or unwell or in, you know, sort of the more extreme examples, you know, in a disease state.
Kristy: Dani, perhaps let’s expand that upon you, because your work is how the microbiome has an effect on birth, depending on the method of birth, there’s a number of microbiome interplays, and we really want to educate women about the types of birthing experiences that you can have and what that means for the microbiome.
Dani: I think it’s a really important point. The most common exposure that I have to women asking me questions about the microbiome is around mode of delivery. So, I mean, I think what Matt said is that diet does have an impact. We’ve got research that says if you’ve got a high fat diet when you’re pregnant, that you change the gut microbiota for your babies, at least for the first six weeks of their life and probably into the future, which then sets up what we’re talking about is a lifelong inflammation potential to chronic disease. So that’s one aspect of it. But the question I get asked is, “if I have a cesarean section, am I doing something bad?” or “if I need a caesarean section, is there anything that I can do to help my baby get the bacteria that they would have had if they were born vaginally?” So when you hold the paradigm as an obstetrician to talk to women about this, it’s very difficult because being a mum is filled with guilt. You are just guilt ridden from conception until they’re 18,or until you die, probably. It’s probably a lifelong process of parenting. And there’s a lot of pressure on women to do it a certain way, a good way. And there’s a lot of societal impacts that kind of make the decision-making process even more challenging. So what I like to say to women is it’s definitely different. So if you’re born vaginally, we’re aiming for hopefully a head first baby, sometimes a bottom first baby, to come through the vaginal canal. We know that the vagina is full of the good bacteria that we’ve been talking about, Lactobacillus species that are trying to inoculate or transfer to the baby through the passage of the vagina. The baby’s ideal position for birth is to face the floor. OK, so facing the rectum of the mum to pass through what is likely a passage of poo. Every woman is terrified of passing poo when they have their baby. And it’s like, that’s a good thing. There’s a natural process and there’s a mechanism that is involved in that that is clearly there for a reason. So the baby’s birth passage, if it’s vaginal, is supposed to come into contact with vaginal microbes and our gut microbes, and then the baby’s inoculated with that. We know that babies that are born vaginally have a different microbiome, in their mouth and in their tummies and in their guts, to babies born via caesarean section. And if there’s a medical reason to have a cesarean delivery, if it is the choice of the woman to have a cesarean delivery, then I think it’s also important to tell them that it can change the baby’s microbiome. But there’s research being done to try and see whether we can help shift those changes that happen as well. So I know a lot of Steven’s work will touch on to what we can do from that point onwards. But yes, it is true that if your first exposures to the world are in an operating theatre, with sterile surgeon and sterile surgical gloves, having been given antibiotics, that those babies come out, that they look different. Their bugs in their stool looks different, they look different probably until the age of about six months. And what we don’t know yet is what impact that has long term. I mean, I guess there’s another trending topic around vaginal seeding, and that’s quite controversial. So it’s saying, if I want to have a caesarean delivery, is there a way of me passing the different bacteria and microbiota from her vagina, or from the mum’s vagina to that baby after the birth of the baby? And there’s lots of research to say that that’s potentially beneficial. We haven’t adopted that wholeheartedly in Australia at this point because it’s still in that exploratory, experimental phase. But I guess it’s another way of us saying that there are things we’re trying to do so that if we have to go down the pathway of a cesarean delivery for maternal request or because it’s medically indicated that there are things we can do to help that baby, to gain the microbes that we have coevolved with and that we need in order to be healthy individuals.
Kristy: And Steven, your work is there is mode of birth, Leah, a lot of your work is preparing people to have the best microbiome established for when they do give birth. Dani, you look at what can happen during the birthing process. Steven, you work with parents, with researchers, with clinicians to look at, OK, depending on what type of birth you have had, what are the elements around how the microbiome may contribute to the health of that child?
Steven: When we’re talking about the gut microbiome and health and everything like that, so that really starts off at birth. So the baby does need to be protected. You don’t want to you know, as soon as they’re born, you don’t want to send them out in the middle of the soil and all of that sort of thing, that can come later. So you want them to be well inoculated with good bacteria that sets up the development of their microbiome. However, if that doesn’t happen, you know, if the mother does have to have a cesarean section, there are things that can be done to, you know, set up that good development of the microbiome. So the immune system needs to be trained and needs to be taught what is good and what is bad. We want the baby to be exposed to Bifidobacterium. So we think that’s key. And Bifidobacterium, its growth is supported by breast milk. So those two things together really protects the baby in the first six months while it’s breastfeeding. And then so the science around that is sort of training the immune system, you know, getting the baby in a good position where it can support itself, because in the first six months, the baby, in a way, is still being supported by the mother’s immune system, by antibodies in its blood and everything like that. But around six months, when you start introducing food, that’s when the baby’s, you know, its immune system starts to take over. It has to support its own, it has to support itself, in protecting itself against bugs. And this is important when you start feeding your child at around six months, yeah, you want to be feeding them, I guess, good foods, the foods that the baby needs to support its growth, the nutrients. But also, yeah, you can sort of start thinking about feeding its microbiome. And there’s nothing different from how you would, you know, support your microbiome. So around about 12 months of age, the baby shouldn’t essentially be eating anything different from you.
Matthew: Steven, I just have a question on that, because the way it was put to me once was, yeah, colostrum, that magical, you know, early milk the first day, two days, whatever, of a mother’s milk, a mammalian’s milk, it’s absolutely you know, it’s high protein, it’s got lots of antibodies. And what that is doing is in humans in particular, I think it’s low in sugar. So what it’s doing is it’s not feeding the baby. It’s feeding the bacteria and the immune system. And then the other milk comes in, which is more feeding the baby. And it sounds like at going to solid food, you are feeding not only the baby, but feeding their immune system. Is that, would that be kind of correct?
Steven: So there’s a key component of breast milk and it’s something called human milk oligosaccharides. So this is getting a bit ‘sciencey’ now. So the mother produces human milk oligosaccharides. The baby, it’s not for the baby. The baby doesn’t absorb those. That is specifically for Bifidobacterium and for the microbiome development. So that’s why breastfeeding is important for gut development.
Kristy: But we also want to be clear to women that for some reason, if you cannot breastfeed, that there are things that you can do to still prepare your child to have the best microbiome possible.
Steven: If you’re not able, or you choose not to breastfeed, you can supplement your diet, your baby’s diet, with these human milk oligosaccharide equivalents that do the same sorts of things. That can support that bacterial growth in the first six months of life when they’re still when they’re not eating solid food and they’re still getting breastfed or, you know, so formula fed.
Kristy: And Leah, I want you to jump in on that point, because you work with women who are often thinking, am I doing the right thing? I can’t breastfeed, I’m not helping my baby the best way that I possibly can. What are some of those other things that mums can do that do replicate that good stuff that you get from breastfeeding?
Leah: Absolutely. Look, I think it’s people like Steven and Dani. You know, there’s amazing research into a lot of the different formulas that are out there. If you compare a baby formula from 20 years ago, it’s vastly different. And they are putting in the prebiotic species in them. And there’s obviously quality differences among brands. It’s about choosing the best brand that they can. But solid introduction is an incredibly powerful stage that you can do for a child. It’s very much around, you know, working with your health care provider and determining the age of onset, of introduction of solids, and taking it really slowly. So a lot of women kind of go baby’s four and a half months of age, I’m just going to go for it. And then they just give baby everything. And the digestive system doesn’t have an opportunity to mature at the appropriate rate, and neither do the bugs that are in the gut have an opportunity to grow and proliferate and set them up so that they can have a healthy digestive system. So it’s very much around ascertaining age of onset slowness with food introductions. So one of the things that I’ll often say to women is take two to three days with each food before you introduce the next one. First, make sure there’s no reaction, but at least give the baby’s digestive system a chance to work out how they’re going to metabolise it. Because if you give something like cooked and cooled sweet potato, for example, or cooked and cooled potato, you’re going to be feeding all these short chain fatty acids, which will eventually act as a prebiotic, which will eventually proliferate the growth of various species. And if you do that too rapidly, they tend to get constipated really fast because the digestive system gets confused. So it’s looking at it and going, what foods do I want to start with? What are going to nourish the digestive system? What are going to feed the microbiome, and what foods are also going to set their palate up for life? So the kids, we know that the kids that you speed up their solid introduction, and you give them lots of simple carbohydrates very quickly. We know they have a higher chance of obesity later on in life and a higher sweet palate. So if you slow it down and encourage a wide variety of vegetables to start with, it’s usually the best way.
Kristy: Now, Matthew, I wanted to ask you, you don’t specifically work with women or women and men seeking to have a baby. What sort of awareness do you think there is?
Matthew: I don’t think there’s as much awareness as we would like to assume on this panel. I think we, you know, because we are immersed in this, are all very interested in this as a topic, I think a lot of people still see germs or bacteria as germs. So that so that so everything has to be, you know, you bleach to clean things, you boil your baby’s bottles. You make sure there’s no germs anywhere. And I think most people still see they don’t understand this sort of interconnectedness between us, the things that live in and on us, and how they can drive our immune responses. And how giving yourself and your child the best chance is based on some pretty old concepts, but they’re not foreign concepts because they are just going back to a different way of looking at our lifestyles, which includes the food that we eat. But I think most people yeah, I think it’s a bit of a mystery to them. They are like “what? we’ve got how many bacteria? There’s no way we could have”. You know, this is just it seems unimaginable that when you eat an apple, you eat 100 million bacteria. You know, it just seems unimaginable. But that’s the case, you know, like don’t be frightened of most of these things. Ninety-nine-point-nine percent of them are harmless or doing us good. And I’d love to see that knowledge get out there, that actually, you know, most of the time, most of the things are doing us good. And it’s only when things are a problem that we need to have medical intervention or to actively kill bugs, germs. Most of the time, you know, we should be fine with what we’ve got in and on us and around us if we look to natural systems.
Kristy: So it’s for everybody to do this, not just people who are trying to have a baby
Matthew: For us, it’s everybody, you know, but it is of particular interest at that time. And I think you were saying that I think we used to think of the mother and the baby as separate entities, but now the mother is giving gut microbes pre-birth.
Leah: Yeah, that’s exactly right.
Matthew: Yeah, that’s amazing, isn’t it? Like I was taught there was no bacteria inside, you know, inside things, it was just stuff on the outside. And we have to wash it all off or kill it, kill whatever’s on the outside so it doesn’t get on the inside. But now we know it’s in and on us and everywhere. And this beautiful thing where, you know, your gut is talking to your brain. So what you eat has an impact not only on your baby but can also have an impact on your mental health, is something that we should all embrace and say, that’s it. This beautiful thing that’s happening in modern medical science, there’s a lot more to learn, but we already we already know the basics. You know that what your grandma ate is probably what you should eat when you’re going to have baby, you know, or maybe in some places what your great grandma ate, these days, because we’re so far removed from the land that gives us life. But it’s not rocket science. You know, it’s not complicated, and it doesn’t have to be expensive. In fact, in some ways it’s a lot simpler than processed food and separating yourself from the plants and soil that gave us life.
Kristy: Thank you all for being here today. It’s been an absolute pleasure. And I don’t think it’s very often that scientists and clinicians, naturopaths and people who’ve made a career of helping people get back to nature and connect and eat probably all get together in one room to discuss such an important issue about how to empower women, in particular, to ensure that they are the healthiest they can be to pass on that healthy microbiome to their children. So thank you.
Keywords: Microbiome, Immunity, Fertility, Disease, Environment, Birth, Newborn, Gut Health
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