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/

Featuring

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. Now, we’ve talked a lot about women, Dani, and the process of birth and the mode of birth, Leah, I want to talk to you about dads. You see couples trying to achieve bringing a child into the world. Women tend to have a lot more higher level of awareness around the microbiome and how it interacts with the journey to pregnancy. What about men? And what can they do as a partner trying to achieve a child?

Leah: I mean, there’s lots of really fascinating research starting to come out about the interactions between the male and the female, and that’s, you know, been coined the seminal-vaginal microbiome at the moment. And it’s the idea that whatever the male brings to the equation goes to the mother’s body. And then if let’s say hypothetically, he brings an infection or a disruption in his microbiome, it potentially can disrupt and disturb her vaginal microbiome, which then can increase her risk of miscarriage or increase a risk of late term loss or something like that. And there’s lots and lots of building evidence in that regard. But I think it’s very much around, you know, same sex partners, any partners, anyone that you’re intimate with. It’s about remembering that it’s a journey of becoming parents together. And so it’s a journey of both of you having a preconception focus and both of you improving your health. And you can’t have one person that’s a smoker and a drinker and uses all sorts of chemicals lying in bed next to someone that’s really clean and doing everything, because we know, you know, the smoking is coming out of their skin and all the chemicals are going and affecting them. And we know that, for example, men that smoke, we can detect all the chemicals and the by products in her vaginal microbiome, which can disrupt all the subsequent health stages. So it’s very much around them working together. And when you work with one in isolation, unfortunately, you don’t generally get the same outcome. But I think, again, the motivation of kids and improving the health of the next generation generally unifies couples. And I think it’s a beautiful way to start working together for it.

Kristy: Steven, how do you find the impact of both parents and both the choices both parents are making, plus their own genetic predisposition in what a child, what the microbiome of a child may come to be in its early years?

Steven: I guess early on, really, I guess the major impact would be from the mother and the breastfeeding of the mother. But I guess, as Leah has mentioned, is that the mother can be affected by the father, but the child is getting all of its bacteria from all of its environment. So all of these things will be affecting the child. I guess there’s a lot of anxiety around that because you can’t see the bugs. You can’t see what’s infectious. And I guess that’s really what we’re trying to avoid. You know, so what is infectious but what’s not infectious? So pets are good, but probably, you know, pet poo is bad. You know, going back a long time ago, yeah, you want to do the simple things. Don’t let your kids play in pet poo. But it depends on the pet. And I would sort of say it comes down to what the pet eats as well. So, one of the things that could be good would be an animal that only eats vegetables. So, you know, sort of cow pats. I’ve heard stories of parents, so a parent from the city, being absolutely terrified that she saw a small toddler stick their hand into a cow pat, and sort of say, are you going to stop that? And then the parent who lived in the country was like, oh, no, they’ll be fine. And there’s a bit of that lost knowledge about what is potentially dangerous and what’s not so dangerous. But an animal that eats meat, that’s where, you know, sort of some of the dangers lie. And that’s probably what you want to avoid. Dangerous sort of stuff is, I guess we already sort of know it. You don’t want to leave food out. You want freshly prepared food and those sorts of things to avoid. I guess what you already know about the dangerous bugs. And I guess both the mother and the father have to be aware of that and be sort of careful what they would give to themselves, but also be careful of what they’re going to give to their child. The child’s learning from everything; the child learns from its environment and the microbiome learns from its environment as well.

Kristy: And Matthew, you’d see this a lot, perhaps a disconnect from people who live in regional environments, who are connected to the soil, who do send their kids out to be exposed to various elements and things outside compared to perhaps people who live in inner city and are less exposed to the natural environment.

Matthew: Yeah, and I think that’s really good research that people who live rurally, you know, have less of some autoimmune diseases. But it’s not just living rurally. It’s they know this difference between different groups who live close to the soil. Whether, like the Amish, who don’t tend to use tractors, and then there are others who do. And if you’re closer to the soil, you have less autoimmune disease than if you’re driving the tractor, so it’s not to living in the country, it’s actually, you know, having some exposure to soil, because soil probably helps the inoculation over time. And it certainly has contributed to that to the to the human microbiome evolutionarily. So, yeah, this idea that, you know, that playing in dirt, you know. You know, I grew up when kids always used to sit in gutters and a lot of the autoimmune diseases have risen and sure, there were bad things about sitting in gutters, but generally being exposed to soil and earth and the plants, the biome on plants, because plants have bacteria all over them as well, has, that’s what we’ve actually evolved to have. So I think a lot of people are sort of surprised to hear that, especially from the cities. Because they’ve been told, I guess, by a whole marketing arm of, you know, of cleaning product companies that, you know, it kills 99.9% of household germs. So that’s a good thing, you know. When now, we know that killing 99% of bacteria is not a good thing.

Kristy: Steven, we’ve talked a lot about your research, in particular around what women can do if they can’t breastfeed, if they feel that they can’t keep their microbiome to their babies. And your study, appropriately named ‘Restore’, which is about how can women give those things to children when they’re perhaps medically unable to or perhaps when they don’t have enough of it themselves?

Steven: What we’re trying to do with the Restore Study, it really comes down to what we think is important early on, and that’s the Bifidobacterium and then support of the growth of that Bifidobacterium with the human milk oligosaccharides or HMOs. And what the Restore Study aims to do is, provide that Bifidobacterium and the human milk oligosaccharides so that the microbiome has a good chance to develop well in the baby’s gut. And when we sort of say develop well, it means train the immune system, train the immune system early on. So it knows that it doesn’t have to react to any sort of bug. It doesn’t have to, you know, generate inflammation when it sees everything new. It can down regulate that inflammation and that will allow the baby, you know, sort of its best chance for a healthy life, free from disease. And that’s really what we’re trying to do with the Restore Study. And it doesn’t matter if the baby is vaginally delivered or caesarean delivered, there seems to be these big shifts in the microbiome. So it doesn’t matter if the baby is born from vaginally or cesarean delivery. And potentially it’s not the fault of the mother that their microbiome is not providing, you know, these bacterium to the child. It’s really more societal problems. And that’s what we’re trying to you know, we’re trying to return the baby’s development to how a baby’s microbiome would develop. I guess you know, how your grandmothers, your grandfather’s, you know, hundreds of years ago, how their microbiome developed early on when there was no option to be, you know, cesarean delivered. There was no option other than to breastfeed and there was no option other than to grow your own vegetables and then provide those vegetables to your child. So in a way, that’s what we’re trying to achieve with the Restore Study.

Kristy: Dani, you’re not part of the Restore Study, but obviously closely watching the research and the results of it. How is what Steven said about restoring those microbiomes, interacting with some of your work?

Dani: Look, I think what’s really important here is to say there is coevolution of humans with their microbes. And what we’re trying to do now is say we’re in a world where we can provide safe obstetric care. So, yes, the mortality rate and the dangers to women and babies and their lives many years ago, hundreds of years ago, were much higher than they are today. So balancing modern medicine and safe obstetric delivery of your babies with that ability to then provide what we think our interventions are disturbing. And so I think that’s really important. And that’s a really interesting space to hold. I like the human milk oligosaccharides or HMOs. That’s an area of research that I think part of my study will become a sub-study of. Is that looking at human milk oligosaccharides actually in the blood during pregnancy and in the amniotic fluid around babies. So clearly there’s a passage of those key players in terms of then how the baby adapts to the external world once born.

Dani, some of the other work you’re doing is a really large study of over two thousand women called the Mothers Babies Study. Can you talk to us a little bit about what your research is finding out there?

Yeah. So the Mothers Babies Study is based at the University of New South Wales and also the Microbiome Research Centre at St George Hospital in Kogarah in Sydney. So that’s the engine of it. However, we’ve got sites all across New South Wales in both cities and in rural contexts. So it’s helping us to get a wider view of the microbiome during pregnancy in the Australian population and that pre pregnancy stage as well. Look, I think this is an interesting study. It’s world class. It’s difficult to do. Research into pregnancy is hard. My MUMS study, it’s the springboard to the Mother’s Babies Study. So it’s kind of a pilot to make sure that we could do the science in Australia in the way that we wanted to do it. And what we worked out quite quickly, touching on what Leah is talking about and the rest of the panel, is that it’s not just what happens during pregnancy that has an impact. The Mother’s Babies Study is looking at two thousand women and looking at women preconception and their partners to see what impact pregnancy has on their microbiome, but also what their pre pregnancy microbiota has an impact on in their pregnancy in terms of the development of pregnancy complications like high blood pressure or gestational diabetes. So it’s a study unlike any of its kind in the world. It’s a large effort. It’s currently recruiting. And so, therefore, you know, we’ll find some answers to that in the next few years, I’m sure. But it helps add the piece to the puzzle, which is pre conception, which is probably the vitally important step, which my study lost. My study was not able to do the pre conception part. So this adds that vital bit of information.

Kristy: So potentially, together with the Restore Study, Australia could become a world leader?

Dani: Absolutely.

Kristy: At microbiome research, educating women.

Dani: Yeah. Absolutely.

Kristy: Leah, whilst science is working on restoring some of these good bacteria to mothers to pass on to babies, what’s your advice to people from even a really simple level of, OK, whilst science is doing its work, What can I eat? What can I use? What is the best thing that I as an individual can do to ensure that I can give my child the best start of its microbiome life?

Leah: Yeah, absolutely. Look, I think it’s really important that, let’s just focus on women for the minute, so what she can do, both during her pregnancy will influence her gut microbiome, which will then pass through into the baby in utero. And then also what she can do after, while she may or may not be breastfeeding or when solids are introduced. And it really comes down to looking at evolutionary types of diets and what we have always traditionally eaten. You look at any culture and every culture will always have a bitter at the start of the meal. They’ll have an aperitif. It may be something exotic or it may be something as simple as just rocket with lemon juice. It might be something as simple as always, using fresh herbs and spices or making a salsa verde that goes with the protein, because then you’ve got the digestibility and the prebiotic stimulation from all of those natural food sources. But it’s also very much around encouraging all of your traditional prebiotic foods. So Japanese culture may have used miso, any of the Eastern European countries would have used sauerkraut. All of these different types of fermented types of foods act as probiotics, which we eat, and then feed our microbes, as well as every aspect of our digestive system. And so when you can do that during the pregnancy, you’re then encouraging the gut health of the mother and then the baby, when you’re doing that while she’s breastfeeding, super important to have a variety of a diet. So a breastfed baby, we know, is exposed to multiple types of flavours in milk. And we know that when we look at cultural analysis of various types of food choices and how the food choices that are passing through the milk influence the children ,their eventual palate for the rest of their life and the microbes that they’re comfortable with. You know, kids that are exposed to high spice intake within the diet, for example. And then when we introduce solids, a child that’s been brought up on breast milk, you know, where mum had a curry or mum had a Laksa, mum had something with spice in it, is very comfortable with spices when they’re introduced solids as well. But definitely when solids are coming in, it’s very much around as many vegetables as you can possibly put into them and a variety of those vegetables. And starting really slowly with a wide variety of all of those prebiotic grains, buckwheat, amaranth, quinoa, things that are not necessarily traditionally eaten, but will encourage the growth of bacteria much more than just a piece of bread.

Kristy: Steven, in your experience, because you work in infanthood, what is the really vital time that makes a huge difference to an infant being set up for life with a healthy microbiome?

Steven: Yeah, so the important time seems to be that birth to six months of age. While they’re breastfeeding, that seems to be key and it can affect say disease or later life disease. You’re learning throughout your life and your immune system is learning throughout your life as well, or the child’s life. Hopefully, even though we don’t know the answer yet, even if there’s been problematic times in the first six months of life, we’re looking towards whether we can rectify that later in life as well. So in terms of the microbiome, nothing is set in stone. It can be changed. And I guess that is one of the key messages involved in microbiome research is you can change your microbiome.

Kristy: And I wanted to ask each of you if you had advice to women, at any point, either trying to get pregnant, during pregnancy, during the birth process or afterwards. What would that advice be? What’s the most important thing that you can tell someone who is really, really wanting to ensure that their child is prepared with the best, healthiest microbiome it can have to eradicate disease later on?

Steven: I would say eat well, you know, sort of get the advice from someone like Leah, you know, from someone like Dani, speak to your obstetrician and eat well. I mean, also enjoy your food. But that’s a key message.

Leah: Simplify and go back to nature. It’s always easier.

Kristy: Very simple and very wise.

Matthew: For people sitting at home, this might seem incredibly complex. The science is incredibly complex. What happens in our body is incredibly complex. But our response doesn’t have to be complicated. And whether it’s for nursing mothers, pregnant women people with small children or everybody, it’s pretty much the same. We know that if you eat more than – it’s so boring, it’s that uncomplicated -It’s that simple, it’s so boring -Eat plants, you know, like eat what your granny told you, your mother told you, eat your vegetables. We know that if you eat more than 30 plant based foods a week, you have less autoimmune disease than if you eat less than 10. So, as Steven was saying, every time you feed yourself, you are training your immune system and you train your immune system by eating a wide variety of plants. Now, that can be as tiny as a little bit of parsley on your pasta. It doesn’t have to be something complicated or a whole dish of something made of plants, but that’s it. It’s really boring. Eat your vegetables and eat a wide variety of them. And it’s pretty much what my mum told me and probably what most people’s mother told them. But that will set you and your family up to have the best immune system that you and they can have, as you know, is a simple thing. The complicated stuff, the disease stuff, that’s what the researchers are working on for when things go a little bit awry. But for everyone else, you know, what your mum told you.

Kristy: Leah, I just wanted to ask your comments on that point that Matthew just made around it’s training your body. When people are thinking of having a child, how long does it take for the retraining, if they really do all the right things, to start to take effect?

Well, we lean into sort of two different theories. So one theory is that on average, it takes three months to address a nutrient deficiency either through dietary or supplemental means. So on average, you’re assuming that. If it affects red blood cells or iron or B vitamin, it can take up to 120 days. But then we’ve also got the egg and the sperm. And so spermatogenesis, the generation of sperm, take seventy two to seventy six days. So two and a half months, for men, you can make dramatic changes with their reproductive health. And for women, they’re born with all their eggs. But we focus on the final stages of development of those eggs. So it’s an average three to three and a half months for her as well. So your general rule of thumb is three months.

Kristy: Stephen, what happens when people don’t look after their microbiome and we get a situation where the bad bacteria, as we call it in general terms, overtakes the good bacteria?

Steven: So we’re starting to use this term called dysbiosis, and it’s thrown around a lot. But really what it means is, is there’s just the balance, the good being those that don’t really, you know, stimulate our immune system into inflammation and the bad being those that do stimulate inflammation. And dysbiosis, it means the balance has gone wrong. The bad have taken over. And they’re stimulating inflammation when they shouldn’t. And that’s really in a nutshell what dysbiosis is.

Kristy: Dani, your final observations? If you were speaking to women, as you do day in, day out as an obstetrician. What’s the advice that you give them?

Dani: Oh, look, I think it rounds up everything that everyone else has said. Come back to your origins. Diversity is key. Diversity in the food that you eat is key. Thirty different types of plant based foods a week is fantastic. Therefore, diversity in your microbiome is what you’re aiming for. And I guess the other concept is we used to say we are what we eat, but maybe we are what our microbiome thrives off, you know, like I think we’re feeding our bugs more than we’re feeding our bodies.

Kristy: Women who do want to educate themselves about microbiome often hear the terms, prebiotics and probiotics. Can you give us some information around what that actually means?

Dani: I think simply put, prebiotics are what our bacteria eat and what feeds them. So putting the right ones in to try and manifest and grow the right population in a community of bugs is important. And then probiotics are the introduction of live bacteria, which is leading on from Stevens’ Restore Study. So we’re actually giving the body bugs and hoping that they set up camp and have a happy home.

Kristy: Dani, you’ve mentioned your participation in the University of New South Wales MothersBabies Study, which of course, was in part contributed to by the MothersBabies organisation. What drew you as an obstetrician to participate in that study, to work on it?

Dani: I think it’s what drew me to participate today and come out of my comfort zone of a labour ward, which is around education and educating women as to what they can do to optimise the health of themselves, their family and their evolving children throughout their lives. I think it’s really important. Scientific research is hard to fund in Australia particularly, and it’s very hard to fund research into women and babies because we’re healthy. Essentially, most of the time. So a lot of funding for scientific research happens in cancer and obesity and lifestyle diseases. So I think participating today was an avenue for me to be able to help educate women around this important topic, which no one’s talking about or no one’s talking about correctly. And also to say that, you know, contribution to research that we’re doing in Australia, which is worldwide leading, is really important and vital for its ongoing sustainability to answer these important scientific questions.

Kristy: And Steven, how important are organisations like MothersBabies and the work that’s ongoing at the University of New South Wales that you do with immunology and the study that Dani is working on as well for general awareness for women and for families? So like Dani, MothersBabies got me out of my comfort zone. So I’m you know, I like the lab. If people don’t know what you’re doing, it doesn’t matter. But what we’re doing does matter. So part of what MothersBabies is doing is getting that message across. And that’s an incredibly important message. And I think it’s worth supporting you know, that message and getting that message out.

Kristy: Leah, this is a huge passion of yours. You have educated hundreds and thousands of women across Australia. How important is the role of organisations like MothersBabies in continuing to assist you to do that?

Leah: Look, I think with my clinical hat on for a moment, there’s nothing worse than having someone with you that you can’t find an answer for, that you can’t help, you know, that you see have tragedies or, you know, things happen that are not positive. And I think that organisations like MothersBabies are both highlighting such a key, important area of science for us so that we can hopefully accrue much more research. And certainly in the Australian context, it’s vastly different to other countries. And we can’t lean on the other countries research. But as well, it’s about educating the public so that they can be empowered individually and independently, because it’s all very well that I can see some people, obviously I can’t see everyone, and no one would want that, but it’s more about that people can get back to their grassroots and can get back to the knowledge that as a mother, you generally will know what your child will need. And maybe you need to just connect back to that knowing and connect back to nature and the world around you. And organisations like MothersBabies are imparting that, which I think is just invaluable.

Kristy: And Matthew, from what you do, educating, raising awareness, teaching the general population how to connect with nature, how important that is for their microbiome and their food choices. There wouldn’t be that many organisations that you have come across.

Matthew: Yeah. What I loved about coming here today and MothersBabies generally is, when I talk about this topic like the biome and how to feed the biome and how to look after your immune system at our farm. People think of it as ‘woo-woo’ and a bit witchy, you know. But this is science. They’re doctors. Yeah, this is science. This is the real deal. And they’re making steps. You know, it’s matching, I guess, some historic wisdom with modern science. But what I really love about this topic and MothersBabies and what they’re trying to do is this is generational change, because this is not only about what I eat today and looking after my immune system or your immune system, it’s about the next generation, the generation after that. And historically, we have seen a drop in our immunity because of how we feed our immune system through our diet and through neonatal and antenatal care and all that kind of stuff. And this is about improving all of that for generations to come. So what happens today and what the organisation is involved in can have a ripple effect for hundreds of years. And that’s a beautiful thing.

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 properly 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.