29 February 2016

Giving birth naturally lowers risk of diseases

Did you know that in 2014/2015, close to a third of all births in England were by C-section?

Data from the Health and Social Care Information Centre shows that in English hospitals, 26% of all deliveries in NHS hospitals were by C-section, an increase by 0.3% when compared with last year’s statistics.

And this increase also occurs elsewhere; an Expert Review published in 2013 reported that the rate of C-sections in the US was 32%, 40% in China, and 46% in Brazil. However, the World Health Organization advises that C-section deliveries may be indicated in 15% of deliveries only.

This means that so many unnecessary C-sections are carried out every year throughout the modern world - sometimes by convenience, sometimes because of misinformation e.g. risk of  vaginal birth after a first delivery by C-section.

WHO advises C-section may be indicated in up to 15% of deliveries, but NHS stats amount to 26% – Do you want to tweet this?

Although risks and fears associated with natural birth are an endless list of scary stories for mum-to-be, the risks associated with C-section delivery are an equally long list of scary stories for baby – but it seems that parents who request elective C-section are not made aware of these risks.

During natural delivery, the contact between baby and mum’s vaginal flora is an essential source for the start of baby’s gut colonization. Not only these start-up germs are responsible for the development of baby’s immune system but by being born naturally (or at least breaking waters), the baby receives his mum’s signals about how to modulate his developing immune system (more about this here).


mother protecting child

Unfortunately, many studies focusing on the differences in gut flora in infants born naturally and by C-section observed that differences can occur until at least 7 years after delivery.
While the baby born through natural path is colonized predominantly by Lactobacillus, C-section babies are colonized by potentially bad germs typically found in hospitals and on the skin such as Staphylococcus and Acinetobacter.

The long-term consequences of not being colonized by the right germs via natural birth include differences in essential regulatory immune markers in babies’ blood. This lack of markers is consequently linked to an increased risk of developing diseases associated with immune regulation (auto-immunity).

Although some degree of contradiction exist between studies, talks surround:
  • Increased risk of developing asthma (20% increased risk)
  • Increased risk of developing allergies (e.g. allergic rhinitis, food allergies)
  • Increased risk of developing Type I Diabetes (19% increased risk)
  • Increased risk of developing gastrointestinal diseases (e.g. gastroenteritis, coeliac disease, inflammatory bowel disease in pre-terms)
  • Increased risk for skeletal disease
  • Increased risk in childhood cancer (e.g. leukaemia, neuroblastoma, testicular cancer)
If these risks are related to C-section delivery only or in addition to risks associated with the unavoidable antibiotics that are used during C-section is still to be determined.

Have you delivered your baby/children by C-section, by choice or for medical reason? Would you smear your baby’s head with vaginal secretions if you had to do it again?

If you would like to share your thoughts, please feel free to leave me a comment, I’d love to read them.

The information contained in this article has been compiled from these two papers: 1. Cho C, Norman M. Cesarean section and development of the immune system in the offspring. American Journal of Obstetrics and Gynecology 2013; April: 249-254. 2. Neu J, Rushing J. Cesarean versus vaginal delivery: Long term infant outcomes and the hygiene hypothesis. Clinics in Perinatology 2011; 38: 321-331.

22 February 2016

Tonsillectomy, breastfeeding, and the risk of obesity

Breast is Best! The NHS hammers that into our head, the WHO too. Recommendations are to exclusively breastfeed your baby for at least 6 months, and yet by saying breast is best, it implies that the alternative is good. This was brought to my attention by science writer Alanna Collen, author of the brilliant book entitled 10% Human.

Although babies’ formulas have been studied extensively these last few years, it is nowhere near as nutritious and protective as mum’s natural milk.

The role of breastfeeding is not only a nutritious one but also a protective one – Would you like to tweet this?

Breast milk contains so many components such as micro-organisms that will colonise the baby’s gut not only to help out with milk digestion but also to help out with immunity (more about it here).

Tonsils are those glands at the back of your throat that contain an army of immune cells. Their job is to investigate any food that comes in in order to educate the immune system on who’s good and who’s bad (wouldn’t want to have an auto-immune reaction against chocolate, now, do we?).

In fact, the tonsils we think are tonsils are only a part of ‘The Tonsils’ but they are the ones that get infected like crazy, and this is due to their surface being formed of deep grooves where bad bacteria can hide and develop leading to frequent infections, sore throats, and respiratory issues.

There is no doubt that in some instances, removing them is the right thing to do (e.g. respiratory obstructions, sleep apnoea); however, those tonsils are essential to educate our immune system, which has an essential role in keeping our heart healthy and controlling our body weight.

The strict recommendations (by the almighty WHO) are to wait until the child turns 7, which is the appropriate age at which the tonsils have had time to educate the immune system on all the stuff it may encounter (outside, school, friends, family, house, shops, etc…)

In fact, many studies have reported children at higher risk of being overweight if they undergo the operation too soon. One of these specifically reported that (adeno)tonsillectomy between 0 and 7 years old was statistically associated with overweight and obesity by 8 years old, and this was not explained by preexisting overweight.*

breastfeeding

Coming back to breastfeeding, another study, from 1996 (i.e. we’ve known for a while) showed on the other hand that children undergoing tonsillectomy were less likely to have been breastfed, which effectively means that being breastfed is linked to a lower risk of developing recurrent infections and respiratory issues, which lead to tonsillectomy.**

Risk factors leading to an increased risk of developing each step:
No breastfeeding => Recurrent infections => Tonsillectomy => Obesity

So? Breast is Best? No, it’s the only good option (more about it here) with formula being a back up plan.

Unfortunately, a lot of women encounter difficulties in breastfeeding their baby – And I know what I’m talking about here, having gone through every single difficulty myself! But I believe there is not enough support from: empathic health visitors (who are a bit too rude if you suggest you might try formula), family, or the general public (breastfeeding in public anyone?). Maybe if some steps could be taken there, breastfeeding would be considered the absolute norm (with formula as a back up). Maybe then we would avoid a whole host of future health problems.

Have you undergone tonsillectomy when you were a child? Would you like to share your baby feeding experience?
Feel free to share your thoughts in the comments box, I’d love to read them.

*I got the info on the link between tonsillectomy and obesity from this paper: Wijga AH, et al. Adenotonsillectomy and the development of overweight. Pediatrics 2009; 123: 1095-1101. **And this short article can be found: Pisacane A, et al. Breastfeeding and tonsillectomy. British Medical Journal 1996; 312: 746-747.

15 February 2016

Breast is not best, breast is the one and only

As soon as a baby is born, he receives his first germs from his Mum. The way babies are born nowadays, naturally or by C-section, has a massive influence on their initial microbial population, with a risk of long-term consequences such as obesity, asthma, and allergies for babies born by C-section.

pregnant plus child

During pregnancy, a mother prepares her gut and vagina flora to pass on to baby. The specific germs to be passed on are dedicated to milk digestion and gut immunity training (more about this here and soon to be available here). It becomes worrying therefore that when a child is born by C-section, his first germs are those of his mother’s skin, which are not really super good at helping milk digestion.

When his wife encountered difficulties giving birth to his child, Dr Rob Knight, a specialist in microbiota, didn’t take any chances: after his child was born by emergency C-section, he smeared him with his wife’s vagina secretions.

For those who are a bit grossed at the idea, there is another fantastic tool that women have been equipped with to ensure that baby gets all he needs: breast milk!
Breast milk is ideally (and the only one) conceived for baby, and that includes having a specific set of germs to pass on to baby - Do you want to tweet this?
Germs that will play a role in both nutrition, intestinal tolerance, and immunity. In fact, when looking at mum’s first secreted milk, called colostrum, it is actually full of components to shape baby’s immunity, and less for nutrition.

Breast milk is a savant mix of pre- and probiotics, along with other components, that will help mum provide her child with that famous passive immunity:
breastmilk-compo1[1]

Probiotics bacteria by definition are friendly bacteria that have a positive effect. Breast milk's include Lactobacillus rhamnosus, L. gasseri, L. lactis; Leuconostoc mesenteroides, and Bifidobacteria.

Prebiotics are molecules that help our bacteria. In breast milk, they are Lactoferrin, medium-chain saturated fatty acids, long-chain unsaturated fatty acids, lysozyme, or oligosaccharides. Oligosaccharides are forms of sugar that friendly bacteria love. For example, high levels of prebiotics correlates with high levels of Bifidobacterium, an excellent infection protector.

For so many women who encounter lactation issues or other breastfeeding difficulties and for whom the need for formula is their only viable choice, there are just so many more who have forgotten how natural breastfeeding is and are not encouraged enough to pursue it.

Do you think breast is best or really the only one good?
I’d love to read your thoughts and experience, feel free to leave me a comment.

I used this scientific article as my source: Parigi SM, et al. Front Immunol 2015; 19: 415.

8 February 2016

Our microbiota helps us fight colds

Our immune system is a fantastic well-oiled machinery where each component has a defined role. If we remember our Biology classes, there are two main types of immunity: a non-specific one (the innate) and a specific one (the adaptive, capable of learning baddies’ attacks and remembering how to fight them off).

All these immunity (police) agents have elected certain sites such as the skin, the intestines and the appendix as their home because their biggest job is to keep our residing micro-organisms under control. It is not surprising then that they ended up interacting, right?

In fact, it is our own police agents who decide that it would be OK to accept those microbes to populate our body, right from birth:
When a baby gets born, his skin, body, or gut doesn’t contain any microbes (although this is now a debatable matter, more on this later). As soon as baby is out through the birth canal or through his mum’s belly, baby picks up microbes. But bizarrely, he’s fine with it, he doesn't get sick. The reason for this acceptance is that a growing baby’s immune system is purposefully down to accept the little bugs, knowing that they will be useful later on.

baby

From this, we can already wonder if there is a difference then between being born naturally and being born by C-section. This is a very interesting point and I’m planning on addressing it very soon in another article.

For now, let’s come back to our gut immune cells and microbes working together to fight off illnesses:

The way it works is complex. But let’s imagine a virus trying to infect us. Infection intensity will depend on 1. how well we are physically, 2. what our genetics say, and 3. where the virus is attacking. This viral invasion triggers highly specialized populations of cells to collect cues from right, left and centre in order to develop responses that will allow to fight the virus.

It was recently discovered that when our gut bacteria break down the fibres from our food, they produce short chains fatty acids, SCFA. These amazing SCFA were shown to regulate the part of our immune system that modulates our human genes. This in turn results in a positive effect on essential components of our adaptive immune system (T cells and dendritic cells) that will fight the invasion for us (I will be exploring the impact of low fibre diet very soon).

NK cell attacking a cancer cell
Two immune cells attacking a cancer cell

The innate immune system also can be modulated by our gut bacteria, fungi or viruses that all live and act for everyone’s sake:

Indeed the reason why our tiny allies are fighting for us is also to defend their home by stopping the bad invaders to colonise their territories. They do so by forbidding the virus to eat on site, or by creating a difficult place to live in (acidic environment, production of natural killing juice).

Most of our immune cells reside where our friendly bacteria are, for a mutual protective role – Do you want to tweet this?

Clever little buggers, aren’t they? Bu then again, they have been existing for far longer than us…

Do you remember the basics in immunity we used to learn at school? Do you think next generations will or should study this as part of their normal curriculum?

I based my article on the review by Belkaid Y and Hand TW, 2014 that was published in Cell, a highly reputable scientific journal.

1 February 2016

Our babies' first invaders

When a baby is still in his mummy’s tummy, his gut is free of germs (although this is now a debatable matter). As soon as he is born - the natural way or by C-section - baby will encounter millions of germs that will be the firsts to colonize this brand new body.

As we are learning now, the type of microbes that first set foot in our baby’s gut will determine a multitude of factors with long-term consequences.

If we think about the way a baby is born naturally, the first microbes he will encounter will be those of his mum’s vagina and poo. You may think how gross it is that baby’s head first contact is with poo but rest assured it is all in the Plan:

pregnant

When you look at a mum-to-be’s microbiota, changes in her gut flora already occurred during her pregnancy: what happens is that Mum is preparing to offer her future baby with the best and most useful microbial starter pack with which he can establish his own colonies. This process of microbial shifts even includes mum's gut microbiota ending up in her vagina for a swift delivery to baby when he’s out through the birth canal.

Mum-to-be’s microbiota is changing during pregnancy to provide baby with the best microbial start - Do you want to tweet this?

When baby is ready and contractions finally start, mum’s gut and vagina are travelling 'down' to populate the birth canal with a specific collection of germs that is specifically designed for baby, e.g. lactic acid bacteria such as Lactobacillus and Prevotella are specialists in educating a baby’s digestive system and immunity:

They will become the first armed police of the gut - thanks to the natural antibiotics they produce - and will fight off other invaders that might not have been invited such as Streptoccocus, Pseudomonas, C difficile – all nasties for such a young and delicate age.

These lactic acid bacteria are also perfect because they help baby digest milk by converting the milk sugar lactose into lactic acid, creating energy. Most of this lactose will have been digested by our small intestine beforehand but the leftovers that are passed on to our large intestine will be taken care of by gut bacteria.

As baby develops, he will acquire more diverse germs as his own diet diversified.
It stands to wonder then, what happens to babies in the Western world who are born by C-section (available soon)?

Although in some cases it is in mum’s and baby’s best interest to adopt these modern techniques, we may wonder soon if some countries where being born by C-section is the norm don’t overdo it at the unbeknownst detrimental effect on our babies...

Do you think modern societies are too sterile
when it comes to baby birth? 

Would you like to share your thoughts? Please leave me a comment, I’d love to read them.

All this amazing information was found in this scientific review: Belkaid Y, and Hand TW. Cell 2014; 157: 121-41.
 

My bugs and I Published @ 2014 by Ipietoon