Expert / 28 November, 2018 / Professor Neil Shah
Leading expert Professor Shah is back with an informative article on the importance of probiotics for infants. In this article Professor Shah explains why the first one thousand days of your baby’s life starting from inside the womb is so crucial to their long term health. Probiotics and prebiotics together with a natural diet and an emphasis on eating well are all key to achieving good gut health. Research now proves that a healthy gut is the cornerstone for prevention of the main health problems facing many modern economic countries today.
There are over a trillion bugs that live in your gut, mostly bacteria. There is more genetic material and metabolic product produced by these bugs in our children’s intestines than they have in their own bodies. This diverse ecosystem is called the microbiome. Imbalances in the microbiome or a lack of diversity is called dysbiosis.
In the last ten years there has been an explosion of research and understanding with the realisation that our microbiome (which contains many different species of bacteria) influence everything from our immune systems, metabolism and even our behavioural development.
As infectious diseases become less common, we’re seeing the rapid emergence of immune driven diseases like allergy, Crohn’s disease and rheumatoid arthritis. Dysbiosis is thought to be the reason for the emergence of these conditions.
There are both probiotics and prebiotics that you can give your child that can improve your child’s microbiome.
A probiotic is an oral supplement consisting of enough micro-organisms (usually containing bacteria) to alter ours or our infant’s microbiome with potential life-long health benefits.
A prebiotic is a non-digestible food, often containing special carbohydrates that can stimulate the growth of one or more bacteria and improve our microbiome’s healthy patterns.
Breastmilk is the gold standard of nutrition but many factors can influence a baby’s microbiome from birth including being born by C-section, early hospitalisation and antibiotic usage in early life.
Medications can affect our microbiome, with the most obvious candidates being antibiotics. The practice of prescribing infants antibiotics that are also given to animal life-stock has been under increasing scrutiny.
Anti-reflux medications called proton pump inhibitors are often prescribed for infants suffering for what is assumed to be reflux. The may actually be of little benefit when used in the long term, and are associated with increased rates of gastrointestinal infections.
Medication is one of many factors leading to an infant’s underdeveloped gut immune system being exposed to adult bacterial forms. The infant’s immature immune system would normally only see these adult bacterial forms later in life when it can cope with these bugs in a much better way.
As you can imagine, the growth of the gut and its immune system plays a very important part in our health and well-being. We all have a unique profile of bacteria in our gut and less diversity is associated with ill health. Getting the right “profile” is complex and not just a simple case of adding probiotics to your child’s diet, but it’s not a bad first step.
Resolving this lack of diversity of bacteria is the focus of a great deal of our medical research. Changing diet, encouraging a natural diet and an emphasis on eating well, in addition to adding pre and probiotics into our infants’ diets are all ways to improve this lack of diversity.
Vegetarian diets are very different from the diet of an omnivore. Having an unhealthy diet with an imbalance of processed foods, artificial sweeteners and many other factors can change our microbiome, as do excess saturated fats and excess protein consumption. Very high protein consumption in very early life is increasingly being recognised and closely linked to adult obesity.
Getting our babies’ microbiome right in their first thousand days of existence has almost become a ‘mantra” for the medical professions and especially paediatricians. The first thousand days incorporates the antenatal period (a healthy pregnant mother leads to a healthy baby) and our infants’ first two years of their life.
A diverse microbiome is vital not just for their short-term health but will also probably have a lifelong impact on prevention of cardiovascular disorders, healthy ageing and prevention of obesity and diabetes.
The way probiotics are stored, how they are administered, in addition to the type of probiotics used are all factors that need to be considered when making the decision to give them to our children.
Probiotics are not all equal and only some have had their clinical effectiveness properly medically assessed. The good news is that there is very little evidence that they could cause harm in normal infants.
Probiotics have protective effects through the production of a special kind of fats called butyrate. These can have an anti-inflammatory effect, improve the protective gut lining, and protect against future allergic disease as well as reducing gut inflammation. Infantile colic can be improved with shortened periods of crying by using some strains of probiotics.
Although our understanding is improving, we are still a long way from knowing what the best profile of bacteria is to give our infants the best long-term health. A combination of good diet, plenty of vegetables and dietary fibre will be a good step to a healthy bacterial gut profile. An addition of pro and prebiotics are likely to be beneficial. Some infant formulas have had pre and or/ probiotics added in with some clinical benefits as suggested by international paediatric medical societies but much further work needs to be done.
The great thing about being a paediatrician but specifically a children’s gut specialist is witnessing the focus now changing to the importance of good gut health. Good gut health is now being recognised as the cornerstone for prevention of the development of the main health problems facing many modern economic countries. Getting it right in infants in their first thousand days means we are looking after their health for their entire lives.
It’s a very responsible position to be placed in but a really exciting one. Infant probiotics are almost certainly a good, safe supplement but determining the ideal combination of probiotics is yet to be done. Early but exciting times lie ahead.
Professor Neil Shah,
Consultant Paediatric Gastroenterologist, MD MRCP(UK)
The Portland Hospital 215 Great Portland Street, LONDON. W1W 5PN