00:00:00.000]
[00:00:50.097]
[laughing and shouting]
[00:00:53.272]
[00:01:01.909]
- [All] Let them eat dirt!
[00:01:04.501]
[00:01:08.364]
- When I think of dirt,
[00:01:09.480]
I think that it's going to be full of germs.
[00:01:11.920]
- I would say I'm probably somewhere towards
[00:01:15.790]
a conservative clean freak.
[00:01:18.953]
[00:01:20.240]
- When I was a kid it was sort of like
[00:01:21.820]
constant vigilance against what people put in their mouth,
[00:01:25.890]
washing hands, don't touch this, that's dirty,
[00:01:28.340]
- I remember learning about microbes
[00:01:29.770]
in a 7th grade science class
[00:01:31.520]
and they taught us that microbes were germs
[00:01:35.370]
and that they were essentially bad for your health.
[00:01:37.543]
[00:01:38.601]
- [TV Announcer] We like to keep the things
[00:01:40.260]
that we own as clean as we can.
[00:01:42.750]
That's why Dan is cleaning his bike.
[00:01:45.350]
It looks much better now, but his hands don't.
[00:01:48.760]
Now they need cleaning.
[00:01:50.800]
Dan washes up, because for one thing,
[00:01:53.240]
the soap and water are washing away microbes.
[00:01:56.118]
[otherwordly sound effect]
[00:01:58.711]
- Microbes, microbes [laughs].
[00:02:02.208]
Um, I don't think about microbes, nope.
[00:02:04.753]
[00:02:06.310]
- As parents, we all just want to keep our kids safe.
[00:02:09.220]
I don't think we ever stop worrying about them.
[00:02:11.910]
But some of the trickiest worries
[00:02:13.690]
are about things we can't even see.
[00:02:16.032]
- [TV Announcer] We like to keep the things that we own
[00:02:18.184]
as clean as we can.
[00:02:19.820]
Dan washes up because dirty hands
[00:02:21.910]
don't look very good.
[00:02:23.110]
- Before the internet, that's how we learned
[00:02:25.190]
about important issues.
[00:02:26.530]
Have you learned anything? - Nope.
[00:02:29.570]
- Well what were they trying to tell you?
[00:02:31.727]
[laughing]
[00:02:33.040]
- Dan needs to wash his hands because his hands are dirty.
[00:02:38.040]
[00:02:38.890]
- Definitely old school, so what does modern science
[00:02:42.338]
tell us about germs and microbes?
[00:02:45.676]
[energetic string music]
[00:02:47.820]
- [Brett] Microbes are everywhere.
[00:02:49.840]
They're in deep sea vents
[00:02:51.140]
way under the sea at high pressures.
[00:02:53.183]
[00:02:54.130]
They're in lakes a thousand feet under the ice.
[00:02:56.553]
[00:02:57.980]
They've been here long before we were
[00:02:59.830]
[00:03:01.030]
and they've built this world as we know it
[00:03:03.130]
[00:03:05.140]
and contributed to all the life forms we see around us.
[00:03:07.890]
[00:03:08.990]
- Microbes are actually part of our physiology.
[00:03:11.953]
[00:03:13.440]
The way we developed, the way our organs
[00:03:15.800]
and our systems develop in our body depend
[00:03:18.130]
not only on functions that are encoded
[00:03:21.810]
or produced by our genes, they're reliant on our microbes.
[00:03:25.663]
[00:03:28.340]
- [Brett] There's at least as many microbes
[00:03:29.690]
in and on us as there are human cells.
[00:03:31.753]
[00:03:32.680]
They're so numerous that they outnumber
[00:03:34.127]
the number of stars in the galaxy.
[00:03:35.753]
[00:03:37.860]
- We all have around 35 to 40 trillion
[00:03:40.510]
bacterial cells alone inside our bodies.
[00:03:42.903]
[00:03:43.870]
Most of them reside in our intestine,
[00:03:45.890]
and they play a fundamental role
[00:03:47.720]
in how our bodies develop and how they function,
[00:03:50.980]
everything from producing little chemicals
[00:03:53.050]
that your body needs,
[00:03:54.550]
all the way through to fighting off other pathogens--
[00:03:57.370]
other dangerous bacteria or dangerous viruses
[00:04:00.540]
which you would otherwise be susceptible to.
[00:04:02.840]
- We and our microbes, it's not just two separate things.
[00:04:05.920]
It's just like another organ that we have.
[00:04:08.166]
[00:04:09.074]
- [Jack] Microbes can produce chemicals
[00:04:10.380]
which actually affect how our brains develop
[00:04:12.490]
and even how we behave. [baby crying]
[00:04:15.777]
"Hangry" may be a real thing.
[00:04:17.800]
We know that microbes can play a role
[00:04:19.380]
in diabetes, in obesity, in asthma and food allergies.
[00:04:23.843]
[00:04:27.784]
- In the last 50 years, we've seen an incredible decrease
[00:04:30.843]
in the amount of infectious diseases--
[00:04:32.810]
measles, mumps, tuberculosis, hepatitis.
[00:04:35.893]
That's great.
[00:04:37.220]
But in the same time frame, we've seen
[00:04:39.460]
almost an equal increase in the number
[00:04:42.200]
of autoimmune diseases, allergies, asthma,
[00:04:45.670]
diabetes, intestinal disorders, and obesity.
[00:04:49.113]
[00:04:50.451]
[waves lapping]
[00:04:53.118]
[00:04:55.803]
- My brother and my sister had very severe, chronic asthma,
[00:04:58.670]
the type that does not get controlled easily.
[00:05:01.210]
You almost have to put them in a cocoon
[00:05:03.140]
to prevent them from getting sick.
[00:05:05.800]
They can almost stop breathing
[00:05:07.400]
or you can see them changing color
[00:05:09.310]
due to the lack of oxygen.
[00:05:11.799]
[00:05:13.557]
[gentle piano music]
[00:05:16.307]
[00:05:22.130]
- When I see Ziair in an attack, sometimes I can't think
[00:05:27.130]
[00:05:27.815]
because I'm trying to think of what to do.
[00:05:30.520]
And there's nothing to do other than
[00:05:32.550]
just give him the three medications that they give him,
[00:05:36.032]
and if that seems not to be working
[00:05:37.821]
I feel scared.
[00:05:39.153]
[00:05:41.830]
- I try not to think too much about the fears,
[00:05:43.906]
but they're there.
[00:05:45.295]
[00:05:47.870]
- He is 12 weeks, I want him to be healthy
[00:05:51.310]
and grow up to be whatever he wants to be.
[00:05:53.633]
[00:05:57.352]
- There's only about a hundred different kinds of bacteria
[00:05:59.310]
that actually cause bacterial infections,
[00:06:02.130]
yet we have thousands of different species
[00:06:03.920]
in and on us, living on our bodies.
[00:06:06.255]
They help our brain develop, they help our gut develop,
[00:06:08.900]
they help our immune system develop,
[00:06:10.970]
and when you take them out of the equation
[00:06:12.730]
we realize this doesn't happen.
[00:06:14.280]
[00:06:15.350]
Then we started to see this rise in obesity
[00:06:17.620]
and allergies and asthma and autism and ADHD
[00:06:20.720]
and, y'know, you pick your disease.
[00:06:22.303]
[00:06:25.940]
- But how could microorganisms that live in your gut
[00:06:28.500]
affect your odds of developing asthma,
[00:06:30.840]
which is a disease of the lungs,
[00:06:33.081]
or diabetes, which is a blood sugar disorder?
[00:06:36.650]
In the next 50 minutes, we're gonna talk to families,
[00:06:39.510]
researchers and scientists to try and figure out
[00:06:42.660]
what's harming our microbiome,
[00:06:44.910]
and what we can do to reverse this dangerous trend.
[00:06:48.453]
[00:06:49.540]
But first, a quick biology primer.
[00:06:52.243]
[00:06:53.150]
A microbe is basically any living thing
[00:06:55.540]
that's too small to see without a microscope.
[00:06:58.330]
That includes protozoa, viruses, fungi, and bacteria.
[00:07:03.330]
[00:07:03.670]
Microbes are the oldest and most successful
[00:07:05.930]
life forms on earth.
[00:07:07.320]
And we've evolved with them, in a deeply complex
[00:07:10.410]
symbiotic relationship.
[00:07:11.943]
[00:07:13.060]
Microbes train our immune systems,
[00:07:15.283]
help us digest our food, and even help us fight disease.
[00:07:19.773]
[00:07:21.660]
Without microbes producing vitamin K for example,
[00:07:25.290]
our blood wouldn't coagulate
[00:07:27.170]
and we'd pretty much all bleed to death.
[00:07:30.060]
Yuck!
[00:07:30.893]
[00:07:32.606]
- It turns out that you and I
[00:07:33.470]
are basically genetically identical.
[00:07:34.840]
We're 99.99% of the chromosome the same between us, right?
[00:07:39.140]
And all humans are like that.
[00:07:40.550]
What's different is their microbes.
[00:07:42.322]
[jaunty orchestral music]
[00:07:45.380]
What we're finding is that we're actually
[00:07:47.320]
not being very good to our microbes.
[00:07:49.662]
[00:07:52.880]
Ironically, our grandparents had much better microbes
[00:07:55.412]
than we do now.
[00:07:56.420]
[00:07:58.832]
- And how do we know what kind of microbes
[00:08:00.970]
people had a hundred years ago?
[00:08:02.520]
[00:08:04.218]
Mostly from the guts of World War I soldiers
[00:08:06.597]
buried in permafrost.
[00:08:08.820]
And even further back, from frozen Viking latrines.
[00:08:13.300]
The microbes in these samples
[00:08:14.420]
are totally different from what are found
[00:08:16.140]
in modern European populations today.
[00:08:18.693]
[00:08:19.670]
- [Marie-Claire] In the past century or two,
[00:08:21.330]
we really have been cleaning up the world,
[00:08:23.710]
and there's been really drastic changes
[00:08:25.780]
not only in the type and the number of microbes
[00:08:28.390]
that we get to live with,
[00:08:30.091]
but also the consequences in our bodies.
[00:08:32.743]
[00:08:35.250]
- We're missing these essential microbes
[00:08:36.900]
that we need just to live normally.
[00:08:38.943]
- And that leads to disease? - Yep.
[00:08:40.560]
There's a lot of data indicating that this does.
[00:08:42.750]
You can take mice that don't have any microbes.
[00:08:44.670]
Their brains don't develop normally,
[00:08:46.060]
their immune system does not develop normally,
[00:08:47.840]
their gut doesn't develop normally.
[00:08:49.640]
And what we're now realizing
[00:08:51.210]
is that many of these diseases have screwed up microbes,
[00:08:54.240]
and in several cases we're showing
[00:08:55.990]
that the screwed up microbe
[00:08:57.420]
is actually contributing to the disease.
[00:09:00.753]
[00:09:09.070]
- So what happened?
[00:09:10.800]
If the rise of so many modern diseases
[00:09:13.140]
stems from our kids' missing microbes--
[00:09:15.620]
the ones that our grandparents all had--
[00:09:18.696]
where'd they go?
[00:09:20.597]
[blocks crashing] [all laughing]
[00:09:24.264]
[00:09:25.564]
[upbeat instrumental music]
[00:09:28.380]
- In this one generation, in about 30 years,
[00:09:30.890]
the rates of asthma have quadrupled.
[00:09:34.120]
That's huge, huge numbers.
[00:09:36.370]
And it can't just be genetics,
[00:09:37.780]
because my mom's genes aren't particularly different
[00:09:41.110]
from my genes.
[00:09:42.385]
So it's something about the environment
[00:09:44.093]
that kids are growing up in today.
[00:09:46.790]
- [Marie-Claire] We're depriving our bodies
[00:09:48.710]
of this healthy exposure to microbes,
[00:09:50.840]
especially when we're young.
[00:09:52.783]
[00:09:54.160]
- [Becky] Dr. Marie-Claire Arrieta
[00:09:55.400]
is looking at how microbiomes in different cultures
[00:09:58.400]
can lead to different health outcomes.
[00:10:01.150]
In Ecuador, for example, she studied a community
[00:10:03.660]
where part of the population got clean drinking water,
[00:10:06.520]
and part did not.
[00:10:07.803]
[00:10:10.850]
- People that had potable, clean water in their homes
[00:10:14.740]
had a higher risk of asthma,
[00:10:17.150]
and that really surprised us
[00:10:18.810]
because it possibly showed that it is really
[00:10:21.340]
that microbial environment around the type of water
[00:10:25.410]
that they're drinking and other exposures
[00:10:28.000]
that are driving this risk.
[00:10:30.523]
[00:10:31.450]
Now of course we want clean water
[00:10:33.095]
because we need to avoid infectious diseases,
[00:10:35.630]
they're quite dangerous-- but we want both.
[00:10:38.940]
We want clean water, but we also want lower risk.
[00:10:42.240]
[00:10:44.700]
- [Becky] Now, along with Dr. Cecilia Ximenez
[00:10:47.210]
of The National Autonomous University of Mexico,
[00:10:50.110]
she's looking at microbiome-related health outcomes
[00:10:53.310]
of kids in Xoxocotla, Mexico.
[00:10:55.583]
[00:10:58.560]
- Whether it is a tropical forest
[00:11:00.620]
or the arctic tundra or our gut microbiome,
[00:11:04.320]
one of the critical aspects in ecosystems
[00:11:07.320]
is this concept known as diversity.
[00:11:09.913]
[00:11:13.510]
Even from early ages, the microbiomes here
[00:11:16.330]
start a lot more diverse.
[00:11:18.263]
[00:11:19.280]
With the process of industrialization,
[00:11:21.450]
we seem to have lost about a third of the diversity
[00:11:25.100]
in our microbiome.
[00:11:26.457]
And that's pretty huge.
[00:11:27.723]
[00:11:29.020]
These kids, just like kids in North America,
[00:11:31.710]
will play a lot with other kids,
[00:11:33.220]
but they may do it in a different way here.
[00:11:35.740]
They may be bare feet when they're kicking around a ball
[00:11:38.990]
and they're also more exposed to animals--
[00:11:40.810]
and not just your average cat or dog,
[00:11:42.830]
they have goats and chickens and cows
[00:11:46.150]
and pigs, even, around where they live.
[00:11:48.803]
[00:11:49.710]
I mean, these kids eat peanuts in preschool
[00:11:52.360]
as a healthy snack.
[00:11:54.180]
It's a very different way of growing up,
[00:11:56.840]
and we can learn a lot from diversity
[00:11:59.470]
and other components of the microbiome
[00:12:01.130]
and their immune system.
[00:12:02.373]
[00:12:04.864]
[speaking in Spanish dialect]
[00:12:08.531]
[00:12:44.356]
[chiming instrumental music]
[00:12:46.730]
- Even though they are at a socioeconomic disadvantage,
[00:12:49.920]
for all intents and purposes
[00:12:51.360]
these are healthy children.
[00:12:53.510]
However, their microbiome is completely different
[00:12:56.050]
to the microbiome in North American children
[00:12:59.160]
and also in other Western countries.
[00:13:02.265]
[00:13:04.580]
In Mexico, the rates of asthma and immune diseases
[00:13:07.287]
like allergies or autoimmune disease
[00:13:09.914]
are down in comparison to the rates
[00:13:12.910]
that we're seeing in the more developed world.
[00:13:15.210]
[00:13:19.500]
- [Becky] Yet even within the more developed world,
[00:13:22.230]
lifestyle differences can profoundly affect
[00:13:24.610]
the variety of microbes that live on and in our children,
[00:13:28.620]
which in turn can significantly impact their health.
[00:13:31.523]
[00:13:33.900]
- We're no longer dying in our millions
[00:13:35.630]
from pathogenic infections thanks to vaccines,
[00:13:38.250]
thanks to public health works.
[00:13:39.780]
However, removing that exposure overall
[00:13:42.413]
may have led to our bodies now becoming
[00:13:45.000]
over-sensitized to the rest of the world.
[00:13:47.103]
[00:13:49.360]
We've known for many years that the rate of asthma
[00:13:51.400]
can be higher in the urban communities, in the cities,
[00:13:54.140]
than it is in the rural communities,
[00:13:56.560]
which we put down to the fact
[00:13:57.700]
that people in urban environments
[00:13:58.930]
are being exposed to more pollution
[00:14:00.840]
in the environments around them.
[00:14:02.440]
[00:14:03.900]
When we first started exploring the Amish populations,
[00:14:06.340]
we noticed that that population of people
[00:14:08.650]
had a very low rate of asthma--
[00:14:09.941]
almost 3% or 4%--
[00:14:11.616]
compared to the average for the United States
[00:14:13.730]
which is around 7% to 8%.
[00:14:15.403]
[00:14:16.450]
We also noticed a sister population to the Amish
[00:14:18.930]
called the Hutterites.
[00:14:20.160]
Both these populations have adopted
[00:14:21.850]
a technology-free lifestyle.
[00:14:23.460]
But the Hutterites had almost 25% asthma
[00:14:26.248]
in their population.
[00:14:28.000]
Genetically, the Amish and the Hutterites
[00:14:30.510]
are the same people.
[00:14:31.690]
They drink unpasteurized milk,
[00:14:33.530]
they eat unpasteurized cheese.
[00:14:35.200]
They live this ultimate foodie lifestyle, almost.
[00:14:38.430]
However, the major difference between them
[00:14:40.335]
is that the Amish live on their farms.
[00:14:42.550]
Their front door is 50 feet from the barn door.
[00:14:45.200]
The kids, before school and after school,
[00:14:47.470]
are working in that farming environment.
[00:14:49.940]
The Hutterites don't.
[00:14:51.400]
The men get in their buggy in the morning,
[00:14:52.880]
drive out to the farm, change into work clothes,
[00:14:55.080]
work on the farm all day, drive home.
[00:14:57.110]
And so the children living at home
[00:14:59.390]
have no exposure to that farming environment.
[00:15:01.560]
They have 25% asthma in their population
[00:15:04.000]
compared to the Amish, who are living and working
[00:15:06.500]
on the farm all the time,
[00:15:07.540]
who have 4% or 5% asthma in their population.
[00:15:10.223]
[00:15:13.100]
- That's powerful evidence.
[00:15:14.970]
Unfortunately, we can't all keep a cow in our front yard.
[00:15:18.153]
[00:15:21.990]
So I've been wondering about my family.
[00:15:24.380]
What do our microbiomes look like?
[00:15:26.380]
I mean, I've chosen to raise my kids here in the suburbs.
[00:15:29.510]
How do our microbes compare to those
[00:15:32.060]
of families from less-developed nations,
[00:15:34.230]
or even farm families right here in the U.S.?
[00:15:37.047]
[00:15:39.090]
There are a number of different companies
[00:15:41.240]
that provide test kits to do just that--
[00:15:44.110]
find out what microbes are in our guts.
[00:15:47.360]
But here's the thing.
[00:15:48.650]
You know how we test for that?
[00:15:50.230]
- Your poop. [laughing]
[00:15:52.840]
- It's for science. - Yay!
[00:15:55.403]
- It's disgusting, yay. [laughing]
[00:15:59.070]
- You just swab a piece of used toilet paper
[00:16:02.130]
and put the sample into the vial that they provide.
[00:16:05.983]
[00:16:07.978]
I'll spare you watching this part.
[00:16:10.926]
[00:16:14.310]
A few weeks later, I get back the results,
[00:16:16.570]
and call up Dr. Arrieta to help me understand them.
[00:16:19.483]
[00:16:21.211]
- Hi. - Hey Claire, how are you?
[00:16:22.836]
- Good.
[00:16:23.669]
How are you? - I'm great.
[00:16:24.880]
I'm really curious, are my family's microbes normal
[00:16:29.210]
or are they close to what used to be normal?
[00:16:32.140]
- Great question.
[00:16:33.178]
You and your kiddos
[00:16:34.411]
have the prototypic North America microbiome...
[00:16:37.790]
- Is that good or bad? - It's different.
[00:16:40.700]
We're now at a time where we can only talk
[00:16:43.668]
in terms of "associated with."
[00:16:46.257]
We do not know if that particular bug
[00:16:48.656]
is going to cause diabetes later on, or obesity later on.
[00:16:52.880]
We're still not there yet, but we can associate it.
[00:16:56.600]
- So my son, Finn, has asthma.
[00:16:58.600]
Is there any benefit in taking him to visit a farm?
[00:17:02.467]
- Unfortunately, no.
[00:17:03.690]
I mean, you're thinking of just packing it up
[00:17:05.550]
and moving to a farm hoping
[00:17:07.220]
that his asthma is going to get better?
[00:17:08.879]
No.
[00:17:09.712]
In fact, it would probably get worse.
[00:17:11.810]
At the same time, we do know that being raised in a farm
[00:17:16.320]
is a protective factor.
[00:17:18.710]
This exposure to the microbes
[00:17:21.310]
that are common in a farm,
[00:17:23.503]
they are able to train the immune system
[00:17:26.950]
into this state that is not going to lead to asthma.
[00:17:31.300]
So it seems that it's early life when it matters the most.
[00:17:34.473]
[00:17:39.480]
- All right, let's dig into that a little.
[00:17:41.380]
Asthma is a chronic disease that already affects
[00:17:44.650]
about 1 in 12 North American children.
[00:17:47.230]
And it's on the rise.
[00:17:48.803]
[00:17:50.700]
Scientists who study the microbiome
[00:17:52.500]
focus so much of their attention on asthma
[00:17:54.680]
because it's often just the first
[00:17:56.350]
of many immune disorders that cause problems.
[00:17:59.063]
[00:18:00.500]
- It affects families like you wouldn't believe.
[00:18:03.103]
[00:18:04.070]
Parents miss work, children miss school.
[00:18:06.560]
I've had parents actually lose jobs
[00:18:08.620]
because they had to take off so much time.
[00:18:10.970]
So that affects all of society,
[00:18:12.820]
because then now the parent isn't able to go back to work
[00:18:15.670]
because the child has been sick so often
[00:18:17.850]
that the employer finally has to let them go.
[00:18:20.960]
So it has large, far-reaching repercussions.
[00:18:25.960]
[00:18:26.403]
[water bubbling]
[00:18:27.953]
[00:18:33.002]
- Do you see how much he's pouring?
[00:18:34.782]
Keep on going.
[00:18:36.420]
I began to see him labor with his breathing.
[00:18:40.640]
I could literally see in his throat,
[00:18:43.504]
[inhaling and exhaling slowly] I could see that.
[00:18:48.504]
[00:18:49.410]
Then I began to hear it.
[00:18:51.847]
[00:18:54.671]
He literally would not be able to breathe,
[00:18:56.588]
and it would just come out of nowhere.
[00:18:58.740]
- It's hard to breathe when I'm like that,
[00:19:01.230]
and then my stomach starts hurting and I feel sick.
[00:19:05.950]
- This is an illness that's chronic,
[00:19:08.590]
that could take my son's life.
[00:19:10.383]
[00:19:14.770]
- I hear children saying all the time, "I don't take gym.
[00:19:17.347]
"I know I'm overweight, but I can't take gym
[00:19:19.577]
"because I have asthma."
[00:19:21.037]
[00:19:22.780]
We want them to be physically active,
[00:19:24.700]
but they are afraid to be active
[00:19:26.110]
because they're afraid they're going to have
[00:19:27.460]
an asthma attack and die.
[00:19:28.713]
[00:19:30.016]
[tender piano music]
[00:19:32.516]
[00:19:33.980]
- We try to let him operate as a regular kid, you know.
[00:19:37.520]
But the reality is, is he's not.
[00:19:40.143]
[00:19:44.775]
- When the kids are playing I'll be like,
[00:19:47.072]
"Naw, I don't wanna go outside."
[00:19:49.922]
[00:19:51.514]
And I just stay inside.
[00:19:53.730]
[00:19:54.750]
- I can't control his breathing.
[00:19:56.940]
I can't control the medicine intake.
[00:19:59.630]
I can't control the doctor's prescription.
[00:20:02.530]
But what I can control is the love
[00:20:05.500]
and the commitment that we have for one another.
[00:20:08.343]
[00:20:12.510]
Ziair's big brother, Amir, takes really good care of him.
[00:20:16.593]
[00:20:17.590]
He is always around and, like, literally,
[00:20:20.780]
he wants to be around him.
[00:20:22.620]
He comes around when other big brothers
[00:20:25.230]
would rather have their little brother be somewhere else.
[00:20:28.690]
How you feel? - I feel good.
[00:20:30.976]
- You need your medicine? No? - I don't think so.
[00:20:34.678]
- [Audrey] Amir is often sad
[00:20:37.150]
because he's in the same position as me,
[00:20:39.740]
watching his baby brother struggle to gasp for air.
[00:20:44.740]
[00:20:48.060]
If I had a magic wand, my son would be able to breathe
[00:20:51.360]
so that he could live the best life that he can have.
[00:20:54.483]
[00:20:59.140]
- Asthma is the number one reason
[00:21:01.460]
for children going to hospital,
[00:21:03.430]
number one reason for children missing school.
[00:21:05.990]
Number one reason for billing
[00:21:07.750]
to the healthcare system, is asthma.
[00:21:09.673]
[00:21:10.980]
About 10 years ago a bunch of Canadians
[00:21:13.150]
got together and said, "We don't know what's causing asthma.
[00:21:15.697]
"There's a huge increase, we've gotta do something."
[00:21:18.297]
[00:21:21.120]
The Allergy, Genes and Environment Network
[00:21:23.370]
had already been looking into the causes
[00:21:25.250]
and treatments of asthma and allergies.
[00:21:27.290]
So AllerGen, along with a Canadian team of leaders
[00:21:30.490]
in clinical work and research, launched
[00:21:32.720]
the Canadian Healthy Infant Longitudinal Development Study.
[00:21:36.293]
[00:21:39.010]
- The CHILD Study was developed to explore
[00:21:41.530]
the early origins of allergy and asthma--
[00:21:44.550]
what happens during pregnancy
[00:21:46.270]
and the first few years of life.
[00:21:48.273]
[00:21:50.010]
- One of the things that was really brilliant
[00:21:51.720]
about the CHILD study was that we took the stool samples
[00:21:54.940]
from those kids when they were born,
[00:21:57.020]
when they were three months old,
[00:21:58.283]
when they were one year old, and we froze them down.
[00:22:01.432]
And then we were able to compare the bacterial composition
[00:22:04.462]
in kids who went on to have asthma versus those who didn't.
[00:22:08.170]
And we found that those kids who were at highest risk
[00:22:10.372]
of asthma seemed to be missing four bacteria,
[00:22:14.032]
and interestingly they were missing those bacteria
[00:22:16.357]
in the first 100 days of life.
[00:22:18.800]
- What are the bacteria? - So the bacteria
[00:22:21.030]
have complex Latin names--
[00:22:23.310]
Faecalibacterium, lachnospira, veillonella and rothia.
[00:22:27.790]
That's a bit of a mouthful, so we nicknamed them FLVR.
[00:22:31.760]
F-L-V-R.
[00:22:33.180]
- But how would the bacteria fight asthma?
[00:22:37.011]
- So asthma and allergy is really actually
[00:22:39.003]
an immune system problem.
[00:22:40.728]
And what we've learnt is that the gut bacteria,
[00:22:43.430]
we call that the microbiome,
[00:22:44.990]
is really important for training
[00:22:46.690]
and educating the immune system.
[00:22:48.700]
We don't know exactly what's going on yet.
[00:22:51.720]
We have evidence that those FLVR bacteria make chemicals--
[00:22:54.675]
we call them metabolites--
[00:22:56.333]
and that those metabolites train up the immune system.
[00:22:58.820]
We know that children who get more antibiotics,
[00:23:01.427]
they have higher risk of asthma.
[00:23:04.183]
Children born by ceasarean section
[00:23:06.424]
have higher risk of asthma.
[00:23:08.230]
Kids who live on farms have a lower risk of asthma.
[00:23:11.180]
[00:23:12.110]
So when you start putting all those elements together
[00:23:14.602]
one of the common themes there is actually
[00:23:16.540]
the bacteria that live inside us.
[00:23:18.503]
[00:23:21.050]
- If this were a crime show, I'd say
[00:23:23.358]
"Lifestyle changes. Guilty"
[00:23:25.616]
But lifestyle and environment aren't the only suspect,
[00:23:29.470]
and asthma is not the only crime.
[00:23:32.363]
[00:23:33.421]
[brooding instrumental music]
[00:23:36.088]
[00:23:38.440]
Every doctor and scientist I've talked to
[00:23:40.600]
says you can't start too early
[00:23:43.180]
developing a healthy microbiome.
[00:23:45.170]
Those first 100 days are crucial.
[00:23:48.000]
There is some indication of microbial transfer in utero,
[00:23:51.970]
but the biggest transfer happens at the moment of birth.
[00:23:55.463]
[00:23:59.250]
- Birth is a very messy process.
[00:24:00.660]
Ironically, this is important.
[00:24:02.010]
I jokingly say that the best birthday present
[00:24:04.720]
you ever give your kid is the very first one
[00:24:06.630]
and that's this-- this big dose
[00:24:08.400]
of vaginal and fecal microbes.
[00:24:10.380]
Boom, you're born with this.
[00:24:11.955]
Welcome to the world, kid.
[00:24:13.338]
- Happy Birthday! - Happy Birthday.
[00:24:14.670]
That's really important because it kicks up
[00:24:16.390]
the immune system and it gets the digestive tract going,
[00:24:19.140]
it gets the brain going, and if you have a C-section,
[00:24:22.010]
unfortunately you miss that.
[00:24:24.343]
[00:24:25.230]
- Between 2000 and 2015, the rate of C-section worldwide
[00:24:28.950]
has doubled, and children at the age of seven
[00:24:31.700]
had a 50% increased risk of obesity
[00:24:34.460]
if they were delivered by C-section
[00:24:36.470]
compared to their vaginally-delivered counterparts.
[00:24:39.323]
[00:24:41.870]
- We know that ceasarean sections
[00:24:44.055]
are often life-saving and medically necessary
[00:24:46.580]
for both moms and babies,
[00:24:48.500]
but babies born by C-section really don't get exposed
[00:24:51.530]
to mom's vaginal flora at all.
[00:24:53.500]
Their bacteria often resemble that in the
[00:24:55.690]
operating room, or of the mother's skin.
[00:24:58.850]
But babies born by ceasarean section
[00:25:00.960]
are at increased risk of different health problems
[00:25:03.550]
including obesity, allergies and asthma.
[00:25:06.653]
[00:25:08.930]
- My first children are one-year-old twins
[00:25:11.210]
and they were born via C-section.
[00:25:12.890]
And then I did get pregnant again [laughs],
[00:25:15.957]
and because it was so close together
[00:25:19.210]
it's really not recommended to have a vaginal birth
[00:25:22.150]
because there's a possibility of uterine rupture.
[00:25:25.033]
[00:25:27.630]
- I had a complete previa with her,
[00:25:30.260]
so they had to do a C-section for that one
[00:25:32.650]
and there were some complications.
[00:25:34.910]
So then the doctor recommended a C-section for Liv also.
[00:25:39.683]
[00:25:40.950]
- I've worked with kids that have had health issues,
[00:25:43.300]
and even the minor ones, it's alot for a child.
[00:25:45.820]
It's alot in school, it's alot for the parents.
[00:25:48.510]
It can be very difficult.
[00:25:49.950]
So if there was any way that I could decrease
[00:25:52.840]
those chances of them having health issues, I would do that.
[00:25:57.170]
I think any parent would do that.
[00:25:58.673]
[00:26:02.330]
- I hope that they're going to be safe,
[00:26:04.230]
[00:26:07.602]
and that they have a good childhood growing up
[00:26:10.470]
[00:26:13.140]
and that nothing ever happens to them.
[00:26:16.307]
[00:26:21.900]
- [Becky] Antibiotics are wonder drugs.
[00:26:24.340]
They've saved countless millions of lives.
[00:26:27.482]
But what we now realize is that antibiotics
[00:26:30.310]
don't just kill the bad germs that cause infection,
[00:26:33.660]
they can kill all microbes.
[00:26:35.673]
[00:26:36.800]
- The negative effects of damaging the microbiome
[00:26:39.270]
at an early age is that you are damaging
[00:26:41.972]
the way their immune system develops.
[00:26:44.453]
[00:26:45.910]
And because of that, they can get diseases
[00:26:48.232]
such as asthma, allergies, multiple sclerosis--
[00:26:51.468]
even autism, we're learning now--
[00:26:53.540]
and also metabolic diseases such as obesity and diabetes.
[00:26:57.043]
[00:26:59.910]
- Life expectancy today is 30 years longer
[00:27:02.670]
than it was just a century ago, largely due to antibiotics.
[00:27:07.303]
[00:27:08.810]
During the Civil War, more people died
[00:27:10.820]
of infectious diseases than from bullet wounds.
[00:27:14.463]
[00:27:15.550]
But with all the benefits of antibiotics,
[00:27:17.690]
have we traded one class of ailments for another?
[00:27:20.935]
[00:27:25.460]
Doniga Markegard raises grass-fed beef
[00:27:27.838]
just south of Half Moon Bay, California.
[00:27:30.660]
And her kids? - Oh, it pooped!
[00:27:32.600]
- Yeah, they're fairly free-range as well.
[00:27:34.913]
[00:27:38.760]
I love seeing your kids out here playing in the pond.
[00:27:42.090]
Do they swim in here in the summer?
[00:27:43.500]
- Oh gosh, yeah. [laughing]
[00:27:45.310]
Strip down naked, cover themselves with mud.
[00:27:48.383]
Yeah, they love it. - It's great.
[00:27:50.500]
- Yeah, all my kids were born right here on the ranch.
[00:27:53.620]
And I made it a point that they would go
[00:27:57.710]
right from breast milk to food that we either
[00:28:01.003]
grow or raise, or that we source from local organic farms.
[00:28:04.830]
And they don't suffer from any of the common things
[00:28:08.278]
that you see with kids, like allergies or asthma
[00:28:12.336]
or runny noses and things like that.
[00:28:15.470]
[00:28:17.760]
- [Becky] Of course, this is just one family
[00:28:20.330]
who might just be lucky.
[00:28:22.550]
But the real reason I've come here
[00:28:24.110]
is to talk about a simple fact.
[00:28:26.660]
- 80% of the antibiotic use in this country
[00:28:30.230]
is fed to livestock. - Wow.
[00:28:32.163]
[00:28:33.030]
- It's proven that antibiotics help growth promotion,
[00:28:36.573]
[00:28:37.810]
whereas our animals that are raised on a natural diet
[00:28:42.440]
take a couple years to finish.
[00:28:45.110]
In a feedlot, many of those animals might start on grass,
[00:28:48.446]
but then they'll go into a feedlot to finish.
[00:28:51.380]
And so with the feed rations and that antibiotic use,
[00:28:55.504]
they can get those animals to finish in 18 months.
[00:28:58.423]
[00:28:59.990]
It's a profitable way that farmers have found
[00:29:04.160]
that they can produce large amounts of meat
[00:29:06.840]
in a shorter amount of time.
[00:29:09.073]
[00:29:10.420]
- [Becky] So it seems like ranchers have known for decades
[00:29:13.530]
that antibiotics make livestock put on weight faster.
[00:29:17.530]
And experts confirm the same is true of humans.
[00:29:21.816]
- Babies exposed to antibiotics,
[00:29:23.770]
especially in the first six months, the first year,
[00:29:25.861]
are more likely to develop obesity later in childhood.
[00:29:29.273]
[00:29:31.370]
It's not that every child that receives antibiotics
[00:29:33.570]
is going to develop asthma or become obese.
[00:29:35.820]
But we do see a significant association.
[00:29:38.173]
[00:29:39.780]
Antibiotics sometimes are really important
[00:29:41.475]
and life-saving drugs,
[00:29:42.712]
but sometimes they're also used unnecessarily.
[00:29:44.903]
[00:29:46.570]
- In fact, even the CDC states that
[00:29:48.847]
"30% to 50% of antibiotics prescribed in hospitals
[00:29:52.237]
"are unnecessary or inappropriate."
[00:29:54.927]
[00:29:58.150]
So, antibiotics-- good, but not great.
[00:30:01.963]
[00:30:08.680]
Food allergies increased 50% between 1997 and 2011.
[00:30:13.680]
[00:30:14.440]
And the map tracking obesity since 1980?
[00:30:17.234]
Well, it's dramatic-- and a little scary.
[00:30:19.818]
[00:30:21.900]
We heard earlier about the link between antibiotic use
[00:30:25.230]
and obesity, but is there actual proof
[00:30:28.360]
that microbes play a role in the obesity epidemic?
[00:30:31.973]
[00:30:33.730]
Kids are eating more, and playing and being active less.
[00:30:38.320]
But the rates of childhood obesity
[00:30:40.730]
have gone through the roof.
[00:30:42.120]
- Yeah, there's no doubt exercise and diet
[00:30:43.930]
play a role in it, but what we now realize
[00:30:45.475]
is that there's microbes, too.
[00:30:47.510]
This field got kickstarted about 10, 15 years ago
[00:30:50.400]
when a guy named Jeff Gordon did fecal transfers.
[00:30:52.830]
They took a fat mouse, an obese mouse,
[00:30:54.850]
took its feces, put it in the thin mouse,
[00:30:57.070]
thin mouse got fat.
[00:30:58.680]
Fecal transfer just took thin mouse
[00:31:01.113]
into fat mouse, the fat mouse got thin.
[00:31:03.303]
[00:31:08.310]
- [Becky] One simple preventative factor
[00:31:10.140]
may be something that moms have been giving their kids
[00:31:12.450]
since, well, pretty much since there've been moms and kids.
[00:31:16.263]
[00:31:17.640]
- If there's one gift that a woman could give
[00:31:20.850]
to her children it would be breast milk.
[00:31:24.183]
[00:31:26.770]
- When I'm breastfeeding my girls
[00:31:28.470]
I know there's something else going on
[00:31:30.290]
besides just the nutrition.
[00:31:32.123]
[00:31:33.900]
I think they're learning that they belong here.
[00:31:36.250]
[00:31:38.520]
- Where we're from, Guatemala, everybody nurses.
[00:31:41.706]
Everyone.
[00:31:42.606]
And if you can't nurse, another person that had a child,
[00:31:45.040]
they will nurse your child.
[00:31:46.390]
[00:31:47.260]
- The recommendation from the World Health Organization
[00:31:49.840]
is to exclusively breastfeed for six months,
[00:31:52.120]
and then to continue breastfeeding for up to two years.
[00:31:55.140]
Today in the United States, about a quarter of moms
[00:31:58.346]
are attaining that six months of exclusive breastfeeding.
[00:32:01.070]
In the UK it's less than 1%, and that's a problem.
[00:32:04.710]
Breastfeeding is associated with lower rates of asthma,
[00:32:07.530]
certain types of allergies, lower rates of obesity.
[00:32:10.303]
[00:32:11.210]
The other component of breastfeeding
[00:32:12.590]
that's often forgotten or ignored
[00:32:14.830]
is that it also benefits the mother.
[00:32:17.360]
Moms who breastfeed have a lower rate of diabetes later on.
[00:32:20.600]
They have lower rates of breast cancer and ovarian cancer.
[00:32:23.553]
[00:32:25.350]
- [Becky] But what does all this have to do
[00:32:26.570]
with our kids' missing microbes?
[00:32:28.950]
As it turns out, when you breastfeed
[00:32:30.860]
you aren't just feeding your baby,
[00:32:32.860]
you're feeding your baby's microbes
[00:32:35.190]
in ways that even the most advanced infant formulas
[00:32:38.158]
aren't yet able to do.
[00:32:40.023]
[00:32:41.000]
- [Meghan] Over thousands and millions of years,
[00:32:42.940]
breast milk has evolved to feed babies and their microbiota.
[00:32:46.185]
[00:32:47.069]
- [Lars] Why is Mom making 150,
[00:32:48.967]
200 different complex molecules
[00:32:50.729]
at very high concentrations if there wasn't a benefit
[00:32:53.830]
for either the infant or the mom?
[00:32:56.250]
- We now know that those oligosaccharides
[00:32:58.120]
are feeding the gut microbes.
[00:32:59.710]
So they're not feeding the baby,
[00:33:00.780]
they're feeding the baby' microbes,
[00:33:02.260]
and that's incredibly important.
[00:33:04.070]
These microbes help us digest the food that we eat.
[00:33:06.390]
That's also true for babies.
[00:33:07.630]
They generate certain vitamins
[00:33:09.340]
that we're not able to generate on our own.
[00:33:11.790]
- [Lars] In addition to that, there is certain bacteria
[00:33:14.260]
that are killed or at least their growth is stopped
[00:33:17.470]
by certain oligosaccharides.
[00:33:18.870]
[00:33:20.400]
- [Becky] In other words, in addition
[00:33:21.780]
to helping your baby develop beneficial microbes,
[00:33:24.880]
breast milk provides a natural antibiotic
[00:33:27.287]
that helps keep the nasty microbes in check.
[00:33:30.513]
[00:33:32.380]
- Breast milk is so much more than a food.
[00:33:34.160]
It really could be considered a baby's first vaccine,
[00:33:36.760]
because it's a dose of incredibly important
[00:33:39.220]
immune boosting factors.
[00:33:40.793]
[00:33:41.810]
Breast milk is really the original personalized medicine.
[00:33:45.090]
Every mom makes different breast milk.
[00:33:46.950]
And even that mom's breast milk changes over time,
[00:33:49.390]
so as the infant grows the breast milk changes
[00:33:51.590]
to meet its needs.
[00:33:52.950]
So if a baby gets sick, breast milk changes
[00:33:55.740]
to adapt to that change.
[00:33:57.263]
[00:33:58.517]
In the CHILD study where we looked at breastfed babies
[00:34:01.390]
and bottle-fed babies,
[00:34:02.730]
we saw the exclusively breastfed babies
[00:34:04.750]
had the very lowest rates of asthma.
[00:34:06.637]
And the formula-fed babies--
[00:34:08.430]
all fed from a bottle, all fed formula--
[00:34:10.105]
had the highest rates.
[00:34:11.388]
But in between that was the babies
[00:34:12.770]
getting some of their breast milk in a bottle.
[00:34:15.539]
We don't exactly know why that is-- whether it's because of
[00:34:18.420]
this sucking and lung exercise is one possibility.
[00:34:21.700]
Another is going back again to the microbiome,
[00:34:23.780]
because breastfed babies are also getting
[00:34:25.430]
their mom's skin microbes through breastfeeding,
[00:34:27.550]
and maybe those are important.
[00:34:29.050]
[00:34:30.800]
- So why don't more women breastfeed?
[00:34:33.530]
Well, I can tell you, it ain't easy.
[00:34:35.863]
[00:34:37.920]
Ugh, when I think about those days-- so hard!
[00:34:41.582]
[00:34:42.482]
And for many women, it's complicated.
[00:34:45.113]
[00:34:46.080]
- It's a loaded question to ask a mother
[00:34:48.230]
what her plans are for breastfeeding,
[00:34:49.970]
because I think it's this horrible combination
[00:34:54.590]
of it being the most natural thing in the world
[00:34:56.440]
and probably one of the hardest things in the world to do.
[00:35:00.053]
[00:35:01.170]
- I think it's no surprise that who breastfeeds
[00:35:04.260]
follows along typical racial and class lines
[00:35:07.460]
in terms of inequality.
[00:35:09.520]
I don't think I could have done it for as long as I had
[00:35:11.800]
if I didn't have an employer
[00:35:13.800]
that made lactation rooms available,
[00:35:15.890]
if I didn't have the money to invest in a good pump
[00:35:18.720]
that would allow me to keep producing
[00:35:20.520]
when I wasn't with the baby.
[00:35:21.920]
[00:35:23.120]
- My husband, he's really supportive.
[00:35:24.807]
"What can you do, he's crying, y'know?
[00:35:26.990]
"Just take it out."
[00:35:28.815]
He's like, "Don't care about what people think."
[00:35:31.510]
And here I go, when he cries, I breastfeed.
[00:35:35.303]
[00:35:40.780]
- [Lars] One reason why we are not talking
[00:35:42.300]
about these things very often
[00:35:43.620]
is because it's an uneven playing field.
[00:35:46.000]
The formula industry has a multi-billion dollar market
[00:35:48.970]
and marketing campaign behind it
[00:35:50.519]
that pushes the product which is not
[00:35:52.750]
the equivalent to human milk.
[00:35:54.200]
[00:35:55.240]
- [Meghan] It's an issue well beyond just educating mothers.
[00:35:58.020]
It's a societal issue, moms have to be supported.
[00:36:00.280]
Either they have to go back to work
[00:36:01.710]
and they don't have a paid maternity leave,
[00:36:03.330]
maybe they don't have the support from their family members.
[00:36:05.850]
Maybe they feel stigmatized out in public.
[00:36:08.090]
These are all things that are societal issues
[00:36:10.540]
that policies could help address.
[00:36:12.390]
[00:36:13.800]
- The last thing we want is to stigmatize women
[00:36:16.660]
that cannot breastfeed or choose not to breastfeed.
[00:36:19.824]
I think we need to be sure
[00:36:21.873]
that we have alternatives available,
[00:36:23.963]
whether that's donor milk or substitutes
[00:36:26.530]
in the form of infant formula.
[00:36:28.771]
If it's infant formula, we need to make sure
[00:36:30.840]
the infant formula is as good as it gets,
[00:36:33.080]
and that's where some of the science needs to go as well.
[00:36:35.930]
[00:36:36.900]
- So, breastfeeding--
[00:36:38.100]
if you can swing it, pretty strong recommendation.
[00:36:41.340]
And even after that, we need our kids
[00:36:43.970]
to keep feeding their own microbes.
[00:36:46.096]
Yeah, with veggies.
[00:36:48.804]
What do you tell your kids to help them understand it?
[00:36:51.220]
- I tell them that they have a zoo.
[00:36:52.550]
So I would say, "You have a zoo in you,
[00:36:54.587]
"and you have to feed it too."
[00:36:57.010]
And they like it.
[00:36:59.118]
It's this idea that they do literally have a zoo
[00:37:02.335]
of bacteria and bugs in their tummies,
[00:37:04.550]
and that it's almost like their pet
[00:37:06.350]
and they have to feed it every day.
[00:37:07.680]
Otherwise bad stuff can happen to them, and they realize it
[00:37:11.150]
and they almost see it as second nature now.
[00:37:13.422]
[00:37:14.414]
[playful instrumental music]
[00:37:17.331]
[00:37:19.290]
- [Becky] Being a parent is hard.
[00:37:21.180]
Just when you think you've finally mastered one level,
[00:37:23.260]
they grow, they change, and you feel
[00:37:25.230]
like you're back to square one.
[00:37:26.783]
[00:37:28.020]
So to help me sort out everything we've been talking about,
[00:37:31.050]
I go to someone I trust most-- my own kids' pediatrician.
[00:37:35.413]
[00:37:36.525]
- Hi! - Hi!
[00:37:37.651]
[00:37:38.986]
- It's so nice to see you guys!
[00:37:40.111]
- You've been with us-- maybe you guys
[00:37:41.980]
were a day or two days old when we first met.
[00:37:44.370]
- Just new to the world!
[00:37:46.165]
- You've been our pediatrician for 10 years.
[00:37:48.123]
- I can't remember that. - You can't remember?
[00:37:50.089]
Shocker.
[00:37:50.922]
- I remember that, I remember your mom coming out
[00:37:52.620]
with you guys in little baby bucket seats.
[00:37:54.450]
- We missed the vaginal birth part with twins,
[00:37:57.200]
and yet I feel like we're doing the best we can.
[00:37:59.640]
Everybody seems like they have a piece missing sometimes.
[00:38:02.066]
Y'know, you have antibiotics, whether or not
[00:38:04.140]
you were able to have a vaginal birth,
[00:38:06.130]
whether or not you were able to breastfeed.
[00:38:08.090]
These are all elements as parents
[00:38:09.860]
that you're trying to keep in place,
[00:38:11.390]
but it's hard to do them all.
[00:38:13.150]
- It is, and it's hard, y'know sometimes people feel like,
[00:38:15.987]
"Oh no, I failed at that."
[00:38:18.340]
And, y'know, kids-- people are amazingly resilient.
[00:38:22.120]
[00:38:23.228]
And so we pick up microbiome in other places.
[00:38:25.600]
And as scientists and as doctors,
[00:38:27.460]
we're always trying to figure out,
[00:38:28.590]
how can you help build that?
[00:38:29.990]
[00:38:31.040]
- This picture evokes for me
[00:38:32.760]
that feeling of helplessness as a parent.
[00:38:35.200]
Y'know, here's this tiny little guy
[00:38:36.660]
with a hospital bracelet on.
[00:38:38.302]
[00:38:39.160]
You see that?
[00:38:40.769]
Look how little you were.
[00:38:42.135]
[00:38:43.570]
Look how sick he was, he just was, like, listless.
[00:38:46.640]
And it was so scary for me as a parent.
[00:38:49.130]
And I remember thinking, "Carpet bomb this kid.
[00:38:51.727]
"Like, whatever it takes, let's get him better."
[00:38:54.270]
- It's tough, because for us as well
[00:38:56.370]
we don't know, is this kid going to get better
[00:38:58.640]
or are they going to need the antibiotics?
[00:39:00.680]
And often the easiest thing for a pediatrician
[00:39:02.970]
is to say, "Let's just treat," right?
[00:39:04.700]
You will never get sued for using antibiotics
[00:39:06.630]
in the way that you might if you don't, right?
[00:39:08.940]
Just to be blunt about it.
[00:39:11.440]
- So this guy has had more antibiotics,
[00:39:13.543]
he's had food allergies, asthma, he was colicky.
[00:39:17.662]
[00:39:18.679]
It's all those little signs that there's something going on
[00:39:22.236]
with this microbiome here.
[00:39:23.721]
[00:39:24.813]
And as a parent I feel like we're doing everything we can.
[00:39:29.313]
[00:39:30.654]
I can't get him to only eat kale [laughs], but I'm trying.
[00:39:35.646]
[00:39:37.001]
- It's not happening. [laughing]
[00:39:40.590]
- When these guys were teeny tiny
[00:39:42.600]
we were so worried about giving them vaccines,
[00:39:45.390]
and you really talked us off the ledge and said,
[00:39:47.217]
"Nope, this is good, this is going to make things better."
[00:39:50.870]
- [Katya] Vaccines act by showing the body the shape
[00:39:54.330]
of a particular kind of illness,
[00:39:55.650]
whether virus or bacteria.
[00:39:57.060]
So it is actually a really wonderful way
[00:39:59.270]
to gently exercise the immune system.
[00:40:01.120]
And the nice side effect is that when giving immunizations
[00:40:04.180]
the ear infection rate dropped a lot,
[00:40:06.546]
which meant kids got fewer antibiotics,
[00:40:08.340]
which meant less disruption to the microbiome.
[00:40:10.938]
[00:40:14.620]
- Regular vaccines equal fewer infections,
[00:40:18.850]
which means fewer antibiotics,
[00:40:21.360]
which means healthier microbiome.
[00:40:23.250]
- Yes.
[00:40:24.183]
- [Becky] And just to explicitly
[00:40:26.110]
address vaccine safety-- - You have
[00:40:28.320]
a one in a million chance of getting
[00:40:29.670]
an adverse reaction to a vaccine.
[00:40:31.550]
You have a 1 in 100 chance of dying of an infection.
[00:40:34.520]
I think the problem is people have never lived
[00:40:36.200]
in the pre-vaccine world.
[00:40:37.450]
[00:40:39.110]
Talk to your great-great-grandparents--
[00:40:40.825]
what was it like when you had a 50% chance of dying
[00:40:43.697]
before you got to school?
[00:40:45.520]
It was scary.
[00:40:47.428]
Every time you got a fever, you could die that day.
[00:40:50.128]
[00:40:51.145]
Vaccines work, we see the experiment.
[00:40:53.380]
These poor kids get these awful diseases
[00:40:55.250]
that are vaccine preventable, and those break my heart
[00:40:57.290]
because that kid should not have that disease.
[00:40:59.590]
[00:41:01.705]
[upbeat instrumental music]
[00:41:04.288]
[00:41:10.142]
- Just do that, and then put the ends in there, OK?
[00:41:12.792]
[00:41:16.460]
A lot of the research that we've talked about so far
[00:41:18.860]
is brand new.
[00:41:20.129]
The field is advancing so fast.
[00:41:23.149]
But this much we know is true--
[00:41:25.600]
changes in our environment, our lifestyle,
[00:41:27.848]
our medical practices and our diet have had a radical effect
[00:41:31.180]
on our children's natural microbial balance.
[00:41:33.910]
The question now-- what can we do about it?
[00:41:36.453]
[00:41:37.320]
- We need a reversal in the whole general way
[00:41:39.360]
we treat microbes.
[00:41:40.620]
Most of them are our friends.
[00:41:42.210]
There's only a small number that actually cause infections.
[00:41:44.860]
[00:41:46.350]
There are dangerous organisms out there,
[00:41:48.687]
and you do need to wash your hands after going to the toilet
[00:41:51.450]
and wash your hands after handling raw chicken.
[00:41:53.930]
But do you need to sterilize the banisters in your home?
[00:41:56.813]
No.
[00:41:57.646]
Do you need to use some kind of sterilizing floor cleaner?
[00:42:00.740]
No, not unless you intend on preparing
[00:42:03.040]
your raw chicken on the floor
[00:42:04.117]
and then cleaning it up and then licking it.
[00:42:06.163]
[00:42:07.220]
- Watch a kid in action.
[00:42:08.979]
What does a kid do?
[00:42:10.800]
Puts everything they possibly can in their mouth, right?
[00:42:13.310]
Why are they doing that?
[00:42:14.450]
If that was so bad,
[00:42:15.588]
they should have evolved so they stand like this
[00:42:17.203]
and never put anything in their mouth.
[00:42:18.869]
I'll tell you one story that drives it home.
[00:42:20.442]
Soothers, binkies, right?
[00:42:22.210]
OK, so you have the soother,
[00:42:23.740]
you put it in a kid's mouth,
[00:42:24.988]
and what does this kid do?
[00:42:26.363]
Spits it out, right?
[00:42:27.320]
OK, it's bouncing around on the floor.
[00:42:28.950]
What do I do with this thing?
[00:42:29.800]
I can go to the washroom and wash it off
[00:42:31.370]
and put it back in the kid's mouth.
[00:42:32.610]
Or I can put it in my mouth,
[00:42:33.940]
and then shove it in the kid's mouth.
[00:42:36.269]
The studies show that if you put it in your mouth
[00:42:37.740]
and back in the kid's mouth,
[00:42:38.980]
those kids would have decreased asthma,
[00:42:41.100]
allergies and obesity by this microbe transfer.
[00:42:44.293]
[00:42:46.970]
Should people be running out
[00:42:48.230]
and buying all kinds of probiotic pills, and kefir,
[00:42:51.730]
and more yogurt?
[00:42:52.945]
- Well, I think the idea of eating fermented foods
[00:42:55.170]
and more natural foods that might have some dirt on it
[00:42:57.600]
or whatever, that's probably OK.
[00:42:58.990]
Probiotics is a bit of a Wild West
[00:43:00.800]
in terms of what things work and what don't.
[00:43:03.479]
[00:43:04.337]
They're not regulated,
[00:43:05.240]
so you can pretty much claim anything you want.
[00:43:08.170]
- This is a probiotic yogurt.
[00:43:09.490]
The bacteria living in yogurt cannot take root in your gut.
[00:43:14.270]
They have no competitive advantage.
[00:43:15.890]
It would be like taking a gazelle
[00:43:18.230]
and dropping it in the Arctic, right?
[00:43:20.590]
It ain't gonna survive for very long.
[00:43:22.560]
Yes, eat more fermented foods if you want.
[00:43:24.490]
It can't hurt, and it might help.
[00:43:25.880]
The issue is we just don't know.
[00:43:28.247]
[00:43:29.590]
- With The American Gut Project,
[00:43:30.840]
there are some collections of stool from thousands
[00:43:32.970]
of people who crapped in a cup for science
[00:43:35.100]
a decade or more ago,
[00:43:36.195]
and where we have complete health records going forward.
[00:43:38.750]
So what I'm really excited about
[00:43:40.110]
is the possibility not just for the microbiome
[00:43:42.532]
to diagnose what's going on with you right now,
[00:43:44.780]
but to be able to help you predict the future
[00:43:46.880]
and ultimately be able to change that future.
[00:43:49.153]
[00:43:50.980]
- Which brings us to...
[00:43:52.790]
[00:43:53.910]
[upbeat instrumental music]
[00:43:55.951]
[00:43:56.800]
- In this lab we take stool samples,
[00:43:58.920]
poop, from people from around the world,
[00:44:01.140]
then we extract the bacterial DNA--
[00:44:03.863]
the genomes of the bacteria present in the poop--
[00:44:07.150]
and examine how they differ
[00:44:09.075]
between healthy people versus sick people.
[00:44:11.052]
And we tease that information out
[00:44:12.767]
and use it to try and identify
[00:44:14.599]
what makes somebody maybe develop a disease,
[00:44:18.033]
and how could microbes be responsible for doing that.
[00:44:20.673]
[00:44:22.000]
The next generation of probiotics
[00:44:23.470]
are going to be designed to go inside the body,
[00:44:25.470]
take up residence and integrate with the existing microbes
[00:44:29.010]
in your gut to actually rebalance how that ecosystem works.
[00:44:32.290]
The thing I'm most excited about trying to discover
[00:44:34.123]
is whether there's a way to manipulate the microbiome
[00:44:37.350]
by removing specific organisms or specific functions.
[00:44:42.020]
We're now trying to develop ways to leverage viruses
[00:44:44.566]
that will go in and selectively kill
[00:44:47.310]
that organism and remove it from the equation entirely.
[00:44:50.600]
Like assassins sneaking into the gut
[00:44:52.900]
to kill off the one bad actor.
[00:44:55.100]
And if we can develop that strategy effectively,
[00:44:57.490]
we won't need antibiotics anymore.
[00:44:59.520]
We'll be able to literally walk into a situation,
[00:45:01.921]
know which organism is causing a disease,
[00:45:04.410]
and just wipe it off the map.
[00:45:05.860]
[00:45:10.420]
- If someone had a really bad infection,
[00:45:12.630]
how do you think doctors would treat them?
[00:45:14.950]
- Antibiotics? - OK, anything else?
[00:45:17.423]
[00:45:18.900]
- Advil.
[00:45:20.045]
- OK, Advil and antibiotics.
[00:45:21.770]
- Solitary confinement?
[00:45:23.178]
- Maybe, quarantining them.
[00:45:24.410]
Listen to this, one of the ways that they're treating
[00:45:26.600]
a really nasty infection called C. difficile
[00:45:30.970]
is that they're doing something called a fecal transplant.
[00:45:34.533]
[00:45:35.460]
What do you think that is?
[00:45:36.822]
- Poo transplant?
[00:45:38.705]
- Yeah.
[00:45:39.538]
- Eww!
[00:45:40.375]
[00:45:43.550]
- [Brett] C. difficile is an infection
[00:45:45.000]
caused by taking antibiotics.
[00:45:46.490]
So if you treat with antibiotics
[00:45:48.110]
you maybe cure 20% of it.
[00:45:50.140]
If you do a fecal transfer--
[00:45:51.643]
put feces from one person, healthy, into another person--
[00:45:54.372]
you've got a 94% cure rate.
[00:45:55.830]
[00:45:57.150]
- I was in medical school about 15 years ago
[00:45:59.010]
and they talk about this,
[00:46:00.308]
about fecal transplant being a potential therapy
[00:46:03.332]
for something called C. difficile colitis.
[00:46:06.050]
And at the time I just thought, "Oh, that's so ridiculous."
[00:46:08.570]
But there's actually documentation
[00:46:10.410]
of fecal transplant being used in China
[00:46:13.177]
thousands of years ago.
[00:46:15.200]
I can't believe now I've done like over 200 of these,
[00:46:17.930]
because it's really kind of the most successful thing
[00:46:20.180]
we've seen for recurrent C. diff infection.
[00:46:22.643]
[00:46:25.920]
- She was balling over in pain and she yelled "Help me."
[00:46:30.296]
[00:46:31.600]
I just don't want her to cramp like that again.
[00:46:34.940]
I love her so much and, as a mom,
[00:46:39.664]
when she hurts, I hurt.
[00:46:41.255]
[00:46:42.810]
- I have cramping and ulcers in my colon,
[00:46:45.810]
and it's been going on for years.
[00:46:47.930]
[00:46:50.170]
It's hard for me to participate in physical activity,
[00:46:53.470]
like in P. E. I always sit out.
[00:46:56.363]
[00:46:58.224]
To one of my friends, I would say
[00:47:01.247]
a fecal transplant is just where
[00:47:03.880]
you transfer one's fecal matter into someone else's body.
[00:47:08.880]
[00:47:08.907]
And I would just leave it at that.
[00:47:10.200]
I won't go into detail
[00:47:11.920]
because that'd be way too much for my friends.
[00:47:14.533]
[00:47:15.960]
- Olivia is such a strong girl.
[00:47:18.230]
She's only 13, and when they're putting needles in her veins
[00:47:21.760]
she looks to watch them.
[00:47:23.810]
She's not one to shy away from anything.
[00:47:25.770]
And I hope that there's some kid out there
[00:47:27.980]
who is scared, will see her as an example.
[00:47:31.970]
She's an example to me,
[00:47:33.205]
and I hope she'll be an example to other children.
[00:47:35.380]
[00:47:36.990]
- It's remarkable to see people
[00:47:38.570]
who've had this problem for so many years,
[00:47:40.870]
and with something as simple as a fecal transplant
[00:47:43.190]
just go back to normal.
[00:47:44.610]
This is what we're trying to investigate in our study
[00:47:47.490]
that we're doing currently at UCSF.
[00:47:49.698]
But I have people come to my clinic all the time
[00:47:52.040]
with the idea that the fecal transplant is this panacea,
[00:47:55.727]
and everything is going to get better
[00:47:57.200]
with a fecal transplant.
[00:47:58.290]
But the truth is, we don't know.
[00:47:59.580]
I'm hoping that 20 years from now,
[00:48:01.441]
there's a more refined way that we can deliver therapy
[00:48:05.327]
that restores microbial health to the colon
[00:48:08.260]
without just transferring stool from one person to another.
[00:48:11.210]
[00:48:12.830]
- Where we're going, as we affectionately like to call it,
[00:48:14.783]
is re-poopulating people.
[00:48:16.110]
We're going to grow microbes in the lab--
[00:48:18.060]
human microbes, in test tubes, so we know what's in there--
[00:48:21.242]
sort of a drug-grade microbe,
[00:48:22.790]
good bugs to actually fix things
[00:48:24.700]
based on real scientific sound knowledge.
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- We talked about how C-section babies
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miss out on microbes from mom's birth canal.
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But when my twins were born,
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sure, I really wanted to have a natural delivery,
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but then things got intense.
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And my OB said, "Listen, this is medically necessary
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"for you to have a C-section."
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I didn't know then what I know now about missing microbes.
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But in the moment, what are you supposed to do?
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[rhythmic percussive music]
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- There was a great pilot study by our collaborator,
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Maria Gloria Dominguez Bello.
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She took babies who were born by ceasarean section
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and swabbed them with mom's vaginal fluid,
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and she saw that the babies who got swabbed,
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their microbiome looked more like a baby born
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by vaginal delivery than C-section.
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However, this pilot study was very small in numbers.
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- [Becky] Now, Dr. Hourigan and her colleagues
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have launched a new study,
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swabbing hundreds of C-section babies
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and following their health for the next three years.
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Half the babies are swabbed with fluid
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from mom's birth canal,
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and half are swabbed with a placebo.
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- This is Evelyn Vukadinopich.
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She is three weeks old tomorrow.
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We won't know if she's in the placebo
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or the experimental group for a couple of years.
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But just the chance to have her
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in the experimental group was worth it.
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- So this is our daughter, her name is Clara Rose.
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Here we are at 39 weeks, and she has not flipped.
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So we are here for a C-section to get her out safely.
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It's so surreal to think we're coming as a family of two
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and we leave with our daughter.
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It's exciting, but I think I'm ready.
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My body's ready to be done with pregnancy.
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[tender piano music]
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- [Cory] Been waiting for this for a couple of years now.
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[tender piano music]
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- [Doctor] There she is!
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Definitely a girl.
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[baby crying]
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- [Cory] This is Clara Rose Kwitkin.
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She's a big 'ol baby,
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[baby crying]
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7 pounds, 14 ounces [laughs].
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[tender instrumental music]
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- She's perfect.
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Something I've always wanted, and now she's here.
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We'll do anything in the world to protect you.
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- What I would say to mothers
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who are considering doing vaginal seeding themselves
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is to wait until we have better evidence
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from trials to know whether this is really effective
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in improving the baby's health, and whether it's safe.
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- Advances in our understanding of the human microbiome
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are happening almost daily.
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But based on what we know now,
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we can confidently make some recommendations
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that'll improve both your health
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and the health of your children.
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First, use antibiotics wisely.
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When the pediatrician says,
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"Let's wait and watch before prescribing," trust them.
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Second, have a C-section only when medically necessary.
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Third, breastfeed if at all possible.
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Then, diversify your baby's microbiome
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with a variety of foods and experiences.
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And finally, let your kids eat dirt!
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Or at least play in it, so long as it doesn't have
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any chemicals or heavy metals in it.
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- The overarching realization, I think,
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is that the last 125 years we have really tried
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to clean this world up.
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Hygiene hangover, I call it.
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"Let's use hand sanitizer, vaccines, antibiotics.
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"Clean it up."
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Worked great for infectious diseases,
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but now I think the moral of the story
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is that we're really realizing we've gone too far.
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It's too clean, we've taken the microbes
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that our ancestors evolved with right out of us.
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[upbeat instrumental music]
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You can affect your child's health
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just by how you raise them and thinking about
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these kinds of microbes in their life.
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- Perhaps at the end of the day
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one important message is that we change our frameset
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on how we see ourselves
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and especially how we see our children,
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and understand that they're not just humans
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but they're a mixture between humans and microbes,
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and that we have to understand health
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in the context of both human and microbial health.
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- I force my kids outside.
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I live in an area where I'm able to do that.
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I understand that some places it's not safe
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for children to play outside.
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But provide them with an opportunity
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to seek the outside world and to embrace it,
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to get it inside their body,
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to get it out on their skin,
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to breathe and live the life which they're supposed to live.
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Like my mum said, y'know,
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"Keep your home tidy enough to be happy,
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"but dirty enough to be healthy."
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- I think this message is somewhat liberating,
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to allow families to be a little more relaxed
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letting their children be out in the environment,
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not locked up.
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And then some practical messages
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are that we want to encourage breastfeeding
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and facilitate that to be as successful as possible.
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I think to cherish antibiotics,
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to use them really when we need them.
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And then if we can have a normal vaginal delivery
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and that's safe, that's probably the best for children.
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I want you to think about how we grew up
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and evolved as a species.
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The things that our grandparents did
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were probably pretty good advice.
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- [Becky] And when the aunties and uncles
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are holding the baby,
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they're helping their microbiome to flourish?
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Is it that simple?
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- [Stuart] And they're loving and cherishing the child.
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I think this is an important message for families.
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[uplifting instrumental music]
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[laughing and chatting]
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- Want some?
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