Scientists are attacking food allergies in new and inventive ways, driven…
Let Them Eat Dirt
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Allergies, obesity, asthma, diabetes, auto-immune and intestinal disorders are all on the rise, with the incidence of some diseases doubling every ten years. New research points to changes in the ecosystem of microbes that live on and inside every one of us -- our microbiomes -- as a major cause. But how could one's gut microbes increase the odds of developing conditions as radically different as asthma and diabetes?
Hosted by Good Morning America's Becky Worley, and based on the book of the same name by B. Brett Finlay, PhD and Marie-Claire Arrieta, PhD, LET THEM EAT DIRT features families, doctors, and researchers who are sleuthing out what's harming our microbes -- and what we can do to reverse this dangerous trend.
'While it might come as a surprise for many viewers, whether they are parents, teachers, primary school students or even undergraduate students, microbes are essential to our biology and health. Let Them Eat Dirt does a great job of celebrating our microbial world and suggesting that embracing it instead of fighting it will insure that kids grow up healthy! More educational materials like this could impact the trend of increasing chronic and allergic diseases that we are experiencing in the western world.' Dr. Jacques Ravel, Professor and Associate Director for Genomics, Institute for Genome Sciences, University of Maryland School of Medicine
'Excellent film. This is a comprehensive, clear, and up to date portrait of how the microbiome had changed over time, and how the microbiomes of children in the developed world may be affected by facets of modern life and medical decisions and practices. The relationship between the microbiome and common pediatric illnesses is well explained, the presentation is scientifically sound, and the guidelines that are advocated are clearly explained in terms of current knowledge. The film not only presents facts and data by experts in the field, but also provides tools for healthy living and health care decisions that will be appreciated by parents and educators.' Maureen W. Groer, RN, PhD, Professor of Nursing, Adjunct Professor of Internal Medicine, University of South Florida
'Compelling...The film nicely breaks down the role that microbes play in these diseases by highlighting years of work done by pioneers in the field. Although the scientific community still has much work to do to fully understand the human microbiome and its immense complexity, the audience is left with simple take-home messages that are supported by the evidence that has been gathered so far.' Dr. Joseph Zackular, Assistant Professor of Pathology, University of Pennsylvania, Children's Hospital of Philadelphia
'Let Them Eat Dirt goes a long way toward solving the mystery of the missing microbes. It shows us how microbes are an essential part of human biology, and it identifies the social and medical trends that are eliminating them from our bodies for the first time in the history of our species. Many questions remain, but it is reassuring to know that there are things we can do - as individuals, families, and societies - to harness the power of the microbiota to promote healthy development and prevent disease.' Dr. Thomas McDade, Professor of Anthropology, Director, Cells to Society (C2S): Center on Social Disparities and Health, Northwestern University
'This entertaining and informative video helps parents, educators, and physicians understand the impact of microbes on child health and disease. Supported by examples from the latest research, complex scientific concepts are accurately distilled down so they can be easily understood and acted upon. Let Them Eat Dirt provides a new and important perspective on how the body's microbes are necessary for maintaining health and preventing disease.' Dr. Michael Bailey, Associate Professor of Pediatrics, The Ohio State University, Principal Investigator, Center for Microbial Pathogenesis, Nationwide Children's Hospital
Medow, Rivkah Beth (film director)
Medow, Rivkah Beth (film producer)
Marshland, Brad (film director)
Marshland, Brad (film producer)
Marshland, Brad (screenwriter)
Worley, Becky (host)
Camera, Jason Blalock [and 8 others]; editor, Chris Brown.
Distributor subjectsAnthropology; Biology; Child Development; Childbirth/Parenting; Consumerism; Counseling; Environment; Family/Consumer Sciences; Food And Nutrition; Gastroenterology; Health; Immunology; Medicine; Microbiology; Nursing; Obstetrics/Gynecology; Outdoor Education; Pediatrics; Recreation; Social Work; Women's Studies
[laughing and shouting]
- [All] Let them eat dirt!
- When I think of dirt,
I think that it's going to be full of germs.
- I would say I'm probably somewhere towards
a conservative clean freak.
- When I was a kid it was sort of like
constant vigilance against what people put in their mouth,
washing hands, don't touch this, that's dirty,
- I remember learning about microbes
in a 7th grade science class
and they taught us that microbes were germs
and that they were essentially bad for your health.
- [TV Announcer] We like to keep the things
that we own as clean as we can.
That's why Dan is cleaning his bike.
It looks much better now, but his hands don't.
Now they need cleaning.
Dan washes up, because for one thing,
the soap and water are washing away microbes.
[otherwordly sound effect]
- Microbes, microbes [laughs].
Um, I don't think about microbes, nope.
- As parents, we all just want to keep our kids safe.
I don't think we ever stop worrying about them.
But some of the trickiest worries
are about things we can't even see.
- [TV Announcer] We like to keep the things that we own
as clean as we can.
Dan washes up because dirty hands
don't look very good.
- Before the internet, that's how we learned
about important issues.
Have you learned anything? - Nope.
- Well what were they trying to tell you?
- Dan needs to wash his hands because his hands are dirty.
- Definitely old school, so what does modern science
tell us about germs and microbes?
[energetic string music]
- [Brett] Microbes are everywhere.
They're in deep sea vents
way under the sea at high pressures.
They're in lakes a thousand feet under the ice.
They've been here long before we were
and they've built this world as we know it
and contributed to all the life forms we see around us.
- Microbes are actually part of our physiology.
The way we developed, the way our organs
and our systems develop in our body depend
not only on functions that are encoded
or produced by our genes, they're reliant on our microbes.
- [Brett] There's at least as many microbes
in and on us as there are human cells.
They're so numerous that they outnumber
the number of stars in the galaxy.
- We all have around 35 to 40 trillion
bacterial cells alone inside our bodies.
Most of them reside in our intestine,
and they play a fundamental role
in how our bodies develop and how they function,
everything from producing little chemicals
that your body needs,
all the way through to fighting off other pathogens--
other dangerous bacteria or dangerous viruses
which you would otherwise be susceptible to.
- We and our microbes, it's not just two separate things.
It's just like another organ that we have.
- [Jack] Microbes can produce chemicals
which actually affect how our brains develop
and even how we behave. [baby crying]
"Hangry" may be a real thing.
We know that microbes can play a role
in diabetes, in obesity, in asthma and food allergies.
- In the last 50 years, we've seen an incredible decrease
in the amount of infectious diseases--
measles, mumps, tuberculosis, hepatitis.
But in the same time frame, we've seen
almost an equal increase in the number
of autoimmune diseases, allergies, asthma,
diabetes, intestinal disorders, and obesity.
- My brother and my sister had very severe, chronic asthma,
the type that does not get controlled easily.
You almost have to put them in a cocoon
to prevent them from getting sick.
They can almost stop breathing
or you can see them changing color
due to the lack of oxygen.
[gentle piano music]
- When I see Ziair in an attack, sometimes I can't think
because I'm trying to think of what to do.
And there's nothing to do other than
just give him the three medications that they give him,
and if that seems not to be working
I feel scared.
- I try not to think too much about the fears,
but they're there.
- He is 12 weeks, I want him to be healthy
and grow up to be whatever he wants to be.
- There's only about a hundred different kinds of bacteria
that actually cause bacterial infections,
yet we have thousands of different species
in and on us, living on our bodies.
They help our brain develop, they help our gut develop,
they help our immune system develop,
and when you take them out of the equation
we realize this doesn't happen.
Then we started to see this rise in obesity
and allergies and asthma and autism and ADHD
and, y'know, you pick your disease.
- But how could microorganisms that live in your gut
affect your odds of developing asthma,
which is a disease of the lungs,
or diabetes, which is a blood sugar disorder?
In the next 50 minutes, we're gonna talk to families,
researchers and scientists to try and figure out
what's harming our microbiome,
and what we can do to reverse this dangerous trend.
But first, a quick biology primer.
A microbe is basically any living thing
that's too small to see without a microscope.
That includes protozoa, viruses, fungi, and bacteria.
Microbes are the oldest and most successful
life forms on earth.
And we've evolved with them, in a deeply complex
Microbes train our immune systems,
help us digest our food, and even help us fight disease.
Without microbes producing vitamin K for example,
our blood wouldn't coagulate
and we'd pretty much all bleed to death.
- It turns out that you and I
are basically genetically identical.
We're 99.99% of the chromosome the same between us, right?
And all humans are like that.
What's different is their microbes.
[jaunty orchestral music]
What we're finding is that we're actually
not being very good to our microbes.
Ironically, our grandparents had much better microbes
than we do now.
- And how do we know what kind of microbes
people had a hundred years ago?
Mostly from the guts of World War I soldiers
buried in permafrost.
And even further back, from frozen Viking latrines.
The microbes in these samples
are totally different from what are found
in modern European populations today.
- [Marie-Claire] In the past century or two,
we really have been cleaning up the world,
and there's been really drastic changes
not only in the type and the number of microbes
that we get to live with,
but also the consequences in our bodies.
- We're missing these essential microbes
that we need just to live normally.
- And that leads to disease? - Yep.
There's a lot of data indicating that this does.
You can take mice that don't have any microbes.
Their brains don't develop normally,
their immune system does not develop normally,
their gut doesn't develop normally.
And what we're now realizing
is that many of these diseases have screwed up microbes,
and in several cases we're showing
that the screwed up microbe
is actually contributing to the disease.
- So what happened?
If the rise of so many modern diseases
stems from our kids' missing microbes--
the ones that our grandparents all had--
where'd they go?
[blocks crashing] [all laughing]
[upbeat instrumental music]
- In this one generation, in about 30 years,
the rates of asthma have quadrupled.
That's huge, huge numbers.
And it can't just be genetics,
because my mom's genes aren't particularly different
from my genes.
So it's something about the environment
that kids are growing up in today.
- [Marie-Claire] We're depriving our bodies
of this healthy exposure to microbes,
especially when we're young.
- [Becky] Dr. Marie-Claire Arrieta
is looking at how microbiomes in different cultures
can lead to different health outcomes.
In Ecuador, for example, she studied a community
where part of the population got clean drinking water,
and part did not.
- People that had potable, clean water in their homes
had a higher risk of asthma,
and that really surprised us
because it possibly showed that it is really
that microbial environment around the type of water
that they're drinking and other exposures
that are driving this risk.
Now of course we want clean water
because we need to avoid infectious diseases,
they're quite dangerous-- but we want both.
We want clean water, but we also want lower risk.
- [Becky] Now, along with Dr. Cecilia Ximenez
of The National Autonomous University of Mexico,
she's looking at microbiome-related health outcomes
of kids in Xoxocotla, Mexico.
- Whether it is a tropical forest
or the arctic tundra or our gut microbiome,
one of the critical aspects in ecosystems
is this concept known as diversity.
Even from early ages, the microbiomes here
start a lot more diverse.
With the process of industrialization,
we seem to have lost about a third of the diversity
in our microbiome.
And that's pretty huge.
These kids, just like kids in North America,
will play a lot with other kids,
but they may do it in a different way here.
They may be bare feet when they're kicking around a ball
and they're also more exposed to animals--
and not just your average cat or dog,
they have goats and chickens and cows
and pigs, even, around where they live.
I mean, these kids eat peanuts in preschool
as a healthy snack.
It's a very different way of growing up,
and we can learn a lot from diversity
and other components of the microbiome
and their immune system.
[speaking in Spanish dialect]
[chiming instrumental music]
- Even though they are at a socioeconomic disadvantage,
for all intents and purposes
these are healthy children.
However, their microbiome is completely different
to the microbiome in North American children
and also in other Western countries.
In Mexico, the rates of asthma and immune diseases
like allergies or autoimmune disease
are down in comparison to the rates
that we're seeing in the more developed world.
- [Becky] Yet even within the more developed world,
lifestyle differences can profoundly affect
the variety of microbes that live on and in our children,
which in turn can significantly impact their health.
- We're no longer dying in our millions
from pathogenic infections thanks to vaccines,
thanks to public health works.
However, removing that exposure overall
may have led to our bodies now becoming
over-sensitized to the rest of the world.
We've known for many years that the rate of asthma
can be higher in the urban communities, in the cities,
than it is in the rural communities,
which we put down to the fact
that people in urban environments
are being exposed to more pollution
in the environments around them.
When we first started exploring the Amish populations,
we noticed that that population of people
had a very low rate of asthma--
almost 3% or 4%--
compared to the average for the United States
which is around 7% to 8%.
We also noticed a sister population to the Amish
called the Hutterites.
Both these populations have adopted
a technology-free lifestyle.
But the Hutterites had almost 25% asthma
in their population.
Genetically, the Amish and the Hutterites
are the same people.
They drink unpasteurized milk,
they eat unpasteurized cheese.
They live this ultimate foodie lifestyle, almost.
However, the major difference between them
is that the Amish live on their farms.
Their front door is 50 feet from the barn door.
The kids, before school and after school,
are working in that farming environment.
The Hutterites don't.
The men get in their buggy in the morning,
drive out to the farm, change into work clothes,
work on the farm all day, drive home.
And so the children living at home
have no exposure to that farming environment.
They have 25% asthma in their population
compared to the Amish, who are living and working
on the farm all the time,
who have 4% or 5% asthma in their population.
- That's powerful evidence.
Unfortunately, we can't all keep a cow in our front yard.
So I've been wondering about my family.
What do our microbiomes look like?
I mean, I've chosen to raise my kids here in the suburbs.
How do our microbes compare to those
of families from less-developed nations,
or even farm families right here in the U.S.?
There are a number of different companies
that provide test kits to do just that--
find out what microbes are in our guts.
But here's the thing.
You know how we test for that?
- Your poop. [laughing]
- It's for science. - Yay!
- It's disgusting, yay. [laughing]
- You just swab a piece of used toilet paper
and put the sample into the vial that they provide.
I'll spare you watching this part.
A few weeks later, I get back the results,
and call up Dr. Arrieta to help me understand them.
- Hi. - Hey Claire, how are you?
How are you? - I'm great.
I'm really curious, are my family's microbes normal
or are they close to what used to be normal?
- Great question.
You and your kiddos
have the prototypic North America microbiome...
- Is that good or bad? - It's different.
We're now at a time where we can only talk
in terms of "associated with."
We do not know if that particular bug
is going to cause diabetes later on, or obesity later on.
We're still not there yet, but we can associate it.
- So my son, Finn, has asthma.
Is there any benefit in taking him to visit a farm?
- Unfortunately, no.
I mean, you're thinking of just packing it up
and moving to a farm hoping
that his asthma is going to get better?
In fact, it would probably get worse.
At the same time, we do know that being raised in a farm
is a protective factor.
This exposure to the microbes
that are common in a farm,
they are able to train the immune system
into this state that is not going to lead to asthma.
So it seems that it's early life when it matters the most.
- All right, let's dig into that a little.
Asthma is a chronic disease that already affects
about 1 in 12 North American children.
And it's on the rise.
Scientists who study the microbiome
focus so much of their attention on asthma
because it's often just the first
of many immune disorders that cause problems.
- It affects families like you wouldn't believe.
Parents miss work, children miss school.
I've had parents actually lose jobs
because they had to take off so much time.
So that affects all of society,
because then now the parent isn't able to go back to work
because the child has been sick so often
that the employer finally has to let them go.
So it has large, far-reaching repercussions.
- Do you see how much he's pouring?
Keep on going.
I began to see him labor with his breathing.
I could literally see in his throat,
[inhaling and exhaling slowly] I could see that.
Then I began to hear it.
He literally would not be able to breathe,
and it would just come out of nowhere.
- It's hard to breathe when I'm like that,
and then my stomach starts hurting and I feel sick.
- This is an illness that's chronic,
that could take my son's life.
- I hear children saying all the time, "I don't take gym.
"I know I'm overweight, but I can't take gym
"because I have asthma."
We want them to be physically active,
but they are afraid to be active
because they're afraid they're going to have
an asthma attack and die.
[tender piano music]
- We try to let him operate as a regular kid, you know.
But the reality is, is he's not.
- When the kids are playing I'll be like,
"Naw, I don't wanna go outside."
And I just stay inside.
- I can't control his breathing.
I can't control the medicine intake.
I can't control the doctor's prescription.
But what I can control is the love
and the commitment that we have for one another.
Ziair's big brother, Amir, takes really good care of him.
He is always around and, like, literally,
he wants to be around him.
He comes around when other big brothers
would rather have their little brother be somewhere else.
How you feel? - I feel good.
- You need your medicine? No? - I don't think so.
- [Audrey] Amir is often sad
because he's in the same position as me,
watching his baby brother struggle to gasp for air.
If I had a magic wand, my son would be able to breathe
so that he could live the best life that he can have.
- Asthma is the number one reason
for children going to hospital,
number one reason for children missing school.
Number one reason for billing
to the healthcare system, is asthma.
About 10 years ago a bunch of Canadians
got together and said, "We don't know what's causing asthma.
"There's a huge increase, we've gotta do something."
The Allergy, Genes and Environment Network
had already been looking into the causes
and treatments of asthma and allergies.
So AllerGen, along with a Canadian team of leaders
in clinical work and research, launched
the Canadian Healthy Infant Longitudinal Development Study.
- The CHILD Study was developed to explore
the early origins of allergy and asthma--
what happens during pregnancy
and the first few years of life.
- One of the things that was really brilliant
about the CHILD study was that we took the stool samples
from those kids when they were born,
when they were three months old,
when they were one year old, and we froze them down.
And then we were able to compare the bacterial composition
in kids who went on to have asthma versus those who didn't.
And we found that those kids who were at highest risk
of asthma seemed to be missing four bacteria,
and interestingly they were missing those bacteria
in the first 100 days of life.
- What are the bacteria? - So the bacteria
have complex Latin names--
Faecalibacterium, lachnospira, veillonella and rothia.
That's a bit of a mouthful, so we nicknamed them FLVR.
- But how would the bacteria fight asthma?
- So asthma and allergy is really actually
an immune system problem.
And what we've learnt is that the gut bacteria,
we call that the microbiome,
is really important for training
and educating the immune system.
We don't know exactly what's going on yet.
We have evidence that those FLVR bacteria make chemicals--
we call them metabolites--
and that those metabolites train up the immune system.
We know that children who get more antibiotics,
they have higher risk of asthma.
Children born by ceasarean section
have higher risk of asthma.
Kids who live on farms have a lower risk of asthma.
So when you start putting all those elements together
one of the common themes there is actually
the bacteria that live inside us.
- If this were a crime show, I'd say
"Lifestyle changes. Guilty"
But lifestyle and environment aren't the only suspect,
and asthma is not the only crime.
[brooding instrumental music]
Every doctor and scientist I've talked to
says you can't start too early
developing a healthy microbiome.
Those first 100 days are crucial.
There is some indication of microbial transfer in utero,
but the biggest transfer happens at the moment of birth.
- Birth is a very messy process.
Ironically, this is important.
I jokingly say that the best birthday present
you ever give your kid is the very first one
and that's this-- this big dose
of vaginal and fecal microbes.
Boom, you're born with this.
Welcome to the world, kid.
- Happy Birthday! - Happy Birthday.
That's really important because it kicks up
the immune system and it gets the digestive tract going,
it gets the brain going, and if you have a C-section,
unfortunately you miss that.
- Between 2000 and 2015, the rate of C-section worldwide
has doubled, and children at the age of seven
had a 50% increased risk of obesity
if they were delivered by C-section
compared to their vaginally-delivered counterparts.
- We know that ceasarean sections
are often life-saving and medically necessary
for both moms and babies,
but babies born by C-section really don't get exposed
to mom's vaginal flora at all.
Their bacteria often resemble that in the
operating room, or of the mother's skin.
But babies born by ceasarean section
are at increased risk of different health problems
including obesity, allergies and asthma.
- My first children are one-year-old twins
and they were born via C-section.
And then I did get pregnant again [laughs],
and because it was so close together
it's really not recommended to have a vaginal birth
because there's a possibility of uterine rupture.
- I had a complete previa with her,
so they had to do a C-section for that one
and there were some complications.
So then the doctor recommended a C-section for Liv also.
- I've worked with kids that have had health issues,
and even the minor ones, it's alot for a child.
It's alot in school, it's alot for the parents.
It can be very difficult.
So if there was any way that I could decrease
those chances of them having health issues, I would do that.
I think any parent would do that.
- I hope that they're going to be safe,
and that they have a good childhood growing up
and that nothing ever happens to them.
- [Becky] Antibiotics are wonder drugs.
They've saved countless millions of lives.
But what we now realize is that antibiotics
don't just kill the bad germs that cause infection,
they can kill all microbes.
- The negative effects of damaging the microbiome
at an early age is that you are damaging
the way their immune system develops.
And because of that, they can get diseases
such as asthma, allergies, multiple sclerosis--
even autism, we're learning now--
and also metabolic diseases such as obesity and diabetes.
- Life expectancy today is 30 years longer
than it was just a century ago, largely due to antibiotics.
During the Civil War, more people died
of infectious diseases than from bullet wounds.
But with all the benefits of antibiotics,
have we traded one class of ailments for another?
Doniga Markegard raises grass-fed beef
just south of Half Moon Bay, California.
And her kids? - Oh, it pooped!
- Yeah, they're fairly free-range as well.
I love seeing your kids out here playing in the pond.
Do they swim in here in the summer?
- Oh gosh, yeah. [laughing]
Strip down naked, cover themselves with mud.
Yeah, they love it. - It's great.
- Yeah, all my kids were born right here on the ranch.
And I made it a point that they would go
right from breast milk to food that we either
grow or raise, or that we source from local organic farms.
And they don't suffer from any of the common things
that you see with kids, like allergies or asthma
or runny noses and things like that.
- [Becky] Of course, this is just one family
who might just be lucky.
But the real reason I've come here
is to talk about a simple fact.
- 80% of the antibiotic use in this country
is fed to livestock. - Wow.
- It's proven that antibiotics help growth promotion,
whereas our animals that are raised on a natural diet
take a couple years to finish.
In a feedlot, many of those animals might start on grass,
but then they'll go into a feedlot to finish.
And so with the feed rations and that antibiotic use,
they can get those animals to finish in 18 months.
It's a profitable way that farmers have found
that they can produce large amounts of meat
in a shorter amount of time.
- [Becky] So it seems like ranchers have known for decades
that antibiotics make livestock put on weight faster.
And experts confirm the same is true of humans.
- Babies exposed to antibiotics,
especially in the first six months, the first year,
are more likely to develop obesity later in childhood.
It's not that every child that receives antibiotics
is going to develop asthma or become obese.
But we do see a significant association.
Antibiotics sometimes are really important
and life-saving drugs,
but sometimes they're also used unnecessarily.
- In fact, even the CDC states that
"30% to 50% of antibiotics prescribed in hospitals
"are unnecessary or inappropriate."
So, antibiotics-- good, but not great.
Food allergies increased 50% between 1997 and 2011.
And the map tracking obesity since 1980?
Well, it's dramatic-- and a little scary.
We heard earlier about the link between antibiotic use
and obesity, but is there actual proof
that microbes play a role in the obesity epidemic?
Kids are eating more, and playing and being active less.
But the rates of childhood obesity
have gone through the roof.
- Yeah, there's no doubt exercise and diet
play a role in it, but what we now realize
is that there's microbes, too.
This field got kickstarted about 10, 15 years ago
when a guy named Jeff Gordon did fecal transfers.
They took a fat mouse, an obese mouse,
took its feces, put it in the thin mouse,
thin mouse got fat.
Fecal transfer just took thin mouse
into fat mouse, the fat mouse got thin.
- [Becky] One simple preventative factor
may be something that moms have been giving their kids
since, well, pretty much since there've been moms and kids.
- If there's one gift that a woman could give
to her children it would be breast milk.
- When I'm breastfeeding my girls
I know there's something else going on
besides just the nutrition.
I think they're learning that they belong here.
- Where we're from, Guatemala, everybody nurses.
And if you can't nurse, another person that had a child,
they will nurse your child.
- The recommendation from the World Health Organization
is to exclusively breastfeed for six months,
and then to continue breastfeeding for up to two years.
Today in the United States, about a quarter of moms
are attaining that six months of exclusive breastfeeding.
In the UK it's less than 1%, and that's a problem.
Breastfeeding is associated with lower rates of asthma,
certain types of allergies, lower rates of obesity.
The other component of breastfeeding
that's often forgotten or ignored
is that it also benefits the mother.
Moms who breastfeed have a lower rate of diabetes later on.
They have lower rates of breast cancer and ovarian cancer.
- [Becky] But what does all this have to do
with our kids' missing microbes?
As it turns out, when you breastfeed
you aren't just feeding your baby,
you're feeding your baby's microbes
in ways that even the most advanced infant formulas
aren't yet able to do.
- [Meghan] Over thousands and millions of years,
breast milk has evolved to feed babies and their microbiota.
- [Lars] Why is Mom making 150,
200 different complex molecules
at very high concentrations if there wasn't a benefit
for either the infant or the mom?
- We now know that those oligosaccharides
are feeding the gut microbes.
So they're not feeding the baby,
they're feeding the baby' microbes,
and that's incredibly important.
These microbes help us digest the food that we eat.
That's also true for babies.
They generate certain vitamins
that we're not able to generate on our own.
- [Lars] In addition to that, there is certain bacteria
that are killed or at least their growth is stopped
by certain oligosaccharides.
- [Becky] In other words, in addition
to helping your baby develop beneficial microbes,
breast milk provides a natural antibiotic
that helps keep the nasty microbes in check.
- Breast milk is so much more than a food.
It really could be considered a baby's first vaccine,
because it's a dose of incredibly important
immune boosting factors.
Breast milk is really the original personalized medicine.
Every mom makes different breast milk.
And even that mom's breast milk changes over time,
so as the infant grows the breast milk changes
to meet its needs.
So if a baby gets sick, breast milk changes
to adapt to that change.
In the CHILD study where we looked at breastfed babies
and bottle-fed babies,
we saw the exclusively breastfed babies
had the very lowest rates of asthma.
And the formula-fed babies--
all fed from a bottle, all fed formula--
had the highest rates.
But in between that was the babies
getting some of their breast milk in a bottle.
We don't exactly know why that is-- whether it's because of
this sucking and lung exercise is one possibility.
Another is going back again to the microbiome,
because breastfed babies are also getting
their mom's skin microbes through breastfeeding,
and maybe those are important.
- So why don't more women breastfeed?
Well, I can tell you, it ain't easy.
Ugh, when I think about those days-- so hard!
And for many women, it's complicated.
- It's a loaded question to ask a mother
what her plans are for breastfeeding,
because I think it's this horrible combination
of it being the most natural thing in the world
and probably one of the hardest things in the world to do.
- I think it's no surprise that who breastfeeds
follows along typical racial and class lines
in terms of inequality.
I don't think I could have done it for as long as I had
if I didn't have an employer
that made lactation rooms available,
if I didn't have the money to invest in a good pump
that would allow me to keep producing
when I wasn't with the baby.
- My husband, he's really supportive.
"What can you do, he's crying, y'know?
"Just take it out."
He's like, "Don't care about what people think."
And here I go, when he cries, I breastfeed.
- [Lars] One reason why we are not talking
about these things very often
is because it's an uneven playing field.
The formula industry has a multi-billion dollar market
and marketing campaign behind it
that pushes the product which is not
the equivalent to human milk.
- [Meghan] It's an issue well beyond just educating mothers.
It's a societal issue, moms have to be supported.
Either they have to go back to work
and they don't have a paid maternity leave,
maybe they don't have the support from their family members.
Maybe they feel stigmatized out in public.
These are all things that are societal issues
that policies could help address.
- The last thing we want is to stigmatize women
that cannot breastfeed or choose not to breastfeed.
I think we need to be sure
that we have alternatives available,
whether that's donor milk or substitutes
in the form of infant formula.
If it's infant formula, we need to make sure
the infant formula is as good as it gets,
and that's where some of the science needs to go as well.
- So, breastfeeding--
if you can swing it, pretty strong recommendation.
And even after that, we need our kids
to keep feeding their own microbes.
Yeah, with veggies.
What do you tell your kids to help them understand it?
- I tell them that they have a zoo.
So I would say, "You have a zoo in you,
"and you have to feed it too."
And they like it.
It's this idea that they do literally have a zoo
of bacteria and bugs in their tummies,
and that it's almost like their pet
and they have to feed it every day.
Otherwise bad stuff can happen to them, and they realize it
and they almost see it as second nature now.
[playful instrumental music]
- [Becky] Being a parent is hard.
Just when you think you've finally mastered one level,
they grow, they change, and you feel
like you're back to square one.
So to help me sort out everything we've been talking about,
I go to someone I trust most-- my own kids' pediatrician.
- Hi! - Hi!
- It's so nice to see you guys!
- You've been with us-- maybe you guys
were a day or two days old when we first met.
- Just new to the world!
- You've been our pediatrician for 10 years.
- I can't remember that. - You can't remember?
- I remember that, I remember your mom coming out
with you guys in little baby bucket seats.
- We missed the vaginal birth part with twins,
and yet I feel like we're doing the best we can.
Everybody seems like they have a piece missing sometimes.
Y'know, you have antibiotics, whether or not
you were able to have a vaginal birth,
whether or not you were able to breastfeed.
These are all elements as parents
that you're trying to keep in place,
but it's hard to do them all.
- It is, and it's hard, y'know sometimes people feel like,
"Oh no, I failed at that."
And, y'know, kids-- people are amazingly resilient.
And so we pick up microbiome in other places.
And as scientists and as doctors,
we're always trying to figure out,
how can you help build that?
- This picture evokes for me
that feeling of helplessness as a parent.
Y'know, here's this tiny little guy
with a hospital bracelet on.
You see that?
Look how little you were.
Look how sick he was, he just was, like, listless.
And it was so scary for me as a parent.
And I remember thinking, "Carpet bomb this kid.
"Like, whatever it takes, let's get him better."
- It's tough, because for us as well
we don't know, is this kid going to get better
or are they going to need the antibiotics?
And often the easiest thing for a pediatrician
is to say, "Let's just treat," right?
You will never get sued for using antibiotics
in the way that you might if you don't, right?
Just to be blunt about it.
- So this guy has had more antibiotics,
he's had food allergies, asthma, he was colicky.
It's all those little signs that there's something going on
with this microbiome here.
And as a parent I feel like we're doing everything we can.
I can't get him to only eat kale [laughs], but I'm trying.
- It's not happening. [laughing]
- When these guys were teeny tiny
we were so worried about giving them vaccines,
and you really talked us off the ledge and said,
"Nope, this is good, this is going to make things better."
- [Katya] Vaccines act by showing the body the shape
of a particular kind of illness,
whether virus or bacteria.
So it is actually a really wonderful way
to gently exercise the immune system.
And the nice side effect is that when giving immunizations
the ear infection rate dropped a lot,
which meant kids got fewer antibiotics,
which meant less disruption to the microbiome.
- Regular vaccines equal fewer infections,
which means fewer antibiotics,
which means healthier microbiome.
- [Becky] And just to explicitly
address vaccine safety-- - You have
a one in a million chance of getting
an adverse reaction to a vaccine.
You have a 1 in 100 chance of dying of an infection.
I think the problem is people have never lived
in the pre-vaccine world.
Talk to your great-great-grandparents--
what was it like when you had a 50% chance of dying
before you got to school?
It was scary.
Every time you got a fever, you could die that day.
Vaccines work, we see the experiment.
These poor kids get these awful diseases
that are vaccine preventable, and those break my heart
because that kid should not have that disease.
[upbeat instrumental music]
- Just do that, and then put the ends in there, OK?
A lot of the research that we've talked about so far
is brand new.
The field is advancing so fast.
But this much we know is true--
changes in our environment, our lifestyle,
our medical practices and our diet have had a radical effect
on our children's natural microbial balance.
The question now-- what can we do about it?
- We need a reversal in the whole general way
we treat microbes.
Most of them are our friends.
There's only a small number that actually cause infections.
There are dangerous organisms out there,
and you do need to wash your hands after going to the toilet
and wash your hands after handling raw chicken.
But do you need to sterilize the banisters in your home?
Do you need to use some kind of sterilizing floor cleaner?
No, not unless you intend on preparing
your raw chicken on the floor
and then cleaning it up and then licking it.
- Watch a kid in action.
What does a kid do?
Puts everything they possibly can in their mouth, right?
Why are they doing that?
If that was so bad,
they should have evolved so they stand like this
and never put anything in their mouth.
I'll tell you one story that drives it home.
Soothers, binkies, right?
OK, so you have the soother,
you put it in a kid's mouth,
and what does this kid do?
Spits it out, right?
OK, it's bouncing around on the floor.
What do I do with this thing?
I can go to the washroom and wash it off
and put it back in the kid's mouth.
Or I can put it in my mouth,
and then shove it in the kid's mouth.
The studies show that if you put it in your mouth
and back in the kid's mouth,
those kids would have decreased asthma,
allergies and obesity by this microbe transfer.
Should people be running out
and buying all kinds of probiotic pills, and kefir,
and more yogurt?
- Well, I think the idea of eating fermented foods
and more natural foods that might have some dirt on it
or whatever, that's probably OK.
Probiotics is a bit of a Wild West
in terms of what things work and what don't.
They're not regulated,
so you can pretty much claim anything you want.
- This is a probiotic yogurt.
The bacteria living in yogurt cannot take root in your gut.
They have no competitive advantage.
It would be like taking a gazelle
and dropping it in the Arctic, right?
It ain't gonna survive for very long.
Yes, eat more fermented foods if you want.
It can't hurt, and it might help.
The issue is we just don't know.
- With The American Gut Project,
there are some collections of stool from thousands
of people who crapped in a cup for science
a decade or more ago,
and where we have complete health records going forward.
So what I'm really excited about
is the possibility not just for the microbiome
to diagnose what's going on with you right now,
but to be able to help you predict the future
and ultimately be able to change that future.
- Which brings us to...
[upbeat instrumental music]
- In this lab we take stool samples,
poop, from people from around the world,
then we extract the bacterial DNA--
the genomes of the bacteria present in the poop--
and examine how they differ
between healthy people versus sick people.
And we tease that information out
and use it to try and identify
what makes somebody maybe develop a disease,
and how could microbes be responsible for doing that.
The next generation of probiotics
are going to be designed to go inside the body,
take up residence and integrate with the existing microbes
in your gut to actually rebalance how that ecosystem works.
The thing I'm most excited about trying to discover
is whether there's a way to manipulate the microbiome
by removing specific organisms or specific functions.
We're now trying to develop ways to leverage viruses
that will go in and selectively kill
that organism and remove it from the equation entirely.
Like assassins sneaking into the gut
to kill off the one bad actor.
And if we can develop that strategy effectively,
we won't need antibiotics anymore.
We'll be able to literally walk into a situation,
know which organism is causing a disease,
and just wipe it off the map.
- If someone had a really bad infection,
how do you think doctors would treat them?
- Antibiotics? - OK, anything else?
- OK, Advil and antibiotics.
- Solitary confinement?
- Maybe, quarantining them.
Listen to this, one of the ways that they're treating
a really nasty infection called C. difficile
is that they're doing something called a fecal transplant.
What do you think that is?
- Poo transplant?
- [Brett] C. difficile is an infection
caused by taking antibiotics.
So if you treat with antibiotics
you maybe cure 20% of it.
If you do a fecal transfer--
put feces from one person, healthy, into another person--
you've got a 94% cure rate.
- I was in medical school about 15 years ago
and they talk about this,
about fecal transplant being a potential therapy
for something called C. difficile colitis.
And at the time I just thought, "Oh, that's so ridiculous."
But there's actually documentation
of fecal transplant being used in China
thousands of years ago.
I can't believe now I've done like over 200 of these,
because it's really kind of the most successful thing
we've seen for recurrent C. diff infection.
- She was balling over in pain and she yelled "Help me."
I just don't want her to cramp like that again.
I love her so much and, as a mom,
when she hurts, I hurt.
- I have cramping and ulcers in my colon,
and it's been going on for years.
It's hard for me to participate in physical activity,
like in P. E. I always sit out.
To one of my friends, I would say
a fecal transplant is just where
you transfer one's fecal matter into someone else's body.
And I would just leave it at that.
I won't go into detail
because that'd be way too much for my friends.
- Olivia is such a strong girl.
She's only 13, and when they're putting needles in her veins
she looks to watch them.
She's not one to shy away from anything.
And I hope that there's some kid out there
who is scared, will see her as an example.
She's an example to me,
and I hope she'll be an example to other children.
- It's remarkable to see people
who've had this problem for so many years,
and with something as simple as a fecal transplant
just go back to normal.
This is what we're trying to investigate in our study
that we're doing currently at UCSF.
But I have people come to my clinic all the time
with the idea that the fecal transplant is this panacea,
and everything is going to get better
with a fecal transplant.
But the truth is, we don't know.
I'm hoping that 20 years from now,
there's a more refined way that we can deliver therapy
that restores microbial health to the colon
without just transferring stool from one person to another.
- Where we're going, as we affectionately like to call it,
is re-poopulating people.
We're going to grow microbes in the lab--
human microbes, in test tubes, so we know what's in there--
sort of a drug-grade microbe,
good bugs to actually fix things
based on real scientific sound knowledge.
- We talked about how C-section babies
miss out on microbes from mom's birth canal.
But when my twins were born,
sure, I really wanted to have a natural delivery,
but then things got intense.
And my OB said, "Listen, this is medically necessary
"for you to have a C-section."
I didn't know then what I know now about missing microbes.
But in the moment, what are you supposed to do?
[rhythmic percussive music]
- There was a great pilot study by our collaborator,
Maria Gloria Dominguez Bello.
She took babies who were born by ceasarean section
and swabbed them with mom's vaginal fluid,
and she saw that the babies who got swabbed,
their microbiome looked more like a baby born
by vaginal delivery than C-section.
However, this pilot study was very small in numbers.
- [Becky] Now, Dr. Hourigan and her colleagues
have launched a new study,
swabbing hundreds of C-section babies
and following their health for the next three years.
Half the babies are swabbed with fluid
from mom's birth canal,
and half are swabbed with a placebo.
- This is Evelyn Vukadinopich.
She is three weeks old tomorrow.
We won't know if she's in the placebo
or the experimental group for a couple of years.
But just the chance to have her
in the experimental group was worth it.
- So this is our daughter, her name is Clara Rose.
Here we are at 39 weeks, and she has not flipped.
So we are here for a C-section to get her out safely.
It's so surreal to think we're coming as a family of two
and we leave with our daughter.
It's exciting, but I think I'm ready.
My body's ready to be done with pregnancy.
[tender piano music]
- [Cory] Been waiting for this for a couple of years now.
[tender piano music]
- [Doctor] There she is!
Definitely a girl.
- [Cory] This is Clara Rose Kwitkin.
She's a big 'ol baby,
7 pounds, 14 ounces [laughs].
[tender instrumental music]
- She's perfect.
Something I've always wanted, and now she's here.
We'll do anything in the world to protect you.
- What I would say to mothers
who are considering doing vaginal seeding themselves
is to wait until we have better evidence
from trials to know whether this is really effective
in improving the baby's health, and whether it's safe.
- Advances in our understanding of the human microbiome
are happening almost daily.
But based on what we know now,
we can confidently make some recommendations
that'll improve both your health
and the health of your children.
First, use antibiotics wisely.
When the pediatrician says,
"Let's wait and watch before prescribing," trust them.
Second, have a C-section only when medically necessary.
Third, breastfeed if at all possible.
Then, diversify your baby's microbiome
with a variety of foods and experiences.
And finally, let your kids eat dirt!
Or at least play in it, so long as it doesn't have
any chemicals or heavy metals in it.
- The overarching realization, I think,
is that the last 125 years we have really tried
to clean this world up.
Hygiene hangover, I call it.
"Let's use hand sanitizer, vaccines, antibiotics.
"Clean it up."
Worked great for infectious diseases,
but now I think the moral of the story
is that we're really realizing we've gone too far.
It's too clean, we've taken the microbes
that our ancestors evolved with right out of us.
[upbeat instrumental music]
You can affect your child's health
just by how you raise them and thinking about
these kinds of microbes in their life.
- Perhaps at the end of the day
one important message is that we change our frameset
on how we see ourselves
and especially how we see our children,
and understand that they're not just humans
but they're a mixture between humans and microbes,
and that we have to understand health
in the context of both human and microbial health.
- I force my kids outside.
I live in an area where I'm able to do that.
I understand that some places it's not safe
for children to play outside.
But provide them with an opportunity
to seek the outside world and to embrace it,
to get it inside their body,
to get it out on their skin,
to breathe and live the life which they're supposed to live.
Like my mum said, y'know,
"Keep your home tidy enough to be happy,
"but dirty enough to be healthy."
- I think this message is somewhat liberating,
to allow families to be a little more relaxed
letting their children be out in the environment,
not locked up.
And then some practical messages
are that we want to encourage breastfeeding
and facilitate that to be as successful as possible.
I think to cherish antibiotics,
to use them really when we need them.
And then if we can have a normal vaginal delivery
and that's safe, that's probably the best for children.
I want you to think about how we grew up
and evolved as a species.
The things that our grandparents did
were probably pretty good advice.
- [Becky] And when the aunties and uncles
are holding the baby,
they're helping their microbiome to flourish?
Is it that simple?
- [Stuart] And they're loving and cherishing the child.
I think this is an important message for families.
[uplifting instrumental music]
[laughing and chatting]
- Want some?
Distributor: Bullfrog Films
Length: 57 minutes
Grade: 10 - 12, College, Adults
Closed Captioning: Available
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