Author: jack

Acetaminophen after childhood shots, or even before, is common advice to parents vaccinating their children. Acetaminophen has become synonymous with easing childhood pain and discomfort. The idea is that the active ingredient in brand name Tylenol, acetaminophen or paracetamol as it is called in Europe, acts as an anti-inflammatory agent and helps alleviate some of the side effects of vaccines like fever, injection site reactions and body aches. Far from helping, acetaminophen can cause damage and is something that should be avoided with vaccines altogether except in a very few select cases.

A 2008 study showed that acetaminophen use after childhood vaccinations was associated with an eight fold increase in autism disorder.(1) The study compared acetaminophen use after shots with ibuprofen use after shots but did not find the same association with ibuprofen use. Although the study was small with under 200 children, a recent study came to the same conclusion.(2) This study from 2013 showed how although Cuba has compulsory vaccination in its public healthcare and has a measles vaccination rate of 99.7% the autism rates in Cuba are far lower than the US. It turns out that the use of acetaminophen or paracetamol is very low in Cuba because it is a prescription drug that cannot be purchased over-the-counter and is not routinely prescribed for vaccine side effects. Other studies out of Denmark and the Netherlands associate acetaminophen use in women during pregnancy with negative behavioral and brain development in their children.(3, 4) With all these studies combined I think it is time to reconsider our use of acetaminophen in infants and children, especially in preparation for or recovery from vaccination.

Acetaminophen also depletes glutathione levels in the body which is bad news for our ability to handle and process toxins. Glutathione is a critical nutrient in the detoxification process that helps rid the body of toxins that we acquire in everyday life from our food, air, water and environment. The main enzyme of the glutathione detoxification pathway is inhibited by acetaminophen.(5) Acetaminophen use before or after shots will only decrease the detoxification system needed to help process some of the ingredients in the vaccine.

The side effects of shots that most parents give acetaminophen or ibuprofen/NSAIDs for include fever, body aches/pain and irritability. These side effects occur because of the inflammation caused by the vaccine. When our body has an immune response to an infection or a vaccine there are a ton of inflammatory molecules that are produced. These inflammatory molecules recruit white blood cells to fight the infection, or vaccine agent in this case, and often produce a fever. This inflammation is needed to help signal the immune system to respond to the vaccine and have it be effective. Most fevers do not get high enough to need suppressing. Taking either acetaminophen or ibuprofen before shots lessens your body’s ability to respond to the vaccine.(6)

Make sure your doctor does not routinely give acetaminophen with childhood shots. Consider ibuprofen only after vaccination to help with the more severe vaccine side effects in your child. While fevers are a common side effect from vaccines and can be uncomfortable for children, it is best to let the fever run its course, rather than trying to suppress with acetaminophen or ibuprofen. Remember the increased temperature is essential for the body to mount the white blood cell defenses against the infection, or vaccine antigen in this case. Only in cases of ibuprofen and/or other NSAIDs allergy should acetaminophen be considered. As a mom and as a doctor I error on the side of caution. It doesn’t make sense to stifle the immune responses to vaccination with pain relievers and with the additional risk acetaminophen poses, it is time to skip acetaminophen with shots in our children.

 – Dr. Catherine Clinton

1 http://www.ncbi.nlm.nih.gov/pubmed/18445737

2  http://www.greatplainslaboratory.com/home/eng/articles/Evidence-that-increased-Acetaminophen-use.pdf 

3  http://archpedi.jamanetwork.com/article.aspx?articleid=1833486 

4  http://ije.oxfordjournals.org/content/early/2013/10/24/ije.dyt183.abstract

5  http://www.ncbi.nlm.nih.gov/pubmed/19537930/

6  http://www.ncbi.nlm.nih.gov/pubmed/19837254

Intestinal permeability, also known as leaky gut, is a condition that affects adults and children alike. Irritation and inflammation in the gastrointestinal tract causes the cells in the lining to open ever so slightly. This loosening of the cell junctions is called leaky gut. These openings allow undigested food particles to enter into the bloodstream and cause systemic inflammation in the body. This leads to a vicious cycle that just repeats itself over and over again and can make tackling leaky gut difficult at times. To heal leaky gut you have to look at several things at once.

First, you must remove the source of irritation. Food allergies/sensitivities, chronic stress, infections, poor diet, toxins, chronic alcohol, certain medications and medical treatments such as chemotherapy can all promote gut inflammation by producing inflammatory chemical messengers or cytokines in response to the irritation. The irritation creates inflammatory cytokines, which lead to intestinal permeability, which in turn creates more inflammatory cytokines, leading to more intestinal permeability and so on. This feedback loop can be hard to break and near to impossible if the source of irritation continues. The irritation that leads to the loosening of the tight junctions must be found and removed in order to end the cycle of inflammation.

Once the source of irritation is removed, a three-pronged approach to healing is the best way to tackle leaky gut. True gut health depends on three factors: the gut microbiome (bacteria,) the mucin layer, and the gut lining itself. If any of these three areas are inflamed then the balance begins to tilt toward the inflammatory state associated with intestinal permeability.

Our gut bacteria have a dramatic impact on our immune, metabolic, and digestive health. Maintaining a healthy balance of bacteria helps support overall health. Feeding the bacteria in your digestive tract a diet rich in a variety of fiber is the first step to cultivating a healthy gut microbiome. Gut bacteria thrive on the fiber we eat, fermenting the resistant starches in the fiber creating butyrate which fuels the cells in our gut lining. A diet rich in fiber is essential. Recent research demonstrates a change in fiber can dramatically change the make-up of your gut microbiome even over the course of 3-4 days. (1) Making sure your diet is rich in probiotics from fermented foods and supplements is also an important step in achieving a balanced gut microbiome. Eating beneficial probiotics help to keep the balance between the beneficial bacteria and harmful bacteria healthy. We are what we eat and this is particularly evident in the gut microbiome.

Nurturing the gut lining is another step in tackling leaky gut. You want the cells that line the gut to be strong with tight intercellular junctions so that the barrier is intact. The cells that line the digestive tract use butyrate as their primary source of fuel. A diet rich in fiber, as mentioned above, is a great way to fuel the epithielial cells that line the gut. Coconut milk and oil contain short chain fatty acids that can also provide butyrate to fuel the gut lining. L-glutamine is a wonderful amino acid that promotes intestinal integrity and dramatically reverses intestinal permeability. (2) A diet rich in anti-inflammatory foods like curcumin, ginger and eating a rainbow of foods helps provide the phytochemicals that help to combat the inflammation that damages the lining the gut. (3,4)

Maintaining a healthy layer of mucin in the gut is the last, but not least, step in addressing leaky gut. Mucin is the mucous substance that lines our intestines. Not only does it physically act as a barrier to the epithelial cells from the contents of the intestines, but it also provides housing for the bacteria of the gut. Cultivating a rich mucin layer helps protect the lining of the gut as well as promotes a healthy population of gut bacteria. Without a healthy, thick mucin layer the lining is more easily irritated and the bacteria have a decreased environment to thrive in. It also promotes chemical messengers to lessen the immune response to foreign substances in the gut, helping prevent inflammatory responses to “good” gut bacteria and food. (5) Mucin production is upregulated by healthy bacteria, amino acids, clove extract and flavonoids. (6,7)

Leaky gut can be a difficult condition to treat. Without looking at all the components needed for healing the inflammation that’s causing the intestinal permeability continues. By addressing all four pieces to a healthy gastrointestinal tract we can begin to heal from leaky gut. Talk with your healthcare provider today if you suspect you are suffering from leaky gut and need help treating it. 

– Dr. Catherine Clinton

(1) http://www.nature.com/nature/journal/v505/n7484/full/nature12820.html

(2) http://www.ncbi.nlm.nih.gov/pubmed/19211824/ 

(3) http://www.ncbi.nlm.nih.gov/pubmed/26995272

(4) http://www.ncbi.nlm.nih.gov/pubmed/23222413 

(5) http://www.nhs.uk/news/2013/09September/Pages/mucus-in-the-gut-may-help-relieve-bowel-inflammation.aspx

(6) Scientific Reports 5, Article number: 9253 (2015) doi:10.1038/srep09253

(7) http://jn.nutrition.org/content/136/6/1558.full

I recently wrote a three blog series about the how, what and when to introduce food to babies. There seems to be a sweet spot in the 5-7 month window for introducing foods to babies for the prevention of multiple allergic and autoimmune diseases. I received several emails from readers in the months after with one main question. People wondered whether babies could really digest grain so young. Many had heard that babies could not digest grains until 12 months of age. Let’s dig deeper into whether babies can digest grain.

Can babies digest grains?

In a recent post I recommended whole grains as an introductory food for babies. Readers asked if infants were able digest grains so young because they had heard that infants can’t digest grains until 1 year. It is true that the pancreatic secretion of amylase, the enzyme that digests the starch in grains, is quite low compared to older children and adult levels of pancreatic amylase.(1,2) This led to questioning the advice of introducing grains to infants. However, research from Italy in 1975 showed that most of the starch fed to 1-3 months olds was completely absorbed in the intestines.(3) So what is going on here?

It turns out infants have a few sources of amylase to help digest grains besides the pancreatic source of amylase. Salivary amylase, as well as the amylase that is present in breast milk, both help to digest the starch in grains and vegetables.(4,5) Salivary amylase reaches 2/3 of adult levels by 3 months of age.(4) The amylase in breast milk is highest in colostrum and gradually decreases until it plateaus at 6-27 months of age.(5) Additionally, the lining of the gut secretes its own glucoamylase enzyme that also digests the starch in grains. Glucoamylase increases from the first feeding and reaches adult levels at 1 month.(6) Now, this is not to suggest that babies’ diets be built around grains like the old advice of giving white rice cereal as the first food but it does show that grains are far from forbidden food for infants. 

The Bottom Line

What this means to me is that babies are capable of digesting grains around 5 months and should be introduced to them, at least once, for the education of the immune system. Akin to the hygiene theory, it looks like babies need to be introduced to a variety of foods to create a tolerance to them later in life. Grains, especially ancient grains like quinoa, barley and millet, have their place in a healthy diet but we should be mindful to remember the nutritional importance of breast feeding when thinking about introducing food to infants. The research clearly points to the positive impact breast milk has on the baby’s immune system, including its reaction to food. While we’ve learned how grains can be a part of a baby’s healthy diet, we shouldn’t lose sight of the importance that breast milk, organic vegetables, legumes and fruit, as well as healthy fats from nuts/seeds, coconut and animals have in baby first diet.

-Dr. Catherine Clinton

http://www.jpeds.com/article/S0022-3476%2868%2980037-X/abstract

http://www.nature.com/pr/journal/v6/n12/full/pr197289a.html

http://www.jpeds.com/article/S0022-3476%2875%2980703-7/abstract

http://ajcn.nutrition.org/content/39/4/584.abstract

http://www.ncbi.nlm.nih.gov/pubmed/1701531

http://adc.bmj.com/content/61/9/896.full.pdf

A healthy diet is the cornerstone of a healthy gut microbiome. Many of us know that most processed foods offer little in the way of nutrition compared to the abundance of sugar, unhealthy fats, chemicals and additives they contain. Processed food have been linked to obesity, metabolic syndrome, cancer, heart disease and autism/neurological behavioral changes. New research is adding to the reasons you don’t want a diet high in processed food. Turns out our gut bacteria don’t like processed food either.

Processed foods are usually loaded with sugar and unhealthy fats such as hydrogenated oils or trans fat. With little nutrition, high in sugar, chemicals, additives and unhealthy fats, most processed foods provide our bodies and our gut microbiome little to run on. The gut microbiome relies on the fiber in our diet to ferment into butyrate for fuel.

A recent study showed that a two week change in diet has a notable impact on the gut microbiome. Researchers compared African-Americans eating a standard American diet to South Africans eating a traditional diet. The traditional diet is much higher in fiber while the Western diet is higher in industrial fats, refined carbohydrates, and animal proteins. Researchers gave the Africans a Western diet for two weeks, and the African-Americans a traditional African diet for two weeks. The gut microbiome changed dramatically in this short time. The healthy gut microbes that make butyrate increased 2.5 fold in the Americans on the African diet, whereas butyrate levels dropped by 50% when the Africans switched to the Western diet. Researchers also found greatly increased markers of intestinal inflammation after the two week Western diet while the inflammatory markers in the American guts dropped after two weeks on a traditional diet. (1) This study is a prime example of the impact that food has on our gut microbiome, dramatically impacting our overall health. Our microbiome is intimately tied to the food we eat and processed food is not only empty nutrition but it actually changes the balance of beneficial bacteria in the gut.

A diet high in processed foods exposes the gut bacteria to an array of chemicals, additives, fillers, binders, emulsifiers and more that irritate the gut lining. This irritation can lead to leaky gut or intestinal permeability. Tight junctions hold the bases of the cells that line the gut together so that food cannot enter the bloodstream. They do a great job when they are functioning properly but they can also lose integrity and become permeable under inflammation. The inflammatory cytokines that are released in response to irritation promote the loss of integrity of the tight junctions and promote the intestinal permeability in leaky gut. Research has shown how the chemical emulsifiers in processed food changes the diversity of the gut microbiome for the worse. Emulsifiers in food have been shown to promote bacterial translocation across epithelial cells. Now they have been shown to increase the inflammatory state of the gut. (2)

Researchers fed mice two very commonly used emulsifiers, polysorbate 80 and carboxymethylcellulsose, comparable to amounts found in processed foods. They found that mice that consumed the emulsifier had changes pro-inflammatory changes in the gut microbiota. The pro-inflammatory microbiota had an enhanced capacity to infiltrate the dense mucus layer that lines the intestine, which is normally harbors few bacteria. (2) The mucin layer houses the gut microbiome and acts as a barrier to the lining of the gut. Disturbances in the mucin layer affects the balance of beneficial bacteria and makes it easier for the gut to get inflamed.

Researchers found that these altered bacteria initiated chronic colitis in mice genetically prone to this condition, due to altered immune systems. While in mice with normal functioning immune systems, emulsifiers induced low-grade intestinal inflammation and metabolic syndrome. So even in healthy subjects with normal immune systems the emulsifiers caused inflammation that led to metabolic syndrome. (2) While this research needs to be reproduced in humans, in combination with the other strikes against processed foods this research is compelling.

The associations between several chronic diseases and processed foods have already been made. Add that to this new research which highlights the impact processed food has on the gut microbiome and it becomes clear that we need to make an effort to limit processed foods in our diets. A varied diet packed full of whole foods or processed foods with minimal ingredients that can be easily recognized is the best foundation for a healthy gut microbiome.

 – Dr. Catherine Clinton

(1) O’Keefe, S. J. D. et al. Fat, fiber and cancer risk in African Americans and rural Africans. Nat. Commun. 6:6342 doi: 10.1038/ncomms7342 (2015).

(2) http://news.gsu.edu/2015/02/26/widely-used-food-additive-promotes-colitis-obesity-metabolic-syndrome-research-shows/

We are hearing a lot about the MTHFR enzyme and how it can be mutated in a large percentage of people. More and more adults are being tested and appropriately supplemented for this genetic mutation that can lead to many health conditions and diseases but we don’t hear that much about MTHFR mutations and children. This post is dedicated to exploring what MTHFR mutations are, how to test for them, and what to do if you or your child has MTHFR mutations.

What are MTHFR Mutations?

MTHFR mutations are single nucleotide polymorphisms that occur within the DNA. Single nucleotide polymorphisms (SNPs) occur when one nucleotide on the DNA is altered. These small point mutations within the DNA affect how a person develops a disease as well as how they react to drugs, toxins, pathogens, vaccines and other agents. As of 2013 there were over 62,000,000 SNPs recorded in humans. MTHFR is a SNP with about 50 different variants.

So if there are over 62 million SNPs why does the MTHFR mutation get all the attention?

MTHFR stands for methyl-tetrahydrofolate reductase, an enzyme that is necessary for cellular synthesis, production and repair of DNA, detoxification functions, neurotransmitter production as well as supporting healthy formation of platelets, white blood cells and red blood cells. As you can see the MTHFR enzyme is necessary to so many vital body functions. MTHFR mutations can make it hard for the body to do all those vital functions which can cause a whole bunch of health concerns.

The two most challenging MTHFR mutations that can occur are C677T and A1298C. These names denote the location of the mutation on the gene. The most common forms of MTHFR mutation involve various combinations of these genes being passed on from each parent:

Homozygous mutation: the same mutated gene passed on from both parents- can occur if both pass on the 677 mutation, or the 1298 mutation.

Heterozygous mutation: one parent passed on the 677 mutation or the 1298 mutation but the other parent passed on a normal gene.

Compound Heterozygous mutation: one parent passed on the 677 mutation and the other passed on the 1298 mutation, this is the most problematic combination. 

Remember, there are lots of different kinds of MTHFR mutations, these are just the most common and problematic.

As many as 40% of people have some form or combination the MTHFR mutation. Research links MTHFR mutations to an increased risk for heart disease, colon cancer, stroke, recurrent miscarriage, Alzheimer’s disease, and depression in adults (1,2)

But what about the importance of detecting and treating a MTHFR mutation in children?

We know that a MTHFR mutation affects the development of the baby inside and outside the womb. Detecting a MTHFR mutation is especially important for women of childbearing age, as this defect can increase the risk of many problems in an unborn child, including folate related disorders like Spina Bifida. MTHFR defects have been directly associated with congenital heart disease and cardiac malformations. (3) Since heart formation occurs so early in embryological development, it is a good idea for mothers to be supplementing before conceiving to prevent congenital heart disease.

Cleft lip and cleft palate are also directly associated with a mother who has homozygous C677T status. (4)

Autism is a rapidly growing epidemic in our young with thousands of children receiving autism spectrum diagnoses each year. A 2013 Meta-Analysis found C677T mutations are highly correlated with Autism Spectrum Diagnoses. (5) MTHFR mutations, in A1298C, not C677T, are linked to an increased risk of ADHD. (6) Certain drugs for ADHD work by increasing norepinephrine to improve focus and attention and proper MTHFR function is necessary for normal norepinephrine levels.

Clearly, testing and appropriate supplementation for a MTHFR mutation is especially important for today’s children.

Testing for MTHFR mutations:

There are a few ways to test for MTHFR mutations. The company 23 and Me does comprehensive genetic testing without a doctor’s order so this is accessible to the general public. There are also a few specialty labs that do genetic testing like Pathway Genomics and Boston Heart Lab. I personally use Spectra Cell lab’s genetic tests with most of my patients. If you are concerned about MTHFR, genetic testing is a good thing to discuss with your healthcare provider. (I am not affiliated with any lab nor do I receive any financial compensation for mentioning them.)

MTHFR Tips:

You cannot change a gene mutation, but there are things that can be done to lessen the potential problems:

Promote Gut health: Proper digestion and absorption of nutrients is essential to health especially in those with a MTHFR mutation. Addressing any gastrointestinal infections, gut inflammation and intestinal permeability is especially helpful to people with a MTHFR defect. I recommend a clean diet packed with vegetables, fruits and fiber as well as rich in probiotics from fermented foods or supplements.

Avoid Environmental Toxins: Those with an MTHFR gene defect have an impaired ability to eliminate toxins. Avoid plastics, chemicals in beauty supplies, cleaning products, and household products as well as furnishings and flame retardants in clothes and bedding, which can all release harmful chemicals.

Don’t Take Folic Acid: Folic acid is the synthetic form of folate that cannot be metabolized by people with a MTHFR mutation. Since it cannot be metabolized, the folic acid builds up and creates a toxicity. Supplements and foods with added folic acid should be avoided. Instead, look for supplements containing 5-MTHF folate as most with MTHFR defects are able to utilize this methylated form of the vitamin. One consideration with supplementing a MTHFR mutation is those who get more hyperactive, aggressive or have other side effects from 5-MTHF supplementation. These people often have additional genetic mutations and cannot metabolize the adrenaline they produce with 5-MTHF. Be sure to work with a qualified healthcare provider when navigating a gene mutation and its supplement therapy.

Eat Your Greens: Dark leafy greens contain the methylated forms of folate that those with a gene defect can use. Including cooked, dark leafy greens like spinach, kale, bok choy, and Swiss chard in your diet is a great tool.

Support Detox: Since those with a MTHFR defect have an impaired ability to eliminate toxins, it is important to support this process with Epsom salt baths, sauna use, drinking enough clean water, dry brushing or lymphatic massage, exercise and sweating.

It is clear how pervasive and important the MTHFR enzyme is for overall health. MTHFR mutations have been associated with a long list of chronic diseases. With many adults being tested and treated for a MTHFR mutation, it is time to start addressing this genetic mutation in our children. If you are concerned about a possible MTHFR mutation in your child contact a qualified healthcare provider to test and appropriately supplement for a MTHFR mutation.

– Dr. Catherine Clinton

(1) http://www.ncbi.nlm.nih.gov/pubmed/23116396

(2) http://www.clinchem.org/content/55/9/1742.full.pdf

(3) Shi H, Yang S, Liu Y, et al. Study on Environmental Causes and SNPs of MTHFR, MS and CBS Genes Related to Congenital Heart Disease. PLoS One. 2015 Jun 2;10(6):e0128646. doi: 10.1371/journal.pone.0128646.

(4) Pan X, Wang P, Yin X, et al. Association between Maternal MTHFR Polymorphisms and Nonsyndromic Cleft Lip with or without Cleft Palate in Offspring, A Meta-Analysis Based on 15 Case-Control Studies. Int J Fertil Steril. 2015 Jan-Mar;8(4):463-80.

(5) Pu D, Shen Y, Wu J. Association between MTHFR gene polymorphisms and the risk of autism spectrum disorders: a meta-analysis. Autism Res. 2013 Oct;6(5):384-92. doi: 10.1002/aur.1300.

(6) Gokcen C, Kocak N, Pekgor A. Methylenetetrahydrofolate reductase gene polymorphisms in children with attention deficit hyperactivity disorder. Int J Med Sci. 2011;8(7):523-8.

Gut health is critical for overall health and proper development in our children. It is important that parents have the tools to help cultivate a healthy gut microbiome in their little ones. Numerous new studies point to the importance of a healthy gut for children.

Let’s review the top three things that we can do to support a healthy gut in our children.

Probiotics- A diet rich in probiotics from fermented foods or supplements is important to help support overall gut health. Gut health is dependent on the beneficial bacteria that line our gastrointestinal tract. These beneficial bacteria help with digestive function as well as play a vital role in inflammation and the immune system. Making sure your child’s diet is rich in fermented foods such as sauerkraut, kombucha (non-caffeinated for the kiddos), yogurt, pickles or any variety of fermented vegetables and/or probiotic supplements is a great way to support their gut health.

Diet High in Fiber- A diet rich in fiber from a variety of sources such as organic vegetables and fruit, whole grains, legumes, even fiber from animals helps support beneficial populations of bacteria in the gut. Sometimes it takes getting a little creative to get fiber into our little ones but it is worth the effort. In recent study out of Africa switched rural Africans’ diet with the more processed Western diet of urban Africans. (1) The switch in diet produces a change in gut microbiota within just two weeks. Diet has such an intimate relationship with our gut microbiota. While breast milk is rich in fiber like oligosaccharides, weaned children need lots of fiber to sustain the healthiest gut. Vegetables are an ideal source of fiber to feed the gut microbiota. Dr Alan Greene’s website and Nourishing Our Children are good resources if you need tips getting fiber and good nutrition into your little one’s diet. 

Let Them Play in the Dirt- Numerous studies have associated a life that is too sterile due to over cleaning, hand sanitizers and lack of exposure to regular everyday dirt with increased risk for disease. (2) Children and growing babies need to be exposed to the greater world so their body can be ‘educated’ to tolerate harmless substances instead of mounting an allergic response and to be able to mount an immune response to infections. There are a multitude of bacteria, viruses and fungi that we come in contact with in everyday life. Although seeing a sweet baby about to put a dirty hand in their mouth makes most of us cringe and reach out to stop it, this is exactly the introduction their immune systems need (within reason). It is essential that little ones get an introduction to the world so that their growing immune systems can get the exposure they need to be robust, strong and flexible.

It is vital as parents that we tend to our children’s gut health. It is never too early to focus on a healthy gut microbiome, especially in our babies and children. 

– Dr. Catherine Clinton

1. http://www.nature.com/ncomms/2015/150428/ncomms7342/full/ncomms7342.html

2. http://www.njchl.com/content/uploads/2014/08/Fukada-Article-Gut-Health.pdf

Antibiotic prescriptions have been the mainstay of modern life since they were put to widespread use in early 1940s. While antibiotics are an amazing addition to modern medicine, they also come with substantial risks. Public health agencies have warned medical professionals and the general public about risks associated with the excessive use of antibiotics for years now, but it seems those warnings have fallen on deaf ears. A recent survey conducted by the World Health Organization found people misinformed about antibiotics, with two thirds (64%) of those surveyed believing that antibiotics can treat colds and flu.(1) Antibiotics make up ¼ of the medications prescribed to children, so this deserves much more discussion. With more and more research pointing to the risks that antibiotics pose, especially for our babies and children, let’s recap what antibiotics do and why they should be saved for when absolutely necessary.

Antibiotics are a type of prescription medicine that goes into the body and mounts an attack against bacterial infections. They do this by either killing or blocking the reproduction of bacteria by targeting various parts of the bug. Antibiotics do not treat viral infections, which are responsible for the common cold, flu, most coughs, sore throats and many ear infections. They aren’t helpful during a viral infection and can often lead to more harm than good. While appropriate antibiotic use is one of modern medicine’s miracles and absolutely has its place, it has too many risks to use without serious thought. 

There are really two main areas of concern with antibiotic use. One of the main issues with antibiotic use is antibiotic resistant bacteria. This is a major and growing public health issue as more bacteria strains are becoming resistant to more varieties of antibiotics. Each year as many as 2 million people in the US become infected with an antibiotic resistant bacteria resulting in at least 23,000 deaths and the numbers are rising worldwide.

Our understanding of how antibiotics interact with bacteria is changing. Even the traditional wisdom of finishing the entire antibiotic prescription has come into question. Numerous studies comparing longer versus shorter antibiotic treatments have found shorter rounds of antibiotics just as effective. (2,3,4,5,6,7) Taking antibiotics puts pressure on the beneficial bacteria in our bodies along with the harmful ones. In addition to eradicating bad bugs that could become resistant, antibiotics can encourage good bugs to develop drug-resistant genes, which can then be transmitted to bad bugs. Killing drug-susceptible bacteria in infections too quickly makes it easier for drug-resistant bacteria to multiply due to less competition for resources. The gut ecology works as a system, the good bacteria keep the bad bacteria in check. When you wipe out too many of the good bugs with antibiotics then the more resistant are left to flourish and multiply. This means more chance of transmitting the resistant bacteria to another person which is exactly what we want to avoid. A recent study found this very thing in mice infected with both drug-susceptible and drug-resistant malaria. When the infected mice were treated less aggressively, they were 150 times less likely to pass on the resistant pathogens. (8) This is not to say don’t finish your antibiotic prescriptions but this is something to discuss with your healthcare provider the next time you receive an antibiotic prescription.

The other major concern with antibiotic use is what happens to each person’s gut microbiome and immune system after a round of antibiotics. More and more recent research shows that early exposure to antibiotics leads to long term health risks. Antibiotics alter the gut microbiota by killing both good and harmful flora. This is a problem because once you wipe out a beneficial strain of flora, the benefit also disappears. A study out of the University of Minnesota in 2015 found that antibiotic use in infancy increases the risk for certain diseases later in life. (9) The study highlights how the use of antibiotics may eradicate key gut bacteria that help immune cells in the prevention of allergies or how antibiotic-induced changes in the gut microbiota resulted in increased levels of short-chain fatty acids that affect metabolism, increasing obesity risk. This was also a key finding in a recent study out of the University of British Columbia in 2014 where researchers found that different antibiotics killed different strains of gut flora which in turn, resulted in different diseases because of the lost strain. (10) These studies show the importance of all the different individual strains of gut microbiota. Remove or decrease just one strain and the body suffers. Interesting research from the University of Helsinki in 2016 looked at 142 Finnish children, aged 2 to 7 years. Researchers investigated how many courses of antibiotics the children had received in their lifetime and how the use of antibiotics impacted their intestinal microbiota. They found that the more rounds of antibiotics, particularly the class of antibiotics called macrolides, such as azithromycin or clarithromycin, a child has in the first two years of life the greater the risk for asthma, obesity and metabolic diseases. (11) Encouraging news from these researchers highlights how that it takes about one year for the gut microbiota to recover from a course of antibiotics but those who had heavy use of antibiotics in early life and then avoided antibiotics for two years had gut microbiota similar to children with low lifetime antibiotic use. With all the news about the importance of our gut microbiota, it is nice to see that recovery from the damage that antibiotics can inflict is possible.

Exciting animal research out of Oregon State University in 2015 demonstrated how antibiotics can kill the intestinal epithelium and impair mitochondrial function. (12) Damage to the intestinal lining has various health effects as this is the site of nutrient absorption, part of our immune system and it has many other biological functions that play an important role in our health. Impaired mitochondrial function impacts cell signaling, growth and energy production which are essential for health. And if that wasn’t enough, the study found that one of the genes affected by antibiotics is critical to the communication between the host and microbe. When this communication is impaired, dysfunctions all over the body pop up. These dysfunctions include diarrhea, ulcerative colitis, obesity, food absorption, depression, immune function, sepsis, allergies and asthma. Whew.

The bottom line:

Antibiotics are an amazing achievement of modern medicine that definitely have their place. But the decades of over prescribing and rampant use in our livestock have made a huge impact on our global and individual health. This post is not to dissuade parents from treating their family with antibiotics. This post is simply meant to give parents all the facts so they can have meaningful discussions with their healthcare provider about the proper prescription and use of antibiotics. Talk with your healthcare provider about what you can do about antibiotic resistant infections. Ask whether leaving the doctor’s office with the prescription for the antibiotic unfilled and using a wait and watch approach for a few days would be appropriate. A wait and watch approach means prescriptions for antibiotics are given and not filled while cultures are tested to see if infection is actually bacterial, as well as seeing if the infection resolves in a few days without antibiotics, as is the normal case for most infections. Ask if there are things you can do to feel better without the use of antibiotics. If you and your healthcare provider decide antibiotics are appropriate, discuss a narrow spectrum antibiotic that is very specific rather than a broad spectrum antibiotic that kills many strains of bacteria. The CDC estimates that over five years 37,000 lives could be saved from resistant bacteria with more infection prevention and proper antibiotic prescribing. (13) In 2014 the CDC launched the Get Smart campaign to help raise awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic prescribing and use. The CDC Get Smart website offers lots of information about antibiotic resistance and the proper use of antibiotics and is a wonderful resource. With all of the research coming out about the risks of antibiotic use, this is an important discussion to have with your healthcare provider.

-Dr. Catherine Clinton 

Sources:

(1) http://www.who.int/mediacentre/news/releases/2015/antibiotic-resistance/en/ 

(2) el Moussaoui et al., 2006, British Medical Journal

(3) Haider et al., 2008, Cochrane Database of Systematic Reviews                          

(4) Chastre et al., 2003, Journal of the American Medical Association                            

(5) Pugh et al., 2011, Cochrane Database of Systematic Reviews).                                

(6) Sandberg et al., 2012, The Lancet).                                                                            

(7) Peltola et al., 2010, The Pediatric Infectious Diseases Journal).

(8) http://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1003578

(9) Pajau Vangay, Tonya Ward, Jeffrey S. Gerber, Dan Knights. Antibiotics, Pediatric Dysbiosis, and Disease. Cell Host & Microbe, 2015

(10) Shannon L. Russell, Matthew J. Gold, Lisa A. Reynolds, Benjamin P. Willing, Pedro Dimitriu, Lisa Thorson, Stephen A. Redpath, Georgia Perona-Wright, Marie-Renée Blanchet, William W. Mohn, B. Brett Finlay, Kelly M. McNagny. Perinatal antibiotic-induced shifts in gut microbiota have differential effects on inflammatory lung diseases. Journal of Allergy and Clinical Immunology, 2014

(11) Katri Korpela, Anne Salonen, Lauri J. Virta, Riina A. Kekkonen, Kristoffer Forslund, Peer Bork, Willem M. de Vos. Intestinal microbiome is related to lifetime antibiotic use in Finnish pre-school children. Nature Communications, 2016

(12) A. Morgun, A. Dzutsev, X. Dong, R. L. Greer, D. J. Sexton, J. Ravel, M. Schuster, W. Hsiao, P. Matzinger, N. Shulzhenko. Uncovering effects of antibiotics on the host and microbiota using transkingdom gene networks. Gut, 2015

(13) http://www.cdc.gov/getsmart/week/index.html

Trying to find something to soothe your child during a cold or flu can be hard. This recipe is one of our favorite ‘treats’ when the kids aren’t well (I’ve been known to have one or two when sick too). These immune boosting popsicles are a piece of cake to make and are handy to have around during cold and flu season. They taste great and can be quite soothing when your little ones are sick.

Elderberry Cream Cold and Flu Popsicles 

12 ounces of organic coconut milk

2 teaspoons of elderberry syrup

1 and ½ cup of organic blackberries fresh or frozen

Raw honey-optional to taste (honey should not be used by infants under 1 year due to concerns about infant botulism.)

Blend ingredients in a blender until completely blended. Pour contents into popsicles molds and freeze for at least 3 and ½ hours. Enjoy!

The elderberry in the popsicles helps fend off viruses. An active component in elderberry doesn’t allow the virus to bind and replicate, making it a great addition to any cold and flu recipe. The monolaurin in the coconut milk in the popsicles is also an effective anti-microbial helping to fight infections. And last but not least, the blackberries in this frozen treat are packed with antioxidants and other phytonutrients that help keep the immune system running strong.

– Dr. Catherine Clinton ND

This is the final post in our three part series on when, how and what food to introduce to baby. We’ve talked about the best time to introduce food and how best to introduce it and now it’s time to explore what solids to feed to baby first. There are many different theories out there about which foods to feed infants first. Some recommend vegetables before fruit to avoid spoiling the taste buds with sweet flavors. Some suggest starting with foods that taste similar to breastmilk while others warn against adding herbs and spices to baby food. Let’s see what foods we should be introducing to our little ones and why.

The conventional advice of starting baby on a cereal with a little breastmilk or formula leaves much to be desired. Processed foods offer so little nutrition and so many more chemical additives compared to unprocessed foods that we should be avoiding processed foods with baby all together. While making your own baby food can be fun and rewarding, it is not necessary to make special food just for the baby. Baby can be fed mashed up or cut up portions of adult food. Don’t be afraid to let your baby experience a full range of spices and herbs. Spices and herbs contain an incredible amount of nutrition with antioxidants and a multitude of phytochemicals that promote overall health, making them a perfect addition to your baby’s diet. Fat is another ingredient not to shy away from. Fat is essential for your baby’s development and can easily added to foods. Extra virgin olive oil, coconut oil and quality organic butter and lard are great additions to your little one’s diet. Let your baby join in your meal. Shared mealtimes let your little one learn your eating habits and can be fun opportunities for bonding.

Here are some of my favorite foods to introduce to baby and why:

• Avocado – This was both of my babies’ first food. Avocados contain B vitamins, vitamin A, vitamin E, potassium, folate, and fiber as well as a multitude of beneficial phytochemicals– making avocados a nutrient-rich option for your growing baby. Avocados are one of the only fruits that contain monounsaturated fats which are essential for your baby’s development. They are a super convenient, super nutrient rich food that is a perfect introductory solid for baby.

• Cold water fish – Cold-water fish are full of healthy polyunsaturated fats, or PUFAs, and monounsaturated fats, or MUFAs which are essential for baby’s development. They are particularly high in polyunsaturated omega-3 fatty acids. Eicosapentaenoic acid and docosahexaenoic acid, also known as EHA and DHA, are omega-3s unique to cold-water fish. Cold water fish is also a good source of vitamin D3, selenium and phosphorus, and a very good source of protein, niacin, vitamin B6, and vitamin B12. Wild caught salmon, sardines and anchovies are great choices that are also low in the mercury that bigger fish contain.

• Green veggies – Green veggies like kale and broccoli are such nutritional powerhouses they make ideal first foods for baby. Cruciferous vegetables are loaded with vitamins, minerals and phytochemicals that help ward off cancer and help the body’s detoxification pathways. Conventional advice goes with the sweet potato and squash which are fine choices for baby’s first food, I just choose to go with the most nutrient dense foods. Steamed or roasted with a little added fat of your choosing should have baby reaching for more of these green superfoods.

• Stewed meat – Rich in iron and zinc, easy to eat stewed meats make a great introductory food for baby. Iron deficiency has such negative effects on an infant’s development and has become increasingly more common. Iron supplements are routinely recommended at well baby visits to help boost baby’s iron levels and introducing iron rich foods are also a great way to keep levels where they belong. There are other factors that go into iron deficiency in infants such as cord clamping time (check out last month’s blog about delayed cord clamping) and the ability of the body to absorb the iron in breastmilk more efficiently than from food.

• Whole grains – Barley or whole rice cereal with breast milk or grains like quinoa or millet cooked in bone broths make wonderful introductory foods for baby. Packed with nutrition properly prepared whole grains are a great food to introduce to baby.

• Eggs – Eggs are loaded with protein, all the B vitamins, choline, biotin, vitamin A, D, E and K as well as selenium, manganese and omega 3 fatty acids which are all important for baby’s development and health. They are easy to make and eat which makes these nutritional powerhouses an ideal introductory food for baby.

• Beans and lentils – Beans and lentils are a superb source of protein, iron, folate, zinc and manganese for little ones. Be sure to make beans and lentils baby-friendly by soaking them for a few hours or overnight, drain, rinse and cook until very soft. Whether cooked to a puree with some added spices and fat or whole beans used for finger foods, beans and lentils make a great choice to introduce to baby.

• Mushrooms – Powdered, diced or sliced, mushrooms are powerful modulators of immune system. They contain potassium, copper, selenium, niacin, riboflavin, and pantothenic acid. They also hold powerful antioxidants and beta glucans which are vital for immune function and health. While not a conventionally suggested food, mushrooms are a wonderful nutrient rich option when introducing solids to baby.

With the current guidelines promoting the introduction of possible allergens in the baby’s diet at 4-6 months there really isn’t a food that is off limits to introduce. One exception to this is honey as it can harbor a bacteria that can be fatal to infants so it should not be introduced until baby is one year old or older. As long as you are giving foods properly prepared for baby so as not to risk choking, follow your gut about which foods to introduce first. I simply chose the above foods due their nutritional content and nutrient density. With all of the research showing how important nutrition in early life is to overall development and lifelong health, I lean towards foods that give you more bang for your health buck. If you are concerned about food allergens or have a family history of severe food allergies, wait 3-4 days in between new food introductions so you can see if they cause an allergic reaction like hives, swelling, gi distress or a rash. And remember that the bulk of baby’s nutrition should still come from breastmilk. Food introduction is just that- a way to gently, slowly introduce baby to a variety of different foods. When, how and what food did you introduce to your baby first?

– Dr. Catherine Clinton

In last week’s blog we explored when to introduce solids to your baby. It became clear that the new research is showing no benefit to delaying food introduction past 4-6 months and some decrease in allergy risk when food is introduced at 4-6 months. How do we make sense of this when previous research showed a benefit to waiting 12 months or more with certain food allergens? Let’s look at what is really going on and how we should introduce solids to baby.

First, let’s explore how our body deals with the introduction of something new. Our body’s immune system has many different responses to keep us healthy. First, there are the Th1 responses that fight infections and cancer. It is the Th2 responses that mount allergic responses or help to fight parasites. Then there are the Th3 responses that help the body recognize and tolerate non-harmful foreign substances or antigens. Whether they be airborne or ingested antigens, our body’s Th3 responses help dampen allergic reactions and promote an environment necessary for tolerance. Tolerance is an important piece of health because it helps decrease inappropriate allergic reactions as well as autoimmune reactions. It is exactly what we want when introducing food to baby.

When we look at the Th3 tolerance branch of the immune system, oral tolerance is something we should look at. Oral tolerance is the idea that introducing small amounts of the potentially allergenic food can help train the body to not react to the food. Many studies are beginning to show the potential for oral tolerance in the prevention and/or treatment of food allergies. For example, recent research demonstrated repeated administration of the allergen in slowly increasing doses, subcutaneously or sublingually, appears to be effective for allergic rhinitis.[1] Tolerance is the principle behind injection immunotherapy or allergy shots. Recent reports have demonstrated partial success with oral, sublingual, subcutaneous and epidermal immunotherapy in the treatment of food allergies. [2,3,4,5] So now we know how important tolerance is to accepting food and not mounting a response to it. It is essential for baby’s transition to solids.

One of the major protective factors in introducing foods to baby is the presence of breast milk. Breast milk has so many immune boosting and stimulating components in it that are important for baby’s digestive, neurological and immune development and health. When combined with food introduction breast milk seems to help increase the tolerance of food antigens or potential allergens as recent research highlights. 1140 infants in the UK were followed to see if the timing of food introduction was connected with food allergies. Again, the study found that food introduced before 16 weeks increased the risk of allergy whereas introduction of solids after week 17 decreased risk of developing an allergic disease. [6] The study indicated that breast milk helps promote the tolerance immune response that we want during food introduction. Recent research also shows us that breastfeeding while introducing gluten reduces the risk of celiac disease by 52%. [7] It is easy to get caught up in the excitement and turn the exploration of solids into mini meal sessions as breastfeeding fades into the sunset. But it turns out that breastmilk is too important for overall health to let fade away. For the first year baby should be breastfed as the main source of nutrition as it helps promote tolerance, trains the immune system and promotes a healthy digestive tract in addition to all of the other health benefits.

To add another piece to the puzzle, an interesting study from April of this year showed the delay of solids increased the risk of the most common childhood cancer, Acute Lymphoblastic Leukemia. [8] Researchers suggested that the increased risk of cancer was a result of not exposing the immune system to food and leaving the immune system uneducated. The immature immune systems of infants need the education that food introduction brings. This study echoes some of the research that illustrates the importance of exposing baby to germs to let the immune system properly develop. It is important to have a balance. Our babies are born into this world and need to be introduced and fully enveloped by this world. They need contact with dirt and animals and food. Should we have baby snuggle up to the patients in the communicable disease ward with a peanut butter sandwich? Of course not, that would be ridiculous. As it turns out, it’s just as ridiculous to sanitize away most of the germs in our little ones’ world or make the transition to solids so black and white. We need a balance. Introducing foods to our babies should be gradual with plenty of rotation. Introducing a food and then having it become a daily fixture of baby’s diet is not the best method. They need to be exposed to a variety of foods and spices. But more on that next week when we explore what foods to introduce to baby in the third part of our series. 

-Dr. Catherine Clinton

1- Petalas, K; Durham SR (2013). “Allergen immunotherapy for allergic rhinitis”. Rhinology 51 (2): 99–110.

2- A.D. Buchanan, T.D. Green, S.M. Jones, A.M. Scurlock, L. Christie, K.A. Althage, P.H. Steele, L. Pons, R.M. Helm, L.A. Lee, A.W. Burks Egg oral immunotherapy in nonanaphylactic children with egg allergy J. Allergy Clin. Immunol., 119 (2007), pp. 199–205

3- P. Meglio, E. Bartone, M. Plantamura, E. Arabito, P.G. Giampietro A protocol for oral desensitization in children with IgE-mediated cow’s milk allergy Allergy, 59 (2004), pp. 980–987

4- Fernandez-Rivas M, Garrido FS, Nadal JA, et al. Randomized double-blind, placebo-controlled trial of sublingual immunotherapy with a Pru p 3 quantified peach extract. Allergy. 2009;64(6):876–883

5- Dupont C, Kalach N, Soulaines P, Legoue-Morillon S, Piloquet H, Benhamou PH. Cow’s milk epicutaneous immunotherapy in children: a pilot trial of safety, acceptability, and impact on allergic reactivity. J Allergy Clin Immunol. 2010;125(5):1165–1167

6- http://www.southampton.ac.uk/news/2013/11/20-introducing-solid-foods-could-prevent-child-allergies.page

7- Akobeng AK, Ramanan AV, Buchan I, Heller RF. Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies. Arch Dis Child. 2006;91(1):39–43

8- http://www.abstractsonline.com/Plan/ViewAbstract.aspx?mID=3682&sKey=08d99429-4efb-4bdc-b63a-559261434201&cKey=2af3b213-b284-4b67-bd52-091c853112e5&mKey=19573a54-ae8f-4e00-9c23-bd6d62268424