Category Archives: Nutrition

Starvation and the infant gut

Even worse for babies...

Even worse for babies…

The gut microbiota—the collection of trillions of bacteria that populate the bowel in humans—goes through somewhat predictable developmental stages in infancy and early childhood. Some types of bacteria dominate right after birth, while others increase in number as the diet changes from milk to solid foods over the course of the first two years of life. The final profile is largely set by about age 3—what you’ve got in your gut at that point is basically what you’ll have into adulthood.

Many factors can affect the final profile—I’ve written about cesarean birth, antibiotic use, and the typical high-calorie, high-fat western diet as likely culprits. As you might suspect, these are problems of affluence. We can debate the effects of too many cesareans, too much antibiotics, and too many calories, but in developing countries there’s another potent shaper of the developing gut microbiota in childhood: starvation.

A recent study performed by Washington University in St. Louis and the International Center for Diarrheal Disease Research in Dhaka, Bangladesh, showed that children with severe acute malnutrition (SAM) have immature gut microbiota profiles—the types of bacteria in the bowel didn’t change over time as would be expected in well-nourished infants and children.

The study followed Bangladeshi infants and toddlers with SAM over the course of acute treatment and for several months afterwards. The malnourished children did gain weight rapidly with very high-calorie diets, but they were unable to achieve or maintain a normal weight once the treatment ended and they switched to a more typical diet. Signficantly, their gut microbiota remained immature—the bacteria present in the gut both before and after treatment were woefully inefficient at extracting calories from food.

So now we have evidence that the gut microbiota plays an important role in two very different nutritional diseases: obesity and malnutrition. Future SAM research will be aimed at supplementing probiotic bacteria as well as calories in hopes of promoting healthy, long-lasting changes to the microbiota.

The sooner the better, given the terrible toll malnutrition takes on children in many parts of the world.

Photo courtesy of Chris Turner

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Filed under Gut microbiota, Nutrition, Obesity

Breaking news: School kids would rather eat junk!

Well, that didn’t take long…

Fox News reports on an epidemic of “starving” schoolchildren in the wake of recent changes in federal school lunch programs that made the meals a bit healthier.

Shockingly, Fox reporters discovered that part of the problem is that, well, kids would rather eat pizza and chocolate milk than more fruits and veggies, less meat and cheese, and plain old low-fat milk. (Which was true in 1971 at Bishop McNamara High School in Kankakee, Illinois, too–I know this for a fact.*)

Why is this even an issue? Fox’s concern makes a bit more sense when you consider who was behind the school lunch changes: none other than Michelle Obama, whose husband happens to not be Fox News’s choice for president.

Normally I’d pontificate a bit about this, but nobody says it better than Jon Stewart:

*Me, suavely ignoring broccoli, 1971.

“Why is this news?!” he rhetorically asked. “If [Michelle Obama] said we needed clean air, half the country would demand gills, because, freedom!” Stewart said.

Watch Stewart’s take on the “issue” here.

(And yes, it is a bit ironic that Stewart’s video is preceded by an ad for Jack-in-the-Box…)

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Filed under Nutrition, Politics

Michelle Obama and “Let’s Move!”

As anyone who watched her speech at the Democratic convention knows, Michelle Obama is an impressive woman. She’s quite sincere in her concern for children, too, as evidenced by her “Let’s Move!” initiative–an admirable, sensible approach to fighting childhood obesity. (If you haven’t visited the “Let’s Move!” website, here’s the link. It’s worth a look.)

“Let’s Move!” isn’t just a public relations stunt. Michelle Obama has had considerable success in changing the national conversation on childhood obesity, such as putting mega-food producers on notice. I’d like to see her be more aggressive on fast food industry shenanigans (marketing to kids and such), but for now she’s no doubt held in check a bit by her First Lady gig. It’s definitely a vast improvement over the efforts of past administrations, though.

It will be interesting to see what her future holds. I’m betting she gets the girls off to college (after a second White House term), then enters the political fray herself, with Barack tending the garden back home… Should be interesting, and good for children.

* * *

Photo by Statsministerens kontor

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Filed under Nutrition, Obesity, Politics

Food for thought: Teen brains and obesity

Teen brain + metabolic syndrome = Trouble

A worrisome new study in the journal Pediatrics has found that teens with metabolic syndrome (MetS)* have something in common with adults suffering from the same disease: They, too, can have brain deficiencies and cognitive difficulties.

When a group of 49 New York teens with MetS was compared with 64 normal-weight kids, the MetS teens had lower scores on tests of mental ability, arithmetic, and reading. In addition, MRIs showed that the typical MetS teen had a smaller hippocampus than his or her normal classmates–that’s the part of the brain that deals with memory formation and storage. Such changes in adults had been thought to be the result of long-term metabolic disease; the discovery of similar changes in teens was unexpected, and scary.

Are these changes permanent? Does the brain recover if a teen loses significant weight and reverses his or her metabolic syndrome? No one knows for certain as yet, but this study adds a bit more urgency to the fight against childhood obesity. As Dr. Antonio Convit writes in the study’s conclusion:

“Although obesity [alone] may not be enough to stir clinicians or even parents into action, these results in adolescents strongly argue for an early and comprehensive intervention. We propose that brain function be introduced among the parameters that need to be evaluated when considering early treatment of childhood obesity.”

* * *

Metabolic syndrome is defined by the American Heart Association as the combination of high blood sugar, elevated blood triglycerides, reduced “good” cholesterol, abdominal obesity, and high blood pressure.

Photo by Dierk Schaefer

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Filed under Nutrition, Obesity

Poor kids likely to eat more sugar. Why?

Here’s a follow-up to my last post:

The deck really is stacked against poor kids in terms of risks for obesity. Not only are they less likely to be breastfed, which can help prevent obesity, but they’re significantly more likely to have high-sugar, high calorie diets.

Lots of sugar, not much fruit…                      (Photo by Dominic)

Why? Because sugar is cheap and convenient, and poor kids tend to live in neighborhoods where convenience stores–with their snack-and-proccessed-food-heavy offerings–dominate the local market scene. The politics of of American farming has a lot to do with our unhealthy way of eating, too.

The good news is the increase in local efforts to bring fresh fruits and vegetables to the neighborhoods where they’re most needed. Here in Santa Rosa, CA, we have the Megan Furth Harvest Pantry, a mobile, miniature produce market that distributes healthy foods, as well as nutrition education, to needy families with kids five years old and younger.

Megan Furth Harvest Pantry

You can find other examples all across the nation, like this one in St. Paul, and this one in New York. Still, until the big-box grocers venture back into the poorer neighborhoods they abandoned long ago, far too many children will have sugar-heavy, unhealthy diets.

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Filed under Breastfeeding, Nutrition, Obesity, Politics

World Breastfeeding Week, and a bit of history

Happy World Breastfeeding Week!

We are in the middle of the 20th annual World Breastfeeding Week (August 1-7)–and though it’s not exactly the Olympics in terms of media coverage, WBW is a very worthy cause for public celebration.

WBW is sponsored by the World Alliance for Breastfeeding Action (WABA). This year’s theme is Understanding the Past – Planning the Future: Celebrating 10 years of WHO/UNICEF’s Global Strategy for Infant and Young Child Feeding, and I’ll be writing a few breastfeeding-centered posts in the next week. In keeping with the “understanding the past” theme, I’d like to lead off with a bit of breastfeeding history.

This is an excerpt from an article I wrote on breastfeeding that never ran in the San Francisco Chronicle a few years back (don’t get me started…). The “public scolding” at the end refers to the personal situation of a mother in my practice. Due to a chronic illness she was unable to produce enough milk to exclusively breastfeed, and found herself being scolded by strangers when she of necessity “topped off” her baby with formula after breastfeeding as much as she could. Her story led me to read up on the cultural history of breastfeeding.

The “breast-versus-bottle” controversy is a relatively recent development in the history of infant feeding. For hundreds of years, the argument centered not on the merits of breastfeeding itself, but rather on whose breast was best suited for the job.

Wet nursing–one woman breastfeeding the infant of another–was common among affluent women from before the founding of the Roman Empire through the end of the French Revolution.  But debate surrounded the practice from earliest times, as evidenced by the writings of Soranus of Ephesus, a renowned Greek physician of the second century AD.

Soranus was a staunch proponent of wet nursing. He considered a new mother’s milk “unwholesome, raw, hard to digest… and not prepared to perfection,” and declared that the breast milk from a woman who had already nursed a child of her own for at least two or three months was the healthiest choice for a newborn. Damastes, a physician and rival medical writer, strongly

Soranus: Wrong…

disagreed, asserting that nature intended for a baby to feed at its own mother’s breast. His teachings drew Soranus’ published ire.

“One ought to censure Damastes,” Soranus wrote, “who orders the mother to give the newborn her breast immediately [because] nature has provided for the production of milk beforehand so that the newborn may have food straightaway.” This was “plausible sophistry” to Soranus, who compared a mother nursing her own infant to an exhausted, barren field – she risked “grow[ing] prematurely old, having spent herself through the daily suckling.”

The writings of Soranus influenced infant feeding practices for well over a thousand years. Until the mid-eighteenth century, babies born to women of the aristocratic and merchant classes of Western Europe were customarily “placed out” to wet nurses. The practice was so entrenched that fewer than 1,000 of the estimated 21,000 babies born in Paris in 1780 were nursed by their own mothers. The common wisdom–that nursing spoiled a woman’s figure and made her “old before her time”–echoed Soranus.

The wide acceptance of wet nursing was a catastrophe for Europe’s newborns. Many wet nurses – often poor and malnourished – took on more babies than they could possibly feed, resorting to a thin, germ-ridden ‘pap’ of bread and water to supplement their own overtaxed milk supplies. The death rate among wet-nursed and artificially fed babies, mainly from infectious diarrhea, was staggering–over 90% in some areas.

Breastfeeding surged in popularity in the late 1700s, after physicians established the connection between feeding practices and infant mortality. By the early 1800s, the majority of women of all social classes nursed their own babies, including an estimated 95% of infants in the United States.

But the Industrial Revolution dealt breastfeeding a blow from which it has yet to fully recover. Science equalled progress in nearly all aspects of nineteenth-century life, and infant feeding was no exception. Artificial feeding and commercial formulas became acceptable to women, even necessary for the growing number of female factory workers.

The twentieth century ushered in the age of “scientific mothering”, which dominated Western-style infant care through the 1950s. Babies were raised “by the book”–books that often emphasized cod liver oil and artificial feeding. Independence – toughening up a child for his own good–was the goal.  Encouraged by physicians, “medicalized” infant care became the norm.

We know now that the emotional, nutritional and immunological benefits of breastfeeding make nursing the single most important thing a mother can do for her baby. Yet the challenges facing nursing mothers today–smaller, more isolated families, demanding careers and an often unsupportive society–are daunting.

Nearly two millenia after Soranus took Damastes to task for his views on infant feeding, the intense emotions that surround breastfeeding remain largely unchanged.  No record of Damastes’ reply has survived to the present, but if contemporary behavior is any indication, he likely cornered Soranus in a local market and gave him the ancient Greek version of a modern public scolding.

More on breastfeeding coming soon…

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“You’ll sit there until you finish your peas, young man!”: Update, 2012

Since time began…

I don’t know what it is about kids and vegetables. As I learned from personal culinary experience with child #2, it’s sometimes easier to get them to eat sand (with gusto) than green beans. Now I know where I went wrong. Maybe it’s not too late for you…

The secret? Smile when you eat your own veggies! That’ll make your youngsters, who are very sensitive to adult emotions, more likely to dig into their own heap o’ Swiss chard.  At least that’s what an article in the British Journal of Developmental Psychology says.

Researchers showed kids pictures of adults eating with happy and disgusted faces, and found that their young subjects were more willing to give veggies a try after viewing the happy, veggie-eating grownups. Their analysis:

“Adults may unconsciously influence children’s food preferences via their facial expressions of pleasure or disgust.”

Which raises two questions:

1) In the whole history of the world, nobody thought of this before?

2) If we show kids pictures of adults gagging on Milk Duds, will they start demanding spinach?


The researchers didn’t specify the type of smile that works best, but it can get tricky. No telling what effect the wrong veggie-grin might have on impressionable children.

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Soybeans and baby brains

Just like Gram Sloan used to grow…

The second study (following up on my last post), also published in Pediatrics, involves a comparison between soy formula and cow’s milk formula. The concern: given the known differences in cognitive development between breast and formula-fed babies, does soy pose any additional risks when compared with cow’s milk formula?

The authors, Aline Andres and colleagues at the University of Arkansas, focused on the role of isoflavones, an estrogen-like chemical found in soy. Their results: there was no difference in behavioral, psychomotor, and language development in the soy-fed babies compared with those who drank cow’s milk formula.

But…what they did find (again) is that neither the soy nor the cow’s milk groups did as well on testing as did breastfed babies. This difference held up even after mother’s age, socio-economic status, and IQ were taken into consideration.

So what is the deal about breastfeeding and better scores (or should I say formula feeding and lower scores)? More on that subject down the road…


Filed under Breastfeeding, Development, Nutrition

More on breastfeeding…

As if you needed more reasons to choose breastfeeding, this just in from the journal Genome Biology:

Babies who breastfeed have a wider variety of bowel bacteria than those who are formula-fed. Why is this important? Because the bacteria in the newborn bowel (also known as the gut microbiota) help direct the development of the newborn’s immune system, among the many other beneficial functions they perform. A more diverse gut microbiota is associated with a healthier immune system.

We already know that babies born by cesarean section have a less-diverse gut microbiota than vaginally-born babies, and that following a c-section the newborn gut microbiota is often dominated by bacteria picked up from the hospital environment. Some of those hospital bacteria–clostridium difficile in particular–are associated with a number of nasty diseases in humans. From the looks of this study (and others), formula feeding may exacerbate the problem.

Nature intended for us to have a diverse gut microbiota, dominated by the types of bacteria picked up in the course of a vaginal birth and breastfeeding. We’re only now learning of the long-term health consequences of tinkering with that plan…

PS: In no way am I criticizing women who, for whatever reason, formula feed their babies. Exclusive breastfeeding isn’t always an easy thing to do in this day and age. But however it happens that a baby isn’t breastfed, the potential health impacts are the same.


Filed under Breastfeeding, Cesareans, Maternal-child health, Nutrition

Vitamin D and…food allergies?

Vitamin D deficiency: The root of all evil?

When I started writing posts about vitamin D, I thought it would be a straightforward three-part series: What does vitamin D do? What happens when you’re deficient in it? How can we prevent that from happening? The more I read on the subject, though, the more interesting things I learn—all of which underscore the need to supplement infants with vitamin D.

This latest item is from Australia—where they get plenty of sunshine—and turned up an association between vitamin D deficiency and food allergies in infants. Children in the Melbourne area with documented vitamin D deficiency were nearly four times more likely to suffer from food allergies than were those with normal vitamin D levels.

This supports the work of a number of researchers (one example here) who have found that people who live farther from the equator (and hence get less sunshine—and thus less vitamin D) are more likely to end up in an emergency room or hospital with a severe food allergy reaction than those who live in the tropics.

Sunshine and food allergies! That would have sounded like science fiction back in my 1970s med school days.

More on the relationship of vitamin D and immune system function coming up…


Filed under Allergies, Nutrition