Get Your Children Good and Dirty Researchers are discovering how crucial microbes are to our health and to avoiding a range of newly common diseases. So it’s time to get dirty, eat better and stop overusing antibiotics By B. Brett Finlay and Marie-Claire Arrieta
http://www.wsj.com/articles/get-your-children-good-and-dirty-1473950250Dr. Finlay is a microbiologist specializing in bacterial infections and the Peter Wall Distinguished Professor at the University of British Columbia. Dr. Arrieta is an assistant professor in the Department of Physiology and Pharmacology at the University of Calgary. This essay is adapted from their new book, “Let Them Eat Dirt: Saving Your Child From an Oversanitized World,” published by Algonquin Books of Chapel Hill.
Our friend Julia moved to a small free-range pig and poultry farm when her first child, Jedd, was a preschooler. When her second baby was born, she would strap him on her back every morning so that she could go to the chicken coop to pick up eggs. Jedd would chase and ride the chickens—and sometimes taste their feed and touch the fresh eggs. A couple of times, she even caught him chewing on something he had picked up from the ground.
At first, all of this caused Julia to freak out. But once she realized that Jedd wasn’t getting sick from these encounters with the chickens, she relaxed a bit. Her second child, Jacob, soon followed suit and never hesitated to get dirty on the farm. She once found him knee-deep in a cesspool of pig waste. Her early worries that her children were going to contract diseases from all this messiness dissipated, and she was pleased to see that they remained healthy.
Was Julia being an irresponsible parent—or might we all have something to learn from her example?
For most of the past century, we have considered microbes bad news, and for good reason: They cause disease, pandemics and death. Most human communities have experienced the benefits of medical advances like antibiotics, vaccines and sterilization, which have radically reduced the number and severity of infections that we suffer throughout life. Dying from a microbial infection is now a very rare event in the Western world, and, in the U.S., lifespans have increased by some 30 years since 1915—in large part because of success against infectious diseases.
Unfortunately, this progress has come with a price, as news reports have been telling us for some years now. Our anti-microbe mission has been accompanied, in industrialized countries, by an explosion in the prevalence of chronic noninfectious diseases and disorders. Diabetes, allergies, asthma, inflammatory bowel diseases, autoimmune diseases, autism, obesity and certain types of cancer are at an all-time high. The incidence of some of these disorders is doubling every 10 years, and they are starting to appear sooner in life, often in childhood.
All of these diseases have a genetic component, but their alarming growth cannot be explained by genetics alone. Recent studies find a direct link between the presence and absence of certain bacteria and all of the chronic diseases mentioned above. It turns out that the microbes within us are much more than quiet residents; they are an inherent part of our physiology, and altering them leads to disease.
Our own 2015 study (published in the journal Science Translational Medicine) found, for example, that 3-month-olds who had four particular microbes in their feces were much less likely to get asthma later in life. When those four microbes were introduced into mice, they protected against experimentally induced asthma, showing for the first time that alterations in gut microbes can drive the development of the disease. Lab experiments also have found that obese mice lose weight when they get a transfer of gut microbes from lean mice (and the reverse holds true as well, with lean mice growing fat after a transfer from obese mice).
The practical upshot of all this research is clear: Our health depends to a large degree on maintaining a robust and diverse community of microorganisms in our bodies—and establishing good gut-health as children is especially important.
From the moment we are born, we begin getting colonized by bacteria, which kick-start a series of fundamental biological processes, including the development of our immune system. Before birth, the lining of our gut is full of immature immune cells. When bacteria move in, the immune cells react to them, changing and multiplying. They even move to other parts of the body to train other cells with the information they have acquired from these intruders. If deprived of this interaction, the immune system remains sloppy and immature, unable to fight off diseases properly.
Scientists haven’t figured out exactly how microbes do this at the molecular level, but we do know that most bacteria will teach these immune cells to tolerate them, whereas some bacteria—the pathogens that cause diseases—prompt strong resistance. The result is to make the intestine a relatively controlled and harmonious place.
Another fundamental function of microbes is to aid in the regulation of our metabolism. Like other animals, humans obtain energy from food that is digested and absorbed in the intestines. Besides helping us digest certain foods that the intestines can’t handle on their own, bacteria produce compounds that help to define how we use or store energy in our bodies. New research also shows that our microbiota plays an important role in neurological development and even in the health of our blood vessels.
Such discoveries have led scientists to call our microbiota a “new organ,” perhaps the last human organ to be discovered by modern medicine. Most of this knowledge is still relatively new and many pieces of the puzzle remain unsolved, but protecting the initial developmental stages of our microbiota clearly has a significant impact on our health.
Inflammatory diseases (such as asthma, allergies and inflammatory bowel disease) and metabolic diseases (such as obesity and diabetes) are characterized by alterations in our immune system and our metabolic regulation. Knowing what we do now about the role of the microbiota, it is not surprising that these diseases are being diagnosed in more children. They are, to a great extent, a consequence of relatively recent changes in our lifestyle—modern diet, oversanitization, excessive use of antibiotics—that have altered the specific microbes that affect our metabolism early on. We urgently need to find ways to modify our behavior so that our microbes can function properly.
Never before in human history have babies and children grown up so cleanly, and our diets have lost many of the elements most crucial to the health of our guts. We have become very bad hosts to our microbes.
What to do about it? The U.S. Food and Drug Administration took one helpful step earlier this month when it banned some chemicals used in antibacterial soap, but the most important changes need to take place in our everyday routines.
Parents can expose their children to an array of microbes by encouraging them to spend time outside, like our friend Julia on her farm (but not necessarily with chicken and pig waste). Today children spend much less time outside than they did only 20 years ago.
Babies and toddlers often aren’t allowed to play in the dirt or sand, and when they are, they are wiped clean immediately. Phrases like, “Yuck! Don’t play in the mud!” or “Don’t touch that bug, it’s dirty!” have become second nature.
We need to unlearn these habits. By preventing babies and children from following their innate impulse to get dirty, we shield them from the microbial exposure that is essential for the development of a healthy immune system.
Parents can also promote good gut-health in their kids through diet. It is well established that the Western diet—high in fats, sugars and highly refined grains—is very strongly associated with a number of diseases, especially obesity and the closely linked disease of type-2 diabetes.
Our ancestors grazed on a variety of foods, which ensured a variety of microbes in their intestines: Eating a range of different foods provides a hospitable environment for a range of different microbes. Today, 75% of the world’s food comes from just 12 plant species and five animal species. Amazingly, just three species—rice, corn and wheat—account for 60% of the calories that humans obtain from plants. Except for regions where a lack of economic development has preserved older farming and dietary practices, more people are eating refined white sugar, white flour and processed fats, instead of our ancestral diet of vegetables, fiber, fruit and nuts.
A 2010 study in the Proceedings of the National Academy of Sciences compared the microbiota of children living in rural Burkina Faso in West Africa to the microbiota of urban, city-dwelling children in Italy. The African children ate a high-fiber diet of vegetables, grains and legumes, with no processed foods, whereas the diet of the European children was full of sugars, animal fats and refined grains. The gut microbes of the children from Burkina Faso were very different from—and much more diverse than—those of the Italian kids.
We wouldn’t want to say that children in Burkina Faso have a healthier lifestyle than Italian children. They are more likely to suffer severe infections and malnutrition, and they have a lower life expectancy than children born in Western Europe. But they also have a decreased risk of suffering from the immune diseases that are epidemic in the Western world.
In an ideal world, children would harbor a rich and diverse community of microbes without the threat of severe infectious diseases, but our current practices only address half of this equation. Given how well bacteria respond to diet, eating a variety of foods is perhaps the best way to increase microbial diversity, and there’s no better time to do this than during the first few years of life.
As a practical matter, this means that we shouldn’t feed a baby only rice cereal for weeks until the package is finished. We should offer a variety of grains, including oats, rice, barley and quinoa. It’s also important to offer whole grains instead of refined ones. The Western diet is extremely low in fiber, and refined grains contain very little of it.
Protein-rich legumes, such as lentils, beans and peas, have an abundance of fiber and can be easily mashed for babies. Also try nontraditional starchy vegetables such as sweet potatoes, parsnips or cassava (tapioca) rather than just sticking to low-fiber veggies such as potatoes. For older children, add fermented foods, such as yogurt, kefir, sauerkraut and other pickled vegetables.
Most people in developed societies won’t crave these foods the same way that they crave the texture of macaroni and cheese or the like, but infancy is the best time to introduce good dietary practices. For children, eating healthy foods becomes a habit in the same way as cleaning their room does: by doing it frequently.
Food isn’t the only way that we have altered our microbiota, however. Our microbes have perhaps taken the biggest hit from one of the best things humanity has ever invented: antibiotics. These wonder drugs have saved millions of lives and will save millions more in the future.
But antibiotics aren’t targeted missiles that kill only the bad bacteria causing infections; they are carpet bombs that kill good and bad bacteria indiscriminately. Research now suggests a link between the use of antibiotics in early childhood and problems such as obesity, diabetes, asthma, allergies, autism and inflammatory bowel disease.
We ought to become more restrictive with the use of antibiotics in children. Parents shouldn’t assume that all infections have to be treated with these drugs. Upper respiratory tract infections and colds are often caused by viruses, so antibacterials won’t cure them. Most sore throats, especially if the child also has a runny nose and cough, are caused by viruses and don’t need antibiotic therapy. If a child has a mild ear infection, it’s reasonable to watch and wait for a few days to see if it gets better on its own before starting antibiotic therapy. Also, parents should consider giving probiotic supplements (with live bacteria and yeasts) to a child if he or she is being given antibiotics.
With the scientific information now available, parents can make informed choices about helping their children to develop a thriving microbiota. We are still years away from learning the whole story of how microbes contribute to our physical well-being, but what we know today is pretty convincing evidence that they are crucial, especially early in life.
For much of the past century, we have ignored, and often destroyed, the microbes that keep us healthy. It’s time now to correct the balance.
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