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There's a topic I spend an inordinate amount of time thinking about. To the point that I think I may be obsessed. To put it into perspective, I live in Paris. Just wandering through the streets of the city in the Spring-time is a visceral experience worthy of song, poetry and, of course, blog posts. The other day, I was with my 12 year old son walking the dog, thinking about the way the gut and brain ARE. Not the way they communicate, but the way they are. The way we are.
I caught myself as I hurried to catch up to Leo. I slipped my arm into his and set a pace to match him, as I finally took in the sun, the breeze and perfect beauty of the day. I pushed the other thought away. For awhile. Clearly, it has returned. It always returns because mommas, babies and families are not as well as we could be. Not by a long shot.
As a lactation consultant I used to think about breastfeeding. I thought about my own babies, my clients and their babies, about what I read and observed and learned. I loved nursing my babies and I love helping mommas nurse their babies. So, I am still a lactation consultant, but now I pretty much think about the gut. And all that is associated with the gut — like the brain, hormones, the nervous system, structure, personality, emotions and general well-being. Because I think about the gut and the brain, I also think a lot about bacteria and inflammation. Not because bacteria cause inflammation, but because more often than not, lack of bacteria does.
In essence, bacteria are the way we are. Today, I took my son to the Muséum National d'Histoire Naturelle. The building is ancient, of course, but so are the displays. The cursive handwriting on the jars intrigued me as much as the specimens. There were thousands of skeletons, fossils and organs of species long extinct and of those still here. Including homo sapiens. Leo asked me what was here before any of them. "Microbes," I said.
Microbes have a 3.4 billion history on Earth and microbial mats are the oldest known ecosystem on Earth. Whatever form life on Earth takes, microbes share the journey with us. They are the way we are; they are the way that life is. NASA and other scientific sources use the term co-evolution to describe the fact that all life has evolved in relation to microbes. Microorganisms can form endosymbiotic relationships with other organisms. Examples are rampant, but the relationship that interests me is the one between the bacteria that live within the human digestive system and the human organism itself. These microbes contribute to immunity, synthesize vitamins and ferment complex indigestible carbohydrates. They drive our relationship with the world around us.
So, how does this relate to babies, birth and infant feeding? In every possible way, it turns out. While the infant gestates in a sterile environment, the mother's body is prepared at birth to immediately alter that scenario, exposing the newborn to her own microbes, inoculating him with the flora that will rapidly multiply and populate his gut. As the infant journeys through the birth canal, he is exposed to a medley of microbes, designed to optimize his potential for thriving in the world his mother inhabits. The inner terrain and the outer terrain find perfect balance in the transition from intra-uterine to extra-uterine life.
According to archeologist and prebiotoc researcher Jeff Leach, "... this cycle links the co-evolution of intestinal 'microflora' of the mother to child, and may represent a more significant bond for those who understand it exist(sic). This evolutionary bacterial right of passage has been and continues to be critical to the success of our species, and all mammals for that matter." Once inoculated in the birth canal, the baby is further populated by the microbes in his mother's milk, on her skin and in her mouth. In the normal physiologic process of birth and feeding, the infant is being prepared for life in the world the mother's body has adapted to survive in.
This is where my head starts to whirl. I ask question after question, trying to see all the connections. There is no doubt, given the physiology of this process, that several things should and should not happen. First, babies clearly need to be born vaginally. At birth, they need to be touched only by their mothers and they need to go to breast. They need to be kissed by their mothers. This process of inoculation by microbes that initiates in the birth canal is given robust life at the breast. The human organism, which contains 10x more bacteria than human cells, has its blueprint for functional health and well-being laid down in utero (that's another post) and is given form and structure in the birth canal and at breast.
Human milk contains carbohydrates known as oligosaccharides, which are virtually absent in cow milk. They are undigested in the stomach and small intestine and are able to reach the colon intact where they provide food for the bifidobacterium, enabling them to multiply rapidly. Now here are two pieces of interesting information that fit a lot of pieces together for me. First, according to Jeff Leach, "As the bacteria thrive on this 'food' from mother's milk, they grow in number and absorb water, resulting in more regular and soft bowel movements. It's important to know that the bulk of infant feces are made up of live and kicking bacteria." Second, the insoluble fiber in human milk acts as a kind of irritant in the gut, causing the production of a lubricant that further speeds up the process of elimination.
Someday, I am going to write "Confessions of an IBCLC Heretic" because for almost 20 years, I have been saying that it is absolutely not normal for babies of any age to have fewer than several significant bowel movements per day. Not per week! Per day. The more I learn about the gut and the gut-brain axis, the more I have to learn. But, I am confident that human milk is not "all used up" and that babies are not "efficient enough that there is no waste."
Such comments do not even bear up under the scrutiny of common sense. If all those babies who stop pooping at 4-6 weeks are using up all the milk, what are the babies who are pooping 6-8 times per day doing? Making it? Babies need to poop.
There is so much that we impose on mothers and babies in our contemporary, invasive birth practices that damages intestinal flora. Frankly, I think disruption of this essential process of gut inoculation is reason enough to avoid cesarean unless there is clear and real medical necessity. And it is reason enough that babies not be touched by anyone who is not the mother before the baby nurses. Introduction of any substance other than mother's milk damages the gut — this includes artificial milk, sugar water and drugs.
So, the infant gut, pristine in utero, becomes a hotbed of microbe activity at birth and the nature of those microbes will become how and who that baby is. Gut flora determine our relationship to the environment around us, as 75% of the immune system resides with the gut. They determine much about our emotional well-being as 80% of our serotonin is in the gut. The enteric nervous system — often referred to as the "second brain" - is embedded within the gut. Gut microbes determine our vulnerability to disease and to stress and direct our potential to thrive emotionally, physically and intellectually.
Given the significance of gut function to the well-being of the infant, I want to see all babies have strong healthy guts. So, when I see a baby who is not on solids, not sick, getting enough food and still not pooping as often as I know healthy babies do, I want to know why.
I will rule out or refer for treatment any tongue-tie and other structural causes of vagus nerve suppression, such as birth trauma. I want to rule out oversupply or over-active milk ejection reflex. I want to know what a baby's poop looks like. Pasty poop is not normal, nor is mucus or poop that soaks into the diaper or is green, simply a skid mark or takes a lot of straining to achieve. And volumes of poop once per week does not indicate the milk has been "all used up." It means it has been sitting in the colon, going nowhere. Pasty poop has not absorbed enough water. Poop that smells foul indicates an imbalance of intestinal flora.
Other indications of poor gut function include cradle cap, eczema, skin rashes, "baby acne", a red ring around the anus, thrush, dark circles under the eyes, difficulty organizing states, cognitive delay, difficulty sleeping, poor appetite, poor growth, "colic," "high-needs" behaviours, congestion, reflux, refusing the breast, arching at the breast, gassiness and infection.
Clinically, I know that gut function is a problem because when babies are treated, gut function is restored. Restoring gut function is a complex topic and is somewhat individualized. Treatment eliminates allergens and food sensitivities and might include use of probiotics, bentonite clay for detoxification, digestive enzymes, slippery elm bark powder and other healing herbs, castor oil compresses on the belly and most importantly healing the maternal gut through elimination of pro-inflammatory foods and the inclusion of healing foods, supplementation, and structural or bodywork or energywork for baby and mom. Remember, the intestinal flora in the mother's gut ends up in her milk.
The process of microbe inoculation that is clearly a primal imperative is interrupted and incomplete at best in most babies. Within weeks of birth, many mothers are observing the kinds of symptoms I have described. Because common tends to be referred to as "normal," often symptoms are dismissed by health care providers or labeled as "dairy allergy" (as if there is no other allergy), reflux, GERD or "colic" or worse: "breastmilk allergy" and many moms end up weaning prematurely because the gut damage tends to worsen with time or the "treatment" involves weaning to artificial infant milk. Sometimes, on the other hand, the symptoms seem to disappear and certainly the gut can heal, especially on a diet of exclusive momma milk. But often, the symptoms have simply changed or are not recognized as such. Ear infections, frequent colds, bed wetting, asthma and "tummy aches" often replace the vomiting, colic and sleeplessness of infancy. The bottom line is that our babies need healthy guts both to survive and to thrive in the world. Passing off as "normal" common indications of poor gut function serves no one, least of all, the baby.
I will continue thinking about the gut and about microbes and about how we are as they are. And with any luck, as people become more attuned to the primary urgency of protecting the gut integrity of the infant, practices will change. In the meantime, I hope we will all begin to see babies and in a different way and be more inclined toward restoring full function than simply managing dysfunction. And that we remember that to heal the baby, we have to begin by healing the mother.