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The best part of my departure from conventional models of psychiatric care is that I no longer have to engage women in the Sophie's Choice between treatments that may be good for mom and not for baby or vice versa. Healthy medicine relies on interventions that benefit both mom and baby at once.
The most profound starting point for this shared journey, for a woman contemplating pregnancy, pregnant, or nursing, is the gut. Thanks to holistic providers and journalists sharing their wisdom about the importance of microbiota, and to advances in sequencing technology, this concept is finally trickling down to the masses.
Many of us now know that we are outnumbered 10:1 by microbes, and that these residents are so influential in our states of health, that they could be considered an organ themselves. They are responsible for breakdown and synthesis of nutrients, elimination of waste, and complex immune signaling.
The gut:brain connection is relevant for women looking to heal themselves from states of mental illness, and it is equally relevant for the mental health and global wellness of their babies who will grow into people reflecting that formative exposure to bacteria.
The communication between our guts and brains appears to rely, in part, on the vagus nerve, and is bidirectional in nature as reported in this 12 year prospective study that looked at relationships between gut problems like irritable bowel disease, anxiety, and depression. Bodily states of inflammation and immune imbalance also impact the brain through brain cells called microglia.
So, where does this particular population and specific diversity of bugs come from? How does it get corrupted? What can a woman do to help set a great stage for her baby?
Heal Your Gut
This process starts with a gut healing diet. For most, elimination of potentially inflammatory foods is done in a sequential fashion. I start with:
1. Gluten and Processed Dairy
2. Grains and Legumes including peanut
3. Eggs, Nuts, and Nightshade vegetables.
For some, a FODMAPs diet may be indicated, and for others, a GAPs or Specific Carbohydrate Diet. Most patients don't come into my office expecting to be smearing their poop into vials within a week of consultation, but a stool test can be an instrumental tool for identifying how things have gone off track. Often, gut flora can be disturbed and inflammation raging, without any gastrointestinal symptoms.
Fats like those in bone broths, organic meat, low contaminant fish, pastured eggs, coconut oil, and ghee can be healing for some inflamed guts. Importantly, organic food is a cornerstone of minimizing gut sabotage as we learned from these brilliant researchers. Pesticides kill our gut bugs and promote inflammation. Each and every dose.
Every person's journey to a healed gut is different, but the sooner you start yours, the better.
Have a Physiologic Birth
There's a reason babies come out of the birth canal and are breastfed. We may be learning those reasons at a time when surgical births are performed almost half the time and our children are the sickest they have ever been. In my opinion, the "who wants to experience pain?!" epidural is the beginning of a cascade of interventions that dramatically increase the likelihood of having a surgical birth. Without vaginal transfer of mom's flora, the baby misses out on the most important inoculation (and I don't mean Hep B!).
A study of 24 Canadian babies at 4 months demonstrated that elective section resulted in the most diminished bacterial diversity. Surgically born babies had significantly less Bacteroides and Escherichia-Shigella species. In this cohort, formula fed babies had overrepresentation of Clostridium difficile, Peptostreptococcaceae, and Verrucomicrobiaceae.
Excitingly, research is being done on "vaginal swabs" for inoculation in the setting of C-section. You might consider doing your own pilot studies if you find yourself in the operating room.
Breastmilk contains unique nutrients for beneficial bacteria called oligosaccharides, but importantly, it is the vital follow up to the mother's vaginal flora, designed to support the baby's immune system during its infancy marked by an "anti-inflammatory" phenotype. During these first few months, the baby relies on the mother's breastmilk to help inform its immune system of what is dangerous. Over the course of lactation beginning with colostrum, the makeup of these bacteria and growth factors changes. How amazing is that?
A recent study confirms that mom's gut bacteria are vertically transferred through breastmilk and that this "entero-mammary" connection is what helps to develop the baby's immune system. This is the beginning of natural immunity, which is so much more complex than vaccinologists would have you believe.
One of the many problems with formula is the glaring omission of these microbes leaving the baby susceptible to colonization by inappropriate strains, suboptimal diversity, and stimulation of the immune system by many of the toxic compounds in this synthetic food. Here is a stunning analysis of formula shortcomings.
Interestingly, this rat study demonstrated that the types of bacteria in the guts of these rat pups determined their response to stress on a physiologic level, and that it was more difficult to correct later in their rat-infancy. The gut bacteria influenced behavior and brain growth in these animals.
Shun antibiotics for mom and baby
It is imperative to appreciate the use of antibiotics is infrequently an evidence-based practice. As discussed in this paper, largely ignored by the obstetrical community, antibiotics for Group B Strep positivity in pregnancy does not improve outcomes and is likely to negatively influence mom and baby flora. Similarly, liberal antibiotic use in neonates in the ICU has no effect on incidence of sepsis or on mortality as demonstrated in this trial. Many holistic providers discuss the fact infections can be treated naturally and the immune system can be supported through the process.
Understanding the role of bacteria (and even viruses as discussed here) is medicine of the future, as this relationship underlies all modern diseases. Healing starts with an informed woman making powerful choices.