1. Nutrient and calorie extraction from our foods which determines how well nourished we are - and how well we can regulate our weight

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1 The digestive system (gut) is a tube that begins at the mouth at the top and ends at the anus. Along the way one encounters the stomach, small intestines, and large intestines. Each of these regions has its own functions, ph levels, chemicals, amount of protective mucus, and microbial neighborhoods. The gut is responsible for extracting nutrition from our food, elimination, and surprisingly, is home to a large amount of our immunologic surveillance, protection, and response. The microbiome is the term that describes the collection of literally trillions of microorganisms that inhabit our body. When we are in optimal health our microbiome is a continually fluctuating collection of microbial communities containing the right mix and balance of healthy flora responsible for: 1. Nutrient and calorie extraction from our foods which determines how well nourished we are - and how well we can regulate our weight 2. Production of specific nutrients, for example, vitamin K, B vitamins, and others. This means that the microbiome is important in the regulation of bone development and converting glucose into energy, and the health of the nervous system - which can affect mood, learning, and behaviors. 3. Detoxification of internally produced (i.e. hormones) and environmental toxins 4. Maintenance of a healthy gut barrier that protects immune integrity 5. Production of neurotransmitters, the chemicals that influence mood and immune response 6. Regulation of immune response

2 Dysbiosis is the term used to describe a disrupted microbiome leading to a shift in type and amount of gut flora away from the more favorable (or commensal) populations toward the less favorable. Dysbiosis can due to disruption of healthy gut flora at birth, stress, infection or illness, poor nutrition, damage to the gut lining, and medications, for example, antibiotics. Symptoms can be obvious - gas, bloating, frequent loose stools, or constipation - or more subtle, for example, eczema, allergies, and asthma can be the only symptoms your child demonstrates. Checking for dysbiosis can be done by an integrative or functional medicine doctor, but these tests aren t always entirely accurate, and most haven t been validated for ideal ranges in children. If your child was born by cesarean, wasn t breastfed, had colic as a baby, had an antibiotic in the first year of life, or more than a couple of rounds at all, or has digestive system symptoms, then you can probably put dysbiosis on the high likelihood list, but since the treatment is safe - and consists of dietary and lifestyle strategies, and using probiotics which are considered safe for most children, it is safe to treat based on reasonable likelihood - including having any of the 4A s. We ll talk about strategies for turning dysbiosis around in Units 3 and 4. How a baby is born can determine whether the gut flora gets off to a good start. A baby s gut is sterile at the time of birth. When born vaginally, babies are literally bathed in the microorganisms of the mother s vagina which, I know, sounds gross. But it s important. The skin, nose, and mouth are colonized with mom s microflora - particularly Lactobacillus, and over the first few days of life, the baby s gastrointestinal system also becomes colonized with immune system stimulating microorganisms. These microorganisms set the template for the healthy response of the baby s immune system. Here s the problem: We ve got at least a 34% cesarean section average in the US, and babies born by cesarean do not receive this healthy gut colonization. They have an overall lower range of diversity of gut flora, fewer of the beneficial strains, and more of the potentially negative strains. This has all been linked to allergies, eczema, and asthma as well as later obesity in childhood.

3 It s tricky to talk about the overuse of cesareans because I don t want anyone to feel badly about having had one - we all do what s best in the moment. But as a culture we also need to take a hard look at what s going on, because as a larger societal phenomenon it s having an impact on our children s long-term health. Below this lesson is an information sheet called 7 Ways to Prevent a Cesarean. If you have had a cesarean, evidence shows that you can help your baby s gut microbiome by giving a probiotic for a few weeks after birth; and evidence also shows that if moms take a probiotic in pregnancy, it helps protect against asthma and eczema if a cesarean is done. Try not to worry - this information can help you to understand why your child may have developed one of the 4 A s, and in Unit 3 you ll learn much more about what you can do to repair gut disruption. The transmission of mother-to-baby flora continues at the breast. Exclusively breastfed babies have a different microbiome composition than non-exclusively breastfed and bottlefed babies. The microflora in the gut of exclusively breastfed babies contains protective Lactobacillus and Bifidobacter strains. Human breastmilk also serves as prebiotic, food for the gut microflora, particularly stimulating the growth of the beneficial species Bifidobacterium. The microbiome of exclusively breastfed babies is better equipped to perform important functions in the synthesis of B vitamins including riboflavin, tetrahydrofolate, and biotin. Babies that are formula-fed are more likely to develop Clostridium species in their gut - including C. difficile. Higher levels of Clostridium spp. have been associated with the development of eczema. How long should you ideally breastfeed for optimal microflora and immune development? A year is ideal. If you didn t - again, probiotics can be helpful. Due to improved sanitation, better water, and vaccinations, our kids are less likely to get measles, mumps, and other infections than they were 100 years ago. But 100 years ago, the chronic problems our kids now face were almost non-existent. It seems that one of the problems is that kids today are way too clean! The combination of much less time spent playing out of doors, farming, being around farm animals, and the overuse of antibiotics,

4 hand sanitizers, and the consumption of inorganic and processed foods that contain few natural microorganisms has led to an overall loss of the flora to which we d have historically been exposed, and with this, less natural stimulation of the immune system. Even the lack of getting natural infections may have biased our immune system away from the types of immune stimulation that would have historically prevented allergies and asthma. This phenomenon, referred to as the Hygiene Hypothesis since the 1980s, is considered the hidden price of modern hygiene. It seems that sanitary conditions, while reducing any number of often serious acute infectious diseases from cholera to measles, has disrupted the delicate balance between our body s inner ecology and the balance of the type of immune cells we produce (Th1 or Th2 cells, types of immune Helper Cells ). This phenomenon is also considered a contributor to autoimmune diseases including multiple sclerosis, inflammatory bowel diseases like Crohn s and ulcerative colitis, and Type 1 diabetes. As a result of modern lifestyles it seems we may also just not be getting colonized with some of the important bacteria that we evolved with and that our ancestors played host to. When we are missing our old friends, say The Old Friends Hypothesis researchers, our immune systems aren t appropriately stimulated, and our gut integrity is also not appropriately maintained, leading us to develop immune dysregulation. Solutions include getting our kids to play outside more, get dirty, and have them spend time around other kids, pets, and farm animals! Also, avoiding antimicrobial chemicals found in hand sanitizers, toothpastes, dish soaps, and numerous other cleansing products contributes to being overly hygienic while simultaneously disrupting the natural flora in the areas they come in contact with! I recommend avoiding antimicrobial soaps and products in favor of washing with plain soap and water, and using household products that do not contain antimicrobial chemicals. The small intestine is lined with a row of cells called enterocytes. These are the absorptive cells of the intestine, lined at the surface with villi, fingerlike projections of the cells that increase their surface area.

5 Between these cells are tight junctions, gatekeepers whose job it is to keep those cells close to each other to regulate what gets across the intestinal lining and into contact with the immune cells just below this layer. When your gut barrier and microbiome get disrupted these tight junctions develop gaps, and this results in what is called intestinal hyper-permeability, or more commonly, leaky gut, or leaky gut syndrome (LGS). Fragments of protein and bacteria that aren t supposed get across this barrier can now reach the sensitive immune centers in the gut and trigger them to react as if they ve detected a harmful invader. Your body responds by producing antibodies that mount an immune system reaction against these molecules, and other molecules that resemble it. Food sensitivities, foods allergies, seasonal and environmental allergies, asthma, and eczema are commonly associated with Leaky Gut Syndrome, as are many autoimmune conditions including celiac disease, Crohn s disease, and ulcerative colitis. Even Type 1 diabetes has been found to be associated with LGS. Leaky gut is considered in functional medicine to be one of the main underlying dysfunctions leading to immune dysregulation in both adults and children. In Unit 3 you ll learn to use The 4 R program to heal the gut, restore the microbiome, and cool down the chronic inflammation. The overuse of medications in this generation of kids has led them to be called Generation RX! Antibiotics, non-steroidal anti-inflammatory drugs like ibuprofen, and PPIs like Prilosec, are especially likely to contribute to microbiome disruption and or LGS. The first antibiotic exposure begins at birth for at least 30% of babies born in the United States who received a proxy dose of antibiotics through mom because of cesarean section or for prevention of transmission of maternal Group B Strep infection. Antibiotics given at

6 birth not only potentially damage baby s gut flora, but affect the microflora of mom s breastmilk, which is meant to be uniquely specific for helping baby s microbiome and immune system develop properly. Exposure to antibiotics continues throughout childhood. A recent study showed that most kids 1-3 years old have had more than one course of antibiotics each year and by age 18, most kids in the United States will have had as many as 20 rounds of antibiotics. Shockingly, at least 50%, and as high as 70% of antibiotics prescribed to kids are unnecessary. Antibiotic overuse isn t just a global problem that has led to serious antibiotic resistance; it s a personal problem. First of all, there are at least 142,000 emergency room visits annually for antibiotic-related adverse events, and many of these are in children. But most relevant to this course, antibiotics can do serious damage to the microbiome. Not only do they take down the bad bugs that we re using them for, but they take out the good ones, too. Antibiotic exposure in early life has been linked to a wide range of inflammatory and immune system disorders including asthma and inflammatory bowel disease. In fact, even antibiotic exposure through mother s breast milk was associated with a greater likelihood of developing wheezing. While ideally in a healthy gut, the good organisms will rebound after a course of antibiotics, this is not always the case. Even in a generally healthy person, it can take weeks for the healthy gut flora to get reestablished, and even one course of antibiotics can permanently wipe out susceptible species that may play important roles that we don t yet even know about for our health. I ve had many pediatric patients in recent years who have come in for treatment of a serious chronic problem, for example, ulcerative colitis, that began after they were treated with repeated rounds of an antibiotic for an infection. It s not only the gut microbiome that is affected by antibiotics. The respiratory tract is also colonized with its own microbes which serve as protectors of the respiratory mucosa - the delicate moist passages that line the nose, throat, and lungs. Treatment with antibiotics may also disrupt this ecosystem as well, removing the organisms that protect us, and leaving our kids vulnerable to recurrent strep throats and ear infections that don t respond well to further antibiotic treatments, and leading to rounds of recurrent infections.

7 While of course, antibiotics are life saving for serious infections, and we should absolutely use them when necessary, avoiding unnecessary antibiotics use is central to preventing allergies, eczema, asthma, and autoimmune conditions. It is well known in medicine that the use of NSAIDS like ibuprofen can lead to stomach ulcers, upper-gastrointestinal bleeding and even the need for surgery and blood transfusions in as short as 5 days. Often, however, the damage is more subtle, but nonetheless, problematic. Many scientific studies conducted over the past two decades show a correlation between NSAID use and leaky gut syndrome (LGS). According to a study by the National Institutes of Health (NIH), "All the conventional NSAIDs studied were equally associated with small intestinal inflammation." Another study concluded, "NSAIDs are thus shown to disrupt intestinal integrity and long-term treatment leads to inflammation of the small intestine. In children, we most often give these medications for fever. They are also given for ear infection, sore throat, and minor aches and pains. As with antibiotics, it s best to avoid their use as much as possible. In Healthy All Year you can learn about many natural alternatives for making your child more comfortable during a fever, and how to approach ear infections naturally without the need for medications in most cases. PPIs, such as Prilosec, are amongst the most widely used medications in the US. They are given to babies as young as 6 weeks old for infant reflux. Recent studies show that, in spite of their widespread use, this class of medications is not very effective in reducing infant reflux. Moreover, in addition to causing possible nutrient deficiencies because they block the stomach acid necessary to absorb nutrients like calcium, this change in ph has a downstream effect of making the upper gut more susceptible to a phenomenon called SIBO, or small intestinal bacterial overgrowth. This is a form of dysbiosis where microorganisms that should not be flourishing in the upper part of the small intestine get the upper hand, leading to inflammation, digestive problems including bloating, flatulence,

8 or abdominal discomfort, problems with peristalsis, nutrient malabsorption, and increased intestinal permeability. We ll talk about the treatment of dysbiosis, leaky gut, and SIBO in Unit 3. See the information sheet below this video for Dr. Aviva s Top 6 Tips for Avoiding Unnecessary Antibiotics. If you do have a child that gets sick often with colds, ear infections, etc., and frequently requires antibiotics (meaning at least once each year), then you ll want to consider doing Healthy All Year, the Healthiest Kids University course on boosting immunity and preventing antibiotic overuse. Your purchase of The Allergy Epidemic entitles you to a special discount on all additional HKU courses, including Healthy All Year, which you can begin to use immediately upon purchase.