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Dr. Payal Adhikari posing against a white background wearing a white blouse and black blazer

The Impact of the Infant Microbiome on Health: Podcast Episode #192

Kristin Revere chats with Dr. Payal Adhikari of Infinant Health and the impact of infant microbiome on health.  You can listen to this complete podcast episode on iTunes, SoundCloud, or wherever you find your podcasts.

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Kristin:  Hello, this is Kristin with Ask the Doulas, and I am here to chat with Dr. Payal Adhikari.  She is the director of clinical implementation at Infinant Health.  Her background is a pediatrician, mom of two, and of course, recently joining the biotech company Infinant Health after learning how important the microbiome is to developing bodies.  Welcome, Dr. Adhikari!

Dr. Adhikari:  Thank you so much for having me!

Kristin:  So let’s get into – I have so many questions related to the microbiome and newborns.  So I would love to get a definition for our listeners and doula clients about really understanding gut health with the newborn.

Dr. Adhikari:  Awesome.  First, I’ll talk about the microbiome itself, which I think is a word we use so frequently but is not often understood completely.  And the microbiome is really all the organisms that are in and on our body.  So this includes bacteria, fungi, viruses, all of those little live things that are on our skin, in our guts, in our mouths, all over our body.  And it really plays a vital role in our overall health.  So I know we think about washing our hands to get the bugs off; we have to wash in the shower to get everything off of our body.  But really, those bugs are truly important to our health in a good way, as well as sometimes in a bad way, but generally, in a good way.

Kristin:  That makes sense.  I mean, again, we have – we don’t wash the newborn immediately.  Let’s get into a bit more about their gut bacteria and understanding their internal health.

Dr. Adhikari:  Totally.  So the gut health, which also I think is a very topical term, is very impacted by what bacteria live in our gut.  So when a baby is born, their guts are virtually sterile.  So there’s generally no bacteria in there yet, and it’s a clean canvas for our society to sort of say, hey, what bugs are we going to put into this baby’s gut which will inevitably impact short term health but also long term health.  So when baby is born, their guts are exposed to bacteria, and it depends on how they’re born.  If they’re born vaginally, then that vaginal flora in the canal is generally the first opportunity for bacteria to seed the baby.  The vaginal canal is obviously very canal to the other tube of fecal matter, and a lot of that bacteria is good bacteria for the baby as well.  Those are the things that kind of get into the baby to start.  And then after that, it depends on how baby is feeding.  Are they on mom’s breast and getting some of that flora that’s on mom’s skin?  Are they being held by another grown-up whose skin flora is getting into the baby?  So it depends on kind of what is around the baby that will determine what colonizes their gut.

Kristin:  I know with some of the gentle Cesarean births, there is interest in getting some of that bacteria, like seeding after the birth with skin to skin time and, again, trying to have as similar to a vaginal birth as possible for the baby.

Dr. Adhikari:  Absolutely, and it’s so important, thinking about these things and planning ahead of time because along with C-sections usually comes antibiotics.  The antibiotics are antibacterial, so they are obviously necessary for a lot of procedures, but in addition to killing the bad bacteria that they’re intended to, one of the unintended consequences is that they may kill off some of the good bacteria that baby was meant to be exposed to.

Kristin:  Yes.  So as far as that initial skin to skin time and differences between breastfeeding and exclusive pumpers and formula feeding clients, what would be the suggestions to get the optimal gut health established for a newborn, with the three different types of feeding?

Dr. Adhikari:  Great question.  So to clarify, we’re talking about nursing, pumping, and then formula?  Yeah.  So thankfully, those are all three great options for babies’ health.  Babies’ health comes first, but the way flora gets into the baby when you’re nursing is through mom’s skin flora and through the breast milk itself, so you get both of those.  When you’re exclusively pumping you will get both as well because when you’re pumping, some of that skin flora is going to get into the milk as you pump, as well, so those are very similar ways of introducing bacteria into the baby.  Formula is a little bit different in that formula companies will try to put good bacteria.  You’ve probably seen a lot of formula that now says “with probiotics” which are good bacteria, and they’ll say that on there.  It’s a little different than when you get it truly from human to human because they’re different sorts of bacteria and cost prohibitive.  It’s really not a good spend of money for formula companies to put a ton of probiotics into their formula.

Kristin:  That makes sense.  So would you explain what a probiotic is for our listeners, Dr. Adhikari?

Dr. Adhikari:  Yeah, so probiotics are really the good bacteria that get into our bodies.  Many cultures include probiotics in their normal daily diet.  So we hear of kimchi and kefir and sauerkraut, and those are really those fermented foods that give us good bacteria naturally through the gut.  The US diet tends to use probiotics more as a supplement than through our actual food.  But that’s fine; you know, it’s another way to do it.  And the role of probiotics is really to take the food we’re getting – so probiotics are that good bacteria that line the gut, and their job is to take the food that we’re getting and convert it into other really good things for the body.  So I always say there’s the prebiotic, which is the food that we’re eating; the probiotic, which is the good bacteria, and then the postbiotic, which is whatever is coming out of that process.  So it’s really that postbiotic that helps with health.  For adults, it’s usually butyrate is the postbiotic that helps with gut health, and for infants, it’s more lactate acetate.  And what they do is very scientific and I won’t get into the whole biochemical processes behind it, but essentially what they do is they decrease the pH of the gut.  So they make the gut more acidic, and by making it acidic, they allow less pathogens to grow.  So a lot of that icky, gas producing inflammatory bacteria, E. coli and staph and klebsiella, kind of these words we hear about more in a hospital setting, but these bugs tend to like growing in a higher pH.  So by lowering the pH of the gut, it makes that environment much less hospitable for those kind of pathogenic bugs to grow.

Kristin:  Makes sense.  And so how do you know that it’s working?  So if you are again focused on food and supplements and getting good gut bacteria for your newborn, how do you know that it’s effective?

Dr. Adhikari:  That’s a great question.  It really depends on why you’re taking it.  So for adults, you have symptoms, right?  You have gut symptoms, whether it’s more IBS symptoms or just general discomfort.  You would know it’s working because those symptoms would get better.  For babies, it’s a little different, right, because with babies, when we talk about using probiotics, some of the value is in the short term, and that comes with less gas, less fussiness, better formed stools, better weight gain.  Those are sort of the things we see in the infant population.  But really what we want to see is long term benefits.  So there are studies that show when you take probiotics from a young age, it changes your kind of immune – the ability of your body as an immune fighter.  So things like becoming less susceptible to inflammatory diseases, autoimmune disease, atopic diseases, things like asthma and food allergies, long term obesity, diabetes.  So there’s a lot of studies that show there’s a correlation between gut health of infants and sort of that longer term disease process.  So the better your health is as a baby, the less chance you have of developing some of these diseases later on.

Kristin:  Okay.  So outside of fussiness, gas, what are other signs that an infant would need a probiotic?

Dr. Adhikari:   Yeah.  So every baby – in my opinion, every baby should be on a probiotic for that preventative health piece, which I know is a hard sell for our society, right?  Our society isn’t as preventative as they are reactive when it comes to health.  But for prevention, I think every baby should be on a probiotic.  But a lot of the parents who come in with these fussy babies who are gassy, not sleeping well – when I start a probiotic, they will say, hey, my baby is just happier.  They’re, like, less whiny and fussy and kind of – you know those babies who are just squirming all the time?  It’s that.  My baby just seems more relaxed.  That’s how we kind of know they’re working in the short term because what these probiotics are doing is they’re taking over the gut and they’re really pushing out a lot of that pathogenic gas-producing inflammatory bacteria, and they’re creating a home for more of the good bacteria.

Kristin:  Love it.  So are you finding that with the use of probiotics, there would be less need for the mother to do some elimination in the diet related to dairy or other things that may cause gassiness or irritability with an infant?

Dr. Adhikari:  That is such a good question, and I will speak anecdotally on this.  As a pediatrician – if you asked me a year ago, Kristin, I would have said, sure, try a probiotic.  Any one is fine.  You know, whatever’s on sale.  I had no idea because they’re very complicated, and I’m sure as parents, we look at the kid aisle, and we’re just overwhelmed by the amount of diapers and wipes and baby foods.  There’s just so many, and it’s the same with probiotics.  There’s so many types and strains and claims.  I work for Infinant Health, and we make a product called Evivo.  And what’s really cool about Evivo is that is a natural bacteria that we realized babies in the US and a lot of developed countries are missing, that babies in less developed countries still have in their guts.  So what they found – and I’ll kind of do some background on this because I find it to be so fascinating, but there were some researchers at UC Davis who were examining breastfed infant stool.  Like, that was their job was to look at the stool of breastfed infants and figure out what is in it.  And what they found was that the HMOs or the human milk oligosaccharides in breastmilk, which is about 15% of the solid component of breastmilk, so a big percentage of breastmilk, were coming out in the stool completely undigested.  So they were just – exactly, they were like, wow, why is that?  You would think, mom is working so hard.  Her body is working so hard to create breastmilk.  Why would baby just waste it?  So they started to look at stool all over the world, and they found certain populations that HMOs were getting digested and they were coming out as metabolites, right?  So they were – something was happening in the body where the baby was using it, and then they were coming out in portions or parts.  So they then looked at those babies’ microbiomes and said, what is different about those babies’ guts that we don’t have here?  And they found that there’s a specific bug called B Infantis EVC001 or Evivo that was missing in these babies who were not digesting HMOs.  So they thought, this must be important, right, if this is the job of this bug, it must be important.  So they looked to see what it does, and they found that it takes the HMOs in breastmilk and produces lactate and acetate and decreases the pH of the gut.  And the really cool thing about Evivo versus other probiotics is it colonizes the gut.  So when you take it – and the recent study shows if you take it for about a month, if an infant early on takes it for about a month, it takes over about 80% of that gut.  So it pushes out all that bad bacteria.  About 20% of the room is left for any of those bad bugs to live in, and it sticks around, which is so different from other probiotics where when you take them, they work, but when you stop, they tend to shed.  With Evivo, they gave babies Evivo for three weeks at the beginning of life, and then they stopped, and they continued to monitor their microbiomes up to a year.  And at a year, they still found that there was a lot of this bacteria in their guts.  So this bug wants to be there.  It really wants to live there, and it was meant to.  So it’s different from other probiotics that companies create, and they do a good job when you take them, but when you stop taking them, they don’t work anymore.

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Kristin:  So how can our listeners find Evivo?

Dr. Adhikari:  Well, you can go on our website or on Amazon, where I feel like a lot of new parents shop.  It’s definitely a place to find it.  And it is a powder packet.  You keep it on your counter next to your vitamin D or whatever else you’re giving baby every day, and you give it to them once a day.  You can mix it with a little bit of breastmilk.  You can make it into a little paste with some breastmilk and put it on your nipple if you’re exclusively nursing.  You can put it in a bottle.  Either way is fine.  But what I see with my patients really early on is that the babies are more relaxed, they’re sleeping better, they’re pooping better, and what I mean by that is babies – you know, when I was in medical school, we were taught breastfed babies poop 10 to 12 times per day, and it’s liquidy because liquid in, liquid out.  That was what I was taught.  And what we’ve found is that the reason babies are having so many liquidy stools is because they aren’t digesting some of the breastmilk.  Because it’s a solid, they’re pulling more water in, and so their stools become more watery.  And when you give them this probiotic that helps digest more of the breastmilk, they’re able to absorb not only more of the breastmilk, but also absorb more water along with it.  And this is one of the things parents will always comment.  My kid’s stool changed!  And I’m like, that’s a good thing, right?  We think, oh, they should be pooping 10 to 12 times a day, and that’s really not the case.  So these babies often will poop once every few days, and their poop will be a little more formed, more peanut butter consistency, not that watery consistency.  And because they’re absorbing more water along with the breastmilk, they tend to not need to eat as frequently.  And this is just something that I see with my patients.  They’re like, oh, they’re on a better schedule because they’re not just trying to eat for hydration sake.  They’re trying to eat just for nutrition.

Kristin:  Wow, how fascinating.  And how does that impact formula fed babies and their stools and eating patterns?

Dr. Adhikari:  Yeah, so it should do the same thing with formula fed babies.  You’re not going to get that robust colonization with formula fed babies because you’re not getting as many HMOs.  So even if formulas will say comes with HMOs, it’s also cost prohibitive for them to put in not only the amount, but also the variety.  So breastmilk has somewhere between 200 and 300 types of HMOs in it.  And formula tends to have just a handful.  So Evivo will absolutely work with formula fed babies, and it can feed off of those N-Glycans of formula, but it’s not going to get that robust colonization that you see with babies who are even getting a little bit of breastmilk.  You know, parents can be giving 95% formula and 5% breastmilk, and you’ll still see that colonization.

Kristin:  Okay, so supplementation will make a difference.  Interesting.  So any other tips for our listeners related to the microbiome, gut health, probiotics?

Dr. Adhikari:  Oh, my gosh.  I could go on forever.  You know, I think it’s really important for us to realize that the gut is not just the gut.  The gut is really a way of connecting what our bodies are taking in, what our bodies are creating.  So it’s really important for us to treat it well.  80% of our immune system is in our gut, and we know that as gut health does affect our ability to not only get diseases but to fight diseases.  I saw a really cool article, and I’m just going to repeat the headline because that’s all I really looked into, about how there was a case of melanoma where the standard treatments weren’t working in an adult, and they did a fecal transplant, which is basically taking the microbiome from a different adult and putting it in that adult, and his melanoma just stopped growing, which is so fascinating, right, that the gut can impact cancer.  So we’re learning more about it every day, but for babies when they’re in that first 100 days of life and they’re developing so rapidly; their guts are developing; their brains are developing; their immune systems, it’s all developing so rapidly, and it really can determine what happens long term in their health.  It’s important for us to treat that early on.  So that’s when I say, tell parents to give Evivo at least that first month of life, and as a pediatrician, I feel really good about what you’re doing for your baby’s long term health.

Kristin:  Excellent.  So you as a pediatrician – do you offer Evivo in your office and other pediatricians that partner with you, or is it exclusively from the website and Amazon at this point?

Dr. Adhikari:  Some pediatricians do offer and sell Evivo through their offices.  We offer samples in our office.  I usually give them three or four days because that’s when parents will start to see the benefit of it, and then I just send them to the website to order.

Kristin:  Great.  And the website is evivo.com.  I know you’re also on social media, so how can our listeners find you on social?

Dr. Adhikari:  Yeah, so on most social, we are just Evivo or Evivo Health.  So they can find us on Instagram, Facebook, LinkedIn.  Our Instagram is @evivohealth.

Kristin:  Excellent.  Well, thank you so much for sharing your wisdom with our listeners and doula clients.  It’s been fantastic to learn so much about infant gut health and probiotics.  Thank you for the important work you’re doing!

Dr. Adhikari:  Thank you so much, Kristin, for having me.  Thank you for all that you do!

Kristin:  Thank you, and we’ll plan to connect again soon on a related topic!  I would love that!

Dr. Adhikari:  Sounds great!

Thanks for listening to Gold Coast Doulas.  Follow us on Instagram, Facebook, and YouTube.  If you like this podcast, please subscribe and give us a five-star review.  Thank you!  Remember, these moments are golden.

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