Children’s gut microbiomes and how to help them, with Lucy Jackman – Food For Kids Podcast episode 69

Joanne Roach (00:13)

Hello and welcome to the Food for Kids podcast. I'm Joanne from the Foodies.

At this time of year, social media feeds are filled with lot of wellness adverts and one of the things you see a lot of adverts for is probiotic supplements and intolerance and microbiome test kits. Now might be thinking, well it's hard enough just keeping everyone at the table happy and fed with the food I'm putting on the plate. So now, you also need to be listening to these adverts and podcasts and news articles and worrying about your child's gut microbiome? And if so, how on earth do you do anything about it?

So to help us out on today's episode, I'm talking to Lucy Jackman who is a specialist dietician at Great Ormond Street Hospital. Lucy deals with all kinds of complex tummy and bowel issues, but she also posts really helpful information about general principles that parents can use to keep little guts healthy. So let's listen to our chat about what we parents can do for our children's microbiome health.

Joanne Roach (01:17)

Okay Lucy, so before we start talking about practical things that we can do for our children, can you give us an overview of what we mean when we talk about the gut microbiome and why it is important for children's health and development as well as us as grown-ups?

Lucy Jackman (01:31)

Yeah, absolutely. I mean, I think we hear microbiome, you know, those words kind of thrown out all over the place, don't we? Particularly at the moment in the media everywhere. But it's, there's kind of four distinct parts that make up the full microbiome.

So you've got your microbes, which are essentially all the bacteria, the viruses, the fungi that live in all of our guts. So you can think of those like a village, you've got your individual people that live in their individual houses.

You've then got your microbiota, which is whenthese bacteria or these microbes kind of join together as a group. you know, those people going to work, they go to the office, they all sit together and do things.

Then what you've got is your metabolome, which is essentially everything that's produced by the microbiota. So those groups of people working together, they're producing something in their work is. And then you get all these things produced as a byproduct. So that might be vitamins that we have, produced by the bacteria. They also might be something called short chain fatty acids, which are particularly important for supporting sort of immune function and keeping that gut epithelial barrier. So the little kind of building blocks of barrier within the gut, keeping those nice and tight, which prevents all the bacteria that we don't want, all the pathogenic bacteria, so the bad bacteria going through and causing infections and things like that.

And then collectively the microbes, microbiota and the metabolome is what makes up the microbiome essentially.

Joanne Roach (03:02)

Okay and so you've talked about what’s involved in a microbiome but what factors can shape particularly children's microbiome and what can we as parents be doing about it everyday ways to help them to have as healthy one as possible?

Lucy Jackman (03:17)

Yeah, so there's lots of different evidence out there about what kind of shapes the microbiome and particularly the first three years of life is the vital that really shapes that how the microbiome is then potentially going to be for the rest of your adult life, although we can adapt it, you know, depending on what we eat as we get through to adulthood. But in those first three years of life, there's a number of key events that impact the microbiome.

So you've got mode of delivery. So if a baby is born via or a vaginal delivery, the mode of feeding after birth, so whether they're breastfed or formula fed or a combination fed, if they've needed any antibiotics for whatever reason, which of course is a life-saving medication if it's needed, but it also does have the impact of kind of wiping out the bacteria that we have in the Also if there's things like pets in the home, if you live in a city, if you live in the countryside, you know, all of these things really impact the microbiome. And then of course, when solids are introduced, that is another big shift in developing the microbiome.

And I suppose for parents, the key thing that we want to think about is how we can, support the development of the bacteria that we would like to populate most prevalently in the gut microbiome. And so that's really around those types of things. So the mode of delivery, which is almost is often out of our hands, you know, have a birth plan, but doesn't go to plan and that's absolutely fine. Again, we might have a plan for feeding and it doesn't go to plan, whether it's breast or formula feeding. And so don't beat yourself up it hasn't gone to plan, you know, you've not ruined things for your little one's microbiome. You know, your next step is definitely when those solids come in. And that's where it's really key. So we need to encouraging lots of sort of plant based diversity, lots of different fibre sources and multicoloured foods within the diet and really trying to limit those processed foods as much as possible because we know that they don't support the development of the microbiome as we would want it to be.

Joanne Roach (05:18)

Okay so that's really helpful in general but also particularly for those first three years but let's say you're listening to this and you've got an eight-year-old and you're like well I didn't do any of those things very well, is there still stuff that you can do with older children?

Lucy Jackman (05:30)

Yeah and it's essentially the similar sort of principles so we really want to be increasing what we call plant-based diversity so that's things like fruits and veggies, seeds, nuts fermented food, olive oil is a great source for the gut as well and omega 3s.  All of these types of things, different grains, pulses all have a really good impact on the gut and so it's not necessarily particularly about the quantity of this fibre you're having, it's about the diversity. So as much of these different things you can get in is ideal. And we recommend to kind of aim for about 30 plant points a week to be able to get that diversity within the gut and for the bacteria.

Same would apply for kind of limiting those more processed foods. Of course, processed foods form part of our diet and some of them have great nutritional value as well, so things like certain cereals or fortified plant-based milk, they are ultra processed, but they do give us a nutritional benefit. But where possible, some of those other things like very highly processed convenience type foods, we really want to try and limit those as much as possible and replace those with something that is more nutritional benefits and has slightly higher fibre content as well.

Joanne Roach (06:47)

We've just had a two part series actually talking about ultra processed food foods. And I think, what came out of that was the idea that we are going to eat some processed foods, but that, if you are having some foods in your diet, that are more processed, then adding in other things alongside it to make sure that your body's still getting those other things is really important.

Lucy Jackman (07:04)

Yeah, so keeping up that variety. You've got a shop bought pizza that you stick in the oven, for example, you can load that with extra veggies, you can have some crudités on the side with some hummus, which is another great fibre source. You know, so you're building that plate around the fibre and the processed part of it is as minimal as possible. But obviously, we don't want to also demonise food for children, you know, that sets them up for poor relationships with food and things like that. So it's trying to limit it where is realistic would be my view.

Joanne Roach (07:34)

So in my work, I have a focus particularly on building familiarity with fruit and veg and other plant foods, because those are foods that parents often struggle to help their children to accept. And because we all know we need to eat more of them. But some children also struggle with other foods. So do non-plant foods also affect our gut health?

Lucy Jackman (07:51)

Yes, I mean, everything we eat has an impact on the microbiome. What we know about the plant sources is that they particularly feed the beneficial bacteria that we want. And so that's not saying that we shouldn't have animal protein and we can't have these things. Absolutely. They can be part of the diet, but we would always want to make sure that we have a good volume of sort of plant-based diversity alongside, if you choose to eat meat or fish or you know, so you've got that balance basically. And actually things like fermented dairy is ideal for the gut. So things like kefir yogurts and kefir drinks, there's lots of evidence that they're really supportive of improving our gut microbiome and our overall gut health.

Joanne Roach (08:34)

Particularly around this of year, there's an awful lot of wellness content out there. Listeners might have seen adverts for tests for microbiome health, either for them or their children. And there's always loads of information about prebiotic and probiotic supplements around. Are they worth thinking about for parents?

Lucy Jackman (08:50)

So I'll start with the tests. So this is one of maybe a bugbear of mine that actually… they are really interesting, particularly if you're into science and you're into nutrition, they give us a snapshot of what is going on in the gut. But what they don't tell us is: “right, you're low in this certain bacteria, you need to eat this food and that is going to increase that bacteria." We don't have that information we don't have that knowledge yet, I suspect it is coming but we just don't have it at the moment. So yes we can look at the microbiome and we can say yes this is a little bit low or this is a little bit on the higher side. The advice that you're going to get from these tests is to increase your plant-based diversity for me you're better off saving that £200 that the test costs, and buying some nice fruit and veggies and nuts and seeds and herbs and spices and all of those things in your weekly shop rather than, a test that is just going to give you a sort of a photograph of what's happening at that precise minute.

With regards to probiotics and prebiotics, so yes and no would be my answer to that, which is probably not very helpful. But there is certain probiotics, so that is sort of the bacteria that give us a health benefit essentially. There are certain probiotic strains that are useful in certain conditions. So for example, if a breastfed baby has colic, there's certain strains that we know in the evidence can reduce crying time. There's also certain strains, different strains that we can use if you're taking antibiotics that can reduce the length of time any antibiotic associated diarrhoea, for example. And so yes, probiotics can absolutely be helpful. It does depend on what the symptom is, what the scenario is that you want to take a probiotic, but taking a probiotic for probiotic’s sake is probably not helpful and not necessarily multi strain is better. And we see sometimes these products that have got 10 different probiotic strains in, they can kind of compete against each other and you might not get any benefit at all. So, you know, my advice would be if you're going to start a probiotic, maybe have a chat with a health professional who knows about the symptoms that your little one is having, whether the probiotic would be helpful or not.

With the prebiotics, that's essentially kind of the food that feed the bacteria that live in our gut. And so you can get that from food. You're better off eating foods that particularly are high in prebiotic fibre, so things like garlic and onion and things like oats and apples, they're high in prebiotics. So they really do feed the bacteria in the gut. The same with some of the fermented foods as well. The difficulty is, is that sometimes you can bad wind or a bit bloated, a bit farty, know, when you first introduce these. So with all of the fibre and the prebiotics and probiotics actually, even if you're taking them for a specific reason, go slow with it, gradually build it up, because then you're less likely for your little ones to get symptoms.

Joanne Roach (11:58)

If your child had to have antibiotics, or they've had a nasty tummy bug, and you know that their tummy is very upset, what's the best way to go about trying to, get them back on track?

Lucy Jackman (12:11)

Yeah, so I mean, it's quite natural after infection, we'll call it I suppose, or a virus, appetite is reduced, you know, kids maybe don't want to eat as much as they had before. What I would say is again, build up slowly, probably start with the less fibrous foods to begin with, although I'm mostly talking about how great fibre is. If you've suddenly, you know, had a very big output from the gut, we kind of want to slow down that transit a little bit to make things not move through quite as fast. So, you know, gradually return up to normal diet, make sure they're really well hydrated, which is key because you're to be losing lots of electrolytes and things like that. And then just slowly build up to what they're going to accept’

Joanne Roach (12:52)

So that's a much better way of recovering than buying a bunch of supplements and hoping that that will help. Just recovering their gut slowly with food, normal food over time.

Lucy Jackman (13:01)

Yeah, exactly building up to what their normal diet is and then, you know, if your plan is to kind of build up to increase the fibre, the diversity, do that once they're kind of back at their baseline. And like I say, you can use the probiotics alongside antibiotics whilst they're taking them and for around a week after, certain strains. You've got your Lactobacillus rhamnosus and then also there's one called S. Boulardii. They're two probiotic strains that have been shown to be beneficial to reduce the length of time of diarrhoea associated with antibiotics.

Joanne Roach (13:37)

I found that super helpful to understand that although the science can now tell us all kinds of cool individual facts about gut makeup, it really isn't advanced enough yet to mean that a test can give us an individual silver bullet to somehow fix or hack our microbiome into some kind of perfect state.

On one level, that's sort of disappointing that the answer is the same advice we always get, to eat as wide a range of foods as possible, including a lot of plants. But on the other hand, it's also quite reassuring because we already know that. So it's not confusing us or making us go off in all kinds of different directions that are all at odds with each other, like some of the messages we can pick up in the media.

Don't forget that this is a marathon, not a sprint. We don't have to lose heart if our children won't eat an enormous range of plant foods right now. We can build up their familiarity steadily over time and bit by bit their range will grow. Thirty plants a week sounds enormous at first glance, but it also includes things like herbs and spices, grains, beans, seeds and nuts, olive oil, things like popcorn, peanut butter and dark chocolate as well as the fruits and veggies. And as Lucy said, the diversity is more important than huge quantities, so don't worry if your child's still building up their confidence with plant foods.

Sometimes when I'm working with children, I talk to them about meeting new foods being like meeting new friends. You don't have to be best friends or even like them straight away. It's OK to just get to know them in your own time. And just like in Lucy's description of gut bacteria being like communities and groups of people inside the world of your gut, what we're doing here is to help children to meet as many different food friends as possible on the outside to help make their bacteria communities as diverse and interesting on the inside as can be.

Lucy has a brilliant Instagram feed under the name The Happy Tummy Dietitian with lots of helpful practical ideas including what to do with tummy problems when they occur. I will link to her account as well as her website in the show notes. I'll be back with a new episode later in the week so I hope I'll see you then and in the meantime happy tummies and happy eating!

Chapters

00:00 Introduction

01:17 What is the gut micriobiome?

03:02 What factors shape the microbiome?

08:33 Microbiome tests and probiotic supplements

11:58 What to do if your child has antibiotics or a tummy bug

13:37 Summary and outro