How To Prevent Childhood Obesity And Create Health For Our Kids

Coming up on this episode of the Doctor's Pharmacy.

The average two-year-old can recognize junk food and call for it by name when they go to the grocery store and.

They can't even walk.

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Episode of the Doctor's Pharmacy. Hi, this is Lauren Phinney, one of the producers of the Doctor's Pharmacy podcast. A third of American kids are overweight or obese, and in addition to raising rates of childhood obesity, we're also seeing a significant increase in type 2 diabetes in children. This may sound alarming, but the good news is that there are many things we can do to change the trajectory of our children's health. In today's episode, we feature three conversations from the Doctor's Pharmacy about the importance of childhood nutrition. Dr. Hyman speaks with Dr. Elizabeth Boham about how we can address the skyrocketing obesity epidemic in our children. He also speaks with Sam Kass about the importance of nutrition in school programs, as well as with Dr. Tracy Shafizadeh about the role of a healthy microbiome starting at birth.

Let's jump in. When a child gets obese or overweight as a child, it makes it so much harder for them when they're an adult.

It kind of programs them.

It programs them, it gives them extra fat cells. It makes it very hard for them to maintain a normal weight as an adult. Prevention is really key here. It's very important that we deal with prevention because it makes it easier for that child for their whole life if we prevent that weight gain in the first place. And it's not just the health consequences, which are staggering, right?

Increased heart disease, gallstones, fatty liver, sleep apnea, high blood pressure, asthma, sleep apnea, all kinds of orthopedic problems. Those are bad enough, but it is the worst stigma for a kid to be overweight. I mean, they've studied kids and they'd rather hang out with a kid in a wheelchair who's a quadriplegic than a kid who's overweight. That's how bad the stigma is. And we often stigmatize each other and the kids because we have this view that it's personal choice. But when you're dumped into an environment with foods that are highly addictive, that are designed to hijack your brain chemistry, hijack your hormones, hijack your metabolism deliberately, Designed by food companies in taste institutes who hire craving experts to create the bliss point of food. I'm not making this up. Literally the terms they use in their internal corporate documents to create heavy users. I mean, this is just criminal in my view.

It's criminal.

And the food marketing to kids, I mean, the average two-year-old barely talk, but they can recognize junk food and call for it by name when they go to the grocery store and they can't even walk. That is terrifying to me. And kids can't distinguish on television or an ad between reality and fiction until they're eight years old. And there's now stealth marketing, which is terrifying because kids see thousands and thousands, maybe 10,000 commercials a year on television. But Facebook, for example, had 5 billion with a B, billion ads for junk food targeted at kids in one year. How do you fight that?

It's so hard. It's so hard to fight it. And, but it's important. I mean, what, when, when you go, when you bring your child to the doctors, what you're looking at, they look at the growth chart and they look at the BMI. And if, you know, the, the BMI or body mass index is not a perfect marker. I mean, there's, there's problems with it, but it is a, it is something we use as a guide and it can give you some indication of where your child is at. So if you're greater than 80, you're greater than the 85th percentile for your child's age and sex, they're considered overweight. and greater than 95th percentile on that growth chart, you're considered obese. And now we have a category for the severe obesity, which is super obese, which is 20% over that 95th percentile.

Or- It's going to be more than 100%.

I know.

It's like you're 120%.

Right.

And so if your BMI is greater than 35 for a child- Just to.

Put that in perspective, you know, these percentile graphs are made on population data where they look at the entire population and the whole population has to fit into 100%.

Right.

Zero to 100. Now they had to create a new category of 120% or more.

Yep.

Well, how does that happen?

It happens because the entire population shifts into a category that never existed before. There were no kids who were that overweight unless they had some weird genetic disorder, like, you know, Pickwick syndrome or something.

Yeah.

You know, I think we are really in this crisis now because we're threatening the next generation of our entire human race. And this is happening globally, it's not just here.

Absolutely. We see it's 5% of children are adolescents in the US. And for those teenage years, 7% of girls and 9% of boys are in that severe obesity category. And as you mentioned earlier, a third of children are either overweight or obese. And as we have just talked about, prevention is key here. That's just making it so much harder for them throughout their whole lives. And whatever we can do at this stage of the game, with your young children, whatever you can do at this stage of the game is really critical for setting them up for success.

And it's often a lack of education, awareness, understanding, it's generational, it's food apartheid, which is this term that's been used over the last few years by people in these communities to talk about what's really going on. Because the food desert sounds like a natural phenomenon. Oh, it's a desert, it's a forest, it's a river. No. This is much more serious. This is segregation and division of our culture in ways that lead and perpetuate to racial injustice, to structural racism and structural violence that drives these communities to continue to suffer from chronic disease and health disparities and obesity. I mean, the average African American kid drinks twice as much soda as a white kid. Not because they like it more, It's because it's just a lack of education, awareness, and there's also increased pressure of marketing in these communities. I mean, every time there's a food stamp come out every month and you get your food stamps for the month, the local bodegas will actually put giant ads up for, you know, get your two-liter bottle of soda. We take EFP, electronic funds, whatever they call EFTs. And it's like, it's just unconscionable to me. And it's terrifying to me because we're really threatening the next generation of our population. And if we don't stop and take care of this now, it's terrifying. Harvey Karp, who's a friend, a physician, who's a pediatrician, said, you know, if a foreign nation were doing to our children what we are doing, we would go to war to protect them. We would go to war. We are not doing anything to protect our kids.

Nothing.

We're not limiting food marketing. We're not, getting rid of all these junk crap foods that they're targeting kids.

Not fixing the school lunch program.

Fixing the school lunch program. School lunches are better because of Obama's Healthy Hunger Free Kids Act, but it's.

Still not where it needs to be. A pizza is still a vegetable.

Yeah.

And I mean, that's a great place to start is just with the added sugar. I mean, they say that the average child is consuming 270 calories a day, which is 10 to 15% of their total caloric intake on sugar-sweetened beverages. So that's 10 to 15% of calories that that are nutrient devoid, no nutritional value, and are only leading to this whole problem of weight gain, insulin resistance, type two diabetes, and metabolic issues throughout their whole life. You know, as we've talked in the past all about how that shifts your fertility and, I mean, there's so many aspects to it. So, I mean, that's a great place to start. And no, really most of our kids, all our kid, very few of our kids need any sort of sports drinks at all.

Energy drinks, sports drinks, juice boxes.

Yeah.

I mean, it's terrible. One soda increases a kid's risk of being obese by 60%.

One soda a day.

It's crazy.

It's pretty crazy. And it's a huge part of their caloric intake. It's up to 15% of the average kid's intake. And it's something that's just so unnecessary. I was at a conference on childhood obesity, and it was in Atlanta, and Bernice King was there. It was really fascinating with was with, you know, one of the major universities there, Emory, I think.

And.

There was a guy, a doctor there who was a liver specialist. And I'm like, what are you doing here? He's a pediatric liver. I'm like, he said, well, you know, we're seeing enormous rates of fatty liver in kids. And we're seeing teenagers on the transplant list for livers.

All because of insulin resistance and mostly from sugar-sweetened beverages, right?

From high fructose corn syrup, which specifically targets the liver in terms of creating a fatty liver. And for those of you who really want to understand a lot about these issues, there was a movie a few years ago came out in 2014 that I started, well not really started, but I was in it. And it's called Fed Up. It's on Netflix and I encourage you to watch it because it really highlights the ways in which our children are so affected by this. Here's a kid who's 16 years old.

Who needs a gastric bypass. Right, right.

How does that make sense?

It doesn't make any sense. So we wanna talk about what can we do, what can you do when, you know, how can you feed your child right from the start, right? And so the first thing we always talk about is the importance of breastfeeding. You know, we know that whenever possible you wanna breastfeed your child because it decreases their risk of obesity lifelong. So, you know, that is an important thing.

There's, you really- How does that work?

So, you know, that's a great question.

I have some ideas, but I want.

To hear what your idea is.

You know, there's, you're shifting. It's the composition of the breast milk. You're shifting. There's better limitations on what the baby will consume. So when they're breastfeeding, they don't consume as much as when they're bottle fed. You know, the bottle feeding, you get more milk faster through a bottle than you do through a breast. And so that actually impacts the amount of calories that the consumes, there's probably issues, sure, there's issues with the microbiome that gets shifted through breastfeeding that is not happening when babies are bottle-fed. There could be even what's in the bottle itself, right? So if the bottle is a hard plastic, we know, for example, BPA is impacting our metabolism and our weight.

Dr. Yeah, pre-diabetes, insulin resistance.

Dr. Yes, so there's probably so many issues with with the, with the, with the fascinating.

Yeah, you know what's fascinating is when.

You drink formula, it actually changes the microbiome and, and, and feeds bugs that are pretty toxic and create inflammation in the body.

Yep.

And what's really fascinating about breast milk is that there's all these undigestible fibers and starches in there called these oligosaccharides that, you know, have no nutritional value for the baby. but they're designed completely to feed the microbiome, which is just this beautiful sort of virtuous cycle that is allowing these kids to thrive and get healthy and reduce inflammation and really get them healthy. So not everybody can breastfeed, but it is really important. I think that's really key. What else can parents do?

You know, and avoiding those sugar-sweetened beverages, as we've mentioned, that's, you know- no.

Liquid sugar calories, period.

Period.

No juice.

No juice, no sports drinks, no soda, you know, no, I don't know, Kool-Aid or any of those. There's just no need for any of it. It's empty calories and there's no need. Every once in a while, you know, you can give a child some diluted 100% juice if you want to, but it's not necessary. It's not something they should have every day. And it's not- It's not part of their fruit and vegetable consumption? No, it's not part of their fruit and vegetable consumption. So that's key. You know, getting your kids moving, getting them outside every day, you know, that's really important. It gets them, you know, unfortunately, it's harder to move these days unless you put it into your schedule and we need to put it into our kids' schedule. We need to make it part of their day that they get out and they move and they either they're playing a sport or they're just having fun and they, you know, they're doing a.

Lot of finger exercises on their phone.

Oh my goodness, the phone, it's, you know, it's scrolling. It's making it so much harder for parents. It's making it so much harder for parents to to help their kids grow and develop. So screen time, really the recommendations are none for kids under the age of two. And then, you know, less than 2 hours after that, you know, you want to limit screens in the bedroom. You know, there's no need for a TV, a phone or computer in the bedroom. So you just have the kids not have it in there. It helps with their sleep, which is another thing that's critical. Most kids are not sleeping enough in this country, and that has a huge impact on their metabolism. We know that when we're sleep deprived, we're more likely to gain weight. We have higher levels of insulin. We have higher levels of insulin resistance and metabolic syndrome. So it's really important that you put restrictions on your children's sleep and wake cycle. That really is helpful. You know, our teenagers still need eight to 10 hours a night. Those six to 12 year olds need nine to 12 hours of sleep a night. And of course, you know, the one to two year olds are needing 11 to 14 hours so, you know, as you get younger, you're needing more sleep. But even though teenagers need eight to 10 hours of night of sleep, and that's, you know, it gets harder when they get older. They wanna stay up late, they wanna be on their phone, they wanna talk to somebody, and, you know, it's really important. It's really hard. We know that children in the children years, if they get to sleep before 8:00 PM, they have a lower rate of obesity, and they have a lower rate of weight gain. They have less, of course, sleep deprivation. They get better sleep. We know that sleep deprivation, as I mentioned, increases insulin, it increases ghrelin, which makes them hungry.

Yeah, if you don't sleep enough, you're.

Hungrier and you crave more sugar and carbs. Absolutely, and then you create- It's true for adults as well. It is, it creates this inflammatory process in the body that even if you're eating the right foods, you're more likely to gain weight, which I think is important to remember that even if you're eating the right foods, if you're not sleeping enough, your metabolism can be messed up.

I talk to my daughter about this.

One all the time.

I bet.

You know.

Well, you know, the other thing I.

Often talk about is how do you make your home a safe zone.

Yes.

I mean, you know, the kid who's three years old who's gaining weight or five years old isn't saying, hey, dad, can I have the keys? Go car. I'm going to go to McDonald's or I'm going to 7-Eleven to get a big gulp. But they're not doing that. How do you make your home a safe zone? I think this is so important. Yes. It's okay to have treats if you're making, make cookies yourself. Like, make it from real ingredients. Don't, you know, eat a ton of them. You can have stuff, but if you want french fries, make them yourself. You know, like, I think there, there's a level of of responsibility that the parents have, which was also important for themselves to actually create a safe home environment for their children. People put little things in the plugs. I mean, a kid is less likely to die from electrocution than they are from the bad food that you have in your cupboard than the Froot Loops you're serving them for breakfast or the French toast or the, you know, the, the, the sweetened yogurt, which has more sugar per ounce than a can of soda. So we really have to take that seriously. And in my house, my son once said, Dad, I want to invite my friends over, but there's nothing to eat in the house. And of course there was a lot to eat. It just was stuff you had to cook and make, and it was real food. I said, okay, let's go to the grocery store. I said, you can get whatever you want. Buy whatever you want. There's one condition. You have to read the label. and it can't have any trans fats or high fructose corn syrup. He's like, Dad, there's nothing to buy. Nothing. And I'm like, Exactly. There are grocery stores where you can buy healthier forms of snacks. There are a place like Thrive Market. You can go to thrive market.com and find delicious snacks that are lower in sugar, that are higher in protein, that have good fats, that don't have all the refined starches and sugars. So you can do it, but it takes a little work and it takes a little education. And I think that's the problem is we really are taking this seriously as a society.

And now your son is an amazing cook and he loves to cook and make delicious food that I've gotten the great opportunity to consume. So, I mean, I think it's, I think we have to be getting our kids into the kitchen at a young age, as, you know, even when they're, when they're two, you know, having that high chair or, you know, their bouncy seat right in the kitchen, getting them used to and around your cooking, getting them involved, having them have input. you know, really is helpful. You know, we don't wanna be just like, oh, you can't have this and you wanna have this. You want them involved in the process. It makes it a lot better. Absolutely. You know, you want them having suggestions like, well, you know, let's come up together with some healthy food that you wanna have tonight. What would you like to help me cook? Can you help with preparation, peeling or cutting or mixing? That really gets them involved and they become part of the recipe and the preparation and then they love it more and then they wanna eat it more.

Two out of ten kids now are obese, not just overweight, four out of ten are overweight. We're seeing this affect their cognitive behavior and academic performance. What's most striking in the studies that really shocked me was that the ones, the kids who are the most obese are also the most nutrient deficient. When you look at their vitamin and mineral levels, they are among the lowest because they're eating crap and it's affecting their cognitive function, their metabolism and setting them up for really bad bad outcomes in lives, lower life expectancy, lower ability to earn higher incomes. And in schools, it's a cesspool there. Sugar, salt, processed carbs, industrial refined fats. And they look, I mean, I went to the school, they had McDonald's Monday, Taco Bell Tuesday, Wendy's Wednesday. They had advertising all over the gymnasiums and bathroom stalls. and you guys really went to work on this with the Hunger Free Kids Act, the Healthy Hunger Free Kids Act, which was signed into law in 2010. Can you tell us about that and what were the challenges you found that you faced in addressing changes to the school lunch program from the food industry and from the Congress? And what was that like?

There are lots of them. So when we got there, there was no rules at all about what you could sell in schools. So in vending machines and in the a la carte lines in the lunchrooms, There was literally zero standards. You could sell anything you wanted. And the guidelines hadn't been updated in terms of the nutrient standards for the school lunch meal itself in 20 years. There had been a new resource for the program in 30.

Wow.

And part of the challenge, there's lots of different challenges. One, we were trying to do it in the middle of economic collapse. not too different from what's happening right now.

That's right, that was 2008, right? Yeah.

And so, you know, we were working on this in 2009, so, you know, pretty intense time to try to get a bill like that done. But, you know, for us in the administration, and it, by the way, took President Obama intervening and push helping to push with the first lady to get that done. You know, as we think it was the bedrock of the future of the nation. And so that's why it was such a priority for us. You know, I think there's a lot of challenges. One, like on the vending machines, you know, they are huge sources of revenue for things that we care about in schools, like art class and music class, the school's budget. Sports. Yeah, for sports. So these budgets have been cut so much that schools are depending on basically selling these kids junk food to keep programs that we all care about. alive. So there was a real, you know, tense conflict there. But, you know, obviously, you know, killing them or prematurely over the long term, like not a solution for art.

So they can, they can write great poems as they're dying and great songs as they're dying.

We had to work this out. You know, there was huge raging. And sometimes, you know, the debates in Washington just, you know, make leave you scratching your head, but. huge debates on whether you had to just offer the vegetable to the kid or actually had to serve them the vegetables.

Well, they talk about competitive foods in schools, which makes me crazy. I mean, if you, a competitive food is a donut versus an apple. So if you put them side by side, guess which one the kid's gonna pick. Yeah. So exactly competitive.

Big, big, big fights there. And, you know, then there was a pretty infamous effort by the Frozen. Food Institute, which is basically the pizza and french fries.

That.

Made the tomato sauce on the pizza to be counted as a vegetable. And french fries, we were working very hard to put limit. We proposed limitations on the amount of fries that could be served in a given week.

Which is also a vegetable.

Right, exactly. You didn't know.

Ketchup also is a vegetable.

Yeah, and so they got Congress to intervene and they attached that onto another bill and got that through. So we were able to then increase the serving of vegetables so you could serve fries, but you still also had to serve like broccoli or something like that. So it really kind of defeated the purpose of serving the fries. able to constrain that significantly at the time.

Anyway, I remember a story that, you know, Swanson's Pizza, which is, is a big pizza company in Minnesota, is the largest supplier of pizza to schools.

Yeah.

And, and Amy Klobuchar, who's the senator from Minnesota, Democrat, was instrumental in getting pizza being included as a vegetable, which just goes to show you the ways in which the food industry is so influential and driving our policies, which have nothing to do with science.

Yeah, that is true. We had big fights on potatoes in many arenas, similar to school lunch as well as with WIC. But I gotta say, there was real fights. I do think there's this, like.

I.

Have gotten over the outrage that industry is going to pursue their interests. I'm sort of just like, we gotta get over it and just win. and just beat them at their, at this game. And we need to be smarter and more strategic and get in power, run for office, get in power and win.

So you think that the congressmen and senators would be your allies? Did you find that? I mean, clearly the food industry pushed back.

Yes, sometimes they, well, we got it all passed. And the bill was actually quite good outside of those things that I mentioned, you know, the whole grain provisions, the sodium provisions, the amount of vegetables we had to serve, like all those things were actually quite very, very strong. There wasn't enough money for the program. Could it be improved? Of course. Could it be significantly improved? Absolutely. But was it just a transformational bill compared to what was there before? Absolutely. So, you know, and it took a Herculean effort to get it done at be given everything else that was going on in Washington. So, so, you know, look, I mean, that was just a huge win.

And.

Was there any follow-up data on how kids did in terms of their weight, their academic performance, the impact of the new school lunch guidelines?

I haven't seen a robust analysis for the whole program in its entirety. The other part of the bill that we buried and didn't really talk much about because we didn't look at the But maybe the most impactful thing in this bill, I don't know, one you could debate it, was provision that basically said, it's called the Community Eligibility Program, and it allowed schools that had 40% free or reduced basically where the majority, almost the majority of their kids were low-income kids, you could serve breakfast to every kid in the school for free. and every kid got lunch for free. And so it was what was, what's very powerful about that is not as much at lunch, but at breakfast. Because at lunch, everybody's eating together and you don't know who's who. But breakfast was only in the cafeteria for the poor kids. And so what would happen is those kids would have lunch at school. They'd go home. Most of them don't get food at home when they get there. Maybe a little bag of chips or and then they come back to school, but they were so ashamed of being identified as poor that they would skip breakfast even though they hadn't eaten since lunch the day before. And so by serving it in breakfast in the classroom and serving it to everybody, all like millions of poor kids are getting food now that otherwise wouldn't. And so you saw there, increased participation, better improved, significantly improved attendance, and significantly improved reading and math scores because, you know, those kids, you know, can you remember when you were like 12 or 13, how hungry you were all the time?

Yeah.

And imagine you hadn't eaten since, you know, lunch and it's now nine o'clock, the lunch the day before and it's now nine o'clock and you're asked to like focus on the test.

Yeah, and you get it.

Forget that. I could barely do that if I was full, let alone if I was starting.

Right?

And so, you know, so it was a transformational piece of legislation in that regard. And for the district, they've seen just incredible results. There's been challenges to implement it, but those resources remain and more and more districts each year are signing up for it. And so, you know, I think, I think we have to be careful, like things are messy and politics is messy and you're gonna have people lobbying for their own interests of their businesses sometimes in ways that, you know, I can understand sometimes that I find disgusting and just abhorrent.

And you share stories of what you experience that, you know, kind of reveal the underbelly of what you're fighting against?

I mean, look, it cut both ways. I mean, I think, you know, when we were banned trans fats, which, you know, there was an attempt to try to figure out from the industry side, if they could still, because of a few people who wanted various icing and other couple products where it was harder to replace, they wanted to go fight to try to allow a certain level in under the ban. Am I allowed to swear on this podcast?

You can.

I mean, and I told a lot of them, it had lobbies for these guys, like, if you want to have that fucking fight, like, I let Let's go because I cannot wait to take it to you on this. If you want to make sure that you're pumping trans fats, that is a known killer, let's go at it. So, you know, there's people like, that's like clearly something that was killing everybody, a very specific thing that had ample evidence. And sometimes just like ready for a nasty fight. But I will also say, and it's important for everybody to understand, there's a lot of nuance and a lot of gray. So there's some issues like pizza in, you know, as a vegetable or trans fat, which is a black and white issue. But there's a lot of other companies that have done tremendous work to try to make it easier and more affordable for families to get decent food that are working with real constraints from Wall Street. If CEOs try to change too much too fast and lose some revenue in a three or six month period, they're going to get fired. So those efforts would be undone in a minute. So if you're trying to get somebody to change, there's a pragmatism that has to be taken from them as well. And by the way, like a lot of people talk about wanting to eat better and how we need better food, but consumers, you know, tend to eat what they eat and tend to like pretty unhealthy food.

And that's because that food likes them. It's addictive and it sort of sets up the biology of hunger and craving and addiction, which is very hard to fight with willpower. and that's part of the problem.

I totally, that's absolutely right. But it's also a real problem for the industry. So they create, they box themselves into a problem of creating, you know, highly craveable food. And now it's, they're, it's, people want it and they like it, and they identify themselves with eating it. So it becomes the whole, you know, what we eat is really how we understand who we are.

Yeah.

And so when it starts to change, you're saying you want to change me as a human. and so it gets super complicated and people aren't changing as fast as we think they are. And so for some, for a CEO who's like, I get it, like my portfolio is not good. I've got to make some real change. It's not like they are in the position to say, I get these products are terrible. I'm just gonna get rid of them.

Yeah.

Well, they're innovating.

These companies are innovating. They're getting the crap out.

They're reformulating their products. They're getting there. They're getting. I just think we have to be careful to see like the monolith evil food industry versus everybody because it just actually doesn't capture the reality, nor is it gonna go away. And so I think we have to work to figure out who's a good actor trying to do the right thing, who's not and just needs to get called out and pressured and fought and won. And then work strategically to make progress, you know, to work collaboratively when you can and fight when you have to.

Yeah, it's hard to have the sniff detector on for the greenwashing. you know, what's true, what's not. And a lot of people are saying the right things, are they doing the right things? You know, one of the things that's challenging, all the hard work you did with the Obamas to get the Healthy Hunger Free Kids Act passed in 2010, the current administration is trying to roll that back. And their arguments are that, oh, kids are throwing out the food, it doesn't.

Taste good, people won't eat it, you know, so we have to fix those.

Guidelines, quote, fix the guidelines, and which means, roll them back so that more junk can be in the schools.

And I think, you know, there's a real challenge in the culinary world in school lunches. And as a chef, I'd love your.

Opinion about this because like we were talking about before, you've learned how to.

Make delicious yummy meals in a short.

Order from ingredients that aren't going to break the bank and that can be done. And I think there are models of this. You know, my friend Jill Shaw, I think I might have talked to you about her.

Yeah.

Who's also gonna be on the podcast talking about My Way Cafe where she got top chefs to create delicious meals within the school nutrition guidelines within the school budget for school lunches, which is not very much. And kids love it and they're not throwing it out and they're eating it.

And I've seen this happen over and.

Over throughout the country. So can you speak to the rollbacks that are happening, why they're happening and.

And what we can do to fight those? Yeah. Well, the main reason they're happening is because of the School Nutrition Association, and that is an organization whose name they, it does not deserve.

Maybe the School of Malnutrition Association.

Yeah, basically. So basically what's happened with them is, you know, they represent the school chefs, as I call them, and, you know, they've been under a lot of pressure for many years. And, you know, I will say that school chefs around this country have, for the most part, they go into these cafeterias with very little resource, with almost no support. They love those kids and they're really trying to do right by them. Unfortunately, the organization that represents them is one that is just dominated by some of the worst players in the food system. Those same pizza and french fries guys, ConAgra and a few others are the most influential companies on their board. And they were very supportive of of the Healthy Hunger Free Kids Act and the work that we were doing. And we were real allies of theirs. And then they realized that this was, standards were going too far. And kind of in the middle of the whole thing, they fired the CEO, brought in a bunch of hacks for big food and have then since started fighting us. And now have been lobbying the the Trump administration to roll back these standards. And so if they're listening, I haven't talked to you guys in a while, but shame, shame on you. It's just an abomination of your role in our society to be safeguarding the well-being of the kids that are eating in our schools and representing and supporting the people, mostly women, who are working so hard with so little support. day in and day out to do the best they can with these resources. And I just am so disappointed in how that has played out. You know, the argument that it's just good enough to have some green beans on the line, that that's like a serious argument for a 10-year-old to say they want it. It's just a joke. The reality is all the evidence shows that the evidence shows two things. One, people, kids have been throwing out school lunch since the day it was invented. and that is nothing new. And there's zero evidence that our new standards led to any increased food waste. Secondly, the evidence shows that there's a substantial increase in consumption if you actually serve the food to the child. If it's on their plate, they're more likely to eat it.

Do you know?

In fact, we had to research that, but it's true. it turns out that's how it goes. So that's where these things really get back and they're going to do that, which is really troubling, especially given the fact that while we made a tremendous amount of progress, this is a generational.

Effort.

And we have a long way to go. And so we should be tripling down on our efforts, not rolling them back.

And as a chef, you believe that that if we somehow figured out how to get food service providers to recalibrate what they're doing and get, you know, cooks, I mean, getting the ladies and the guys who are in the kitchens and schools actually cooking that it's doable.

So I think it's doable to, if there was a tremendous increase in funding. But right now, most of these schools don't, a lot of them don't have real kitchens. Infrastructure is lagging, schools haven't upgraded in years, schools have way bigger, a big part of the problem for school lunch is that, you know, these school kitchens were designed, cafeterias were designed for like, you know, 300 students, now there's 700 in the school. And a big part of the problem that nobody really talks about is like a lot of kids are getting lunch starting like 10 o'clock and then they have like 20 minutes to eat.

Yeah.

And they're just not being able to they just don't have enough time to eat. So there's a lot of really structural problems. And so I think there's a middle ground where if we could bring some capacity of cooking back into kitchens or have better sort of hub and spoke models where food is being prepared more fresh and integrating that with high quality sort of pre-made foods, I think that's a likely scenario. But you're talking about billions and billions and billions of dollars of infrastructure hundreds of billions.

You mean kitchens, is that what you mean?

Yeah, kitchens and staff. Like now all of a sudden you need a lot more people to cook.

Well, this is what you know, Jill Shaw said that you actually don't increase costs at all, that you can do it if you put the kitchens in and then teach the staff how to do it and create the right recipes with food that's low cost but delicious and nutritious, that it's doable.

I'm not saying it's not doable, I'm just saying that it's definitely hard. And there's some school to do. I'm just saying it takes increased resources. The food costs don't necessarily need to go. I agree with her. But there's no way she's. I just. And I love her, so I don't want to disagree with her about anything. There's just. Each school is different, so it's hard to speak. Just, you know, General. You know, it's just complete generalities. But if you have a staff that all they're doing is taking Frozen things and heating them. you have a pretty lean team. If you're going to prepare everything and chop every vegetable, then you're just going to need more hands, most likely. Now, there could be some things that have a big staff and you could do that, but for the most part, I think there's some increased costs there, most likely.

And it's, it's a more decentralized, right? It's not a federal program. It's all based on local school districts and everybody decides themselves. So it's, it's a harder thing to sort of nationalize.

Right?

Much harder. Yeah, that part is hard. And look, what we found in the restaurant, sorry, what we found in these schools is that for the school chefs who really were excited about serving better food, passionate about it, really wanted to do right by their kids, they figured out how to make really delicious food within the budget and meeting the standards and sometimes dramatically exceeding the standards. And we found that in districts where They didn't believe in it. They didn't care about health. They thought that, you know, these Democrats in the White House were, you know, like trying to tell them what to eat. Nanny State. Nanny State. They just, they serve food that tastes terrible. And so, you know, a lot of it is just about your will and your commitment to doing.

Well, we need to do it because we are destroying our children in the future generation. And it's, you know, a friend of mine said it was a doctor that was a pediatrician said if we're if a foreign nation was doing to our children what we're doing to them, we'd go to war to fight it.

We can no longer ignore the microbiome as a key organ in our body. If we think about babies, when babies are born, they're essentially born with a sterile gut. They have very few microorganisms in their intestine. They're brought into this world as we like to think as a blank slate. that's good news and bad news. The good news is we have the opportunity to set them on a path of having a healthy gut microbiome from the moment they're born. The bad news is most babies don't get put on that healthy trajectory. Most babies have a disruption in their microbiome from the day they're born. So maybe I'll just take a step back and think a day in the life of a baby as it's being born. So a baby is essentially thought of traveling through the vaginal canal during vaginal birth. We all can appreciate that vaginal delivery is a crazy, messy process. There's a lot of stuff happening. One thing that we want to happen is we want moms to be able to pass their gut microbes on to their babies. Well, what's in mom's gut has to get to baby somehow. Babies traveling through the vaginal canal and as they exit the birth canal, their little faces emerge first. They hopefully will get exposed to mom's gut microbes through what we call a fecal oral transfer. We can leave it at that or we can go into that. You can totally ask.

Sounds like eating poop.

Yeah.

So that if mom has a healthy gut microbiome, then she essentially gives the gift gift of seeding the baby's microbiome from the day they're born with their first little inoculation of microorganisms in baby's gut. And then, human breast milk is miraculous in that it contains everything that baby needs to grow and develop and go through the milestones of those first six months of life. It also has all of the food for the healthy bacteria that mom has passed on to baby. It has food for baby, has food for microbiome. When all goes according to plan, it's a beautiful synergistic symbiosis, as you mentioned. But if we think about it, how many different ways can we disrupt that beautiful process? There is a need for babies to sometimes be born by C-section. In fact, up to 30% of babies can be born by C-section in this country. they bypass the opportunity to be exposed to mom's good gut microbes. If you think about just physically, they don't pass through the birth canal, they don't get exposed to mom's microbes. Well, where are their first microbes coming from? So they get their first microbes that sets them up for a lifetime of either health or disease from the microorganisms that do well on the surfaces of the hospital, countertops and surfaces, or from skin or from clothes, so their first microbes look very, very different than the.

Nurse who was in a bunch of other rooms, other patients, who knows what was going on, right?

It's a little bit of a circus for those babies who are born by C-section. And then if you also layer on top of that the number of moms who are given antibiotics during labor and delivery for, say, Group B strep, which can also be close to 30% of moms, any good microbes that they have in their gut that even if babies born vaginally may or may not be there to pass on to baby. So we now, after generations of moms being born by C-section themselves, being exposed to antibiotics and babies being exposed to antibiotics, there are now generationally we have now really, really limited that natural transfer of good gut bacteria, specifically a type of bacteria that infants need. called Bifidobacterium infantis. We've almost eliminated it in our population here in the US.

I can imagine there's probably maybe not a single person who's never had an antibiotic. Maybe there is, but I can't imagine that there would be too many on this webinar that have not had an antibiotic. Which means then that all the women who are listening who've had antibiotics have destroyed this particular bacteria, which turns out to be exquisitely sensitive to antibiotics, right? So if you just like had a, you know, cold and the doctors said, oh, take this amoxicillin, like you're screwed because then you decimate the population and it's gone.

So what we're seeing is this, is.

This phenomena of missing microbes. Now there's a wonderful book written by, I think, Michael Gershon about missing microbes talking about this terrible phenomena of modern society that has literally decimated whole populations of really critical gut microbes that are necessary for our health, like Bifidobacterium and Lactobacillus. So basically women have taken antibiotics either before or during pregnancy or birth, they babies are born by C-section. So the likelihood of your baby not having any of this particular bacteria is pretty high. And so now I want to come back to something you said about the breast milk. Because this is striking to me when you think about how beautiful nature is, you know, 15 of mother's milk is not digestible by the baby. It's not like the baby's not getting any benefit from it, except it feeds this indigestible carbohydrate feeds this particular bacteria that you mentioned, bifidobacterium infantis or B. Infantis. And it, and it, and it loves this stuff. It's like, it's like actually made for you know, like, like, you know, like, I don't know what the, what's the analogy? I don't know. Can't think of it. But, you know, like, it's, it's really, it's made for this particular bacteria.

So.

Talk about, talk about a little.

Bit about how this works and what happens and, and why formula is a problem.

Because this, these, these sugars, these, these.

Carbohydrates called oligosaccharides are, are not in formula. so, yeah.

Yeah.

So as a nutritional scientist, I think that this part of the research and part of the story is probably what was most impactful to me when I was learning about this topic and the research that was coming out of UC Davis and a team of researchers that were using human milk as an example of food that in its perfect form. Because if you think about it, human breast milk has not been impacted by mass industrialization and we haven't really toyed with it too much. It's actually the pressure on human milk is actually from human evolution and it really the body is constantly dialing in human breast milk to be exactly what the baby needs to thrive and grow in the six months of life. So this team of researchers at UC Davis at the Foods for Health Institute said, well, let's dissect and analyze every aspect of human milk and let's see what's there and we'll use that as a template for what babies are supposed to be consuming. And everything was there that you would expect. The lipids, the protein, the lactose, the water, the micronutrients, the macronutrients were there. What was really fascinating and you touched upon it is 15% of the nutrients in breast milk where these complex carbohydrates called human milk oligosaccharides or HMOs for short, that were completely indigestible by the baby, which makes absolutely no sense that human milk, which is very metabolically taxing for the mom to make, would have 15% of nutrients that completely were not used, utilizable or indigestible by the baby until they figured out that food for the infantus in the baby's intestine. So then you go back to kind of our day in the life of a baby. It's a, it's a rough 24 hours, but they, you know, they, they get through it and the baby is born. They're exposed to Mom's gut microbes. B. Infantus, hopefully, sets up camp in baby's intestine, and it needs food, too. So human milk starts coming in to the intestine and. It feeds the baby and it feeds B. infantis. And then all of a sudden, those 15% of nutrients in human milk are no longer locked up in these complex carbohydrates. B. infantis is utilizing them for fuel and turning them into something that the baby can actually use. And that's these short chain fatty acids called lactate and acetate and others. And those are actually signaling molecules. They're actually a fuel for the growing colonocytes, the intestinal cells as the baby is rapidly developing they are changing the pH of the baby's intestine so that pathogenic or bad bacteria can't thrive. They're creating this protective environment in the infant's gut. It's such a beautiful story that nature has designed. And so when baby has Bifidobacterium in their gut and they're consuming HMOs, preferably from breast milk, then it sets up a protective environment where pathogens can't grow, B. Infantis is getting everything it needs. Baby's getting 100% of the nutrients in breast milk. And it's a very calm, low inflammation, protective environment in baby's gut. Now, if you can imagine the opposite scenario, which B. Infantis is not in baby's gut, HMOs are coming in through the diet completely locked up and not utilizable by the baby. Instead, pathogens are growing because the pH of the colon is in their perfect zone, which hasn't been curated by B. infantis. And those HMOs are actually being excreted in large amounts in baby stool. What we see is we see babies that are missing B. infantis with five to eight to 10 watery stools per day. They're just pumping out HMOs. And if you think about it, that's what pediatricians have been telling us moms for a long time. If you have a breastfed baby, expect five to ten watery stools per day. But I'm not sure that that is actually what we're striving for because in clinical studies that we've been, that we've conducted, we see that when babies do have B. Infantis and they are utilizing HMOs, they stop kind of pooping them out, dumping them out into the stool. They're no longer in the diaper and babies are accessing 100% of the nutrients and benefits of breast milk. Now, you asked me about formula. All babies need to be fed, all babies. And if a baby is not getting breast milk, formula is the next best option. And we are big advocates of that is best. However, we know from a nutritional composition perspective, there are big differences between breast milk and formula. and formula companies are working very hard to try to get formula as close to breast milk as possible.

Yeah.

There are, there's a long way to go.

Long way.

There's a long way to go. And yeah, the HMOs in formula, although they do have them on some of the labels, contains HMOs. They are not nearly at the, at the concentration of breast milk, nor are they at the composition of what's in breast milk. So that is, it It is a hot tip to the idea that there are HMOs in formula.

It's like window dressing. It's good marketing.

It is indeed. So I would say that babies exposed to antibiotics, babies born by C-section and babies that are receiving formula, they're not going to create this high B, infantis protective environment in their gut. And they will. That is where we start to see the high levels of inflammation in the gut and then the longer term effects. negative health effects as baby grows.

Absolutely, because the baby's immune system when it's born is not developed and the first year is critical for its development and it develops the immune system by sampling the environment through the food it's eating and through the microbes that are in there. And when those microbes are off or out of balance, it's going to drive lifelong changes that are often challenging. And as a functional medicine doctor, I see this very often. What's the story? Baby born by C-section. given antibiotics in the first years of life, lots of ear infections, sore throats, maybe then they get some eczema and diaper rash, then they get asthma, then they get allergies, and they get autoimmunity, and it just, you see this pattern over and over when you start to pay attention to it. So when I take a patient's history, I start with the mother's health before birth, and I go all the way through to the timeline of what's going on. The study I read that was so striking to me that just put this in bold relief was a study where they compared the microbiome and the short-chain fatty acids that are produced with babies who are breastfed versus formula fed. Now, you mentioned a few of them, but one of the most critical short-chain fats is something called butyrate. And it regulates immunity, cancer, it feeds the colon, it's so critical. It's anti-inflammatory, it's used to treat colitis. I mean, it's quite an amazing molecule and it's produced by the bacteria, the right bacteria, digesting the starch, the fiber. In this study, they looked at the kinds of short-chain fatty acids that are produced depending on what you're eating, if it's formula or breast milk. The breast milk babies all had high levels of butyrate, which is what you want. The formula-fed babies had high levels of another short-chain fat called propionic acid. Now, it's a big medical word, what does it mean? It's one of the short chain fats, but it turns out that this is very neuroactive in a bad way. So they are able to induce autism in animal models by giving them propionic acid. And guess what it's also used for? It's a preservative used in flour. So anybody eating wheat in this country, unless you know for sure that the company is organic and this and that and doesn't put anything in it, they put propionic acid in. which leads to behavioral issues and mood issues, attention issues, and like I said, in animal studies, it can induce autism. That's terrifying to me. And so I really think that we should be looking at children's microbiomes. We should be looking at their poop. We can measure, I do this every day in my practice. I measure short-chain fatty acids. I look at the types of them. I look at the kinds of bacteria there. And it's quite amazing to see how many people have disordered gut microbiomes and we don't even think about it. As a physicians, we basically treat the downstream problems and not the gut. what you're talking about is going way upstream way back to day one of a baby's life. And maybe even, I mean, I read a study years ago where they gave the mothers a probiotic and then the babies and they gave the mothers a probiotic, help the baby actually have less asthma and eczema and allergies. So essentially, if you don't have this as a mother in your system and you don't pass it on to your baby, the baby doesn't have it, the baby doesn't get the ability even to use the oligosaccharides ends up with all these problems, it creates a pretty bad situation long term for the baby. So instead what's growing there are, we call them potentially pathogenic bacteria. It's not like getting E. Coli or Salmonella or Shigella. It's not these horrible, but it's this imbalance in things like Klebsiella and Pseudomonas and Enterococcus and all these weird bugs that can be potentially infectious, that are irritating and they, they, they're critical to get rid of or to change the environment in there because it will program the body for life. So talk about how important it is to, to have this early in life and what the consequences of not having it are when these other bugs tend to overgrow and lead to all these secondary problems down the road, not just colic and diaper rash and fussiness and a little diarrhea as a baby. Who cares? Okay, the baby's miserable. You're miserable for the first year, it'll get that's not the real problem. The real problem is what I started out this webinar with, which is talking about this pandemic of inflammatory adult diseases that start in childhood, in infancy. So can you talk a little bit about that and what happens with all these bad bugs and what do they do?

Yes.

So one thing that is paramount to us here at the Avivo team is.

That.

We insist that science leads the way for what we do here and where we go and what we publish and what we bring forth for people to be able to use and the products that we make. I would say that the vast majority of the probiotic industry kind of glosses over the rigorous clinical science that needs to take place in order to really be able to say, we understand what's happening in the gut microbiome, here's a probiotic product that's going to actually address that problem, and here are the clinical outcomes that are that you can expect. That is a the rigor that is required, I think, is lost in the majority of probiotic products that are out on the market today. Our group, our team, which is, as I mentioned, a spin out from UC Davis and the Foods for Health Institute, we set out to say, let's let science drive the direction that we are going to go and let's look systematically at what do babies look like if we don't do anything and we just look at a population of babies born today in the Davis, California area, breastfed babies? What does it look like if we actually give B. infantis back to them, feed them a Vivo every day? And what does that do not only to the amount of B. infantis in the baby's intestine, but to the abundance of the other pathogenic bacteria that were there? in the absence of B. Infantis. So that is what over the last five years, close to 20 different clinical publications that we've been able to publish in peer-reviewed journals have shown that when a baby is missing B. Infantis in their intestine, whether that's because of antibiotics or C-section, whatever reason, there is instead an almost full composition of what you mentioned as potentially pathogenic bacteria. And to your point, I want to make sure that we're clear. That doesn't mean overt infection. That means kind of a quiet.

But.

Abundant composition of the infant gut microbiome that you can't really see from the outside of pathogenic bacteria setting up shop in the baby's gut microbiome, including Staph, strep, klebsiella, clostridia, as you were mentioning, and they are causing inflammation in the infant gut. What we don't want to do is jump on the bandwagon, the microbiome probiotic bandwagon, and over interpret or hype, over hype any data that we have so far and say, just spend a lot of money on probiotics and you'll be fine. We will not do that as a team and as a company. So what we've done is we've gone through and said, not only can you restore B. infantis back to the infant gut through feeding Evivo to babies, we were able to answer that definitively in one of our early publications where we showed a complete restoration of B. infantis to babies who are fed Evivo. But then we looked at the composition of the infant gut and can we reduce those pathogenic bacteria? Yes, we can. to up to 80% reduction of those pathogenic bacteria. Then, if you do that, can we see a reduction in the inflammation markers of inflammation? Can we see a reduction in antibiotic resistant genes? Can we see a reduction in many other of the markers that show that a baby is either on a path toward autoimmune and autoinflammatory diseases or not? And that's really what we are still on this journey, I would say collectively, not just the AVIVO team, but field of microbiome science, you have to be able to follow those kids out and do the clinical studies to be able to definitively show that you get prevention or treatment of any of those diseases that you mentioned. We're not there yet, but we have many very large clinical studies ongoing right now because there is enough early data, there's enough early basic science that shows we believe that this is exactly what's happening. We're reducing the inflammation, we're reducing those pathogenic bacteria by feeding a baby, and now we're going to systematically go through and say, what conditions can we prevent in those babies going forward?

I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in.

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