Conversation (YouTube interview) between Wendie Trubow, MD and Dr. Elisa Song about how early-life gut microbiome development influences childhood and later autoimmune and allergic diseases. Key claims: infants acquire 70–100 trillion microbes after birth; roughly 70% of a child’s immune system resides in the gut; critical foundation period is 0–3 years; antibiotics and antacid use in the first six months is linked to increased risk of allergic/autoimmune conditions by age four; birth method (C-section versus vaginal) affects initial colonization and vaginal seeding has been proposed; breastfeeding historically promoted beneficial microbes but many modern breastfed infants lack bifidobacteria. Practical focus: prevent or reverse microbiome disruption early to reduce downstream autoimmunity.
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So let's, let's talk about the gut. Then Hippocrates was talking about, credited with saying, all disease starts in the gut. So why are we talking about the gut when we talk about autoimmune disease? What's the, what's the relationship there? Especially as applies to children?
Yeah, so this is especially important for children because the listeners here, you guys are savvy, you know the importance of the gut microbiome, or at least you've heard of the gut microbiome and the importance of a healthy gut for your immune system. How does that apply to children? When children are born, they're more or less born with a, quote, clean slate in their gut. Some of that may not necessarily be true because we know that mom's gut microbiome, even in utero, can impact the baby's developing gut microbiome. But all of those 70 to 100 trillion microbes that end up populating your child's gut microbiome needs to get started from the moment that they're born through their entire life. Now, the way that your child's gut microbiome and all of those gut microbiota form and colonize influences how their immune system develops. 70% of your child's immune system is in their gut. And your gut microbes, your probiotics or your dysbiotic, your abnormal gut microbes will inform how your child's immune system develops. So let's take an example of, we'll talk about these tonsil like patches. We all have tonsils, right? We used to. These tonsil like patches also line our gut, our entire gut. And those are called gut associated lymphoid tissue. It doesn't matter what it's called. Think of them as tonsils in your gut lining, okay? Your gut microbes communicate with those patches and tell the immune system in your blood how to respond to things that are passing through. And we're one large tube, right? Everything that we encounter, we're going to also encounter through our gut. And that's the largest interface with food particles, with viruses and bacteria, with environmental toxins. And as those pass through your gut bugs, take a look at what's passing through and decide, is this friend or foe? Should I respond with an immune response or should I let it just go right now sometimes a signal gets crossed and if you have the wrong kind of bugs in your gut, you might start attacking foods that maybe wouldn't have been allergenic or sensitizing beforehand, right? So then you start attacking and maybe too much inflammation is called in, right. That's when we get chronic inflammation and chronic disease. Sometimes, though, your immune system identifies something as faux that really isn't and then calls in the wrong troops. It identifies that piece of a virus or piece of a bacteria or piece of a food as something similar to one of your cells, something in your organ and starts developing antibodies against that particular organization, antigen, and in the process attacks you, attacks your thyroid, attacks your joints, attacks your gut, and you end up with celiac or you end up with Hashimoto's, or you end up with rheumatoid arthritis. And so that's how autoimmunity can develop. And your child's gut microbiome has this key period, this critical time between 0 to 3 years of age where that foundation is set. We know that antibiotics and antacid medications given within the first six months of life can increase the risk by the time that child is 4 years of age of virtually every single allergic and quote, autoimmune disease. Right. Eczema and asthma are now known to be autoimmune reactivities. Hay fever, anaphylactic, food allergies, you name it, hives. And so if we understand the shift in the gut microbiome that occurs after a disruptor like antibiotics or anti acid medications, and we know how to then reverse that disruption, we can impact so much that child's developing immune system and help prevent the downstream autoimmunity that might occur.
You know, I'm struck by you and I are essentially in sister specialties because I used to function as an obstetrician, gynecologist. So I did cesarean sections, thousands of them. And I remember early in my career that one of the old timers, I was horrified, you know, because I had yet to do functional medicine. And he said to the woman, I'm just going to inoculate the baby basically, and took some of the woman's vaginal flora from the C section and put it in the baby's nose and mouth. And I was like, whoa, hold on here, right? Because you think about once it's come out of the vagina, you don't think about putting it in your mouth or nose. But he, he said to me, you know, you think about the baby is sterile at this point and it needs those bacteria to develop the healthy microbiome. Now he's way ahead of his time, right?
Because his time.
Fascinating now.
Yeah, I mean, that is amazing. So that's something called vaginal seeding, which now there's been a few small studies. And when you Think about it. Your baby, again, born with a, quote, sterile gut, and relies on the birth canal exposure to mom's vaginal microbiome and gut microbiome. Right. There's all sorts of body fluids and poop and stuff going on there. Right. And so they rely on that experience exposure to get colonized, to have their gut microbes really start off in life. Babies who are born by C section have very different gut microbiota compared to babies who are vaginally birth. Babies more by C section tend to have more skin bacteria and also tend to have more abnormal bacteria in their gut microbiome, as opposed to babies who are able to be exposed to their mom's vaginal fluids and all of the fluids as they're passing through. So that vaginal seating, I mean, how cutting edge, right? Right. You know, to expose that baby. Now, we also know, you know, being vaginally birthed and being breastfed starts off the baby's life with a, quote, better gut microbiome. However, even that is not necessarily a free pass for your baby's gut microbiome because of all of the way that we are living in this world and all the forces that work to disrupt mom's gut microbiome and vaginal microbiomes. The breastfed baby of today, the modern breastfed baby, their gut microbiome is very similar to the gut microbiome of formula fed babies a century ago. We have lost most of the beneficial bifidobacteria species in our babies, even in our breastfed babies. So we all need to work on our gut microbiomes and our vaginal microbiomes, hopefully before our babies are born. And then once our babies are born, we work on optimizing their gut microbiome, no matter what their history is.
