Appogia production.
Hi everyone, thank you for tuning back into Tenantus for Nurses. I suspec Woodbine here this season. I am so excited to announce that the podcast is being supported by Nutritia, which is a global leader in medical nutrition. They understand the needs of nurses in the nutrition space and for over one hundred and twenty five years have provided products to support child health. Some of Nutrita's pediatric brands include Neo Kate Junior for children who have food allergies and
app to Grow for those fussy eaters. And those of us who have children know many kids who go through the phases of definite fussiness. For more information and resources, visit the nutritiona Pediatrics hub at nutritia dot com dot au forward slash Pediatrics. I just want to say a huge thank you to Nutritia. Their desire to support nurses is truly appreciated, and they are allowing me to continue this podcast so that we can all grow as nurses.
This season, we have some amazing speakers in the pediatric space which I cannot wait to share with you all. Hi, my name's Beck Woodbine and welcome to Tenderness for nurses.
I'm grateful for the person that I have the opportunity to be, so I hit it and parked it for Nelly four years. We always have free will, We always get to choose. We are autonomous.
Hi everyone, thank you for tuning back in to Tenderness for Nurses. My name's beck Woodbine and I'm a nurse practitioner and today we have the fabulous doctor Emma Beckett chatting with us, and we're actually talking about immunity in the first thousand days of a child's life. We'll be touching on a few other bits and pieces along the way,
but I'm really excited about this conversation. When I speak to my clients that have come in or have skin issues around because they've just had a barb or about to have a barb, and one of the things that's always discussed is feeding. It's just one of those things that mums always tend to ask other mums, how are you feeding?
You know you're getting some sleep.
And I think it's a really great conversation to have in that we don't judge mums for whatever choices they make. We all know that breast is best, but sometimes for whatever reasons, whether you have to go back to work, Buba isn't feeding well, mum's not making enough milk. There could be so many different circumstances that sometimes mums do
have to make the choice of bottle feeding. And that's where the conversation with doctor Emma is coming in, and we're going to unpack this a little bit so that you all have a little bit more knowledge so that we can all be supportive of each other, whether that is breastfeeding, which we know is the ultimate choice and the one that we should all be going for the gold standard, but if you can't, it's all about making good decisions for your bubba. So welcome Emma, how are you?
Hello and wonderful, thank you for having me. So why don't you explain a little bit of your background for people that are listening today.
So I'm a food nutrition scientist, biomedical scientist, communicator and educator. So I'm a very multifaceted professional and I love that because it gives me an opportunity to look at interactions and intersections between different sciences. I got interested in immunology because I'm a child of two geologists, and geology is a very slow science and so when I started my BioMed degree, I got very fascinated by the small things that happened quickly in the body that you couldn't see.
Then I moved into nutrition as I got further into my career because I realized there's no immunology without nutrition. If you're giving vaccines to a malnourished baby, that's not going to be very helpful. And so nutrition for me was the science that helped everyone. And then I got into nutrition communication because I realized my point knowing all these things, if we can't share them with people in a way that can actually change what they're doing and
change the world for the better. So I've ended up in this messy space where I'm kind of not a specialist anymore. I'm a generalist with overlapping specialties. But I feel like it's a very powerful space to help people.
Oh my god, that's like a nurse practitioner.
We know a little bit about a lot in our specialties that we've segue into. Yes, we know more, but we know a little bit about a lot. Some thing's a lot about a lot. But that's exactly what the space that nurse practitioners did in is where you are currently.
And the power is sharing it with people, right, which is another thing that nurse practitioners specialize in, because the information is nothing if we can't get it to people in a way that actually works for them.
Yeah, dissemination is paramount in healthcare.
I am quite fascinated by you because you add a really quirky spin to nutrition to education. Got a huge following on social media. Why did it become so paramount to you to start sharing this information about immunity and immunology and babies.
Firstly, there's a lot of bad information out there, and there's a lot of beautiful people talking stories about inflammation that aren't quite correct. They might have kind of a root in science that then gets spun into something a little bit more confusing. So it's important to be your whole self in communication because there's a lot of people using a lot of parts of their lives as hooks
to share non scientific information. But for me, this whole story of immunity and particularly early life immunity, if I think about my values as a communicator and as a scientist, it's very much centered around fairness and that first thousand days of life is about programming. It's a out setting
the scene. It's about laying the foundations. I've always been interested in things in my career about how do we level that playing field and make sure everyone gets a good go or everyone gets the chance to be the best version of themselves possible, And so by sharing nutrition information in my own way, I hope to be a part of doing better in that space.
I did many years ago a stint at Logan Hospital, which back in those days was lower socioeconomic area.
And I'm not a midwife.
I was working the operating theaters there but knew some of the midwives and I remember them saying some of these young girls would come in and they would encourage breastfeeding because it was free, but they knew that the minute they left the hospital they were going to bottle feed these babies.
I used to.
Do some lists in the dental area. These mums would come in with bottles full of coke, and the baby would be in having all their teeth removed like a toddler, and then the new bub would be there sitting in the prem with the coke, and I really felt we let them down and if there had have been products or education more strongly around that area, would have they continued to be making the same mistakes or is that
all they knew? And now that we've got social media and that ability to disseminate good information, surely we should be doing that. But then how do you know what's good information and what's not good information?
I think you've hit on something really important there. In nutrition, it's not just what we say, it's what we don't say. And if we don't fill the gaps, then people need to fill those gaps for themselves. And we spend a lot of time talking about what's perfect and what's best, and we just hope that people find their way to perfect and best and come on that journey with us. And that's true in early life nutrition, and that's true
in adult and childhood and everything else nutrition. So I think there's a lot of power in talking about, even if it's not perfect, how do we make the best of it, and what are our choices that we can make that fit within people's circumstances that actually support them where they are. So meeting people where they're at, I think is a really important thing, not just in nutrition but in healthcare generally.
Couldn't agree with you more so, sometimes you just have to assume that someone knows nothing and just break it down for them and give it to them in a kind manner, of course. But I know when I had my son major issues, total refusal to eat in and out of hospital, fed with a naser gastric tube, and then at the end wouldn't even feed from a bottle. Thankfully, I had great people around me, and I was four months we were actually starting to feed him food because
you just total refusal to drink. But what happens if people don't have those people around them.
It's a really good question, because if you don't have that support, it's very difficult to know where to get that information from. And we often rely on instinct or we rely on what people around us are telling us. But knowing how quickly medicine changes, how quickly science changes, if we're just relying on the kindness of strangers or the kindness of family members, we can get left behind quite quickly and not be doing what's best in our situation.
So it is really difficult. And being able to share good quality information and get it to people in a way that they can use, I think it's so important.
So you're currently working on a website for healthcare professionals to get information about feeding, whether that be mixed feeding or bottle feeding. And we know breast is best, and we are absolutely two hundred and ten percent promoting that. We are just talking in this podcast in relation to those families where they might choose mixed feeds or they might choose another option such as formula feeding. So we
are not disparaging breastfeeding. But for those of us who have had to go back to work early done some mixed feeding, it's good to get that information. And you've been working on a website in relation to that, haven't you.
Yeah, So the website for health professionals, and we've got a fact sheet specifically for nurses that's a guide to help in the conversations, because if you're empowered as a professional, then you can empower people that you work with. And it's about, as you said, not comparing different types of feeding, but knowing everything that is in the toolkit so that the optimal decisions can be made to support immunity in
that early life. Because if we lay that foundation right early on, then we don't just reduce the risk of infection and gastro intestinal upsets and those kinds of things that are very important in early life. We're laying a foundation for immunity for the rest of our lives as well. So knowing that breast is best if formula is required, that not all formulas are created equal. They're all going to have the basic nutrients that you need. But we know now that nutrition is so much more than just
essentral nutrients. So it's not just about having the building blocks to create the things that grow a baby and keep that gut healthy and that immune system thriving, but it's about the biological signals that are sent. And there's different things in different formulas, and particularly bioactive compounds like prebiotics, that can change the way those formulas influence the immune system.
And knowing that selecting a formula that has those prebiotics is going to give you that better outcome for immunity can help reassure a mum that she is making the right decision, because we hear a lot about breast milk being important for those immune factors that are communicated from the mum to the bub but it's not just the direct communication of immune factors that impact the baby's immune system. It's also things like prebiotics that are in the milk or can be added to the formula as well.
What is the difference between a prebiotic and a probiotic.
So probiotics are when we add living bacteria, so the bacteria is able to pass through digestion and colonize in the gastro intestinal track.
That's probiotic.
Probiotic is a step before that because prebiotics feed those bacteria. So if you're taking probiotics but you're not getting enough prebiotics, you're potentially just throwing those bacteria down there and not giving them what they need to survive. Prebiotics aren't digested by us, but by the gut bacteria, and particularly the good gut bacteria, the ones that producing all the things that do stuff like strengthen our gush and help our immune system.
And so the probiotics could.
Be things like fibers, complex sugars, or they could be things like polyphenols, but the key thing is they're good bacteria food.
Probiotics in formulas are they're probiotics or you're looking at just the prebiotics.
So you can add probiotics two formulas as well, and you'll often see formulas that have both a probiotic and a prebiotic. The bulk of the evidence around improving immunity, gut function in early life, reducing risk of infection in early life comes from the prebiotics, not from the probiotics. So the probiotics specifically is where the data says we're seeing this benefit.
And how does that work if it's food for the bacteria.
So the bacteria are already seeded in the gastro intestinal tracts. So baby is born with some microbiota that comes from mum, and it's acquired from all around the environment. If you've got a kid, you'll know they'll put anything in their mouth.
Yep.
And so the prebiotics are about feeding the good ones and maintaining that balance in a beneficial way, as opposed to adding things in.
So let's go back a couple of steps. When you are feeding a little one a pre biotic, you're helping them avoid infections, colds, coughs, flues, gestros. What the number one hospitalization for babies up to what too?
Would that be?
Yep? And infection up to three years is the number one reason to see.
A doctor any infection. We're talking respiratory, we're talking guard we're talking anything. So if you then do your immunizations and you've got these prebiotics on board as well as your probiotics, does that mean that uptake of that vaccine is going to be better.
Yes, So it's it's important to remember that if we're giving vaccines and we want them to have a good immune response to protect the child for later, we need that child to be nourished, so they need to have all of the basic nutrients. But it's becoming more evident that that early life programming is not just about the vaccine in and of itself. It's not just about the nutrition in and of itself. It's about the signaling that
occurs at the same time. So all these things are interacting with each other, and we know throughout life that what happens in the gut has a knock on effect to all the other areas in the body, but particularly for the immune system because the majority of our immune cells are in the gut, and that makes sense because that's where the body is exposed to so many things externally, and so by making sure that we nurture that in early life, we're part of making sure that balance works.
Because immunity is really tricky. You don't just want to go immune response on. You want to go we're responding to the right things in immunity, and we're not over responding to self or to normal exposures, because that's when autoimmune conditions, that's when allergies become a problem.
So it's this really fine balance.
And I don't say that to stress people out, as in you're going to get it wrong, But it's about balancing those responses for ongoing programming. So we want to be able not to overreact, we want to react to the right things, and we want to support all those pathways to work at the same time, rather than just focusing on one or the other.
Let's say you're a new mum.
You've breastfed for the first month six weeks, but just because of financial concerns, you have to go back to work and you're working part time, so you've made the decision to mixed feed, and but will take the bottle? I mean, I know my daughter totally refused the bottom. Also, she was breastfeed the whole way through. Bub's taking the bottle. The family's got itself sorted. What can you expect to see by adding in a bubby formula that's got the
probiotics in it. Do you do a gentle start, do you just go straight in and morning and night breastfeed and in between you just do bottle Like how does a parent do it? How do you add mixed feeding to the regime.
The introduction is going to depend on the situation for the mum and bub We talk about when people are introducing probiotics and fibers in adults, we always talk about introducing it slowly because once you start feeding the gut bacteria, they start fermenting, and fermenting creates gas, and so that can be unpleasant when you're adapting.
But when you're.
Looking at introducing a probiotic in a formula, it's really going to depend on the needs of introducing that for formula, and the gastro intestinal environment and the social aspects of things like gas are very different when.
You're a child, absolutely, and so.
Kids are allowed to have gas on and adults we are socially less acceptable. So introducing the formula in a way that's needed and having that probiotic there at the same time is definitely the priority. So having the probiotic is an excellent bonus that I would encourage, but getting the formula in so the bubb is fed first is
obviously the most important step. And I've just realized I keep saying prebiotics like as though you know that will be written on the tin when you're looking at a formula, and it's probably not going to say prebiotics on the front of pack. And so what you want to be looking for when you're looking for a prebiotic is in the ingredients list. The number one performing in the data of the probiotics are a combination that's called goss and
foss so galacto oligosaccharides and fructo oligo sachrides. So those are really big words, but they'll be written out in full. Galacto oligosacride and fructo oligosachride will be written out in the ingredients list of these formulas.
So that's really what you want to look for, amazing.
So I will add those to the show notes so that if you guys are interested or want to share that information, they will be there for you what the full name of the prebiotics are, so that it's there in black and white for you.
And I'll get doctor Emma to check it for us, the role.
Of the nurse in educating mums and dads and families around good feeding habits.
When does that start.
I think the role of the nurse begins immediately, and
I don't think it ends. I think as one of the most trusted professions and one of the most accessible healthcare providers, there's a lot of incidental inquiries about these kinds of things, dental conversations that happen, and I think that's true throughout the entire lifespan, but it matters particularly in early life because in early life we are laying this foundation, but we're also laying a foundation about these conversations and the fantastic role that nurses can play acknowledging
their scope of practice is not dietetics, it's not nutrition, but being able to have kind and clear and empowering
conversations so that people can access that entire toolkit. It helps parents feel supported, it helps baby be nourished, but it also reinforces that role of nurses as that caring an accessible profession because there's a lot of times where people are not comfortable having these conversations because they're afraid of being judged, and so if a nurse can have these conversations without judgment and with kindness and backed by evidence,
then that reduces the fear of having these conversations again with nurse in the future in a more empowering way. So I cannot stress enough how much I think nurses can play a really positive role in improving these outcomes for babies and their parents.
Since you have introduced and done research into prebiotic being added into formulas, were you able to get a good reading of the reduction of hospital visits or do some research into that area of the impact it, you'd have.
So there's data that shows reduction in infection rates, not necessarily hospitalizations, not because that doesn't happen, but probably because that's not been looked at yet. But there is the reduction in infection rates, and there's a lot of data for the actual functional changes that we know will have a knock on effects. So it's important to remember in science we don't always look at the end outcome directly.
Sometimes we're looking at the different functional and biological markers long the way and then putting that together to be able to make the recommendation for how things would and could fit together. Because obviously that endpoint of infection is a very complex one, but there's good data for things
like increasing good bacteria in the gastro intestinal tract. There's good data for increasing the amount of IgA which is produced, and that's the globulin is something that we're encouraging breastfeeding for so getting that from mum. So that's one of the anti bodies that's going to help protect bub against infections.
And we see improvements in things like staol consistency, stool frequency, reductions in pH of the stool, which means we've got more of the good metabolites being made by the gut bacteria. And so if you put all that together, it makes sense that this is going to reduce infection rates and then hopefully that has a knock on effect of things like hospitalization as well. But obviously we need to keep collecting data.
On those things. And how do you collect the data is it through stool samples.
So there's lots of different ways this research is done. It can be through health records, it can be through collecting stool samples, which again much easier in kids than it is in adults, and obviously looking at the biomarkers, looking at things like blood levels and those kinds of things as well. So a lot of really wonderful parents will have volunteered to be part of studies that look at putting these probiotics into formula and showing these benefits.
And I think that's important to acknowledge because we can't keep improving the science if we don't have people who want to participate in the science. So I think that's a really great role that these mums and bubs have played to allow us.
To keep growing.
Actually, I just received a final questionnaire from the University of Queensland for a longitudel study that I did with my daughter about development. Totally forgot all about it until I got the final questionnaire and it was like, oh my goodness, I participated in something that went for twenty five years.
Pretty cool.
It's so powerful and in a few years maybe someone's doing a podcast sharing some new advice based on that study. Is just so impactful, and I think that really highlights what I was saying before about it's easy to take for granted raising children because we've raised children for eons. But as we learn more about the science, we can do better for those children. And we live in different environments now, and so we have different pressures to do better for those children. And when I think about a
concept like prebiotics that's younger than me. Prebiotics has only been a term since nineteen ninety five. So if we relied on what my grandma told my mum, we really could be missing a trick in supporting immune health and in supporting parents.
You spoke before about autoimmune ca conditions. Do the prebiotics help long term with that, not just with kids but with adults. Is the research looking into that currently directly?
I wouldn't say that data is there yet, But again, from that join the dot's perspective, and knowing what we know, having a well programmed immune response to pathogens and priming that gut microbiota to be biased in the positive direction is very likely to have positive outcomes for other conditions as well. But I wouldn't want to overstate that not having that data yet. The data is really clear for gut function, it's really clear for the gut bacteria. It's
really clear for the metabolites that are being produced. But we do need to do more research to get that direct evidence, because obviously when we're looking longer term, that takes longer to get.
Absolutely, it would be wonderful because the amount of autoimmune conditions that are just spiking, it's phenomenal. And look, I have my own ideas about that. I do think our stressful life and not caring for ourselves impacts a lot of that, But that's not science backed. That's just from me talking to lots of people. It's interesting. A colleague of mine is a specialist in a emergency department and we were chatting the other week and he was quite surprised.
We just got chatting about different things that are presenting at the adults emergency and he was saying that he just can't get over autoimmune conditions, heart attacks, strokes, weird cancers, brain tumors. He said, they're seeing things they've never seen before, presenting in much younger demographics. And I said, Demma, what do you think and he goes, I definitely think it's stress, he said. I think it's our phones attached to our ears all the time. People have the phone on their wrist,
there's never any downtime. And it sort of made me think, you know, I think all of this impacts the gut and impacts the brain. I just don't know if we're feeding our bodies the right things to also be coping with all of this stress, because I know if I eat a good, healthy meal, look after myself properly, I feel far better than if I eat fast food.
Do you agree with that?
Do you think food, the mind, stress all plays a role in autoimmune conditions, in cancers, in tumors. I'm asking not scientifically, I suppose just your personal belief. It's really hard for me to separate personal tiberance. But we know that the gut and the brain are connected in both directions, and so what goes on in our brain affects our gut. What goes in our gut affects our brain, What goes on in our gut affects everything in our body. If I was to pick the organ system that has the
biggest impact on health, it's always the gut. Knowing that we live in this environment that, as you said, is quite technological, it's quite hectic, there is a lot of stress going on. Again goes back to how we can't just keep doing what we've always done and keep giving the advice that we've always given because science is always going to be in flux with that change. So keeping up with what we can do to optimize responses and improve outcomes is always going to be important in nutrition
and in health sciences generally. But going back to you know, stress and the impact of stress on the gut and how then that leads to disease, I think this is all the more reason of why we want to be across the importance of that first thousand days of life.
So first thousand days of life being from conception to two years of age in the child, because that is the programming stage, That is the priming stage, and programming and priming is going to determine how resilient we are to these other stresses and these other exposures, because obviously
we keep getting exposed to things throughout our life. After formula, after breastfeeding, we're transitioning into solids, which brings a whole new set of exposures to the gastrointestinal track, brings a whole new set of stresses in the brain as well. And so no matter what we're doing at whatever life stage, getting that foundation right first gives us the best chance at those outcomes being what we want them to be later.
What are the things you do in my research beforehand and you brought it up before about the phs stools. Why is that so important in bubbers?
Well, the PHR stool is important for everyone because it's an indicator of overall functions. So stool should be slightly acidic, so it shouldn't be too basic, it shouldn't be bang on neutral, and it shouldn't be very acidic either. So like everything in the body, you know how we have our pH buffering in blood, and each of our organs has their own pH environment, our gastrointestinal environm.
It's an indicator of its overall health. It's pH.
And one of the reasons why pH changes with the health of that environment is because the good gut bacteria are producing short chain fatty acids, so things like acetates and propenoates and butyrates, and they're actually the signaling molecules that go on to have those knock on effects that cause benefits for the immune system and cause benefits for
the gut wall. So one of the reasons why keeping your gut microbiome healthy is improving your health outcomes and particularly your immune outcomes, is the gastrointestinal microbiome the bacteria produce energy and produce metabolites that actually feed the wall of the gut, So you don't need to be a scientist to know that a healthy wall of the gut is going to improve immune outcomes because it means the right things are getting in and the right things are
being blocked out, having a nice exchange of information between the inside and the outside of the body. So the store pH is a marker of all that going on and working appropriately.
What age do you recommend for little ones to start introducing solids? What is the most beneficial age?
So from an age point of view, it's around six months. There are physiological markers of children being ready in terms of being able to hold their head up and the way they can move their jaw and those reflexes, but six months is key. It's important to remember though we're very rarely going bam. We're done with breastfeeding and formula
feeding and now we're eating solids. It's a transition period and that's another place where I think prebiotics are going to prove to be important in formulas or coming from breast milk, because there are probiotics in breast milk as well. Because when we start introducing solids, we start introducing allergens and we start introducing pathogen So there's going to be bacteria on food, there's going to be bacteria on plates.
Don't panic.
I'm not saying they're unclean. There's bacteria everywhere, and those meeting the immune system in the most optimal way, which is supported by probiotics, is going to help with that programming in that stage. So it's a high risk, high reward stage when you do start introducing those solids, and remembering we get probiotics in our solids as well, and so introducing prebiotic rich solids can help support that stage as well.
So you would encourage if your breastfeeding still breastfeed, cut it down to two three times day, If you are still bottle feeded, continue the bottle feeds, but ad in the solids as well and just slowly integrate them and just one or two little things each week or if the child shows interest. Would that be a fair statement.
It's definitely a staged approach. It's definitely a transition, not hard cut point, and it's going to be different for every child. So I think one of the things that we do wrong in nutrition generally, but particularly in early childhood nutrition is. We make a lot of comparisons about behaviors and stages and speeds and ways of doing things, and there's lots of ways to get to the same endpoint, and each of us is a very unique, very wonderful individual, and that goes for our kids as well.
I'm a little bit interested in the gut brain, how it works together, and the impact that food has on mood. Could you explain a little bit more about that.
It's complicated.
All of those things that I was talking about before, in terms of the short chain fatty acids and the signaling molecules and the immune system itself are all going to have knock on effects to what goes on in the brain, because the hormones that affect the gut affect the brain. The hormones that affect the brain affect the gut much and so knowing the beginning point in these cycles is often quite difficult because if there's something going on in the brain that can have consequences for digestion
and absorption and gastrointestinal microbioda. But if there's things going on in any of those places as well, that will have knock on effects for the brain and mood and hunger and mental health and all of those things. So the complexity of those signaling molecules and the nerves that run from the gut to the brain and vice versa, the complexity of those is it's really hard to come up with definitive answers about do this get that result
or this one thing causes this other thing. And so I think it's important when we're looking at this evidence to take a step back and say, well, from a holistic point of view, based on the evidence, what are
the best decisions we can make? And that's where you come back to the evidence for nurturing that gastro intestinal tract and nurturing that gastro intestinal microbiome through adding the probiotics when necessary, but adding the probiotics so that they have something to eat and they can be nourished in the same way that our bodies are nourished.
So if we aim to do this in that first thousand days of life, we are setting our children up to try and optimize their health moving forward.
Is that a correct assumption.
Yeah, it's about laying the foundation. This is not a journey that ever ends. We do need to keep eating well throughout our lives to help reduce our risk of disease and to protect ourselves and to optimize those health and wellbeing outcomes. But if you think about it as you want to give your child the best jumping off point, because that means it's less effort later, it's less of a barrier to overcome, and so getting that program being supported early it's a no brainer. It doesn't mean if
you've missed that window, it's over. It means that if you can optimize that window, you improve chances and outcomes later and there's less work to catch back up.
So it is very important in the scheme of things.
The research is now showing those first thousand days after a bubba is born food wise is really important to try and set them up with as many probiotics and prebiotics to feed the probiotics.
Is that right? That would be a fair assumption.
Yeah, Like obviously there are entire societies and entire schools of research that are dedicated to this first thousand days. I don't think we want to be as overstated in saying as many as possible, because it's about having the right ratios and the right amounts. So it's not like you need to add a probiotic formula and then find
extra ways to gm probiotics into your children. The formulas are optimized to have the correct ratio, so if you start adding too many probiotics, then you're going to be displacing other things that you want to be getting in. So, like everything in nutrition, it's not more is better, it's
about having those right ratios. And the research around these probiotics in formulas, the most evidence is around the goss and the foss that we talked about earlier, and a nine to one ratio of those, and there's an optimal amount to be adding because we don't obviously want to be displacing the carbohydrates and the fats and all those other great things that are in formula that nourishes baby from a building blocks point of view, we don't want to displace those with probiotics.
After one of those shows on Netflix, and that was saying to get the best gut health and probiotics and probotics, you should be eating from this fast variety of food in a week and something like sixty different nuts, seeds, greens, reds. Anyway, I gave it a bit of a crack. I swear to god, I was flat out and doing twenty cost me a fortune.
It tasted like crap. I was like, I can't do this.
That's why I think, you know, the formula side of thing is fantastic, And if you can use a product that has that already scientifically proven amount and it's been added in the correct way into a formula, is a really great option. And don't do it like me where I lasted two weeks and my bank balance took a hit end I couldn't afford the brazil nuts anymore. It's crazy and I got sucked into trying that. Don't get me wrong, I get sucked into a lot of things.
But if I have a healthcare background and I thought it would be worthwhile trying twenty thirty forty fifty different fruits veggies, imagine how complex and confusing it must be for someone that doesn't have that health background. I mean, they must find it exceptionally confusing trying to work out what is best for their family for themselves.
And so this is hard.
When we hear things in the world about what we should eat and then trying to translate that in our brains about what are the best decisions for our children is quite difficult, So I think it's a couple of things. Is the recommendation for that variety comes from the fact that different things can act as prebiotics, and plants make these things as part of plants protecting themselves from stresses. So if we spread our variety, we get more types
of these things which could have functional benefits. But when that target feels impossible, then we can start feeling like we're failing and that this is too difficult, and that can cause us to go, well, let's not do this at all. And so I would definitely say those when we talk about variety targets, those are arbitrary numbers, they're
not rules. But then when we translate that into the data that we have for the infant formulas, the important thing to remember is in breast milk there is a whole bunch of naturally produced prebiotics that will be there. It probably isn't possible with the science yet to mimic that fully in the formula from a structural point of view, but what the research looks to do is to mimic that in a functional point of view.
And so when the goss and the foss.
When the galactoligosachrides and the fructologosachriides are added in that nine to one ratio. That's what we're getting as close to the functional benefits as we can with the science so far.
So it's not.
Necessarily about having all the things, it's about how do we get those functional benefits, possibly in a different way, because in nutrition there's always more than one pathway to the same outcome.
What if mum has a really poor diet and is breastfeed what happens.
Then The quality of breast milk depends on mum's diet, so that is really important. But also creating breast milk that is of quality is a priority in mum's body. And so if mom isn't looking after her diet, she could be sacrificing her health outcomes in later life, things like bone health, for example, for the health of her child now. So definitely, it's like on the planes when they say you need to put your mask on first
before helping infants. In children, you do need to be looking after yourself in parenting, not just when you're breastfeeding, but parents do need to be looking after themselves as well so that they can be looking after their children. And that's also about role modeling, Yeah, because we don't want kids to be growing up seeing that mum doesn't eat, or mum only eats once the kids are eaten and eats the leftovers off their plates, or those kinds of things.
That's not setting up good cycles of role modeling for children in the future.
And this is coming a little bit off baby topic, but it is something that I'm interested in as a lot of my clients have had gastric bypass surgery or the sleeve. Now I know this isn't your specialty, but in my mind, particularly gastric bypass where it bypasses the gut altogether, how much of the good pre and probiotics are actually work in the gart compared to the intestine.
Is that going to be a huge issue you think down the track.
So I think this is an example of it depends. Unfortunately, the answer is almost always it depends in nutrition. So when we have banding or bypass, we're skipping the top part of the gastro intestinal tract and we've still got the function in the lower part of the gastro intestinal tract.
So there's some studies that will show benefits for gut health post those kinds of interventions, and there's others that will show harms to gastrointestinal health that comes post those interventions, and that's probably down to what is the nutrition like and what is the care like post intervention, because like anything, just doing the intervention is one thing, and then it's how do we maintain and support the body in the best way post that.
If you have an.
Intervention like a gastric sleeve or a banding or bypass, and then you don't change your diet, you're probably not going to see any benefits to your gut health, and you might see harms to your gut health. But if you use that as a jumping off point to improve nourishment and keep adding prebiotics and keep adding probiotics and not doing the things that will damage gut bacteria, which is alcohol and junk food and smoking, then it's very
likely you'll see a beneficial effect. And so it will definitely be different outcomes for different situations, and again it's about getting the support to make sure that you can do the things that are going to optimize those outcomes.
With nurses doing shift work, you know, with the largest demographic workforce, with women in it, A lot of them are mums and working night like I did night duties. Sleep How important is sleep with nutrition?
Sleep's very important with nutrition.
So sleep is when your body is processing everything that you've eaten throughout the day into repair, development, maintenance in your body. And sleep is also going to impact hormones, it's going to impact gut function, and that's going to have a knock on effect for microbiome and all these other things that we have been talking about. So sleep
is definitely important. But that said, some people are in situations where they're sleep will be disrupted because of night shifts, because of crying baby, because of other care as responsibilities, and so knowing that that will have an impact and that we do want to optimize those outcomes through sleep where possible, But knowing that even in the context of poor sleep or disrupted sleep or shift work, you can
still make the best choices to support your health. So, knowing that people will have different pressures and different risks because of those sleep related challenges, we want to fix those challenges first if we can, but we still want to make the best decisions possible on top of that in that context, because like we said, right at the beginning.
Perfection is not a thing.
We're never all going to be in the situation where we're all getting the perfect amount of sleep and eating the perfect amount of things and living the perfect lives, And so what decisions can we make? And if you're not sleeping well, making those decisions can feel harder. So this isn't going to be a one size fits all approach. It's not going to be a if we all put in the same amount of effort, we all get the
same outcomes. This will be different for all of us, and we can walk those journeys with kindness for ourselves and kindness.
For each other. That is so true.
If you are a family member that has a child that doesn't sleep, how does that impact the child gut wise? If they're just like my son did not sleep for three years. We were flat out having him have an hour in one go. He was a nightmare and by the end of three years, I was a basket case. Decided not to have any more children. But what would have the impact been on him and his gut health? Because they never found out what was wrong. They thought it might have been silent reflux. He was in that
hospital fed with a tube. It was very complex and no one could ever give us an answer.
Even to this day.
He's funny with certain foods that could have had a huge impact on his gut health and his immunity. And is that a correct assumption, do you think, Emma.
So it's hard to say.
I don't think we've got the data on sleep and stress and those kinds of things in children. It's been studied well in adults, but obviously, for ethical reasons and practical reasons, that's a lot harder to study in children. I think one of the really important things to remember, and we've talked a lot about doing our best and optimizing and giving the best jumping off point, but the
human body is a very complex and robust organism. Even if we've missed a window, or even if we've had a window disrupted by ill health or by whatever else, that doesn't mean we need to beat ourselves up about
the fact that those things happen. And from each decision making point, we can just strive to make the best decision based on the best evidence in the circumstances we find ourselves in, even though from a scientific point of view, unpicking what that means, what the consequences are can feel important. It's important not to let those circumstances get in the way of making your next best decision in the next
decision making moment. I think that's what happens when it comes down to, you know, the breast is best conversation. We can't let that get in the way of making the next decision when that's not possible for whatever reason, whether it's work, whether it's biological function, whether it's adoption,
whatever it is. We can't let that history get in the way of decision making moving forward, because that's just being a slave to history rather than being optimistic and being prepared for the future.
I think we've come a long long way because when I was talking to my mum about this, I was not breastfed.
I was fed carnation milk. That's what they did.
And I'm don't tell anyone like fifty four ish.
But that's what they had.
Just didn't have other things, certainly not saying it was the best, but it was the best that they knew at that time, so they just did the best they could. And it was a bit frowned upon back then to breastfeed, and I don't know why it was probably how no one wanted to see breast.
It was rude. I don't know, and then.
It has evolved and evolved, and then when I had my kids, it was certainly breast is best. You do your best, and then when that doesn't happen, then you go down other pathways, which is still current. It's just that there's more current evidence around if you can't breastfeed, that there are some better choices in formulas, and it's just important to have that knowledge around what those decisions are.
So when I was reading the information around the prebiotics and the big names, and I had to look in the chemist and had to look at some of the tins and things like that, it was very interesting when I interviewed doctor Elizabeth and she said, there's little information out there for parents to look at how to actually
bottle feed appropriately. So like me, a lot of people are just going off the tin, Whereas now you have helped work on this website, this information line for people to have some really great evidence based information on how to feed a little one that might be doing mixed feeding might be bottled only due to whatever reason. And I think that is such a fantastic thing for healthcare professionals to be able to recommend.
It feels to me like this is way overdue.
And I think it comes down to sometimes in nutrition we're making decisions for survival, and that sounds like you're on the carnation milk. My mum was bottle fed as well. She was adopted at a very young age. She then managed to breastfeed. I think nine of the ten siblings that I have, the premes needed to be fed from a milk bank, but the rest of them she breastfed. And so sometimes we're making those decisions for survival, but sometimes we're in a position where we can make those
decisions for thriving. And I think that's where looking for the right formula and in this case specifically the ones that have the goss and the foss those prebiotics added, that's a decision for thriving that sets bub up for
fewer challenges in the rest of their life. And so, you know, whatever that jumping off point is, we can start making those decisions, hopefully in that thriving sense, and less of them in the survival sense as we move forward with that better science and with that less stigma that by not having those conversations around the choices. We are leaving it up to people to make their own decisions.
It's either perfect or figure it out yourself. And we can definitely do better in having those conversations in the middle ground and the other options as well.
Ground.
Isn't it supporting whatever your choice is and disseminating the correct information that is evidence based, that is researched, so that we can set those bubbies up for life to thrive and also set the parents up. There's nothing better as a parent than seeing your little one happy, smiling, thriving, eating, being fed and happy in that milk drunk sort of situation. It's one of the most beautiful moments as a parent
because you feel accomplished. And whether that be from breast milk or from a bottle, there is just nothing better to see a little baby so satisfied that they just pass out from being fed. But I just think that we as healthcare professionals really need to support the families
in our care and not be judgmental. Everyone is doing the best they can and sometimes they don't know what's better, and maybe we in a very kind and considerate way to seminate that information or point them in the right direction, where really smart people like doctor Emma have worked really hard with research to work out what is best for
bubbs in the first thousand days. Why wouldn't we just jump on that and share that information and go to that website and tell our colleagues about it, and tell our midwives about it and just support each other. I think that's the best thing we can do as healthcare practitioners, because, oh my god, it is tough out there.
I think that is a really beautiful way of putting it, because yes, there's science for this, but there's also all the stressful and negative emotions that can be attached to this as well. So being able to balance the science and the society and the parent and bob needs, I think is a really powerful and empowering space to be and so glad to have been a small part of it.
Thank you so much, doctor Emma. I am in awe of your skill set and your skin.
I swear to God.
If that's pre and probiotics, I'm getting onto them. Doctor Emma has the most amazing skin, and as you guys know, dermatology is my specialty, so I've been sitting and.
Looking at it in all it is flawless.
So if ever there is a really great reason to have a good diet and pre and probiotics, just have a look at your skin.
Amazing skin is a great way to get people interested in nutrition because it's very hard to imagine cardiovascular disease outcomes and bone outcomes in your eighties. But you can see your skin as well, and what you see on the outside is often a reflection of what's going on on the inside.
Well, your skin looks remarkable. Thank you so much for taking the time to chat. It's such a huge topic. Like it's a huge topic and very on point at the moment because people really are wanting to do the best for their loved ones. So thank you so much for the research you do, for the work you do, and also for working so hard on getting an amazing website for families and healthcare professionals. I can't wait to share it, so thank you, Thank.
You so much.
I've thoroughly enjoyed the conversation, and all the best conversations meander you don't know where they're going to go. Well, I will say lots of other people have worked on this research, in this website, these resources, not just me so shout out to the entire team who have brought this information together so that it can be practical.
Thank you guys all so much, and thank you Doctor Emma. Thank you.
This season, I am so excited to announce that the podcast is being supported by Nutritia, which is a global leader in medical nutrition. They understand the needs of nurses in the nutrition space and for over one hundred and twenty five years have provided products to support child health. Some of Nutritiona's pediatric brands include Neo Kate Junior for children who have food allergies, and app to Grow for
those fussy eaters. And those of us who have children know many kids who go through the phases of definite fussiness. For more information and resources, visit the NUTRITIONA Pediatrics hub at nutritia dot com dot au forward slash pediatrics. I just want to say a huge thank you to Nutritia. Their desire to support nurses is truly appreciated, and they are allowing me to continue this podcast so that we can all grow as nurses.