PHOTOGRAPH BY RON HAVIV, VII
Published June 4, 2014
Doctors have learned how to stop malnutrition from killing small children, but they've been unable to figure out why these children remain at a disadvantage even after they're well fed. A new study suggests the answer may lie in gut bugs.
Infants and toddlers who are malnourished have an immature ecosystem of microbial organisms in their digestive tracts, according to new research published in this week's Nature. The current treatment for malnourishment doesn't help the child's system catch up to normal maturity, which may explain why formerly malnourished children still suffer from short height, immune problems, and intellectual delays, said Jeffrey I. Gordon, who studies the gut microbiome at Washington University in St. Louis and who led the research.
"There's something lacking in our current approach to treatment," said Gordon, who suspects the children may need to eat therapeutic foods for longer and/or get supplements of probiotics, or beneficial microorganisms, to catch up. "We need to think of food as interacting with this microbial organ." (See our Future of Food series.)
The study also outlined a method for determining the maturity of a child's gut bugs, which could be used in other health-related contexts.
Gordon said he is currently comparing the ecosystems from the healthy Bangladeshi children cited in this study with the gut bug populations of healthy infants and toddlers in Malawi, South Africa, India, Peru, and the United States. Early indications suggest there are common patterns of development around the world, he said.
A child's gut bugs, immune system, and brain appear to develop simultaneously, Gordon said. Once researchers know what normal, healthy gut bug populations are supposed to look like as a child develops, they can better understand—and treat—what goes wrong in conditions like malnutrition, and maybe even autism, he said.
"We as humans, when we're developing after birth, there's a microbial dimension to this development that we should monitor, and measure," Gordon said. "Perhaps healthy growth and attainment of our full potential requires healthy development of our [gut] microbial organ, and also microbes living in other parts of our bodies." (Related: "What Lives in Your Gut?")
Babies are born without any microbes in their digestive tract. The microbes that colonize the body over the next two years likely affect the child's health throughout its life.
"The microbes we acquire early in life are very important," said Martin Blaser, a professor of medicine and microbiology at the NYU Langone Medical Center and author of a book about this early development called Missing Microbes. "We really have to understand the dynamics of how the microbiome develops in young children."
Blaser praised the new paper for its insights into malnutrition and benchmarks for normal development.
"This provides more evidence that the early life microbiota is vulnerable," he said.
To conduct the new study, Gordon and his team collected monthly fecal samples from 50 healthy Bangladeshi children for the first two years of their lives. From those children, they found that a combination of 24 species could be used to predict the maturity of a child's microbial ecosystem.
When these healthy children had diarrhea, their microbial systems regressed but quickly bounced back, the research showed.
The researchers then examined fecal samples from 64 infants and toddlers hospitalized for malnutrition and diarrhea. The children received antibiotics and therapeutic foods for a week or two and then their families were taught how to better support their nutrition.
But these children, who had an immature balance of microbes to begin with, only got a little maturity bounce at the beginning, then remained far behind their peers, Gordon said.
"Food alone wasn't able to repair the maturity," he said.
How much of the delayed maturity in the microbiome of the malnourished was due to the antibiotics they were given? Is that effect only temporary or could it be long term?
Food does and can help. You have to know how foods heal. Plant-based high fiber foods will help boost the good bacteria. Antibiotics destroy the good bacteria, setting the person's health back even further. For diarrhea, use high fiber and good quality yogurt with minimal sugar. Sugar feeds the bad bacteria and perpetuates the gut imbalance. and yes, babies are not born sterile. Newborns have bacteria, they've been exposed to bacteria. The gut and the immune system are immature at birth. With breast milk, exposure to further bacteria, both the gut micro biome and the immune system mature. The real problem is when mothers don't breastfeed. Nothing can build the immune system and the gut like breast milk.
This could have great implications for the many organizations and individuals fighting to improve global health. Something that seems so simple can make a world of difference to the millions that suffer from malnutrition.
"Babies are born without any microbes in their digestive tract. The microbes that colonize the body over the next two years likely affect the child's health throughout its life."
Placenta not sterile as previously thought, influencing gut bacteria in neonates:
Oh, I have long suspected this. My brother and I were in concentration camp when we from birth (him) , age 2.5 for me for 3.5 years. We were malnourished but survived. He is very short, I am short, Immune problems (me), difficult tooth problems (me), and I do remember "waking up" intellectually in my later teens. Very great learning problems as a young child (me). After waking up and becoming conscious I seemed able to learn prodigious amounts of material in very short times and remember it extremely well. What would I be if I hadn't wakened up? Still unconscious and living in vast confusion. I remember the confusion well and my knowing other people didn't seem to have it.
@Deana Bossio A lot of folks living in these regions have limited access to limited foods. Yogurt, for example is not available (outside the grocers catering to ex-pats in the capital) in Sierra Leone, where childhood malnutrition is significant.
I was sorry to see no mention in the article of the importance of exclusive breastfeeding, which reduces infections and improves the gut flora.
@Gwendolyn Mugliston What an interesting story!
It's all hands (and paws) on deck when it comes to the poaching crisis in Africa.
In this new series, writers and photographers from around the world reflect on places that hold special meaning for them.
For Sebastián García Iglesias, the ghosts of his ancestors are stitched to the tapestry of the land they pioneered.
The Future of Food
Food. It's driven nearly everything we've ever done as a species, and yet it's one of the most overlooked aspects of human history.
We've made our magazine's best stories about the future of food available in a free iPad app.