Should I give my baby probiotics?
The gut microbiome supports good health, and if the healthy colonies of the millions and trillions of bacteria that live in our gut are disrupted, research suggests that this can lead to greater chances of developing diseases such as diabetes, allergies and asthma, irritable bowel syndrome, and some cancers.
This risk is even greater if this disruption or dysbiosis occurs early on in life. Dysbiosis in the gut means when the balance of bacteria is out of balance with the 'bad' bacteria dominating. In fact, establishment of a ‘healthy’ relationship of gut bacteria early in life appears to be extremely important for maintaining a healthy gut ecosystem of bacteria going forward. So it makes sense to colonise babies' guts with healthy bacteria to lower their life long risk.
Breast-fed babies obtain 30% of their healthy gut bacteria directly from their mother's milk and 10% from the skin on the mother's breast. This boost of healthy gut bacteria from breast milk continues even after solid food has started, as long as breast milk continues. A great start for baby's gut health.
A common practice for adults is to directly take probiotics to build up a healthy gut microbiome. How effective is this? Studies have found that the benefits of this are often fleeting which means that unless you keep taking the probiotic, it is not really effective as no lasting changes to the gut bacteria balance occurs.
A small but interesting recent study has shown that breast fed babies who received a very short course of a probiotic still had colonies of those beneficial gut microbes 30 days after the end of 3-week probiotic treatment.
This is significant, as this shows lasting change once the probiotics had been ceased, with beneficial bacteria not only thriving, but dominating. The probiotic chosen (B infantis) was a strain known to pair up well with natural sugars in breast milk, which may have promoted the good results. However, it is not known if these changes would be maintained once breast feeding is ceased.
So while we continue to keep an eye on the fast emerging world of gut biomes and health, what is the current evidence for supplementing babies with probiotics (either indirectly through the maternal diet or directly) to help combat food sensitivities?
In terms of evidence, taking probiotics has only been linked with reducing eczema, and the supporting evidence for this is weak. Other studies give mixed messages but the take home message is that probiotics might be useful for babies who are food sensitive with symptoms such as colic, reflux and constipation, but further research is needed to delve into this properly. It has been established that probiotics are safe and well tolerated in normal healthy infants and children.
If you decide to take a supplement- just check that there are no other ingredients (called excipients) that may be an issue, such as dairy, soy, wheat or ingredients high in natural chemicals such as herbs or stevia (if avoiding these). This is even more important if giving the supplement directly to your baby. I find that the companies are very helpful if you e-mail a question asking what extra ingredients or excipients are added to the probiotic. Once you are satisfied that the probiotic is free from problem ingredients, then it is a matter of trialling the probiotic and seeing how it works for you and your baby. If it does not seem to help then a different probiotic could be trialled.
Note that probiotics contain amines as a result of the fermentation process so not recommended during the elimination phase of the Royal Prince Alfred (RPAH) elimination diet which reduces salicylates, amines, glutamates and food additives in your food and environment. This diet is also called the FAILSAFE diet (strict level of the RPAH diet). The probiotics can be used introduced in the challenge phase to test out if your baby can tolerate the probiotic without triggering amine symptoms.
For those who feel probiotics have helped their food sensitive baby- the accepted wisdom is to start with very, very small amounts of the probiotic (if been given directly), for example 1/8 of the suggested dose and very, very slowly build up to the recommended baby dose. As discussed above, there is a lack of scientific evidence to support the provision of probiotics to babies, and of course this means there is a lack of science to guide choice of any particular strain or strains of probiotics for maximal effect.
We are only at the beginning of the gut microbiome journey- one can only guess what will be uncovered in the next 5 years! REFERENCES
Pia S. Pannaraj, Fan Li, Chiara Cerini, Jeffrey M. Bender, Shangxin Yang, Adrienne Rollie, Helty Adisetiyo, Sara Zabih, Pamela J. Lincez, Kyle Bittinger, Aubrey Bailey, Frederic D. Bushman, John W. Sleasman, Grace M. Aldrovandi. Association Between Breast Milk Bacterial Communities and Establishment and Development of the Infant Gut Microbiome. JAMA Pediatrics, 2017; DOI: 10.1001/jamapediatrics.2017.0378
Steven A. Frese, Andra A. Hutton, Lindsey N. Contreras, Claire A. Shaw, Michelle C. Palumbo, Giorgio Casaburi, Gege Xu, Jasmine C. C. Davis, Carlito B. Lebrilla, Bethany M. Henrick, Samara L. Freeman, Daniela Barile, J. Bruce German, David A. Mills, Jennifer T. Smilowitz, Mark A. Underwood. Persistence of Supplemented Bifidobacterium longum subsp. infantis EVC001 in Breastfed Infants. mSphere, 2017; 2 (6): e00501-17 DOI: 10.1128/mSphere.00501-17
Joy Anderson, food-sensitive babies, 2016, Specialist Dietetics and Lactation Service