A baby’s immune system develops rapidly in the first 1,000 days of life, with the first six months and year being most important. In The Baby and the Biome, Meenal Lele, medical researcher and founder of Lil Mixins, the #1 pediatrician-recommended allergy-prevention product , explains how diet, environmental toxins, antibiotics, and even common parenting practices can damage the delicate balance of our children’s microbiomes, thereby increasing the risk for a host of immune diseases, including eczema, asthma, food allergies, IBS, and more.
Lele discovered firsthand how critical our microbiomes are to our overall health when she sought to understand the root causes for her son’s food allergies. Drawing on her medical background and through extensive research and interviews with scientists and doctors, Lele discovered the simple, practical steps that all parents and pregnant moms can take to help foster a healthy and protective microbiome in their baby. The Baby and the Biome will empower parents to protect and safeguard their children’s health for years to come.
|Publisher:||Penguin Publishing Group|
|Product dimensions:||5.60(w) x 8.30(h) x 1.20(d)|
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The Rise of Immune Diseases
Common Misconception: Food allergies are genetic.
Many people assume that food allergies are entirely hereditary, and that if there's no incidence of a food allergy anywhere in the family tree, a child will be fine. I used to believe this, too, and that's why I was floored when my son developed allergies that no one else on either side of the family had. The fact is that while some of the risk for food allergies does lie in a child's genetics, it's not like some babies have an allergy gene. The real risk of developing food allergies rests in the food children eat, the medicines they take, the pathogens and environmental factors they face, and more. By protecting against these things, a parent can protect their child's immune system from breaking down and triggering a massive allergic response.
When Scott and I took Leo home from the hospital after his asthma attack, we unpacked our bags with even more prescriptions than we'd had before. There were so many medicines that we couldn't find a drawer big enough to hold them, and we spread them out on his old changing table like a bootleg pharmacy.
Leo now had a daily antihistamine to prevent itching and skin flares and three different topical steroids to treat the flares that happened no matter what preventative measures we took. He had a daily inhaler to prevent asthma attacks and a rescue inhaler in case he had an attack anyway. These medications were on top of the special soaps, detergents, and emollients we already used. He was on a strict avoidance diet to prevent him from having an allergic reaction, but we also had three sets of EpiPens in case he accidentally ate one of those foods and had an allergic reaction anyway.
Have you noticed a pattern of futility yet?
I am not one to suffer-or parent-in silence, so as we settled into our new "normal," I began opening up to friends and family about the pain of watching my child hurt and my fears about his future. When I started talking with others, I thought I was the only one dealing with a sick kid, but I quickly discovered I was wrong. As Dr. Julia Getzelman, a pediatrician and functional medicine practitioner in San Francisco, said to me, "Today, doctors and parents spend a lot of time dealing with chronic noninfectious illnesses such as food allergy, eczema, asthma, autoimmunity, inflammatory bowel disease, celiac, and more. All of these conditions-many of which used to only plague adults-are now being considered normal in the pediatric population."
Every teacher I talked to saw multiple cases of one or the other in each class, and every pediatrician I encountered said each week they treated at least ten or twenty patients with these conditions. The more I looked, the more widespread immune diseases seemed to be, even among people I thought of as healthy.
What was going on?
What Are Allergic and Autoimmune Diseases?
The first thing you should know is that all allergic diseases (like the food allergies and eczema Leo suffers from) are actually immune diseases. Not all immune diseases are allergic diseases, though. For example, Type 1 diabetes, rheumatoid arthritis, and lupus do not develop because of allergic reactions. Some immune diseases are classified as autoimmune diseases and are distinct from allergic diseases for reasons I will describe below. Finally, all immune diseases-both allergic and autoimmune-are sometimes called self-diseases because they involve a normal body system going haywire.
Each immune disease affects a different part of the body: eczema happens in the skin, asthma in the lungs, celiac in the colon, food allergies in the gut, type 1 diabetes in the pancreas, and rheumatoid arthritis in the joints. While it is possible to have many immune diseases at once (like seemingly everyone I talked to), each condition is triggered by a different combination of genetics, environmental factors, or even viruses. But at its core, every manifestation of an immune disease is the same: the immune system malfunctions, goes rogue, and attacks something it shouldn't.
I've used the term flare casually in my descriptions of Leo's illnesses, but the term deserves more explanation. A flare is a sudden intense onset of the symptoms of any immune disease brought on by a trigger. In the case of inflammatory bowel disease (IBD), a flare can mean intense cramping or diarrhea from eating spicy foods, drinking alcohol, or having too much sugar (all of which can be triggers). For Hashimoto's thyroiditis or lupus, it can mean fatigue or aches and pains caused by everything from gluten to stress to certain kinds of drugs. For asthma, it means significant difficulty breathing after a person is exposed to environmental allergens or, in Leo's case, a cold virus. These immune responses may come in waves, with days or weeks of flare-ups, and a person may have long periods of remission with no symptoms.
If the immune system attacks internal proteins or cells of the body that it should really leave alone, it's classified as an autoimmune disease. In the case of type 1 diabetes, the immune system goes after the beta cells that produce insulin. As the beta cells are killed off, the pancreas is destroyed, and the body is no longer able to produce insulin. Crohn's disease, ulcerative colitis, and IBD are all caused by a perpetual attack on the cells that make up the intestinal lining. This chronic inflammation of the digestive tract eventually destroys the intestines or colon.
Allergic diseases happen when the immune system attacks an external protein like pollen, food, or mold (antigens) that it should also ignore. The damage to the body is a side effect of an attack on the antigen, rather than from a direct attack on a healthy tissue. However, the immune response that occurs in an allergic response sometimes causes symptoms very similar to those we see in autoimmune diseases. Over time, if people experience a persistent allergic response like uncontrolled eczema, it can eventually destroy their tissue. All in all, the self-diseases we call immune disease are dangerous and, far too often, deadly.
Immune diseases can be hard for some people to wrap their brains around, so I find it helpful to think of them in terms of other, more tangible or familiar diseases. Think of the coronavirus that causes COVID-19. A person does not go to the hospital, get strapped to a ventilator, or die specifically because they contract this particular type of coronavirus or one of its many mutants. A person suffers through the immune response to the coronavirus, which may include shortness of breath, loss of taste and smell, fatigue, and unfortunately, sometimes organ failure leading to death. This cluster of immune responses is the disease called COVID-19.
Similarly, you are already familiar with another group of self-diseases: cancer. Consider three common cancers: breast, cervical, and lung. Breast cancer is triggered by genetics, cervical cancer by a virus (HPV), and lung cancer by pollutants that you breathe. In cancers, both internal (genes) and external (viruses or pollutants) root causes can make the normal body process of cell replication go haywire. In each cancer, cells replicate in a tissue incorrectly, and this malignant growth eventually harms an organ, causes sickness, or leads to death.
Cancer can sometimes be stopped by removing the root cause of the particular case (for example, think of quitting smoking), but often the disease is relentless and won't end without treatment. Luckily, allergic diseases can usually be stopped by removing the triggers. For example, if you're allergic to peanuts, you can avoid eating peanut butter. In autoimmune diseases, however, it can be impossible to remove the cell or protein the immune system is attacking, and without proper treatment, the disease may become relentless. As happens with cancer, the symptoms of allergic and autoimmune diseases may come and go despite your best efforts to manage them, and the true damage can be hard to see.
Because this book is about the emerging research on the conditions that my son has, most of what I discuss focuses on allergic disease. I will sometimes talk about allergic disease and sometimes about allergic and autoimmune disease when both apply. Just remember that all of them are diseases resulting from the malfunction of the immune system or, as I call them, immune diseases.
Finally, there is a huge overlap between the people who suffer from allergic disease and those who have autoimmune diseases. For example, children with type 1 diabetes are more likely to have asthma. Since these diseases often go hand in hand, I find it easiest to refer to them under a blanket term: immune disease.
Now let's try to make sense of this all.
The Immune System
To get this whole story across, we have to start at the top. The immune system is a mind-blowingly complex and effective system designed to keep you alive and your body healthy. As we go about our days, we are exposed to millions of different viruses, bacteria, molds, chemicals, heavy metals, and more from the air, surfaces, and food. All of these things can hurt us, and your immune system is always working to sort out the helpful stuff from the dangerous stuff, then clear the bad guys out-all without your noticing a thing.
You are born with part of your immune systemyour innate immunity. This includes your barrier organs like the skin, gut, and lungs, and the cells that fight off bad stuff. Think of innate immunity as the infrastructure in an airport that keeps us safe: the security scanner, the police on Segways, and the computers that keep data on everyone going through the check-in counter and boarding gates. Adaptive or acquired immunity, on the other hand, develops as you go through the world and interact with things. This consists of the antibodies and other cells your body develops to become more efficient at recognizing threats and dealing with them.
A good analogy for the immune system is the brain. Babies are born with almost all the neurons they will ever have. These neurons are the intelligence infrastructure. But over time, these neurons shape and connect to one another to adapt to the world you encounter. The connections in your neurons create knowledge and memory, making your brain more efficient, too.
As I mentioned in the introduction, a child's immune development is timebound. In the first thousand days of their life-roughly three years, from newborn to toddlerhood-a child doubles, then triples, in size and learns to walk, talk, and socialize. While innate immunity is set from birth, the foundation for their adaptive immunity is formed during those first thousand days, with the first six months to a year being more critical and impactful than the second two years.
The outside influences a baby experiences play a critical role in how the immune system develops. Just as physical or emotional trauma in infancy can lead a brain to develop in unhelpful ways, environmental exposures in infancy can cause a person's immune system to develop in disease-prone ways as well.
The Barrier Organs of the Immune System
The skin, gastrointestinal tract, and lungs are the largest immunologic organs in the body. All have an incredible amount of surface area that is constantly exposed to the outside environment, and they face the most common antigens-pollens, dander, dust, and foods-through the air, via contact with the skin, or through food when eating. Ideally, this large surface area should act as a stable barrier against pathogens.
As food, water, and anything else passes through the long unbroken tube that extends from the opening of your mouth through to your stomach and the intestines and eventually to your anus, some things are selectively allowed to cross the barrier and enter your body. The rest is flushed out. When you walk outside and face pollution, pathogens, and other environmental factors, your skin also acts like a barricade, allowing some things in and blocking others. Your lungs are not a tube, but a balloon, with your mouth and nose representing the open end. As with food, air is allowed into the balloon. Your body selectively allows oxygen into your bloodstream and then pushes everything else back out when you exhale.
Together, your skin, your gastrointestinal tract, and your lungs make up the barrier that protects you from the outside world. These barriers are also called your epithelium, and the cells of all the barriers are called epithelial cells. The skin is made of multiple layers of epithelial cells and is covered in proteins like ceramides. The gut barrier has a thick mucus that coats the epithelial cells and protects them from the acidic environment. The lungs are covered with a mucus as well-something you most often notice when you have a chest cold.
Different parts of the epithelial barrier contain their own mechanisms for immune defenses, in fact. For example, the intestines can distinguish between foreign pathogens and safe nutrient proteins. The esophagus and mouth each have their own systems that are attuned to proteins and bacteria, respectively, and the skin's defense mechanism is sensitive to parasites and chemicals. Finally, the lungs' immune system is particularly attentive to particles of different sizes.
If your epithelial barrier is dysfunctional or broken, however, outside things will get inside when they shouldn't. Your immune system is designed to react and continue to react until the invader is gone. And in general, your immune system is biased toward overreacting because the consequences of underreacting can be really, really bad. In the next section I'll try to explain how the immune cells react when things break or sneak through the barrier.
Table of Contents
Overview of My Son's Immune Disease Development xiii
Chapter 1 The Rise of Immune Diseases 1
Chapter 2 Meet Your Real Baby 20
Chapter 3 Antibiotics Change Everything 43
Chapter 4 Baby Care the First Six Months 66
Chapter 5 The Importance of a Good Diet 104
Chapter 6 The Impact of the Environment 135
Chapter 7 Nurturing Your Baby's Biome During Pregnancy 154
Chapter 8 Biome Care at Birth 179
Afterword: When Your Allergic Child Goes to School, Parties, or Playdates 205