411 | Nutrition from Conception to 2 Years of Newborn Babies with Dr. Fede Amati

[00:00:05] Welcome to the Optimal Body Podcast. I'm Dr. Jen and I'm Dr. Dom and we are doctors of physical therapy bringing you the body tips and physical therapy pearls of wisdom to help you begin to understand your body, relieve your pains and restrictions and answer your questions. Along with expert guests, our goal of the Optimal Body Podcast is really to help you discover what optimal means within your own body. Let's dive in.

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[00:02:45] We are so honored to welcome back Dr. Federica Amati. We absolutely loved her first conversation, which if you didn't listen to that one, that was episode 395, where we talked about nutrition across a woman's lifespan. And now we're going to talk about the first thousand days of a baby's life, which actually starts at conception and then goes until about two years. So this is such a fascinating conversation. She's a wealth of knowledge. Dr. Federica Amati works as a head nutritionist for science,

[00:03:13] nutrition company called Zoe, and holds a PhD in clinical medicine research from Imperial College London, has a master's in public health, and is an association for nutrition accredited nutritionist. She is the nutrition topic lead at Imperial College London School of Medicine, and has led research teams for NIHR, ARC, and the WHO Collaborating Center. Alongside her research in nutrition, Federica has written two books, Recipes for Better Menopause,

[00:03:43] and Everybody Should Know This, which was released in the UK, but I believe it's also available in the US as well. So let's get into this incredible interview. Dr. Fetty, thank you so much for being back with us. We absolutely loved our conversation so much the first time around. We were so excited to get you back and be able to pick your brain, especially when we're recording this.

[00:04:07] We're coming into the perfect time, baby coming and understanding better nutrition for baby. But we know it starts before that. So we want to talk about, you know, what it means to understand the first thousand days from you and what exact when that starts and what that is. Amazing. Well, thank you for having me back. It's so nice to see you both again. I had lots of fun last time, so I'm excited to have more fun this time.

[00:04:36] So when we talk about, I'm passionate about the subject because there's so much opportunity with every pregnancy, essentially, and every child to help shape their future health. So I want to sort of start this by saying that what we'll talk about today is not like the be all and end all. So when I talk about the first thousand days, people often say, oh my gosh, what can I do though? Like my child is now seven and we're out of this window. It's okay. Like, don't worry. You missed it. Yeah.

[00:05:06] It's a lost cause. Lost cause. Or even, you know, for some people it's like thinking about themselves when they were tiny or thinking about how their mothers went through pregnancy. Oh my God, I'm doomed. Okay. So just to, you know, say at the start that this is not about definitives. Science doesn't really work like that. There's very few times where like a single gene or a single output or a single exposure is actually going to result in definitely something. Right. I just want to say that at the top.

[00:05:37] Now, being that this is a podcast about prenatal and postpartum nutrition, I want to talk about Needed, which is what Jen and I were taking all the way from preconception through now in the postpartum period. Needed has absolutely helped Jen keep her nutrition levels optimal throughout the entire pregnancy, birth, and postpartum phase. Needed offers products that are formulated by experts in women health and recommended by over 6,000 practitioners.

[00:06:07] Needed also formulated their supplements by testing thousands of women to truly understand the optimal amount to make sure everyone is getting what is truly needed to thrive, not just survive. You also won't find unnecessary fillers, poor nutrient forms, unsustainably sourced ingredients, high heavy metal loads, and nutrients that are better taken separately like omega-3 and iron.

[00:06:29] Needed truly offers what is needed in the body to make sure you have the optimal levels of nutrition regardless of what phase of life you're in. Head over to thisisneeded.com and use code optimal to get 20% off your first order. That's T-H-I-S-I-S-N-E-E-D-E-D.com and use code optimal for 20% off your first order. They truly have something for everyone. Let's get back into the interview.

[00:06:56] However, this is a really important window of opportunity. So when we think about the life course, which is essentially how your life is going to pan out from birth, there's a few windows. I call them windows of opportunity where we can make quite a big difference to future health by sort of intervening at that point. And the windows of opportunity approach really starts with the first 1,000 days. And in the literature, in research, we call this the golden window of opportunity.

[00:07:25] Because it's when, and I'll say this and it'll seem obvious, but just think about it. It's when all of our tissues, all of our organs, all of the cellular structures that will continue being our body are actually made. So it's when the entire blueprint and first build of the body that we're going to call our body for the rest of our lives is set. So this is why it's called that. And it starts, day zero is technically conception day. So when were you conceived?

[00:07:55] And day 1,000 is your second birthday. So of course, some people will be listening to this and say, well, my child was born early. But it's like a rough guide. And these first 1,000 days are also what underpins a science which is called DOHAD, so Developmental Origins of Health and Disease.

[00:08:12] And the DOHAD hypothesis essentially centers around the idea that these early life exposures have an impact on the way our bodies respond to our environment that stays with us for the rest of our lives. So this includes foods, but it also includes environmental exposures, things like stress, how you were born, so lots of different things.

[00:08:38] So we'll focus on the first 1,000 days and how nutrition plays a part because that's where I've sort of specialized in. And it's really this, I want to start by taking a little bit of a cheat and talking about the 30 days preconception.

[00:08:53] Because actually, when we think about the first 1,000 days, the quality of the egg or the sperm that goes to make the eventual baby are really kind of impacted by their exposures in the 30 days prior to ovulation, 30 days prior to ejaculation. That's a rough guide, but for most people, it's around that time. And it's not 30 days, sorry, 90 days, so three months. So it's 90 days prior to ovulation, 90 days prior to ejaculation.

[00:09:23] You have this period of time where what you eat, whether you're smoking or drinking alcohol, whether you're taking recreational drugs, whether you're really stressed, whether you're sleeping enough, whether you've taken certain medications, all has an impact. And now in sperm, it's slightly different in that new sperm are literally created from the germ cell in 90 days. So it's a real fresh opportunity in that 90 days to impact it from the very beginning.

[00:09:51] In females, of course, we are born with all of our eggs. So actually, they've already been exposed to whatever your lifestyle has been up to the point of maturation. And then the 90 days where they get selected and matured and eventually folliculized and released is just an additional benefit. I say that because I don't think that male partners often realize just how much power that 90 days can have on like all of the sperm quality.

[00:10:22] So just worth pointing that out. And it does take two to tango. So if a couple is thinking about conceiving, it's really crucial that both partners engage in like changing their lifestyle in those 90 days. Now, if you go to a sperm bank, there's more checks, actually. So it tends to be better quality sperm. So you've done a bit of the work there. Now, when we think about what do we need to do in those first thousand days, it's like really think about this as what building blocks do you want to put in?

[00:10:53] Considering the fact that that initial conception is going to trigger a series of events. Which will help not only to build the baby, but also to build the placenta that's going to hold the baby throughout the pregnancy. And why it's so important to think about this is because oftentimes women's dietary habits really change in pregnancy. Most often not by choice.

[00:11:19] So we have to consider like morning sickness, which is actually all day sickness, as we all know. Sometimes hyperemesis gravidarum, which is a very severe form of morning sickness where you can't even keep water down. And taste preferences change as well. And there is a bit of confusion out there about what pregnant women should even eat. So should they be eating for two? Should they not be eating for two? Should they have allergens in their diet? Should they be avoiding allergens in their diet? Should they cut things out?

[00:11:46] There's a lot of myths around what's safe, not safe, and what can help you have an easier birth, which need to be debunked. And I think it's especially rude to predate on pregnant women. Like, you know, that is not where if you have some ethics, that is not where you go to sell your fad thing. Yeah. You're really impacting two generations, right? So when we think about like first thousand days, think about the building blocks. That includes things like where are you getting your protein from?

[00:12:16] Is it high quality? Is it a plant protein? Are you building a really healthy placenta, which is going to be very vascular and providing all the blood flow that you need? So iron status in women is a real problem. Quite a lot of women in the U.S., between 40 and 50 percent is the kind of estimate, are probably low in iron, not necessarily iron deficient or anemic, but certainly not optimal level. And iron is really important for fertility.

[00:12:42] And it's really important for making sure that the placenta has enough oxygenated blood and has a good success rate with feeding your baby. So that's something to really think about. Thinking about the quality of your diet is more important than the quantity. So apart from the final trimester, so the last three months of pregnancy, there isn't really a huge increased need for energy.

[00:13:07] In that final trimester, there is, but it's barely minimal in terms of like additional food. It's maybe an extra snack a day. It's not like you need to eat enormous portions. But the quality of food is really important. So when we look at the dietary patterns that impact the health of the baby, there's like some really clear trends. So one of the things that is most damaging, and there was a study published just a couple of weeks ago. I don't know if you saw it from the UK Biobank where they looked at.

[00:13:37] So there was a natural experiment in the UK during rationing in the war where essentially some pregnant mothers had no access to sugar for a while. So there was no added sugar in the diet whatsoever. And they looked at like how that impacted the child, the offspring's risk of hypertension, type 2 diabetes. And guess what? Those people who had no access to sugar in their mother's womb had reduced risk of hypertension and of type 2 diabetes.

[00:14:05] So there is this really important note here to say that added sugars in our diet. And I want to be clear that it's added sugars. So I'm not talking about the sugar in your banana. I'm really talking about sodas and ice creams and biscuits and pastries. Those added sugars have a detrimental impact. Do you like how I'm holding my daughter's scrunchie, by the way? They have a detrimental impact on the metabolic health of that person's future.

[00:14:35] So if there's one thing that we know women should be more mindful of, and I say this because in the US, there's about 17 teaspoons of added sugar per day in an adult diet. So it's everywhere. It's in the sauces. It's in the dressings. It's not just the sugar you see in your sugar holder. Cookies or anything. It's food, right? Yeah. So being really mindful of that.

[00:15:05] There's never really a good reason to drink soda. And there's even less of a reason to drink soda in pregnancy. So if that's something that's part of your life, just really trying to take that out is important. And I would actually urge to just cut out the diet soda as well. So even though that doesn't have the added sugar, we don't think it's going to be beneficial. So that's a simple one-ish, like when we think about all the different things.

[00:15:31] And then really looking to make sure that the foods you're eating have high nutrient density. So partly this will address the iron status as well, because a lot of highly nutritious foods, like lentils, like nuts and seeds, like eggs. I like salmon. So like oily fish, they contain iron as well. Shellfish. So those are really excellent to have as part of your diet. And making sure that your majority of the diet, like the food that you're eating every day,

[00:16:02] comes from high quality whole foods. So the current diet in the US is upwards of 60% of energy comes from ultra-processed foods. And the evidence we do have, the epidemiological evidence we have that looks at ultra-processed food consumption in pregnancy shows that the higher your consumption of ultra-processed foods in pregnancy, the worse the outcomes are for the children and the mother.

[00:16:28] Let's not forget that whilst we're feeding the child, we're also feeding the mother. And pregnancy is a highly challenging metabolic state. We become more insulin resistant to help make sure there's enough sugar getting to the baby. And it's really important to reduce the risk of gestational diabetes and reduce the risk of hypertension in pregnancy, which is called, oh my God. Proeclampsia. Proeclampsia, yeah.

[00:16:57] This always happens to me with proeclampsia. So called proeclampsia, we need to reduce the risk of both. They can both be, well, proeclampsia especially can be life-threatening. And type 2 diabetes is one of the main contributors to complications in birth. So large, very large babies, macrosomic babies they're called, are much more likely to be born of a woman who has gestational diabetes.

[00:17:23] And it really speaks back to this excessive amount of sugar in the diet or in the blood, that then actually ends up being in the amniotic fluid as well. It causes this growth of the baby that is too big for a natural birth, vaginal delivery. So those are just some of the considerations when we think about what we're eating in pregnancy. Now, a lot of the same considerations are applied to eating for healthy sperm.

[00:17:52] So going back to like, how can we make sure a nutrient-dense diet? We do know that the BMI of the father is very closely related to health outcomes. And what's interesting is maternal BMI and paternal BMI have different effects. So a higher maternal BMI is associated with worse outcomes in terms of metabolic health for the baby. So increased risk of diabetes, type 2 diabetes and of obesity in childhood.

[00:18:20] But actually, when we look at paternal BMI, higher BMI in fathers is associated with neurocognitive issues and mental health. So for example, having higher paternal BMI. And when we talk about BMI, we are talking about higher adiposity as opposed to like being a bodybuilder. Just in case anyone was wondering, it's like an unhealthier higher BMI. We see an increased risk in schizoaffective disorders and neurocognitive disorders.

[00:18:49] So it has different effects, which is really interesting. It's not the same. I have kind of a high BMI. It does take Tita Tango. Huh? I said, I just was like, I have kind of a high BMI. From the muscular side of things. It's the clarification of like, is that higher adiposity? Yeah. As opposed to like just your super, super muscly and you go to the gym. It's the higher adiposity. So yeah, it's like the metabolically unhealthy higher BMI.

[00:19:16] So it's, it's really, it's fascinating. And it seems like a lot to think about, but there is actually a dietary pattern that is well, well, well, well, well reset for maternal outcome, infant outcome and fertility. And that is the Mediterranean diet. So it's like no secret. I wrote, um, I published a review on this, looking at Mediterranean dietary interventions and offspring outcomes as well as maternal outcomes and across the border improved outcomes.

[00:19:45] So including on quite like less obvious things, like, um, with the, one of the studies actually looked at DNA, DNA expression and methylation helped there. So, um, so there's really clear evidence, not just from my own research, but from lots of studies that following a Mediterranean diet really helps to improve fertility and improve pregnancy outcomes.

[00:20:11] Um, because if you know, anyone who's struggling with fertility now knows it's like, it's not just about getting pregnant. It's actually having a healthy pregnancy and then a healthy baby at the end. So we want to improve the entire outcome. And then ideally the same intervention actually improves outcomes 50 years down the line, which is what we see with the Mediterranean diet. Um, so I think it's about, we like, first of all, really prioritizing this time of life,

[00:20:42] putting a lot more, giving women a lot more support to help make these dietary choices and to help them to access these foods. And then really framing it as like, okay, this is a nine month sort of intervention period where it's really going to pay off to eat healthy foods, reduce excess sugar kind of goes without saying, but I'll say it not drinking alcohol, not smoking, not taking recreational drugs at all. So like ever.

[00:21:11] So whilst the occasional gelato is going to be okay, drinking and smoking and drugs is not. Um, and then really, and vaping just in case anyone's wondering and really doubling down on healthy food. That's going to help support all these amazing structures being built, including this crazy organ that we just build to support life, um, and support the additional 50% blood flow needed.

[00:21:41] So like the amount of new blood that you're creating, the amount of extra fluid you're carrying around to actually circulate that blood is amazing. When you start to look at the physiology, it is a real challenge and we need to support our, our bodies in actually achieving this and also feeling good whilst we're doing it. Not, you know, not feeling like we're on our last, literally like last bit of energy because we haven't got the tools and the nutrients to support our health.

[00:22:09] Um, baby hasn't even been born yet, but there's, you know, think about when we really think about all the tissues being created, including we've talked about the placenta, but also the new breast tissues that women create. And, you know, we don't normally lactate. Suddenly we switch on these, uh, new glands that normally don't do anything. And, um, yeah, so there's a lot. And of course, like there's a lot of changes in our hormone levels.

[00:22:38] So we have much higher hormone levels than usual and it's just a whole physiological metabolic change to support a new life. Immunologically, it's very interesting as well. Our immune system has to adapt to not throw the baby out as an, as a foreign object. So there's, um, there's just a lot going on and it's really important that we focus on

[00:23:06] making dietary choices that the woman can tolerate, especially in the first months. And this is where the preconception nutrition plays a huge, huge role because your egg has a yolk sack and that yolk sack that feeds the initial stages of embryonic development. The nutrients from that come from what you had in, in terms of egg quality. They also come from endometrial milk, which is fairly, a fairly new concept.

[00:23:34] And it's essentially this idea that the endometrium, so the lining of your womb actually has glands in it and they release growth factors and amino acids into the space, into the womb space. So people often think, oh, you know, it doesn't matter what I eat or drink in the first few weeks because there's no attachment, direct attachment through the umbilical cord. But actually we still have the endometrial milk, which depends on what we fed ourselves. So there's, it's always important. If you have good nutritional status to start with, then you'll be well nourished.

[00:24:04] If you can't tolerate eating a lot in the first trimester, if you haven't had a good nutritional status, perhaps you became pregnant by surprise or you just weren't planning it. Then it's quite important to try and make sure women are supported through the first trimester to get that nutritional status up as much as possible. And can you, for those who are like really struggling with getting the nutrients or feeling the aversions and eating a more healthful diet, is that where supplementation comes in or we just

[00:24:34] still can't out-supplement, you know, a poor diet? You definitely can't out-supplement. I would say, but folic acid in pregnancy has very clear evidence that preconception and first eight weeks is worth doing, right? There's nothing else, no other supplement. And even folic acid, like it doesn't out-do the need to eat good food. What I will say is that when you have stronger aversions in this time, there's a couple of ways to really tackle it.

[00:25:02] And one of them is cold, cold, cold foods. So like iced smoothies, because often with morning sickness, like smells and flavours, strong flavours can absolutely send you off the edge. So I remember when, with my first pregnancy, I was like, I'm going to try and eat this really nutritious, sweet corn fritter with eggs. What was I thinking? I nearly threw out the minute and turned up. So there's certain things that help.

[00:25:32] And it can, so frozen smoothies. So it might be that you're somebody who usually there's a window of time where your nausea subsides for like an hour. This is generalizing. If you have HG, you need professional support. You may need medication. So it's very different conversation, but for sort of normal levels of nausea and vomiting, it's, there's usually a window. So it's not the same for everybody. Some women it's in the morning, some women it's like later in the afternoon. Get to know your window where you're like, oh, I don't feel completely green right now.

[00:26:02] Then that's usually a good time to intervene and go in with like a really nutrient packed smoothie, ice cold. So I'm talking like frozen spinach, frozen cauliflower, frozen berries, yogurt and kefir, nut butters, like put it all in the seeds. And I will say like, don't use protein supplements in pregnancy. They're actually associated with intrauterine growth restriction. So they don't work. So we're trying to get those proteins still from the nuts and the seeds and the whole

[00:26:31] foods, um, blend it all up and drink it. And then for some women, you'd have the same thing with hot bland food. So you might be a hot bland food person where you can make a soup and like, don't really, don't put spices. Don't put herbs. Just go for like the veg, the beans, the lentils, um, and just have that. So it depends. Other, other, other women say that they like specific flavor profiles. So I use myself as an example with my second daughter.

[00:26:59] I had a real love for salt and vinegar, which I normally eat never. So like, but of course, like I couldn't, salt and vinegar crisps are not that nutritious food. So it was about finding ways to make things taste like salt and vinegar. So it was like salt and vinegar, roasted chickpeas and, and seeds mixed. And it was, so it's like finding ways that if there's a flavor profile that works for you, how can you apply it?

[00:27:24] And, and I think the last thing I would say is if that starchy foods like potatoes and pasta, less so rice, cause there's very hardly anything in rice really, but potatoes and pasta, if they're cooked, cooked with potatoes with skin on and let them cool down, then you actually, they're, they're actually surprisingly an iron source and they have fiber and they have easily available carbohydrates. And if you let them cool down, some of that starch turns to resistant starch, which is great for your gut microbes.

[00:27:55] Like, can you, does that appeal to you? Can you add a little cheese there? Can you add some beans there? Or, you know, just see what works, some extra virgin olive oil. And pasta is a great vehicle for, and often tolerated for lots of foods. So you can make like a green pesto or you can make like a tomato sauce, or you can make a bean dish and tailor it to what your taste buds will allow you. But the texture often of potatoes and pasta is quite like thumbs up in pregnancy.

[00:28:23] So it's just about making those foods nutritious and going for like the skin on potato that's slightly cooled and the good quality durum wheat pasta, which has better nutritional profile than like a cheaper quick cook pasta, for example. I mean, I think that that was like an amazing little TEDx snippet of that pregnancy stage. Yeah. And there were so many good tidbits in there about the importance of, I mean,

[00:28:51] I love the building block analogy that you use because, I mean, that's literally the truth. And when you think from a physiologic standpoint, like it's no surprise that all these outcomes, even 20, 30, 40 years down the road are so much better when you're putting in the things that your body actually knows how to build with rather than putting in things that the body might struggle to process a little bit more. So now, post-birth, baby's born.

[00:29:20] And I know breastfeeding is the first thing everyone talks about. Can we talk a little bit about breastfeeding? Is it important for everyone to try and breastfeed for those who might struggle with breastfeeding, whether it's a supply thing or they can't for some reason if they had a double mastectomy? Yeah. What are the other considerations? Yeah. So I think we have to talk about birth, right? So mode of delivery actually has an impact.

[00:29:45] So how your baby is delivered changes the initial exposure of microbes. So babies are born pretty much sterile when they're born. And the first dose of microbial sobbing they get is from birth. So if a child is born through vaginal delivery, they're exposed to microbes from mom's gut and vaginal microbiome. And that seeds a completely different gut garden compared to children who are born by

[00:30:10] cesarean section, who tend to have the majority of their gut microbes come from skin microbes. So skin to skin contact and actually the skin biome in the air of the operating theater from everyone else, right? So that's the difference there. Now, there is some research to show how that impacts outcomes. But actually, what seems to have more of an effect is what happens next.

[00:30:34] So if you have a baby that's born by cesarean section, you can pretty much rule, like you can bring back the composition almost the same to a vaginally delivered baby if you breastfeed. But if you have a child that's born by cesarean section and then bottle fed exclusively from birth, there's quite a gap. So this really makes a difference to gut microbiome composition. And why is that important?

[00:31:03] Well, the gut microbiome is how our immune system is trained. So the immune system is completely immature. It's basically non-existent in newborns, which is why it's so important to keep them sort of not in crowded places. So I often get asked about traveling with your newborn on a plane. And I just think first six weeks, like, no, just don't do it. It's quite high risk. Their immune system is really, really, really premature.

[00:31:30] A common cold virus can end up being very serious in a newborn. And there's things like asking anyone to come in to visit to wash their hands. Don't let anyone kiss your baby's face. All valid. Like, their immune system is not ready to deal with pathogens that potentially, you know, your loved ones or your friends don't know they have it because it's not doing anything to them. So really important. And so the gut microbiome is the main player in training that immune system up for the baby.

[00:32:00] So if you think about why is breast milk recommended and why do we make such a song and dance about it, basically, is because it is literally a combination of hundreds of chemicals. And probiotic microbes and the prebiotic foods that the microbes need to thrive. But it's not just about the microbes thriving.

[00:32:27] Those specific prebiotics, when broken down by the microbes, turn into amino acids, vitamins. They turn into enzymes. They turn into like lipids. They turn into a variety of chemicals. So everyone thinks, oh, well, it's fine because you have the sort of human milk oligosaccharides, but they're just like prebiotics for the microbes and then the microbes just break them down. They don't just break them down.

[00:32:54] That breakdown produces hundreds of chemicals for the health of the baby. So when we think about breast milk, it literally is created to help sustain the life of a newborn, including immune system like proteins and antibodies. So it actually acts as a secondary immune system for the baby. So there's a really cool, and it's been repeated, there's a few of them, but there's a really cool

[00:33:22] study that looked at what happened if you exposed a mother, a breastfeeding mother to a virus. So say you're in an elevator and you're exposed to like someone sneezing. Within three hours, the mother's milk had the antibodies to help fight that virus. So it's literally like an external immune system. Pretty cool. Now, not everyone can, so I guess for me, it's like the breastfeeding. The biggest problem we have in the US and UK is that we don't support women to breastfeed. So it takes about eight hours a day for a good five weeks.

[00:33:53] And that in itself is sometimes news to people. It was news to me when I did it the first time. And so actually setting women up to success for success means letting them be home with their baby for eight hours a day for the first few weeks of life. We also don't educate women. So if you look at countries with really high breastfeeding rates, like Kenya is like the star of the show. They live in communities where older women will teach the younger women how to breastfeed.

[00:34:20] And they'll literally be like hands on, take your boob, put it in the mat, like really showing you how to do it. That doesn't exist anymore. And there's very little funding for lactation consultants and for basically supporting women to learn how to do it. It is, it's natural, but it's a learned skill. You still have to figure it out with your baby. It's also kind of interesting to think about someone in America and generalizing. But if you told a mother, all right, now you need to go to your daughter and teach her how to breastfeed.

[00:34:48] I bet that would make a lot of people uncomfortable, which is odd to think that like such a vital life producing and nourishing thing for your new grandchild. And it would make you feel so uncomfortable to teach your daughter how to breastfeed your grandchild. I don't know. It's interesting. It is, right? So when you look at this research, you realize that countries that are doing it really well, it's because your auntie, your sister, your grandma, your mom, they're all showing you how to do it. Also, you're around it all the time.

[00:35:16] So now like, you know, in parts of America, it's not really safe to get to breastfeed because you'll get heckled or, and we had this in the UK. I think the UK has become a little bit more tolerant, but it's, you know, it's not, women don't often feel comfortable doing it. So we're not in a society where it's normal and people can be like, oh, that's how you do it. But there's a huge problem in this and the, what's really sinister. And I'll move on because otherwise I could stay here all day is that formula companies

[00:35:44] have used very good advertising and marketing to make it so that formula feeding is the right choice. If you want freedom, it's the right choice. If you want to share responsibilities with your partner, it's the right choice for the career woman. It's the right choice. They're like, no one has that marketing money for breast milk. No one is, no one's advertising it. The WHO is like doing its best to be like, we need to try and breastfeed for at least two years of life for like optimal health outcomes.

[00:36:14] And like the optimal health outcomes are really good. They're really worth doing. But the money behind the formula companies is outstandingly huge. And, and they do a really good job of trying to be on your side. And then they're not allowed to advertise formula milk for infants here in the UK. So what they've done is they've created follow on milk instead, which is the same. And they advertise that instead. And it's like, we know what you're doing.

[00:36:40] Like, so there's a lot of problems with how little support women receive if they want to breastfeed and how, how much money is behind making formula feeding the primary thing. Now, of course, as you rightly pointed out, not everybody can breastfeed, not all parents can. And so my answer to that is, okay, this is where formula milk can be really, really useful. But also have we considered that we could have human donor breast milk as the actual natural option? So there's countries like Brazil that have done this really successfully.

[00:37:11] They have human donor breast milk networks that allow families to access screened and safe human donor breast milk as the primary alternative. Yeah. I think that's just like been hard to find. Yeah. And I know someone, and this is where like the Facebook mom groups can be so powerful in your local area because I know someone who does have a double mastectomy and she just posted about it before she gave birth in a mom Facebook group.

[00:37:40] And everyone was like, oh, I have, I have milk. I have milk. I have milk. And she just started like, all of a sudden she was like, I wasn't relying on it. I knew that, you know, I would have a formula if I needed it. And all of a sudden, like the first, I think like almost six months of life, she had donated breast milk from local moms, which is like amazing. Right. And that's, and isn't that like, that's where we, I believe that's where we should be. Like where that's the primary protocol.

[00:38:08] And then formula milk is there to sort of provide the rest. But we saw what happened when, because there's only a few companies in the world that run the majority of the supply. One of them goes down, like women are left without access to feed their babies. People were making their own at home. That is dangerous that we shouldn't be there. So, and it's expensive. It's like super expensive to feed your baby. So then it becomes an access issue. And the women who have the least education are the ones that are most likely to need it.

[00:38:38] And it's just all wrong. Like the, the, the kind of societal injustice. Yeah. So, so how a baby's born, how it's fed in the first six months of life has a really huge impact on its immune system, how it develops. And this leads to things like risk of asthma, risk of atopic allergies. They're quite linked in our, things like peanut allergies have a strong genetic factor as does hay fever and eczema.

[00:39:07] So often if one of the parents has eczema or hay fever or allergies, it will, um, kind of come up in their offspring. But diet in the first few months and how a baby's fed can impact that risk. So again, we're talking about like increased risk or decreased risk. It's not a hundred percent, but it helps. And we also know that children who have a higher risk of allergies. So typically children who have very severe eczema as babies have a much higher risk of allergies.

[00:39:37] And there's a couple of things that we can do there. One of them is to make sure that we don't overbathe our children. I know that sounds really silly, but often newborns are bathed. They don't need bathing. They don't sweat. And actually stripping their skin of the protective layer can increase their risk of coming into contact with proteins from the environment or from food that the skin isn't supposed to come into contact with. And they kind of get this unusual reaction. Their immune system is like, what's this? Why is this on the skin?

[00:40:06] Is this an external protein that we should be reacting to? And we think one of the reasons why peanut allergies went up so much is because for a while, the leading brand of eczema cream contained peanut oil. And so there was a lot of exposure to the peanut protein on broken skin with inflammation. Wow. So the immune system was like, alert, alert, this is bad, right? Yeah.

[00:40:33] You can imagine now none of the eczema creams contain peanut oil because that was a mistake. But we have to be very mindful of like baby skin is delicate, not overbathe them. Don't use perfumes and fragrance soaps. It just isn't necessary at all. Don't overwash their hair. You know, cradle cap is something a lot of mothers worry about. It's again, it's like you don't need to wash it every day. It's just an aesthetic thing because cradle cap is not dangerous in any way.

[00:41:03] So I think those things are important. And as we then think about if you have a child who has a lot of eczema and you're worried about allergies, early introduction of allergens can be helpful. So looking at introducing, regularly introducing allergens earlier in life seems to really reduce that risk. And so here we're good to speak to your allergist and speak to your pediatrician, but essentially it's introducing small amounts of peanut butter or peanut, like ground peanuts from sort

[00:41:31] of four months onwards regularly, not just one and done because that's not going to help. And that can really help as well. And then, you know, when we start thinking about weaning, there's a trend at the moment where I've met families who have exclusively weaned their children on food products, not food. So if we go to the baby aisle nowadays, it's like it used to be just the Dr. Gerber pots, do you remember that?

[00:41:57] And now it's like rows and rows of different pouches and melty puffs and veggie sticks and bananas, whatever, flapjack situations. It's like so many things. And all these are food products. They're not food. And they're marketed very cleverly again, preying on the vulnerable things like ideal for learning to self-feed or brilliant for four months plus, or, you know, it reduces the risk of choking.

[00:42:26] I mean, that is really preying on fear right there. So there's this really, and then added vitamins, you know, a source of this, a source of that. But at the end of the day, they're never nowhere near the same as the real stuff. Like, so I think one of the biggest things we could give to parents takeaway is to wean your children on real food. And that might just look like scrambled eggs to start with. It might look like boiled broccoli.

[00:42:51] It doesn't have to be fancy and it doesn't have to be, there isn't like one way of doing it. There's plenty of science to show that babies in general will do a combination of weaning with purees and weaning with baby led weaning. Most, most babies don't just like one type and there's no difference in rate of growth or health with when you mix it up. So my suggestion is see what your child likes. Some babies love purees, love them.

[00:43:20] Some babies really love smushing food in their hands and swished into their own face, but providing nutritious foods as options is our job. And it's fairly straightforward to find how to do it. So there's just different ways you cut food to make it safe at different stages, but nutrient dense foods, fruits and vegetables, avocados. There are so many wonderful nutrient dense foods that we should be exposing our children to, to start with.

[00:43:47] And basically, ideally get to a place where your baby is eating whole foods, no added sugars in the first year of life. There is really no need for it. And then they can start to experiment more. And it's really difficult to never have snack foods with babies and children nowadays. So I guess my, I don't think we should aim for perfection because it can be very stressful.

[00:44:11] But at the moment in the US and the UK, about 70% of children's calories come from ultra-crisis foods. So I'm just saying like, bring it down a bit. Yeah. 20% maybe. It doesn't have to be perfect. But at the moment when we're failing our kids, we're not doing a very good job. And it's not the parents' fault. It's our food environment is absolutely stacked against us. So there are millions of these products sold to us.

[00:44:40] They're often affordable. People often think, well, the pouches must be nutritionally complete because they're created for my baby, right? But unfortunately, they're not created for your baby by someone who works in public health. They're created for your baby by the food industry to make a profit. So the bigger the profit margin, the happier they'll be. And it's also really hard to distinguish if your baby does have an allergic reaction, you don't know what in the pouches caused that.

[00:45:10] In the early weaning phase, to understand how your baby reacts to food, you do need to give them the whole food and just see how they react. And the final thought on that is a lot of these pouches and snacks contain what we would call xenobiotics. So these are chemical additives or ingredients that we haven't evolved with. And we don't know how they impact our health. We know that they do have an impact on the gut microbiome.

[00:45:37] We know that they're not just inert. They don't just go through and it's all fine. They are interacting. So I would say that we want to avoid exposing our children to xenobiotics in this really sensitive period where their immune system is literally building. And then after one, I think between one and two, most children start having a bit of a... I mean, weaning is easy at the beginning. They'll eat anything. You can give them sauerkraut.

[00:46:06] You can give them minced meat. You can give them liver. You can give them oily fish. You can give them all the vegetables. You can give them literally boiled cauliflower by itself. And they'll be like, then after one, usually around 18 months, it can be a bit earlier for girls. Food becomes a way of them expressing their own preferences. And I think a lot of parents get very worried at this age.

[00:46:33] They're like, oh my God, my baby used to eat everything and now they'll only eat three things. And it's a good reminder that if your baby is growing and not losing weight and not sleepy, so they're clearly getting enough nutrition, even if it seems like they're getting it from nowhere, just remembering that the rate of growth really slows down at one year. The first year is wild, like how quickly they grow. Just the amount of energy and nutrition and nutrients they need is amount. And it starts to slow down at one.

[00:47:02] And we also get this time when they start to actually have a bit of a personality. They want to tell you what they're going to eat. And babies this age, toddlers, they don't have choice over much. They can just about, that's the only thing they can choose is whether to open their mouth or not. So I often advise just give them a choice over what shoes they wear. Give them a choice over what dress they wear or what pants they're going to put on or whether they have gloves.

[00:47:30] And then at the table, give them a choice. Like, did you want broccoli today or did you want green beans today? And that just helps to give them some agency because, you know, they're little people. They want to have a little bit of a say. And you're telling them where they're going. You're telling them what time they're sleeping. You're telling them like who they play with. So this is just, it's often a developmental kind of milestone, to be honest.

[00:47:56] But if your child is losing weight or is suffering in some way, then it's really worth speaking to a pediatric dietician and ruling more serious conditions out like ARFID or perhaps celiac or an absorption issue, malabsorption issue. So just, but vast, vast majority is just, they're slowing down on their growth and now they want to say no more. Yeah. I feel like all the stuff that you've been saying, it's been so affirming in just like

[00:48:22] our journey with our first son because we were told to try, or no, we wanted to try kind of the baby led weaning and we were told to start around four months and it just didn't take. And we're like, okay, let's start, let's start mashing this stuff up. Like let's give them the purees and that worked better. And then, like you said, putting everything in front of them. He started eating sardines. He ate bone marrow. Just last week I was, and he's a little older now, but I was cooking the turkey for a little

[00:48:50] Friendsgiving gathering that we were having. And you have all the innards. And I was actually just cooking them for my dog to give my dog the turkey liver. And he just goes, meat. He looks at it and points at it and goes, meat. And I start feeding him turkey liver and he just ate it up. And then I went to feed the turkey heart to our dog in her bed. And he walks up and sits in her bed right next to her. And I start handing him slabs of turkey heart and he's eaten away at it.

[00:49:20] And so, but the last thing I think that you brought up with the picky eater is like the options. And I think that has been the saving grace for us because sometimes I'll go through five or six things before we hit one or two that he's just like, all right, yep, I'm eating this for my eating. And then he'll eat, yeah, he'll eat a whole tin full of like sauteed mushrooms and a handful of olives. And that will be his lunch. And I'm like, okay, great.

[00:49:47] It's our job as parents to offer healthy foods. It's their job as people to choose what they're going to eat. And sometimes like the one thing that's so beautiful about children and toddlers is that they don't have any social conditioning on hunger. So when they're hungry, they're hungry and you'll know about it. When they're not hungry, you can't force feed them. That terrible idea would never do that. But like, they're not going to just eat to please you. That comes later. And that comes because we teach them that.

[00:50:18] And that overruling of their hunger and satiety is what's then really hard to undo as adults. Because we learn it so young, finish what's on your plate. You can't get up until you finish. You can't have dessert until you finish that. That is like, I'm asking you to overrule your satiety signaling. You've told me you've had enough. I'm asking you to overrule that to please me as your parent or your grandma or your caregiver, your teacher. And that starts young.

[00:50:45] So it's like this age before the age of two is magical because they don't care if you want them to finish their plate. They're going to eat when they're hungry. So the best thing we can do is provide them with healthy food choices when they're hungry. And this leads me to like a final point. And I got quite a lot of, I got a comment on this when I spoke about this recently and it was an Instagram clip. And it's basically saying like, it's our job to create a food environment where your toddler

[00:51:13] or your child is moving around the house and they find something to eat. It's healthy. It's up to you. And someone said, well, you know, but they'll just not eat the dinner and they'll go and get some chocolate after. I'm like, well, you put the chocolate in the drawer that they can reach. You can change that, right? And I think that's wrapped up in how we were raised, like previous generations, having like the cookie jar at home and the treat box and the like snack drawer was such a sign

[00:51:41] of like homeliness almost. And it's like, we don't need to do that again. Okay. Like we now, because previous generations, the food environment outside the home was pretty healthy. So you would have the chocolate in the home and it's a treat and it's like, you don't really find it outside the home. We have flipped that. So now it's the only thing we have control over is what's inside the home and creating a food environment in the home to counteract what's happening out there is much more important.

[00:52:10] So it's like you can't, once they get older, they go to school and they go to the corner store and they buy their own stuff. That's up to them. But in the home, we can create the environment which will help them to think what is and isn't like food that they would reach for normally. And it translates into later life, right? So we know that children who are exposed to say nuts and seeds, whole fruits, eggs, bread

[00:52:35] with nuts, butter, like just food, a snack, carrots, cucumbers, they tend to then make those choices later. Of course they'll have like, I'm waiting for the day when my daughters have their first McDonald's, right? It'll happen. I'm not going to stop them. Yeah. But it's not part of their lives. They don't know what it is yet. And they have never seen a soda in their life. We don't have it at home. We don't have it in the house. It doesn't mean that my adult husband doesn't have one if he goes out for dinner one day, but it's not in our home.

[00:53:06] And I think it sounds like, and listen, soda is my thing. Other people are very, um, no, you don't want to have sweets in their home or they won't have it. You, everyone has their thing that they want to have in the home. But as a general rule, if 80% of the food in your home is healthy with the 20% for whatever your family thing is, ours is ice cream, then you're, you're starting that you're, that's what they'll learn to be their environment. So I can't stress that enough.

[00:53:35] I think kids aren't there to outsmart you, right? Especially at this age, they respond to what the environment is. So if they don't have their dinner on the table, but what they can access in the drawer is mixed nuts and raisins, that's okay. But if they're not having their dinner on the table and what they're accessing in the drawer is like, I don't know, snack bars and candy bars and sweets, they're not getting any, they're not getting any nutrients from that.

[00:54:01] I know, it reminds me of the other day he was walking around with a huge bag of, it was nuts and figs and because that's what he grabbed from the cabinet. It was a leftover bag of what was on our charcuterie tray. So he was just walking around. And he just, he unzipped it and he just starts picking out the little bits of fig and he starts eating these figs and I'm like, okay. Great. Have at it, kiddo. And you hit the point that I was thinking about.

[00:54:29] But it's, you keep saying it's up to us as parents, like, how can we replace that snack drawer or that chocolate, you know, candy bowl or wherever it is with the fruit basket and the bowl of nuts and seeds and the options that even if they don't eat their dinner, but then they go and have a banana and a handful of cashews. Great. That's fine. And so I call that, I call that health architecture. It's like this idea of building your own environment that you want that can support your health.

[00:54:58] And there's different versions of it, you know, with food, there's different versions of it with how you live your life. Like can you walk to the next place you're going? Can you set yourself up for success to actually incorporate these things that we know are good for you? So, um, as I say, you know, I think it's, it's, what's his name? Um, James Clear talks about the fact that he puts his beer at the back of the fridge. So he drinks it less regularly.

[00:55:22] It's like, you know, that it's little things, but it just makes it, I mean, I was like, you could just not buy the beer, but that's, but you know, it's little things that mean that your, your environment helps you to reach the goal. So if one of our goals as parents is to help children have a healthy relationship with food and like healthy food, then having a healthy food environment in the home and then letting them navigate their own hunger and satiety is like a good way to, is a good place to start.

[00:55:53] Man, we always get so much out of these podcasts with you in these interviews, and we just appreciate the wealth of knowledge and how you make it accessible. And I think that's the key here is that you, you give practical tools that people can actually follow and use starting anytime. And that is what's so beneficial. You know, it's not just, you just, you, you give it in a sense where people can apply it. And that's what we, you know, we're trying to do here.

[00:56:22] So we really appreciate the work you're doing, the research, the evidence-based outcomes and how you're presenting it. So thank you so, so much. Where can people go to continue to learn from you? Because that's what we want. Thank you. So my Instagram, I post there quite regularly on TikTok, Dr. Fede Amati. And I think my book, Everybody Should Know This is now available on Amazon in the US. So people might, and Audible as well. So you can, or you can listen to me talk through the whole book. Yeah.

[00:56:50] And then I often go on the Zoe Science and Nutrition podcast, talk about things like emulsifiers and the impact they have on our body. So if you want to learn more about that. Yeah. Those are like main cases, I think. Okay. Perfect. We'll put, yeah, put that all in the show notes. And I do, when we get to the end of these interviews and chats with you, always end up with more questions. So we might have to make you a regular guest and bring you back a third time. You're not going to get rid of us.

[00:57:19] I love it. Keep doing the good work. We're raising the next generation, right? So we always absolutely love having Dr. Fede on.

[00:57:44] And as new parents ourselves, it's so important hearing about these first 1000 days and how vital they are to a kid's lifelong health. If you enjoyed that episode or know someone who's thinking about getting pregnant, is pregnant or has little ones, please pass it along. We want this information to get into the right hands. Also, if you haven't heard yet, we're having another Pelvic Floor Foundations Challenge. Jen is in her postpartum period and wanting to do this with the community. We are still in the early bird discount period.

[00:58:13] So you have to go down to the link in the show notes. It's only live for two more days, but if you miss it, don't worry. I'll put an extra discount code down in the show notes so you can still get that early bird discount as a podcast listener. We want you to come join us. We want you to find that dynamic control in your pelvic floor. And you can do it in this challenge. Come join us and we will see you next time on the Optimal Body Podcast.