How to arm your baby’s fledgling immune system

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There are two immune responses involved in the fight against any germ: there is the very rapid innate immune response that forms the first crucial line of defense, and then there is the slower adaptive immune response, which is required for the effective vanquishing of that germ. There is nothing one can do to shore up the adaptive immune response, other than vaccinations against specific illnesses. When your baby is born, he/she is protected by the adaptive immune components (IgG antibodies) that are transferred via the umbilical cord into the baby.This rich and potent protection transferred from the mother starts to wane after the first 21-30 days of life, however, and is utterly depleted by  six months. Even after this protection wanes, active, fulminant infections may be largely prevented by optimizing/shoring up that first line of defense. Indeed, there is both anecdotal and scientific evidence to show that doing these very simple things may reduce the incidence of infection, and if infection results, then it is much milder and easy to get over.

                                                                           Vitamin D

The levels of this “vitamin,” which is really a hormone that is so important that it may have shaped the evolution of human skin color, have been shown to be far too low in large sections of the population, and low levels strongly correlate with both disease incidence (topic for other post) and predisposition to infections, particularly respiratory infections such as pneumonia and influenza, enteric (stomach) infections, ear infections, urinary tract infections, and even the deadly dengue fever. It has also been implicated in susceptibility to tuberculosis. The correlative evidence, which shows that people who develop infections have generally lower levels of Vitamin D, is really, really strong. But is correlation also causation: i.e., are you really at greater risk for infections if you are vitamin D deficient, or did you become Vitamin D deficient as a result of your infection or general state of health? This is much harder to study.

To do so, you have to supplement one group of people with vitamin D, and give a similar other group of people a placebo, and see if the group that gets vitamin D get sick less often. Obviously, this would require a very large group of study subjects, observation over long periods of time, and a really good study design. Such difficult studies are underway, and the results are mixed: For example, one study in children showed a potential beneficial effect in decreasing the incidence of influenza. But the results are not clearcut: another clinical trial in adults yielded no protective effect. Yet, when I look at this study, I see two clear issues: 1) none of the study subjects was severely deficient (levels below 10 ng/mL; this group is the most vulnerable), and 2) the dose they supplemented with (1000 IU/day) was far too low. But such studies are difficult to design, and it is clear that theoretically, Vitamin D can protect you in 2 ways:

•  Vitamin D is required to increase the levels of a really important innate immune peptide, cathelicidin, which is capable of killing bacteria, viruses, and fungi. It is also required for the production of beta-defensin.
•  Equally important is Vitamin D’s extremely potent anti-inflammatory role, which helps rein in the immune response at the peak or tail end of the infection: often, what can end up being deadly during an infection is actually the immune system’s out of control response (for example, the cytokine storm triggered by the influenza virus), which can sometimes end up even killing the host.

To summarize, Vitamin D is very important in optimizing and bringing balance to the immune response, and levels below 20 ng/mL may make your child more susceptible to infection and even worse, damage from the resulting inflammation. Breastfed babies are especially vulnerable to Vitamin D deficiency.  However, given its multiple roles, it is best not to get too high, and it is best if the vitamin D blood levels can be maintained at between 25-45 ng/mL. If your baby has little to no regular sun exposure (requirements would vary greatly depending on race), supplementing with this (400-800 IU/day) is crucial. Checking the blood levels of this at some point (fit it in whenever your child has a blood test for something else), and adjusting the dose you give your child based on his/her blood level is a very good idea.  

Probiotics:

The immune system and indeed, your overall health is largely modulated and regulated by the ginormous microbial population that populates your gut and also your skin. Scientists have long coined the term “normal flora” to describe the microbes that live in your gut, on your skin, in the membranes of your throat, etc. We need these bacteria, very badly so, to maintain health and to protect us. So unless you are sick and are sneezing/coughing on your hands, do not go gung-ho with the hand sanitizer on a regular basis when in the comfort of your own home/workplace.

 Recently, a great deal of attention has been paid to figuring out the composition of the normal flora in healthy and diseased people, and the striking thing is, that there are clear differences in the microbial communities. Scientists are now feverishly working to understand all this better. What they do know is that certain bacterial species may be protective, and indeed, a great deal of research has been directed towards identifying useful probiotics.

One such very promising candidate, especially in newborns and infants, is Lactobacillus reuteri. This bacterium, which was originally isolated from breast milk, is very promising because it produces a strong natural antibiotic reuterin that zaps various types of bacteria, and even fungi, viruses, and parasites. Basically, this one can keep all the really bad guys from moving in and making themselves at home, so to speak.  To summarize the research on this one: General digestive health:

• Colic: Two out of three clinical trials, and considerable anecdotal evidence also support that this probiotic is more effective than other remedies in reducing the severity of infant colic, but this effect seems to be truer for breast-fed babies rather than formula-fed babies (also reviewed here).
• Spitups: One small study showed a significant effect in reducing regurgitation in babies with reflux.
• Constipation: One study showed that continued administration of L. reuteri helps resolve some parameters of constipation in infants
• Diarrhea/gastrointerstinal disease: There is very strong evidence to show that L. reuteri reduces the incidence of diarrhea, as well as its duration and severity of gastroenteritis (reviewed here).

Protecting against specific conditions or microbes:

• Asthma: Animal studies suggest thatL. reuteri may be protective against asthma. A study in asthmatic children also backed this up, which is pretty darned exciting, IMO.
• Hemolytic uremic disease: While E. coli are generally harmless, certain strains can be very scary. Enterohemorrhagic E. coli (EHEC), for example, can cause a life threatening condition  called hemolytic uremic disease; one study in mice showed that prior administration of L. reuteri protected mice against EHEC, which I find an extremely compelling argument for taking this probiotic.
• Methicillin resistant Staphylococcus aureus (MRSA): The very mention of this antibiotic-resistant superbug can strike terror into the hearts of hospital administrators: There is limited evidence to show that many probiotics (including L. reuteri) could act as natural deterrents to MRSA infection. Another really good reason to take this (and other) probiotics!

To summarize, this probiotic may promote health, comfort, and resistance to multiple infections in infants and children. Its safety in non-immunocompromised infants and even in pre-term babies is well established. This probiotic is marketed by BioGaia, a Swedish company. Subsequently, the L. reutri brand has been bought out by Gerber, and is marketed as Gerber Soothe. Both the original BioGaia ProTectis drops and Gerber Soothe Colic drops are available via Amazon in the US, and should be widely available in Europe as well, given the origins of the company. Note: This was originally isolated from breastmilk, suggesting that some, if not all women will pass it on via milk. However, its presence in your breast milk depends on your own microflora, and you may not have it at all, or have it in low quantities. Hence it is a good idea  for even breastfeeding moms to supplement with this (you can give it orally or in expressed breast milk, or some breast feeding moms directly apply it to their skin).

Virgin coconut oil:  

This is the richest source of lauric acid and also contains other fatty acids such as caprylic acid. This oil has been a traditional staple of many civilizations, and only in the last century, has incorrectly got a bad reputation for “increasing cholesterol.” That turned out to be a case of misinformation and misrepresentation that may have actually contributed to the increase in heart disease seen today, but that is a topic for another post.

Generally, the populations that consumed coconut oil traditionally enjoyed excellent health. I found this page extolling the virtues of virgin coconut oil very interesting reading, though all of it is anecdotal.

Lauric acid, the main fatty acid in coconut oil, is abundant in breast milk. As a side note, its levels in breast milk are not set in stone: they can go up and down depending on the mother’s diet. This highlights a very important point about breast milk: it acts as a distilled source of what is good for the baby, but the mother has to first obtain these things (such as DHA or lauric acid) either via diet or by synthesizing it from precursors. It would hence be a good idea for breast feeding mothers to incorporate coconut oil or products in their own diet.

Breast milk contains a lot of different things. Why focus on lauric acid? It is rather awesome because its rather eye-poppingly potent anti-microbial, anti-viral, and anti-inflammatory properties. Here is what I could find on either lauric acid or virgin coconut oil:

•  Has bactericidal activity against a range of bacteria, including Staphylococcus aureus.
• Alone and also combination with organic acids such as lactic acid and citric acid,  both lauric acid and caprylic acid can inhibit the growth of enterohemorrhagic E. coli (EHEC) strains, with caprylic acid (present in small amounts in VCO) being the most potent. Now, EHECs are scary news, causing about 73,000 infections annually in the US. While this rarely results in fatalities, the healthcare costs resulting from these infections is staggering. If this could be warded off by a little relatively cheap coconut oil, would it not be so worth it?
• Multiple studies (giving this one as an example) have shown an effect against the causative agent of acne, Propionibacterium acnes
• Inhibits the growth of C. difficile, an organism that is one of the most common causes of diarrhea.
• There seem to be only limited studies on effects of lauric acid/virgin coconut oil on viral infection, but based on very limited evidence, it seems to inhibit some part of viral life cycle in a poorly understood way. One study showed that it inhibited the growth/production of VSV (a virus that mostly causes disease in animals) and also that of the Junin virus, which causes the appropriately frighteningly named disease, Argentine hemorrhagic fever (AHF).

To summarize, virgin coconut oil is safe and is even recommended for babies, given that they need a lot of saturated fat in their diets, especially the lauric acid. If you are formula feeding, check whether your formula contains coconut oil. Not all formulas have this. Even if they do, it may be hydrogenated coconut oil, which is far from ideal. It is a good idea to hence try supplementing even  store-bought formula with this one. Remember to get an organic, extra virgin source. If you are breast feeding, it would make sense to take the coconut oil yourself. When bottle feeding, you can add it to the formula. Where to buy all of these: If you do not live in the USA or Europe and cannot find a  good brand of these items locally, then iHerb, which offers international shipping to most countries, is a good resource for getting both the Virgin Coconut Oil and Vitamin D. Finding the probiotic (Biogaia ProTectis) is harder. Living in India, I usually have somebody send it over from the USA. You can also check this website to see if it is available in your country.

Collectively, we spend billions of dollars battling scary infections. Antibiotics, which were hailed as the white knights of modern medicine, are being beaten back by a wave of antibiotic resistance that some claim will reverse the advances made by modern medicine. The best weapon we have is the immune system, a marvelous multifaceted army, that when optimized to shore up that first line of defense, can beat off most things. If we arm it well at little cost to ourselves, it is not any guarantee that we will never get sick, but it is likely that the majority of people will atleast fall ill a little less frequently, and may be protected from some of the more scary things out there such as MRSA and EHECs, which are truly deadly when they strike.

Evidence from studies aside, do these things actually work? My daughter, who was born via surrogacy, was born via c-section, received intravenous antibiotics for a mild respiratory infection that looked like it was acquired in utero, and is not breast milk-fed: three strikes against the development of an optimal, balanced immune system. After we got home, I started her on a homemade formula that is made using goat’s milk, lactose (which promotes the development of a normal flora), virgin coconut oil, olive or safflower oil, and ghee, and is supplemented with Vitamin D, the probiotic (Biogaia ProTectis), and a fish-oil source of DHA. When she came home from the hospital, nearly everybody in the house caught a nasty cold that laid us low for days. Then one day, she started coughing sporadically, and I was convinced she would get the infection too. Magically, it never progressed, and she never showed the full-blown symptoms of the cold/bronchitis that we all had: I gave fervent thanks, but I never knew what was responsible for her managing to fight off a bug that all the adults in the house could not.

Since then, it has been two months and counting, she has never fallen even mildly ill, shows no signs of colic or spitups, her bowel movements resemble that of breast-fed baby, and is generally doing marvelously. When you consider this and her risk factors based on her circumstances (C-section delivery, antibiotics at birth, not breast-milk fed) and compare it with the mile-long list of things I have done, you have utterly no way of telling if any of those things was actually helpful, but you have to wonder. There is no way to know the true impact of any of these things, but you just have to do what you can do, when it is easy, economical, and safe.