The First Thousand (or so) Days
The Importance of Early Life Nutrition for Lifelong Health.
A talk I prepared for Gladstone Communities for Children in 2017.
Hello and thank you, Wendy, and the team at Communities for Children for the opportunity to speak this evening.
Count the first thousand days:
To start, I thought we could tally the first thousand days , starting with preconception.
Remember the ovaries are made during embryonic life, and stay in stasis until adolescence. It takes about a year for the pre-egg to finally mature enough to be presented as part of a tertiary follicle. The late tertiary follicles compete to become the dominant follicle which releases the egg for fertilisation. This is also the period in which sperm are made in the testicles. The most sensitive time for this process is: 90 days prior to conception.
Following this period is Embryonic life, including the 2 weeks in transit from fertilisation to implantation. During this time the organ systems differentiate from the initial ball of cells. This is the time traditionally considered to be the highest risk time for the development of malformations: 56 days
Fetal life, including the remainder of first trimester: 28 days
Second trimester: 98 days
Third trimester: 84 days
Neonatal period: 30 days
Infancy: 335 days
Toddlerhood: 730 days
Which brings up to a grand total of 1451 days, give or take.
This period of human development is wonderfully and astonishingly complex. It is also the period of time where our environment can have profound influences on our life trajectory.
To explain that further, I will touch on some genetics.
In humans, each cell normally contains 23 pairs of chromosomes, for a total of 46. Twenty-two of these pairs, called autosomes, look the same in both males and females. The 23rd pair, the sex chromosomes, differ between males and females.
The chromosomes contain DNA, which could be considered like a vast library containing all of the information the body could possibly need to build a cell or an enzyme. However, there are further mechanisms at play here. Genes, the books within the library, can be covered or uncovered, read or not read, depending on the cellular environment.
The science surrounding this is the new field of epigenetics.
Epigenetic effects are closely related to the nutritional status of the individual.
Epigenetics provides an explanation as to why a person who does not have asthma may have a child who does, or why a child who is conceived during a time of famine may become become obese during adulthood.
Epigenetics is not limited to early life, it is a process which occurs throughout the lifespan, however times of rapid growth are when we are most vulnerable to its effects.
Another important thing to understand is that the epigenetic change is heritable, that is, it can be passed down to future children and grandchildren.
How the body copes:
When I was in high school, it was the beginning of the time when personal computers were being introduced to school. We were taught basic programming, and we were told “garbage in, garbage out”, meaning the programming needed to be correct in order to have a useable result.
The body has the capacity to make do – to MacGuyver it’s way out of a problem – but that does not mean that it will function at its best when doing so, especially if it needs to do that all the time.
It’s compensatory strategies may even be harmful in the long term.
An example of this is persistently elevated insulin from a carbohydrate rich diet in a person genetically prone to diabetes. The elevated insulin, of itself, promotes inflammation, independent of blood glucose levels.
If you really take time to think about the changes made to food production since the industrial revolution, and especially in the last 50 years, it starts to make sense that the countries of the world who have embraced these changes are the places where obesity, inflammatory and autoimmune conditions and cancer are skyrocketing.
Missing or inadequate in the standard Australian diet are components critical to the smooth functioning of the whole body- the brain and mood, the immune system, the gut, the heart, everything.
Macronutrients:
Just as a refresher, I will remind you about the role of macro and micronutrients in the diet.
Macronutrients include protein, fat and carbohydrates. There are nine essential amino acids, and two types of essential fatty acids, there are no essential carbohydrates. The term essential means that the body is unable to manufacture that substance for itself.
Ingested fats are absorbed through the intestine and sent directly to the bloodstream, where they can be sent to storage in adipose tissue or used directly for energy. The human body can also make fat by utilising carbohydrates through turning them in to saturated and monounsaturated fats. Fats stored are used for energy through a process called ketogenesis. Trans fats are not manufactured by the body and are usually a product of industrial processing. When ingested, they are very damaging.
The body requires essential fatty acids, which are polyunsaturated fats generally divided in to two groups, omega 6 and omega 3 fatty acids. The ratio of the omega 6 and omega 3 fats in the diet is important. A Standard Western diet tends to have more omega 6 fats than is required, and this is considered a pro-inflammatory ratio.
Amino acids are the building blocks of protein. There are 22 amino acids used in the human body, nine of which it cannot manufacture for itself, and six of which it can usually, but not always manufacture for itself. The body can convert protein to glucose for energy. This process is called gluconeogenesis. It is more energy wasteful than using carbohydrates for energy, and the body will preferentially use carbohydrates if they are available.
Carbohydrates, while not essential, are an important energy source for humans. There is currently a lot of debate surrounding the optimal dietary composition of carbohydrates, and into the future, I think this will vary on an individual basis, depending on genetic make – up, including epigenetic effects and on the microbiome, which I I’ll discuss later. One thing that is agreed on is that simple sugars and processed carbohydrates are harmful, including in individuals who do not have a weight problem.
Micronutrients:
Micronutrients include vitamins and minerals. These are required in trace amounts in the diet, but their presence is essential to the myriad enzyme processes in the body.
Minerals include calcium, phosphorus, magnesium, sodium, potassium, chloride and sulfur. Trace minerals include iron, manganese, copper, iodine, zinc, cobalt, fluoride and selenium.
Calcium, magnesium, iron, iodine, zinc and selenium insufficiencies are common contributors to ill – health in patients in my practice.
The vitamins are divided into fat and water soluble vitamins. The fat soluble vitamins are vitamins A,D,E and K. Vitamin deficiencies of fat soluble vitamins are possible in people who are careful to consume a very low fat diet.
Vitamin D has recently become the focus of intense research. It is now thought vitamin D acts more like a hormone than a vitamin. It is difficult to obtain sufficient vitamin D from dietary sources (unless you eat a lot of sea-mammal blubber). Vitamin D is manufactured in the waxy layer of the skin after sun exposure. It is possible to wash this layer off, prior to absorbing the vitamin D after sun exposure, and a good sunscreen will stop the production of vitamin D. Adequate vitamin D is required for bone health, but it is also required for immune system health. A recent observational study showed an inverse relationship between vitamin D level in cord blood and the development of early ADHD symptoms in toddlers.
The water-soluble vitamins are the B group vitamins and vitamin C.
Vitamin C is present in foods which have been recently alive. It is not present in grains. Two of vitamin C’s many important roles include the production of collagen, which is the scaffold on which all our organs are built, and as an antioxidant, which protects against cellular damage. Humans and primates cannot manufacture our own vitamin C. Other animals, which can manufacture vitamin C, significantly increase their production of vitamin C in response to illness or injury.
The B-group vitamins are a collection of eight water-soluble vitamins essential for various metabolic processes. Some of the B group vitamins are especially important in nervous system health. Most of these vitamins can’t be stored by the body and mustbe consumed regularly in the diet. A vegan diet puts a person at risk of deficiency of some of the B group vitamins.
Extended cooking, food processing and alcohol can destroy or reduce the availability of many of these vitamins.
Bioflavinoids:
A third group of beneficial food chemicals, called bioflavonoids comprise a group of four thousand substances. These include such things as the blue colour of fruits and vegetables and the active ingredients in Cocoa. Much research is currently underway on this group of chemicals, which remain somewhat of a scientific enigma. Their effects on the body are in some ways medication – like. It might also be that part of their effect is on the microbial population of the gut, rather than on the human body itself. Eating a rainbow of vegetables daily is the best way to access this important group of foods.
The Microbiome:
For many years, the medical world looked upon the bowel as a waste disposal unit, filled with evil bacteria which would destroy us if only given the chance. More recently, we have understood that this concept is far from the truth and that we need our microbes in order to live a long, healthy and happy life.
Each of us carry within ourselves 10-100 trillion microbes – bacteria, fungi, viruses, the genetic code of which makes up our microbiome.
The microbes within and upon us live in a symbiotic relationship – they excrete chemicals which affect our mood and modulate our immune responses.
Like our human genome, the microbiome is also affected by our environment.
We begin to establish our microbial population when we are in utero. Research in the past 10 years or so has revealed that the amniotic fluid, placental and fetal membranes of healthy pregnant women contain pioneer bacteria which are harvested from the mother’s gut by her immune system and deposited in the uterus to prepare the baby for the outside world.
Vaginal birth and breastfeeding further expand our microbial population, in numbers and diversity of organisms.
Caesarean birth and antibiotics given in the perinatal period, can deleteriously affect the establishment of a healthy microbial population. Both of these interventions can be lifesaving, so care needs to be taken in balancing the need for these interventions with the potential effect on the baby’s future health.
This is an area for much further research. At the moment there has been benefit shown with probiotic supplementation in late pregnancy reducing the risk of allergy, specifically eczema in the children. However, foetuses from 22 weeks gestation respond immunologically to their environment, so optimising the maternal microbiome throughout pregnancy is important.
By the age of three, the stable microbial population is established. Each individual has a microbial diversity, a fingerprint of bugs, which will stay with that individual for life.
An individual’s microbiome is influenced by the food that is fed to the microbes, and also substances such as antibiotics, antifungals, insecticides, herbicides, detergents and emulsifiers found as part of the diet.
The microbial species adapted to a host diet consisting mostly of processed food differs from that of a person who eats mostly vegetables. The bacteria which thrive on the vegetable type diet tend to be those which are associated with beneficial effects on the immune system, and also maintenance of the health of the cells of the bowel itself. This makes sense if you look at it from an evolutionary point of view – the species which have lived in a long term symbiotic relationship with us are likely to be the ones which keep us healthy.
Strategies to Optimise Health in the first 1000 days:
Prior to conception, ensure that both parents are replete in vitamin D. They should both eat a varied diet, rich in vegetables with sensible amounts of good quality protein and fats. Awareness that processed food can damage gut health and contain trans fats and excessive carbohydrates, can make it easier to think twice when offered these foods.
Preganancy
The mum-to be can use a multivitamin which contains folic acid and iodine, as a minimum. People who are vegetarian or vegan may need iron and/or B group vitamin supplementation in addition to a multivitamin.
In the neonatal period, encourage breastfeeding. Consider the addition of a baby-specific probiotic if formula feeding. Continue a multivitamin for mum, and continue a diet rich in vegetables, good quality protein and fats, including omega-3 containing foods.
Consider probiotic supplementation in the event of caesarean birth or antibiotics for mum or baby. Continue vitamin D supplementation or healthy sun exposure.
In Toddlerhood, continue to offer a variety of vegetables, protein and good quality fats at every meal. Toddlers are exerting their independence and ability to say no. Be prepared to offer food many times before it becomes a regular part of the diet.
Beware making the only opportunity for toddlers to try meat and veggies being with the evening meal, when they are tired, not that hungry and can’t be bothered chewing.
Try not to fall in to the trap of thinking that breakfast needs to come out of a box. Vegetables, good quality fat and protein will set the toddler up for the day, reduce the “hangry” mid morning episodes and increase the intake of pre-biotic fibre, vitamins and minerals.
Now, to put it all together.
The first thousand-ish days are a time of unparalleled growth. Optimal growth and functioning require better than adequate macro and micronutrients.
The developing human is exquisitely sensitive to nutrient insufficiencies, and to damaging chemicals in the environment.
The maternal microbiome influences the development of the child’s microbiome, which is also very sensitive to the child’s diet and environmental toxicants.
The environment of the developing child has the potential to have epigenetic effects which can influence the life trajectory of that child’s grandchildren.
Thank you for your attention this evening. I hope that my talk has been helpful for you as advocates for child health.
References:
Prescott, Susan L, 2015 : Origins Early-life solutions to the modern health crisis. UWA Publishing
Timeline of Humandevelopment – https://embryology.med.unsw.edu.au/embryology/index.php/Timeline_human_development#Introduction
Nutrient Reference Values, Australia and NZ. https://www.nrv.gov.au/nutrients
Inverse associations between cord vitamin D and attention deficit hyperactivity disorder symptoms: A child cohort study. Mossinet al Aust N Z J Psychiatry September 30v 2016
Vitamin C. https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/
Vitamin B. https://www.betterhealth.vic.gov.au/health/healthyliving/vitamin-b
The global burden of asthma: executive summary of the GINA Dissemination Committee Report. Allergy. 2004 May;59(5):469-78.
Short and long-term dietary patterns affect the ratios of Bacteroides, Prevotella, and Firmicutes over whelms inter-individual differences in microbial gene expression. Nature 2014 ;505, 559–563.
Early-life environmental determinants of allergic diseases and the wider pandemic of inflammatory noncommunicable diseases.Prescott,S: J Allergy Clin Immunol 2013;131:23-30
Maternal and Early Postnatal Nutrition and Mental Health of Offspring by Age 5 Years: A Prospective Cohort Study. Jacka, F, et al: JAACAP 2013; July 19
The intestinal microbiome in early life: health and disease, Arrieta et al: Front. Immunol., 05 September 2014