Birth, Breastfeeding, and the Truth About Baby Food | Dr Federica Amati

0:03In part one, we comprehensively walked through the golden window, preconception, sperm and egg health and GLP-1s and fertility. We spoke about important considerations during pregnancy and more. before we kind of pick up where we left off i want to zoom out just for a moment here and contextualize this conversation and topic and and really i guess the motivation for why you wrote your book when you look at the whole span of someone's life you know 80 90 perhaps even 100 years of age how much of of what determines their long-term health let's say like their risk of disease, even how they think and how they function, would you say is actually shaped in this 1 ,000 day window?

0:57Yeah, yeah. I mean, that's a great question, isn't it? Because essentially, the way to think about it for me is that this 1 ,000 day window offers the biggest potential impact we can have on long-term health and trajectory. But we want this to be an empowering, it's an empowering message as opposed to a terrifying message because whenever I talk about this topic people will say okay but my my child is like eight now does that mean I've missed the window and I'm screwed and it's it's not that it's just that we understand it's purely because so much assembly happens in the first thousand days from the actual formation of organs to I mean the brain that what happens to the brain in the first three years of life is amazing is so fundamental we know that this is a golden window of opportunity, it doesn't mean you can't then refine and improve and build your health later in life.

1:51But we do know that exposures at this point in your life do have lifelong trajectory and consequences. There isn't a number. There isn't like one number for everybody. But when we look at different studies for some of the ones we mentioned in our last podcast, like the MRC Gambia study, which followed people up for 60 years. And when you are conceived you've impacted how likely you were to have type 2 diabetes and to have died. Now, these are all long-term associations. What happens in between is it helps to shape what actually goes on. It's just that we know this first thousand days of life has long-term repercussions because it's so fundamental in assembling your body.

2:32But I want it to be an empowering message because I think the more we understand about this phase, the better we can support families, the better we can support parents to know how to best improve their child's health for life. And also, as I said, I think it helps us understand where we come from. So if you know something about yourself in the first thousand days that helps to explain perhaps some of the risk factors for yourself, it can be quite apparent because you're like, okay, well, I understand why, you know, I've been at slightly higher risk of xyz so it is impactful there isn't a precise number what happens from two three years to later still has an impact that's why my book is about life course health it's not just about the first thousand days there's still so many opportunities to have an impact and change trajectories but the way one of the analogies i use is that the first thousand days kind of helps to set the ramp of aging, the speed of aging, right?

3:31So it sets the ramp, but then how you run down the ramp and what you do to slow down aging can still affect that rate. So hopefully that's a helpful analogy, but there isn't like a precise number I can put on it. No, I think that's helpful. I agree with you. It's a bit of a tricky topic because, and I've seen this come up in conversation where clearly this is very important and education, helping people understand the importance of the first thousand days is critical. And at the same time, as you alluded to, sometimes when we learn about these things and we look back on our early life, and I've seen people kind of fall into this space where they learn about, for example, vaginal birth versus C-section, which we're going to talk about today, and then think, oh, great, I was born through C-section, am I doomed?

4:21And the helpful and additional part that you're speaking to is understanding that it's not all set in stone and there still is things that you can do despite the early exposures being critically important and we want to set our kids up for as good health as possible throughout their life. But even if things don't go perfectly to plan, it's not a guaranteed poor health outcome and it doesn't mean you can't change the outcome with certain lifestyle behaviors and focus on certain things later in life. Yeah, and you've just touched on something really critical here, which is just that just because it's a critical window or an important window of opportunity, it doesn't mean it's fragile.

5:01It doesn't mean that biology isn't adaptive. So fundamentally, actually, our biology is amazing at adapting to an imperfect world. So even though this is such a critical window, it's so much opportunity, it's not fragile. Our biology will do its best to be resilient and get us as healthy as we can. And I think that's also important framing. So just because you were born through C-section, you haven't shattered the entire thousand days. You know, actually it's more nuanced than that. There's several factors and biology at its core is resilient. So that's a good thing. I want to circle back to a few of the, I'd say under-discussed nutrients, important nutrients during pregnancy.

5:43And we briefly spoke about them in part one, choline, iodine, and omega-3s. So perhaps we can start with choline here. You mentioned it a few times in part one as one of the nutrients with strong evidence for benefit during pregnancy. Why is choline important and how much do women during pregnancy need? Yeah, it's important. It's involved in essentially in healthy brain and neural formation. So it's an important part of how the brain and the nervous system forms. So we need it in pregnancy. We also need it in early life as well. And the requirement's about 450 milligrams a day, which means nothing.

6:25So let's talk about it in food. And I guess choline has had more interest in the past four or five years because there was a big review that was published, which showed that a lot of women aren't necessarily getting 450 milligrams a day in their diet. So that's important to note, right? But it's also important to note that true choline deficiency isn't common. So we don't see one of the sort of potential impacts of choline deficiency in pregnancy is neural tube defects. And there hasn't been like a big boom in neural tube defects as a result of choline deficiency. So we have to be really careful with this because I have seen online quite a lot of rhetoric about eating four eggs a day to get your choline.

7:08And eggs are a good source of codeine, but there are others. And actually, I would not recommend eating four eggs a day to get your codeine if you're pregnant. It's not the best way to do it. So whilst it's important, 450 milligrams a day, you can absolutely get it from your diet without thinking too much. So whenever you speak about this to people who work in pregnancies and obstetricians, they'll say, I don't worry about it. Most women get this in their diet because it's in so many foods. It's in oatmeal. It's in chia seeds. It's in tofu. It's in soybeans, edamame beans. Shitake mushrooms are particularly high.

7:41I know that's a bit niche, but I find that quite interesting. It's in broccoli florets. Actually, choline isn't a rare nutrient. So whilst it's good to be aware of it, and it's good to know that it's important, it's one of the nutrients we need to be conscious of. But unlike iron, which can drastically, if you're iron deficient or only making pregnancy, it actually puts you at risk of dying if you hemorrhage. You know, choline deficiency isn't like a massive red flag. It's just good to know that there are choline sources and try to get them basically. So presumably, coming back to how much you need, you said the neural tube defects are not increasing despite women not getting the 450 milligrams.

8:24So the amount to reduce the risk of neural tube defects is less than the 450. Is the 450 an optimal amount? Is that important for other things outside of neural tube defects? Yeah. I mean, it's important for formation of the brain. It's important for other, and it's more for maternal health too. I guess what I'm saying is that just when you do dietary data analysis and you see that there's potentially an underconsumption of one nutrient per day, this goes back to resilience of biology and pregnancy nutrition being quite specific, pregnancy nutrition is very efficient at getting the nutrients it needs and getting them to the baby, sometimes at the cost of the mother.

9:02So what I'm saying is, even though there is this signal that women perhaps aren't consuming enough chaline in their diet, according to survey data, so depending on what day you've spoken to this person, there isn't like a mass deficiency and clinical marker that we should really be worrying, which is different, right, to folic acid deficiency, folate deficiency, because actually there, there is a signal that when you don't fortify with folic acid, countries do tend to have higher neural tube defects. So that's an example where actually, that's why we recommend every woman who is trying to conceive or pregnant, especially in the first trimester, takes folic acid because it does actually measure a bead decrease.

9:42So I'm not undermining choline's importance. I'm just saying that be aware of choline. It's in food. If you have a good prenatal supplement you know where women have really poor nausea very bad nausea and they really struggle to get a variety of foods in the first few weeks a good supplement with choline could be an extra bit of reassurance but i'm just very aware of the amount of noise on social media that is recommending women eating like five four or five eggs a day to get their choline because it's a huge deficiency and we're all it's like actually don't panic about it. And as we said, if you really worry that you're not getting enough food in general, then a good supplement can help and choline might be one of the things you want to see in there.

10:29And they usually add about 50 or 100 milligrams of choline into those prenatals. Yeah, they vary, right? So they tend to not have the full recommendation, but they vary. And And sometimes some of them will say take one or two, depending on food intake. Work with a healthcare professional if you're not sure as well. But just, as I said, you can get the 450 milligrams just by eating a variety of foods that contain codeine, including eggs, if you like eggs. I wasn't going to go into folate, but now that you've brought that up, If someone has heard that folic acid increases risk of cancer and they should supplement with a different form of folate.

11:13The cametal folate or something. Is that something that you hear quite often? Sometimes. It goes in waves. Sometimes people get worried about it. and let's like to be honest with you the science is much we have much more science on folic acid supplementation being effective than we have on different methylated forms there's no problem with methylated forms but it's just that folic acid supplementation pregnancy is one of the oldest safest best understood mechanisms to help pregnancy outcomes including fertility if you have low folate status, the pregnancy is less likely to be successful too. So actually taking it as a fertility supplement too is important.

11:55The concern about the folic acid and the cancer, and it's colorectal cancer, is interesting. And it's not that it's a fake thing. There is some evidence that very high intakes of folic acid in specific populations that have genetic predispositions can lead to a faster progression of the cancer. So what's interesting about the pholic acid cancer debate is that there is a grain of truth as as there often is with these things where there's like and it's why by the way the uk has been so slow to adopt pholic acid as a national fortification plan and it's because there's a small group of people who have very vocally said we don't want everything fortified with pholic acid because this very small subset of people may be at high risk if they receive this folic acid in their food.

12:48Now, it's an interesting problem because it's taken this long for the government and for the food agencies to assess risk benefit and to finally say, actually, there is a clear benefit at a public health level for fortification. So what does it mean for an individual who's worried about it? honestly like my understanding of the risk of folic acid for colorectal cancer is that you have to take have very high amounts of the folic acid in food or a supplement for it to have an impact and if you're someone who perhaps knows they have this specific mutation which means that they are if you're one of those people then it may be worth in this case buying a brand of bread in the UK that doesn't fortify.

13:35So some brands don't now. They've sort of made a statement about this, but it's such a small risk compared to the benefit of preventing urotube defects and preventing some of their earlier miscarriages that that's why it's adopted by the majority of countries who can afford to do it. They're definitely public health drive. I'm often asked for advice on building a podcast or a business. One thing that I've learned is that the people I've watched build well aren't necessarily doing more than everyone else. They're delegating better. There's a point in anything that you're growing where the constraint stops being effort and starts being expertise.

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15:05Visit upwork.com right now and post your job for free. That is upwork.com to connect with top talent ready to help your business grow. That's upwork.com. Upwork.com. It's a very similar conversation to one that occurs in preventive cardiology where you're talking about a risk and what's the magnitude of that risk and weighing that up against data on outcomes. So, because what you're saying is, look, the outcome evidence for protecting neural tube defects, which is, you know, one of the big concerns during pregnancy, is supporting folic acid. it it's not there for the methylated forms it doesn't mean that they may be just as protective but i guess that that data just doesn't exist right which is why the guidelines recommend folic acid first and foremost and it's interesting that there's that risk of colorectal cancer but and someone the decision to be made is do you want to supplement with the form where there's proven evidence to to prevent neural tube defects or can we assume that the methylated form would be just as protective.

16:13And where I was going with cardiology is there's a similar conversation between statins and some PCSK9 inhibitors, for example. They both lower LDL cholesterol, but there's far more outcome evidence supporting statins. And yet some people have concerns with some of the side effects, which are also real and do exist. And so we're weighing up this kind of risk versus outcomes, which I think is an interesting piece of context and nuance that sometimes isn't discussed in podcasts. I'm glad that you brought that up. I guess, I mean, just to finish there, there is that the evidence to support folic acid preventing neural tube defects is much, much stronger than the evidence that says that folic acid supplementation may increase any risk of co-rectal cancer.

16:55So actually, it's not a like for like thing. And it's not even, and the methyl folate versus folic acid, it might change in the future, but folic acid is much more stable and affordable as a form. So adding it to bread is more likely. So it's an interesting debate and considerations, but I can't believe how long it's taken the UK to do it. We're like 30 years behind the rest of Europe, Canada, the US. So here we are. Let's slide over to iodine. You mentioned that iodine deficiency can be quite devastating. What's the amount of iodine that a woman during pregnancy needs and where does that come from, from food or where does supplementation fit in?

17:39So iodine is like critical for brain formation again, which is a bit of a theme here, as you'll see. And it's depending on where you are, it's between 220 to 250 micrograms. And the iodine story is similar to photocastidine that actually supplementation or adequate, not supplementation, but adequate intake needs to begin preconception. and it's really important for maternal thyroid function like thyroid hormones are tightly involved in fertility and then it's required for healthy fetal brain development and to help the babies on thyroid hormone production to be healthy in the future so it's a really important micronutrient and one of my favorite thing about iodine is that if you live by the sea you basically breathe it in from the sea which is so cool So like getting some sea air.

18:32So people, coastal populations have higher iodine levels. And it's in part because they tend to eat more fish, which is a major source of iodine. But it's also because you actually can inhale it from sea air, which is cool. Iodized salt is used in many countries as a way to ensure iodine sufficiency. And it's very effective as well, because people use salt most of the time. Many countries like the UK don't regularly use iodized salt. So you have to go and find it if you want to have it. And many prenatal vitamins will have iodine in them. And it's because it's so critical for this part of brain growth.

19:04The places you can get it otherwise is like dairy, eggs, seafood. Those are the primary ones. And so actually, if you follow a plant-based diet, iodine supplementation becomes quite important. And many plant-based milks and yogurts will have iodine fortified. So they'll be fortified with it. And the third or actually now fourth micronutrient I just wanted to touch on briefly here was omega-3s. Yes. One of my caves. Again, brain. So many brain things. Yeah. So during pregnancy, is DHA and EPA both important? Is it just DHA? And again, how should a woman think about this in terms of how much she requires, what's optimal and way to get that from?

19:48So DHA is super important for brain and eye formation. So DHA is a structural omega-3. It makes the things. EPA is still important as well. And it's very involved in flexibility of your vascular system, things like that. But we have a higher DHA requirement in pregnancy because it's literally used to build the brain and build the eyes. And the recommendations are to meet this by eating one to two portions of oily fish every week. So So that's salmon, mackerel, anchovies, sardines and herring, SMASH, which is an acronym that's used quite a lot for that. And we typically recommend women who are pregnant to eat the smaller fish, because actually when you plot omega-3 and mercury, the little fish with high omega-3 have very little mercury.

20:36So if you aim for the little fish, you're avoiding the mercury and you're getting the omega-3, which is great. so salmon is slightly bigger i would say like mackerel sardines anchovies trout are a good option and the the fish that you want to be avoiding which are also really low in omega-3 are like swordfish shark does anyone eat shark marlin and then listen tuna is not really omega-3 rich and it is higher in mercury but you can have it occasionally it's a good source of protein it contains iodine so i think sometimes people are very anti-tuner they're like it's the devil but it doesn't have to be as long as you're not eating every single day obviously now if you don't eat fish i know there's lots of reasons why you wouldn't especially with the pollution of the seas and everything else there you can get very good algal dha like algal epa dha supplementation so if you don't eat fish though i would really recommend that you do get a good quality prenatal algal supplement and the prenatal part will make sure that there's more DHA, which is really important in this phase.

21:46That's kind of it. So like, again, it's interesting because so many of these supplements are so implicated in the brain formation. And it just goes to show you that it's a very important time and delicate time. And omega-3 supplementation is important right through to the third trimester because a lot of brain growth actually takes days to the third trimester. If someone's not eating fish and they go for that supplement, whether it's fish oil or algal oil, is there an amount of DHA that's clear in the evidence that someone should target? About 300 milligrams of DHA. And then there'll be like plus some EPA in there.

22:24Some of the supplements have 250, which is okay. So like anything between 200 and 300 milligrams of the DHA. And before we leave pregnancy nutrition here and moved into birth and breastfeeding. Is there anything specific that a woman should be doing or focus on with her nutrition in the kind of final weeks to prepare the body for birth? Yeah. So it's a really good idea to make sure, check your iron status before you go into the birth process. If you're worried or if you're slightly low on iron, really try to make sure you're getting enough stores as possible. Speak to your doctor. This might involve some supplementation as well.

23:05Another good thing to think about is your gut microbiome. So feeding your gut microbiome this time is important because it starts to change. Your gut microbiome and vaginal microbiome starts to change to help seed the initial infant gut microbiome. So you see changes both in the gut and the vaginal microbiome to have more bifidobacteria and supporting this by eating plenty of fiber plants. If you eat fermented dairy or fermented foods in general, this can all help. So maintaining a really nice, healthy diet in that sense. At the same time, we don't want to disrupt the vaginal microbiome. So one of the key markers of preterm labor is when there's a vaginal microbiome disruption.

23:47So this could be bacterial vaginosis or it could just be a little bit of dysbiosis that you might not necessarily be aware of, but it's a real precursor. So making sure you have a healthy, happy vaginal microbiome and you're eating plenty of fiber, ferments and different plants is a really good idea. This is also important because many women do struggle with constipation after giving birth. And that is due to a variety of reasons. Of course, if you have any sort of anesthesia or a C-section, it's worse. And by making sure you have a good soft stool before you give birth can really help to reduce the pain associated with going to the new after birth, which is honestly, it can be a terrible experience for some women.

24:29And of course, hydration is important. many women are prescribed lactulose as a solution as well but just keeping your gut healthy and happy beforehand is a good idea there is some fun evidence i say it fun evidence because it's not like it's not necessarily clinical trials but the eating dates before giving birth can be helpful many women swear by eating dates like in the weeks leading up to birth to help stimulate the birth but as i said it's fun evidence as opposed to clinical trial evidence and then And another thing to sort of think about is that post-birth, it's a recovery period from what's essentially quite a traumatic physical experience.

25:07So making sure that your iron replete, that you've had plenty of good quality proteins in your diet and a lot of antioxidant polyphenols from plants just helps your immune system be prepared for the repair that needs to happen afterwards. And the iron piece is just super important to lower your risk of losing blood to a point where might become problematic. How does a woman know if she has vaginal dysbiosis? Is that something you would definitely know about? Can you test for that? And in lead up to giving birth, what can a woman do to support the vaginal microbiome? Yeah, you can test for it. I don't think everybody needs to test for it.

25:46I think women who have a history of vaginal infections, essentially, whether that is thrush or whether that is bacterial vaginosis may want to be monitor it more closely and the interventions that women who don't have a history so who people who just want to try and support this environment as much as possible can do are we talked about the diet piece so making sure that you're eating plenty of fiber ferments drinking plenty of water and the other things are actually quite practical things like wearing cotton underwear so breathable underwear that's really helpful wearing like looser clothing so avoid wearing really super tight leggings that essentially increase heat and sweating in the area other things that are worth considering are like basic hygiene principles so always making sure that you are wiping from front to back so avoid any kind of contamination from the rare passage to the vagina try to avoid using anything that might cause disruption so like some i remember i spoke to the substituent once who just said to me actually i like not having sex at this time is probably quite a good idea just avoid anything kind of disturbing the area in general as much as possible like obviously without ruining your relationship and just keeping keeping that area sort of as as clear don't use any douching any sort of soaps so a lot of the products that are sold for intimate cleansing can actually be very destructive to the vaginal microbiome so washing with water keeping the area dry cotton underwear.

27:18These are the kinds of things that can support a healthy vaginal microbiome. And in terms of timing, how many weeks before giving birth are you talking about here? What's that window? It depends. It's a change from 32 weeks on-ish. You start to see this shift in microbial populations. You start to see changes from then. And the papers that exist looking at, interestingly, they look at vaginal dysbiosis and they look at periodontal disease, so gum inflammation and they're quite strangely connected, which is a whole other topic for another day. But they start to show that when there is this inflammation of the gums and or vaginal microbiome dysbiosis from like first two weeks on, it's a red flag for pre-ten back.

27:59Switching gears to giving birth, you write in your book about the mode of delivery and the infant microbiome. So here we're talking about vaginal delivery versus C-section. and I believe your own second daughter was a breech emergency cesarean. So you've lived this. How does mode of delivery affect a child's microbiome and subsequently their health? What's really interesting about the evidence here is that when you look at the effect of delivery on the infant's microbiome, it sort of acutely, so straight after, they're very different. so an infant gut microbiome that's born through cesarean section has a lot of microbes that are associated with skin microbiome which makes sense because their their first contact is skin to skin and they have less of the microbes that are associated with vaginal delivery so for for a while and actually to this day there are some studies looking at what happens if you do vaginal seeding.

29:04So should we be inoculating babies born by C-section with essentially a swab of vaginal microbiome taken during birth into the mouth, on the face, around the eyes and the nose? So what's really cool about science is that for a long time, when we discovered that there was such a big difference between the two microbiome populations, it was like, oh, let's see what we do about this but actually what's more impactful on outcomes so even though there is this difference in gut microbiome in very early weeks after delivery the health impact after like sort of two years it kind of converges so it's actually the cesarean birth part is likely to the effect of it is likely to have died down by the baby is too so this like this this perceived lack of bifidobacteria seems to be able to converge back to similar to a vaginally delivered baby.

30:04But the big caveat is the factor that actually seems to have much more impact is whether a child is breastfed or not. And if we want to go like one level deeper than that, it's whether the child is breastfed by a mother who actually has the bifidobacteria or not. So more recent evidence shows that actually quite a large proportion of women themselves don't have, don't even have Bifidobacterium phantus, for example, in their gut, and therefore their breast milk doesn't have it. So does being born C-by-C section put you at lifelong disadvantage? Not really. Like actually, the evidence shows that the differences there, they're not very interesting.

30:49What does make a difference though and the difference is we can like outline exactly which one's strongest right the strongest difference between a baby who is breastfed from birth and one that is formula fed exclusively from birth is an infection risk so what like the clearest evidence we have is actually that babies who are breastfed have a lower risk of upper respiratory infections ear infections and gastrointestinal infections in the first two years in the first two years yeah But if you go out beyond two years in the literature, is there any signal that someone born by C-section would say have a higher risk of allergies or getting sick later in life?

31:33Not really. So the C-section, the impact of delivery isn't that powerful later in life. Whereas when we look at mode of feeding, later in life metabolic health is slightly different between babies who are breastfed and those who had formula FN. And this has also been replicated in studies where they compare in families, because there's so much confounding with this research, right? It's all association. And so there's been some really elegant studies that have looked at same families, so same socioeconomic status, same parents, same education level and siblings who are fed differently. And you see a difference in metabolic health outcomes between the two.

32:11The actual difference is like a 15 % decrease risk of obesity if you're breastfed, which is a relative. So it's like, it's not a big risk. It's real, but it's not like, oh my gosh, this is transforming someone's metabolic health forever, but it adds to a risk. So if you compare them, there is clearly a signal there that persists when you're just for confounding. Now, the smallest signal is the one that's most talked about in the press. And that's the cognitive IQ effect. So actually, the least exciting difference, or the least noticeable difference is in IQ. There is a couple of points difference between breastfed and formula fed babies within the same families, a couple of IQ points.

33:02So that's unlikely to have an impact on your life, basically. Coming back to the importance of the mother's microbiome and the presence of particular bacteria, bifidobacterium, which I think you mentioned is thought to be driving some of those benefits that occur with breastfeeding. Is that something that a woman has control over? Okay, before pregnancy and during pregnancy, can you supplement with bifidobacterium? Is there a way to colonize the gut with that important microbe before delivering the baby and before breastfeeding? This is quite a new problem that's appeared in a cohort analysis led by, his name just skipped me, it'll come to me later, the gut microbiome scientist who discovered Acomantia, I can't remember his name now, Professor Vildavos, he discovered this.

33:50And supplementing could be a route. So there could be a world in which you could supplement with Bifidobacteria infantis to impact the gut microbiome of the mother and then the child. Direct supplementation of the children is also something that could be done. So there are, you can't get probiotics. The difficulty is that most women don't know whether they have it or not. So unless you're testing for it and then supplementing, which some women are, it's kind of more of a question of why is this happening? Why has this been this mass reduction in one of the most important cornerstone species. Exposure to human milk oligosaccharides, which are the natural prebiotics for these bifidobacteria strains, can be really helpful in reinstating a healthy population level.

34:35So in babies, babies can definitely create a situation in which they can support the right bifidobacteria strains. But if the mother's completely lacking, it's hard to know whether dietary change alone could influence that in the mother or whether you would have to supplement probiotics. I've taken creatine daily for years now. On a plant-based diet, you start from lower muscle creatine stores than someone who's eating meat. So it's one of a few supplements that I feel really adds something to my diet. And the evidence on strength and power is about as solid as it gets when it comes to supplements with emerging data on cognition, which raises a question that most of us never ask.

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37:37That's P-R-O-L-O-N-L-I-F-E.com forward slash the proof to claim your 15 % discount and your bonus gift. prolonlife.com forward slash the proof. And talk to us about how breast milk, I guess, is distinct to formula. Because I think some people might be thinking and perhaps have seen marketing that infant formula contains prebiotics. It contains probiotics, bifidobacterium, for example. And I think in your book, you were, you're pretty strong in your position with regards to being, I think you might've even said it was irresponsible to encourage women to use replacement formula unless it was absolutely necessary.

38:24So can you just explain to us what the research shows in terms of breast milk versus formula, specifically with regards to outcomes? So with regards to outcomes with breast milk, the most stark difference is in infection rate. So babies who are breastfed have a much lower rate of infection from gastrointestinal infections to ear infections, upper respiratory tract infections. They tend to be babies who are less sick, essentially. And this is so impactful that in neonatal intensive care units, babies who receive breast milk are at lower risk of necrotising enterocolitis, which is a very serious problem in preterm babies where part of your gut dies, essentially.

39:10And it can result either in quite severe bowel resection or death. So this is big effect in terms of protecting the gut and other areas of the body from infection. That's the biggest one, the biggest signal. There's a signal that, so there's a very strong role for breast milk to play with our immune system. So we do also see that babies who are breastfed do have lower rates of asthma, atopic eczema, and these kind of common allergies. Then the second strong of the signals is on metabolic health. So we see this difference, this reduced risk of metabolic dysfunction, whether it's obesity, overweight is what people tend to look at, is reduced in breastfed infants right into adulthood.

39:52And then, as I said, there's this very small signal, which is much smaller, which looks at IQ and cognitive performance. And it's actually not that big between the two. So I think it's really important that we get this right because the science is pretty strong on breast milk versus formula milk. But guilt is so big for mothers. So it's like, this is one that we need to, I think, be really mindful of. The first thing to say is that formula milk can absolutely feed, nourish and help a baby thrive. So formula milk babies grow to be healthy adults and they contain standardized amounts of the macronutrients to reflect breast milk.

40:34So about 80 % water, mostly carbohydrates, fats, and then proteins in that order in terms of how much there is. So that's really important to say. Modern infant formula is engineered to match that in terms of macronutrients. But what they can't do is actually recreate the living system that is breast milk. Breast milk is not just nutrition. It's like an entire living system. There's so many components to breast milk from the human milk oligosaccharides. Sure, some formula companies have actually managed to sequence and put some in, but there are hundreds of them that are found in human breast milk.

41:10We haven't necessarily even classified them all. And they are there purely to support gut microbiome growth and assembly. So human milk oligosaccharides aren't digested by the baby at all. They are there just to support the assembly of the gut microbiome. So why there's this strong effect on gut microbiome and immune system function is purely because of this. Then you also have enzymes, hormones, you have varying levels of vitamins and minerals, you have different antibodies. So the breast milk contains antibodies that reflect what the mother has been exposed to in terms of infected agents, pathogens.

41:51so if you're holding your baby and you're a breastfeeding mother and you go into an elevator and someone sneezes all over you with some nice virus within two hours the antibodies to that virus are in your breast milk for your baby to protect him or her so it is not just food and that's where it's really hard to compare them right because when you think about them as just food they both do the same thing and that's why it's important to say formula feeding is absolutely adequate for a baby to thrive and grow. But current formula milk formulations just haven't come close to recreating. And I don't think they will because every feed, every breast feed changes throughout the feed.

42:34Each feed is different day to day and breast milk changes considerably from the first month of life, second, third, fourth, fifth, sixth. Right. How can you replicate that? It's impossible to replicate that. It's a living system. Yeah. But it doesn't mean that breast milk is perfect. And actually, if we want to talk about formula milk having a benefit, it's that it contains vitamin D. And so, for example, like it's already fortified with certain nutrients that we know are important for baby's health. And you don't need to think about it if you're formula feeding your baby. So I'm really not anti-formula milk at all.

43:08It's just the way that it's marketed I have a problem with, because I don't feel that the marketing around formula milk, which is allowed to happen, gives parents an informed choice on what they're doing. And when you combine a big advertising machine that exists for formula milk with a lack of support for families, lack of parental leave, lack of dedicated, specialized, like breastfeeding education, then that is not a level playing field, Simon. That's why I get annoyed about it because it's just not fair to do that to parents and just to pretend like they're the same. They're not. I think you mentioned it in your book or to me that the UK has one of the lowest exclusive breastfeeding rates in the world.

43:55It's hilarious. I was shocked. Yeah. Is it 1 % at six months? Is that right? Yeah, that's the 1%, yeah. Right. So if I'm hearing you correctly, your point is that through marketing, there is a misconception likely out there that these are like for like. And as a result of that, many women are opting for formula when they could continue with breastfeeding. It's a different story for someone who can't breastfeed for whatever reason. But it sounds like what you're talking about is the person who could breastfeed, but is exposed to this giant marketing campaign from these big companies and is kind of left feeling like, well, this is going to give my baby just as good an outcome.

44:47I'm just going to switch early. Yeah. Or they might not even try to breastfeed at all because in the same breath, due to the lack of support and due to the lack of education, breastfeeding feels extremely scary because you don't know what you're going in for. Pretty much anyone knows how to make formula milk. It's like you see it in adverts. You see it on social media. yeah, it's like, it's easy, right? It's so easy. And then, so what happens is that some women are like, I'm so terrified of breastfeeding because it's a mysterious nebulous thing that sounds really hard and takes hours and can be painful and da da da da.

45:23So with a lack of support and a lack of, as I said, expert intervention to actually teach women how to breastfeed, coupled with the advertising machine that during the pandemic, actually, one of the companies got into trouble with the Advertising Standards Agency here because you're not allowed to market infant formula, which we should beg the question, why, right? Why is it not allowed to be advertised and marketed? Because the health outcomes are so different and because actually the WHO and other health organisations have said we need to help support people to breastfeed if we want to improve health outcomes for mother and for baby.

45:59We forgot to mention that breastfeeding helps to lower risk of breast cancer as well for the mother. So there's benefits to the mother too. It also helps to maternal weight to return to pre-pregnancy weight more quickly. So there's lots of benefits for both the mother and baby. So it's illegal to market infant formula. So instead, the formula industry created follow-on formula and markets that really heavily because it's not for infants. It's follow-on formula. It's exactly the same product. It's entirely unnecessary for a child's diet. In fact, it's one of the most harmful food products that exist.

46:33It's the highest sugar food that exists designed for toddlers that is sold in the UK. The highest sugar content. So it's just not a very nice industry, I'm afraid to say. Formula itself is necessary and helpful. It is an option, an absolute option to feed your baby. But it's just unfair how there's this element of perceived informed choice that isn't informed choice. And it's also not supported choice because maybe you want to breastfeed, but if you only get three weeks off for maternity leave, how on earth are you supposed to breastfeed? So it makes me very angry, Simon, as you can tell. No, I think rightly so.

47:17Is that the difference between a country like the UK and Sweden where breastfeeding rates are much higher? Is it the support and the kind of structural differences? Yeah, exactly. So I think where the anger should go isn't to the mothers have parents have enough on their plate it's not about individual choice being incorrect it's the structural it's the system that isn't supporting an informed choice that's pro-public health so we go back to this idea of like is it set up for public health or is it set up for profit and again in this case it is very much set up for profit and the profit of the formula industry in this case and when we look at sweden but also when we look at countries like Kenya, where public health intervention literally pushed to increase breastfeeding rate, because in countries that don't necessarily always have access to clean water, formula feeding can be dangerous, right?

48:11So in those countries where there was a real concerted public health effort to increase breastfeeding, because it was so much safer, the rates are like 96%. And women, it's the normal thing to do to breastfeed your child up to the age of two. and women support each other there is also culturally much more acceptance for women teaching each other how to breastfeed and you know even something that now in countries like the US and UK we might be a bit like oh that's a bit odd but culturally we used to breastfeed each other's babies so if like you needed a rest and your mate your friend or your sister was also breastfeeding you would just sort of you know give her a rest all of that has gone so breastfeeding is so foreign to so many of us.

48:52I'll never forget when I was breastfeeding, my mother-in-love, who I love, Simon, she was very confused because she was told when she had her children that formula feeding was the best medical solution and that's what she should do. So she never breastfed. And she was like, do you have to clean your breast? I was like, no. And it's like, she just had no idea. She just didn't, she had no exposure or experience of it. And so she was like, do you I was like, no. And it just goes to show you that when there isn't structural support, when we don't make an effort to make breastfeeding and looking after your children and raising them, if that's not a priority at societal level, it doesn't really work.

49:36Denmark, Sweden, these countries that have shifted, Germany actually has made huge leaps, shifted the narrative. And you start to see breastfeeding rates go up. And you start to see that families don't struggle as much when it comes to raising a family the birth rates are going back up so it is a structural it's a decision that has been made yeah i also have to think that some of the the pressure that that women feel to kind of quote-unquote bounce back could also play into this a little bit yeah i mean now that whole area is really scary because lots of players try to play on that pressure so i've seen adverts for GLP-1 receptor agonists targeted at women postpartum.

50:21Not a good idea. Please don't do that. And so I think there is also this narrative that, you know, as women, we grow the baby, we push the baby out, and then we just get back to it, sort of back to work. And actually, again, who is that benefiting? And I love my job, and I wanted to go back to work quite soon and balance that. But if you're being forced to go back to work, or if you feel like you have to, it's only benefiting the productivity of the company it's like again we know that one of the most important factors for a healthy brain we've talked about omega-3 and choline and all these wonderful nutrients but actually when we look at the developing brain in a child which is fascinating because just the sheer density of synapses and the size of a baby's brain is ridiculous it's like 80 percent of adult size by the age of three it's huge brains these huge heads and these tiny babies.

51:08We think about all these nutrients, but actually the single most important factor that predicts good mental health and school performance and a child's ability to learn is the nurturing environment they grow up in. So if you really want a public health intervention that will improve the health of the future generations, you will support parents to spend time with their children and be able to focus on creating that nurturing environment and actually have the tools to do that and have the tools to breastfeed if they choose to. And if they want to make a decision between breastfeeding and formula feeding, if they have a choice, some families don't have a choice, then being able to do that in an informed way.

51:46And I guess there are some cool innovations coming down from microbiologists who are trying to create probiotics that are actually like they replicate human breast milk microbiome signature. So in the future, Simon, we might actually have formula milks that are closer to being similar to breast milk. And that's great. But what's still missing is the structure that actually supports parents and young families to make informed choices, to understand the health consequences, what to do, and also to create an environment that actually supports a baby's development. Some food for thought for all of the business owners out there that put together the leave policies.

52:32Yes. I mean, the US is shocking. I'm always shocked. Yeah. Well, I think you're right. I think you're hitting on a very important point that a lot of our kind of professional settings don't necessarily respect this biology and the importance of it. No, they don't. And at the end of the day, you might be somebody who thinks that's not your problem because it's not your child and you didn't want the child. But the uncomfortable truth is that if we don't have children and we don't have young people to be our doctors when we're old and to be our nurses and to run the towns and like if we want to survive as a species we do actually need to have babies and so whilst there's lots of reasons why people don't want to have babies at the moment and one of them is this lack of structural support we should really be pushing for that choice to be easier for those who want to have babies and if you don't want to that's absolutely fine.

53:25I would say that if you don't want baby's keys don't have them because you're probably both going to have a terrible time. Most people don't think about brain health until something feels off. Personally I'd rather look at the data while everything's functioning fine. That's part of why I use function. It gives you access to a set of tests you'd otherwise chase across several appointments. Two markers I pay a lot of attention to, omega-3 index which reflects your EPA and DHA status. DHA, of course, heavily concentrated in brain cell membranes, and homocysteine, which is consistently associated with cognitive decline risk.

54:01Both of these are modifiable, which is the point, measure, and then intervene. Members can also add on tests like APOE, the genetic test for inherited Alzheimer's predisposition, if that's something that you want to know. None of this, of course, replaces your doctor, its information, a more comprehensive a view of what's going on inside you so the conversation starts from data rather than guesswork. Check your health the way that I do. Function provides more than 160 lab tests for$1 a day and member pricing on advanced imaging. Join at functionhealth.com forward slash Simon Hill and use the code Simon25 for a$25 credit.

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55:23It's not a health product, obviously, but the mental load of holding a household's logistics in your head is underrated. And if you're not thrilled after four months, send it back. Full refund, no questions asked. Families are better when they're working together. Right now, Skylight is offering our listeners$30 off their 15-inch calendars by going to myskylight.com forward slash the proof. Go to myskylight.com forward slash the proof for$30 off your 15-inch calendar. That's myskylight.com forward slash the proof. you mentioned breastfeeding up to two years i think or two or three years you may have said what's the kind of guideline recommendation around optimal time to to breastfeed is it six months is it going beyond that to 12 to two years what does that look like so it's the first six months exclusive breastfeeding so nothing else just breastfeed just breast milk and then after that it's breastfeeding up to two years with complementary feeding that's the minimum recommended by the WHO.

56:30So many people see the six months exclusive as the deadline for breastfeeding, but actually that's just the exclusive breastfeeding piece. Complementary food and breastfeeding are supposed to continue till the age of two. And the reason why these recommendations were made is for the immune system benefits that you see. So there was continued value to breastfeeding beyond six, 12 months, right up to two years. Beyond two years, there is still benefit. it doesn't stop being this incredibly interesting live organism. It's just that the nutritional requirements aren't supported by the breast milk after that age.

57:03So it becomes less impactful, I would say. But there are women who will breastfeed till three, four years of age, and that's still going to be supporting their immune system and the gut. But most women will stop well before the age of two. Is there any data on the length that a woman breastfeeds for and her long-term health? Yeah, so the data is that basically the more you breastfeed, the more you lower your breast cancer risk. And of course, if you breastfeed, you can still absolutely get breast cancer. I just want to be clear this is like relative risk decrease. So literally, it's a dose response curve.

57:40So the longer you breastfeed your children for, the more you lower your breast cancer risk. Ovarian cancer has quite a similar relationship, but less strong. So yeah, for women, there is a benefit to breastfeeding for as long as possible. And in the UK, so it's six months, about 1 % of mothers are still breastfeeding. And you mentioned there the follow on formulas being very high in sugar. And I think another fact in your book was that infants under the age of two are getting as much as 69 % of their daily calories from ultra processed foods in the UK. So talk to us about weaning. And when you're adding these complementary foods, what does ideal look like?

58:24And then how is a country like the UK going? And are all of those ultra processed foods a problem? Weaning looks like introducing foods in a family setting. I think this is the biggest thing I learned working with families is what we're missing often is actually just the convivial part of eating. So children have to learn how to eat from their adults, from their people that surround them. And the way to think about weaning is just whatever you're eating, give your baby some, it has to be age appropriate. So the biggest things to think about is like no small round balls, no really hard food. And you can find out like how to understand age appropriateness.

59:05The smush test is my unofficial way of doing this. So if you've boiled a broccoli or a carrot if it smashes between your fingers you did a good job and you know there's different ways of weaning that there's when you get into it there's quite a big fierce debate about baby led weaning or spoon feeding and there's actually been trials on this now which i'm laughing but i shouldn't but the reality is that most people do a bit of both so you basically end up if you're making like a puree for your child and it's got broccoli and some carrots and sweet potato, you will take out, before you blend it, you take out a bit of broccoli, a bit of sweet potato, a bit of carrot, let them finger feed those, and then still give the puree as well.

59:45So the difference between the two is actually quite interesting. So I think it is a good idea to do both, but also you'll find that children will gravitate to one or the other. So some babies just love spoon feeding and some babies just love baby-led weaning. So it depends. But the trials that have been done show that the baby-led weaning babies are slightly better at appetite control. So they respond more to their fullness cues because they're not being fed. So they will literally stop as soon as they're full or as soon as they've had enough. And there is some data to show that those babies who have more baby-led weaning have slightly better self-regulation for appetite later.

1:00:23So they're just better at knowing when they're full. But on the flip side, spoon-fed babies tend to have slightly more nutrient density. So they get a bit more nutrition because they eat what they're given. So there is no clear winner. Both of them have their benefits. And I would say do both. What to eat. So the core nutrient that starts to deplete around six months when we introduce foods is iron. So having plenty of iron-rich foods in the diet is important. But that is a consideration to make. So you want to introduce pulses and lentils. You want to make sure you're adding a source of vitamin C with those for the absorption.

1:01:02Oily fish, meat and chicken and eggs, a variety of foods, as much as possible. And really, the trick is, the key is to expose your children to as many foods as possible. Acceptance of flavour and of foods can take up to 12 exposures. So many parents will say, oh my gosh, I gave my baby a parsnip and she hated it and I'm never going to give them a parsnip again. And actually, that's not doing them a favour. Repeated exposures result in acceptance a lot of the time. So it's between 8 and 12 for a lot of foods, especially bitter foods. So don't be put off by your child having an opinion on broccoli.

1:01:41Actually, just expose them again and see how they get on. And then repeated exposure is likely to get them to accept. They will accept it. But actually, I quite like this now. Now, one of the problems is that there is a real fear of choking in this population. And the pouches that are sold and the melty sticks and these kind of snacks that are sold as ultra processed foods play into this fear, right? So parents feel safe when their child has a very homogenized, super pureed pouch because the risk of choking is negligible. But actually, what we know is that baby's gag reflexes are really good. so they will gag that food out before it becomes a risk of choking now as i say this i want to like there are some children that have problems with chewing and may need extra support so if you know of course there's always variations to this but generally speaking if your child is at the right age so they are able to sit upright and hold their head up critical a lot of parents try to dive into feeding a bit early and if a baby still isn't quite able to hold their head up the chances that that food won't go down the right way is higher.

1:02:47So really having that head support is a really important marker for readiness. And as long as you're cooking the food thoroughly and you're presenting it in the right way, as I said, no hard balls, nothing that's sticky. If you're serving meat early on, it's better to puree or blend it because it's too chewy. Then the risk of choking is really low and eating whole foods is absolutely necessary for a healthy weaning process. so you know the recommendations by the who by specialist feeding groups like first nutrition for example is really to only serve whole foods to babies so they don't need any of these food products baby rice baby oatmeal baby biscuits baby pouches like these are all products that have been created for profit they are not essential for baby weaning in any way shape or form and i think that's really important to hear.

1:03:42So there is no pediatric or nutritional recommendation for these food products. They're just products. And unfortunately, they've become so pervasive. And I think the UK might be one of the worst places for this, that we know now that babies and toddlers have a really high consumption of these ultra processed foods. But the really sad thing is, is that parents are choosing them because they're marketed as being a healthy choice. So there was a big survey that was done as part of a BBC Panorama program that was a big expose on baby pouches. And they found that many of the pouches also had negligible amounts of some of the key micronutrients for growth, like iron, like vitamin C.

1:04:23So they were advertising standardized nutrition information, which actually wasn't reflected in the food products when they tested it in independent labs, which is a problem. But also when speaking to parents who are surveyed for this, they were so clear that they were like, why is this allowed to be sold as safe for my six-month-old baby or like a good option if it's not? So where is the policy and where the regulation for how these products are allowed to be marketed to parents, right? It's a very vulnerable phase of life. You want to do the best you can for your baby. And if something is marketed as being great for first tastes, a complete meal, source of nutrients, then you're going to opt for it because you want to do a good job.

1:05:01And so there's a lot of deceit. It's a bit like the supplement industry. But as you say, given this is such a vulnerable population, if parents are buying these pouches for a lot of their child's nutrition, you would expect, and this doesn't happen, at least not in countries that I'm aware of, you would expect that every batch of that food, because when you turn a pouch around, it'll have a lot number or a batch, you would expect that every single batch is tested for the micronutrients and even if they're going to claim like DHA and EPA so that there is like a third party that's actually substantiating and saying you know what this company is actually putting these ingredients in and they're not just claiming it and then producing a cheaper product.

1:05:47Yeah or like the way they've processed this food hasn't completely obliterated anything in it exactly that's something and it is shocking and you think that that doesn't happen. So that is why the recommendation for all parents is to feed your baby whole foods. Remember to include a good iron sauce, right, in the meals and eat with them. So learn, as I said, it's a learning experience for them. Children are supposed to make a mess. They will put their hands in it. They will put it on their face. They'll put it on their hair. That is part of learning about food. It's so important that we remember that play is a part of learning.

1:06:23And so this idea that you have like a perfectly dressed baby with like eating with a perfectly little spoon super neatly, like children need to touch things, feel things, smell things. They want to know what happens when you drop a spoon. That's actually like a really cool way that their brain learns about spatial awareness, basically. And it's infuriating because you're putting a spoon on the little table and then they're going on the floor. But when you realize that this is all learning, the brain is forming synapses every time they squish a broccoli, every time they flick a pea, synapses are building.

1:06:55Then you say, okay, this is actually, this is cool. Like my baby is learning all this stuff as they go. And so see food as a learning experience. See it as a bonding experience, like an actual shared experience. Make sure you model eating. So when you put a plate of food in front of a baby, they're like, okay, what do I do? Like, no, seriously, it's not a joke when you say that children learn faster when their caregiver literally like takes a piece of a pea and goes, mmm, yummy. And like, enjoy your food in front of your children. Model the behavior that you'd like them to have. So if you want them to like try food and show you that they like it or show you that they don't like it, model that behavior.

1:07:36Yeah. And I know that we're talking about, like we're not talking about nutrition right now, but one of the most fundamental parts of weaning is learnt behaviour around food. It's fundamental. So if you're making, I don't know, say for dinner, you might be making yourself a stir fry. Okay. And it's what you and your partner and maybe other children you may have in the home are eating. Like make your baby part of that experience. Give them a little bit of the stir fry veggies in a safe way for their age. Give them a little bit of the noodles chopped up. Let them be part of it. Reduce the salts if you're putting loads of soy sauce on it because babies' kidneys are not equipped to deal with loads of salt yet.

1:08:16But it's a learning experience. It's a convivial experience. Make sure that you treat it that way. And in the early parts of weaning, children are actually more open to trying lots of things. So don't be scared and allergens are important. Of course, we can't really talk about weaning without touching allergens. I think what's really exciting is that science on this has come on incredibly. So the LEAT trials, the EAT trials, we now know that early exposure to allergens reduces the risk of allergies, which is amazing. So when you're introducing food at six months, offer peanut butter, offer fish, offer shellfish, offer eggs, offer wheat.

1:08:55make sure that you're exposing your child to a variety of allergens letting them try it several times so that they know that it's a safe protein in their gut and this is the gut microbiome working its magic once again so all of these way you can literally reduce the risk of your child having a soy allergy or a peanut allergy by just exposing them to these foods earlier in life caveat there is of course if you have an allergy yourself in the house and it's dangerous don't do it but there is so much data now to show you that this early exposure to allergens helps reduce allergies later in life i mean that is i think that's so cool that we know that now and your emphasis a couple times there on iron is that because the the level of iron in breast milk goes down half of six months no so breast milk does have iron it has iron as lactoferrin and it's lower than formula milk.

1:09:49So formula milk has iron added to it in a different format. Lactoferrin is lower, but lactoferrin is also highly available. So it's very easy to absorb in the gut. So actually it's because babies are born with iron stores. So having an iron rich diet during pregnancy or being iron repeat is important for those stores. And it's just that by six months, they start to run out. And the best way to make sure babies get enough iron is through food. They can't get all the iron they need through formula milk or breast milk alone. As simple as that. But it's because their stores are running out. And you mentioned heavy metals before when you were talking about fish.

1:10:25Yes. I don't think we can talk about the first thousand days of life without at least touching somewhat on environmental exposures. I know that you're pretty passionate about microplastics. Talk to us about this. How worried are you about microplastics during the first thousand days of life period? The problem we have, Simon, is that babies born today are exposed to an environment that has never been seen before. So the amount of plasticizers, so it's not just the plastic itself, it's the chemicals that are used on the plastic to make it bendy, to make it hard. And then other endocrine disruptors that exist as plasticizers, plus the environmental pollutants such as PFAS, the forever chemicals.

1:11:09We're living in a soup of these chemicals, unfortunately, now. So babies born today have this exposure that we just have never seen before. And we don't know enough about it. I guess there's like two big points to make because it's a huge topic. So I'll try and keep it concise. Microplastics themselves are bioactive. So we know that they do interact with, for example, with our gut microbiome. We don't know exactly what the actual plastic does, but it's just with any kind of novel foreign body, we know that there's an interaction. The different chemicals, so the different endocrine disruptors have different effects and actually they're better documented.

1:11:41So for example, we do know that phthalates in the first trimester can impact actual health outcomes in the babies. One of the most famous ones is that phthalates exposure in male babies, male embryos, between the 8 and 14 weeks, the very closed window, can impact the formation of their genitals and actually change their fertility later in life. So there's some science on very specific exposures and how they impact outcome. PFAS is another one which has pretty strong science suggests that exposure before pregnancy during pregnancy can lead to some pregnancy complications including small for gestational like small babies and preterm babies but we just it's just everywhere so I think there's two pictures stick it there's a big picture the macro picture where we need to start to ask questions about why is so much plastic being produced like we need to turn the tap off telling us to recycle at individual levels is like blooding a city and telling people to use buckets to throw it out of their house.

1:12:44It makes no sense. Like we need to turn off the tap. And there are other materials that are available. I mean, you might also remember a time when we used to just get groceries in a paper bag and take them home and not everything was wrapped in plastic. But then I guess for the audience is like, what can I do as an individual to reduce the exposure to these chemicals? And actually, especially in the first thousand days, the clearest win is to reduce exposure through feeding. So what does that mean? So for example, like propylene bottles, so your classic plastic bottles that are used for formula feeding and also used for express breast milk, when they're heated up, they can release, I think it's like 16 billion microplastics per litre.

1:13:26So that's a huge amount. But the simple solution is to, if you can, switch to a glass bottle or a stainless steel one, they do exist they're a bit harder to find or even simpler heat the milk up because actually it's important to say that heating up formula milk is important formula milk is not sterile when you make it up into a feed so heating it up to 70 degrees kills any pathogens that you don't want your baby to ingest but heat it up in ceramic in glass in stainless steel and then once it's cooled you can transfer it to your bottle your plastic bottle to feed your baby so there are some simple, they're just heat and plastic aren't friends.

1:14:04So like also don't heat your food in the microwave in a plastic tub, like try to heat it up on a plate or in a glass container. And as much as possible, if you have products that are plastic, but could be wood, so your spatulas, your spoons that you cook with, even your drinking cups, if you can switch them to a material that is not plastic, so therefore it also doesn't have the plasticizers, it doesn't have the phthalates, It doesn't have BPA. It doesn't have all these things. It actually just helps to reduce our exposure. And I think the science is showing us that just reducing that soup is helpful.

1:14:40And in the first thousand days, it can have measurable impacts. So those are the key considerations. We know that there's plastics in the placenta, plastics in our brain. So plastics are sort of everywhere. And so the next thing is A, put pressure on governments to just reduce the actual production and b so find alternatives and we can do that as consumers by asking for better solutions and b as individuals where you can reduce plastic do if you're buying clothes for example that are mostly made up of plastic fibers can you buy cotton can you buy other materials that are natural if you're as i said using mostly plastic utensils can you switch to something else so it doesn't need to feel like a black hole of overwhelm but there's some really key little changes that you can make and the heating your food or heating drinks in plastic is like the easiest lever that we can pull.

1:15:32Did you speak at the House of Lords on this? Yeah, I did. So there's a group of us and it's called Plastic Free Babies. And we're just working as a group of experts to try and push the government to actually make a policy to reduce the amount of plastics that are released into our environment. So this is a global effort. But if you want to find out more, you can look up plasticfreebabies.world and you can sign a petition. You can write to your politicians. And there's also information on how you can reduce plastic and endocrine disruptor exposure in your home and in your life. So it's not our fault that there's so much plastic around.

1:16:09So it's not an individual problem. But there are some things that we can do as individuals whilst also asking for systems level change for just the sheer amount of pollutants that we put into the environment. I've been using WHOOP for over six years, and I can confidently say it keeps me on track when it comes to my sleep and exercise routines. The next generation of WHOOP isn't just tracking your workouts. It's monitoring your sleep quality, your recovery state, and even giving you insights into your biological age. No screen, no distractions, just continuous data on what your body actually needs.

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1:17:22So when you spoke, you were bringing this to the attention of policymakers. I realized that that was not that long ago, but have you received any feedback? Was it well received? What were the policymakers saying about this issue? It's always well received. So what's interesting is working in these groups where we get to speak to the House of Lords and speak to policymakers, oftentimes they're not aware of the size of the problem or the amount of evidence behind something. So, you know, when it comes to certainly the plasticizers and the PFAS, microplastics, as it emerging, we have plenty of evidence that we don't actually need more evidence to act on the precautionary principle that it would be a good idea to reduce this exposure.

1:18:02So it's always well received. And I think the biggest interest is in how we can support the manufacturers that are using alternative materials. So there's some really cool work going on with using mushrooms, for example, to make plastic-like materials. There's some amazing innovation that's happening, but for those solutions to be affordable and scalable, they need a huge amount of investment or just some investment to say, okay, yes, we're going to switch this product. And so the interest is in the solutions being ready to go and to test. I'll give you, we're working with a, I'm not going to name the hospital because it's not official yet, but we're working with one of the biggest hospitals in London who have pledged to go plastic free.

1:18:47So they will be one of the first to have end to end from like preconception, like IVF, through to delivery, postpartum care, plastic free. If one can do it, you know, it's like a domino effect. Once you have a tested way of doing it and you can try and test it, you have a domino effect. And I think that's what's exciting is that people are willing to give it a go and they're keen to go back to a time when plastic wasn't so pervasive. I mean, it's only since the 70s that plastic has become so pervasive. And so it's not that long ago. And we can go back, we can find ways to actually use less plastic, which then needs less pollutants.

1:19:27It means less of these endocrine-destructing chemicals leaching into our environment and affecting our health, essentially. it because don't forget the first thousand days is super sensitive to it but these these endocrine disruptors have an impact on things like age of menarche so like what age girls are entering puberty and getting the first period they have an impact they're also obesogens so you know simon a lot of this comes back to ultra processed foods again which are often the foods that have the closest contact with heat to these chemicals so yeah there's loads of work to be done And there's lots of innovation, but it's really important that people get a bit angry about this and direct their anger to writing to the politician and then making choices in their home of what they can swap.

1:20:12What can they reduce? What can they use instead? And one final tick on that is women have a higher toxic burden of these chemicals, and it's mostly to do with our jobs. So cleaning jobs and beauty parlor jobs are mostly taken up by women and the exposure to those chemicals there is higher. But it's also, we tend to have more beauty products that we use because of societal standards and that's some of the conversation. And so when you look at your makeup, your face creams, your shampoo, your conditioner, there's lots of brands now that actually have reduced a lot of these chemicals. So you can seek those out.

1:20:46And one of the simplest ways to identify if something will have plasticizers and endocrine disruptors is if it says Parfum on the back. So just have a look at that. Reduce that. You'll save loads of money as well if you buy less makeup. And you mentioned that infant formula needs to be heated up and in doing so it kind of sterilizes it and if there's any harmful bacteria, the heat will kill them. But how do you feel about filtering water within the household? Are these microplastics getting into tap water? I would presume that boiling the water doesn't get rid of microplastics. It doesn't know.

1:21:23So filtering your water is a really interesting topic because it really depends on where you live. So different states in the US, different countries have different acceptable levels of PFAS, forever chemicals. So the UK is one of the countries where in certain regions, it's really quite high compared to others of exposure to different hormones. The water system is closed, right? So, for example, in the UK, in London specifically, we have quite high levels of cocaine and estrogen in our water. And that's because of people taking HRT and contraceptive pills and taking cocaine. It ends up in the water system when they urinate, basically.

1:22:00So depending on where you live, your water is going to look different. It's important to say that water is pretty tightly regulated because it has to be safe. so if you can filter your water a reverse osmosis filter will remove pretty much everything including PFAS and then you need to remineralize your water because water also has really helpful minerals in it but I think it's important to to point out that that's not the biggest lever because in most places water is tightly regulated and controlled and exposure levels are well below threshold so I want to reassure people that actually not all but a lot of government agencies do their job Of course, there's areas in the US like Flint where, no, that did not happen and it was a disaster.

1:22:42I have a water filter at home, but they can be expensive. So if you are concerned, you can look up the data for your water where you live and then make the decision based on that. And buying bottled plastic water, however, is not really the solution because the plasticizers from the plastic leach into the water. So filter your tap water. If you're lucky to live somewhere that has natural springs, get it from there. But just remember that food intake, exposures in the home, it's a bit of a pyramid. So try to do what you can. Also remembering that you don't want to stress yourself out to the point where the stress is actually more harmful than these exposures.

1:23:19Well, thank you so much. This has been really helpful. I'm sure our listeners that are preparing to have kids or maybe they're in the middle of a pregnancy or have young kids are going to find this extremely informative and you speak so well on it. So thanks for making the time to hang out with me. And I recommend everyone goes and gets a copy of your book, Everybody Should Know This, The Science of Eating for a Lifetime of Health. Is there anything that we didn't get to or any final message that you want to leave our listeners with? Human biology is super resilient. It's not about perfection, right?

1:23:52So as long as if you're listening to this and you're trying to like put these things into practice, you're probably already doing a really good job. and just trying to think about eating as well as you can, mostly whole foods, plenty of plants, moving outside every day. And then when your baby comes, spend as much time with that baby as you can. Breastfeed if you can. If you can't, don't worry because formula feed works very well. And just use the tools we have in whole foods and in just time spent together as the key drivers and the key levers to like have a happy child essentially. and look for your also like look for your support network we aren't supposed to raise children by ourselves even in like a nuclear family so find others if you have family lean on them if you have friends lean on them and it that truly makes a difference as well to like the experience and the mental health and and the kind of family setup that you have thank you fed is being right there you have it friends i hope you enjoyed this episode if you did and want to stay up to date with future episodes, be sure to hit that subscribe button on YouTube and follow on Apple or Spotify.

1:25:01Finally, thank you for showing up and the effort that you're making to take control of your health. I look forward to hanging out with you again in the next episode.