The first 1000 days: The 5 ways early nutrition determines your future risk of obesity and heart disease | Prof Lucilla Poston & Dr Federica Amati

14:55Dr Federica Amati:And could we talk a bit more about the factors that can influence fertility, the chances of conceiving? And within that, I'd love to pick up on your, I think, very surprising answer to that question at the beginning about the father's lifestyle also influencing the child's future health.

15:15Dr Federica Amati:if we say hormones what's the first thing that comes to mind probably your reproductive system or maybe your thyroid we're going to guess you're not thinking about your gut well you should be it's a hormone factory it produces some of the most important hormones for our overall health like ones that regulate our metabolism appetite and energy levels all your hormones together function like an orchestra, each playing their own part to contribute to a symphony. When your gut health suffers and your microbiome is disrupted, it can throw the whole orchestra off. The good news is that tuning things up is helped by your diet.

15:56Dr Federica Amati:Feed your gut the right variety of plants, fiber, and other key nutrients, and it'll be able to do its job producing and processing hormones much more effectively. At Zoe, we want to help you to listen to and understand your internal hormonal orchestra. Find out more about hormonal health with our free guide. You can download it now at zoe.com forward slash fertility or click the link in the show notes.

16:24Prof Lucilla Poston:Back to the podcast.

16:28Prof Lucilla Poston:Even before the embryo is formed, so this is why preconceptional health is really important, The mother's ovaries can be affected. So the cells within the ovaries, the oocytes, the eggs, if you look at them under a sort of microscope, if you like, or in the laboratory, they have potentially metabolic defects. So they don't work as well as they should. You can show that they have more oxidative stress. So that means they have free radicals. They get damaged by having damaging molecules. So if you're living with obesity, your eggs might not be as healthy as others. And if you look at the early embryo, the same thing.

17:07Prof Lucilla Poston:Metabolically, it can be suboptimally healthy. So you start off with that potential disadvantage. Not everybody, as I say, is going to have that. So don't get too worried about it. But we know that people have looked at the eggs and the early embryos. And I've done this myself in rodent studies. but there's some very good studies from people who've given their eggs and early embryos from IVF for research, which was a very helpful thing to do for us to understand. So we know there are metabolic potential problems, and that's probably why there's a high rate of miscarriage in people who are living with obesity.

17:42Prof Lucilla Poston:So that's part of the problem. Now, the fathers, yes, less understood, but certainly the sperm can be affected by obesity in the father. so that there's good evidence that the sperm again have the free radicals and oxidative stress and the actual genetic epigenome, the genetic makeup of the father's sperm can be affected, the actual health of the genes in the father's sperm. And again, studies in animals have shown unequivocally that if the father is living with obesity himself, then it can have an effect on the health of the embryo. I think we should emphasize relative risk. So, you know, there is an increased risk, and that risk might be small or greater depending on yourself and your fitness and your health, you know, but there is a risk, increase in risk, yeah.

18:29Dr Federica Amati:I'm guessing for the fact you're talking about this, though, this is not like this just changes this by 1%. This is quite a meaningful...

18:34Prof Lucilla Poston:Yeah, it is a meaningful change, yeah.

18:35Dr Federica Amati:Is the only thing that matters before conception, you know, whether or not I'm overweight, or is there more to do with the quality of my nutrition?

18:43Prof Lucilla Poston:The other most important thing is folic acid intake. And so I'm very pleased to say that our government here in the UK has now followed America and Canada and a lot of other countries in now putting folic acid into our flour, only at the moment into white flour. But, you know, hopefully it might go across the board in all sorts of flour. But this will help because about 80 to 90 percent of women who are of reproductive age have inadequate folate stasis. so you can measure it in people's red blood cells and there are about 60-70 % of people who have a level of folic acid in the red blood cell which is low enough to cause congenital defects in the children.

19:25Prof Lucilla Poston:This is a massive problem in the UK. Most other countries have had folic acid in their flower for a long time and this problem has gone away to a certain extent but we're only just in the UK getting there so this is very important.

19:39Dr Federica Amati:And I think what this touches on is the fact that we live in a world where we often have too much energy, too many calories, but actually not enough nutrients. So we have this double burden. So we have people who are maybe overweight or living with obesity, but they're not getting enough nutrient dense foods. If we think about where does folate come from in food, it's beans, it's leafy greens. So it's the foods that we're not eating enough of. And luckily now public health has intervened and said, okay, we need to fortify bread, which a lot of people eat every day. But then you have this discord, right, Jonathan, and where you have people who are living with obesity or overweight, but actually their nutrient status isn't optimal.

20:14Dr Federica Amati:And presumably I could be listening to this, I'm not overweight, but also I could not have all the optimal nutrients if I'm looking to conceive. Yes, it goes both ways because the quality of our diet is suboptimal at population level, right? So it does vary with income, education level. There's lots of variety within that. But at a population level, we're not really hitting the mark when it comes to nutrient intake.

20:37Prof Lucilla Poston:In terms of nutrients that we're particularly worried about, one is folic acid. The other two are iron and vitamin D. So those, you know, I was saying maybe you don't need to take multivitamins. The majority of the population would benefit from being aware of the issues about iron and folic acid and vitamin D. But we don't give iron to everybody who's pregnant because they might get iron overload. We have to measure their hemoglobin, first of all. We have a profound amount of anemia in our population of young women, about 40%. So in anemia, if you're anemic and you don't have enough oxygen with the baby and you may be very tired, you may be more prevalent, more likely to have postpartum hemorrhage and things like that, and infection.

21:22Prof Lucilla Poston:So those are the three, the really three important micronutrients to think about before pregnancy and in pregnancy.

21:29Dr Federica Amati:What else could potential parents do if they're looking to increase their chances of conceiving?

21:36Prof Lucilla Poston:A balanced diet is the most important thing. I mean, nutrition, they're just a balanced diet. The other important element is physical activity. You know, you're not suggesting you should suddenly start running 20 miles a day or whatever, but to increase your level of physical activity, because physical activity improves your glucose control. And as we mentioned, one of the most important complications of pregnancy in women affected with obesity is getting gestational diabetes. And we could talk about that because that requires a lot of visits to hospital. It requires monitoring your blood glucose and so on.

22:09Prof Lucilla Poston:So being physically active will help your glucose control. And then when you become pregnant, carry on. Don't stop with physical activity.

22:19Dr Federica Amati:Don't stop with physical activity. No, keep it up. And don't start new exercises or contact sports, right? Don't stop playing football. But certainly keep it up. It's super important. Also, birth is quite hard physically. So being physically active is helpful for that. Not smoking, not drinking. It still needs to be said because there's actually quite a high proportion of couples trying to conceive who smoke and drink. So reducing those is really important, cutting them out altogether. And then there's some evidence around caffeine intake, which I'd love to get your take on, but mostly during pregnancy.

22:50Dr Federica Amati:But if you're like me and you drink four coffees a day easily, you might consider switching that down a little bit if you're trying to conceive so that when you then are pregnant, you can easily have your one cup of coffee a day.

23:03Prof Lucilla Poston:What do you think, Lucilla? I think the jury's out on that, to be honest with you. Yeah, I mean, you see one study saying it's bad and another study saying you might be okay. But it's a stimulant and it's probably anything like alcohol, which is stimulant and caffeine. It's good to abstain, but not complete. I mean, alcohol, yes, but not caffeine.

23:23Dr Federica Amati:Caffeine, one cup of coffee a day. So one thing I'm always conscious whenever we talk about anything to do with pregnancy or breastfeeding or any of these sorts of things is that there's an enormous amount of guilt associated with not being a good enough parent and particularly not being a good enough mother. and there's probably be a whole bunch of people listening to us right now who are already pregnant, who are saying, well, I didn't do any of those things and I'm worried my iron level was too low or I wasn't doing any physical activity. How worried should they be? What can you say to them?

23:56Prof Lucilla Poston:Well, you know, the statistics are you'll probably have a normal pregnancy because we're talking about risk, increased risk. So, please don't panic. But there are things that you can do. And And one of the most important things is just to eat a really balanced diet. Now, I think it's important to recognize you can get inexpensive foods, like, for example, oily fish, which recommended that you should eat in pregnancy. There are some expensive oily fish and some very inexpensive, like mackerel. And then if you're living a sort of chaotic lifestyle, maybe you're a single mother, those things will all affect your pregnancy to add on to the problems of nutrition.

24:31Prof Lucilla Poston:So we absolutely understand that. And we've been doing studies in South London recently to try and pinpoint exactly what it is that interferes with a healthy pregnancy. It's not just nutrition, but there are all these other factors. And we in population health need to address these to actually really improve the situation holistically. I mean, in the UK, the government's put funding into community hubs now, which I think are doing a really good job in being accessible by anybody living near a hub. Mother and child hubs we have in South London are extremely good. where advice is freely available.

25:05Prof Lucilla Poston:You can address your worries and have a chat with someone, because mostly you're going to be okay. But it is, of course, sensible to think like there's your baby there and you need to be helping your baby as much as possible, but don't panic.

25:19Dr Federica Amati:I love that we have now successfully conceived in this conversation just now, which is brilliant. I've now had this vision, the fetus is there. And we started talking about misinformation, which is definitely something I wanted to talk about, because there is so much information online now and in social media about pregnancy and what you should and shouldn't do. And there's a lot of contradictory information out there as well. So I'm actually really keen to understand what the latest science tells us. And I think I've just heard something very reassuring about how resilient, in fact, the fetus is and that you don't need to be perfect.

25:56Dr Federica Amati:But I'd love to talk a bit more about what we both know you really do need to make sure you're doing, but also then maybe touch on some of these things that are a bit controversial.

26:08Prof Lucilla Poston:Okay. One of the first big intervention studies I was involved with was to request that pregnant women living with obesity came into a study whereby half of them were allocated to what we call the intervention arm so that they saw a health trainer every week for about 10 weeks. We gave them sensible dietary advice, which was tailored to their personal needs. are saying, you know, in terms of expense and what they were able to do in terms of physical activity and so on. And then the other half just had normal care from their midwives and so on. So the women were very receptive to the dietary advice and they did improve their diets.

26:47Prof Lucilla Poston:Then we looked in the blood samples of these ladies and their metabolism was better. So all things that we could measure like glucose and products of abnormal glucose all were good and went down. So that was very good. The dietary advice was, but we've just been talking about an affordable, healthy diet. There is this misconception that you should eat for two. And we mentioned that before. Absolutely no need to eat for two. In the UK, we recommend that women need just an extra 200 calories in the third trimester. So you don't really need, you say, the baby's looked after very much by the mother's metabolism and the mother metabolizes their own fat to help the energy get to the baby.

27:24Prof Lucilla Poston:And physical activity, which I can't really emphasize enough. There's been a recent collaboration which has put together all of these studies, which was in the British Medical Journal just a few weeks ago, was that physical activity is looking to be a good one to focus that on. And physical activity does help you improve your blood glucose levels.

27:41Dr Federica Amati:At an individual level, I think it's important to remember what we talked about a bit earlier, that physiologically, your body will do everything it can to get what it needs from your diet and from your lifestyle to support your baby's growth as best it can. There's a lot of misinformation online that says, you know, one stressful event in pregnancy will ruin your child or one cookie that you eat will change the epigenome, the genetics of your child. That is not the case. Pregnancy nutrition requires adequacy, not perfection, not optimization. A balanced diet, so it contains all the food groups.

28:15Dr Federica Amati:You have lots of fruits and vegetables. No surprise here, but fiber is really important for pregnancy outcomes. So lots of plants and plants can be inexpensive, tinned beans, frozen berries, and then your oily fish, maybe maximum six eggs a week will be fine. Tofu, if you like it. So just a variety of foods. Try to avoid some things I found in some of the research I've done is that sugar-sweetened beverages can be harmful. So reducing those in your diet, that's the one thing that really… Drink water. drink water. But otherwise, your body, like pregnancy has evolved to support the baby's growth, sometimes at the cost of the mother's nutritional status.

28:53Dr Federica Amati:But so don't worry too much. And as Lucila said, try and get support if you can. If you live in a country where there is support for pregnant mothers, access the care as much as you can. Get that extra input so that you can have a healthier pregnancy. Can we talk a little bit more about how important the time is that I spent in the womb for my long-term health? Because the example you gave was if I'm really small, that there might be this long-term impact. But now you're saying that's not really the problem anymore because our parents are all getting enough calories. Bluntly, why do I care?

29:29Prof Lucilla Poston:Yeah, well, the problem is that all studies, and I've done some myself, show that the mother, when you're in the overweight and obese categories, is directly related to obesity in the child as the child is going up. I mean, it's an extraordinarily strong relationship. What's that about? Because that is worrying. Because if a baby is born large, that baby has a higher risk of becoming obese. So obesity tends to track through childhood and then into adulthood.

30:00Dr Federica Amati:And Lucilla, if the child is born large and has a higher risk of obesity, what will that mean for their health and their health risks?

30:07Prof Lucilla Poston:Then the health of the child later on is likely to be affected by their obesity. So they may get diabetes, they may get more cardiovascular disease. And this has been reported. I mean, observationally, this happens. So if you're looking in the UK at the moment, when children first go to school, about 9 % of them are already obese. And by the time they get to 9 or 10, 20 % of them are obese. And then that tracks through to adulthood.

30:37Dr Federica Amati:If you're saying 9 % of children when they first go to school, they're still at age four, are already categorized as living with obesity. What would that have been like 50 years ago? None at all. Like zero. So it's an immense change. And you're saying that that isn't just because they're being given bad food after they're born.

30:59Prof Lucilla Poston:So it's a combination of, we know from a lot of research that the fetus is very susceptible to extra calories. And so the baby grows. We also know that the baby's brain is very susceptible to those extra calories. And what we think is happening is that the area of the brain which controls eating behaviors seems to be permanently rewired. So that, I mean, not a huge way, but there's very good evidence that this happens. So that area of the brain is called the hypothalamus. And then there are studies using imaging studies with MRI, which suggests if you look at the brains of adults whose mothers were living with obesity, that you can pick up this change in the hypothalamic structure.

31:49Prof Lucilla Poston:So that is, you know, worrying. What you're thinking you might be doing is rewiring that part of the brain. So the child might be born to be more susceptible to eating more or having less satiety.

32:02Dr Federica Amati:I think you're saying that even while I'm in the womb, because of the food that my mother is eating and maybe all the food she's been eating for many years before I'm born, this is actually going to affect the way that my brain is developed. And this hypothalamus in my brain is actually being rewired. And this is going to affect my hunger and therefore how I eat later. And I guess none of that sounds as surprising as it would have done a few years ago as we now see these amazing GLP-1 drugs. Because I'm hearing this and saying, well, this all sounds quite linked. Do we know whether this is playing into this, Lucilla?

32:41Prof Lucilla Poston:When a baby is too much glucose basically getting across from the mother, too much sugar going from the mom to the baby, the baby grows adipose tissue. So it starts getting a bit fat. The adipose tissue is the cells of fat mass. They start producing this hormone called leptin when they get bigger and the more of them. And leptin goes across into the brain of the baby. And this leptin is known to change the way the cells of the brain develop. And this is absolutely unassailable evidence for that. So leptin, if there's too much of it, it can actually stop the neurons in the hypothalamus, in that area of the brain which controls appetite.

33:23Prof Lucilla Poston:stop them growing normally, so they don't get to where they should. So it's the actual development of fatness in the baby, which feeds back to the baby's brain with this hormone, and that can change the way the baby's neurons and cells of the brain develop. We don't always have a mechanism for these things, but there is a mechanism which suggests that's happening. And it does go back to the GLP-1 receptor agonist story, because that's all about hypothalamic control.

33:48Dr Federica Amati:If the mother has too much sugar in her blood, then actually the fetus can end up putting on too much fat in the womb. Then it makes this hormone, you mentioned leptin, that goes into the brain of the baby. That actually means that part of their brain, you call this the hypothalamus, which is around managing hunger, actually doesn't grow properly. So we actually understand now sort of the set of mechanisms. I feel like as a small baby after you're born, we all think like putting on fat is great. It's sort of the thing that you're most looking for, right? When the baby is born, it's actually quite skinny generally.

34:24Dr Federica Amati:And the thing that you worry about as a new parent, I remember is like putting on weight. So why is it that putting on weight here in the womb is a bad thing?

34:33Prof Lucilla Poston:Because the brain is developing. It's at a rapid stage of development. At postpartum, the hypothalamus is pretty much developed. So in utero, in the womb, the fetus is particularly susceptible, the fetal brain is particularly susceptible.

34:48Dr Federica Amati:If a baby is born with a lot of fat tissue, that's not helpful for long-term health outcomes. But also this, what we call rapid rebound weight gain. So when babies are born a bit skinny and they gain a lot of fat very quickly, that's actually also not that helpful. What you really want ideally is for a baby to be born a normal weight for their gestational age, normal fat distribution, and then to track that and not have these random weight gains with more fat tissue because it does then alter their long-term metabolic health. I guess what I'm thinking is a healthy baby is quite a chubby baby, right?

35:23Dr Federica Amati:At least in my mind, you don't expect a baby to be as skinny as you would expect their child when they're older. Is that? That's true. Yeah. There's adequate adiposity. There's like a nice level of roles. You want the roles.

35:36Prof Lucilla Poston:Yeah, exactly. And so what we're seeing is when they first go to school, they've got that fat, which they've probably had all the way through the first two and a half or four years of life. We should look at the diet of children postpartum, after delivery, up to the time they go to school. It's probably the most important time for prevention of obesity. And I don't think most governments have really taken that on board yet. But do you want to go back to diabetes in pregnancy and glucose?

36:03Dr Federica Amati:I think you were saying that having too much blood sugar in the mother's bloodstream is a problem.

36:10Prof Lucilla Poston:So a lot of people who are living with obesity have a risk of getting diabetes in pregnancy. So why is that? Because they haven't had diabetes beforehand. They may have, but generally they haven't. When anybody becomes pregnant, your blood sugar goes up a bit. and that's a really normal response to pregnancy. So your hormones, estrogen and progesterone, all the hormones that go up massively in pregnancy, they actually help push glucose up a bit, basically helps the glucose get across into the baby. So it's a good thing. It's a good thing. Now the problem about that is if you are also living with obesity and you have a large fat mass, then those fat cells will contribute to what we call insulin resistance so what's insulin resistance insulin controls our blood sugar and you and me and everybody but if you become resistant to insulin it means that the glucose in your skeletal muscle in your muscle in your liver in your fat tissue doesn't get taken up into the cells of those tissues enough and then what happens is the glucose stays up in the blood.

37:20Prof Lucilla Poston:So the mother who has got a high BMI, high body mass index, will, when she becomes pregnant, her glucose will go up normally, but then her high increase in fat mass will make her insulin resistant. And that can be enough to tip you over into full-blown diabetes. Pregnancy itself is a risk for gestational diabetes, particularly if you are living with overweight or obesity. We have an epidemic of it at the moment.

37:48Dr Federica Amati:So there's a huge number of people who don't have diabetes, get pregnant, and then while they're pregnant end up having diabetes, which means this very high level of sugar in their blood. And then when you stop being pregnant, you stop having the diabetes again?

38:03Prof Lucilla Poston:Yes, but then you are at much greater risk of getting long-term type 2 diabetes.

38:08Dr Federica Amati:Because pregnancy is really a metabolic challenge, right? You have this naturally increasing blood glucose levels, which as we've just said, is a normal part of pregnancy. But it does put a challenge on your body to then distribute that glucose effectively. And if you're already a bit compromised, so if you're already overweight or living with obesity, then your body doesn't quite have that resilience to deal with that. And I think this is really important when we talk about elevated blood glucose in pregnancy. We're not talking about the odd piece of cake or the cookie, because in women who aren't metabolically compromised, your body will deal with that.

38:42Dr Federica Amati:It's in this much more systemic when your blood glucose is elevated all the time that's when it starts to become a problem and lead to issues like large babies. What can women do to help reduce their risk of gestational diabetes during pregnancy? Well so as we've heard from Lucila I think the biggest thing is to try if possible and reach a healthy weight before you conceive. That's the best way and I know that still around 50 to 60 percent of pregnancies in the UK and the US are not planned. But if possible, if you're thinking of having a baby or you're not using contraception, so you could fall pregnant, it's useful to think about reaching a healthier body weight before you fall pregnant.

39:23Dr Federica Amati:That's the best thing. During pregnancy, as we've heard, changing your diet to be healthier will help with your health, but it won't necessarily reduce the risk of gestational diabetes. The best way to do that is to move, So physical activity, because physical activity directly reduces blood glucose concentration whilst you're moving. And I think this is really important. Often when we think about movement in pregnancy, people think, oh, I'll go for like one walk and I'll be done. But actually, it's movement throughout the day that helps to really regulate blood glucose. And post-meal movement, after a meal, really helps your body to remove that glucose from the blood because it goes straight to the muscles that are helping you to go for a walk.

40:03Dr Federica Amati:is it dangerous to do strenuous exercise when you're pregnant?

40:08Prof Lucilla Poston:Well, you would not recommend strenuous exercise. We did a study of people who went on park runs who were pregnant. Absolutely fine to carry on running. Don't start doing park runs if you've never done one before. But don't feel you need to stop. So anything which is not unsafe, like having a ball or skiing or something, when you really might hit yourself in the tummy. But carry on if you've been doing it before.

40:30Dr Federica Amati:As Lucila said, it's not a good time to start a new activity. Now, if you've been completely sedentary and you're entering pregnancy and you want to change your behaviors, then things like walking, low-impact exercises, yoga, swimming, and lighter weight or body weight resistance are recommended. So keep doing what you're already doing. If you're not doing enough, stick to the things that are safe to do if you haven't done it before, basically. Pregnancy and early childhood have become magnets for extreme advice and fear-mongering. In this episode, we're unpacking what the latest science actually says.

41:04Dr Federica Amati:If someone you care about is feeling overwhelmed by conflicting claims or worrying about what to do, why not share this episode with them? It can help them to focus on what truly matters. I'd like to wrap up on pregnancy by really explicitly talking about what you should and shouldn't eat to maximize the health of your fetus with very clear, actionable advice. When you're trying to conceive in pregnancy, the dietary recommendations don't change that much. It's try to have a mostly whole food diet. So where possible, buy the ingredients as whole foods, whether tinned, frozen, dried. Doesn't matter.

41:43Dr Federica Amati:It can be affordable. We talked about tinned mackerel. We've talked about jarred chickpeas. All these foods are fantastic. Try to aim for a diet that has a variety of foods. Lots of different plants. 30 plants a week is a really great place to start. so you're including herbs and spices nuts and seeds whole grains fruits and vegetables legumes and pulses so if you think about it as a plate jonathan about half of your plate is made up of plants then you've got a quarter of your plate is made up of as complex carbohydrates so whole grains this is your barley your rye your quinoa pearl barley is delicious i love it and all these like lovely carbohydrates complex carbohydrates sweet potatoes and then the other quarter is where you would choose your preferred protein source.

42:26Dr Federica Amati:So that might be chicken, it might be eggs, it might be tofu, it might be your tinned mackerel. Oily fish, three times a week is recommended. Eggs are great, but no more than six a week. So that's like the outline. And then try to choose healthy fats, the extra virgin olive oil, or if that's too expensive, prices have gone up, you can use olive oil or other seed oils, which are healthier alternatives for cooking to things like butter or lard, for example. And we've talked about drinking as well, important that you don't drink any alcohol and important that you have water as your main drink. So really avoiding sugar-sweetened beverages.

43:02Prof Lucilla Poston:Are really important to avoid, yeah.

43:04Dr Federica Amati:So that would be like, you know, the overview. I'm quite cautious with caffeine. So I actually recommend to women I work with that they reduce it right down or one cup a day. But that's a smaller point than everything else we've just covered. What about the paleo diet? I've heard some people promote that that's a really good idea. And I've also heard this recently apparently pregnant women should eat six eggs a day. What are your thoughts on these? So anything like a paleo diet, which excludes entire food groups, is not recommended in pregnancy. I should side note is that if you're vegan and you want to continue with a vegan diet in pregnancy, you can, but you just need support and make sure you're supplementing.

43:42Dr Federica Amati:And micronutrients. What I'm seeing online is so much misinformation about certain foods that you should absolutely be eating in pregnancy. There's this myth that you have to have four or six eggs a day to reach the adequate amounts of choline to have a baby's healthy brain. This is just completely wrong. You don't need to eat that many eggs. About six eggs a week will do it. And there are other foods that contain choline. And as we've discussed, your body's really good at getting what it needs in pregnancy. So if you're a varied diet, you'll get the nutrients you need. And in terms of micronutrient supplementation, I guess, we've talked about folic acid as being the really important one, vitamin D, especially in the winter months.

44:18Dr Federica Amati:Iron, if your iron status has been found to be low. And some women will look at iodine as well. So iodine is another one of these micronutrients, which in the UK, we don't have iodized salt. A lot of other countries do around the world. So you might think about iodine, especially if you don't eat a lot of shellfish.

44:34Prof Lucilla Poston:There is evidence that iodine isn't as high as it might be. But again, if you have a balanced diet, it should be fine. Brilliant.

44:41Dr Federica Amati:I am conscious of time. And you said there's a thousand days and I worry that we're still, by my calculation, we're only at about 280. So presumably the last a thousand now is getting the baby to two years old, which is a period that I only dimly remember with both my children because I was constantly tired. Maybe we could talk a little bit about breastfeeding to start with. How important is that, Lucilla?

45:06Prof Lucilla Poston:It's very important. So for all sorts of reasons, because it helps the baby's immune system develop and it gives the right composition of nutrients in the mother's milk. And the baby doesn't need anything more than the mother's milk in the first few months of pregnancy.

45:24Dr Federica Amati:As Lucila said, the actual composition of breast milk is the ideal combination for babies. It's essential for gut microbiome composition. So a lot of the sugars contained in breast milk are not actually accessible to us as humans. They're there solely to feed the gut microbes in the baby. So there are specific gut microbes that are essential for infant and children's health, and they can only eat these sugars in breast milk. It's fascinating. The amount of microbes that live in it, the specific sugars that are in it, all the immune systems, proteins that go into the breast milk. So for example, Jonathan, if I'm breastfeeding and I get on a lift with somebody with a cold and they sneeze, my immune system will pick up that cold virus, make the antigen to combat it, put it into my breast milk to my baby within two hours.

46:09Dr Federica Amati:Within two hours. Yes, so that the baby doesn't get the cord. That's real. Yeah. That's not. No, it's super important. Super important. So it is essential. Now, I have breastfed both of my girls. I had real difficulty with my first. It's really hard, right? And we don't have enough support for breastfeeding mothers at all. Too quickly, someone will say, well, just give them some formula and get some rest, right? So the system doesn't support breastfeeding mothers. and in other countries human donor breast milk is given before formula milk which makes more sense when you think about it for the baby's health so i think what's really important in this conversation is to point out that a we need to support mothers way more with breastfeeding we need to make it easier for them educate them on some of the difficulties something as simple as adequate latch can completely transform breastfeeding there's a lot of perceived inability to breastfeed So women think they're not making enough milk and they're like, I'm not making enough milk for the baby.

47:02Dr Federica Amati:That's actually physiologically not necessarily true. So women think they're not making enough milk, but they actually are. But this perception makes them stop breastfeeding. So education is really important. Understanding how magical breast milk is for the baby's health is really important. Also empowering women that even if you only breastfeed for a bit or even if you're combi feeding, so if you're breastfeeding and formula feeding, that's actually still great, still better than not breastfeeding at all. That's not to say that, of course, formula milk's replacement is adequate, right? They've been carefully formulated.

47:35Dr Federica Amati:They're very carefully screened and you can't just make up your own formula.

47:40Prof Lucilla Poston:All of them are very carefully screened.

47:42Dr Federica Amati:So they are obviously created to be able to support a baby's healthy growth. So I think also really important to note that if you do formula feed your baby, that is absolutely fine. It's just that formula milk has not yet been able to fully replace all of the benefits that we see from human breast milk. It's just not there yet.

47:58Prof Lucilla Poston:Especially the immune side. Yeah.

47:59Dr Federica Amati:It's fascinating what we know about how much it's sort of feeding your gut and also this link to the immune system. It's really extraordinary.

48:07Prof Lucilla Poston:We looked in the mother's blood, mothers were breastfeeding and not, and found that their metabolism was much healthier when they were breastfeeding. I think it's worth saying, particularly as we were talking about women living with obesity, one of the problems about obesity is actually that it might be difficult breastfeed. It could be that there's a hormonal effect on producing milk. It could be just a physical problem about the discomfort of breastfeeding. Of course, from the mother's point of view, breastfeeding does help weight loss after pregnancy, which is another problem for the mother.

48:40Dr Federica Amati:Intrapartum, so the weight that women gain and keep between pregnancies is actually a big risk factor for women's future health. So if you put on weight for your first pregnancy and then you're not quite able to lose that weight before your next pregnancy, that puts you at higher risk of obesity later in life, which is actually a really important point.

48:58Prof Lucilla Poston:And it increases the risk of problems happening in your next pregnancy. Weight gain between pregnancy is related to more gestational diabetes, more preeclampsia, more stillbirth in your next pregnancy. And this also, this is a preconception health message too, because before the next pregnancy is to regain your pre-pregnancy weight as much as you possibly can.

49:18Dr Federica Amati:So I would like to sort of come to a conclusion now with what should we be feeding babies at the point they move off breast milk or formula? Because I'm hearing all this conversation about just how important the nutrition is for us from the point of like fetus on, what should they be eating? So babies need to be introduced to the healthy, varied diet we've been talking about throughout this podcast. Important nutrients to consider as soon as you start weaning. Iron is one of them. So babies' iron stores do go down throughout infancy. There is iron in human breast milk, and the form that the iron is delivered in human breast milk is really highly available.

49:57Dr Federica Amati:So there's also this myth that human breast milk doesn't provide it. It does. But children do need a lot of iron as they're growing up. So iron-rich foods, beans, lentils, meat, and poultry, and fish, all of these foods contain a lot of iron. So that's great. They need to be exposed to as many foods as possible. So a wide variety of foods. We want them to try vegetables and fruits, whole grains. But, you know, what's wonderful about weaning is that they'll try pretty much anything. So between ages of six months and a year, you can put sauerkraut, you can put all sorts of foods, and the baby will just go for it.

50:33Dr Federica Amati:They develop individual tastes later. So expose them to as much as possible. Spices, don't be shy, put garlic. Don't add sugar or add salt to food.

50:42Prof Lucilla Poston:And don't give them foods which are full of sugar and salt.

50:46Dr Federica Amati:People often say to me, oh, your kids love natural yogurt. How did you do that? Well, I introduced them only to natural yogurt. I didn't give them flavoured yogurt straight away. So be really mindful of not buying prepared products that have added sugar and salt and are marketed as a healthy option for children.

51:01Prof Lucilla Poston:And particularly follow-on formula. Yes. Children do not need follow-on formula. And it is marketed as such. It has a very high sugar content. And then yogurts containing fruit. Natural yogurt is much healthier than yogurt containing fruit because it's full of sugar. And what about all these pouches?

51:19Dr Federica Amati:Because I'll be honest, we pretty much fed our kids on these pouches. As you get a little bit past the weaning stage and you're all busy and you're out, I'm pretty confident I might not have been doing the right thing. So it's absolutely infuriating, right? because these products are marketed as being healthy, ideal for weaning, ideal for finger food. It's absolute BS, right? Essentially, those front of pet claims are there to help sell product. They've got nothing to do with health. And these pouches are mostly water, sugar, and nothing else. There was a big analysis that was done led by BBC in the UK, so like a TV show, and they analyzed lots of pouches, Jonathan, then they found that in the pouches, they didn't even have the nutrients that they claimed to have in front of pack.

52:02Dr Federica Amati:Because you're talking about this is like a pouch that is like says it's an apple pouch. Yeah. Sometimes they say like complete meal, sweet potato and lamb pouch. They're not just the fruity pouches or the flavored yogurt pouches. And they contain preservatives and that have been heated to increase their shelf life. So this is like ultra processed food. Hiding is like the best thing you can do for your child.

52:23Prof Lucilla Poston:Junk baby food. It truly is junk food. Junk food.

52:25Dr Federica Amati:And should I therefore be worried about giving my child a piece of fruit? Because after all, that is also very high in sugar. It's not nearly as high. And the whole fruit gives you all the fiber, all the phytonutrients. More children now know how to open these pouches and packets and they know how to peel a banana.

52:42Prof Lucilla Poston:You know, one of those pouches contains more sugar than the daily requirement of a child for the whole day. About three and a half cubes of sugar in one of those pouches. It's a scandal. And this is, I mean, probably one of the major factors. Follow on formula on these pouches is why our children, when they go to school, have such a high incidence of obesity. And dental caries, right? And dental caries is the other thing because actually the sucking of these pouches is very bad for teeth. And as you probably know, having all your teeth out when you're a young child is the most common operation in paediatrics at the moment.

53:17Prof Lucilla Poston:In the UK.

53:18Dr Federica Amati:Is there any single piece of actionable advice that you'd like to give to parents for their babies at the point that is after they're born, just to wrap up with? Maybe start with you, Lissa.

53:31Prof Lucilla Poston:To think about what you're feeding your child and to look on the packages that you are buying, the content, because they will have it, but it's very poorly disguised at the moment. So be very conscious of the amount of sugar and the amount of salt that is in some of these products. But the most important thing is to feed natural foods, to feed fruit, to feed lentils, to feed, you know, and to vary the food of your child. And so they have a wide breadth of a healthy diet.

53:58Dr Federica Amati:Try to take the opportunity to enjoy food with your children. So make delicious meals with them, get them involved in preparation, get them used to seeing the whole foods. so that in their minds and as they grow up, these whole foods become what they relate to as food. So the banana, the orange, the apple, the bean, the fish, get them used to as much as possible whole food, whole food ingredients. And drinking water. Make them drink water, not the juices. Just water. Just water. I love it. We've covered a lot of different things, so I'm going to just try and pick out the highlights. I think the thing that I start with is this idea that actually in the first thousand days, you're almost built as a human being, which I hadn't really thought about because you're still very small.

54:38Dr Federica Amati:But actually what you're describing is so much is shaped and then it's just sort of getting a bit bigger. And that's part of why this is such an important time period that we now know that many of your long-term health risks are actually going to be shaped by what's happened to you very early, which I think it does mean that this is a really important period. And I think I'm really shocked. I think you said that in the UK, 9 % of children at the age of four are already living with obesity. And I'm pretty sure that number would be even higher in the US. It is higher in the US, yeah. That this starts actually even before pregnancy, I think is another thing that is really sort of amazing to me that you're describing that if either of your parents are living with obesity, this can affect not just your chance of having a baby, but also affect health.

55:25Dr Federica Amati:But there's already things you can do in terms of your diet. And you talked about folic acid multiple times, I think. One of my takeaways is, you know, if you're a woman, you definitely want to make sure that you're taking folic acid, but also things like smoking and drinking already have an impact. Then we talked about pregnancy. I thought what was interesting is I normally think about pregnancy as being all about how you must avoid certain foods. And you haven't once talked about avoiding food. You've really talked about making sure you're eating like the healthy food. And when you are talking about avoiding food, it's all about sort of avoiding junk food rather than, oh, my God, you mustn't eat a piece of steak.

56:02Dr Federica Amati:I think that's fascinating. And I think the other thing is we now understand a lot of the science of what's going on. So when a mother becomes pregnant, her blood sugar increases. That's natural. But because of the sorts of foods that we're eating today, many pregnant mothers, actually, their blood sugar is becoming too high. And this is what you call gestational diabetes. And we now know that in the fetus, that raised blood sugar is actually getting into them. It's causing the fetus to put on more fat. And that's then sending hormones into their brain. It's literally reshaping their brain in a way that is going to be with them for life, which is basically going to make them hungry for junk food.

56:40Dr Federica Amati:So it's just like, I mean, a food manufacturer sounds brilliant. Like I feed the mother this junk and the baby is already hooked on this stuff before it's even born. Is this what you're saying, Lucilla?

56:52Prof Lucilla Poston:Yes, effectively.

56:53Dr Federica Amati:I think that the idea that we allow this not only to be legal, but to be advertised without restriction is extraordinary as you describe that. And I think it also ties into our understanding of why so many of us are having to take GLP-1s and things like this. If this is all the way back to what happened to us in the womb. It's not just about what you eat during pregnancy, however. I think it's really interesting how much you talked about physical activity, both in terms of being able to manage that sort of blood sugar excess, but also that just we now know that it's good for you in a way that I had no idea.

57:26Dr Federica Amati:The advice about what you should eat is actually very similar, Federica. It's the sort of advice that you talk about all the time here. And it's sort of the opposite of this processed food. It's this diet that's really good for your microbiome and all these whole grains. Being very conscious here, it sounds like, about added sugar. And so, you know, we're never very keen on these sugary drinks and fruit juices, but here it's like much more important. because it's not just you, it's thinking about the baby. And then at the end, we talked about, well, what happens at day 280 or so and you get the baby?

57:59Dr Federica Amati:And I took away two things. First thing is we've known for a long time that breastfeeding is good for the baby, but we now understand so much more about why. And that there's actually literally food in the breast milk that is only for the baby's gut bugs is wild. And then this example that like two hours after you experience like a cold virus, you could already be pumping antibodies in your breast milk to your baby is amazing. I think throughout this, we talked about like not feeling really guilty if you can't do this. And you said it's, you're not going to ruin your child forever by not being able to breastfeeding, but like not to give up and to try and make sure you've got the support you can to do that.

58:38Dr Federica Amati:And then we finished, I think, with the fact that the sort of food that again, food manufacturers are pushing for babies and young children is pretty shocking. You said one pouch for a baby that has this great label on it, that it's a complete meal, has more sugar than the entire requirement for the child in a day. And that our children do not need to eat these pouches. And that similarly follow-on formula, which I wasn't so familiar with, is a huge problem. They don't need it at all. It's a huge problem. It is. Yeah. Thank you so much. I wasn't expecting this to be such a like the food industry is really shocking episode as I think it's turned out to be in my mind.

59:20Dr Federica Amati:It's really eye opening. I would like to maybe just wrap up again with a message for anyone who is listening to this, who's just an adult like me thinking, so my parents completely screwed me up. And does that mean that there's nothing I can do and I should give up worrying about what I eat?

59:38Prof Lucilla Poston:what we've been saying is that you have a that you may get an increased risk by what happens in in in the womb but what we haven't really talked about is how you can optimize that risk as you as as you grow up as the child is growing up and of course you can if you think you have a tendency to obesity then all of the things we've been talking about mothers and babies apply as you grow up so it's not the end of the world you can actually mitigate against this so it's you know It's just being aware that you might have that fundamental increase in risk and being particularly careful about what you eat and what your child eats.

1:00:10Prof Lucilla Poston:And it's as simple as that. It's not a doom message that we're trying to get across at all, but it's just a take care message, much more important.

1:00:20Dr Federica Amati:As you can imagine, hosting this podcast, running Zoe, juggling family life, it all keeps me pretty busy. So I try as best I can to stay energized and show up well in all those parts of my life. by fueling my body with the right food, by exercising, and by adding a scoop of Daily 30 to my meals every day. If you haven't heard of Daily 30 yet, it's the gut supplement designed by our gut health scientists here at Zoe. It's made of over 30 high-quality, hand-picked plants, including seaweed, fungi, and different types of fiber. Better yet, it contains ingredients that support gut health, digestion, and energy, which is ideal for packed calendars and busy lives.

1:01:03Dr Federica Amati:Simply add one scoop a day to any meal for an extra boost of fiber and plant diversity. And because it tastes delicious on just about anything and adds a satisfying crunch, it quite quickly slots into your life, becoming a daily healthy habit you'll always have time for. By the way, whenever we talk about Daily 30 as a good source of fiber, we're required to say that it contains four grams of total fat per serving. Obviously, that's all amazing healthy fats from plants. so order yours today at zoe.com daily 30 thanks for listening and see you next time