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Child: Welcome to my Mommy’s podcast.
Katie: Hello and welcome to the Wellness Mama podcast. I’m Katie from wellnessmama.com and I’m so excited to be back with Dr. Martin Makary. And today we delve into topics that are especially relevant to parents and the idea of research every parent should be aware of. If you missed our first episode, highly recommend listening. He walks us through how to analyze our blind spots and become aware of them as well as ways to question them in a way that improves our lives and our health. And in this one, we deep dive onto research parents need to know, questions we need to ask that can help our children and truly impact their lifelong health. And Dr. Martin Makary has quite the amazing resume. He’s a professor at Johns Hopkins University School of Medicine. He’s the author of multiple bestselling books, including one called Unaccountable and one called The Price We Pay that delve into some of the issues in our healthcare system, as well as his new book, Blind Spots, which we deep dove into in our first episode. He’s also the Chief of the Islet Transplant Surgery Center at Johns Hopkins. He’s been the recipient of the Nobility in Science Award from the National Pancreas Foundation, has been a visiting professor at over 25 medical schools, published over 250 peer-reviewed scientific articles, and is constantly quoted in the media for his deep dive work into some of the topics we talk about today. So buckle up, because we talk about allergens, antibiotics, gut health, what the data actually says about birth practices, so much more, screen time, and a lot more. He is absolutely fascinating, and I very much enjoyed this conversation. Let’s jump in. Marty, welcome back. Thank you so much for being here again.
Dr. Makary: Good to be with you, Katie.
Katie: If you guys missed it, definitely listen to our first episode together that goes deep on blind spots that can be dramatically impacting us that we may not even be aware of. And your book by the same name, absolutely fascinating. In this episode, I want to really dive deep for the sake of the parents listening about research that parents need to be aware of that really can be impacting our kids, not just in their current health, but truly their lifelong health. And I find it so fascinating how you tackled some of these really big topics where there’s apparently so much misinformation floating around and where parents might be getting incorrect information, even from their healthcare providers.
I know some of these might have a little bit of controversy involved, but we’re going to tackle them with research. And I know you’ve done so much research on this. So the big one first, I would love to really dive deep on is the topic of allergens, because this seems like something I almost never even heard of when I was a kid. And now I feel like every other kid I meet has some sort of allergy going on. And this is one of the topics that you tackle. But can you walk us through what we need to know as parents when it comes to allergens in our kids?
Dr. Makary: Yeah, so peanut allergies are real and it’s tragic. We’ve got a peanut allergy epidemic in the United States that does not exist in other parts of the world. We’ve had a couple of health professionals from Africa come and work on our research team. And they told me, Marty, what is it with the peanuts here in the U.S.? There’s like food apartheid where everything is labeled has peanuts or doesn’t have tree nuts. And then everyone’s asking these African health professionals when they’re in the U.S., are you allergic? They’re hearing announcements on planes. They’re hearing schools are banning peanuts. And they don’t understand it because, they describe no peanut allergies in Africa.
What’s going on here? Is it genetic? No, it’s not genetic. A scientist in the UK, a Jewish scientist who is a clinical allergist, went back to Israel and realized that very few kids in Israel had peanut allergies, but Jewish kids in the UK had higher rates of peanut allergies. The UK and the US are similar in that they both demonized peanut exposure in young people and told all moms, pregnant moms, lactating moms, and all children zero through three years of age to avoid peanuts in order to prevent peanut allergies. They got it backwards. The medical establishment, in the year 2000, issued this strong recommendation with such absolutism, at least that’s how it was received. That people should remember this moniker of 1-2-3, that at age 1, you could start introducing to a child some milk. At age 2, some eggs. And at age 3 is when you can start introducing some peanut butter.
Well, that was so tragic because that bad guidance created our modern-day peanut allergy epidemic. It turns out that the wisdom of the experts in the year 2000 ignored a basic concept called immune tolerance. Or moms had known about this for a long time and called it the dirt theory. That is, the more you’re around allergens early in infancy, the more your immune system learns to accept those allergies. And when you have total abstinence of something like peanut butter, early in life, you tend to be sort of immune sensitized to it and your body can react to it.
So the peanut abstinence recommendation that lingered for 15 years in the United States, it was only about eight years ago that a study proved it wrong. I mean, not only wrong, but said, this is so backwards. The peanut abstinence recommendation is why we have the peanut allergy epidemic. So it’s now recognized that you want to introduce a little peanut butter at four months of age or five months or six months or seven months, as early as a child can start eating, not in lieu of breast milk, but to supplement as a little exposure. Many pediatricians now also recognize it may also be good to expose kids at those early months of age to a little milk, a little eggs, different types of little foods, and sometimes even cats and dogs. Recognizing this idea of immune tolerance that had been tragically ignored with this dogmatic recommendation that ended up being wrong and ended up creating the modern-day American peanut allergy epidemic.
Katie: That’s so interesting. And I noticed some of that information in how it even changed throughout the course of having my kids. My oldest is almost 18. My youngest is eight. And I remember being told with my first by the doctor to avoid this huge list of foods and the same kind of recommendations about don’t introduce these things to later ages. And I had also switched to midwives, but it seemed like so much of that changed. By the time I had my last child, I actually ended up even investing in a company that was researching early introduction of allergens and the most effective way to do that. And it seems like they were based on that same research that actually early introduction might be helpful and help avoid these problems versus delaying it.
I love that you also mentioned pets because to me, that’s fascinating, understanding that the bacteria that can be introduced through pets being inside, outside, and having a wider exposure to bacteria actually can be beneficial to our kids. I think I even read that kids with pets in the home can have lower rates of allergies potentially because of that. But like you said, some moms have known this kind of all along of wanting our kids to be able to play in the dirt and get dirty and make mud pies and all of the things that seemingly have been phased out a little bit in this kind of overly sanitized childhood that we’re seeing now.
And so I would love to delve into that next. I know we tackled antibiotics a little bit in our first episode, but I would love to talk about this, especially in relation to kids, because I’ve also seen that as a mom, the push for antibiotics from practitioners so often, along with the recommendations to seemingly sterilize their entire life and this overuse of hand sanitizers and everything being sanitized all the time. What does the data say about how that’s impacting our kids?
Dr. Makary: Well, you know, unfortunately, we don’t have an NIH center that funds research in this area. But when you talk to the immunologists that are really smart, when I identify experts that I trust, they show humility, they listen to new ideas. They’re not so dogmatic. They don’t sort of demonstrate those characteristics of closed-mindedness that Dr. Festinger described and we talked about in the last episode. Those are the doctors I latch on to, the doctors who are willing to evolve their position as new information comes in. And there’s a lot of those. And when you talk to the experts who really are impressive, they will tell you, yeah, it makes sense. When we talk about the immune system developing, the more you’re exposed to certain allergens, the more your body is likely to accept them later in life. So we don’t really know, I don’t know from any good study if the early exposure to dogs and cats has a true benefit and what the magnitude of that benefit is. But the pediatricians I really respect to understand immunology are recommending it for their kids.
If you think about the overuse of antibiotics, think of antibiotics as having three different impacts. Number one is it can cure tragic, terrible diseases that used to take the life of kids and parents and women in childbirth. I mean, before we had antibiotics, we couldn’t do surgery. It was too dangerous. Women died in childbirth commonly from infection. And you could, a kid could get a cut from being outside and scraping their arm against a tree and die from that little cut becoming infected because there was simply nothing that could be offered.
So antibiotics have revolutionized medicine. Again, they save lives. I want people to understand the importance of that. But they’re massively overused. And not only is it changing the microbiome in ways we don’t understand, it’s also breeding resistant superbugs out there. And almost every community has dealt with an outbreak of superbugs, be it foodborne E. coli or salmonella or something where maybe none of the antibiotics available work. In the hospital where I work, at Johns Hopkins Hospital, we commonly see somebody come in with bacterial overgrowth of one of their own bacteria in the microbiome. That is, somebody takes an amoxicillin for something mild. Tragically, we look back and realize many times it was unnecessary. They didn’t even need to take it. And then the amoxicillin or whatever the antibiotic is alters the equilibrium of bacteria in the gut. Remember, there’s millions of different bacteria that live in harmony. And there’s a balance. And so when you kill some of the bacteria, the bad or what we call pro-inflammatory bacteria can overgrow and take over that area. And that’s what happens with an infection called C. diff. Kills over 30,000 people in the U.S. each year. You get it from taking a mild antibiotic. And then in the hospital setting, you can either catch it or your own gut has these bacteria that then overgrow.
So I don’t want people to be cynical or frightened. We don’t want to create hysteria. But it’s important for people to know that most doctors, when they talk about the issue of antibiotics in our own medical communities and conferences, we talk about the massive overuse of antibiotics and the harm. And we’re just starting to appreciate it. Consider the fact that microbiome, the lining of the GI system is involved in digestion of food. So when we alter it with antibiotics, unnecessary C-sections, ultra-processed foods, pesticides, or whatever else might impact the microbiome, we’re affecting bacteria that are involved in digestion, produce enzymes and vitamins. They actually, these bacteria make vitamins. They even make GLP-1, the active ingredient in Ozempic, at low doses, suggesting the microbiome may have a role in metabolism.
Some of the microbiome bacteria produce serotonin, which is involved in mood and mental health, which is why there may have been that observation in the Mayo Clinic study that there’s higher rates of learning disabilities and attention deficit disorder in kids who took an antibiotic in the first few years of life compared to kids who didn’t. Now, the head researcher who’s the expert in the microbiome worldwide, a mainstream physician, former head of medicine at NYU, he believes that there may be an association with autism altering the microbiome. As a matter of fact, there’s some clinical trials that have looked at treating autism with certain types of probiotics. There’s no results that are worth reporting out on those studies yet, but we’re recognizing the role of the microbiome. Treating bipolar with probiotics is going on at Shepard Pratt Medical Center. So we’re recognizing now that some of these bacteria are really important and it’s integral in so many aspects of health.
Katie: I’m so excited for continued research on that because it seems like there’s so many possibilities as we deepen our understanding of the role of gut microbiome and the way it impacts truly every area of health. And you touched on this a little bit when you mentioned C-sections, but I would love to tackle some of the misinformation around all areas of birth and what moms especially need to be aware of there. Because I will say, like, I had six kids, five of them were born naturally. My third one was a C-section because I had placenta previa. So I was in that category of necessary C-sections. But I knew going into that, that because of that, he was going to have the potential for gut-related issues or at least a higher chance than his siblings. So it was something I was very aware of when he was young and still make sure I focus on with him today. But I feel like this topic is not talked about enough. So can you walk us through what we need to know about birth and how that might influence our choices when it comes to how we have our children?
Dr. Makary: Well, first of all, it’s so impressive. You got six kids. So that’s great. And it sounds like you are aware of the potential of the issue of gut issues with C-section delivery. Again, C-sections save lives and they’re important many times. We don’t want people to get into trouble with their pregnancy because they’re at an extreme where they’re 100% refusing a C-section. But on the other end of the spectrum, we do have some physicians who can, we call it nudge patients. That is, if you tell a woman in labor anywhere in the world, hey, a C-section might be safer for the baby. Well, then 100% of women are going to say, then do it and do it as fast as you can.
And these are nudges that are not always based on good evidence. There’s misinformation that there’s no difference between a C-section and a vaginal delivery. There are no long-term effects or complications. The better answer is, we don’t know. Or I might suggest from the research I present in the book Blind Spots, we do have a suggestion that there are differences. A study just came out in JAMA Surgery, Journal of the American Medical Association. And it found that the rise, you’re familiar with the rise in cancer in young people, people under age 50, that they found that if you were born by C-section, you were more likely to have colon cancer before age 50 compared to people who were not born by C-section. Why? Maybe it has something to do with the different microbiome.
There’s a study that just came out looking at a bacteria in the microbiome called Fusobacterium. That normally lives in the mouth, but it was found in most colon cancers. What happened? Did the bacteria migrate down to the colon when the microbiome was altered? Did the bacteria promote some inflammation or changes that led to colon cancer? So we’re recognizing now that many of the diseases that are on the rise may have some connection to the microbiome. So I’m glad you had that awareness when you delivered and you had the good guidance and judgment to recognize when a C-section was appropriate and when it wasn’t appropriate. But I think it’s important for people to know some of the best practices now recognized with childbirth. So if you’d like, I can mention some of those if you want to talk about that.
Katie: Yeah, that would be wonderful. Let’s do it.
Dr. Makary: So look, for most of mankind, for most of history, when a baby was born, the baby was put in the arms of the mother. But then as we ushered in the white coat era of medicine in the 1940s and 50s after World War II, doctors would just keep people in the hospital forever. A baby born normally at term was kept in the hospital for a long time, immediately separated from the mother, poked and prodded, and given formula instead of breast milk. Which of course alters the microbiome. And I remember when my sister was born in the 1980s, my little sister. Mom came home from the hospital and we asked, mom and Dad, when can we go and see our new little sister? And they would say, well, the doctors haven’t released her yet. There was nothing wrong with her. She was normal baby born at term, but they just routinely kept every baby in the hospital.
We’re now recognizing you shouldn’t be separating babies at birth. The babies immediately should be held by the mother. When I was a medical student, I noticed we would whisk the baby off to rewarm the baby in some back area under some French fry light. And we would poke and prod and get a temperature. And I’m thinking the warmest place for a baby is in the mother’s arms. And the baby ironically, before we would whisk the baby off, the baby was getting a transfusion into their circulatory system of warm blood through the placenta. And that blood was still pulsating in the umbilical cord. So we’re recognizing now that babies should have their umbilical cord cut in a delayed fashion, not immediately. When I was a student, it was like, there’s the cord, cut it, you know, as soon as you can see it, what are we doing? It’s pulsating, it’s delivering warm blood to warm the baby directly into their blood vessels, stem cells, fetal hemoglobin. And new research has found now that when you do delayed cord clamping, and the mom holds the baby skin to skin for hours, there’s a different myelination of the brain of the baby later in childhood. That was a remarkable finding.
There’s also something magical about the bonding of a mother and their child upon birth. So the best practices, and everybody should really, in partnership with their delivering clinician, come up with a birth plan that includes delayed cord clamping. And research has found that 90 seconds is even more effective than 45 seconds. So somewhere between a minute and a half or two, maybe three minutes until the cord is no longer pulsating, that’s important.
The skin-to-skin time, the first hour colostrum or the golden hour of breast milk and breastfeeding, a baby is more likely to latch when the mom holds the baby initially. And avoiding antibiotics and avoiding C-sections when they’re not medically necessary. Some women are even saying, I’m going to hold off on the hepatitis B vaccine on the day of birth. This is a sexually transmitted infection that you can get also from sharing needles, IV drug use. Do we need to be giving it on the day of birth? I’m not going to weigh in and say yes or no, but these are questions people are appropriately asking to say, can we get back to some of the healthy principles of natural childbirth.
Katie: Such a great synopsis and deep dive. And thankfully, I work as a volunteer doula sometimes. And starting to see these changes actually show up a little bit in some hospitals, at least. I think in the home birth setting, this has been much more widely accepted, obviously, for a long time. But I’ve seen doctors encouraging skin to skin. I’ve even served as a doula in several C-sections that were necessary, but that help with the microbiome seeding and making sure the baby was immediately introduced to the mother’s skin, her bacteria, clothes that she had worn at home versus being taken to a sterile nursery away from the mom. So I’m hopeful that we’re able to start asking these questions and we will start to see, hopefully, wider scale changes in this area. But I love that you dove into all of those.
I feel like also piggybacking on that is that once we have babies, they eventually are going to eat food. And you touched on the nutrition side a little bit, but I would love to go deeper, especially in the topics of refined foods and ultra processed foods and what we know about how this is going to impact our children essentially for life.
Dr. Makary: Yeah, and on your last point, at Mount Sinai Medical Center, they’re doing a study for the kids born by C-section, they’re swabbing their skin with fluid from the mother’s vagina. And the idea is that those bacteria are critical for the microbiome’s seeding and development.
So food is a very controversial topic. And again, you see a lot of the cognitive dissonance. People believe what they heard first, not necessarily what’s more scientifically supported. And a lot of the studies you’ll see out there that show a certain diet works better than another diet for children or adults, those studies are confounded. A lot of them are flawed. You really don’t know what people are eating in the studies. They might tell you they’re on a certain diet. But the reality is a lot patients are not even honest about their weight when they come to the doctor. I’m not sure they’re going to be honest about what they’re eating.
So, we’re recognizing now the importance of getting back to whole foods. And not just whole foods, whole foods that are raised and grown with good soil and good nutrients. Foods from animals that were raised not only humanely, but also in a way that has more nutrients. Not animals raised on corn feed and other processed foods and antibiotics. Foods that are raised in a very healthy way. That’s important.
Now, people sometimes say, well, that’s a little more expensive to buy foods that are raised in a healthier environment. But. I’ll tell you, I’ve seen kids come into the emergency room as teenagers with terrible abdominal pain and excruciating pain. And no one knows what’s going on. And all we do is we give them some umbrella diagnosis. Oh, you have irritable bowel syndrome, or you might have early inflammatory bowel disease that we can’t diagnose, or bacterial overgrowth syndrome, a new diagnosis we’re increasingly using. These diagnoses are all talking about the same thing. We don’t know exactly what’s going on. We know it’s something that’s real and it’s causing body inflammation, particularly in the gut.
And so, one parent even looked at me and said, how could this happen to my poor little kid? How could this possibly happen? And I kind of wanted to say, well, you know, it sounds like you’ve been feeding them really bad stuff for most of their lives. People, for example, have accepted certain things with raising kids that they don’t need to accept. You know, I have to give my kid a smartphone. You know, what am I going to do? Not tell my nine-year-old that they can have a smartphone? Yes, you can not give your nine-year-old kid a smartphone. That sugar and these ultra-processed sugary foods, candy, and things with a lot of added sugar, a ton of added sugar, and we know what those foods are. Parents have a dogma that it’s okay in moderation. But I would challenge that. I think you can raise kids, at least during the formative years, without any added sugar. And I’ve seen some parents do this. I’ve seen my sister do this. Zero added sugar.
Now, it’s challenging because you have to find foods they like. You don’t want them to feel left out. And give them those alternatives during all the birthday parties and holiday parties. I mean, it’s really ubiquitous, the culture around processed food and added sugar. It’s in the kids’ storybooks. It’s everywhere. Making cookies, having a cake. The reality is that there are alternatives. If a kid or an adult were to use cocaine, we wouldn’t say you know, cocaine is okay in moderation. No, we’d say this is a highly addictive substance that has downsides. And sugar is, in my mind, in that group of things where we should not simply conclude, well, it’s okay in moderation. I think personally that it’s been impressive that certain parents have been able to do complete added sugar abstinence, whole foods, healthy foods, foods that have a good background in where they came from and to avoid ultra processed foods whenever possible.
And then those parents recognize the kids are going to make their own choices later in life. So they might start introducing them at age 8, 9, 10, 11, hoping they make healthy choices. But during those formative years, it’s not a bad idea to avoid added sugar and stick with the organic foods and avoid unnecessary antibiotics, particularly in the first two to three years of life when the microbiome is being formed.
Katie: That’s such great insight in that sort of early waiting window until they’re older and can make decisions and you can hand off that responsibility, hopefully with a good foundation and an understanding of why we chose to avoid those things when they’re young. I think that’s such a balanced approach to it.
And you mentioned another buzzword, which is the idea of screens. And in some ways, this might be the most controversial topic we delve into today because screens are so ubiquitous for young kids these days. But I remember reading years ago that Steve Jobs didn’t even give his own kids iPads. And I know that there’s some research on this and you probably delved much deeper into it than I have. But why is it a good idea not to early introduce screens? And do we have any information about what age it becomes more OK for the sake of their brains?
Dr. Makary: Well, the worst behavior that you will see in toddlers and young children is when they have a screen or added sugar put in front of them. They enjoy it, and then it’s taken away. That will bring out the worst behavior you will likely see in most kids, and it’s avoidable. And so just as my sister, for example, has avoided added sugar with almost 100% abstinence until the formative years are over, similarly with screens.
Now, when the kids turned, I think it was 9 or 10. She had a movie night because she wants the kids to understand and assimilate into society and understand what it’s like to watch a movie as a family. Now, the movie she picked was kind of a Mr. Rogers type of movie. It wasn’t a lot of flashing images and those sort of, you know, repetition that becomes addictive, that gives kids the dopamine surge. It was more of kind of a boring, you know, sort of cinematography.
And so it is, I think, important. And if you’re waiting for good, solid research, I would say look at these data points. We know we see the worst behavior in young kids when you take away a screen or you give them added sugar and then you say you got to stop on your own willpower. So don’t introduce it. And I know this is something that is hard. But honestly, I think sometimes people are just throwing screens in front of their kids because they don’t want to invest the time into their kids. Raising kids is hard. It takes time.
So, you know, these are highly addictive things, screens, added sugar. And I think you can actually raise kids and my sister now has kids that look you in the eyes, shake your hand. They don’t have a smartphone. They had minimal screen time in the formative years, almost none. Minimal added sugar in the first few years of life. They love vegetables. She found some foods they like. Her son loves frozen peas for some reason. And so he developed a liking for those sort of foods. So if people, parents can have the discipline to actually recognize that all things in moderation is a dogma and it doesn’t apply to all things in life, and do that hard work of reducing screen time and added sugar, I think there are benefits to it.
Katie: Awesome. And I know you go deep on a lot of these topics in the book and in your work. So I’ll link to those in the show notes. Are there any other ones that are top of mind, big topics that we haven’t talked about yet that you feel are especially important for parents to consider?
Dr. Makary: I think it’s interesting right now we’re learning about cancer in young people. We’re learning a lot of fascinating stuff that’s sort of turning the world of cancer upside down. And cancer prevention may be a very different route than what we’ve suggested. For example, a recommendation just came out to start mammography screening at age 40 for low-risk women instead of starting it at age 50. Turns out there’s no evidence to support that. There’s no evidence that really backed that up. At least no randomized control trial showing that mammography in, when a woman’s low risk and in their forties, saved lives.
But at the same time, we’re learning that ovarian cancer, for example, the most common GYN cancer, that is most common GYN cancer cause of death in women, that ovarian cancer, it turns out, doesn’t come from the ovaries. The most common and lethal form does not come from the ovary. It comes from the fallopian tube. And so when women are coming in now to my hospital, Johns Hopkins, and they’re saying, I’d like my tubes tied, the doctors are saying, we don’t do that anymore. We recommend removing the fallopian tube, leaving the ovaries in place because the value of ovaries intact, if a woman is done having children and removing the fallopian tubes may massively reduce the 1 in 78 chance a woman has of developing ovarian cancer in their lifetime.
And so we’re realizing, hey, we may have taken out millions of healthy ovaries targeting the wrong organ. We’ve taken out the ovaries that were in low-risk women thinking we were preventing ovarian cancer. It turns out, it’s the fallopian tubes where these cancers originate, at least the most common type and the most lethal form. So we now have a protocol when somebody, a woman comes in in her, say, her late 40s, and she’s going to have a gallbladder procedure to remove her gallbladder, we now offer that woman the opportunity to have their fallopian tubes removed at the same procedure, leaving the ovaries in place.
And that is a new protocol. It’s more accepted and more standard in Canada, Germany, and other parts of Europe. But slowly, the data is showing us that offering that procedure is a cancer risk-reducing procedure. Because after a woman is done having children, the fallopian tube serves no form or function for the rest of their life. So removing it may reduce that risk of ovarian cancer. Now, we’re not yet offering it to women who are not having surgery for other reasons. But for women who are having abdominal surgery, for other reasons, it is now offered as a companion procedure with their appropriate informed consent.
Katie: That’s so interesting. I love that we’ve gotten to go into so many topics that are so relevant for all the moms today. And I know that you go so much deeper in the book, which I will link to in the show notes, as well as to your website and where people can find you and follow your work. But I hope we get to have more conversations in the future. I love that you are encouraging and helping people to ask better questions. And I think that your work is so valuable, especially for parents as we make these decisions for our kids that can impact their entire lives. So Marty, thank you so much for being here today. This has been absolutely a joy to have this conversation with you. And I’m so grateful for your time.
Dr. Makary: Thanks, Katie. Really enjoyed it. And thank you for what you do in trying to educate women about different ideas and best practices, both in health and in wellness.
Katie: Well, thank you. And thanks as always to all of you for listening and sharing your most valuable resources, your time, your energy, and your attention with us today. We’re both so grateful that you did. And I hope that you will join me again on the next episode of the Wellness Mama podcast.
If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.
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