This is Maureen Farrell and Heather ONeal. And this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus we laugh a little or a lot along the way.

So join us for another episode. 

Heather: Welcome back to The Milk Minute Podcast everybody. We had just a few more questions for our friends at Evolve BioSystems. 

Maureen: Yeah. We’re here for part two. And you know, last time (part 1 of the interview) when we said goodbye, we talked about how we’d get into a little bit of the practical bits, the nitty gritty, like, you know, we really covered a lot of the what and why, but we’re here for the how. 

Heather: Yeah. Yeah, for sure. 

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Heather: So let’s start with the parents that are, you know, crying to their pediatrician because they’ve got all these issues with baby that they just can’t resolve. And maybe their pediatrician doesn’t know anything about probiotics or really any options other than, maybe it’s your breast milk. So let’s talk about what research parents can trust.

So when they’re going to do this research themselves, what kind of research are they looking for? What quality? And talk to us a little bit about your research quality. 

Dr. Tracy Shafizadeh: Absolutely. So, you know, what’s interesting is most of the times that we’ve chatted with moms or dads or clinicians that have used Evivo  they came to us through an internet search, looking for symptomatic relief or some kind of problems with either their baby or a baby that was in their care was experiencing.

And we at Evolve actually think of it as, that’s way down the pipe. When you already have a problem. We think of it almost as, we need to be thinking about getting B. infantis into babies before there’s a problem because the lack of the infanticide often is what leads to these symptoms and leads to these issues that moms are having. Whether it’s diaper, rash, or colic or gaseous or fussiness or sleep or behavior issues.

And so when you go to your pediatrician and your pulling your hair out and you haven’t slept in weeks and your baby seems miserable, at that point, they’re scrambling. Both mom and provider are looking for a symptomatic relief and something to solve the problem that you leave. So, what we’ve done at Evolve is we’ve actually on the Evivo website, we have created a way to talk to your pediatrician well in advance of being in the midst of a colic crisis.

And we have a one page downloadable PDF of how to talk to your pediatrician or healthcare provider about the infant gut microbiome, about B. infantis and about what role it plays and how and when to use it. And as part of that, it’s intended to just start a conversation with your pediatrician early so that you’re not going in a state of desperation because you just don’t know what to do and you’re at your wit’s end.

The good news is, if you do find yourself in a state of desperation and at your wits end, we also are seeing symptomatic relief when you give Evivo to a baby that has severe symptoms of colic or severe diaper rash, or really issues with sleep behavior. So what we really like, both clinicians and parents to be thinking about is get B. infantis into your baby as early as you can. 

And then if you also are experiencing issues that are symptoms of lack of B. infantis, then Evivo also has a role there. So that the answers kind of, how do chat with your pediatrician about it. When you’re evaluating the different products that you have available to you we think about it as kind of three legs of the stool. Stool and pun intended. They’re three legs of the stool. We need to make sure that we are thinking about the right strain of bacteria. So what are appropriate for a baby that’s zero to six months old and consuming breast milk. It is probably not going to be a bacteria that thrives in an adult gut who’s eating a plant and meat based diet. 

So the right strain of bacteria. And the right food for that bacteria. So in this case, B. infantis is the right strain and human milk is the right food for that bacteria. And then the third leg is at the right time. So it doesn’t make sense for us to take Evivo as adults, because most of us are not consuming high amounts of human breast milk in our diet.

So it has to be the right strain, the right food at the right time. And when you get those three things right, whether you’re talking about an infant, a toddler or an adult, you’re going to be able to piece together the scientific literature and the evidence and the products that are available to fit the right product to the person that you’re looking for a probiotic for.

Heather: Yeah. And also your research has been published in some pretty big journals. I mean, when parents are doing research, I get sent articles all the time from like poop.com. Like a parent finds this article that just terrified them. And they’re like, have you seen this, are you kidding me? And I’m like, okay, this is from poop.com.

Like we cannot take this seriously. So I’m very glad to know that your research has been published and peer reviewed. And you know, this is, you know, like I told Maureen, when I first called her, after I found y’all, I said, all right, Hear me out. I know we don’t usually talk about products, but I really feel like this is one of the most important things that we could possibly talk about right now.

And we’re going to learn so much and she was like, in true Maureen fashion, all right. Yeah. 

Maureen: Well, you talked to my ear off for like 40 minutes straight about it and I was like, okay, sure. Sounds great. Heather’s really passionate about that. I mean, if you’re that excited, you could probably just have said a single sentence that excited and I would’ve been like, okay, sure.

Heather. Listen, I trust you. If you’re that excited, I’m going to love it. 

Heather: So I don’t think we’ve talked about this before, but where, how did you get your strain to do research on? 

Dr. Tracy Shafizadeh: It was actually isolated from the stool of a breastfed baby that did indeed have B. infantis. We feel like that is the absolute most natural and authentic version of a probiotic strain that we could imagine having acquired. And we’re very proud of that. 

Heather: I bet. I bet that baby’s really proud. The proudest poop it’s ever taken. 

Maureen: Yeah. Well, and you know, like we, we read a lot about like fecal transplants for, you know, all kinds of different gut diseases and I’m like, yeah, yeah, we gotta use that healthy poop we have, you know. Totally. Yeah. 

Heather: Well, I think a lot of us know just enough to know that probiotics are good and we should take them in concert with antibiotics to make sure that we don’t get the diarrhea from antibiotics. That’s pretty much as far as it goes, I think. As far as a thought to probiotics, but it seems like in addition to that, parents are also getting prescribed probiotics from pediatricians. Like, Oh, just throw this at it and see if it works for random gut issues. 

Maureen: Or they’re told to give their baby probiotics, period. Not like a kind, not where to get it. Not what to look for to make sure it’s a good kind of probiotic. 

Heather: Right. And then we also get the question from parents. How long do I have to do this? Like their gas has been a little bit better. I guess? Do I just give them probiotics forever? So can we clear up some of the other probiotic myths out there and why B. infantis that you work on is different than just a regular probiotic that you take when you take antibiotics?

Dr. Tracy Shafizadeh: Yeah, maybe I’ll start and then Bethany can weigh in as well. I think this, this exact question is so spot on that we’re even talking about pediatricians saying, probiotics. Sure. Give it a try. It’s not,  even pediatricians don’t know enough about it to actually say, this strain of bacteria would be really good for this particular symptom that you are trying to resolve.

And I equate it to the way we talk about food or the way we talk about medicine. We would never say, go eat some food. It’s probably good for you. We would say there are good foods and there are not great foods out there and they all do different things. And now we have a whole area of science dedicated to understanding the nutritional science behind foods.

Dr. Bethany Henrick, Ph.D.: Yeah. Or go take medicine. 

Dr. Tracy Shafizadeh: Yeah, try a drug. A pharmaceutical drug that might help you with that. We don’t talk about it that way. We know exactly the details of nutrients and pharmaceutical drugs, because we know exactly how they’re supposed to work, what they do and what the clinical science says about them.

We haven’t achieved that with the probiotic nebulous cloud that we talk about. And so therefore, both clinicians and parents are really confused and they’re disappointed often that they’ve heard that probiotics are good. They try one, they don’t get much results and they wonder why is it?

Is it the brand that they bought? Is it it’s just not working for me? And that’s where we really want to elevate the entire category and entire area of science too. Let’s not talk about food, drug probiotics. Let’s talk about specific bacteria, what they’re supposed to do, how they work, and let’s do some rigorous scientific studies to show exactly the mechanism of action.

So that’s what I would say is we have a little ways to go on the education so that both clinicians and parents can make better choices. The good news is the infant gut microbiome, which is only about the first six months of life, is pretty straight forward. It’s the only time in our lives until maybe very, very end of life, where we have one single food source.

And we have very few bacteria that are able to consume or utilize that food source. And there are very specific milestones happening in a short amount of time. So we feel like that’s becoming much more manageable. Once you introduce solid food and plant based fibers and other meats and other things, your microbiome changes dramatically.

And there’s all different types of nutrients. And everybody’s microbiome looks a little different. It’s still a very much an unknown area, and there’s a lot more research that needs to take place for later in life. Bethany do you want to add anything? 

Dr. Bethany Henrick, Ph.D.: I think you did a great job. I mean, I don’t know where I could add. The one thing I guess I could add is that unfortunately, a lot of clinicians aren’t up-to-date with the most recent literature. And this field is growing by the day. What we’re learning about specific strains of bacteria and how they impact human health is not changing, but we’re adding to it every day.

There’s new data from our group and others. And so clinicians often don’t have the time or feel the need because this probiotic board has kind of muddied the waters for different strains of bacteria. So I suggest that if parents are really interested that they have to do some of the research, they have to look at some of the papers.

And often it’s written in a very technical manner. But there are good takeaways from websites of a probiotic manufacturers. From this podcast. There are ways to get that data and I wouldn’t necessarily always rely on the clinical to know what’s best just because it’s such a new field.

Maureen: Right. And, and there’s even then like more to consider. Say, you figure out the exact strain you need to deal with your, you know, eight month old baby’s diarrhea. You know, then you have to find out, okay, wait, it matters how this has been processed and handled and stored up until the point that I’m purchasing it at the store.

You know, can you give us just a little quick summary of say, say you are buying something from the store, you know, are we looking for refrigerated stuff? Is it okay if it sits on the shelf? Liquid? Solid pills? Do we have conclusive data on that? 

Dr. Tracy Shafizadeh: That’s a really great question. And if you walk into whole foods or a CVS there, it’s a whole wall of probiotic choices now. It’s not one or two, it’s hundreds. The way we think about it is bacteria are living organisms. And if you set them on a shelf at room temperature for months, the likelihood that you are going to have the number of viable, working, bacterial cells, by the time you consume it, months, a month or more later, it’s probably pretty low.

So the way we think about it in the ways that we manage and handle the products that are available through Evolve specifically Evivo, a baby probiotic, is it’s cold shipped. The entire process from fermentation and manufacturing and packaging and shipping and getting to mom’s doorstep is temperature controlled. 

And it’s cold shipped. It arrives at your doorstep cold. You immediately put the packets of bacteria in the freezer or the fridge. And you only take out one at a time as you need it each day. Mix it with a small amount of breast milk or water or whatever you’re feeding your baby.

And you just use a dropper or your finger to get into baby’s mouth. Therefore, the amount of viable or live cells that you see on the label is actually what you’re feeding your baby versus the theoretical number, but after months of sitting at room temperature. You don’t know what you’re going to get at the end.

Heather: Yeah, that makes total sense. And I appreciate you saying that for our listeners, because I think it can be really overwhelming for people when, you know, you’re confronted with the wall of probiotics.

Maureen:  It’s overwhelming for me, you know, and I like, know that much more than most people about it. And you stand there and you’re like, well, yeah, I guess I could read every label. Maybe. 

Heather: Right. And when you’re tired, you don’t have time for that.

Dr. Bethany Henrick, Ph.D.:  For the infant microbiome. I will add that you don’t need the wall or the selection. So I pointed out that human milk, you know, evolved to feed humans. But the other thing is babies you know, in the very best of settings are exclusively breastfed for the first four to six months, right?

So we really only need one strain of bacteria that can consume those complex sugars that are in breast milk. To date, we’ve only found one strain of bacteria that does that, and that’s B. infantis. So it makes the choice for parents much easier for their infant. And it probably, I mean, more research will come, but all of the most recent data point to the fact that that first six months is critical for immune development, metabolic set point, your brain. The brain doubles in size in the first six months. 

So we have an opportunity. And the simple fact is there’s one bacteria that colonizes breastfed babies, because it’s evolved to consume the complex sugars we feature most makes the choice much simpler.

And it’s really important that you do intervene in that time because babies no longer have it. And it is linked with all of these major health advantages. You know, the immune programming, the metabolic setpoint and brain development. 

Heather: I think that you just really hit the nail on the head as far as what parents are looking for. And I think most parents treat their clinicians as that person who’s supposed to give them the one answer they need. And I think when a parent is faced with a diaper rash that they can’t cure, even though they’ve tried every single thing under the sun. Or the colic that won’t stop or the infant that won’t sleep or, you know, gas that’s just like, where is this coming from? My baby’s exclusively breastfed. And they go to get the one answer they need. 

Maureen: The one answer they need from someone who also doesn’t have a lot of training regarding breast milk, breastfeeding, like any of that, because, you know, you ask a pediatrician and they’re like, well, I know about babies, you know, and I know they should eat breast milk and that’s kind of the extent of that.

Heather:  But because they’re only eating breast milk, a lot of times we hear, well, my pediatrician told me that maybe my baby, my breast milk, just isn’t good for my baby.

Maureen: Right. Or maybe well, let’s try formula and see what happens. Or, you know, have you tried cutting dairy out of your diet? Without even asking the parent, like how much dairy do you eat? Is that something that you can even do? 

Heather: Yeah, these really upsetting, interrupting, events. Life events and interrupting the process of colonization of the microbiome. And we usually, then they call us. You know, we’re like the second or third in line, when people are already bawling. And they’re like, what do I do? They told me to stop breastfeeding. And we’re like, okay, first of all, no. Right. We’re not doing that. 

Maureen: Take a step back. Why did they say that? Like, does your baby have galactosemia? 

Heather: Yeah. Super rare disease. So having this as the very simple, scientifically proven, let’s try it thing, is going to really make people feel so much better. Because I think when the pediatrician say probiotics, sure. Give it a try. It’s because there’s really nothing else you can do for those babies. Other than to remove things like breast milk, or have you tried not wearing a diaper for the next week?

And the mom’s like, really? Okay, no diaper? We’re doing that now? Yeah. 

Maureen: Well that’s all, that’s all you’re doing. Cause I’ve, I’ve been there. I’m like, okay. We just sit on a waterproof blanket for two, two weeks. Okay. Great. 

Heather: I don’t know if there was a question in there. 

Dr. Bethany Henrick, Ph.D.: Well, no, but Tracy actually has an answer to that, I think, right Tracy, about diaper rash?

Dr. Tracy Shafizadeh: Okay. So I will claim this as my second favorite part of the story. So diaper rash. How many of us have been told by our pediatrician that it’s because we eat acidic foods, that’s what’s causing the diaper rash? So stop eating citrus, stop eating tomatoes, stop eating anything that might acidify or burn baby’s butt. The irony there is it’s exactly the opposite.

So Bethany described the pH of the infant colon and the colonic environment and the healthy breastfed, B. infantis colonized infant actually has a slightly acidic environment in the gut, which actually makes it a little bit more acidic pH of the stool of the feces. Well, the biochemistry there is so amazing because if the stool pH is slightly lower, so slightly more acidic, it actually stops the activity of enzymes that break down the skin. 

But if you allow the pH of the stool to get higher, closer to six, because there’s pathogenic bacteria, it activates those enzymes that break down the skin barrier. So it’s the exact opposite. You want baby’s stool to be slightly acidic. Therefore the enzymes that break down the skin are neutralized and there’s less diaper rash.

And we now see this both with when we poll moms that are using Evivo with their babies. Over 70% said they saw an improvement in diaper rash either immediately or within the first week. And then we also talked to clinicians that say, this was an issue, whether it’s hospitalized infants or pediatricians who see office-based patients, we couldn’t find any way to get rid of this diaper rash but when we corrected the microbiome, it was almost immediate that we saw relief in the diaper rash. 

So, I mean, I just love biochemistry and when it answers the question, it’s like, I love it. So it just makes sense. 

Dr. Bethany Henrick, Ph.D.: To add to that. We actually did publish a paper yesterday showing that we had a significant reduction in diaper rash. So, yay! 

Heather: Well, congratulations. That’s absolutely incredible. 

Maureen: And it’s just, it’s refreshing. We’re like, Hey, let’s use science to figure this out instead of giving parents, one more thing to worry about that literally has nothing to do with the problem. You know, you hear pediatrician say that and you’re like, do you remember how the body makes breast milk?

Like, those things aren’t connecting. Like if you’re eating some acidic foods as a parent, that’s not, it just blows my mind how far of a disconnect there is then between that recommendation and physiologically what happens in the lactating body and then what happens in the infant body. All the way down to that butt. You know, it’s astounding.

Heather:  All the way down to that butt. That’s the title of this new episode.

Maureen: But you know what, let’s jump into poop because I, now we’re talking about it. Let’s get into it. I love talking about poop. You know, so yeah, diaper rash is one thing, but literally the number one question we get from parents is, is this poop normal?

And we get, you know, our clients love to text us poop pictures at 3:00 AM when they’re freaking out and they haven’t slept in two weeks. And people that we work with on Facebook love to post poop pictures.

Heather:  We’re thinking about making a coffee table book of just poop pictures. 

Maureen: Maybe we should. Yeah. Right. I mean the range of infant poop, texture and color is rather large.

Heather: And the number one question, is this blood? Do you see microscopic blood in here? And I’m like, well, let me get out my microscopic glasses.

Maureen: Yeah. We’re going to look for that. But yeah, let’s, let’s dive into like, can we start with what normal, breastfed poop should look like when we have an infant who has the right microbiome? 

Dr. Tracy Shafizadeh: I would buy that coffee table book if you did produce it, so definitely work on that. It’ll be on my coffee table. So I think the one thing I really want to focus on in answering this question is not as much what it looks like, but more about frequency and consistency. Because if you think about that, 15% of the nutrients in breast milk are HMO’s that are indigestible by the baby.

And you need B. infantis to digest that 15%. If B. infantis is not there, those HMO’s get excreted through the stool. So we can see that. When we study the stool of baby’s colonized with, and without B. infantis, you can see significantly more, 90% more, HMO’s in the stool of babies that don’t have B. infantis and aren’t utilizing it.

And when you restore their B. infantis levels you see, or you don’t see very much HMO at all coming out in the stool. So that’s great. That means it’s being utilized. That means 100% of the breast milk is getting utilized by either the baby or B. infantis. So we can see that quantitatively. But if you also think about, if you are nursing every two hours around the clock, about 15% of what baby is eating is coming out in its diaper. You can imagine there would be way more poops per day.

And what we also know about HMO’s are that they are what we like to call osmolytes and the osmolytes are compounds that actually carry water with them. So if you’re pooping out 15% of every nursing session that you have as a baby and carrying water out with it, imagine how many more loose watery stools per day a baby that’s not utilizing HMO’s would have versus a baby that’s utilizing those HMO’s. 

And maybe they would only have one or two soft, well-formed stools per day. And that’s exactly what we saw in our first clinical study that we did with the B. infantis EVC001. Babies that were colonized with B. infantis were having one to two soft, well-formed stools per day versus five to eight or more loose watery stools per day in the babies that didn’t have B. infantis. 

And that, if you just think about loss of nutrients, exposure of the diaper area to feces, there’s no question why you would imagine that a baby not only has a different pH of the stool, but also just exposure to all of that loose watery stool. And so I would say, we are all told, breastfed babies have up to 10 loose watery stools per day. True. Because 97% of babies don’t have B. infantis. But if we go back to what a baby that has B. infantis looks like, one to two soft, well-formed stools per day is very reasonable. Bethany, did you have anything?

Dr. Bethany Henrick, Ph.D.: The only thing I’ll add is when babies are breastfeeding and colonized with B. infantis, they have what we call golden poops. So their poop should not have blood. It should not have mucus. It should not be green. It should be this golden yellow color. And that’s a healthy poop with very little smell.

So as soon as you get that smell, that can suggest that there’s pathogenic bacteria in there. When you get the mucus, that suggests that the mucin layer of the gut is being eroded. We actually have a published paper that showed babies that were colonized with B. infantis EVC001  had a protected mucin layer.

We could actually quantify the amount of mucin that they were pooping out. And what was the final thing? Oh, the blood. The blood is indicative of enteric inflammation, which enteric inflammation is driven by these pathogenic bacteria. So all three of those things you don’t want to see in your baby’s poop, you want to see a golden yellow color.