May 8, 2023
Tahmeed Ahmed had been trying to solve the problem of how children recover from malnutrition for 20 years when he found the research of Jeffrey Gordon, connecting the microbiome to obesity. He wondered, if microbes could affect obesity, might they also affect its opposite?
A decade later he, along with Gordon, may be on their way to doing what Ahmed set out to do 30 years ago. Using a groundbreaking new treatment they are actively targeting the gut microbiome in children recovering from severe malnutrition in order to circumvent the long term damage caused by it.
The new diet based, microbiome focused treatment is a very promising step in the direction of treating and possibly preventing malnutrition. Though research into the microbial differences present in malnourished children is solidly backed, the results of the treatment are still early and more follow up will be needed.
So how did these two researchers come up with this potentially life saving treatment? We will cover that journey in the following sections:
To understand the problems occurring in the microbiome development of malnourished children, it was important for the research team to understand the normal composition and development of a child’s microbiome.
In a well fed, properly nourished child the microbiome is fully developed by the age of three. In a malnourished child the microbiome continues to look like that of an infant well into childhood, Ahmed and Gordon have found. One in six children in developing countries and underweight and at risk of stunted growth and its comorbidities.
Until more recently the importance of the microbiome has been largely overlooked, the traditional outlook on the bugs that live in our body has not been friendly but it turns out they have been crucial to our health all along.
The microbiome is crucial for food digestion but not just that. It also plays an important role in the bodies immune defenses. Making an undeveloped microbiome incredibly dangerous to ones health. Disruptions in the normal development of the microbiome have been tied to increased risk of obesity, allergies and certain chronic illnesses.
And the early days of microbiome development are incredibly crucial because, as research has shown, the microbiome doesn’t develop much beyond the first years of life. In fact later life factors like lifestyle and environment account for less than 30% of microbiome composition - making those early years crucial and difficult to reverse.
The study into how to replenish the microbiomes of undernourished children actually happened in two parts. Part one was establishing exactly what microbes were missing in those who experience malnutrition.
Pinpointing exactly which microbes were missing or present in the guts of the test subjects would be a large and nearly impossible task, as there are millions of microbes that live in any given persons gut. So, instead the researchers focused on grouping like bacteria and seeing which types of bacteria were present and missing.
In order to determine which microbes were missing the gordon lab analyzed the fecal samples collected by Ahmed’s team. The samples were from a group of 50 healthy Bangladeshi infants, collected monthly as they grew. They found that 15 types of bacteria with fluctuating population sizes as the microbiome matured along with the child. They also saw the same exact pattern emerge in healthy children from Peru and India, as well as in germ-free piglets fed the same diet as the Bangledeshi children.
This way they were able to get a broader more universal understanding of the microbial effects of malnourishment. From there they were able to get an idea of what microbes needed to be replenished and move onto how they were going to accomplish that.
The second study utilized the research done into the missing microbes to come up with a diet that would help replenish the missing microbes in hopes of offsetting the microbial effects of malnutrition. When you account for the microbiome treating malnourishment appears more complicated than just providing foods to eat. This missing piece may be why it has long been unusually difficult to treat. Previous treatments for malnutrition have not considered the impact and importance of the microbiome in malnutrition recovery, this diet is the first to do so.
The microbiomes plays a large role in food digestion in the body, so without a fully formed one, many foods cannot be properly digested and used by the body. So the first step treating malnutrition must be to replenish that microbiome so that the body can begin to properly digest and store nutrients and fats.
The researchers tested different foods common to the Bangledeshi diet on mice and piglets to see which foods best supported the development of the microbiome. The diet he settled was a formulation containing chickpeas, banana and soy and peanut flour. They found that the formulation was able to support microbiome development and lead to subsequent normalization of growth in the mice and piglets.
The research team also tested the diet on a group of malnourished Bangladeshi children. They only tested the diet for a month in the children and due to the short period in which the children in the study were followed the researchers were unable to see the effects of the diet on their growth. They did however note normalization of certain blood markers, which they believe is the beginning of a process towards a replenished microbiome and growth.
Further research is needed but the diet shows a lot of promise and could change the way malnutrition recovery is handled.
One in four children in the developing world experience stunted growth due to malnutrition. This research may enable not only the reversal of malnutrition in children before it takes full effect but also the prevention of malnutrition in the first place.
Not only does this research apply to those who are malnourished due to lack of food access but could also be used in recovery from eating disorders or other food related health issues that diminish the health of ones microbiome.
The whole study outlines the importance of the gut microbiome in childhood development and in the bodies ability to turn food into usable nutrients and energy.