Deep Dive
Shownotes Transcript
Okay. All right. Okay. All right.
You're listening to Radiolab. Radiolab. From WNYC. See? Yeah. Latif? Yeah? Lulu?
So I have a special treat for you today. Okay. Recently, I got to do a live show. It was in a little club in New York City called Caveat. Well, I always wanted to go there. Yeah. It's really cute. It's got like a cabaret underground vibe. Are you finally singing? I feel like you've been just needing to get out there and sing. You know, I did not sing in this show at all. But there were live musicians, including Dylan Keefe on his upright bass, our director of sound design. Okay.
Thank you all for coming out. Thank you. And a rock star of sorts. Adieu, Avir Mitra. Can we get some bring on music? Ooh, Avir. Thank you. Yeah. So as you know, Avir Mitra is our ER doctor special correspondent who has done some of the most beloved medical mystery tales on the show. So many vultures, plane crashes. Thank you so much. Easter Island dirt. That's right. Yeah. Yeah.
And he had another one in store that he told on stage that night. Truly an odyssey. Takes us all over the globe. We blow by the Mennonite communities. We go to Gambia. We go back into deep evolutionary time to stage a reunion, a physical reunion with what Avere calls humanity's oldest friend. And he kicked off the whole thing with,
With a bottle full of white liquid. We're talking about the magical substance that is breast milk. And because, as you know, I recently had a baby, the breast milk was provided by me. I have an eight-month-old. I am breastfeeding. I also use formula. This is not... We're not here to say one or the other is better. But instead...
And so we just kind of held it up to the spotlight. Everyone was looking at it. And Avere kicked the whole thing off with just a simple question. I guess I'm going to throw it to the crowd. Like, if we just had to name the components of breast milk, and I'm going to take one off the table, we know that it's 87% water. Okay, fine. That's easy. But the solid part, like, name some things. What's in breast milk? Vodka. Depending on the mother's night. Yeah, right. Fat. Sugar. Butter.
proteins, hormones, calcium. You guys are right. I mean, everything you're saying is right. But there is something that we've missed. It's called human milk oligosaccharides. And what's crazy is it's actually the third largest compound in breast milk worldwide.
Way above protein. So, you know, you have lactose. That's the sugar that someone mentioned. You have lipids. That's fat. And then you have these HMOs and they are strange. Wait, HMOs? Yeah, it's not your health care, health insurance organization. Oh. They are actually sugars. But as Avira told us, they are totally different substances.
than normal sugars. And they form into these kind of gorgeous but strange elaborate shapes. Branches and chains, ferns and weird shapes. And they are not found anywhere else in nature, just in human breast milk. Weird. In fact, Veer calls them alien sugars. And that's the number three ingredient in breast milk, alien sugar. The third biggest, yeah. You can't get them at the local grocery store. And what's crazy about it is...
Humans can't digest this stuff at all. Like literally, no human being can do anything with these sugars. And no one ever really thought to ask like, what's going on really? Until a scientist by the name of Bruce German came along and basically just asked a simple question. Why? Why would a mother who's got very precious limited calories, why would that mother literally dissolve her own body
taking all these precious nutrients and calories to make milk that needs to feed this baby, why would the mom make these sugars that no baby can use? Why? So this is around 2005. Bruce is having these thoughts. And this is the era sort of of the microbiome where we're all thinking about the microbiome. And it's this idea that like we're basically human suits covered in bacteria, filled with bacteria, you know? Yeah.
And so he has this hunch that's basically like, okay, well, if we can't use it, maybe there's a bacteria that can't. In where? That lives inside of a baby. Maybe there's a bacteria that lives in the baby's gut. That would make sense, like food for a baby bacteria. So they design an experiment, basically taking an agar plate where bacteria like to grow. So they decide, okay, we'll take an agar plate, sprinkle the alien sugars on the plate and throw a bacteria in there and see if it grows. Okay.
If you eat it, you'll proliferate. If you don't, you're going to die. Exactly. Okay. Yeah, you got it. So they throw some bacteria, take a common bacteria that lives in the gut, throw it on there, throw some HMOs, it dies. It doesn't work. No luck. Okay. Try another one, no luck. Try a third one, no luck. Okay. How long is this...
Taking. Well, so a year goes by. Yep. Bruce and his team are like begging, borrowing, stealing to get like any breast milk that they can, you know, begging on the street, like, can I get some? You know, it's not working. A year goes by. Two years go by. Okay. Finally, on the third year, boom, they find something. Yeah.
That was perfect. Wow. Why do we prep for these podcasts? We could just do this. I know, let's just always do that. Okay. Okay, so they find something that's growing. You could see all this white stuff is bacteria that's growing. At this point, Avir shows us a picture of a plate with all this bacteria growing on it. Because they put it under a microscope and it looks very strange. If you zoom in on the picture, this collection of squiggles... Zoom in a little more. It's beautiful. Become... Zoom in a little more. These individual little...
A little more. Y-shapes. And so this is the bacteria that likes to eat the weird alien sugar in the breast milk. Exactly.
And so it turns out this bacteria is called Bifidobacterium infantis. Bifidobacterium infantis, never heard of it. Yeah, we can just call it Bifid for short. It is shaped like a Y and with one of the little spires kind of bent over like a little puppy dog ears, kind of cute. Anyway, this was the only bacteria they could find that actually ate those alien sugars in breast milk. Okay. Yeah. Yeah.
So, yeah. Okay, so does that mean this is in my baby's belly? Well, that's the next question. Exactly right. So you have, you found out of the thousands of bacteria, you found one that can eat these sugars. That's crazy enough. Because like, you know, we don't, we can't eat them, but it has all the genes and all the enzymes to eat these sugars that we make that we can't eat. It's just weird, right? Yeah. So you would think, okay, this should be in some baby's guts. Yeah. Yeah.
And so the way to look for that is, you know, when you have bacteria in your gut, you're going to poop out some of that bacteria. So you really got to get into poop. You know, that's where this story is going. And so basically from there, Bruce and his team need to start collecting dirty diapers, you know, which I don't know if that's an upgrade from begging for milk, but that's where they're at.
So Bruce is working at UC Davis. He's around getting his friends and neighbors and strangers on the street to give him their dirty diapers. Let's culture it. Let's see if we can find some Biffet in there. Yeah. But no, he can't find any Biffet in any of these diapers. They're just not... So that theory gone? Well...
It might just be where they're located, you know? So they realize they need to sort of expand the search. And that's where this idea starts what I call the amazing global baby diaper hunt. Okay. So it turns out that the Gates Foundation, for some reason, has collected stool samples from all over the planet.
I'm not sure why. Okay. Don't tell Elon Musk about this, please. Basic science! You never know! So they have just baby poop, like, just lining their walls, I guess. I don't know. Libraries of poop? Just libraries of poop from all over the world. So Bruce...
calls them, you know, sets up a meeting and says, can I get some of this? Let me get some of this poop. So yeah, they set up a deal where they're going to send him poop from all over the world and they're going to look all over the place. So they look. They start looking at poop in Denmark. And no Biffid. Scandinavia, Switzerland, no Biffid. But then they get to Gambia. Biffid. It's there in the poop.
Cambodia. It's there. Rural China. Bangladesh. They have Bifid. Huh. Weirdly, the only people in the U.S. Yeah. Mennonites. Mennonites.
Mennonites have the bifid. The babies have it. Very strange. Why some places and not others? Well, that's the question. At this time, they don't really know why here, why not there. Yeah. It's a mystery. I mean, it certainly could be, you know, maybe this bacteria survives in a certain climate. Maybe it's genetic differences. Maybe it's lifestyle differences. It's an open question. Okay. Okay.
Does he have any guesses of, like, there's obviously some bacteria we like that are great for gut health, some we don't want. Does he have any sense of what it's actually doing? Right, that's the next question. Is Bruce and the team, guy by the name of David Mills, all these amazing scientists want to figure out what is this bacteria doing? Yeah. So what they do is they do another experiment. They basically take some cells from the gut, which you can take, you can culture them, and you can put them on a plate. And when you put...
gut cells on a plate, they actually automatically form themselves into a wall. And so it's kind of cool because, you know, gut cells, what they're supposed to do is basically form a wall and anything you eat or drink has to basically go through those cells to get to your body. So it wants to make sure all the food is the right food. It's all broken down properly.
All the good stuff comes in, all the bad stuff stays out. That's what the gut cells do. So they form into this wall. The gut's being formed into petri dish. They throw some bifidobacterium on the petri dish and see what happens. And right away they notice that the bacteria are able to sort of latch onto the walls of the gut, just like hang there, like mountain climbers. And they start proliferating really fast and basically coating the whole wall. Whoa, so this Y-shaped bacteria that likes alien sugars...
With enough time, it's almost like wallpaper on the inside of the baby's gut? Yeah, exactly. It's like wallpaper on the walls. Okay. So I guess I ask again, is this a good thing? Right. We don't know if it's good or not. So to answer that, I got to tell you a story. Okay. I love a story. Dylan, guys, I'm going to need a little bit of like rogue, don't try this at home,
Just don't try this type of stuff at home. Okay. So our story centers around Dr. Shara Sheldon, who at the time is a PhD student. Okay? Now, she's studying this stuff. She goes to a lecture where Bruce is talking about these results and she sticks in the back of her mind. Meanwhile, her father is a professor at the vet school.
And he works at a lab, not at a lab, at a barn that's raising these thoroughbred horses. Oh, okay. So thoroughbred horses, if you don't know, those are those really expensive horses that they eat way better food than you and I. Their lives are definitely more valuable than ours. These are expensive horses. Yeah, okay. But there's a problem at the barn.
Every new foal that's being born to these horses after a few days is getting diarrhea, fevers, and then dying. Oh. Yeah. And that's sad because we like horses, but also sad because they're losing like hundreds of thousands of dollars every time this happens. On every foal. Okay. Okay. And the problem is next week there's going to be like 20 more foals being born. Oh no. And yeah. So basically what they do is they find out what's going on and it turns out these horses
are infested with one of the worst diarrheal bacteria that we have. And if anyone works, does anyone work in healthcare or anything like that? I mean, what's that one bacteria, diarrheal illness that we don't want to deal with
C. diff, exactly. You know it. Once you've smelled C. diff once, you'll never forget. I mean. Avira showed a picture of C. diff that was right behind us on stage. Okay. Well, it looks kind of like a dynamite stick, like exploding corn dog situation. Yes. The corn dog dynamite stick. This bacteria is terrible. Okay. Like you can't, if you spray this with antiseptic, if you spray it with Purell, like it won't die. Like this thing doesn't die. It's really hard. Needs very strong antibiotics. Yeah. It's,
It kills people all the time. We see this every time in the hospital and it was killing these horses. So these foals infested with C. diff. The dad, who's the professor who works there, is talking to his daughter about it and commiserating. And the daughter goes, wait, like I just heard a lecture by this guy, Bruce German. And he was talking about this bacteria that coats the walls. Like, let's give this to the horses. Yeah.
So the dad goes, yeah, I mean, let's try it. So they take the bacteria from Bruce. They culture it. They mix it up with some milk. And then when the foal is just born, they squirt it into the foal's mouth. Like with a little baby bottle? Yeah, a little baby bottle. Squirt it in. Hope for the best. It's only $100,000 on the line. Right. Okay. And lo and behold, what happens is, sure enough, 20 foals are born. None of them get C. diff. All of them do fine. Whoa. Incredible. Wow.
Can we get a round of applause for Shara? Rebel science. Again, don't try it at home. Clinical trials are good, but ingenuity. Okay. So I want to play my interview with her because I wish I could tell you the story stopped there, but it continues on. Oh, okay. Let's see. I was like, good job, brain. Perfect.
We're remembering the random lecture with Free as German. So in the room, we're actually now watching a video of the interview where you can see Shara on the left put together, short dark hair, and then Avira on the right is like kind of sweaty and was just saving lives maybe. There are so many random lectures I had in med school that I will never remember. Like, I don't know how you did that. I loved it though. I thought it was the neatest thing. I don't know. Okay, so that's an amazing story, but I know that the story doesn't end there.
What happens next? So time goes on. I'm still doing my PhD and got married, got pregnant. And then I had my baby, healthy baby. Everything's going great. And then the change comes. And we started dealing with a lot of gas, a lot of crying, just
Like, he looked like he was in pain. We were trying everything for the gas, the little gas drops out of a natural, the bicycle kicks, all kinds of things. So I just was getting quite desperate to find something that would work. And we kind of hit the breaking point when my husband was out of town.
And so I'm alone with the baby and it was so bad. He was up like all night, just in pain, gassy. And I was like, this is not going to work. And I said, we need something. And so I remembered the bifidobacterium and I said, I'm going to email Bruce. And so...
I sent a desperate email saying, please, please, I know you have some of the bifidobacterium still. Like, I'd really like to try it. Okay. And so does he email back? Like, does he take a week to email back? He got back to me right away. And he said, you can drive up and get it. And I loaded up in the car, drove to Davis and went in and we got like a little bag, just a brown paper bag with
samples in there and the syringe. What, they're in like little vials or something? No, they're in little sachets. Like a little rectangular packet that you can rip across and pour out. Okay, yeah, you got it. Like a bag of drugs, basically.
Yeah. You know, you're using stuff that's being tested for research, so it's not very pretty. Right. I get home. I'm very excited to try this. I grab one of the little sachet packets out and I open it and I see there's like a powder in there. It had kind of an interesting odor, I noticed. And then I mix it in with the breast milk and then suck it up in the syringe.
And then my mom helps me hold Connor and we hold his head and we put the syringe into his mouth, squirt it in. So we did that. And they said, just do one dose a day. So, you know, I'm sitting there with aided breath waiting to see if anything happens, watching him like a hawk. And we didn't really see any changes right away. So I was a little disappointed because you're desperate at this point, right? I want results. I'm so tired. And it took two days.
So, and then it worked. Oh, wow. Okay. What do you mean it worked? Like...
The change was just so drastic. It was like a switch had clicked. And he just was so much happier. He was sleeping. He didn't have the gas constantly and just seemed so much more relaxed. And I just, I was like, this is working. And this is exactly what was missing from his microbiota. Yeah.
Well, you know, the scientist in me has to ask, like, you know, could this have just been a coincidence, you know, like or placebo effect? You know, obviously you really wanted to see some results. Like, how do you know? How do you know for sure that this did that?
I would be doing the same thing, right? Oh, this is just a placebo. But the amount of dirty diapers had been very consistent. I had been keeping track because I love data and I'm a nerd. I was keeping track of all of these things. And to go from like that eight to 11 down to two, I knew it was doing something. Wow. That's, I got to say, I mean, like, was there ever a
a part of you that felt like afraid to essentially be like experimenting on your firstborn child? Or did you just feel that confident? I mean, I felt really confident with it. I mean, there's a small part of you that's like, oh, yeah, I'm giving this novel thing to my baby. But when I saw all the benefit, it was like, this is right and it's working and everything's good. But it is scary. Oh, wow.
I just have to say, is there any other better image of sleep deprivation than like, this thing smelled a little weird, but let's put it down. Wow. Okay, go, Sarah. I mean, what, okay, but to follow up on your question there, like,
do we know what, like, is there still a chance that could have been placebo? Like, do we have any clue about what's actually happening at the cellular level? Like, what is going on? Yeah, so Bruce sort of made a deal with Shara, like, I'll give you the bacteria, you give me his diapers. Okay.
Common theme we're seeing emerge here. So that's what he does. He sort of collects Connor's diapers and a bunch of other kids too. And he's sort of seeing what's going on. Let's check the microbiome. Let's check the stool, see what's happening. Yeah. Let's look for a subtle change, like a change of 5%, 10% in your microbiome. I mean, that's huge. Yeah. But what he finds is actually Connor's diapers went from having zero bifidobacterium to being 80% bifidobacterium. Whoa. Wow.
And this is like insane because, you know, it's not, we're not, this isn't normal microbiome stuff. This isn't like diverse ecosystem. This is just like domination. It's like a monoculture in there. Yeah, exactly. It's all biffid. Wow. Yeah. Okay, so they noticed that and that's interesting. Another thing they noticed as well, just like babies eat and they poop,
well, these bacterias are eating these alien sugars and they have to poop too. But what they're seeing is the poop that these bacteria are creating are acid. So they're creating acidic poop. And the thing is, bacteria can't really grow that well in acid. So acid prevents most bacteria from growing. But it turns out the bifidobacterium is totally chilling in the acid. But the idea is it may be keeping other bacteria away.
Okay. Can I, can I just make sure I understand what's going on? Absolutely. Okay. So bifid is the thing that eats the weird sugar in breast milk. And if you put it in a baby's gut, it'll receive that sugar. It'll eat the sugar. It'll bloom and it'll wallpaper the gut, but also it'll like edge out all the other bacteria. With its acid poop. Yes. It is like bully wallpaper kind of. Okay. And the idea is that that
The bully wallpaper is what helped Shara's baby have less gas and less pooping pain or whatever? Yeah. I mean, we don't know what was happening inside Shara's baby for sure, but that is exactly Bruce German's theory. And, you know, Avir pointed out there's a lot of such situations, especially in a newly developing baby gut, that if the wrong kinds of bacteria get in there, it can release toxins and poke holes in the gut wall.
And allow things to pass through. Instead of going through the cells, they sort of go in between the cells and around the cells. So bacteria can get in, toxins can get in, undigested food particles could get in. And that's called leaky gut. Leaky gut. Yeah. And according to Avira, that can cause a lot more problems than just gas pain or diarrhea. And for this baby that just got an immune system like two months ago, he's trying to figure out
what the hell is going on? And it gets very overwhelmed and confused. It gets inflamed. The immune system is hyperactivated. And it causes a lot of problems. So Bruce's theory is that, going back to Bifid coating the walls of the gut. When Bifidobacterium is here, the Bifidobacterium sticks to the walls, prevents any other bacteria from coming there, so that basically...
nothing bad gets into the body and the immune system can actually like learn and do its thing. And to be clear, so this is a bacteria that most babies, especially here in the US, right now do not have. Exactly. And what's wild is you can actually see the disappearance over time because if you look back over...
over time at poop samples from across the world, which there are. One of Bruce's grad students at the time actually did this, Bethany Henrich. She looked at the historical data and found that baby poop back in the early 1900s used to be way more acidic, like everywhere. Whoa. It's been subtly changing over time. Yeah, over the last hundred years in places like the U.S., it started trending over to neutral. There's this very clear line that
And it's showing that basically our baby's poop used to be acidic to a pH of five, which is acidic. Okay. And it's slowly been working its way up to neutral.
And it's like this very clear thing if you map it out. And again, you said the bifid makes the acidic poop. So watching it get less acidic, is that like watching a disappearance? Exactly. At this point, Bruce and the team is sort of being like, wait, this is a sign. This is the marker of bifid and it's going away. That's what they see. Wow. You're making me miss this thing. I feel like we should get it back.
Yeah, well, that is where we are going next in the show. First, we're going to take a brief intermission. But when we come back, we will not only address that, we're going to have special guests live on stage. We're going to hear about cease and desist orders from the FDA coming down to doctors. And we're going to be doing some real life, I guess you could call it experimentation on the audience. On babies? Not babies. On adults in the bar. Stick with us.
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Okay. Okay, Latif. Lulu. Radiolab. We are back, playing the live show I did with Avir Mitra, telling the story of this baby gut bacterium.
that seems to be protecting the baby's gut. And we didn't delve into this much, but also feeding the baby's gut cells, keeping them going strong, but also appears to be disappearing from our species all over. And according to Bruce German, our main scientist, it is time to bring...
Biffin Beck. At this point, Bruce goes from being just a normal scientist, show up to work, do your research, to becoming a borderline evangelist. His daughters won't take him to the family dinners because this is all he talks about.
He told me that. He sees a baby in a stroller across the street. He's going to sprint over to the baby and throw some bifidobacterium at him. And he actually mortgages his house and gets his co-workers to do the same. They sell the boat, do all these things to start their own startup to sell bifidobacterium. Whoa. Right. Which you can buy and which we may or may not have. And this is just like he's selling bifidobacterium.
Bacteria in a jar? Bacteria in a jar. Okay. Okay, now at this point in the show, I just need to pop out and say, Avere told a story that honestly I have not been able to shake since...
Brian Scottolini is an MD, PhD, and he's a neonatologist who works at OHSU in Portland. So he's working there and as a neonatologist, it's a beautiful thing because you get to see these little tiny preemies grow into like full-fledged adults.
But there is one thing that's like the worst thing that happens in NICUs. And basically that's this. So Avira is showing us this picture. It's like a CT scan kind of thing. And you can sort of tell that it's like the scan of a gut. But it seems to be almost like ballooned out. So what we're looking at is a preemies belly.
Okay. And it's filled with gas. It's very distended. And this baby's not doing well. This is called necrotizing enterocolitis, also known as NEC. And basically what's going on is like a bacteria, an adult bacteria, has somehow made its way into the baby's gut, has sort of bloomed and taken over, and is like completely destroying the gut wall, producing all this gas and all these bad things. Huh. That looks...
painful, scary. I mean, very scary. Yeah. Yeah. I mean, I, I, when I was a resident, I rotated in NICUs and it's terrifying because these preemies can go from being normal and then overnight they can totally crash, get this. And the mortality is very high once they get this. Yikes. So Brian gets sort of wind of this bacteria and,
And they both have this thought, well, maybe we could try bifidobacterium. In the preemies? In the preemies. Okay. He gets some of the bifidobacterium from Bruce and the team and the company, and he just starts giving this to the babies. Without checking with parents? Right, pretty much like, this is on formulary now, we're going to give it to them. I'm having mixed emotions about this idea. Sure. But...
Yeah, I agree. And you've got to think, he's not just waiting until they get NEC to give it to them. He's giving it to all the preemies, even the ones that would be fine without it. Like a preventative measure. Exactly, a preventative. And lo and behold, he finds that the incidence of NEC goes from 11% down to 2%. It was actually 2.7%. Insane. That's huge. And this goes on for years. There's in fact years that go by that they don't see a single incidence of this.
In the NICU? In the NICU. He publishes about it. And he's sprinkling life into this whole time. Yeah, it's just sprinkling. Okay.
This was in, well, he's, we'll get to that. So he does this and yeah, he finds that it's working. Other NICUs are starting to take this up. Okay. So anyway, I've been talking about Brian enough. I want to bring Brian up himself. So Brian, if you're here, let's bring you up. Let's get some play on music. Come on down. You can come over here. Thank you, Brian. Hi, everybody. You just flew in today, just landed. I did. Yeah.
So you had this really incredible result when you studied bifidobacterium. I mean, truly incredible. And it seemed like it was spreading. But I guess I wanted to ask you, like, what happened next? Well, as Avir was saying, for years, our incidence of necrotizing enterocolitis was quite low. And so we started in 2018 to answer that question. And then we had to stop in 2023. Tell me about that.
So for years, even well before me, neonatal intensive care units throughout the world in Europe and in Australia, almost every premature baby gets a probiotic, gets a bacteria that is like this, including this one, Bifidobacterium infantis, to prevent necrotizing enterocolitis.
So I wasn't as crazy as it might have sounded to start using it in our NICU. A little crazy, a little crazy. But we were the first ones to use it alone. So our team decided this bacteria makes sense because of its symbiosis with milk. And so we thought we should use this to prevent necrotizing our colitis. But what happened, as you might expect...
whenever you introduce a bacterium into somebody, whether it's us or babies, and especially babies with an immature immune system, there is a risk that it will find its way into their bloodstream. Now, if you ask me if I'm going to choose between a pathogen, Ambifidobacterium infantis, which has no antibiotic resistance and is meant to be in milk or in the gut to metabolize HMOs, which cannot be metabolized by us, remember that,
I will choose B. infantis. And so, unfortunately, some babies got B. infantis in their bloodstream and had positive blood cultures, meaning that when they looked ill, they had a sample of blood taken and then was grown to see if B. infantis was there. I might add that other bacteria that have been used as probiotics have also found their way into the bloodstream. The FDA knew that NICUs throughout the United States were using this to prevent necrotizing or colitis.
and decided with the instance of a bloodstream infection that all the NICUs in the United States needed to stop using probiotics to prevent necrotizing or colitis. This essentially was like a cease and desist letter. You can read this letter and see there isn't a risk department in a hospital that's going to continue to use this with the FDA saying you shall not use this without an investigational new drug status. So you get this letter...
And I imagine you have some complicated feelings because it's like, I don't know, we could understand where the FDA is coming from. I'm a little inside FDA. But at the same time, you're working hands-on with these babies and you're seeing amazing results. So what's going through your mind? The first was, oh, crap. A bit stronger word than that. Because in the risk-benefit...
We saw necrotizing enterocolitis, we'd get two or three babies die per year. And for several years, no baby that was born in our hospital died from necrotizing enterocolitis. So on one hand, I felt like babies were going to die now. I hate this disease. I can't tell you how much I hate this disease. And I hate seeing babies die in four hours, six hours, they're dead. And
and the impact it has on their parents versus a rare risk like this. So that was going through my mind. But on the other hand, it was sort of like when you were talking about Lulu, it was sort of like, well, we were using something to treat, prevent, or mitigate a disease, which is a drug. And therefore, I see the FDA's point. So I was flip minds. What happened once you removed this bacteria? Yeah.
Unfortunately, we are working on reporting this, but our necrotizing enterocolitis rate has come right back to where it was before. In fact, probably a little bit higher than it was before. So I guess where do you go from here? What are you trying to do now? Well, we suspect this is happening throughout the United States, so we hope to be one of the first to report this. But since that time, we've been working with the FDA to try to have this become a drug, which is not the most simple pathway to
and costs a lot of money to develop a drug. Investors are scared of premature babies. They're afraid of pediatrics in general, and they're really afraid of preterm babies. And so it's a struggle to try to make this continue to move forward. And the only thing that keeps the folks who work on it, working on it as a large team, is the fact that it, at least in our hands, it works.
Okay, Brian, stay here on stage. Thanks, Brian, for being here. Okay, so just to advance the story from here, Brian gets this result. Bruce has this company. He still really believes in it, but unfortunately his company sort of now has a scarlet A and they have to sort of short sell to stay afloat. And so Bruce and his team sort of lose stake in the company. He still has his job. He's not on the streets, but things aren't looking too good.
But Bruce still, and I've spoken to Bruce for hours. He's still positive about it. He's still hopeful. And so anyway, I've been gatekeeping this guy, Bruce, long enough. Let's bring him up to the stage. Bruce German. Hi. Okay, Bruce, I've got a question. Going all the way back to that global poop hunt, I don't know if that's what you called it in your papers, but our shorthand is,
Do we have any clue, like, why in the places like Denmark and most of the U.S., except the Mennonite communities in Switzerland, like, why, where was the bifid going? Why did we lose it if it seems like it is such a harmonious thing in a baby gut? First, I should say that this is the work of
literally over 100 people for 20 years. And I know I'm obviously distractingly tall and good-looking. But really, it's this diversity of scientists from around the campus at UC Davis have brought this science forward. And that's one of the critical questions where you need multiple disciplines because it's a mutualism, what we would call a synergy.
Oligosaccharides don't do much by themselves. The baby poops them out. Bifidobacterium fandus doesn't do much all by itself. The baby poops it out. But you put them together and that's the magic. And away it goes. But
Babies are born sterile. Completely? No microbiome in there? They're sterile. Mother, you are keeping your baby sterile. But needless to say, the minute they're born, they're being inoculated from bacteria all over. If there's no bifidobacteria infantis in their environment, they cannot get bifidobacteria infantis. If mothers can't breastfeed,
then they don't get the oligosaccharides, they don't survive, no bifidobacteria in the baby. No fish food for the bacteria. Nothing. If the mother gets antibiotics, kills bifidobacteria, and that mother will never have bifidobacteria again unless she somehow gets re-inoculated. One step...
in any of those directions, ends the story. And it's been happening over a century. Mothers are losing the ability to pass on the bacteria. You know, another part of this is formula doesn't have these alien sugars and it's not able to feed these bacteria so the bacteria gets starved. And I will say, you won't admit this, but, you know, part of his...
was that he would email all the formula makers and be like, can I meet with you? And he would get some meetings with these formula makers and my impression was they were sort of like, thank you, sir. Here's security, please leave. I'm exaggerating, but...
But lo and behold, a few years ago, all the major formula makers have added these alien sugars into the formula. I'm crediting you with that. Well, I mean, it turns out that there are dozens. That's great. That's great. There are dozens of different oligosaccharides, and so far, industrially, they can only make a couple. And...
You need a lot. Remember you pointed out there's more of this than protein. Evolution's saying it is important to feed the bacteria in the baby as it's a baby.
So we need to get a lot more. Okay. Well, I think one question I had is sort of, you know, you look at the pH changing and the poops changing over the centuries. Like, I can't help but think this correlates so well with the rise of, like, childhood autoimmune diseases and, like, these chronic diseases. I just wanted to, is there something there? Yeah.
Yeah, we've been studying that, and the strength of the immune system is it's so personal. The benefit of that is your immune system can learn to attack diseases your parents never had. There's a flaw. Your immune system has to develop, be educated in the first few weeks of life. And the immune system is basically located in your gut for sort of obvious reasons. It's paying attention to the environment through the bacteria. If the bacteria are...
appropriate bifidobacterium infantis, then it's clear that the immune system is developing appropriately. But if the gut is full of inappropriate bacteria, now the immune system is being miseducated. The result of that is with bifidobacterium infantis, it's clear it's an intelligent immune system. If it doesn't, then it's not an intelligent immune system. What does that mean, intelligent immune system? It makes mistakes.
So the immune system can make two kinds of mistakes. It can say, there's danger, don't worry about it. The other kind of mistake is, it's perfectly benign, I should attack it as if it was dangerous. And that's what autoimmune disease. When someone doesn't have bifidobacteria infantis, their immune system is not developing appropriately. That means it's greater risk. Doesn't mean they're going to get autoimmune disease, but they're at greater risk of having it. We now have
Very convincing data that a part of the problem with autoimmune disease is the bacteria in your gut in this early developmental stage. And lo and behold, throughout human history, bifidobacteria infantis, that's been the one. It's been predicted that if we had not found it, it would probably have been extinct within the next generation. It wouldn't have been findable at all in a few years. Ugh.
You know, I just think it's crazy that there's this like Y-shaped bacteria, right, that no one ever paid attention to, that we almost wiped off the face of the earth by accident.
that basically has this completely symbiotic relationship with us. I mean, like, you know, obviously in school we learn about, like, the birds and the bees and pollination and coral and algae, but, like, who knew that, like, our babies have symbiotic relationships with this random bacteria? Like, that's Sylvie, that's Lulu's baby. My baby.
Like Sylvie is a symbiote with this bacteria. I mean, it's blowing my mind. And if you really think back, like if you really go back in time, let's go back 500,000 years, which is when we broke off to become human. Bruce was telling me, if you go back, you know, trace the genetic lineage of Bifidobacterium infantis, it broke off from its predecessor at exactly the same time.
which to me is crazy because that means like we have literally co-evolved with this bacteria. I mean, like, come on, like this is our best friend. This is like our oldest and best friend that we've ever had. Okay, can we, sorry, can we scratch the emo music? Okay, I mean, you put a picture of my baby up and it's a beautiful thought, but you've gathered like a set.
story here. I mean, Brian was shut down. The study was shut down. Who knows how long, if it's ever going to go. I mean, Bruce is eloquent, but his business sounds kind of on the rocks. And...
And then even if we could get it back, there are all kinds of parents who can't breastfeed for different reasons, economic reasons, body reasons, whatever it may be. So aren't we just being kept away from this majestic, beautiful friend? Isn't this just sad? And we're doomed to be unhealthy? At this point in time, no. If you look back at the history of scientific discoveries, especially related to health, they're always turbulent.
This is a fundamentally different way of thinking. It's now been shown that babies with Bifidobacteria infantis respond better to a vaccine than babies who haven't. So that's not just protection, that's enhancing health in ways we didn't even think about before. If you look back how science moves, it's moving inexorably forward.
It's just a matter of time. Okay, this guy can milk hope out of any situation, I guess. Another pint. Well, I guess with that, you know, we only have one thing left to do, honestly, is we have the bifidobacterium here.
We're going to try some. Yeah. No pressure, obviously. But if you guys want to try some, we can all cheers to Biffett together. Just talk to your bartender. They're going to be bringing it out. We're going to start passing it. Raise your hand if you want it. Once again, you do not have to. Radiolab doesn't necessarily... Wait, you had the Biffett there? Was it alive? Yeah, it was the real stuff. It'll bloom if you drink it. It was like in these little bags. It's kind of just like the smelly powder that Shara had. Wow. What did it smell like?
It was like fish tank light, you know? Sure. And we mixed it in with some water and handed out shots to anyone who wanted. And while we were handing out these little shot cups, I made the band jam out along with... And I think we need to bring in an instrument that has never been played on Radio Lab ever before. Hold on. My breast pump. Wow. Breast pump remix. What?
It was not hooked up. It was not all the way hooked up. You weren't pumping it. I wasn't actually pumping milk. It's very goth, industrial goth vibes. Yeah, it's like a little steampunk. Oh my God, this sound again and again. Why capitalism? Why? Don't drink it yet. We're going to drink it together. We're going to drink it together. Do.
Did everyone, did people want it actually? A lot of people. Yeah. I think like a lot of people, most people did it. Okay. Now everyone, let's turn that music down. Okay. All right. Cheers everyone. Cheers. Okay. We really do it? Okay. What did we actually drink just now?
Straight up bacteria. Who just asked? Yeah, you just ingested, like, I don't know, is it powder? Dried bacteria? It's those little Y shapes. What did we drink, Bruce? Yeah, Bifida bacteria, Longum subspecies infantis. Like, as I drank this stuff down, I thought about how we were all in the room at that moment, literally, physically reuniting with this bacteria that we had been with for so long that we might be...
starting to lose. But the more I started thinking about that whole chain of things that BIFID do in a baby's body, I realized I actually had one last question for Bruce. So this is sort of an emotional question, but in this moment of breastfeeding, which I have found to be one of the most like connecting experiences of my life, you're saying what's happening is the baby, which used to be inside me, is learning to
it's building itself away from me, from other things. Like, it's actually a physiological moment of a wall being built of disconnection. Well, it's true. Okay. But you're paying forward so that that infant can be successful. The genius of milk is we tend to think milk is protective, of course. Darwin, survival, it's more than that.
Evolution is driving not just survival, it's success lifelong. What you're doing is providing the means for your baby to be successful its whole life. Yeah, blah, blah, blah, give them roots and wings so they can fly away. I only heard the first part. I'm sad. Go evolution. Okay.
Well, despite your sadness, that story was great. That was a really fun event. I never heard any of that. Thank you for playing it for us. And thank you also to Avir and to Biffid. Yes. And, you know, I should say this was not our first live show that we have done with Avir. You, of course, did one last summer called How to Save a Life. Yeah, that was the CPR one. And that was also a blast. It also ended with music. We had the entire audience learning how to do CPR at the end.
to the perfect beats per minute of staying alive. They've been really, really fun. And we are thinking of these live shows with Avere as a series that we're calling Viscera because every story is about something going on in your body, in your viscera, and it will have some kind of visceral experience. Yeah, so if you do have a body, want to learn more about it,
Keep an eye out. Maybe we're coming to a city near you. Yep. And lasting thanks, Lulu. We got to do the thanks. No, we already did them on stage. Okay, well, it is time now as we... All right, no problem. Okay, my workday is done.
said if you want to hide a piece of information put it in the credits to a podcast because no one will listen and yet you're all stuck here um so okay so huge thank you he's not even on here but to avir mitra for bringing us this story to bruce german to brian scottalini
Right here on stage to Shara Sheldon and all her hijinks. To our musicians, Dylan Keith and Yvonne Bonbon-Byrne. Thank you to the Radiolab team lurking in the background. Stand up, Harry Fortuna, Sarah Sandbach, Soren Wheeler, Pat Waltz, Anissa Vitsa, Jeremy Bloom, and George Wellington.
Speaking of Radiolab, I would like two OG members, Robert Krowich and Ellen Horn to give a stand up. Our original executive producer. We love you. None of us would be here without you. Everybody here at Caveat, thank you for bringing us here. Tip your waiters, order more drinks. We would love to come back. And of course to our Radiolab members who said there are people watching us on a screen. Hi!
If anyone's still there, thanks. You make everything we do possible. And now, Avere, you have a couple, and I need someone else to read the very last thing. We need a listener. Anyone, an audience member willing? Okay, come on down. Some quick thank yous. This story actually came to me from a Radiolab listener named Tim Brown. So cool. Um,
So thanks to him for sharing this story. David Mills, Carlita La Brea, Bethany Henrich, Danielle LeMay, Katie Hind, Jennifer Smilowitz, Angela Zivkovic, Daniela Burrill, and Mark Underwood, all the scientists involved in this research that I wasn't able to shout out before. Hi, I'm Alexa Petrie, and I'm from Halifax, Nova Scotia, and here are the staff credits. Radiolab was created by Jad Avambrod and
and is edited by Soren Wheeler, Lulu Miller, and Latif Nasir are our co-hosts. Dylan Keefe is our director of sound design. Our staff includes Simon Adler, Jeremy Bloom, Becca Bressler, W. Harry Fortuna, David Gable, Maria Paz Gutierrez, Sindhu Navatsambandhan, Matt Kielty, Annie McKeown, Alex Neeson, Sara Khari, Sarah Sandback, Anissa Vitsa, Ariane Wack,
Pat Walters, and Molly Webster. Our fact checkers are Diane Kelly, Emily Krieger, and Natalie Middleton. Well done! Thank you all! Thank you so much! Have a great night! Hi, this is Laura calling from Cleveland, Ohio. Leadership support for Radiolab science programming is provided by the Simmons Foundation and the John Templeton Foundation. Foundational support for Radiolab was provided by the Alfred P. Sloan Foundation.
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