As we mention a lot at WellBe, gut health is incredibly important. It impacts almost every aspect of well-being, from the immune system to mental health and beyond, and that’s why we focus a lot on improving and protecting gut health naturally. But one area we haven’t touched on is gut health for kids, which is why we were grateful to sit down with pediatric gut health expert Dr. Michael Ruscio. Dr. Ruscio is an influential voice in functional and integrative medicine, as well as a clinical researcher and bestselling author of Healthy Gut, Healthy You. Read on to hear Dr. Ruscio’s take on probiotics during pregnancy, antibiotics and probiotics for kids, the different types of probiotics and how to choose one, plus much more.
Probiotics During Pregnancy + More Ways to Improve Gut Health In Utero
Perhaps not surprisingly, a child’s gut health starts to develop even before they’re born. What a pregnant woman chooses to eat, drink, and do has an impact on the development of her unborn child, so it makes sense that these choices would affect their baby’s gut health. “Early life factors influence gut health in children, and this does extend all the way back to while the child is in utero,” Dr. Ruscio explains.
In terms of what a woman should do to ensure that she’s setting her child up to have a healthy, robust microbiome, Dr. Ruscio says there are three major contributing factors, the first of which is pretty straightforward: diet. The dietary guidelines for pregnant women aren’t much different from the guidelines for any adult looking to support gut health. Women should eat a mainly whole foods-based diet, avoiding excess sugar or processed foods as well as any foods they have sensitivities to. Our free gut health guide has a comprehensive list of gut-friendly foods to eat, as well as those to avoid.
The second factor is a little less intuitive. Dr. Ruscio says that more and more research is supporting the idea that contact with the natural environment is important for creating a healthy microbiome in unborn babies. He cites one study that compared pregnant women’s contact with farm animals to gut health in their offspring. It found that for every additional grouping of animals that mothers had come in contact with while pregnant, there was a corresponding decrease in inflammatory markers, suggesting that exposure to dirt during pregnancy could be quite beneficial.
“So we have to apply a bit of logic to this statement,” says Dr. Ruscio. “I wouldn’t say a dumpster would be the kind of dirt that we’re trying to contact. But we might turn to animals in the environment, naturally occurring germs and bacteria that seem to attune the immune system of the mother and child. So not being a germaphobe — again within reason, if you go to a public bathroom, wash your hands. If you’re hiking and you’re touching dirt or if you’re in contact with animals, that’s the type of exposure that’s going to be more beneficial. So that’s one thing that we can do, is just have whatever reasonable degree of contact we can with a natural environment.”
The third most influential factor, says Dr. Ruscio, is probiotics during pregnancy. He notes that in conventional medicine, it’s common for doctors to err on the side of caution, telling pregnant women to discontinue or steer clear of any sort of supplementation to avoid any possible side effects. However, he explains, probiotics during pregnancy have been shown to be not only completely safe, but potentially very beneficial.
“There’s some really exciting literature [on the topic of prebiotics during pregnancy]. There’s actually some very interesting evidence showing that children born from mothers who are taking probiotics while pregnant and/or while breastfeeding have less eczema, as one example,” he explains. “They’re safe and effective for mother and child.”
A Holistic Approach to Gut Health for Kids
While Dr. Ruscio is an expert in gut health generally, he also has a special understanding of gut health for kids and how it differs from the adult microbiome. Those differences are minimal, he says, but they are quite important, and dealing with pediatric gut health involves a nuanced understanding and a sensitive, holistic approach.
“There’s one key difference in that gut microbiota and the impact it has on the immune system is predominantly formed by the third or fourth year of life. So there’s this really pivotal, formative window that we should be concerned with,” Dr. Ruscio says. “Beyond that, the way we tend the garden that is the gut is quite similar for adults and children. There’s not much change, but there is this maturation, and so the younger you are, the more important these things are because it sets the stage.”
Still, Dr. Ruscio is quick to point out that a child’s gut health is in no way set in stone, and that early experiences that may have harmed gut health don’t doom someone to an unhealthy microbiome for life. For instance, children who weren’t breastfed or who were delivered via C-section (both of which are associated with a less healthy microbiome) can easily make up for these losses by eating a broad diet full of nutrient-rich, non-processed foods.
Another consideration with gut health for kids is the way in which food restrictions and gut healing protocols are handled. “When performing dietary restrictions with children, we should really be as light-handed as possible,” says Dr. Ruscio. “There’s some evidence showing that overly adherent dietary practices in children leads them to have more issues with food, like orthorexia or binge eating when they get older.”
To avoid this outcome, Dr. Ruscio uses a very subtle, light touch when working with children, never pathologizing them or pointing to certain foods as “bad.” Rather, he frames it by explaining which foods will help a child feel their best, skewing the conversation in a positive rather than negative manner. “We don’t want kids to start to internalize psychologically that there’s something wrong with them,” he says.
Probiotics also play a significant role here, even more so than they may when addressing adult gut health. While Dr. Ruscio aims to mostly be a diet-first practitioner, he sees children as a unique case. “With kids, it’s harder to get compliance [with diet], and it’s also easy for them to start to build up these neurotic relationships with food,” he says, explaining that probiotics can help children to build up tolerance to other foods, which then makes it easier to begin to adjust diet. “Probiotics are a good starting point, so that we don’t have to really fetter the children with either the psychological burden or the logistical burden of having to be any more food avoidant than we absolutely have to have them be.”
Antibiotics and Probiotics for Kids
While probiotics can be useful in helping gut-compromised children avoid any sort of distorted relationship with food, Dr. Ruscio also recommends probiotics for kids more generally. “I don’t think it’s a bad idea to have any child on a probiotic, just looking at the benefit that’s been shown in the trials and no real detriment,” he says. “You don’t have to be anal about it, or take them on vacation with you and chase down your kid if they missed a dose one morning. But as a general replacement for the fact that we don’t get enough exposure to bacteria to begin with, I think it’s a good hedge to have in place.”
Probiotics, of course, are also a good course of action if a child needs to take antibiotics for any reason. On this topic, Dr. Ruscio emphasizes that it’s important not to view antibiotics as something to be avoided at all costs, but rather to be discerning about the risks and benefits. He explains that this absolutist mindset shuts down rational thought, and could make parents say no to antibiotics that may be absolutely necessary for their child. The better approach, he says, is to avoid antibiotics when possible and to ensure your child has a healthy gut that can bounce back from any rounds of antibiotics that might be necessary.
“If you do have antibiotics, it’s not the end of the world,” says Dr. Ruscio, explaining that people with a robust, healthy microbiome won’t experience significant negative effects from the occasional antibiotic. To illustrate, he points to a study of a hunter-gatherer tribe in Papua, New Guinea who had access to conventional medical care and would be administered antibiotics on occasion. The researchers found that the tribe members’ microbiotas were vastly healthier than most Westerners’ microbiota, even after antibiotics. “It’s likely because they had a much healthier and dirt-rich environment,” he says. “So that supports the position that antibiotics aren’t the one thing that’s going to irrevocably change the child’s gut health. Now, the earlier the antibiotics are used the more impactful they may be on the gut in a negative way, so we want to be discerning, but there are other things that you can do, namely using a probiotic and trying to get in contact with the natural environment as much as you can as kind of safeguard.”
The Main Types of Probiotics and How to Choose One
It’s clear from Dr. Ruscio that probiotics for kids and probiotics during pregnancy are beneficial, low- to no-risk choices. But with the dizzying array of probiotics available today, it can be overwhelming to make a choice. This can be especially true with probiotics for kids as there’s now a whole market of pediatric probiotics for different ages. However, according to Dr. Ruscio, most of this is just hype, and there are really just a few different types of probiotics, regardless of whether those are probiotics for kids or for adults.
“We can really break probiotics into three different types and then personalize those three different types to the individual,” he says. “The analogy that I use is a stool. So the stool requires legs in order to balance. Now, you can look at the stool as your gut microbiome. We want it balanced, we don’t want it to fall over. So one probiotic formula is akin to one leg of support, but if we can use three different formulas, now we have three legs of support encouraging and holding the gut microbiota in balance.”
The three major types of probiotics are:
1. Lactobacillus and bifidobacterium species blends. This is the oldest and most traditional type of probiotic on the market, with over a hundred different clinical trials supporting its efficacy.
2. Saccharomyces boulardii. This is actually a healthy fungus, which has been shown to help various different conditions, including Crohn’s disease and ulcerative colitis. There have been around 50 clinical trials on this type of probiotic.
3. Soil-based probiotics. A newer type of probiotic, Dr. Ruscio refers to soil-based probiotics as “the golden child of the paleo and ancestral health community.” Depending on what body of literature you look at, there are 20 to 40 studies on the efficacy of this type of probiotic.
When deciding among different brands and types of probiotics, Dr. Ruscio recommends looking for a high species count. “The more species, the more beneficial the effect,” he says. “This has been shown in a few papers for IBS as a model, meaning when researchers look at one species or two species as compared to 10 to 15 species, there is a trend where the more species equals the better result.”
He also recommends beginning with one of the above three categories of probiotics, and then assessing how you feel after a time. “If there’s partial improvement and then more resolution, go on to the second and even to the third category to try to have the most all-encompassing three-leg support for your microbiota,” he says. “That’s what I’ve found to work vastly better than one probiotic alone.” For a list of fully vetted, WellBe-approved probiotics (plus 1,500+ more products across 20 categories) check out our Non-Toxic Product Database.
The WellBe Takeaway on Gut Health for Kids
Gut health is a huge topic, and pediatric gut health is an important and equally complex part of the conversation. Based on our interview with Dr. Michael Ruscio, here’s what to remember about gut health for kids:
- A human being’s microbiome begins to develop while they are in utero. Because of this, specific things that the mother does or doesn’t do can have a direct impact on the gut health of their child. The three most important things a pregnant woman can do are to eat a broad, whole foods-based diet; get in contact with the natural environment; and take probiotics during pregnancy.
- For women who are able, having a vaginal delivery and breastfeeding also contribute to optimal gut health in their baby. However, C-section babies and those who are not breastfed will not necessarily have poor gut health or immune issues as long as their microbiome is supported in other ways.
- The first three or four years of life are the most formative for a person’s gut health. This means it’s important to support children in eating a whole foods-based diet, getting in contact with dirt and the natural environment, and taking probiotics.
- Probiotics for kids are not any different than probiotics for adults. For children with gut issues, probiotics can be a very helpful tool. Dr. Ruscio often recommends probiotics over dietary restrictions to avoid creating an unhealthy or disordered relationship with food in children. For those without gut issues, taking probiotics is also a risk-free way to support optimal gut health.
- Taking antibiotics should be avoided when possible, but shouldn’t be considered evil. Parents should ask questions, but agree to antibiotics for their children when necessary. A baseline healthy gut will be able to bounce back from antibiotics, even those given during a child’s formative years.
- There are three main types of probiotics: lactobacillus and bifidobacterium species blends, the fungus saccharomyces boulardii, and soil-based probiotics. Dr. Ruscio recommends beginning with one category, assessing how you feel, and then adding the other two categories one by one to get the most balanced support. He recommends choosing probiotics with the highest number of species to get the maximum benefit.
If you have children, do you give them probiotics? Why or why not? Share your thoughts in the comments below!
Watch the full interview with Dr. Michael Ruscio to learn why clinical trials for probiotics aren’t all good, how dogmatic attitudes in the wellness space can actually harm public health, why high fiber intake can actually be a bad thing for some people, his red flags when choosing a doctor, his thoughts on the relationship between gut health and picky eating, the vital information that food allergy tests don’t pick up on, why he looks at stool testing as a last resort for kids, and much more.
- Ege, J.M. et al. Prenatal farm exposure is related to the expression of receptors of the innate immunity and to atopic sensitization in school-age children. ENVIRONMENTAL AND OCCUPATIONAL RESPIRATORY DISORDERS| VOLUME 117, ISSUE 4, P817-823, APRIL 01, 2006.
- Garcia-Larsen, V. et al. Diet during pregnancy and infancy and risk of allergic or autoimmune disease: A systematic review and meta-analysis. PLOS Medicine. February 28, 2018.
- Rodríguez, Juan Miguel et al. “The composition of the gut microbiota throughout life, with an emphasis on early life.” Microbial ecology in health and disease vol. 26 26050. 2 Feb. 2015.
- Martinez, I. et al. The Gut Microbiota of Rural Papua New Guineans: Composition, Diversity Patterns, and Ecological Processes. Cell Reports 11, 527–538 April 28, 2015.
- Guslandi M, Mezzi G, Sorghi M, Testoni PA. Saccharomyces boulardii in maintenance treatment of Crohn’s disease. Dig Dis Sci. 2000 Jul;45(7):1462-4.
The information contained in this article comes from our interview with Dr. Michael Ruscio, Doctor of Natural Medicine and Doctor of Chiropractic. His clinical research has been published in peer-reviewed journals, and he is a committee member of the Naturopathic Board of Gastroenterology research division, as well as the bestselling author of Healthy Gut, Healthy You. You can learn more about Dr. Ruscio here.