5 Key Insights From The Pediatric Immune Health Summit
Metabolic Syndrome, Nutrition, and Systemic Health
Renowned pediatric neuroendocrinologist with decades of experience treating childhood obesity, Robert Lustig, MD, brought his expertise in pediatric metabolic health to the stage. During his session “Helping Kids Thrive In A Metabolical World,” Dr. Lustig explored metabolic syndrome as a primary threat to population health, the impact of poor metabolic health on pediatric immunity and development, and the paramount role of proper nutrition.
Clinical Takeaways:
- Childhood obesity has wide-ranging adverse effects on immune status, including an impact on responses to vaccination and infection.
- Obesity is not the problem; metabolic syndrome is the real detriment to population health as it contributes to the development of most chronic, untreatable diseases, including diabetes, hypertension, cardiovascular disease, cancer, dementia, and more.
- Ultra-processed foods inhibit mitochondria and have been associated with depression, cancer, and even premature death. High fructose in the diet alters liver metabolism, making it store more fat, affecting both liver health and whole-body metabolism.
- The downstream benefits of metabolic health include good mental and immune health.
- Nutritional approaches should include more soluble and insoluble fiber, decrease fructose levels for liver protection, and increase alpha-linolenic acid, EPA, and DHA to support brain health.
Sleep and Immunity
Jose Colon, MD, MPH, a sleep medicine specialist and one of Southwest Florida’s top doctors, as named by Palm Beach Media Group, led a lecture on the impact of sleep on immune resilience. Dr. Colon discussed the critical role of sufficient sleep on the development of autoimmunity, numerous sleep disorders and problems that prevent children from getting enough sleep, and the far-ranging consequences of sleep deprivation.
Clinical Takeaways:
- There is no “magic number” when it comes to sleep. What is deemed a “sufficient” amount of sleep depends on numerous factors. Different age groups need different amounts of sleep, but sleep needs also vary by the individual.
- Children between 0 and 3 months require 16 hours of sleep; children between 3 and 18 months need 14 hours of sleep; between the ages of 1.5 and 3 years, the required amount is 12 hours, and that number continues to decrease with age.
- Sleep and immunity are bidirectionally linked; immune system activation alters sleep, and sleep, in turn, affects the innate and adaptive arm of our body’s defense system.
- Sleep deprivation has been associated with alterations of innate and adaptive immune parameters, leading to a chronic inflammatory state and an increased risk for infectious/inflammatory pathologies.
- The most prevalent sleep problems reported in pediatric patients are night wakings, sleep schedule disturbances, and bedtime problems, at 30%, 28%, and 27%, respectively.
Polyvagal Theory, Social Engagement, and Pediatric Health
Stephen W. Porges, Ph.D., a distinguished University scientist and creator of polyvagal theory, presented an in-depth session on the applications of polyvagal theory in pediatric health. In discussing the meaning of polyvagal theory, Dr. Porges explored how the autonomic nervous system controls social engagement and health, the latest research in the field, and potential strategies for intervention.
Clinical Takeaways:
- Polyvagal theory suggests the autonomic nervous system (ANS) is influenced by the central nervous system (CNS), sensitive to sensory influences, and plays a significant role in regulating health and behavior. It explains how safety signals promote spontaneous social engagement behaviors and optimize homeostatic functions; it also describes how threat signals disrupt homeostatic functions, leading to illness and disease.
- The “vagal paradox” proposes that not all vagal pathways support social communication, down-regulate stress, and enhance resilience. Some pathways can be recruited for defense and are potentially lethal.
- The face-heart connection explains the bidirectional neural communication present at birth, which allows mammals to form the core of their Social Engagement System (SES). However, metabolic demands, perceived danger, life-threatening experiences, and illness can retract the SES, resulting in a face that is not social and a physiological state that promotes defensive behaviors.
- Reciprocal face-to-face interactions help regulate the physiological state and reinforce safety.
- Polyvagal theory offers an optimistic strategy capable of increasing flexibility, resilience, and sociality by retuning the autonomic nervous system.
- Potential intervention strategies target the ANS state and include vagal nerve stimulation and the Safe and Sound Protocol (SSP).
Pediatric Gut Microbiome and Immune System Development
An acclaimed expert in pediatric gastroenterology and nutrition, Alessio Fasano, MD, delivered an illuminating lecture on the gut microbiome, intestinal permeability, and the development of immune resilience. Dr. Fasano examined the role of the microbiome in health and its particular importance in programming the immune system during the first 1,000 days of life to establish long-term positive health outcomes.
Clinical Takeaways:
- The colonization of a newborn’s intestine by microbes plays a role in developing their immune function, and the most significant transfer of microbes occurs during birth. During the initial 1-3 years of a baby’s life, their microbiome undergoes substantial and unpredictable changes until it stabilizes around the age of 3.
- Excessive and inappropriate inflammatory reactions are associated with intestinal barrier dysfunction and the loss of mucosal immune homeostasis.
- Tight junctions – or gateways between cells that open and close in response to various stimuli – play a crucial role in immune surveillance, immune function modulation, and the controlled exchange of molecules, proteins, and cells.
- Zonulin, currently the only known regulator of tight junction permeability, brings about a significant change in the approach to treating immune-mediated and chronic inflammatory diseases, such as celiac disease.
- Increased serum zonulin levels have been reported as a marker of intestinal permeability in autistic patients. The overall prevalence of gastrointestinal disorders in children with autism spectrum disorder ranges from 9% to 91%.
- To understand the role of the microbiome in celiac disease development, it is important to analyze its composition and function in combination with other factors. The loss of certain protective bacterial strains in at-risk infants who develop celiac disease appears to have an epigenetic influence on the loss of gluten tolerance, thus triggering the progression from genetic predisposition to clinical manifestation.
Functional Medicine Approaches To Pediatric Autoimmune Disease
Leila Masson, MD, MPH, an integrative pediatric specialist with over 25 years of clinical expertise, shared functional medicine strategies based on her knowledge of nutritional and environmental medicine. Dr. Masson presented a framework for a functional approach to pediatric autoimmunity, relevant risk and protective factors, and treatment protocols for autoimmune diseases to be used in practice.
Clinical Takeaways:
- Autoimmune diseases can be caused by a combination of factors, including genetic predisposition, the hygiene hypothesis, and infections such as Epstein-Barr virus, Coxsackie B virus, and rotavirus. Environmental toxins like solvents, mercury, pesticides, cigarette smoke, and titanium dioxide can also play a role. Additionally, stress, nutritional deficiencies (such as inadequate exposure to sunlight for vitamin D or insufficient intake of zinc and omega-3), and adverse childhood experiences can all have an impact.
- The microbiome of neonates depends largely on the mode of delivery, which further influences the risk for autoimmune disease development. For instance, infants delivered via C-section have a slightly heightened risk of developing autoimmune diseases in later childhood, including inflammatory bowel disease and type 1 diabetes mellitus.
- Up to 30% of a baby’s microbiome is derived directly from its mother’s milk. As a result, formula feeding has been associated with an increased risk of autoimmune diseases as it induces a shift toward Th1 cytokines in infants.
- The use of antibiotics during early life is linked to a higher risk of developing juvenile idiopathic arthritis (JIA) later in life. The risk increases with repeated exposure and is particularly high when clindamycin and cephalosporins, which target gram-positive microorganisms, are prescribed.
- A functional medicine approach to autoimmunity involves following an anti-inflammatory diet consisting of organic, whole foods without additives and minimal gluten intake. At the same time, it should involve the assessment and minimization of exposure to environmental toxins, stress reduction techniques, and proper amounts of sleep and physical activity.
- Importantly, improving gut health, reducing gut permeability, and optimizing nutrient intake are all effective strategies for supporting a healthy immune system for life-long resilience.
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