André Briend & Meghan Azad | Malnutrition, Human Milk & Microbiome (Gairdner Lectures at ICAM 2026)

This

morning, we have the privilege of hearing from two of our Gardner laureates. First of all, we're going to hear from Dr. André Briand, who is a recipient of the 2025 John Dirt's Canada Gardner Global Health Award.

Dr.

Briand is a physician trained at the University of Paris

with

a PhD in human nutrition.

For

decades, his work has focused on improving the treatment and prevention of severe acute malnutrition in children.

Through

research conducted in Senegal and Bangladesh, he helped demonstrate that children at the highest risk of death

could

be identified simply using a measure of mid-upper arm circumference, something that could be done in the community, a method now widely used in global health.

And

then in the late 1990s, he really played a key role in the development of what are called RUTFs, ready-to-use therapeutic foods, which led to a revolution in the management of severe malnutrition, and you'll hear about it today.

He

joined the WHO in 2004 and worked in the Department of Child and Adolescent Health.

He

retired from WHO in 2009

and

has an adjunct position currently in the University of Tempere in Finland and an affiliated professor

in

the University of Copenhagen in Denmark.

And

he continues to collaborate with different research teams focused on the treatment of malnourished children.

And

today's lecture, he's going to reflect on the progress made in the treatment of severe malnutrition, challenges that remain,

and

what it will take

to

ensure that more children can access life-saving care. Please join me in welcoming Dr. André Briand.

Good morning, everybody. It's really great to be here. Thank you, Janet. Thank you, Nicole. I'm very glad to present

the

work that I have done in the recent years. So,

progress

and challenges in the management of severe acute malnutrition. First, a few definitions. Severe malnutrition is defined by WHO either by a weight-for-height index less than minus 3 standard deviation, which is a little bit complicated, or by a low-middle-param circumference below 125 millimeters.

We

don't know exactly the number of children who are affected every year, but we suppose there are many of them, presumably more than 20 million.

So,

severe malnutrition is associated with a high risk of death, and this is shown by the graphic showing the relationship between mid-up-aram circumference and mortality

as

assessed by different studies conducted in the community in the late 90s.

You

can see that mortality increases rapidly once its upper arm circumference is below 125 millimeters. Until 2007, the official recommendation of WHO was to treat these children in hospital and feed them with a liquid-based diet, milk-based diet, which are liquid. And here on this slide, you have the recipe. And there were several problems with this treatment. First, this recipe is a little bit complicated to prepare.

The

recipe is complex because there are vitamins and minerals to be added, but this is not the difficult part. The difficult part is to mix that.

And

also, once it is reconstituted with water,

it

is an excellent growth medium for bacteria, which means it is unsafe to use in unhygienic conditions.

For

this reason, WHO recommended that children with severe acute malnutrition should be admitted to hospital for treatment.

An

additional reason as well is that the formula which are used to treat children with severe acute malnutrition

look

like infant

formula.

And it was difficult for international agencies on one side to recommend promote breastfeeding and the other side to feed children with something which looks like infant formula.

So,

the problem with this milk-based diet really is that they contain water. And

we

can mention the importance of collaborating with colleagues. When I was in Bangladesh, actually, I did conduct a study on the relationship between my nutrition and mortality.

But

I was sharing my office with

a

nutritionist who did the studies on contamination of different foods. And here is a table taken from one of his articles. And on this slide, you can see that the foods which are most unsafe are those who contain water. And foods which do not contain water, like dry rice or bread, even in unhygienic conditions of rural Bangladesh in those days, they have remained with a very low level of bacterial contamination.

After

working five years in Bangladesh,

I

came back to France and had the occasion of discussing the problem of treatment of severe acute malnutrition with a food technologist and engineer

who

just started a small company to produce food for humanitarian relief. And I told him that there was a need to have food that could be consumed by children with severe acute malnutrition and which could be consumed without the addition of water, which was

because

the mix between water and food was really the difficult and dangerous part.

So,

we started with the way to try many recipes. The main problem we have is that the diets which are recommended to treat severe acute malnutrition, it is a very high-fat diet.

And

we tried different kinds of recipes. We tried pancakes,

we

tried donuts, we tried biscuits.

But

all had problems.

And

we wanted to make bars a little bit like the bars that sports people use during competition.

But

here we faced the problem again due to the high content of the high fat which has to be added in this food.

Fat,

we had a problem with fat because if we choose fat with a

low

melting point,

then

the bars become soft and they cannot be transported.

And

if we use the fat with a high melting point, then the bars become unpalatable.

In

the process, I heard that the good secret of good chocolate is to have a melting point around 37 degrees

because

in that stage, when you eat it, it melts in your mouth and it gives a very refreshing sensation.

So,

if we wanted to make a bar which would have a nice state, it was soft. So, eventually, we thought, but why making a bar? Why not making a spread?

And

what prompted us to move to a spread is that I looked

at

the recipe of one popular chocolate spread

that

I put on the slide. I put a black bar so that you want to make publicity for it.

I

looked at the composition and I found that the

proportion

of carbohydrate, protein, and fat was very similar to what the virtual recommended for treatment of severe malnutrition.

So,

why not using a spread? So, I mentioned that to

Michel,

the colleague who was working with me, and

in

a few days, he came back with a prototype of a spread.

And

the spread

can

be obtained easily in changing the recipe of the WHO.

The

initial recipe that I showed you was a mix, basically, the main component was a mixture of dry skin milk, oil, and sugar.

And

you can obtain a spread by replacing half of the dry skin milk contouring in the recipe

by

peanut butter.

So,

a spread has several advantages. First, it can be heated without addition of water. It doesn't contain water.

And

also, it doesn't require cooking, which is a huge advantage. You need just to heat at 40 degrees

to

make the mixing easier,

which

means you can add vitamin. It won't be destroyed. So, this is a big advantage compared to biscuits. Biscuits, you have to bake them around 180 degrees. You destroy a lot of vitamin.

So,

main advantages, no water, bacteria, don't grow in it.

So,

the next stage was to try whether children would accept it. And here, I make a very long story short, because it took several years.

Even

to try to see whether children would accept the food, it took us two years before we could access to a place

where

we could give this food to children for one food. Most people were convinced this would not work, because everybody thought that milk was needed. Only children with severe acute malnutrition will consume only milk.

After

the initial acceptability tests were done,

there

was a clinical trial, which was carried out by a team in Senegal.

You

know, I kept some contact over there with colleagues, and

one

of them was this nutritionist, who did a clinical trial randomly allocating children,

one

group with a classical liquid treatment, and the other group with a solid treatment with spread. And to our surprise, we found that the children who received the spread, the better group of children

who

received the liquid me.

This

first trial was done in inpatient setting, because we were so much concerned, but the people were so much afraid of giving this food, which was completely different from what was used before,

that

we wanted to do that in inpatient setting. So the next step was to see whether this could be used in outpatient setting. And here,

two

people played a key role.

One

of them is this British nutritionist who used to work in Ethiopia,

and

who one day

was

in a situation where there was a crisis,

but

not very important, and the government of Ethiopia refused the opening of therapeutic feeding center.

And

then Steve Collins came and discussed with the people in the Ministry of Health, and said, you know, there

are

French people who develop this new food, which can be used outside the hospital,

and

why don't we use that to treat children?

Which

he did on about 100 children,

and

he found that it worked well, and he sent an opinion piece to The Lancet.

And

I must say I

have

a lot of admiration, because I sent in my career a lot of paper to The Lancet, and most of them were rejected.

And

he got this one accepted right away with very little data, just saying there are a few sentences saying,

we

tried that 100 patients and it worked.

and

it was a very influential paper.

Another

key player was a group which worked in Malawi, and which was directed by Mark Mannery, who is from the Washington University in St. Louis, in the U

.S., and

who also faced problems to treat children with severe acute malnutrition in hospital, and he was willing to

test

this new approach. And what he found is that there were good results.

So

progressively, following these two pioneers, there were

other

people who tried this new approach and started to treat children with severe acute malnutrition in the community. And the feedback we had from our early study is that only 10 to 20 percent of children do need to be admitted to hospital because they had complications that needed specific treatment.

And

for those who were admitted as inpatient, the duration of hospital treatment was reduced to 5 to 10 days compared to 1 or 2 months before.

So

when you make a back-of-the-envelope calculation, you can see that this community-based approach to using UTF increased the treatment capacity by a factor of 2015-20 years, a huge increase.

So

following that, in 2007, WHO, UNICEF, and WFP made a joint statement, and they adopted what we call the community-based management of acute malnutrition, or CIMAM.

So

they accepted the idea that acute malnutrition can be detected by the measure of mid-aparant circumference. They admitted that only complicated cases should be admitted to hospital.

And they

admitted that most cases can be treated with outpatient in the community.

At

that time, when this joint statement was made, I mean, this joint statement followed the meeting which took place in WHO in Geneva in 2005.

At

that time, I was working in WHO,

and

I was in a difficult position because,

you

know, I was involved in the organization of the meeting, and it could be perceived as being a little bit biased. So I took, I was very careful to invite the most vocal opponent of this approach

to

the meeting so that they could express this opinion. But in the meantime, people, most NGOs, had voted with their feet, and they decided this approach was the best. And eventually, this is why it was adopted by WHO.

So

the next story, the next stage is that for UNICEF, now UNICEF promotes this food. It calls it a wonderful. And in 2025, IUTF was included in the WHO model list of essential medicines. So it's,

in

a way, it's a success story.

And

I'm glad to have been awarded for the Kerner Award last year for this work.

So

in 2024, UNICEF released a report, published a report, another advocacy report, saying that we estimate that in 2023, 1.2 million deaths of children aged 6 to 59 months

were

averted by a program that ensured timely access to CIMAM services.

So

I'd like to quote this report, but I don't believe in these figures. Actually, I'm asked very often how many children, how many children lives we see with IUTF, and usually I answer, I don't know.

Because

to really know you need to do randomized control trial with a control group with no treatment, which we cannot do.

So

if people insist, I say,

presumably

maybe. I mean, presumably many, but I don't go beyond that. So I think it's a success story,

but

it's not the end of the story because many children remain untreated. And even if this treatment is making wonders, I think there are problems and limitations.

One

of them is that IUTF is expensive, even if produced locally. Well, I did not mention that, but it is one of the nice things of this

approach

is that

IUTF,

the technology to produce IUTF, is quite simple. It can be reproduced in many African countries, and

more

than half of the IUTF, which is produced globally, is produced in developing countries.

So

it has to be provided by external agencies, and now we're facing a very difficult situation because agencies tend to have funding cuts.

We're

funding cuts from the U.S. government for the reason you know, but also from other governments because they have competing demand from the funds and so on.

So

we need, there's a need for alternative funding. And here I mentioned the initiative of different French NGOs who are lobbying towards a member of parliament of the French parliament to

use,

to create a soda tax, to promote, to

create

funds, to get funds for purchasing IUTF.

And

they do this lobbying work, not only in France, but also in developing countries, because in many places you have a middle class which are consuming high quantity of soda and other type of junk food, who

are

facing

an

obesity problem, and it would be a

good

idea to have this product

taxed

as well in poor countries and use this money used for

purchasing

IUTF.

But

more fundamentally, we have a problem. I think we all agree prevention is better than cure.

And

problems that will be effective, prevention has to rely on two components. You need a nutrient-dense diet and also you need that children live in a non-contaminated environment.

So

the problem is that more many children in developing countries and poor countries have limited access to a nutrient-rich diet. And here are some graphics I took from a recent UNICEF report which showed that a large proportion of children

living

in Africa and South Asia, they do not have access to adequate diet. and this is assessed by a very rough method which is a frequency of different food group which is very,

very

rough tool, as I said,

because

you need to eat the food from different food groups to have a nutrient-rich diet, but this is not sufficient. There's a question of quantity as well.

And

here we face a price problem because the food which are the most

rich

in nutrients are the most expensive. And here on this graph, which is taken from a FAO report, you see that food and vegetable and animal source foods which are the most nutrient-rich are much more expensive related in the calorie content to other common food.

So

there is an alternative, there is a kind of shortcut option which has been proposed is to provide nutrients which typically miss in the diet

but

what we call small quantity lipid-based nutrient supplement.

This

product was derived following the RUTF development because one of the things we discovered is that the RUTF is heavily fortified with highly unpalatable mineral supplement, especially potassium.

and

within the product with peanut butter, milk, and sugar, it tests very nicely. So this property was used to hide nutrients which are very not tasty in chemical form

into

a small form, a small nutrient, a small

supplement

which can be given to children. So

this

idea has been developed and pursued by a team at the University of California, Davis, under the leadership of K-DU, and

there

has been a recent meta-analysis suggesting that distributing this kind of small supplement, low-cost supplement

can

reduce the severity, the incidence of severe worsening and it has also some

very

important effects that it reduces anemia and it also, it has some effect on cognitive development.

So

this is something which is definitely worth pursuing but it is an effective but an imperfect solution because you can see

from

this graph that the efficacy is not 100%.

So

there has been a lot of speculation as well on the effect of microbiota and hygiene on the development of malnutrition.

and

one of the most fascinating experience which has been related in recent years has been to transplant

the

microbiota from children with malnutrition and with healthy microbiota coming from children

healthy

control and could transfer this microbiota to mice, germ-free mice, and you can see that mice receiving

the

microbiota from children with malnutrition they develop malnutrition themselves. So

clearly

there is something happening.

So

there are two explanations. One is that this decision they live in contaminated environment and if you correct this environment you could improve growth.

So

this has been tested in different settings

and

there have been made several attempts to

improve

hygiene and environment of the children

by

improving water supply by giving chloride tablets to clean water

and

teaching people how to wash their hands and so on but

the

result of this study is here you have the result of the meta-analysis and the bottom line showed the result of the randomized trial

and

you can see there was virtually no effect on nutritional status.

So

there have been a lot of discussion about what was the cause of this failure and presumably the level of hygiene we need to have a proper growth

is

something much superior to what was obtained by this low-cost intervention.

Children

in Canada or in France who are not malnourished as a rule

usually

they live in a place where we have access to tap water flush toilets and refrigerators

which

makes an environment much safer

than

what you can see in any of this intervention.

There's

been a lot of speculation as well on the road of diet and microbiota and

what the

data shows is that apparently children with severe acute malnutrition

they

have an abnormal microbiota. Normally during the first month of life

there's

a change in the pattern of microbiota

and

children with malnutrition they tend to be delayed.

They

tend to have microbiota which is comparable to that of younger children

and

this delay in development of microbiota remains even after treatment with RUTF.

So

there's been speculation maybe something is happening that needs to be corrected

and

this led to the development of what we call MDCF or MCF so that this means a microbiota directed food

in

children

and

this has been tested in Bangladesh

and

you have here the result of one of the studies showing first that when you manipulate so in this study the children were given separated into two groups one group which received this specially MDCF food and another group which got RUSF which is a variation of RUTF

and

when you manipulate the diet you change the microbiota

and

here on this graph you have the proportion of different family of bacteria following this change of food and the people who did this study they found there was a small effect on weight gain

and

they found as well a small effect during the follow-up on high gain

so

there was a speculation that maybe it should be manipulating the microbiota should be part of the treatment unfortunately I think we should take this result with great caution because the difference we see between the two groups are not very big

for

instance in terms of correction on weight for height index

the

estimated difference is about 0.1 standard deviation whereas in classical treatment you go up to one standard deviation so they affect you marginal

and

there is another problem as well is that the two diets which have been compared are completely

very

different

and

for instance the MDCA2 diet it has a higher protein content and it has a higher sugar content

and

you cannot say whether the difference is attributable to a change of microbiota

or

to a change in the composition of the food

to

really whether this effect on microbiota is real you need to take the same food in the two groups very comparable food and add some component which and the microbiota in one of the groups

which

has never been done so far

so

conclusion

major

progress in the management of severe acute malnutrition

but

unfortunately this is not the magic bullet it doesn't solve everything prevention is better than cure and so far we don't have a perfect solution

for

prevention

so

we have a huge problem of access to good quality food

I'm

very concerned that this may get worse in the coming years

because

of climate change and also with the current crisis in the Middle East I'm sure you heard there's a big problem coming on with the fertilizer being blocked

and

potentially

a

big problem of access to food in the coming month

thank

you for your attention

so

I think you've all heard an amazing talk amazing contributions but of course like many problems in global health

still

many unsolved problems to face and some of them getting worse so thank you for a very great presentation I'm sure there'll be lots of questions in the panel discussion

so

now we're going to move to the second lecture of the morning which will be delivered by Dr. Megan Azad

and

Dr. Azad is professor of pediatrics and child health at the University of Manitoba where she holds a tier 2 Canada research chair in early nutrition and the developmental origins of health and disease her research explores how infant nutrition and the microbiome which we've already heard about influence child growth development and lifelong health

she

directs the Manitoba interdisciplinary lactation center

and

leads the international milk composition consortium

she

also serves as a knowledge mobilization chair of the child cohort study which is a national pregnancy cohort following 3,500 children to understand how early life experiences shape lifelong health

she

serves on the international society for research in human milk

and

lactation executive council

and

the advisory board to the Canadian breast breast cancer breast feeding research network

she's

a fellow of the CIFAR humans and the microbiome program

and

an elected member of the Royal Society of Canada College of Young Scholars

Dr.

Azad was named among the WXN Canada top 100 most powerful women in 2020

and

Canada's top 40 under 40 in 2021

she

is the recipient of the international milk genomics mid-career investigator award in 2020 and

there

is a Gairdner in here somewhere the Canada Gairdner Momentum Award in 2024

in

today's lecture Dr. Azad is going to explore human milk as both food and medicine and share how infant nutrition and the microbiome shape early life development lifelong health and health equity please join me in welcoming Dr. Azad

thank

you Janet for the very kind introduction and to the Gairdner Foundation for the opportunity to speak with this audience today so I'm excited to jump right in and tell you about human milk as the original superfood and personalized medicine

my

disclosures to start

and

before I get going I want us to hear from some parents so we have a short video to get started

if

there's one gift that a woman could give to her children it would be breast milk

when

I'm breastfeeding my girls I know there's something else going on besides just the nutrition

I

think they're learning that they belong here

where

we're from

in

Guatemala everybody nurses everyone and if you can't

nurse another

person that had a child they will nurse your child

the

recommendation from the World Health Organization is to exclusively breastfeed for six months and then to continue breastfeeding for up to two years breastfeeding is associated with lower rates of asthma certain types of allergies lower rates of obesity

it

also benefits the mother

moms

who breastfeed have a lower rate of diabetes later on they have lower rates of breast cancer and ovarian cancer

as

it turns out when you breastfeed you aren't just feeding your baby you're feeding your baby's microbes in ways that even the most advanced infant formulas aren't yet able to do

over

thousands and millions of years breast milk has evolved to feed babies and their microbiota

why

is mom making 150 200 different complex molecules at very high concentrations if there wasn't a benefit for either the infant or the mom

we

now know that those oligosaccharides are feeding the gut microbes so they're not feeding the baby they're feeding the baby's microbes and that's incredibly important

these

microbes help us digest the food that we eat that's also true for babies they generate certain vitamins that were not able to generate on our own

in

addition to that there is certain bacteria that are killed or at least their growth is stopped by certain oligosaccharides

in

other words in addition to helping your baby develop beneficial microbes breast milk provides a natural antibiotic that helps keep the nasty microbes in check breast milk is really the original personalized medicine

every

mom makes different breast milk and even that mom's breast milk changes over time so as the infant grows the breast milk changes to meet its needs

so

if a baby gets sick breast milk changes to adapt to that change

so

why don't more women breastfeed well i can tell you it ain't easy

it's

a loaded question to ask a mother what her plans are for breast feeding because

i

think it's this horrible combination of it being the most natural thing in the world and probably one of the most hard hardest things in the world to do

one

reason why we are not talking about these things very often is because it's an uneven playing field

the

formula industry has a multi-billion dollar market and marketing campaign behind it

that

pushes the product which is not the equivalent to human milk

the

last thing we want is to stigmatize women that cannot breastfeed or choose not to breastfeed

i

think we need to be sure that we have alternatives available whether that's donor milk or substitutes in the form of infant formula so breastfeeding

if

you can swing it pretty strong recommendation that's an excerpt from a documentary that you can see i was part of kind of a sneak peek of everything i'm going to tell you about today but i thought it was nice to hear not only about the cool science but also the real struggles that moms have even if they want to breastfeed and that's always a challenge in this field

so

what i want to take you through in the next 20 minutes

is

firstly a little bit about the importance of human milk as both a food and medicine

explaining

how this shapes the infant microbiome and lifelong health

and

then thinking about how all of this factored into health equity

so

starting with that medicine piece you're a room full of doctors and medical educators this term personalized medicine we hear a lot i think it means different things to different people i think a lot of times we think of this as is there a medication or maybe a diet or an exercise regime that's that's perfect for me based on my genetics or my circumstances

but

i love this quote framing human milk as a personalized medicine

so

this is caesar rectora and he says human breast milk

is

not only the perfectly adapted nutritional supply for an infant

but

probably the most specific personalized medicine

that

he or she is likely to receive

given

at a time when gene expression is being

being

fine-tuned for life

so

in one sentence this really wraps up everything i do so i study the developmental origins of health and disease which is this concept that what happens to us very early in utero and in the first years of life can have a lifelong impact by programming our gene expression our microbiome our immune system

and

i do that with a focus on human milk

which

of course is food for a baby but it's also so much more than that and i particularly draw your attention to here to who said this quote so caesar victora was actually a gardner awardee in 2017 at a time when actually i was struggling with what i wanted to do with my career and i was trying to do breastfeeding research but nobody wanted to fund it um and it was really a turning point to me to see him recognized for his work on breastfeeding and you can see here that that year there were seven awardees for the gardner and to put in context for you

um

akira endo won that year for discovering and developing statins lewis k won for his development of nmr spectroscopy and rena rapali one for his development of the meningococcus b vaccine so these are huge world-changing discoveries and breastfeeding was read up there on the same stage which was really inspiring to me and i think delivered a very strong message

caesar

victoria led the lancet series on breastfeeding so if you're excited today by what you hear and want to read more that's a great one-stop shop for sort of a summary of all the evidence around breastfeeding and it's important to health

so

this graphic you saw earlier improving breastfeeding practices could save more than 820 000 lives a year that includes many babies but also mothers because as you heard in the video there are maternal breast benefits to breastfeeding as well and you see here a pretty sobering statistic so this says in some countries up to 20 percent of baby deaths are caused by suboptimal breastfeeding

so

these are data from a global health metrics organization you can see on this map color-coded i highlighted there south africa i was giving a talk there one year and almost 18 percent of deaths of children under five in that country are attributed back to suboptimal breastfeeding so this could be because as we heard in the prior conversation they're not growing well they're given a formula which had to be mixed with water which might have pathogens which might cause infections which could lead to death it could be that they're missing out on the benefits of breastfeeding which we know can prevent severe infections

so

of course this graphic is covering where we live in the world in canada

it's

a nice dark blue meaning fortunately here in canada there are not too many deaths attributed to suboptimal breastfeeding

but

that doesn't mean it's not still important to study so here in canada

this

is a pamphlet given out in my home province of manitoba to expecting moms and it goes through eight great reasons to breastfeed your baby

i

won't talk you through all of them but you can see it's convenient it can save you money um can get you back into shape faster but the one i'm interested in of course as a health researcher is

the

benefits to breastfed babies

so

breastfed babies have a 36 percent lower risk of sudden infant death syndrome

a

72 percent lower risk of respiratory tract infections which is the number one reason for a young child to go into the hospital

lower

risk of type 1 diabetes and if we look later into childhood adolescence and even adulthood lower rates of obesity

so

as a biochemical scientist i want to know why that is why is breastfeeding having all these amazing impacts

on

child health

and

i also want to remind you that the answer to this question will help all babies

and

families and societies because if we understand how breastfeeding and human milk are working we can use that knowledge to help all babies even if they can't be breastfed

so

to answer that question we have to think about human milk

what

is it well it's a superfood

maybe

another overused buzz term but i think if one food deserves that label it would be human milk

so

it has all the nutrients that a baby needs to grow and develop in the first six months

but

of course it's much more than a food it's a baby's first vaccine

there

actually are some countries in the world where the first record on the vaccination record is colostrum which is the first milk that a mom produces in the first couple of days

because

it's widely known to have super high levels of protective antibodies

so

a baby is born with an immature immune system it's relying on these antibodies from its mother's milk for immune protection

it's

also as i said a personalized medicine and here's a visual for that so this is milk from the same mother expressed a couple of days apart and you can visually see with your eyeballs that it's different if you could look at the molecules you'd see it's also very different and that's because the baby has an infection and the milk is adapting in response

so

it's dynamic it's changing

and

not only in response to if the baby is sick but day by day as the baby is growing month by month its needs are changing and the milk is changing along with it

even

actually from the morning to night in a single day the milk is slightly different with hormones that help with sleep or waking up even from the beginning to the end of a single feeding milk changes slightly

so

when you think about that it's pretty obvious that we can't replicate it in a one-size-fits-all formula on the shelf

it's

also tailor-made for tiny humans

so

all mammals are making milk that's where the word mammal comes from mammary gland

but

it's very different so i have three mammals up there if you think of a baby human versus a baby cow a calf is actually up and wobbling around on its feet within hours of birth whereas a baby not crawling or walking for months right a baby human is developing its brain

so

cow milk is therefore higher in protein for muscles human milk is higher in particular fats for brain development

so

you can start to imagine the mismatch if we're feeding cow milk to human babies

it's

not a match

and

then

as

you heard in both talks in my video it's also not just about feeding the baby but the baby's microbes so

the

microbiome is all of these microbes living in and on our bodies so we think about our visible organs our heart our lungs our intestines we also have this invisible organ the microbes all over our bodies

and

they're doing really important things you can see here with some statistics that we are actually outnumbered so our microbial cells if you counted them all up in your body they actually outnumber your human cells

by

around tenfold and if you looked at the genetic level it's by a hundred fold so all these microbes and genes on our bodies

are

probably doing something important

so

they are focusing here on the gut microbiome

so

we have microbes on our skin our nose but a lot of them the majority are in the gut

and

they do all of these important things for us so they make vitamins that we can't make on our own

they

help teach and train our immune system and that one's really important in early life when the immune system is still developing they help defend us against harmful microorganisms because of course there are microbes that are bad can make us sick but the good ones kind of help crowd them out

they

influence the calories you harvest from food so we heard in the previous talk about the dysbiosis of a microbiome in malnutrition partly that's important because if we have the right microbes they help us get energy out of food in the right sort of proportions

so

doing all these important things

so

if that microbiome is out of balance let's say can lead to disease certainly intestinal diseases if you have a a gut microbiome that's out of proportion you can have a gut disease

but

it's not just the gut we're learning it's actually almost every disease you can think of cancer liver disease

brain

disease our mood all of these conditions we are finding the more we learn about the microbiome are affected by these microbes all over our body

so

if that's the case then understanding what shapes the microbiome is really important and babies are born essentially sterile and as soon as they're born they start to develop their microbiome

so

i would argue this is a another reason to study the microbiome and to breastfeed your baby

so

one of the first papers you can see there on the left first paper in my postdoc we showed that the microbiome of different babies is quite different and what drives that difference is two things

so

how they are born

and

how they are fed so if they're born vaginally they're exposed to one set of microbes if they're born by c-section a different set of microbes

and

then very importantly how they are fed and then five years later in a bigger study you see the teddy cohort here showed again and this graph is from teddy that of all the many factors the researchers studied to understand which of these is shaping the microbiome

you

can see very big there the pink bar more than everything else put together is breast milk

so

yes there were

differences

sorry by things like antibiotics and probiotics so these are compounds we expect to change microbes um also birth mode as i mentioned but much bigger than all of those things put together in the first months is breast milk and we want to understand why

so

to understand why breast milk is so important to the microbiome we have to think about what's in it

so

these are two pictures giving you the same message which is there are a lot more things in breast milk than the alternative formula

so

that ingredient list there which you can't read i appreciate is

is

not so long for formula and there's all these extra things in breast milk and in the larger picture you can see that those extra things include things like growth factors

hormones

antibodies i mentioned earlier so what about the microbiome i would say there's probably two updates i would make to this figure if it were up to me which is that milk naturally contains probiotic bacteria

it's

another popular word these days but these are bacteria that are beneficial when consumed in adequate amounts

you

can buy them of course in supplements off the shelf you can find them in yogurt but you also find them in breast milk

and

then the second one there is prebiotic oligosaccharides

so

prebiotics are food for the probiotic bacteria

and

again you can find prebiotics in foods you can get prebiotic supplements fiber is an important prebiotic and again it turns out it is naturally found in breast milk so breast milk has got lots of nutrients for babies and it's also got probiotics and prebiotics

and

if you're thinking about megan i've seen new formulas on the shelf these days they have prebiotics and probiotics

this

is true sort of formula companies are always trying to make their products more close to human milk which is a good goal to have but it's really not the same so in breast milk we have

hundreds

of strains of bacteria naturally found in breast milk

the

formulas are adding one or two strains and similar for the prebiotics

we

have over a hundred different prebiotic sugars found in human breast milk and they're starting to be now one two three maybe five added to formulas

so

it's a good effort but it's not the same i wanted to touch a little bit on those oligosaccharides as one of my favorite examples of like the cool things in breast milk

and

one of the things that makes it uniquely human

so

human milk oligosaccharides are HMOs for short are actually the third most abundant component of breast milk so you see there milk is 90 water if you look at the solid components

there's

lactose a sugar that babies can digest lipids important for brain development and energy

and

then even more than protein in milk is these HMOs

and

so actually for a long time it was recognized there are these HMOs in milk

but

babies cannot digest them so what are they doing then

and

it turns out the answer is they're feeding the bacteria

so

they're not digestible to the baby but they're digestible to the microbes

and

they're very diverse so humans make over a hundred of these different sugar molecules and all mammals are making milk are making oligosaccharides but turns out for example cows only make 40 and mice only make two

so

this is one of the elements that makes milk very species specific

it's

also highly variable so it's not that every human mother is making the same hundred HMOs in the same configuration actually different moms make different ones this ties back to their genetics

one

of the things that makes milk highly personalized even among humans

so

we're still learning about what drives this variation and why it's important to babies

one

other story i'll give you this is from the child cohort study that janet mentioned so these are 3 500 canadian families that we've been following since the mothers were pregnant

the

children are actually now 16 we're still following them but this is from back when they were babies

so

we looked at their microbiomes and then we looked at whether or not they developed asthma by three and five years of age

and

what you can see here is that for babies who were exclusively breastfed their microbiome both in their gut and we have studied also their nose developed gradually over time it became more diverse over time

but

on the bottom there you see the babies who weaned early so they stopped breastfeeding and their microbiome accelerated in terms of its diversity too early and that premature development was associated with asthma later on

and

we're starting to learn that that's because the immune system training happened at the wrong time so it really is all about timing when we think about the microbiome early in life

it's

not just about having the right microbes it's about having them arrive in the right order at the right time in that first year of life

and

what's driving that timing is breast milk

so

i mentioned earlier how breast milk itself is changing over time and that's helping the microbiome evolve over time at the right pace

so

we're in canada you probably all recognize this as an animo bar sometimes i go in other places i show a tiramisu but this is an analogy i like because it's about you need the right ingredients to make this lovely dessert but you can just throw them all in a bowl at once you need to add them in the right order at the right time to have this beautiful result

a

nice dessert or a healthy baby microbiome

and

it's really about the breast milk that's driving that important ordering of the assembly of the microbiome

so

that's a large study in canada that's been going on for a decade but i am also doing work internationally and so i'm very interested in andre's work that we heard about before and this is to look at is milk the same in different parts of the world is there one sort of optimal recipe of breast milk or does it matter where you live and your context and so this work is in progress we're actually writing up the final papers now so stay tuned but this was a large investment from the gates foundation which kind of allowed my dreams to come true i mentioned earlier i was having trouble getting funding for breast milk research but this injection of funds really let me look at the entire rainbow of milk components and start to understand the variation in milk the many different components and how they all interact as a system

and

how that influences infant growth and health around the world

so

that's a little teaser coming through

so

we've talked about food as medicine milk as food milk as medicine and the microbiome the last point i want to touch on is around health equity so i think that's an important topic to everyone here and i view breastfeeding as an important part of that early in life

so

this is just one example a phd student of mine did her thesis on breastfeeding and neurodevelopment and behavior and what she found here is that breastfeeding can help narrow the gap of socioeconomic disparities

so

what we're looking at here is behavior problems at the age of five in again this child cohort study

and

we're looking at breastfeeding in two different ways so either the exclusivity of breastfeeding at six months

or

on the right the duration of breastfeeding over time

and

the orange line is children in higher ses families

the

green line is children in lower ses families so they have lower income or a single parent or low maternal education you can see that that green line shows a gradient first of all it's higher than the orange line so kids in low ses households

have

more behavior problems and that's maybe not surprising

lower

ses leads to more behavior problems for a variety of reasons breastfed children have fewer behavior problems and that's also been shown in the literature but what's important in this graph is that

it's

not equal it's not that all children are benefiting equally from breastfeeding in this context

this

is really driven by the low ses families you see that gap narrowing so the orange line children who are in high ses families doesn't really matter how long they're breastfed for this particular outcome they're doing pretty well

but

for the lower ses families the longer they're breastfed the lower they have a chance of having behavior problems they actually even out to the to the high ses families

but those

low ses families are the ones facing the biggest barriers to breastfeeding in the first place

so

they often have to go back to work sooner they can't be at home with their baby

or

they can't afford the breast pump or the lactation consultant

so

it's a real problem when this is something that can help us lower disparities but the people who need it most don't have access

and

so what do the canadian data show this is from the public health agency of canada you can see that at the outset when babies are born over 90 percent of moms are initiating breastfeeding and this is of course a choice that every family can make for themselves but this shows that most families

are

choosing to do this

but

then by six months we have

about

a third still exclusively breastfeeding which is that recommendation for the who

so

what's going on here

is

it just that moms have decided to stop that would be fine

but

actually that's not what the data show when we ask moms why they stopped breastfeeding

you

see that

almost

70 to 80 percent of them either said i didn't have enough breast milk i had difficulties i had a medical condition or my baby had a medical condition

so

these are issues that we should be able to support families to get through

so

the systems and the policies are failing these families where they need it most

so

we have work to do so at the manitoba interdisciplinary lactation center we do research on all the cool breast milk stuff but also i feel that as the data show moms are getting that message they want to breastfeed they think it's great so we have work to do to address those societal responsibilities and i think it's really important to frame it that way it's not all on the moms to do this alone we need a society that supports breastfeeding

so

we're doing things like developing courses for healthcare providers around breast milk videos for families and kids to show them the importance of breastfeeding because we need societies that support moms in that way briefings to parliament we've done some public outreach ask me anything on reddit we've been doing annually supported a milk mentorship program in manitoba so these are peer supporters it's great for healthcare providers to learn about breastfeeding and provide support but sometimes all you need is actually a buddy who's done it before so this is a system that's designed to do that and most recently i'm doing some lesson plans for kids

so

these are all ways that we can reach out and support breastfeeding in different ways

and

i wanted to end with these three ideas since this is a room full of healthcare providers and medical educators so first is that in canada we actually don't track breastfeeding rates

at

a national level

and

that makes it really hard to fix and address problems if we don't even track the data so that's one of my asks for governments

second

is that we really need to have equitable insurance

so

in the us for example

you

probably all know they don't have paid maternity leave so that's a big problem but they do have access to breast pumps so any new mom can have a breast pump for free

we

don't have that here in canada so moms who need a pump

don't

necessarily have access they also don't have access necessarily to specialized lactation consultants so this is something i'm working to change

and

finally maybe most importantly to this room is that i think it's important that healthcare providers and learners are learning something about breastfeeding in their training

so

everyone doesn't have to be and can't be an expert

but

it should be that if a mom shows up in your office and says i'm having trouble with breastfeeding

that

you either have a tip to give or know something to say or know where to refer her

and

i don't know how many of you were at the opening keynote

but

something i found very sobering was the brave parent who was up here talking about her journey through becoming anti-vaccine and then

sort

of reverting that opinion it all started when she went to a gp's office

for

help with breastfeeding

and

the doctor said to her i don't worry about it there's formula

so

she went online to find support was able to find that support a community of moms to help her with breastfeeding

but

that same community is what turned her to an anti-vaxxer so that to me was a really powerful statement of what can go wrong when you don't have the right support for a mom at this critical stage of life

all

right so these were the objectives i hope we've gone through them in a helpful way and i want to i started with a quote i'll end with a quote this one's about the nobel prize which i'm sure you've all heard

of this

is a quote also from the lancet series

if

breastfeeding did not already exist

someone

who invented it today would deserve a dual nobel prize in medicine and economics

so

i love that and maybe we're getting close because you may not have heard but the gardner award is sometimes called the baby nobel prize

and

we now have caesar victoria has won the gardner award for breastfeeding and i won the baby gardner award for my work on breastfeeding so maybe we're getting somewhere but i'll end there thank all the people that have been involved in this work in many different ways i'm looking forward to the panel discussion and if we don't get to your questions today this is where you can reach me online and i'd be happy to hear from any one of you

thank

you megan i hope everybody learned a lot about microbes breastfeeding and you see that the crosstalk between the two two present presenters that we had today so now we're going to move to a panel discussion and you the audience and you online get a chance to ask questions dr breon and dr azadegan reflect on connections between nutrition the microbiome and child health in different global contexts and i'd like now to welcome to the stage to guide this conversation our moderator

dr

christine chambers who is scientific director of the institute of child of human development child and youth health at cihr please join me in welcoming christine and the two speakers to the panel discussion

thank

you both so much for those incredible presentations and it's really a pleasure to be here to moderate the conversation so i'm going to kick things off with with a couple of questions but really would invite invite you to the microphones we have one at this side of the room one at the other side of the room and also encourage you to use the app if you have questions they are going to be displayed for me on the screen here so we'll try to pull from a selection of questions from the audience as well as our conversation so so many things that we could talk about this morning

and

what i'd love to hear from you about to start is that both of your lectures really explicitly acknowledged structural constraints so funding access inequity

so

i'd like to hear from both of you and we'll start with dr azad

what

does nutrition equity mean in practice and who bears the responsibility for delivering it

yeah

it's a great question and that's one of the reasons i finished off with my three asks which actually came from a presentation that i gave when i was here in ottawa two years ago to parliamentarians to say like if you could do something this is what i would like to hear from you um i think it's a real problem that the families that would benefit most from improved nutrition or improved access to breastfeeding are the ones that have the hardest time accessing that support so that's where policy and society needs to step in so for example in winnipeg we've started a free pump loan program that's specifically targeted at low income families so they have to pay nothing at all um and it's funded at this time through sort of leftover scraps from my research grants which shouldn't be the case right it should be the government funding those types of programs um or insurance companies providing so i think there's that type of work that can be done um and from a nutritional perspective um it's also this

uh

you know dual-edged sword because i want people to think of breastfeeding not as only food because it's not just that it's so much more and that's why it needs sort of special regulations um but we really do need our governments at at all levels to be stepping in to support that

great

thank you

dr

biong your thoughts on what does nutrition equity mean

well that's a very difficult issue and i'm afraid it's not limited to child nutrition

even

in adults we see the same thing

i

remember recently attending a meeting where we discussed nutrition

quality

of nutrition and income in france and which showed that you know the official recommendation for the adults is to eat a lot of fruit and vegetables but these are

very

expensive source of energy

and

we see that the people the poor people they consume less of that for economic constraint and somebody in the audience say well this has been shown before and they quoted a study from canada

which

means this happens everywhere

and

this happened even more in chilen

unfortunately

i suspect this has remained a lot under the radar screen because this is very difficult to measure

i

really welcome the recent report from udsafe where they show this graph you know this report where i took the graph from

they

mentioned that this low frequency of the low diversity of food groups

i

think it is a real problem

and

the solution should be a

more

equitable

distribution

of income

yeah yeah thank

you

another

question before we opened it up to the audience and again encourage you to go to the mics or to use your app for questions

um

you know the the theme today and and you both did such an incredible um incredible job in your presentations of framing um food uh as as medicine right food is medicine um versus a you know say um

you

know preventative public health strategy uh what are your thoughts on where we need to go next with that what what do you think are the potential um i guess next next uh steps in in that continuum so i'll start with you again dr yeah

so

maybe you noted that uh

our

utf is now classified it is now in the WHO essential drug list

essential

medicine model list

and

you may have noted that the first there was a statement in 2007 so it took the WHO

16

years or something like that a lot of time to take the decision and there are many reasons for that there are plus and minus classifying our utf as food versus medicine medicine versus food

one

of the problems is that the people did not want the product to be hijacked by pharmacists because they have a very strict regulation rules for production

and

if you put

regulation

from the drug industry from the pharmacy industry into our utf production you stop the the story because it's impossible to produce

the

other issue as well as logistic because the pharmacists are used to transport and supply health facility with tablets

which

fit into a small box when you're talking about our utf it's cartons and it may weigh hundreds of kilos

the

pharmacists don't have the proper facility to store that

so

there was a lot of discussion whether it should be classified as drug or as food

one

of the aspects which tilted the balance is the advocacy side i mean if you have that on the essential medicine list

then

it means really it's important

but

you can see the laboratory is not a prescriptive organization just i mean the essential list is a model list that countries are free to adopt or not

and

it is up to each country to decide

taking

into account their own situation whether it should be classified as food or not but i heard that quite a few now i think more than 40 used to now put actually some of them put our utf in the essential medicine list before it was recommended by the h2o

so

this

question

for me with milk again there's different scenarios so one good example is um

you

know milk mother's milk is medicine for all babies but the ones that arguably need it most is premature babies whose moms might not be producing milk yet so what do we do then if they're in the nicu we have donor milk and this is an interesting area of a lot of innovation happening but it's this idea that we have donor milk from a milk bank it's available to babies who need it we treat it a bit as a medicine so it's regulated in that way but that also does make it to your point harder to access and so we're starting now to get to a point where there's more than enough milk in the milk banks in canada at least for the babies who need it in the nicu so could we make it available to other babies so maybe babies born by c-section right their microbiome is disrupted and if their moms aren't producing milk could we get donor milk to them but how do we make that happen or moms in the community who've had a disruption or maybe need to take a short course of a medication that's contraindicated so there's work going on could we get donor milk into pharmacies so that then it could be prescribed and could be covered under insurance so that moms could access it so there's those types of questions but it does bring it into this whole other domain of how then do you regulate it and then the flip side of that i think of too is formula should we consider formula a food or a medicine and i think specifically in the hospital actually treating it as more of a medicine may be the way to go because then it's not just there as a food give it out to whoever the mom is tired etc no it's there and it's some babies are going to need it it's very important but it is treated as a medication so it's there only when medically indicated so i think reframing our perspective of formula in that way could be useful too

very

interesting

all

right we have some questions in the audience i'll start on this side of the room

great

thank you very much um thank you to both of you for the great presentations um my name is lynn ashdown i'm a patient partner lead advisor to the afmc

and

sort of my question is actually in

in

related to the second um sort of uh presentation on breastfeeding and um i really appreciated how you spoke about the third objective about health equity

and

that plays a significant role in in whether um

uh

you know mothers are able to to breastfeed or for the recommended recommended amount of time etc um and and absolutely i think we would all agree that that kind of

breast

is best um if possible

um

there definitely is you know for for a lot of women um

it's

just not possible and and so i guess sort of the

i

have less of a question and more of a comment um about

sort

of it's a very sort of glamorized kind of um

approach

to you know every mother whether they're able to breastfeed or not um they know the pros and they know the cons and i guess sort of in my role with afmc is to really sort of incorporate um people with lived experience into the discussion and i just wonder if it would have helped to um because i know there's a lot of women that feel like they're failures as a mother if they can't breastfeed

and

i just wonder if it would have been beneficial to

to

have a mother who um

who

is experiencing those feelings and feeling stigmatized or feeling like they were a terrible mother because they couldn't breastfeed

and

everyone wants to do what's best for their child and and so i guess it's

less

of a question and more of a comment um maybe just some some food for thought so

um

thank you thank you so much

yeah thank

you

yeah

very yeah dr azad you want to speak sure yeah i'm happy to respond i i do agree it's um an important perspective and it's one that we build into our research at milk and

one of the

reasons we tried to include the video up front where mothers were speaking to that point as well that it's this really loaded question challenging decision stressful experience and also why i commented on framing breastfeeding as really this societal issue and not on individual moms because as you say there's lots of moms that

heard

the message want to do it but experience all kinds of problems and so are we there for them to support their decision whichever way it goes

um

so i agree that is important and hearing those voices is is really powerful as well

yeah thank

you for sharing that perspective

uh

on this side of the room please

hello

can you okay

great

okay thank you both very much for your talk um so my name is anna i am a phd student from mcgill university and i guess i have more questions for dr azed um because it's just so relevant and it's uh really uh out of curiosity uh i guess somewhere related to the previous question i was curious about what about mothers that are for example immunodeficient or having any diseases that affect their microbiome or any medicine that affects their microbiome

uh

would that be passed on to babies that are breastfeeding

because

i know you mentioned in your presentation that

uh

the breast milk would be the almost like the first vaccine or it really affects the microbiome of the baby

so

do you have any data or any suggestions on that

yeah

it's a wonderful question and so milk is personalized and it's different in each mom and so a very important question is what if the mom has a condition or is on a medication um in many instances for the medication question for example if a mom is on antibiotics we do see that that can change her own microbiome and her microbiome is passed to her baby so there's a chain of connection there at the same time if the alternative is formula which has no microbiome in it whatsoever we're still left with well the antibiotics might change the microbiome of the mom but doesn't change her antibody levels her hmo levels all of these other things so

usually on

balance it's still a good idea having said that in the question of medications beyond antibiotics um something that is starting to change finally is that most

uh

pharma companies have not been motivated to do studies on whether their um whether their products get into breast milk or are safe during breastfeeding they just rather be safe than sorry and say not recommended in breastfeeding so then the poor breastfeeding moms where are they left right so at least in the u.s there's now a new law that new products coming to market do have to do that research this also applies to pregnancy so this population of pregnant and breastfeeding moms have just been left out of the research and so there isn't the knowledge there with that said there is a resource called lactmed this is a place you can go so all the research that has been done is sort of in one convenient place if you're counseling patients or you're wondering um and that will start to grow over time um but in most cases so we do have for example in this child study 3 000 moms we have moms with ibd with asthma with allergies and

you

know the the main take-home message is none of these things are a contradiction for breastfeeding

for

the most part um but it's a relevant question and i think one that that is important to know i think in the international study is more where it's a bigger question for me is what about moms who are severely malnourished um is their breast milk enough for their babies um and there is this sort of idea that well it's always perfect so never mind um but i think we have some questions to answer like what about in some pretty extreme situations so that's what the research we're doing in those communities is about and are there ways that we could supplement the moms or the babies i think it's it's still very important that they're breastfed to get all the antibodies but if the nutrient content is somehow deficient

how

could we address that with supplements to the mom or the baby so all important questions

thank

you so much for your answer i guess sorry if i have i have a second question if that's oh you know what we're going to move on to the app and there's a few other folks who have questions as well so i this question is for you dr brian um the question is a comment uh from the app i'm very happy to have attended this session as an ethiopian who has used rutf for treating children with malnutrition as a psychiatrist i have also used it for people with severe mental illness that present with adult malnutrition the access is limited for adults and especially those with mental illness any thoughts or reflections on ways to improve access for this particular group your thoughts

thank

you thank you for this question but it's a tough one i must say

i

am not sure i am able to to answer this question because traditionally you access to any kind of product is uh

is

focused on the people on individual for which there is a proven benefit in that case the proven benefit i mean it's based only on a personal opinion

so

i think in some individual cases on a compassion basis maybe it can be given but to have that as a policy i think it would be something difficult to achieve

thank

you

a

question on the side

hi

thank you so much my name is maria and i'm a phd candidate at the university of manitoba my question is for dr assad i'm also a mom

so

i think that's relevant um so there seems to be a persistent assumption in public health

that

most people can breastfeed physically

um

and that challenges are largely treatable

so

as you saw you presented and and discuss how the main issues with you know ending breastfeeding

before

six months were not enough milk can't do it physically

um

yet there's

very

limited research on those who are physiologically unable to breastfeed

um

despite

the

support

um

at the same time

conditions

like like lactation insufficiency

they're

not diagnosed by anyone

um

nurses anyone even working um in the field

they

don't diagnose that because they assume anyone can breastfeed

um

so it's just a strange place to be um in in women's health so why do you think

that

this group remains under researched and under diagnosed

and

how should the field address this gap

thank

you

excellent

question we could do a whole session just on this um but so yes first to acknowledge you're right there is this idea well

of

course everyone can breastfeed because our species depends on it so it must be a thing everyone can do but of course we don't live in the context that we did historically as a species and another thing that's true is historically how humans lived was in sort of communities multi-generational families so actually if you couldn't breastfeed as a mom your sister was there your auntie or your neighbor and so kids did get breastfed even if there were problems um so i know a group in australia that is doing a lot of work on this and trying to more carefully document the proportion of moms who actually can't breastfeed and why and could we predict that even during pregnancy perhaps and sort of try and address it up front or recognize that that is an issue and what do we do for these moms i think it reflects the fact that as you said women's health has been understudied and underfunded for decades until three years ago there was no medical specialty in lactation so there's one for cardiology neurology like all the ologies every part of your body except the breast which is

wild

so finally in the last three years there is now the north american board of breastfeeding and lactation medicine it exists so now i hope these types of things will improve because we will have people training in this specialty there also is now a field at one university only in the world called lactology and there are going to be a degree program where you can study lactation in the breast and learn more about it so i think we're catching up with the knowledge

so

in the future we won't have to rely on sort of just this myth everyone can do it we'll know

better

who can't do it what are the problems how can we address them how can we support those moms but i think that's where it stems from and i think there's good news that it's going to improve but it's going to take some time and i'm glad that there are now the opportunities for clinicians to train in this area the other part is i think of course not everyone can specialize but just getting more of this education into the curriculum so that everyone learns a little bit whether it's nursing programs medical curriculums i had the experience of going to my own university and saying i'd love to do a lecture or you know have my clinical colleagues do a lecture on lactation and they said don't worry it's covered it's like well that's great news show me where it's covered like here we have one hour on breast cancer

not

the same so until that um changes we're going to be in the same problem but i do think it's changing

thank

you for uh drawing attention to this broader issue of the need for focus in this space

uh

over on this side question please

hello so

i am from university of manitoba i have recently defended my thesis

so what

an incredible presentation like learned a lot like because uh being a neuroscientist i was just thinking from this presentation how

you

know microbiota and breastfeeding may be the trigger

for uh

maintaining a gut gut brain axis which initiates maybe in the

in

the aging process the neurodegeneration so i was thinking about that

so uh

i have a question to dr azad

so

i am not a mother but i am a father of two daughters

one

being nine years old and one

being

the latest entry two years old

so i

can see being an immigrant and maintaining that work-life balance

my

wife

had

to feed like uh my daughter gauri

whole

night for like five to six times

and

sometimes she complained like you know

i

cannot feed her because

i

cannot i cannot sleep and you know like there's a lot of other problems and sometimes

you

know this

uh

work-life balance and pressure and all sorts of things right

and

i can see like

these

things i heard from a lot of other immigrants which are coming to you know canada

so

how to how to break this barrier like how how

husbands

also can you know be a part of this no doubt like they cannot breastfeed but how how

to

make an

you

know edi and you know and also like

to

break this barrier like i don't know like

um

part of the issue and there are studies that show that you know what are the predictors or the factors that support a mom to breastfeed and there's of course you know having time off work but having her partner's support is a big one too um also her mother-in-law's support interestingly um but so there are things you can do for sure you know helping um take care of everything else the laundry the cooking so she can breastfeed because yes you can't do that um i think that's important and also you mentioned immigrant communities so i think there's a lot to be said about support from your own community um so support groups for new immigrant communities um are important too and so the community support can be relevant as well but i think it's wonderful that you are thinking about that and i think it's absolutely important to acknowledge like this is not easy i see sometimes breastfeeding is free like

only

if you don't value a mother's time and there's so much time that goes into breastfeeding

um

so acknowledging that yeah it is a struggle and you can't sleep and so recognizing that work and trying to offset it in any way that you or others in the family can do um but thank you for the question

thank

you thank you so much

all right um

dr brian i'm going to start with you

what

do you think is the biggest research policy or implementation gap

that

needs to be addressed uh to move from sort of short-term nutritional treatment to a longer term food system resilience

if you

had to choose one what would you identify

access

to nutrient-dense food

this

is the key for

improving

the nutrition situation of children in the world

and

if you were advising global health leaders which you do uh what would you recommend as one key strategy to help address that access issue

so

i mentioned there is a short-term technical fix which is the sqlns which has some preventive effect but this is not uh something which is 100 effective they still manage it on to become malnourished even if they receive the sqlns

so families

poor family need to need to have access to proper diets which is uh

it

means more social equity i feel i'm sometimes i'm talking like the pope although i have no connection

yeah

the theme of social equity is so key yeah

um

megan your thoughts on sort of where the biggest gap is and a key strategy that you would recommend

uh

i think

since

we've heard the global health perspective if i were to think more in our context in canada or western settings i think it's this

um support

so for me a big one is the equitable access to pumps and lactation care um so right now those are not universally covered uh they're available to people who have private insurance but who has private insurance not the people who need it most so that's something we've been working on and i've been learning all sorts of things that it's not the health department it's the tax department that says what are the medical devices or

um

so working on that i think would be a big support for for moms who need it and who are lacking support

wonderful all

right thank you both so much for your fantastic presentations the conversation thank you to the audience for your questions and i'm going to close things up and turn things back to nicole

thank

you dr brian dr azad and dr chambers for such an insightful and thought-provoking discussion your work in leadership

in

advancing research both on nutrition but also the microbiome and child health are truly inspiring

and

we're very grateful for the perspectives that you've shared today and for the important insights into both the progress made but also the challenges that remain in terms of improving child health globally

now

this intersection of groundbreaking discovery but also clinical care is is exactly why afmc remains

a

very lead proponent for a more robust and adequately funded health research ecosystem in canada

one

that empowers our clinician scientists to turn these global insights

into

patient and population outcomes that we strive for