 So, focusing on the golden hour because there is so much of science in that one hour, what is happening in that hour. So, I'm going to discuss that and if I have some time then I'll go more into nutrition aspect of six months and above, but let's just focus on, you know, first golden hour. So, what happens we know about the thousand days, right? So, thousand days, so out of thousand days, your 270 days are basically your pregnancy, correct? So, in that pregnancy time, you know, mother probably has nutritionist, whether has access to OBGYN doctors or whoever, any doctor that takes care of her pregnancy part, right? While pre-nutrition and nutritionist, they take care of the rest of the seven-thirty days, right? So, once a baby is born, that's when the pre-nutrition and then again nutritionists come in in the picture. Now, there is an overlap of about an hour, okay? What is that hour? As soon as child is born, okay? And when the pre-nutrition is called in the delivery room to take care of the baby's initial, you know, important time, you have OBGYN in the room, you have pre-nutrition in the room and you have that, you know, support which has been given by nutritionist to the mother during ANC. So, she has that knowledge, right? So, with three of us, you know, we can basically influence a lifelong health. In a sense, for example, when we have a birthday party, right? When child is born, child has first birthday party, second birthday party and we kind of always, you know, arrange so much. We spend so much time making all this, you know, planning your birthday cake, planning food, planning party for birthdays, right? Think about it. You're bringing this newborn, okay? In the first hour, you have this beautiful baby born in your hospital or in your PhD and you have to celebrate it. And the way you celebrate it is by giving, okay? What you're giving to the child, you're giving the perfect start. How are you giving the perfect start is basically as soon as baby is born, you're putting the child to mother's breast. That is called your basically breast crawler, skin to skin attachment because that is going to give the perfect start and you're giving that perfect gift to that baby and it's lifelong and let's see why it is lifelong and that's why it's called golden hour because, you know, that hour will never come back and the time lost in this one hour, you will never get it back and it has a lifelong implications on child's health. And of course, it has a lot of, breast milk has, I mean, there is a whole science to it in its optimum nutrition. It has bioactive component, it has host different, defense protein, but what I'm going to focus on is basically it is an important source of commensal bacteria for gut colonization, okay? So what happens when the baby is born, okay? The baby has a little bit of bacteria, which is coming on from amniotic fluid, you know, from mother's womb. And then when baby is pretty much has a little bit, but it's pretty much sterile, okay? So now let's see what happens when the baby is sterile. So here this is a gut microbiome with breast milk, we'll go a little bit more detail in exactly what happens in baby's gut, you know, when the colostrum passes on. So here is basically kind of, you know, electromicroscopic picture of your gut bacteria extremely small and you would be amazed to understand gut microbiome and it's like the whole world, you know, in human body. I'm going to focus on, of course, just babies. How many bacteria per ml of breast milk, 10,006 cells per ml, okay? And 7 to 8 billion bacterial cells each day, which are formed in the gut. What is the function of gut microbiome? So this is not a gut microbiome, which are being developed in baby because baby is getting breast milk, okay? So what it does, it basically this microbiome, it metabolizes the polysaccharide, which are basically, you know, your oligosaccharide with the presence in the milk and results in synthesis of, you know, short-chain fatty acids. Those are basically essential fatty acids, you guys know, short-chain fatty acids, which are rich source of energy for the host. And basically, it's also in walls and synthesis of vitamin K. It is important for formation of components of vitamin B. We also know B12, you know, a lot of this gut bacteria kind of releases B12. It is also important for conversion of glutamine. Now, glutamine is basically, or my inner acid, it is important. This particular information is very important because there are new hypothesis coming in where what they're saying is basically gut microbiome of the mother and the baby is also probably related to autism, you know, autism spectrum disorder. And autism rate is really going up, especially in America and it's going up in India too. And probably they are thinking of this could be the reason of conversion of children who have autism. They have decreased conversion from glutamine to GABA. GABA is a neurotransmitter, which is important in your brain, okay? And then also gut microbiome is very important for a breakdown of various polyphenols. Now, as nutritionists, we all know that this polyphenols are so important, you know, we get it from fruits, from vegetables, from green tea and so many other, you know, amazing vegetables and fruits. But unfortunately, if you have a good microbiome, it's going to help you to break down this polyphenols, okay? Another thing, microbiome is also important for detoxifying toxic products. And it also has effect on drug metabolisms. So for example, if child is taking any medication for a reason, then basically the microbiome in baby's gut will have an effect on your drug metabolism. So we have to basically, you know, we have to change the dosage depending upon basically gut microbiome. Also, which is one thing which is extremely important is your maintenance of structural integrity. So again, I'm going to explain a little bit more detail that what is the structural integrity of gut mucus barrier. Because gut is basically your, there's one thing which is completely open to outside is your gut. Another one is your nose and your mouth, but mainly your intestine is completely open to outside. So whatever you're eating, basically, if you don't have a proper gut integrity, if you don't have proper maintenance of those gut cells, then anything can get absorbed into your vascular system, into your blood vessels, right? So gut microbiome is extremely important for integrity of this gut mucus barrier, okay? And it also serves as a barrier. So it basically, again, I'm going to go a little bit detail about it, how it causes barrier against all the pathogenic bacteria and viruses, not only bacteria, but a lot of other microorganisms. And it also important for development of a host immune system. So look at all these effects that gut microbiome has. So you want to have perfect gut microbiome for that baby who's just born because there's all these effects that baby's going to have. Again, we want to find out, okay, where do those gut microbiome come from? What are the sources of this microbiome? Because we want to have perfect ones. So we want to have, it's like giving a perfect cake and perfect ingredient, right? So we want to have a perfect chain of events. The child gets a perfect start in her life, all right? So microbiota comes from amniotic fluid. It comes from meconium, basically, and meconium originates from uterus. So meconium is basically, you know, a lot of time when the baby is born, you know, when they pass stool, you will see that the green liquidy stuff that they pass in the stool, that is called meconium, right? So they can get those microbiota bacteria from meconium. It also comes from maternal vagina, extremely important. This is really, really important to have a basically vaginal birth, you know, to get again the perfect gut microbiome. Another time, sometimes it also comes from maternal feces. It comes from the skin, it comes from breast milk, and it comes from surrounding, okay? So we want to have surrounding as clean as possible. And all these other factors are extremely important because it's going to give them mother's gut microbiome, okay? So externally, it can come from baby's mouth. So what happens is when the baby's sucking on breast, the areola, the bacteria which are present in baby's saliva, it can go back into, you know, in the duct, collecting duct, and it can go back, you know, in the memory duct. And that can basically create a lot of this reaction, and then it will basically go back to a baby. So that is, again, it's really another important source of microbacteria in mother's milk. And another way which some of the studies have found is what happens when there is a translocational bacteria in mother's gut. So for example, mother's gut has, say, some of the good bacteria which can get trans, which can go through a special pathway to mother's memory gland. Can you imagine? This is such a beautiful way of nature's helping that baby to give the perfect microorganism from mother to baby, okay? So this, I will again, just a little bit about the dendritic cells, what are the dendritic cells, okay? And these are the organisms which are found. These are some of the organisms which are found in breast milk. These are some of the organisms which are found in areola skin. And these are some of the organisms which are found in infant's stool. So let's look at what is found in breast milk. If you look at this pink color over here, pink colors are mainly your proteobacteria. So basically breast milk, this was one of the study which was done by Dr. Pannaraj. Okay? So in that, what he found is that mother's milk had a lot of this proteobacteria. Areola skin, so mother's areola skin had all the skin bacteria. So skin bacteria are called your fermicutus. So what are your fermicutus bacteria? Your staphylococcus, your streptococcus, those are all your basically, by and large, your skin bacteria. But if you looked at infant's stool, the infant's stool had a lot more actinobacteria. So actinobacteria is your bifidobacteria. These are all basically your species of bacteria. So why do you think the infant's stool has a lot more this bacteria? Although breast milk has proteobacteria, but what happened in the baby's gut that the infant's stool has a lot more bifidobacteria. And that is because again, this is, I'm going to go a little bit more in detail to understand exactly what happens in baby's gut. Okay? Now, this are all the different kind of bacterias that you see in children, baby's gut. And they all are different. So if you look at babies who are born by vagina, okay? So vaginal delivery babies, they have much higher level of species like lactobacillus, provotella, this are some of the very good bacterias which are very important in babies. And babies who are born more generally, they have those really good bacterias. Now, babies who are born by cesarean, they have different kind of bacteria. So if you look at the gut microbiome, they will have more of cephalococcus again, because the skin is cut, right? So you will have a lot more this cephalococcus, corine bacterium, propionable bacterium. Those are the bacteria that you see in babies who have C-section. And the babies who are formula fed, now those formula fed babies have completely different bacteria. So they will have more of a bacteria or it's close to them. You know, a lot of these other, more of a pathogenic bacteria which will cause a lot more problems. So you will know like, you know, a lot of time when we give formula, you know, and those babies are crying a lot. They may have a lot more gas. They have a lot more bloating. It's because the bacteria is a completely gone haywire, right? And mothers who get antibiotics, so babies who get antibiotics, you know, or during delivery, pre-delivery, those babies have different bacteria. So look at the bacteria change in different bacteria, right? And also when you're weaning the cellar and you're starting the complementary food, you know, depending upon what kind of food you are starting, you know, their children will have different bacteria. So these are the bacteria where a child is given a lot more high fiber food. They will have more of probatella versus children who are given a lot more, you know, like the high fat animal protein diet. They'll have a bacterial. So they'll have a different bacteria. So basically your bacteria will change and by like by three years of age, you know, children's bacteria is pretty much similar to your adult gut bacteria. Okay. Now let's see what happens. Now how the nature kind of prepares this baby to come on the planet earth. Okay. So let's see how the mucosal immune defense developed. So here, so this is basically baby's intestine. Okay. This is an intestinal wall. Okay. Now here, what the first thing what we have in our intestinal gut cell lining, this is the M cells. M cells, it looks like M, right? So this is important. This is the M cells. Then you have something called disaul pairs patch. So this is all your lymphoid pairs patch number two. This is your pairs patches. You have basically your T cells, your B cells. This is all your, you know, your cells basically, you know, your immunological cells, right? Then you have your third one, your lamina prepria. This was your, you know, basically cells which are present just outside the cellular, this thing. And they, they again have a lot of this plasma cells. They have this CD4 T cells, you know, again, those are all the immunological cells. And then you have the intrapital lymphocytes. So these are your intrapital lymphocytes. So these are, all these cells are extremely important, you know, to basically start the immune function because babies absolutely imagine baby was in mother's womb. You know, baby was protected by mother's immunity, right? Now baby's out, baby has to function on his own. So baby requires that little bit of stimulation, you know, to, to have the immune function stimulated, right? It's just like, for example, if we get, say, viral load of COVID, right? That's what's going to happen. Suppose if you're, if you are exposed to somebody who has COVID, what's going to happen in the body? Your body's going to react, right? Now here is a foreign virus coming into your body. Your body's immune function is going to start reacting very fast, right? It will start increasing your T cells, your V cells, all this, you know, you must be understanding all the cytokines and all this levels go up, right? Exactly similar way, when the baby's out from mother's womb, you know, baby is now preparing or nature's preparing baby for that immunity, right? Now to, to increase that immunity, basically baby will require that stimulus. Baby will require something which will basically tell body, okay, you start immune function and protect this baby, okay? So this is what it is. Now again, going back a little bit more into science. So what happens to, once the baby takes this back, this milk, mother's milk, which has mother's good bacteria. So those bacteria has an effect on this columnar epithelial cells. So the one which I showed you over here, so how it affects the columnar epithelial cells, this is the slide over here. So what it does, the first thing what it does, it basically creates this microvilli. So do you see this microvilli over here? This is a columnar epithelial cells. This is the gut lining. This is our lining, okay? This is basically your lumen, this is your gut lumen. This is where the milk comes in, okay? And this is your basically just underlying the gut cells, your columnar cells. You have a lot of these immune cells over here, okay? So all these immune cells are waiting for something to stimulate them so they can start acting up, right? So the first thing what the bacteria in mother's milk, which it does, it tells columnar epithelial cells to basically have a microvilli extension. So here this is important, the microvilli extension. It is not only important for absorption of your a lot of nutrients as you guys know, but it has other functions also. Second thing what it does, normally what happens is when you have this columnar epithelial cells, right? These are all the cells, normally in the newborn, fresh newborn, there is some gap in between these columnar epithelial cells. So they are not attached to it, there is no adhesion, there is little bit of gap. So now you have this, suppose you have a gap, so anything that you put in the mouth, you know, not things which should not get absorbed from that food that you're eating, it will get absorbed because then you have this gap. But thanks to bacteria in mother's milk, immediately that gap becomes sealed. So do you see there's a seal? So it seals then. So this is the first level of defense. It's like literally, you know, your soldiers coming one close to one another and saying, no, we will not let you in, right? So this is the second level, first level of defense. The second level of defense, what it does, basically, it tells a lot of the cells, like there are different cells in your columnar epithelial cells. You must have already known this, you know, there are pennant cells, there are goblet cells, there are all the different cells, right? So what it's going to tell all the cells to start producing something called glycocalyx, also called mucin, okay? Mucin, like a mucous layer. So now it has this beautiful mucous level all over the columnar epithelial cells. This is just the second level, because what happens basically, it will be very difficult for any bad bacteria to go into the epithelial cells. You don't want any bad bacteria. So this is the second level of defense, where basically, you know, it will not allow anything to enter your columnar epithelial cells, right? Third thing what these bacteria will do, it will basically cause a stimulation of these peptides, okay? These peptides are basically formed from your amino acids, as you know, right? And then what it will do, it will basically, those peptides are very important for, as the antimicrobial effect. So it has an antimicrobial effect. Fourth thing what it will do basically, it will, so do you see this area? This is, do you remember that we spoke about m cells? There are m cells, right? And I told you to remember those m cells. Now there is one particular area in your intestine and baby's intestine, where basically there is no mucous production, there is no mucin, there is no microvilli, why do we have that? Because it's important for this immune cell to get exposed to mother's bacteria, right? So if you have everything covered, you will not have stimulation of this immune cells. So here this m cells will allow basically your good bacteria and your bad bacteria to enter the intestinal wall and then basically it will stimulate all your cells underneath, right? So this is important. Now one more thing which is really important is your DC. This is basically dendritic cells. Remember when I talked about dendritic cells, dendritic cells are special cells and what it does, it basically kind of attaches the good bacteria, probably like a commensal bacteria and then it takes it inside and then basically exposes all these other cells to those bacteria, right? So this is another very specialized dendritic cell. So this is the basis of your immunity that how, let's see what happens when, you know, mother's milk comes in, right? Now this is the beautiful picture that I found from one of the study that I was reading and it's the electron microscope of the microvilli. So this is your column in the epithelial cells, okay? This is the cell and this is all the microvilli, right? It's beautiful picture, okay? So now what happens? Now let's see how the immunity develops, okay? So here I discussed about those column in the epithelial cells, right? This is your dendritic cells, right? So what it is doing, it is basically taking all these bacterias and it is bringing into sub-epithelial area, right? There where you have those lymphocyte cells. Now normally what happens initially, you have this T helper cells which are knife cells. Knife cells means they are not exposed, okay? And then normally what happens is that there are different T cells or knife cells are basically get converted into your T helper one cells, T helper two cells, T regulatory cells. These are basically, so it starts to stimulating, right? The normally baby is born with a lot of TH two cells. So here if you look at it, yeah. So basically normally they have predominance of this cells. Why? Because there should not be any rejection. When the baby is developing in mother's womb, there should not be any rejection. So not to have a rejection, basically in nature what nature has done, there is predominance of TH two cells, so there is no rejection. But once the baby is born, now baby is out of mother's womb, there has to be regulation. So you can't have TH two like dominance. Otherwise child will have a lot of autoimmune diseases, a lot of allergies. So what it has to do, it has to basically balance all this TH cells, okay? And another thing what it does, again it also takes this bacteria to your B cells, okay? Now what is the function of B cells? B cells are important for your IGA, right? So what happens? Basically the IGA gets secreted and that IGA helps with, it contains bacterial attachment and penetration. So your secretory IGA is extremely important and I just read a paper yesterday where they found that children, like younger children, the reason they are not getting COVID infection because they have very high level of secretory IGA which prevents the attachment of bacteria and virus to your cells, to your, to your the cells, right? So that's why it's important that children get the right, you know, and obviously you want mothers bacteria to stimulate all this, all the cells. You don't want cow milk or formula to stimulate all the cells, right? Okay, so now there's another very beautiful presentation on development of immune tolerance. What about immune tolerance? Means suppose if you're exposed to any allergens, right? So it could be allergens to any food, any like allergens, you have to develop that immunity so that you don't have this reaction. Imagine if somebody had anything in there had allergic reaction, right? So this, that's called basically immune tolerance, right? So here again, talking a little bit about science because this is again, I find it extremely important and very interesting also. So if you, if you look at it, I spoke about the DC, which is your dendritic cells, right? So, and this is mother's milk. Some mothers milk have your microbiota. So I spoke about all the bacteria that it has. I also spoke about some of this microbial proliferation. So it has human milk oligosaccharide, which I'm going to talk about a little bit later. And it has a lot of other antimicrobial, right? So they all kind of work in synergy, okay? And that basically it helps in prevention of allergies. So let's see what it does. So any antigen is basically taken up by your dendritic cell, okay? And it basically is taken to lymph nodes. And remember I told you that it takes those bacterial cells to those lymph nodes and those cells and it stimulates your, you know, transforming growth factor, which basically induces, remember I told you again, the knife cells changing into T-regular or all that. So this is one reaction which is happening, you know, when mother's milk is going in, right? Second reaction, what is happening? There is something called interleukin-22, okay? This again, you must have read a lot about COVID. You must have read about a lot of this, you know, interleukins and cytokines and all that. So of course, you don't want too much of cytokines, but you know, you need some amount of cytokine to fight your infections, right? So another thing what happens is there is a production of the interleukin-22, okay? And that interleukin-22 is extremely important. Why is it important? Because it is important for formation of the peptide. So remember I spoke about the peptide as it produces the peptide, okay? And this peptide production results in your making of your mucin production, you know, the lining of the gut, you know? So for that, interleukin-22 is very important, okay? And that is basically, it is important for strengthening of gut barrier, okay? Third thing what it does, basically, this particular gut barrier, you know, the mucin will prevent the transfer of dietary antigen across the barrier. So then you will have this beautiful layer. It will not allow any antigen to enter, okay? And for that, you need that interleukin-22, which will stimulate your goblet cells, it will stimulate your panic cells, and it will produce your, you know, mucin production. Then there is another enzyme, okay? There's an enzyme basically, it's called indolamine-23 dioxygenase. So there is a, we call it IDO, okay? I know I'm going, that's a bit too into detail, but this are, I think, a really interesting topic that we have to, if we understand, we will never let child have anything but colostrum, that too within half an hour, okay? So there is a enzyme called IDO, and which gets activated in responsive allergens. So if there is an exposure to any allergen, this IDO gets activated, okay? And then what does IDO do? It metabolizes, there is a few, I mean, of course, you guys know tryptophan, right? That's another amino acid. So what it does, it basically converts your tryptophan to kinurinin, okay? And which has the torogenic effect. So again, basically this kinurin is extremely important in baby, and that will prevent basically any immune reaction, okay? And what it does is, again, basically kind of affects your T-regs, okay? And this is how it's going to prevent allergies. So there are a few of the components which are important in prevention of allergy development, okay? And being a nutritionist, we guys know that, you know, it's so, I mean, a lot of time people have so many allergies. And now when you ask them, do ask them one question. Ask them that when you were born, in how much time did you get mother's milk? Whether did you get mother's milk or did you not get mother's milk? If you did not get mother's milk, what did you get? All this thing, if you ask the question in a lot of people who have allergies, by and large you'll get the answer that they were not fed, you know, colostrum right away, okay? Another science which is coming up is your microbiome, gut and brain access, okay? So what happens basically, again, you must have kind of studied in your nutrition that sometime when we are very stressed, right? When you are extremely worried if we have exams, you know, a lot of times we have stomach pain, we have diarrhea, we have like nausea, like feeling, why do we have that, right? Think about it. So I mean, basically of course there is an autonomic nervous system, you have vagal nerves, you have all this basically connection between gut and your brain, right? So it's similarly when you have basically issue with gut, you know, through a lot of this nervous connection, you know, especially vagal nerve, you know, large metabolites of gut microbiome basically can affect brain. So what they are saying in a lot of recent articles, they're saying that if there are a lot of neuroimmune conditions like multiple cirrhosis, Alzheimer's, autism, anxiety, depression, stress, all this lot of the disease are probably involved because of gut microbiome. I mean, of course, nothing is proven as yet, but as more and more studies are coming out, you know, it is just amazing. So again, let's see how it functions, okay? So as I mentioned, it's basically like a bi-directional biochemical communication. Remember I spoke about GABA, like how, you know, your gut microbiome is important for formation of GABA. It is also important for formation of serotonin. Now, if you remember, serotonin is another neurotransmitter. It's important for happiness, right? If you have a low serotonin, you will be depressed, you will be sad. So it's really important to have this really, you know, important, you know, your neurotransmitter serotonin, right? And basically, so your gut microbiome influences all this production expression of all this important neurotransmitters. So imagine if you don't have, you will have, of course, you will have some neurological issues, right? This one is also important, remember I mentioned about the intestinal barrier and tight junction. So if you don't have those tight junctions, basically large toxic metabolites can pass through hypothalamic pituitary adrenal axis and cause issues, okay? Another important thing about the short chin fatty acids. So again, you know, as I mentioned, short chin fatty acids, serotonin, chineurin, they all have an effect on brain, okay? So think about it when you're putting anything in your mouth. I'm not talking about babies now, I'm talking about adults. You don't want to do anything which can affect your microbiome, right? Because it has effect and you will see it, you know, like large time, when you eat something, when you have bloating next morning, you will wake up, you'll have headache, you'll have something called brain fog, you know? So you will notice it, you have to now kind of really, you know, be aware of a lot of the symptoms which you may not realize, okay? Okay, this is again a picture, a depiction of how the hypothesis of autism and gut dyspiosis, again, nothing is proven, this is a hypothesis, but this was another very good beautiful article that I had just read three days ago. And this is again, you know, this is the altered cut microbiome, you know, and mothers and babies and then basically it affects your brain, you know, through various signals, various pathways. Okay, now another thing which is really important is all these bacterial cells that we have, okay, in our gut. So we live in harmony, okay? When we have good bacteria, we have good immunity because it's going to protect us, okay? When we have good immunity, we'll have a better bacteria, no bacteria as well. So it's like a, it's like a full synergy, right? When you have a dyspiosis, dyspiosis means your commensal bacterias are lower and your pathogenic bacteria are higher, right? So now you will have a lot more of this gut problem of bloating, you know, irritable bowel syndrome, diarrhea, then of course, eventually what you're going to develop, you're going to develop a lot of your immune disease because you, again, your gut lining is not, you know, your gut lining is not well prepared, it has all these holes, you know, your mucus is not protecting, your mucus level is gone, your mucus layer is gone, then a lot of these toxins are getting absorbed, right? And then your body is reacting and you saw there are a lot of these B cells, T cells waiting just underneath your intestinal wall, you know, to react, right? So then basically people who have a lot of this gut microbiome problem, they are at risk for topical dermatitis, they are at risk for food allergies, you know, IBD, necrotizing entropolytes, which we see in pediatric and ICU, we see it all the time in small babies, we see necrotizing entropolytes, we see metabolic syndrome, and we see like this, you know, there's so much of information out there on gut microbiome and disease, right? But if you have excellent gut bacteria, you're eating right food, you know, babies are getting cholesterol, babies getting mother's milk, mother is eating right kind of food, then obviously baby will develop immunotolerance, they will have intestinal homeostasis, they'll be healthy metabolism, right? So it's basically like a win-win situation. And it's very important to keep ourselves in a synergy with the gut microbiome, right? Now, let's see what affects gut bacteria. Now, I spoke a lot about what exactly does in the body, we want to make sure that we protect it, right? So in babies, how will you protect those gut bacteria? You want to have a positive, so green, all your green factors are your positive factors. So you want to have a proper vaginal delivery as much as possible, of course, maybe 15% of the time, mother may need cesarean section, which is okay, but you know, I see that most of the time, like on most, just the other day, there was a news that 57% patients in private get cesarean section. So you want to ask gynecologist why I'm getting cesarean section, so you just kind of be on top of it and try to get as much as possible vaginal delivery, okay? There are complications, obviously, there is no choice. Then you want to have as much as possible term delivery, because babies who are born premature have a different gut microbiome bacteria, right? Then you want to have skin-to-skin touch, skin-to-skin attachment, breastfeeding right away, within as soon as possible, you know, if possible, just drive the baby and put the baby. We have a beautiful video on spoken tutorial. You want to avoid antibiotic as much as possible. So what antibiotic in mothers, what antibiotics in babies, you know, what will alter this gut bacteria, cesarean delivery, okay? Preterm delivery, early bath, okay? Lack of skin-to-skin contact, formula feeding and antibiotic exposure. So formula feeding also includes cow's milk, okay? So any milk other than mother's milk will create a problem in gut bacteria, and if there is antibiotic exposure. So you want to prevent all this as much as possible, okay? This again is some of the other factors which can create, you know, gut disruption and causing, you know, asthma, atopy, diabetes, all that. Of course, later on diet is also very important. So a child may have perfect nutrition for six months and then they continue breastfeeding for two, three years, but if they start, you know, food which is, which can be damaging to gut micro-microbacteria and some of them are like sugar, you know, jaggery, omega-6 loaded, fatty acids. Laws is a trans fat. Laws is saying are very detrimental to our gut microbiome. So we have to be very careful what we are putting in our stomach. Okay, this is another one, another article which just came out just a few months ago and what they found is a lot of time, you know, when mothers come to us, they said, can I, can I get a pump? Can I just pump the milk and give the baby through Vati, a Chumma, a bottle? So in this study what they found is mothers who had, who were pumping their milk and giving the milk through bottle, those baby had different microbiota than the mothers who were directly attaching. So remember I told you when you have a direct attachment that areola, micro-bacteria, you know, areola bacteria is also very important. So those factors were not giving, going in mothers' milk and also what was happening, basically there was probably a lot of contamination of breast pumps. So however hard you try to clean it, it's not direct mothers' milk going into babies, you know. So those babies had different gut bacteria. So this is important to understand. So and what is dyspiosis? Dyspiosis as I said is basically, you know, when there is a symbiotic relationship, it is lost, that's when it's dyspiosis. It means you have a lot more pathogenic bacteria than your normal good bacteria. And what are the implications? So these are the studies which have, which have been done so far. So again, high risk of infections, asthma, celiac disease. Again, you know, very good study which came out almost 30 to 40% reduction of celiac disease in mothers, babies who got mothers' milk. Okay. So it's, it decreases the, you know, prevalence of celiac disease also, your, you know, IBD, autoimmune diseases, irritable bowel syndrome, IBDs, inflammatory bowel diseases, obesity. Look at this, all this, you know, so many. And this one is the new really too much going on in this arena of neurodegenerative disorders and your mental disorders, right? Your autism, stress, depression, schizophrenia, Parkinson's. If you get chance, you do, do kind of reading on this articles on gut microbiome and, you know, neurodegenerative diseases. Now, okay. So now we spoke about bacteria, right? We, we always say, okay, which is a good prebiotic? Which is a good prebiotic? What should I do for my gut? But you won't believe it. As God has given beautiful bacteria and mother's milk, God has given food for that bacteria. Okay. That is called prebiotic. That's called human milk oligosaccharide. So it's, it's amazing. The nature is just mind blowing that God has given perfect kind of food for those beautiful commensals, like a good bacteria, right? So you guys know about prebiotic definitions. I'm not going to go too much in detail, but basically, you know, those are food for your, for bacteria. And basically, it, you know, it allows the specific changes. It changed, it basically allows the change in composition and activity of microflora, right? So this are human milk oligosaccharides. Lot of effects on, again, gut microbiome and also an interesting, very interesting. So again, I'm going to go a little bit in science. So this is your, you know, your structure of human milk oligosaccharide, okay? So it has fucose, it has sialic acid, it has anesthetized glucose, amine, galactose, glucose, right? So this is your structure of HMO. What are they? They are glypins, okay? They are basically found, like, abundantly in breast milk. Colostrum has high amount. You see, look at this, 20 to 23 grams per liter of HMO in your colostrum. It goes down as to when the mother starts getting matured milk, right? Preterm babies have higher amount of HMO. Why? Because those babies need lot more protection from infection. They need lot more protection from lot more other allergic conditions, right? Because anytime what happens, preterm babies, they get formulas, right? And as soon as we start formulas, especially in U.S., a lot of these babies have developed something called necrotizing enterocolitis. So again, I'm going to go a little bit detail in that, see what happens when we start, not start mother's milk and start formula. And then what happens in this HMOs, they need to, they have to be resistant to gastric acidity because those are food for microbiota which are present more in the lower intestine, right? So what it has to, what it has to be done is it has to resist to gastric acidity. It has to be prevented from hydrolysis by enzymes and it has to be prevent from absorption. So it has to go intact lower down in babies and this thing, right? So when those HMOs reaches the distal small intestine, and they end the colon, they are intact and at a very high concentration, okay? And then some of the bacteria, they grow well on this HMO, some of the bacteria, they don't grow well, okay? And then this bacteria, they produce short chin fatty acids. So remember I told you about the short chin fatty acids, those are metabolites, those are powerful metabolites, okay? And if you read a little bit more about short chin fatty acids, there's like a whole, you know, kind of bunch or 100 papers, they will find out effect of short chin fatty acids on our body, right? And basically what it does, it favors the growth of commensals of a potential pathogen. So it allows basically good bacteria to grow and it prevents the bad bacteria to kind of die down, okay? So now again, there's a little bit of science. I'm going to go directly to, I'm going to explain this because this is what I've explained on the previous slide. So what it does, so this HMOs are basically food for good bacteria. So these are your green ones are your good bacteria, the purple ones are your bad bacteria. So when you have food for good bacteria and it basically bad bacteria does not have HMOs. So they're going to die, right? Without food, they're going to die. So obviously you want your mother's milk and baby because if by chance, if baby's getting bad bacteria from somebody's dirty hand or somebody put, you know, touched the baby or put finger in baby's mouth, you know, all these bacteria which are going in baby's stomach those are most likely bad bacteria. So if you have a human milk, oligosaccharine mother's milk, basically those bad bacteria will not going to survive, okay? So what it does, it basically, it acts like a decoy. Decoy means it basically, you know, the cells over here then look like, you know, your epithelial cells over here. So that all those bad bacteria get attached over here and then they take it away from columnar epithelial cells, right? So it works like a decoy. It basically kind of trick the bad bacteria to go away from your epithelial cells, right? So it does not get absorbed. Then what it does, it causes the cell modulation. So this is where there is an immunomodulation where basically, you know, it allows your plasma cells to produce IgA. So there are a lot of this immunomodulation factors that it does. So there's a lot of immunomodulation. I again don't want to too much in detail. Okay, this particular one I mentioned. Babies are born with T-helper cell to predominance, okay? Because they don't want to get rejected in baby's mother's womb. But when you have human milk oligosaccharide, it tries to basically, you see how it causes balance. So there is a balance of this. So not only those gut microbiome causing balance, but also human milk oligosaccharide, you know, that also causes balance of this TH1 and TH2. This will prevent allergies in future. Extremely important step in babies, okay? Now, this E1, this is what happens. So you remember that we have neutrophils, we have WBC, we have all the cells, right? Those are all cells which kind of comes in when there is infection, right? But you don't want too much cells going into your cells, in your epithelial cells, right? So these are basically your neutrophils. These are your neutrophils. So what basically HMO does, it prevents basically the rolling of the cells on the endothelial cells. So these are your endothelial cells. It's preventing the rolling, right? So when you prevent the rolling, then it will not allow the neutrophils to go into your vascular system. Welcome to this spoken tutorial on the importance of golden R and cholesterol feeding. In this tutorial, we will learn about golden R and its importance, benefits of feeding cholesterol to the newborn. Let us begin by understanding what is golden R. Golden R is defined as the first R of the newborn after its birth. This first R is very critical for the child's growth and development. It is also an important factor in a mother's breastfeeding journey. This period helps to strengthen the bond between the mother and her infant. An uninterrupted skin-to-skin contact should be initiated between the two. What is skin-to-skin contact? Skin-to-skin contact is the best way to initiate early breastfeeding. The infant will attempt to crawl and latch on the mother's breast by itself. This is known as breast crawl, which is explained in detail in another tutorial. Next, let us look at the different stages of breast milk and its composition. The breast milk goes through three main stages. These stages are cholesterol, transition milk and mature milk. Each stage is best suited for the changing and growing needs of the baby. We will learn in detail about the first stage, which is cholesterol. Cholesterol is the earliest breast milk produced. It is thick, sticky and concentrated milk. Its colour can vary from creamy white to light yellow or dark yellow. It is so precious that it is also known as the liquid gold. Beta carotene present in cholesterol is responsible for its yellow colour. The breasts begin to produce cholesterol in the 12th to 16th week of pregnancy. It starts getting secreted from the breast after delivery. This special milk is secreted only until first 2 to 4 days after delivery. It is secreted in small amounts about 40 to 50 ml only on the first day. This is about 3 tablespoons of milk. Milk starts to be produced in larger amounts between 2 to 4 days. On the third day, the milk supply increases to 300 to 400 ml. This is about 20 to 25 tablespoons of milk. Even though cholesterol is secreted in small quantities, it is very nutritious. It is easy to digest, which makes it the perfect first food for the infant. It is high in proteins and low in carbohydrates. It is also rich in good fats. These good fats are essential for the growth of the newborn baby. It is also required for proper development of the baby's brain and eyes. Infection fighting elements are also abundantly present in cholesterol. For example, antibodies, lactoferens, lactadirin and leukocytes. Growth and protective factors are also there. In addition to this, it contains high amounts of Vitamin A, E, B12 and K. A large number of white blood cells are also present in the cholesterol. It strengthens the baby's immune system and helps fight disease-causing agents. It contains components which help fight bacteria. Cholestrum provides immense benefits to the newborn. Let's look at each benefit one by one. Cholestrum is the natural first immunization for the baby. Immediately after birth, the newborn is unable to produce its own antibodies. Feeding cholesterol is important, as it is particularly rich in antibodies. For example, immunoglobulin A, M and G. Among these immunoglobulin A known as IgA is the most important. They coat the areas of the baby's organs which are prone to infections. For example, lining of the throat, lungs and intestines. IgA binds to the germs and neutralizes them. This prevents the germs from entering the baby's blood. Cholestrum helps in regulating the baby's immune system. It balances the levels of T helper cells in their body. An imbalance in T helper cells can result in allergies and autoimmune diseases. In autoimmune diseases, the immune system attacks the healthy cells in the body. More than 70% of our immunity lies in the gut. Cholestrum has a huge role to play in the gut health of the infant. It helps in diversifying the baby's gut environment. This helps in prevention of allergies and asthma later in life. It reduces the risk of inflammation of the intestine. The risk of stress and depression is also reduced. Let us understand how Cholestrum is beneficial for the gut of the baby. A newborn baby is born with a leaky gut. There are gaps between the cells of the inner lining of the intestine. Through these gaps, viruses, bacteria and allergens can enter the baby's body. Cholestrum seals these gaps so that no harmful pathogens can pass through. The lining of the cells of the intestine has a brush-like border. This is known as microvilli. Cholestrum stimulates the development and extension of these microvilli. This helps in increasing the absorption of nutrients. Cholestrum increases release of mucin from the cells of the intestine. Mucin forms a layer on the lining of the intestinal walls. This prevents the entry of any bad bacteria. The Cholestrum also contains human milk oligosaccharides known as HMO. They act as prebiotics. This means that they promote the growth of good bacteria in the baby's gut. They block the pathogens from attaching to the cells of the intestine. They are also beneficial for the development of the baby's brain. Feeding Cholestrum to the infant prepares his stomach for digestion. It acts as a laxative to help the baby pass meconium. Meconium is the first dark black or dark green stool of the infant. It gets built up in his bowels during his time in the mother's womb. Passing this meconium early will also help in preventing jaundice. Meconium contains bilirubin. The laxative properties of Cholestrum will help him flush out the bilirubin. If the infant isn't fed well, the bilirubin is reabsorbed from the bowels. It then builds up in his body and results in jaundice. Another property of Cholestrum is that it has a high number of growth factors such as insulin-like growth factor 1 and insulin-like growth factor 2. They are required for tissue development, repair and growth. Another growth factor which is high in the Cholestrum is VEGF. It is called the vascular endothelial growth factor. It promotes the growth of new blood vessels. The Cholestrum is also a major source of epidermal growth factor. It is very important for the normal development of the baby's intestine. It is also essential for repair of the intestine's lining in case of an injury. Thus it provides protection against intestinal disease in newborn babies. For example, necrotizing enterocolitis which is known as NEC. It is a condition caused due to inflammation of the intestine. Fading Cholestrum also helps to prevent low blood sugar levels in the baby. Hence, Cholestrum feeding is beneficial for the baby. There are a few myths regarding Cholestrum feeding. The first myth is that Cholestrum should be discarded because it is stale. This is not correct. Cholestrum is neither stale nor is it harmful for the baby. On the contrary, it is very essential for the newborn. It should not be discarded even if there is a delay in breastfeeding. Any delay in breastfeeding the baby will cause a delay in Cholestrum production. For example, delay due to poor attachment of the baby to the breast. In this case, the mother can express her Cholestrum and feed it to the baby. She can express using press, compress and release technique. This will prevent unnecessary feeding of prelactyl feeds to the baby. Prelactyl feeds are any food given to the newborns before breastfeeding is started. For example, honey, water, jaggery, herbal paste, animal milk, formula milk. These foods deprive the child of essential nutrients. It also increases the risk of infections in newborn babies. The second myth is that the quantity of Cholestrum is less and insufficient. Some people may believe that is not enough for the baby. Many women interpret that the breast milk production is inadequate. This is not correct. The breast milk production is usually in line with the infant's needs. Infants require very small amounts of milk in the first few days after birth. Their stomach can hold about 20 milliliters on day one. Thus, the mother should continue feeding frequently. For the first few days, the infant should be breastfed around 10 to 12 times a day. Gradually, after a few days, the milk production will increase. On the fifth day, the mother's breasts start producing transitional milk. It is the second stage of breast milk which is bluish-white in color. It is produced until two weeks after delivery. It contains a mixture of both Cholestrum and regular breast milk. After two weeks, the breast starts producing the mature milk. It is more watery as compared to Cholestrum and transition milk. Though it is less concentrated, it is still nature's perfect food for the baby. Remember that exclusive breastfeeding should be done up to six months. When the baby completes six months, complimentary food should be started. It should be given along with breastfeeding. Breastfeeding should be continued till two years or beyond. The benefits of it last a lifetime for both mother and the infant. This brings us to the end of this tutorial. Thanks for joining.