Submitted by curiousnboredd t3_10nh3ui in askscience
what is it about infants that make them susceptible to botulism from eating honey that adults are safe from? I’ve asked my professor and she only said it’s cause the adult’s GI can expel the spores while an infant’s doesn’t but I’m still wondering how so.
In addition to this comment, pH also plays a very important factor in botulism sporulating in the stomach. The pH of an infants stomach acid is not low enough to prevent botulism from germinating (come out of spore-form). I believe the magic number is 4.6 if memory serves from classes in college. Under that acidity, the conditions are too acidic for clostridium botulinum to germinate and release its toxin. Newborns have not yet developed the gastrointestinal pH that older humans have to prevent this. I looked it up and adults are around 1.5-2.0. So too acidic for botulism to do it’s dirty work.
Edit: Sentence structure. Fixed for clarity. Edit 2: found the pH of adult stomach acid.
yes! acidity is also the reason that botulism isn’t SO likely in fruit jams, but more likely to be a problem in canned meat.
what i didn’t understand about infant botulism for a long time is: for adults the SPORES aren’t a problem, because they die in your gut. the toxins left over that the bacteria created (pooped out?) while living in the nonacidic canned food is what makes us very sick. for BABIES the problem is the spores can literally create more bacteria in their tummies / intestines, & hang out there eating food & making toxin
they told you when I was young canned food goes off in like 24 hours after opening, I never heard anyone in my town to get this
Canned food is cooked while inside the sealed can. You get botulism from canned food when the can is compromised or leaking, allowing the bacteria to get in and grow on the food.
Botulinum spores can withstand fairly high temperatures and is an anaerobic bacteria; that makes it hardy against for the two major features of cans that keep the food safe. One of the real dangers of botulinum is that food safety rules that protect against other bacteria are insufficient.
A can doesn't need to be burst or leaking to get the bacteria inside because the spores are probably already there. It's when the can or jar was heat-treated at a temperature which was too low (still hot enough to kill off everything else!) or the conditions inside are not acidic enough that it will germinate from the spores and start producing botulinum toxin.
And, because it's the toxin that causes the disease, not the bacteria, re-cooking the food to temperatures that we would usually consider safe might kill the bacteria but the toxin is still there.
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I sorta remember putting a plastic bag over can as child and putting in the cooler and I got scolded like I was a terrorist gonna take out the whole block
this was a real fear
Assuming it was an unopened can, freezing it could cause the can to 'explode' . You see it happen with drink cans a lot because of the thinner material and the carbonation in lots of drinks but it can happen with any sealed liquids without room to expand.
https://youtu.be/t5mdZD00POs this guy demonstrates it by freezing a sealed pipe with liquid nitrogen to spread up the process
this was back in the day when booti killed a few every year
many things were different, back then they said the children are the future
we were so clever with computers and stuff
nobody says that anymore, kids are dum as rocks
That video was really cool. I knew ice expansion was strong but I didn't know it took so little. And the remaining water interacting with the LN2 was awesome too
oh, cannes food going bad after it’s opened is not botulism, any more than a salad going bad in the fridge. that’s other processes & organisms.
botulism grows in NON-ACIDIC, ANOXIC environments. so it can grow inside the can (no oxygen), before the can is opened. industrial canning processes get very very hot to kill the spores so they don’t grow even when the environment is right.
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> acidity is also the reason that botulism isn’t SO likely in fruit jams, but more likely to be a problem in canned meat.
Isn't it due to fruit jams high sugar concentration?
No. One of the most common pathways infants are infected with C. botulinum spores is through honey.
The bacteria goes dormant in spores which are incredibly hard to kill. Sugar has nothing to do with it.
so, the thing about honey seems weird (maybe you have more info than i do though).)
i read in a medical source that after the widespread campaign to NEVER feed babies honey, which every US parent myst have heard of at this point, the rates of infant botulism… did not change.
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So antacids increase the risk?
Long term use of proton pump inhibitors, such as omeprazole or nexium, will increase your risk for Cdiff infection. Very similar process
How long is long term?
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This plays a role into why babies can spit up so much more than adults. If we did that, our esophagus would be toast
So how would you get botulism from separated cheese from a fast food restaurant? This has happened to me a number of years ago, and as far as I could tell, I was otherwise quite healthy at the time.
It’s more likely in that instance that the separated cheese came from a botulism infected source. Clostridium botulinum is a obligate anaerobe so it can’t grow in the air we breathe but it can grow in canned food. Can then gets super puffy and if someone doesn’t notice or realize the problem all the toxins go into the food. You can to cook the food at a high temperature for a long time to inactivate it making botulism one of the big food poisoning agents.
The word botulism refers to a disease caused by the botulinum toxin, not to infection by the bacteria itself. In babies infection that then produces the toxin is the bigger risk, but in adults the larger risk is poisoning from food that has been contaminated with botulinum and that has not been stored in such a way to stop the bacteria spores germinating. So you would not have had a gut infection as I've described, you would probably have eaten the cheese and your gut would have killed off the bacteria but absorbed the toxin.
I am interested that it's cheese though! Botulism is usually associated with canned/preserved goods, and it's an anaerobic bacteria, so I wouldn't expect it to like cheese. When you say 'separated,' do you mean curdled/separated into curds and whey? I found this article that shows that dairy with botulinum contamination does curdle (as curdling is a chemical process and not an organic one, many milk contaminants do not cause it): https://pubmed.ncbi.nlm.nih.gov/10456739/
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Wait, why would we care about sporulation in the stomach? It's the active bacteria that's the problem in intestinal colonization botulism, no?
The bacterium can germinate in a beneficial environment with good growth conditions. If it germinates out of the spore in the stomach it may be able pass to the intestines (unclear). Or it may remain dormant and become active past the stomach.
Per the CDC -"Adult intestinal toxemia (also known as adult intestinal colonization) botulism is a very rare kind of botulism that can happen if the spores of the bacteria get into an adult’s intestines, grow, and produce the toxin (similar to infant botulism). Although we don’t know why people get this kind of botulism, people who have serious health conditions that affect the gut may be more likely to get sick."
I was trying to provide info of the bacteria in general as it pertains to infants and their digestive system and what pH conditions it can/cant grow in, so I thought it was helpful to look at the pH environment of the stomach too. Since we don't know exactly how adults get intestinal botulism I threw it in as additional info. Also, a lot of people don't know about botulinum spores and how pH plays a role so I thought I'd share.
Just to clarify, I wasn't trying to be snippy, I appreciate the information either way. But are you using "sporulate" here to mean "becoming active"? Isn't it the other way around?
If not, how is the bacterium going dormant an issue if it has already entered the body?
No not at all! I appreciate the catch and you're totally right. I used the wrong term and had meant germination, not sporulation. Its been awhile since i've had to think about this lifecycle. Sorry about that! I've corrected my previous posts and used 'germinate' where applicable.
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What do you mean by sporulate? Isn’t this a bacteria we’re talking about?
I was totally unaware bacteria could have spores
Hi! So when Clostridium botulinum is in a harsh (example: acidic) environment it goes dormant and forms a spore to protect itself (sporulation). It will stay dormant in its spore-form until the surrounding environment is optimal for it to survive, become active (germinate), grow, and produce the neurotoxic protein. A Clostridium botulinum spore refers to the dormant state of the bacterium. Germination is when it comes out of dormancy and is not longer in its protective spore. Bacillus and Clostridium are two common spore forming bacteria. Hope that answered your question!
I told a lady once that she really shouldn't give her infant honey because of the botulism risk and she just flat out said that I was making it up.
This^
The best way to think of yourself is as a perpetually changing petri dish with multiple organisms competing in a constantly changing environment of nutrients and exposures. Some organisms work together, some outcompete, some change/mutate. Some environments are more acidic, some less oxygen, some sunlight, some dry, some wet, etc some medications are designed to kill certain organisms and then now other competition fills in its place (think yeast infections after an antibiotic kills some bacteria previously occupying an area). Oh, and what's normal for you isn't normal for everyone.
Regarding the spores, if the environment is right and bacteria take hold it's only because the conditions were so that it outcompeted the others in that location in a high enough concentration to produce toxin that at low concentrations cause issues. Botulinum is quite potent.
(my background is microbiology and a family doc for those that care).
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Will "intestinal flushing" events like a prep for colonoscopy impact the gut biome long term? I've heard it's best to eat probiotic rich diet for a few days after drinking that vile concoction and living on the toilet for 18 hours...
If I instead ate a "regular American diet" after a colonoscopy, would my beneficial bacterial composition return slowly, or incompletely?
You aren’t actually going to flush out the bacteria by flushing out fecal matter. Obviously you will lose some. But you’re still going to have lots and lots adhered to your gut walls. Your gut wall has lots of folds in it to increase surface area. Bacteria are going to hide in these books and crannies. And well as are adapted to adhering or sticking to your gut wall.
Generally bacteria biomes in the gut change when you kill them off with antibiotics. Or they slowly change over time with a chronic disease like diabetes.
But flushing your system clear with a laxative should have a much smaller effect
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if i take antibiotics and ruin my gut flora can i die from honey?
i generally eat bananas after taking antibiotics, i have no idea about gut biology though
Only if you wreck your gut flora enough that you’re also at a high risk of dying from diarrhoea-induced dehydration, or other opportunistic infections. It would have to be very, very bad.
In addition to that, there is the stomach-acid which acts a barrier.
If you’re worried about the effects of antibiotics on your gut biota, you can take probiotics during the course.
But don’t be worried about eating honey, any more than you’d be worried about wearing boots that are too heavy to swim in while it’s raining.
If your doc martens are a drowning risk just because there’s rain, several other very noticeable things have gone exceptionally wrong.
Fortunately your humour is so dry that flooding is impossible around you 🤣
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I searched for This Podcast Will Kill You and I only see 3 episodes. I use the Google podcast app. Is it the wrong one?
There are currently 110 main episodes along with some specials. I use spotify but I just went to Google podcast and it looks like all of the episodes are available? So it might be a problem on your end. Amazing podcast tho, highly recommend
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To add to this, adults generally ingest preformed toxin from canned foods. Meanwhile, as already noted, babies get sick from the spores (commonly in honey) because their gut flora is immature.
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I’ve read also babies have more water in their stomach vs adults having more stomach acid and this is also crucial.
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Why is honey specifically a risk for honey? It’s anti bacterial so I was surprised by that.
Honey typically has spores for the bacteria that causes botulism intoxication. The underdeveloped gut flora of infants allows those spores to grow into live bacteria and produce the toxins for disease.
Botulinum is a sporing bacteria, like anthrax; in conditions it can't reproduce well in, it forms spores, basically dormant versions of the bacteria inside a protective shell that can then withstand environmental conditions, including honey.
Honey is mildly antibacterial because it has such a strong concentration of sugar that it forces all the water out of bacteria by osmosis. Botulinum in a spore can survive that and then germinate into the active bacteria if it later enters safe conditions.
The other reason honey is specifically a risk is bioaccumulation. Botulinum spores naturally occur at low levels in most soil, which means there are tiny tiny traces on most things, including the surfaces of flower—not enough to do anything most of the time. But honey is made with of a lot of pollen. It can potentially build up in the honey the same way that eg. mercury builds up in tuna; tiny fishes absorb a little environmental mercury, but tuna eat a lot of tiny fishes in their lifetime, and they can't eliminate the mercury, so they consume far more mercury than a fish the same size would absorb from the water.
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This is all correct!! Infants who are breastfed tend to be older at symptom onset than formula-fed patients too and this is also thought to be ag least partially because of helpful bacteria from breast milk, helping to slow colonization by c. botulinum.
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The only correction i have for you is that its fauna not flora at least i dont believe there are flowers in my belly
Professor wrong? There's a shocker
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So the exact reason behind why isn’t 100% understood, in fact it took ages to figure out which foods were more likely linked to infant botulism (like honey) and is just a very easy thing to eliminate from infants diets to lower the risk. Infants aren’t born with a developed GI flora of good bacteria which help defend itself, instead their intestines are basically ready to develop their flora by being exposed to good bacteria that can colonize and develop a defense network, thus when the spores are introduced to an infants GI tract, they’re far more likely to colonize and take over in an infant and begin producing the actual botulism toxin that causes infant botulism. An adult’s flora is well developed and the spores don’t have a chance to colonize and begin producing this toxin in the intestines before being destroyed.
However, adults can still get botulism but this is because they eat food that doesn’t just have the spores there, it’s because they’re eating food that has already had the botulism colonize in it, thus it’s already a colonized/grown and heavily present with the actual botulism toxin that the bacteria colonies produce. Nearly anyone that ingests food already colonized with botulism bacteria is going to end up with foodborne-botulism regardless of age of intestinal flora development. An infant is just more susceptible to infant botulism because their intestines are susceptible to allowing the spores to begin colonizing, producing botulism bacteria, and having the botulism toxin produced inside of them.
So would an adult who has been on an extremely heavy course of antibiotics also be more susceptible to botulism? Similar to how they’re more vulnerable to things like C. diff?
They would be more likely to experience botulism from colonized food that had a lower amount of bacteria that was already colonized yes, but from just the minute amount of spores found in SOME types of honey? Probably not. It may be possible but certainly not common. Antibiotics don’t completely remove the bacterial flora from your intestines, nor do they really change the other natural defenses the body builds up in the GI Tract other than just the flora. Sure, antibiotics kill a large number of your healthy intestinal bacteria which makes it easier for opportunistic bacteria like C. diff to take over, but they don’t completely wipe everything out. I have not heard of a case of an adult being confirmed to have been colonized by botulism from spores found in honey to the point where it actually colonized internally and began secreting the toxin. But if your flora is messed up you are certainly more susceptible to any bacterial colonization that Is consumed.
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I just want to point out that an infant given antibiotics is at greater risk.
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Adults taking proton pump inhibitors such as Omeprazole on a chronic basis to block gastric acid secretion are more susceptible to gastrointestinal infections.
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Botulinum bacteria are a soil bacteria. You're much more likely to get botulism from incorrectly prepared root vegetables than from fruits.
Garlic in oil is one of the notorious ones, also baked potatoes in aluminium foil (held at improper temperature), or prison "wine" (often has potato scraps added to boost starch content)
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I would also like a source.
Being a dad to a 7mo old my brain says that formula is a processed chemical masterpiece straight from Satan's butt, so their immune systems must be on high alert most of the time.
The immune system isn't triggered by the meager nutritional rainbow of artificial feed. It's the meager nutritional rainbow (tight-spectrum of nutrients and lack of additional mammalian milk byproducts) that make formula second-rate to breast.
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Because an infant’s immune system has not yet developed the capability to handle it. This is not specific to honey; it’s just that honey is a known risk. Infants are at greater risk of becoming seriously ill from all pathogenic bacteria and viruses than adults.
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There's an idea in philosophy, tabula rasa, or blank slate. The basic idea is that everybody is an empty slate waiting to be filled when they are born. You can apply this to the body, too. A person's immune system can only react to what it has encountered before. Babies haven't encountered much.
Mammoth-Corner t1_j699708 wrote
Your professor is wrong; it is nothing to do with expelling the spores.
The botulinum bacteria is a poor competitor. In an environment where there are already lots of other established bacteria, it struggles to form toxin-producing colonies; babies have less developed gut flora, not just because they haven't picked them up from the environment but also because their diet is much more limited.
Adults do occasionally get intestinal botulism. This usually happens in cases where they have been on antibiotics for some time and the gut flora has been killed off.
I really recommend the This Podcast Will Kill You episode on botulism!