Facebook Pixel Code
Banner image
About the Institute

Profile of Robert Bandsma

Staff profile photo
Dr. Robert Bandsma

By: Mackenzie Hill-Strathy

Dr. Robert Bandsma, MD, PhD

  • Scientist Track-Investigator, Translational Medicine
  • Staff Gastroenterologist, Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children
  • Assistant Professor, Department of Paediatrics, University of Toronto

1. Where are you from?/Where did you study?
I was born in The Netherlands, and completed my B.Sc and PhD and medical school at the University of Groningen. I also completed a research elective at the University of California Berkeley and a clinical elective at The Children’s Hospital of Philadelphia (CHOP). I completed part of my residency back in Groningen and a subspecialty fellowship in the Division of Gastroenterology, Hepatology and Nutrition at SickKids. I finished part of my residency in the Caribbean, which was really fascinating and it is what sparked my interest in Global Child Health. To further my knowledge on the topic, I completed additional training in global health and tropical paediatrics from the Royal Tropical Institute at the University of Amsterdam and the Liverpool School of Tropical Medicine. After completing my residency I spent close to a year in Malawi working as a paediatrician, teaching biochemistry and working on my research. This research brought me into the field of malnutrition, which is what I am currently studying. Eight months ago, I accepted a position at SickKids and moved back to Toronto.

2. What are you researching right now?
My overall goal is to advance global child health by improving survival and the long-term outcomes of children with severe malnutrition.  In the field of nutrition, a lot of people are looking at the obesity end of the spectrum, but most of my work is related to malnutrition, which metabolically actually has some interesting overlap with obesity. One could argue obesity is a form of malnutrition, just a different presentation of the condition.

The mortality rates of children with severe malnutrition are very high, 10- 30% for inpatients have been reported by some centers. One of the things I am currently examining is what mechanisms are responsible for such a high mortality rate, even in the best nutrition rehabilitation centres. We have found that a lot of the time malnourished children die due to diarrhea which leads to dehydration and electrolyte imbalance (such as salt depletion). Diarrhea is traditionally the result of infection, but I am examining how it can also be caused as a result of a lack of nutrient absorption by the gut, particularly of sugars. When sugars are not properly absorbed this can lead to osmotic diarrhea, which is the same thing we see in toddlers drinking too many sugary juices. Currently malnutrition is treated with a diet that contains a lot of sugars, and we postulate it could be leading to further dehydration and malnutrition. We are about to begin a randomized trial where we will examine the impact of lowering the amount of sugars in the treatment combination to see if this has clinical benefits.

Another topic I am very interested in is the liver, because it is the central organ that regulates the metabolism. The liver produces and breaks down proteins, lipids, fats and sugars. It is common for malnourished children either to have very low blood sugars, which we have shown can be related to our observation that the liver is not producing enough sugar. Low blood sugars could make you lose consciousness and lead to death. I am working with Peter Kim, a scientist in Cell Biology, to look at the specific parts of the cells that play an important role in energy metabolism (peroxisomes and mitochondria) to find out what causes the damage or dysfunction of the liver.

Lastly, we are trying to discover low cost interventions for repairing liver function that can be used in a clinical setting. In countries where I do research, such as sub-Saharan Africa, there are hardly any existing interventions. Even simple antibiotics are often a problem to get a hold of. We need to establish treatment options that are cheap, easy to implement and don’t need to be refrigerated.

3. Who is your all-time favourite scientist and why?
I tend to believe more in teams, not individuals. When you read about how most important discoveries were made, there is almost always a team involved. Of course it involves a lot of hard work, a great deal of luck and sometimes genius on the part of one or two individuals, but usually it is the accomplishment of a group of people. This is something that should be emphasized more. It is better to have a community with great team players, than one or two really smart individuals.

4. What in your opinion is the most important scientific breakthrough and why?
It is difficult for me to name just one important scientific breakthrough. Most of the really significant scientific discoveries have been outside the field of medicine, such as Isaac Newton’s law of universal gravitation and Einstein’s theory of relativity. An important breakthrough in my field was Louis Pasteur’s discovery that bacteria are responsible for causing diseases. This has been greatly important in establishing the foundations of the work that I do.

5. What are your major interests outside the lab?
I love movies. French cinema, in particular La Nouvelle Vague (The New Wave) era is my favourite. It is very different and experimental, especially for its time. I also really like Italian cinema. One of the Oscar winners this year, La Grande Bellezza by Paolo Sorrentino was a great movie, I really enjoyed. I love going to the Toronto International Film Festival (TIFF) and also really enjoy photography.

6. Why science?
What I have always liked about science is that you get to come up with your own problems and then find creative ways to solve those problems. I really like how it is a creative process. However I have found that just working in the field of science is not enough to satisfy me, I like to be researching something that serves a useful process. This is probably why I am so interested in malnutrition; because I think it is a problem that needs to be solved and I am genuinely interested in looking for the solution. In health sciences you always have to go back and forth, from the most basic science to the clinical implications. I enjoy how in my job I get to work right in the middle, moving back and forth between fundamental and highly clinical research.

7. Why SickKids?
When I originally applied, it was partly because my best friend from high school who got a position as a nuclear physicist at Michigan State University, suggested I move to the area so that we could catch up every once in a while. SickKids has a world renowned training program in paediatric gastroenterology, hepatology and nutrition, so that is why I applied to SickKids specifically. I completed the fellowship here in paediatric gastroenterology, which was really great because it was both a clinical and research fellowship program. After that I went back to The Netherlands and worked there for a couple of years before getting the opportunity to return to SickKids. I appreciate how this institution allows for people with different interests to pursue what they are interested in and be recognized for them. Whether you enjoy teaching, or are more of a scientist, SickKids values and rewards everyone for the work that they do.

8. What is the most controversial question in your field right now?
Almost all clinical questions related to the treatment of severely malnourished children are controversial, but the problem is that they are also not controversial enough to garner attention. Essentially the problem is that there is a lack of evidence to substantiate policies. There is not a lot of research to support the use of various treatments, because there are very few people in the field pursuing mechanistic studies. As a result, there are also few trials being done. There is not a lot of impulse to generate a paradigm shift that could change policies. The WHO is really advocating for more scientists to become involved and generate the evidence to adapt their protocols.

It is also very hard to collect evidence in this field as it’s very challenging to do research in areas lacking basic provisions. When conducting a clinical study, you also often need a large group of patients which can be extremely difficult. Once collected, this large group is not necessarily representative of all malnourished patients. For example, studying a group of malnourished patients in Malawi, might not represent the same population of malnourished patients in Bangladesh. A treatment may work on a malnourished child with HIV, but that doesn’t necessarily mean it will work on a child with tuberculosis. These discrepancies make it difficult to find solutions.

9. What are you reading right now?
Right now I am reading A History of Western Philosophy by Bertrand Russell. It was given to me a long time ago, and had been sitting on my shelf since, and I have finally gotten around to reading it. One of my all-time favourite books is On the Road by Jack Kerouac. It’s a book from the 50’s and was very influential in the rise of the hippie movement in the early 60’s.

10. If you could give one piece of advice to someone considering a research career, what would it be?
Essentially my piece of advice would be to try to balance idealism with opportunism and pragmatism. From what I have found especially for someone with a medical background, the earlier someone gets exposed, especially to more basic science, the more science becomes part of their thinking. If you remain enthusiastic about science, you will be more likely to pursue a scientific career later on. I think it is important for doctors pursuing more of a clinical path to continue to conduct research, especially for those planning on going into something very specialized. These doctors are originally trained in science and often offer new approaches to tackling clinically relevant research problems.

11. What does the SickKids' Peter Gilgan Centre for Research and Learning (PGCRL) mean to you?
As I previously mentioned, I believe that the best research and scientific breakthroughs are accomplished as a team, so I hope that it will facilitate more team-spirit. Collaboration is easily facilitated at SickKids because we all have the same aim - to improve child health. I hope that the architecture of the building continues to facilitate more sharing and collaborating; certainly the design of the building makes it easier to share ideas, facilities and equipment. An example of the teamwork the PGCRL enables is my work with Dr. Peter Kim, a scientist in the Cell Biology Program. Together we are taking a closer look at what causes liver damage. This is a great example of working together to create a mutually beneficial relationship that furthers both of our research interests.

November 2014

Scientific profile