Treating Reflux in Babies with Diet

Treating Reflux in Babies with Diet

August 15, 2019 54 By William Morgan


“Treating Reflux in Babies with Diet” There has been a longstanding problem
among zookeepers of the gorilla. Latin name: Gorilla, gorilla gorilla. The problem is that they were
throwing up all the time. We’ve never seen wild gorillas barfing, but it had unfortunately been
accepted as routine by many zoos. What were they feeding them? Well, you know they’re
big strong animals, so they made sure to
feed them lots of protein, you know, cottage cheese,
meat, eggs, milk.; until a zoo in Germany
got this radical idea to try giving them their natural diet. And the change following the
alterations to the diet was astonishing. I mean before, the poor silverback
was regurgitating and vomiting during most of the day. But by the third day eating what
they were supposed to eat, he and the rest were
all miraculously cured. Even just removing milk from
captive gorilla diets led to significant improvement. Cow’s milk was historically
considered an essential item in the captive gorilla diet,
but they showed that removal of milk from the captive gorilla diet
may reduce such undesirable behaviors and may be a step toward better
approximating their natural diet. I mean giving an animal
milk after weaning? Giving an adult animal milk? Milk is for babies! And then giving milk from
a bovine to a primate? What were these crazy
zookeepers thinking? Doesn’t make any sense! Reminds me of this landmark study. Eighty-one children presenting with
reflux, gastroesophageal reflux disease, so they were given drugs,
and two thirds got better, but 27 kids still did not. So, they tried eliminating cow’s milk from their diets, and within
one month, all 27 were cured. Symptoms of acid regurgitation,
heartburn, or both, occur at least once a week in 10–20 percent
of adults in the western world. And in about up to 25
percent of all infants. Now it’s normal for babies
to spit up occasionally— that’s not what we’re talking about. It can actually get quite serious. Up to a quarter of infants present
with regurgitation severe enough for parents to seek medical help, and it may just be that they’re
sensitive to cow’s milk. The symptoms of cow’s milk protein
allergy overlap or may coexist or complicate GERD or reflux. Even if there’s no formal
dairy allergy per se, there appears to be some kind
of cow’s milk ‘hypersensitivity’ among many infants and
children with severe reflux. There are all sorts of
invasive tests you can do, like stick pH probes down
the poor baby’s throat, but probably the most practical test
in routine pediatric practice is just a trial of a cow’s milk
protein elimination diet for two to four weeks
in infants with reflux. The gold standard is what’s called an
elimination and re-challenge protocol, where you see full resolution of
symptoms via a strict elimination, followed by recurrence of the symptoms on reintroduction of cow’s milk protein. And when you do that, take 200 or
so infants diagnosed with reflux and then not only put them
on a cow’s milk-free diet, but then do the challenge tests. Eighty-five of the 204 infants with
reflux were actually suffering from a cow’s milk allergy or at least
hypersensitivity or something. What we think is happening is
that our immune system attacks the bovine proteins as
understandably foreign, triggering an inflammatory response, which like irritates the nerves
lining your digestive tract, and that results in abnormalities
in the rhythmic contractions of the stomach, triggering
the regurgitation. And we’re not just talking
about formula-fed infants. Cow’s milk protein allergy can occur
in exclusively breastfed infants, as intact cow’s milk proteins can
be secreted in breast milk. If the mom drinks milk or eats
eggs it can get into her baby. Cow’s milk protein and other foreign
proteins can pass into human breast milk. So breast-fed infants with regurgitation
and vomiting may therefore benefit from a trial of withdrawal of cow’s milk
and eggs from the maternal diet. And indeed, that is now the
consensus recommendation of both the North American and European
Society for Pediatric Gastroenterology, Hepatology,
and Nutrition. Anytime you see reflux, let’s
first try a therapeutic trial of either a cow’s milk protein–free
formula or, for infants who are breastfed, a maternal strict cow’s milk
protein elimination diet. And so, then we can potentially
treat the cause without using unnecessary medications,
and certainly before you start considering performing
any anti-reflux surgery on the poor kid.