I belong to this FB group called Nurture, hopefully I can get you guys on it sometime, but it was a mission for me and I’ve already been booted out once (for not posting enough! :/). anyway, so I’m trying to tread lightly. But all that aside, one of the admins put this up on the page a few days ago and I’m going through it now. It’s really interesting – below her post and her notes
Hi Mamas. I watched a *really* interesting presentation last night on GOLD by Melissa Cole, IBCLC on Infant Gut Health. I am seeing so many allergic babies and children at the moment, and have been wondering what the contributing factors could be. She explains that Mom’s own gut-health and also general health in pregnancy are big factors in a baby’s allergic response, and mentions contributing factors such as alcohol, nicotine, use of certain medications in pregnancy (even down to things such as antacids). If you’re interested, here are my notes (it’s l-o-n-g – make tea first, and I’ll post in segments smile emoticon )
Here are her notes
The term ‘gut health’ is becoming increasingly popular.
Gut health is understood in various ways by different cultures and healing modalities.
Some aspects covered by the term include:
•Effective digestion and absorption
•Absence of GI illness
•Normal and stable intestinal microbiota
•Effective immune status
•State of well-being
• Baby’s flora is primarily from their mother (prenatally and beyond)
•Infants have a naturally ‘leaky gut’ due to immature epithelial mucosa and to allow for immunoglobulins to pass through; if mom has a ‘leaky gut she’ll pass through bothersome proteins to an already susceptible baby.
•Adequate, small/frequent meals of human milk are necessary for long-term gut health.
•If the infant’s gut does not develop properly or get what it expects we can expect health concerns to arise.
•As clinicians, many of the ‘fussy babies’ we see are actually coping with digestive concerns.
•We must cultivate awareness and strategies to help infants dealing with less-than-ideal gut health in order to optimize the current and future well-being!
•The young embryo’s digestive tract (mouth to anus) begins to develop out of the ectoderm, mesoderm and endoderm layers of cells and is initially closed at both ends.
•By the 8th week in embryonic development the digestive tract tube is formed and is open from mouth to anus.
•Soon after, glandular organs (salivary glands, liver, gall bladder, pancreas) begin to bud out from the tube. Swallowing of amniotic fluid begins around week 10.
•During the early stages of embryonic development , faulty gene expression and issues can occur resulting in clefts, fistulas, tongue/lip tie,atresia/stenosis, etc along the midline, GI tract and beyond.
•The enteric nervous system (ENS) consists of millions of neurons embedded in the GI system’s lining.
•The sensory neurons in the ENS help control peristalsis and the release of enzymes.
•The ENS usually receives input and help from the central nervous system (CNS) but it can function independently (even if vagus nerve is severed).
•The ENS develops in utero and is sensitive to maternal meds (antidepressants, etc)
nutritional status and gene expression.
•The endocrine system works with the ENS. Over 90% of the body’s serotonin and 50 % of its dopamine is found in the gut. (Pasricha, J., 2011; Furness, J., 2012; Waller, P., 2010)
•The ENS and related gastric motility can be impacted by nutritional factors and the quality
of one’s diet.
•Breastmilk promotes the growth of biofilms which coat and protect the gut.
•Breastmilk contains oligosaccharides which act as prebiotics, food for beneficial bacteria.
• Breastmilk contains secretory IgA which helps develop the gut mucosa, immune system
and prevents bacteria passing through the epithelium.
•Breastmilk contains various beneficial bacteria
•Exclusive breastfeeding helps protect infants against foreign dietary antigens that their gut
is not ready for.
•Breastmilk contains numerous anti-inflammatory and neurotrophic (ENS) properties
Researchers have been discovering more and more about gut health in recent years. Here
are just a few of their finds:
•The infant’s gut health is NOT sterile at birth, depends on maternal gut health/flora
prenatally, during birth and through breastfeeding.
•Gut microbiota (bacteria, viruses, etc) interact dynamically and are impacted by many
internal/external forces (diet, meds, genetics, etc). Lots of information is communicated from the gut to the brain.
•Gut health plays a huge role in regulating inflammatory responses which are thought to
be linked to many health issues like metabolic issues, autism, IBS, eczema, asthma,
allergies, autoimmune issues, cardiovascular issues, mood disorders and more.
How do you know if you are working with a baby dealing with gut health concerns and why is the baby miserable?
Know is normal and what is not in regards to the following issues:
•Intake and growth
•Food allergies and sensitivities
•Colic and reflux
•Impact of structure and sensory input
An understanding of what is normal infant intake and growth is vital because an infant that is fussy because they are hungry (or over-full) is a different that an infant that is fussy for other reasons.
The fetus drinks appox 10ml portions of amniotic fluid, newborn stomach capacity appox 10-15ml at birth appox 20ml at 1wk.
Frequency of stomach emptying is every 60 min. (Bergman, N., 2011)
Small, frequent feeds are the norm. The gut can be unhealthily stretched over time. Beginning life with inappropriately sized and spaced feeds could set us up for a lifetime of gut health issues.
Intake-what is normal?
According to infant stomach capacity , emptying times and caloric needs, approximate intake will
Day 1-3: 5-15 ml per feed, on demand*
Day 3-10: 15-30+ml per feed on demand
Day 10-20: 20-60ml/per feed on demand
Day 20-1mos: 60-100ml/per feed on demand
Month 1 and on: remains steady at 24-32 oz/day (792ml-1056ml/day) avg 75-120ml/feed
*note- “on demand” for most babies equals appox 8-12++ feeds per day but frequency can greatly vary.
Infants (and ALL people) should stool everyday
The stool count may plateau or decrease a bit overtime BUT for excl Bf babies, not stooling everyday is a sign of something going on. Not every provider agrees on this point but from a gut health perspective we need to not base the “norm” on what is common but what is truly biologically normal.
The idea that babies “used up all the energy” or that “breastmilk is digested so well” there’s nothing to excrete is not really based in science.
I propose that infrequent stooling is not normal and is due to:
ENS/innervation/motility issues, anatomical issues, inflammation, gastric overfilling causing delayed emptying, inadequate gut flora, and/or inadequate feedings.
Decreased or suboptimal stooling can be red flags. What to look for:
Scant stooling – Ensure adequate intake, inflammation (remove maternal food triggers, heal gut w/ probiotics/herbs, body work to ensure no vagus nerve compression, etc)
Mucousy (snot-like) stool – Some mucous is considered normal but copious mucous is not. Body coats and irritant and gets it out, evaluate for irritants and inflammation.
Regular/daily stooling for infants (and grown- ups) is the biological norm. Studies on the frequency of stooling in traditional societies is probably a better reflection of normalcy than studies done within a population (most Western countries) where compromised gut health is sadly the norm.
Infants who had colic symptoms in the first 2 months had less frequent defecation during the first 2 years of life. This study provides the relationship between colic symptoms and stool frequency, and showed that the second month of life was unique in the sense that the frequency of stooling decreased to half of the previous month and 39.3% of these infants defecated less than once a day.”
Researchers worldwide are noticing that food allergies arebecoming increasingly common to the point of being called an epidemic.
Both allopathic and holistic practitioners alike view the causes of this epidemic to be our changing environment, changes in diet and predominant gut flora and radical shifts in epigenetics (changes in gene expression/function, not in DNA sequence).
Food allergy is a substantial and evolving public health issue…. IgE-mediated food allergy now affects up to 10% of infants…. (Prescott & Allen, 2011). 50% of children affected by food allergies in the first 2 years of life have non-IgE-mediated reactions (National Institute for Health and Clinical Excellence [NIHCE], 2011, p.
The pathophysiology of GI related food allergy reactions is complex. There are variables in the sensitization process and how allergies manifest.
The GI tract is the body’s largest immunologic organ. It views ingested bacteria and foods as foreign. A normal response to these antigens would be the development of immune tolerance.
Failure to develop immune tolerance can lead to the development of food allergy. Your body treats the offending allergen as a foreign invader and mounts an ‘attack’ in the form of an inflammatory response.
f baby had allergies, it would have been identified already
right?? NOT NECESSARILY!
Non-IgE reactions often go unnoticed since they are not immediate and are often misunderstood.
It can take some time for baby to become sensitized enough to show outward signs of reactions
Common non-IgE symtpoms are often viewed as ‘normal’ by some (ex: eczema, green poop, excessive spit up, colic, etc).
Families often suffer unnecessarily from undiagnosed food intolerances in their baby.
‘Latch” and Bf issues can often really be food sensitivities in disguise
“The lack of easily accessible diagnostic measures also contributes to the problem. The gut mucosal barrier is thought to have developed to execute an immensely difficult task; digestion and absorption of nutrients without provoking immune responses and cohabiting with commensal flora in a mutual beneficial relationship, while maintaining an immune defense against pathogenic microbes.”
“In the first few years of life, humans gradually develop an intricate balance between tolerance and immune reactivity in the gut mucosa along with a tremendous expansion of gut associated lymphoid tissue (GALT). Not surprisingly, both IgE (FA) and non-IgE mediated food allergy (NFA) is frequently seen during this period.”
For breastfed infants, how do allergies develop anyhow? Contributing factors include:
Maternal gut health, diet, meds, etc
Maternal microbiota (pre-conception and Pg), mode of delivery and feeding
Neonatal gut development and enteric nervous system health
Sensitization is what causes food reactions in the breastfed baby.
Sensitization to food allergens can occur in utero and beyond.
Researchers have noted that, “Because sensitization can occur very early in life, measures already need to be taken by the mother during pregnancy and lactation, as well as for the newborn” (Lopez-Exposito et al., 2011)
Foods consumed by the mother can pass undigested proteins to the fetus through the placenta or to the infant through breastmilk. These proteins can be viewed as ‘foreign invaders’ therefore setting the stage for the infant’s immune system to mount an inflammatory response resulting in the infant becoming sensitized to the proteins in question.
(Jarvinen, Makinen-Kiljunen, & Suomalainen, 1999; Suomalainen, 1997).
Factors contributing to the sensitization process: maternal diet during pregnancy/lactation, exposure to smoke and/or alcohol pre-/postnatally, maternal consumption of antacid medications in pregnancy, antibiotic therapy, environmental triggers, early introduction of solid foods, being formula fed, mode of birth, epigenetic influences and maternal gut flora pre/postnatally.(Lucarelli et al., 2011; Pali-Scholl, Renz, & Jensen-Jarolim, 2009; Rautava et al., 2012; Sanz, 2011).
Food allergies have a genetic component. When one or both parents have allergies, 7 out of 10 children may develop food allergies as well (IQEHC, 2008).
“Epigenetics has recently been considered as a potential mechanism involved in the development of…allergic diseases. …atopic dermatitis and food allergy are influenced by epigenetics. In fact, the exposure to environmental factors during early childhood may induce a long-lasting altered genetic state…”(Tezza et al., 2013)
•“The microbiota inhabiting the intestinal tract develop an array of physiologic roles within the human body, which influences both metabolic and immune functions, particularly during early neonatal life and possibly even in utero.
• Transmission of bacteria from the mother to the neonate through direct contact with maternal microbiota during birth and through breast milk during lactation also seems to influence the infant’s gut colonization, with potential health consequences.
•In this context, intentional modulation of microbiota composition through the use of probiotics during the perinatal and early postnatal period has been proposed as a possible dietary strategy to reduce risk of disease.”
Signs of Food Allergies/Sensitivities in Breastfed Infants
When infants are exhibiting any of these signs and symptoms, it is important that parents work with their providers to rule out food reactions.
Rashes (hives, eczema, peri-anal redness, etc)
Gastrointestinal issues (pain during/after nursing, bloody stool, reflux, vomiting, etc)
Infantile colic, prolonged fussiness and discomfort
Sleep disturbances (very frequent waking, often due to GI discomfort/reflux)
Poor growth, nutrient malabsorption
Holistic testing methods
Maternal food journal – helps track patterns of food consumption and infant’s reactions
Maternal elimination diet – Can eliminate suspected trigger or several main triggers (2+ wks) before re-introducing them and note infant’s response. Make sure to balance nutrients. Most cases improve in 72-96 hr (ABM, 2011).
For suspected IgG or delayed reactions, alternative testing methods can be considered (blood tests like ALCAT, energy tests like EAV (electroacupuncture according to Voll) or NAET(nabudripad’s allergy
elimination techniques), muscle testing, etc. These tests have little evidence supporting validity but they are often non-invasive and can give families some guidance. Consult with qualified holistic practitioners like a naturopathic physician to learn about your options.
Management of Food Sensitivities in the Breastfed Infant:
For parents, coping with food sensitivities in their breastfed babies, the issue is particularly complex because diagnostic techniques and management strategies are not always well defined therefore leaving parents confused and frustrated at times.
Food sensitivities can manifest differently from baby to baby and clinical assessment and management varies too.
If indeed an infant does develop reactions in the postpartum period there are things mothers can do to help reduce the severity of symptoms and promote good infant gut health.
Management of Food Allergies in the Breastfed Infant
1. Maternal diet after elimination. Provide meal/snack ideas.
2. Consider conventional and/or holistic allergy testing methods if elimination is not enough
3. The top 8 allergens are: milk, eggs, fish, shellfish, nuts, peanuts, wheat, soy. These foods
account for about 90% of all food allergies.
4. Continue avoidance of triggers and consider holistic gut healing options
5. Optimize Vit D levels of mother and baby (Baek, et. al, 2014)
6. A trial run of ‘hypoallergenic formula is almost always NOT the way to test if a baby has allergies
Impact on digestion: Colic and reflux
Colic-The medical definition of colic is a condition of a healthy baby in which it shows periods of intense, unexplained fussing/crying lasting more than 3 hours a day, more than 3 days a week for more than 3 weeks. Although any periods of unexplainable crying are often labelled colic.
Reflux – Gastroesophageal reflux (GER) or the more severe Gastroesophageal reflux Disease (GERD) occurs when the contents of the stomach go back up into the esophagus. GERD can irritate/damage esophageal tissue, cause feeding aversions, inadequate weight gain, aspiration, etc.
These terms are often misused and more babies that once had “colic” are now given a reflux Dx…infant fussiness is often very misunderstood.
Conventional Treatment Ideas
Medication- If reflux is suspected, a trial run of an Rx is often suggested by MDs.
Pros – Baby may get some relief, tolerate feeds/gain wt better.
Cons – Use of meds can increase overgrowth of bad bacteria in gut/increase illnesses, ingredients may cause more irritation (lactose, sucrose, etc), lose effectiveness over time, won’t stop the actual refluxing, just inhibits acid.
Non-med ideas – thickening feeds (controversial), upright positioning during/after feeds, surgery in severe cases (fundoplication)
Is suppressing stomach acid the answer?a
1. The release of gastrin (secreted when food reaches the stomach) stimulates release of gastric juice (hydrochloric acid, pepsinogen, mucus, water, intrinsic factor, gastric lipase) and increases gut motility
2. Pepsinogen activates into pepsin by hydrochloric acid and begins protein digestion
3. Hydrochloric acid stimulates secretion of cholecystokinin (CCK) and secretin, both which aid in the release of bile (emulsifies fats), pancreatic juice (digests starch, proteins, fats).
4. CCK is also a neurotransmitter (receptors in immune system and spleen) that helps us feel satisfied and quiets the immune system (lessens chance of attack on new food invaders).
Holistic Gut Healing Options
Just eliminating the triggers is not enough; healing the gut is vital! Please work with someone that specializes in holisitc pediatric care.
Herbs -slippery elm, digestive herbs (Chinese herbals, chamomile, fennel, licorice, ginger, peppermint, etc)
Supplements –Vit D, glutamine, EFAs, zinc (appetite stim), etc
Homeopathics- chamomilla (screaming/flailing), colocynth (want abdominal pressure), dioscorea (don’t want pressure, like stretching, gassy), jalapa (cry all night w/ pain daytime better sour stool) lycopodium (bloated gassy worse 4 pain, better, stool), bloated, gassy, 4-8pm, hate abdominal pressure, constipated), nux vomica (worse after eating, troubled in AM, sensitive to maternal diet)
Probiotics – prenatally and after for mom/baby, specific and allergen free if needed, must replace and re-colonize!
Digestive enzymes –Taken by the mother to help break down foods, especially pancreatic enzymes
Putting it into Practice
Gut health issues are often multi-faceted, view the body and treatment options in a holistic way.
Coping with a fussy, uncomfortable baby takes an emotional toll on parents. Providing empathy along with our clinical care is vital.
As feeding clinicians, we are often in a role that allows us to be amongst the first to notice signs of digestive health issues in babies Learning how to ecognize signs of digestive upset is critical in order to provide comprehensive care.
As new research becomes available, healthcare providers must strive to keep up to date with their understanding of assessment and treatment of food allergies/sensitivities in the breastfed infant; the well-being of mother, babies and our future generations depend on it.”