"How to Treat Reflux in Children with Diet"
Excessive spitting up and vomiting in infants may be treated
with putting them on their left-side down after meals,
but of course never when sleeping— it’s always face-up to wake-up
to reduce the risk of crib death.
Also, you can try smaller more frequent feedings,
thickening or changing formulas, and in breastfed infants
(which is ideally how all infants should be)
eliminating cow’s milk and eggs from the mother’s diet.
I’ve talked about how more than 40 percent of infants with reflux
can be successfully treated with cow’s milk removal.
It can also affect them on the other end too—
can be a major contributor to diaper rash,
and contribute to chronic constipation in 80 percent of affected kids,
though only a single kid tested positive
for an actual cow’s milk allergy.
So, it was like some kind of sensitivity reaction
that can really only be diagnosed by giving a cow’s milk-free diet a try.
Anal fissures in infants may be practically pathognomonic
for cow’s milk allergy, meaning so characteristic of the condition
that it could be used as a diagnostic sign,
no allergy testing required.
It’s like when cow milk hypersensitivity was demonstrated
in 10 of 17 children with severe reflux.
In the majority of patients, the hypersensitivity to cow milk
was identified only by eliminating it and then re-challenging to confirm.
They did endoscopies, measured the acid gurgling up
before and after milk, and then verified by repeating milk exposure
with double-blind placebo-controlled challenges when necessary.
Yet, all but one of the children proven to have this adverse reaction
to dairy tested negative on allergy tests.
So, tested negative for a cow’s milk allergy,
but still got better by cutting the cow’s milk out,
showing that this association between cow milk hypersensitivity
and severe GERD, this severe reflux, was observed not only in infants
but also in older children.
Another disease that can be cured with cow’s milk elimination
is eosinophilic esophagitis, a chronic inflammatory disorder
of the esophagus (the tube that connects the mouth to the stomach).
To figure out what’s causing the inflammation,
an elimination diet is prescribed, where you basically remove everything,
and then every time you add back a food
they stick an endoscope down your throat and take biopsies
to see if that one food made things worse.
And how many freakin’ foods are there out there!
So, you can imagine how difficult, and costly, and invasive
this is for families, how confusing and frustrating.
So, these researchers at Northwestern figured
let’s just see what happens if you just remove one food
from their diet instead of making them go through all that.
And just eliminating cow’s milk induced remission
in 65 percent of the children they tried it on.
I mean normally you’d have to put these kids on steroids,
where they try to coat their throat with steroids
to knock down their immune response,
but then that sets you up for infections like thrush;
and of course, as soon as you stop the steroids
the esophageal inflammation comes raging back,
because you’re not treating the underlying cause.
But steroids are considered the standard of care.
Too bad there’s never been like a head-to-head test
of cow’s milk elimination versus steroids...
until now.
A comparative effectiveness trial of cow’s milk elimination
versus a swallowed steroid and…
they both appeared to work just as well,
which is to say the cow’s milk elimination worked better,
because no side effects and you’re treating the actual cause,
suggesting getting rid of dairy products
should be considered the first-line therapy.
In adolescence, cow’s milk protein intolerance
can contribute to chronic fatigue syndrome,
evidently a common problem in young people with chronic fatigue
and most importantly a treatable contributor to their symptoms.
But again, most were unaware that dairy was a problem,
possibly because it can take hours between milk ingestion
and when you start feeling worse,
so people don’t make the connection.
So, even those who report no problems after milk ingestion
may still be suffering problems after milk ingestion.
And finally, what about adults?
Well there’s lactose intolerance.
Most people on Earth are lactose intolerant after weaning,
with the exception of some human populations
that developed lactose tolerance about 10,000 years ago,
thanks to a mutation in the lactase gene which enable adult humans
to digest lactose (milk sugar).
Or, at least those select European populations;
whereas most Hispanics, most Africans and Asians remain intolerant,
which may be a good thing, since acid regurgitation,
reflux, heartburn is so common among adults in the Western world.
And food intolerance may play a role in adults as well.
Milk was found to be the leading culprit,
but they were using what’s called a leucocytotoxic test,
where you see how someone’s white blood cells react
to individual foods in a petri dish.
This test is frowned upon by professional allergy associations
as not being sufficiently sensitive and specific.
Can’t hurt, though, to put it to the test.
A double blind, randomized, controlled trial performed
in 38 reflux patients for which proton pump inhibitor drugs
failed to completely control their symptoms.
OK, well let’s give diet a try.
They randomized people to a diet
in which they excluded foods they tested sensitive to—
most often dairy—
versus a diet which instead excluded foods
for which they didn’t test positive for to control for the placebo effect.
A month later, the symptoms in the control group dropped,
but the symptoms in the true diet exclusion group
dropped significantly further.
They kinda felt bad for the control group,
so they switched them to the right diet too,
and two months later everyone was feeling better.