"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.