Jun 19, 2017 | Autism & ADHD, Constipation, Food Allergies & Sensitivities, FPIES, GMO & Organic, Growth & Feeding, Infection, Illness & Nutrition
I’m now serving my second generation of clients, working with moms who where were not even born when I finalized my credentials as a dietitian/nutritionist. Recently I did a double take noticing that a young mom I was working with was born on my wedding day – Wow!
It has been quite a journey. I’ve watched earlier clients’ kids, and my own son, grow up to be more functional and able, after rocky and uncertain beginnings. But I have some bad news for you young moms: It is a lot worse out there than it used to be. It’s very different for you than it was for my generation. There’s a whole new normal, and it ain’t pretty.
More than half of US children are now chronically sick or disabled – meaning that it is now more common for kids to have chronic conditions or developmental delays, than it is for them to be healthy, growing strong, and developing or learning normally.
During my graduate years in public health nutrition, this was unthinkable. CDC goals we worked with then have not come close to being met. We’ve not only fallen short, we’ve actually violated the very first goal to “prevent morbidity and disability “- ! Both have increased dramatically for US children in the 21st century.
Type 1 diabetes has quadrupled. Children under age 10 are now getting diagnosed with Type 2 diabetes – actually unheard of when I was trained in the late 1980s; this was only diagnosed in overweight, middle-aged people at that time. At least 80,000 kids in the US are diagnosed with Crohn’s disease, a severe and chronic inflammatory bowel disease, and its incidence in children is increasing. I meet kids each month who have similar symptoms but have never been diagnosed, and I just worked with my first toddler diagnosed with Crohn’s disease this spring. During my training, this wasn’t even mentioned as a condition that a young child could have. Even the phrase “toddler diarrhea” didn’t exist (diarrhea is not a developmental phase!). Babies and toddlers were not diagnosed with, or given medications for, GERD (reflux drugs like Nexium came to be so overprescribed, they were called “purple crack“). Asthma, cancer, allergies, and of course – autism – are all increased far past their 1985 levels, with no signs of slowing down. And are you tired of hearing yet that autism has shot up nearly 150-fold since 1975, and that some estimate that half of US children will have it by 2025? How will this country function, populated by sick and disabled adults? How will we pay for their care?
Those are big questions. But here is the question that has had me scratching my head for the last twenty years: What are our pediatricians doing about it?
Are they even thinking about reversing these trends, in any meaningful way?
If they are as young as you are, it’s doubtful they know how miserably we failed at reaching the CDC’s goals from the late 20th century, for population health. Or that they’ve had much of a deep dive into child nutrition and its role in development, learning, behavior, and immune strength. I also do wonder if they know what it’s like to see kids who never need any prescription drugs, because they’re just …healthy.
Being sick repeatedly throughout the year, needing multiple rounds of antibiotics, being developmentally delayed, having an impacted, inflamed, or ulcerated colon, being unable to eat anything but milk, yogurt, or Pediasure, or having only loose, burning, foul stool or impacted hard stool may be common nowadays, but it isn’t normal.
Your kids should be healthy, comfortable, vibrant, eating, eliminating daily, sleeping well, growing, playing, and thriving! If they can’t because of a chronic condition, then they still deserve to reach their fullest potential, enjoy their highest well being, and feel good as often as possible.
From my perch as a pediatric nutritionist/dietitian, I have watched it get harder and harder to restore kids’ health, away from the chronic gastrointestinal, feeding, growth, developmental, and allergy/immune problems they have. Kids bodies seem more compromised, their immune systems more confused, their intestines less functional. The work is more complex than it was in 1998 or 2000. Diagnoses like FPIES (which my own son had in 1996, before there was a name for it), milk protein intolerance, food allergies, intolerance to breast milk, and EoE are not unusual now, but they earned no mention during my training in infant and child nutrition in the late 1980s.
I often wonder how pediatricians of my generation reconcile this. Do they notice, like me, that children are sicker, as government data show?
Moms under 35 have it rough. You are..
- The first generation to grow up with more antibiotics, vaccine doses, psychiatric medicines, and just plain more prescription drugs than any other.
- The first generation to grow up eating GMO foods.
- In the years you were conceived, patent and marketing laws for drugs changed – and dozens of new drugs flooded the market, whether we needed them or not, and regardless of non-drug options that may have worked as well or better.
- The goal posts have moved for what counts as valid published medical “science” – much of it is now ghost written by the pharmaceutical industry.
- Environmental protection laws are either being stripped or unenforced, allowing more toxins into air, water, and food.
- You are now bearing children with more toxic burden than any parents before you in America’s history.
In short: It’s a lot harder to have healthy kids these days. Your bodies were exposed to more toxins, sooner, than people of my age. And now your children are exposed to all of this even before they’re born, in utero.
So now what? It’s simple: Remember that your kids get to be healthy.
That is their birthright, and their normal. Expect them to be healthy, not chronically sick. But you have to do some serious footwork, even before pregnancy, to help them get there. If your kids are already here on the planet, there is a lot you can do to diminish their odds for chronic disease, developmental injury, and psychiatric conditions. If your kids are already affected by these problems, there is still plenty to do with food, nutrition, and good support for immune function and detoxification – you might be surprised to see how well your kids can be.
Here you go:
- Eat organic whenever you can. It matters. I actually did some work on this during my graduate studies (eons ago) and found that yes, organic foods are more nutritious, and have fewer toxins (though not toxin free, thanks to widespread use of pesticides and GMO crops in the US).
- Don’t eat GMO food, period. Minimize it as much as possible. Here’s why.
- Find out if your kids have food sensitivities or allergies; feed them foods that nourish deeply, not foods that chronically inflame.
- If your kids need antibiotics, restore healthy flora – you will know it worked by appearance of a daily, comfortable elimination (no bloat, hiccups, burps, picky eating, straining, watery stuff, mucus, dry pebbles, or foul odor – just formed easy to pass stool and healthy appetite).
- Drink filtered water, not tap water. Put filters on shower heads. Or, consider a whole house reverse osmosis water filter.
- Don’t use plastic containers for food. Avoid plastics, xenoestrogens, and xenobiotics in lotions, shampoos, soaps, or foods.
- Eat more vegetables, more plant foods, and less meat and sugar than you want.
- Eat loads of ancestral, organic fats and oils.
- Don’t have a C section if you can help it. If you can’t, seed your baby’s gut biome with probiotics or your own flora.
- Don’t get vaccinated while pregnant. It can increase your risk of miscarriage, and it delivers toxins like aluminum, mercury, and rogue viral or human DNA into your body. Effects of vaccinating pregnant women on their unborn children for asthma, allergies, or other immune mediated conditions are unstudied.
- If you need antibiotics during pregnancy, delivery, or breastfeeding, take all precautions to restore your baby’s gut flora with probiotics and a healthy diet.
- Read this 2017 study on the health of vaccinated versus unvaccinated kids. Choose soberly what you want to do.
Those are good starts – a big effort, yes; harder perhaps, but the upstream work is well worth it if there is a chance it can prevent burdensome chronic conditions in your kids. If you need more specific guidance for your own child’s situation, contact me for an appointment and we can get started.
Dec 5, 2016 | Autism & ADHD, Food Allergies & Sensitivities, FPIES, Growth & Feeding
Has anyone on your child’s care team done lab tests, only to tell you they’re all “normal” and there is nothing more to do? Or worse, you’re sent to a specialist for more tests and invasive procedures, when you still don’t understand what is going on?
This is such a common story in my pediatric nutrition practice that I had to address it. The truth is that any lab test result has two interpretations: Lab range, and functional range. Anyone, including babies and kids, can have test results that fall within the lab reference range (considered “normal”), when they are in fact teetering on health disasters. Functional range means your lab test results fall into a more narrow range, and this is where you actually feel good. You’re not just not sick, you’re well!
If your pediatrician is using only lab range to interpret your child’s results, then a lot of opportunity for well-being is missed. And, you may end up doing more invasive and useless diagnostics, when improving these initial findings is all that your child might need.
Establishing what is considered “normal” ranges for lab test results is difficult to do. Groups of individuals who have no known health problems are tested, and a range is created from their findings, for each lab test that exists. These ranges can be wide. But functional lab test results fall smack in the middle of the lab reference range. The lab range is wider than this, and may include findings for people who are not so healthy. This is why it’s good to look closely at your child’s findings and ask questions.
Here’s what to do:
- Always get a copy of your child’s labs, after any visit where your doctor presents them, including emergency room visits. Keep these in an organized file.
- Use your doctor’s secure on line portal (if they have one) to view your child’s labs. Download these and save them as pdfs if you like, so you can carry these into other provider visits with you, and get second opinions.
- Scrutinize your child’s lab test results yourself. If you notice results that are close to being out of range, ask your doctor about this.
- Don’t assume your primary care doctor or pediatrician always or immediately sees lab test findings done in an emergency room visit, or at a specialist visit. Always maintain your own files of these and share other providers’ test results with your pediatrician or primary care provider.
Some typical examples of “lab range” problems from my practice…
- Gluten sensitivity may bet the most frequently missed diagnosis I see. Many doctors run celiac panels, which can be normal, even when a child has a gluten reaction. The problem here is that many celiac panels do not check for gluten reactions – they only check for celiac serology. It’s possible to have debilitating reactions to gluten, without having celiac disease. This is called non-celiac gluten sensitivity and it can really wreck your kid! Definitely get a second opinion if your child continues to grow poorly, have stomachaches or headaches, or experiences ongoing gut or even psychiatric symptoms.
- Iron and Anemia Screening: You may have seen a normal hemoglobin and hematocrit at your child’s annual physical, but this can miss other problems concerning iron. The hemoglobin and hematocrit test is done with a finger prick drop of blood. This will only fall out of lab range if your child has entrenched anemia. Read this blog on iron screening to learn what to do next – prevent complications from marginal iron status that don’t show up with the fingerstick test.
- Ferritin (the storage protein for iron) has a very wide lab range, and labs vary on how they report it. Some labs report a ferritin level as low as 10 as normal; others say it’s okay for it to be as high as 400. Either way, ferritin is so important for your child’s immune function, learning, behavior, sleep and more that more investigating is worthwhile if this lab finding is not somewhere between 40-85.
- White blood cells (WBC) fight infection, and the lab range may sound small: Anywhere from 4.0 to 14.0 for kids is considered “normal”. But if your child’s WBC count jumps from its usual level of 5 or 6, to say 11 or 12, then it’s possible your child is fighting a new infection – even though it’s still “in range”. Or if it always hovers at the low end, say 3.8 to 4.0, then your child may have an undetected chronic infection that keeps him tired, cranky, or inattentive. Is your child having any fevers, intermittent malaise, frequent colds and bugs, tired all the time, unable to shake off a cold or virus? Go back to your doc and ask about it. By scrutinizing the blood count further, your doctor can discern if your child is fighting a bacterial infection, a virus, or struggling with a moldy environment, and may be able to help you more.
- Vitamin B12 can be a red herring if it your child’s serum level is reported above range. This may mean B12 is hanging out in serum instead of getting into red blood cells, where it is needed, so those cells can function normally with normal size and shape. Further scrutiny of a complete blood count will show if B12 is needed, as will a test called methylmalonic acid. Serum B12 level alone can’t give the whole picture. Simple changes in nutrition protocols can fix this.
- Lyme disease antibody may report as a false negative if your child got exposed to this infection long ago and you didn’t know. If Lyme disease is at all suspected, ask your doctor to be as thorough as possible. Do both the Lyme antibody test, as well as all the “reflex bands” and a co-infection panel. Undiagnosed, old Lyme infections can impair immune response to other infections, so the co-infection screening is important.
- Blood tests for heavy metals are not terribly useful. Blood tests can “see” recent or active exposures to heavy metals, but won’t show you about past or old exposures. If your child’s mercury or arsenic screening came back ok, this doesn’t show whether or not those metals are hiding out in places they really like – like kidney, brain, or nerve tissue. Mercury, lead, arsenic and other heavy metals like to avoid watery spaces (like blood) and migrate to fatty tissues, where they tend to stay put. If you really want to know about heavy metals in your child, some other tools are necessary.
These are just a few examples of how your doctor might miss opportunities to really help your kids feel good. If you have questions, always ask. I maintain continuing education credits in functional blood chemistry, and enjoy helping families with using nutrition supports to help kids feel really well. Make an appointment with me today if you need extra help!
Need more kid health blogs like this? Join my newsletter list below. I regularly share recipes, tips, and hot kid health topics.
Sep 13, 2016 | Autism & ADHD, FPIES, Growth & Feeding
Yup, GAPS can fail. And it’s probably not your fault.
Gut and Psychology Syndrome Diet has a lot success stories… But what about the kids who fail on GAPS?
I have met a lot of those kids. After GAPS has just plain not worked (or worse – traumatized the family and injured the child, which can unfortunately happen) – I’m often the next stop.
These are smart people who followed the GAPS protocol carefully, and engaged lots of on line support; some worked with GAPS certified practitioners. But still: Fail. Their kids withered on bone broth; vomited or bled in stool on probiotic foods; and had bloating, rashes, and irritable stools with egg yolks, avocados, and nut butters. Their parents pressed on, for months or even longer; some moms have described to me the intense pressure they felt to stay with this protocol, and the deep sense of failure they internalized about it not working.
Okay, here’s the thing: There is no one diet for everyone. There never is. All children with autism, FPIES, or gut issues do not benefit from or need GAPS. I have met many who failed on it. GAPS works well for some. It fails for others. If it isn’t going well, odds are it’s not your fault. Your child just needs something different.
So, what can go wrong? Why not just try it?
Besides the possibility of wasting a lot of money and effort preparing scratch foods that may be wrong for your child, you’re going to waste time too – which some children simply can’t afford. The younger they are, and the more undernourished they are to start, the harder this can be on a child, if it isn’t the right measure.
And a mom’ s worry is no small thing. Chronic, strong apprehension and anxiety about anything is hard on parents. It changes your chemistry, and ups your cortisol. Sensitive children will sense your strain, and this will strain them. If you’re breastfeeding, altered cortisol levels are in your milk too. Cortisol changes blood sugar metabolism and endocrine function; it can disrupt sleep, appetite, feeding, and immune response. If implementing GAPS (or any special diet measure) is exceedingly stressful, pause; relax and enjoy your children; and secure professional guidance so you don’t have to carry the nutrition-flip project on your own shoulders.
Meanwhile, here’s what can go wrong, when GAPS is the wrong tool for the job:
Fungal Failure – Recently an old study jumped out at me. It examined how children in weaker nutrition status can’t control Candida (fungal) species very well. They have more Candida, and different, more irritating strains of Candida in their intestines, compared to children in good nutrition status. The study found that for children, simply being in better total nutrition status meant better control of Candida colonization.
What exactly does this mean?
For kids, nutrition status = growth status. It is the single most potent predictor of how well a child will manage any illness or infection.
Nutrition status in kids is not a measure of how many vegetables or probiotic foods they eat. Not whether they’re gluten free, GAPS, or Paleo. Not what supplements they’re on, not whether they drink raw camel milk. No matter what a child eats, if growth pattern has wandered below that child’s innate trend, all body systems struggle more.
Even when children eat lousy processed food, if they are in robust growth status, they still have more reserve to tackle a disruptive biome. Whether it’s a fungal load in gut, mycoplasma in lungs, MARCoNs in nasal passages, or a viral story in brain tissue, there is simply more energy and building material around to throw at it, in a kid with a strong growth pattern. This is such old news in nutrition science! Learn more about the cycle of malnutrition and infection in children here.
This does not mean that the quality of your child’s diet doesn’t matter. But it does mean that even if your child eats beautiful food, if they’re in a weak growth pattern, they are going to struggle more in every way – sleep, mood, infection fighting, learning, behavior – and, detoxifying a bum biome and healing the gut.
In the study mentioned above (from 1974, back when there were no GMOs, and less processed food available than is now fed to children worldwide), the groups compared were well fed white Australian children, poor aboriginal Australian children, and poor Indonesian children. The underfed children had weak total diets, meaning they had too little protein, too few total calories, insufficient vitamins and minerals, and sparse nourishing fats. They also had more Candida.
What does this have to do with GAPS? Read on.
A small child’s immune system will sputter when s/he’s underfed – like when eating just broth for more than a week. (Or when exclusively breastfed or formula-fed, with no solid foods, past the first year. Or when on deep dietary restrictions for healthy carbohydrates – which are fundamental to steady growth in children). There simply is not enough protein, energy (calories), and nutrients around to manage, balance, and fight. If an already weak, underweight child attempts GAPS, it may fail, because s/he was too depleted for multiple immune-essential nutrients and energy (calories) in the first place. A more recent study illustrates this well known tenet in infant and child nutrition: Just by not having enough food around, the gut barrier is disturbed, and tissue damage occurs. It doesn’t take long for this to happen in young children. Adding probiotic can hasten recovery, but only when an adequate total diet is also in place.
Hence the susceptibility to Candida – and quite likely, other bad actors in a gut biome, tissues, or organs. So although this first phase of GAPS may clear out some disruptive species from the gut, it can also drop your child’s total body immune response further, and permit other bum bugs to flourish. For kids who are underweight or have marginal iron stores to start, or who have deep total body dysbiosis, this can set up for failure. The detox is too fast, and the re-build fails, because the foundation was too weak to begin with.
Even mild nutrition deficits impact immune response in children. This is one of the reasons why GAPS fails. GAPS can be too restrictive for too long to help these kids recover. Just the introduction phase of this diet can take three weeks; this is an eternity for an already underweight toddler struggling at the bottom of the growth chart. Though broths, probiotic foods and egg yolks are fabulous, this may not be enough sustenance for a growth-impaired small child whose immune system is already straining. Yes, probiotics are critical to immune maturation – but, so is food itself, to nourish the gut tissue –> that harbors the biome –> that helps the immune system “learn”.
Carbs are especially essential for children. In infancy and toddlerhood, they are the fermentable food that normal gut flora require to thrive. Healthy gut flora make fatty acids like butyrate, which in turn fuel cells building your child’s gut tissue. I’ve met many parents who fear carbs, and over restrict them in their kids. This can fail too. Non-sugary, unprocessed carbs are a cornerstone to fuel the tutorials going on in a young child’s gut, between gut flora and the developing immune system. They also fuel growth and gain, and protect the lovely fats and proteins needed for other functions. The trick is finding which ones work best for your child’s circumstance. This is something I work with closely in my practice, for each individual child.
So even though GAPS aims to eradicate fungal load by restricting all carbs for a while and by adding extremely high potencies of probiotics with fermented foods, it can backfire. I often see disrupted stool cultures in kids coming off GAPS attempts, showing weak beneficial flora and ample dysbiotic bacteria, and even yeast in some cases.
When Leaky Gut Begets Leaky Gut – Some GAPS mainstay foods are renown suspects when it comes to intolerance or allergy. Eating broth with probiotic foods for three weeks is not long enough to clear pre-existing food antibodies, which circulate for months; in some kids, for years. If a child starts GAPS with hidden food allergy or sensitivity to egg or nuts, using these daily can exacerbate leaky gut, even when using that beautiful kraut or other probiotic food. I often find strong egg and nut reactions on IgE and/or IgG panels children who have used GAPS for several months. Even yolks can trigger immunoglobulin reactions that may not show on the “drop on wrist” test suggested in the GAPS protocol.
Better move: The “dot on wrist” test may not be enough. Do some food antibody testing before you start any special diet. Identify what foods are safest to work with before you begin. Check for both allergy (IgE) and sensitivity (IgG) to several foods, and work from there. If eggs and nuts light up your child’s panel, GAPS is not for you – or, it will be a bumpier road – consider easier paths than GAPS to gut healing in this case – there are many options.
In my practice, I find that ALCAT testing is less useful. It tends to show too many reactive foods, which makes menu planning really difficult. Even when IgG and IgE panels are alight with multiple foods, in young children, it is not practical or healthful to remove them all. I will remove the top four or five offenders, rotate others, and dial in gut restoration tools suited to that child. This can include anything from simple organic aloe to direct herbal antimicrobial measures to products like Apex RepairVite to arabinogalactan, butyrate, glutathione, or a low FODMAPS + SCD compliant meal plan for a few weeks to start.
FODMAPS Meltdown – Many kids have difficulty with foods that are high in FODMAPs. Another GAPS mainstay, avocado (which is indeed a great food) is a moderate FODMAPs food that is poorly tolerated by many in my practice, especially babies and toddlers with FPIES. I am encountering many FPIES families who turn to GAPS, with poor results (vomiting to shock, blood in stool, lagging growth). Learn why FPIES may be as much about carbohydrate fermentation in the gut than it is about food protein reactions here. Meanwhile, if your child has FPIES, I would hesitate to recommend GAPS, because FPIES reactions can be severe and dangerous. I am seeing success with FPIES in my practice with other strategies, so if you need help, contact me for an appointment.
Dairy Dilemma – Dairy yogurts are another wonderful food that are simply wrong for some of us. If these have worked for your family, that is good. In my house, I can eat dairy while my husband and son cannot. I love raw goat milk. I have occasional organic yogurt binges. I eat ice cream, goat cheddar, sheeps yogurt, and whatever I want. My family can’t. I have countless children in my practice who show clean lab findings for any sort of dairy reaction from opiate formation to IgG, IgE, and ALCAT – but who still disintegrate terribly on dairy. Usually this is a “behavioral” reaction – anxiety, impulsivity, rage reactions, stilted social processing, or poor sleep. For those moms who took my advice and tried the three month, uber strict, zero tolerance dairy free diet, and your kids got inexplicably way better, got off psych meds, and started to eat better, don’t thank me – I thank you. It’s hard to go out on a limb and try something that seems to make no sense. But, sometimes, a meticulous elimination trial is the only way to know if your child really can manage a food.
Are dairy yogurts okay for your child? If you really want to know what is going on, consider doing a Cyrex Array 4 for cross reactivity testing. Your child may react to dairy foods when eaten with other foods, and this panel will find if this is true for you child. This test plus sensitivity and allergy tests (IgG and IgE) can guide you before you begin.
Did GAPS Work For Your Kids? Great! Share your success stories here, I’d love to hear them. If it failed, don’t despair. Get individualized expertise for your child’s gut healing (and thus total body healing) journey. Your child deserves to visibly trend toward thriving. If you’re still struggling, get help, give me a call, set up an appointment. There are many ways to replenish, restore, and heal the gut; it’s okay if every kid is different. Honor your instincts as mom, because they are good as gold.
Dec 20, 2015 | Food Allergies & Sensitivities, FPIES
FPIES – food protein induced enterocolities syndrome – is becoming a frequent presence in my pediatric nutrition practice. There are no prevalence studies for it yet, and it has only recently been recognized with a diagnosis code. FPIES is a debilitating and frightening condition that affects young infants. When the baby eats, there is sudden vomiting and even loss of consciousness, along with watery or mucousy stools, more than the usual crying and discomfort, and poor weight gain. Blood may be seen in stool. The sudden movement of water into the gut, along with complex immune reactions, may cause a hypovolemia (low blood volume) to trigger shock symptoms. Toddlers can be affected too.
My breast-fed son exhibited these very symptoms as a newborn, just days old, in 1996. We were terrified and scrambled for answers. He would take a feeding, then just explode – with all of it coming out of his mouth and nostrils forcefully – and then he would collapse into fleeting unconsciousness. This happened three or four times in his first two weeks. We were offered zero treatment, and zero advice. We were told it was colic and that we were just nervous new parents who were probably exaggerating.
Finally my son ended up in the ER where the only offering was a work up (that failed miserably) for spinal meningitis. No one had a clue, and we were not treated well by the doctors. In fact, this was such a wreckage of a moment for us as new, trusting, and hopeful young parents that it is what galvanized me to redirect my focus as a nutritionist and help others in this frightful dilemma. I knew then this was not ordinary colic; I knew there had to be an inflammatory component, based on my training in infant nutrition (which I later learned few doctors ever get). It horrified me that any other parents or babies would be left to struggle this way. It was isolating for us, as we knew no one experiencing this (no internet!), not to mention painful to navigate the indifference of the medical community.
I breast fed on an extensive elimination diet, and my baby improved – but I was depleted, and didn’t have the skill set I have now to really do this right. Once he was transitioned to a homemade goat milk formula, he did even better, and chubbed up nicely. He began to do more of what babies do: He smiled, gurgled, cooed, chattered, giggled, slept, pooped (more normally), and generally was happier to be here.
Now I hear from parents almost every week who have little ones struggling with this same scenario. They have been given the FPIES diagnosis, but that’s about it. There may have been a few tests done, but little else to help the baby be able to eat normally and grow well. Hypoallergenic formulas, then elemental formulas, are tried. If breast fed, the babies do better when mom is on an elimination diet. But like I was, many of these families have become emotionally and physically depleted. Breastfeeding on a deeply restricted diet is hard, and introducing “safe” foods for the baby is a roller coaster. No one wants to see the baby struggle with FPIES symptoms. If all else fails, it’s on to tube feeding.
There is a huge missing piece here. What the GI community is overlooking so far, when it comes to FPIES, is the baby’s gut biome. Some screening is usually done to make sure there is no outright deadly gut pathogen in there, but that’s all. There is so much to learn about how our gut bacteria support us from birth, but we already know enough to start working with it – there is no need to wait. We know that the immune system is “tutored” by the bacteria that populate the baby’s gut. Babies who lose normal, healthy gut flora (bacteria), for whatever reason, go on to have more inflammatory conditions later in life. And in FPIES, there are clear shifts in the body’s immune cells that show a lot of inflammation is going on in the gut. Tests for kids with FPIES tend to show more eosinophils (white blood cells that are common with allergy or inflammation), more immature white blood cells (this is the body’s attempt to fight fight fight), as well as obvious changes in gut tissue that show inflammation.
What is causing it? Is it food protein? The answer is not clear. Kids with FPIES often have negative food allergy (IgE) test findings. I have found this to be true in my caseload too. When I have looked further for food sensitivity reactions (IgG) in toddlers with FPIES (babies are too young to reliably test for IgG reactions), those are often negative too. While some kids with FPIES show reactivity to dairy or soy protein, they don’t appear to do so more than the general population. And curiously, two of the most common trigger foods in FPIES are not high protein foods at all. They’re starchy foods – rice and oat – foods that are often among the first introduced to babies. So perhaps FPIES isn’t about food proteins after all.
It’s The Biome, Baby! FPIES babies in my practice have shown improvement with efforts to restore expected, healthy gut flora. While GI doctors will conventionally only rule out life threatening gut infections, I use stool microbiology tests to see if the baby has the healthy bacteria needed to develop normal digestion and immune responses in the gut. This testing also screens for fungal species (yeast), because too much yeast in the gut (aka Candida) will disrupt digestion also. And it looks for “commensal” microbes that are not necessarily pathogenic or life threatening, but potentially inflammatory, if there are much more of them than the healthy bacteria babies need.
So far, just as the literature is reporting, I also notice negative food protein reactions in lab testing for FPIES kids. But -and this is where the literature is pretty mum – in my own practice, stool testing for FPIES babies often reveals inadequate helpful flora. Candida species are not a consistent player here so far, but off beat fungal microbes pop up: Saccharomyces cerevisaie (a component of newborn hepatitis B vaccines) or Rhodotorula muculaginosa for example. But the bigger story is that these stool tests do show more of the “commensal” bacteria than expected, at least in FPIES kids I have worked with. Species like Citrobacter, Klebsiella, Hemolytic E. coli, non-difficile Clostridia, or Alpha hemolytic Strep show up, in spades. It appears that there may be more of these commensal strains populating the gut, than the healthy strains.
Is this the problem? Research needs to be done here for sure. When I work with parents to correct these findings, these kids start to improve. I help parents use probiotics, caprylic acid (from coconut oil) and gentle antimicrobial herb tinctures to balance the baby’s gut biome out. Healthy gut bacteria help digest food, and mitigate inflammation. Your doctor may think a prescription medicine could be useful here too, to aggressively clear the commensal bacteria.
Of course, the other major tool at your disposal is food. Gut bacteria eat what we eat, and they eat first. This is where FODMAPs come in. FODMAPs stands for “fermentable oligo-, di- and monosaccarides and polyols”. A mouthful! FODMAPs are carbohydrates that we don’t completely digest. They are fermented (digested) by bacteria in our intestines. Bacteria aren’t supposed to dominate the stomach and upper small intestine (they help finish the job further along in the GI tract, after our own enzymes and digestive juices have worked on our food), but infections may situate there in the small intestine, up high so to speak, when our own digestion is weak, if immunosuppressive effects are in play, or if a recent infection or vaccination was not tolerated well.
Infections that situate in the small intestine are called are called SIBO (small intestine bacterial overgrowth). These are tricky to culture with a stool test because by the time a meal is digested and passed all the way down to the colon, the microbes that may have been busy with that meal at the start of your GI tract may not be detectable anymore – but they can wreak havoc anyway, especially when we eat foods high in those FODMAPs. Breath tests can detect these, but getting that sample from an infant can be tricky. Invasive procedures to dip-stick a baby’s stomach juices have been done, but it’s far easier to just trial some nutrition and food strategies.
Low FODMAPs foods seem to be helping babies and toddlers in my practice with FPIES. They are turning the corner with some weight gain, improving stools, and no more terrifying FPIES reactions. I shorten this list even further, by removing any foods that don’t meet criteria for Elaine Gottshall’s Specific Carbohydrate Diet (SCD). Many foods allowed on SCD are high in FODMAPs. But by limiting foods to those that meet both low FODMAPs and SCD-legal criteria, I have a short list of foods that are most likely to be easily digestible and least likely to be interesting to the commensal microbial overgrowth in a baby’s gut.
Elaine Gottschall, SCD founder
Some components of GAPS diet can work as well, but I have not seen GAPS alone to work as well as creating individual care plans that draw from low FODMAPs, SCD-legal, and direct interventions to help the baby’s gut biome with probiotics or herbs. It’s trial and error, but the parents working with me on this are the true champions who make it all possible.
Interestingly, grains like rice and oat – two of the most common triggers for FPIES reactions – are first to go when following low FODMAPs and SCD-legal food lists. Soy and dairy products are not allowed either, with an exception in some circumstances for yogurt made from raw goat milk with certain bacterial cultures.
I see rays of hope for FPIES kids, with room to leverage what we already know about irritable bowel disease, inflammatory bowel disease, the role of gut bacteria for good health, and how to use anti-inflammatory foods or anti-microbial herbs or food components. When parents are ready to roll up their sleeves and work with me, it’s a delight when things turn around. For more on FODMAPs, check out Chris Kresser’s post too. And thanks for reading this far!
Oct 3, 2015 | Autism & ADHD, Constipation, FPIES, Growth & Feeding
Miralax is one of the most commonly prescribed drugs for infants, toddlers and kids. It was available by prescription only until 2006. Even then, it wasn’t FDA approved for use in kids. Despite this, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) heartily endorses its use in babies, toddlers, kids and teens. It contains ingredients found in anti-freeze. Concerns for its toxicity have mounted – which is warranted: One child in my practice slipped into a coma during an in-patient, closely monitored procedure to give high doses of the laxative ingredient in Miralax (polyethylene glycol 3350) to clear a fecal impaction. So many parents have voiced concerns for reactions to Miralax that there is even a Facebook group just for this, a class action lawsuit, and consumer advocates who have pressed the FDA for answers on how often and freely doctors place children on Miralax.
The label states it is only to be used by adults for up to seven days – but children have entered my practice who have been on it, with their gastroenterologists’ blessing, for years – which is not unusual. And when I meet these kids, they are still constipated, still unable to move bowels without drugs or suppositories, still picky eaters, and they don’t feel good. Their parents want them off Miralax, and so do I. Having messy, uncomfortable “applesauce” stools every day – or none, not to mention side effects like bloating, gas, or psychiatric changes – is not healthy.
The Truth About Miralax Use
The truth is, besides reaching a dangerous level of toxicity for some children, Miralax does not treat causes of constipation. What it does do is turn stool into mush, by pulling more water into the intestine. Children can go from being impacted with hard dry feces – which is indeed uncomfortable or painful, and important to resolve, since this encourages toxins from stool to be reabsorbed – to expelling some mushy stool regularly. Even still, kids can be left with blobs of sticky festering fecal matter throughout the colon, despite using more, more, and more Miralax.
For kids on Miralax for a long time, a common problem that I’ve encountered in my pediatric nutrition practice is “overflow diarrhea”. In this scenario, blow outs of loose stool happen every few days, with or without firm, hard, or dry plugs of stool. This overflow seeps around impacted stool matter, causing staining in pants that kids (and even teens) can’t control. For toddlers, it can explode up the child’s back and and down to ankles. Many moms have described to me the daily chore of stripping kids down, bathing them, and getting fresh clothing because this pattern covers their toddlers or babies in stool. Older kids experience embarrassing stool accidents with this pattern. Needless to day, this is exasperating and concerning for parents – and miserable for kids.
There are other solutions! They are non-toxic, safe, and effective. My top three interventions for constipation are…
1 – Assess and clear fungal infections in the gut.
Prevailing thought in gastroenterology today dictates that fungal infections rarely warrant attention, unless a person is showing clear outward signs – like thrush at tongue, persistent itchy dry patches on skin, vaginal yeast infections, and so on. Even then, a topical medicine may be the only offering. People who are immune suppressed may also need anti-fungal medication. It’s hard for them to fight off any infection, and having a fungal burden makes this even harder. In that case, an oral dose may be prescribed.
It’s rare for a gastroenterologist to regard fungal infections in the gut as a problem or to prescribe an oral medication for it. A pediatrician usually won’t either. The belief is that fungal microbes (yeast, Candida, mold) are normal residents in human intestinal micro-biomes, and relatively harmless.
True enough – if there is little to no fungal growth in there. A lot of fungal microbial overgrowth is not healthy, and can cause problems like constipation, leaky gut, bloating, gas, sugar cravings, picky eating, or behavior issues especially in kids. Without testing stool specifically for fungal burden, this problem can continue unaddressed. Kids can have fungal infections in the gut while not otherwise showing signs like recurring rashes or thrush. Antibiotics, C-section delivery, prior thrush, and long term use of reflux medicine or steroids are just a few ways that a fungal burden can take a commanding posture in a child’s gut microbiome!
If your baby or child has had thrush – that is, a white coated tongue, or a diaper rash with white patches in stool – an anti-fungal medication may be offered, because thrush is a kind of fungal infection. But fungal load can persist deep in the GI tract, which, don’t forget, is several feet long. There is plenty of space between mouth and anus for fungal microbes to thrive. Yeast and fungal microbes can occur in the small intestine under certain circumstances, as well as in the colon. Just because the white coating on the tongue is gone, and the diaper rash too, does not mean the fungal infection is all gone. A lengthier course of medication can clear the problem, if it is lingering in colon or intestine.
Stool tests that screen for fungal dysbiosis are not routine in pediatric gastroenterology, but many functional medicine providers offer this test. I often use these in my pediatric nutrition practice too. Why? Because fungal overgrowth in the gut can be very constipating. A simple but thorough treatment with anti-fungal medicine may fully resolve years of Miralax-dependent constipation. I have observed this many times in cases where a patient’s prescribing MD was willing to give it a try. Anti-fungal medications like Nystatin or azole antifungals can do this.
There are few anti-fungal drugs available, which is one reason why doctors are hesitant to use them unless they really have to. They don’t want resistance to develop against these drugs. But if a child is so constipated that they’ve spent years unable to eliminate normally or painlessly, they suffer side effects from Miralax, or they can’t eat well, grow, or thrive, and quality of life is greatly compromised, then your doctor may be willing to help.
Herbs can help keep fungal infections cleared out too. Common tools include tinctures or capsules of oregano, thyme, grapefruit seed extract, goldenseal, berberine, uva ursi, caprylic acid, black walnut, garlic, undecylenic acid, and many others. Capsules and liquid tinctures are available – these are best used with guidance. See my e book Peaceful Pooping for more details, and set up your own access to my nutrition dispensary here to browse.
Olive leaf extract has activity against fungal strains like Candida albicans.
Probiotics can often resolve milder constipation. But for kids with a longer history of constipation severe enough to require clean outs and medication, I have not found probiotics alone to be effective. Combining a probiotic regimen with herbal or prescription treatment can work best.
Here’s a clinical pearl: A popular probiotic used for intestinal fungal infections is Saccharomyces boulardii (“Sacc B” for short). I see most success in my pediatric nutrition practice when using this short term, that is, for 2-4 weeks. Sacc B is itself a yeast species. When used for longer periods, in my experience, it starts to act like more of a burdensome fungal microbe than a helper. An ideal product for this is Klaire Labs ABx Support. You can join my professional grade FullScript dispensary here to view this product.
While Miralax is not FDA approved for youngsters, anti-fungal medicines like Diflucan and Nystatin are. They can do a good job of clearing constipation from fungal infections. Explore this with your doctor if your child has been constipated for a long time.
2 – Lose the reflux medicine!
Fungal infections worsen reflux, and reflux medicines worsen fungal infections. Click here for more on why you don’t want to leave your child on reflux medicine for very long.
Like Miralax, reflux medicines are widely prescribed for babies and kids – some say over prescribed. Prilosec (omeprazole), a proton pump inhibitor (PPI) reflux medicine, is one of the top ten drugs prescribed in the US. The FDA has not approved PPIs for use in infants or children, unless a diagnosis of erosive esophagitis has been made (this requires endoscopy). Still, I routinely encounter infants and toddlers in my pediatric nutrition practice who are given reflux medicines with no diagnostic testing. As is often the case with Miralax, kids stay on these drugs for months or even years. This will worsen constipation and exacerbate fungal infections while lowering digestive function overall. Using reflux medicine long term reduces absorption of many nutrients, especially minerals, protein, and B vitamins. I have had some cases in my practice in which children who used reflux medicines for over a year suffered fractures, and others have experienced stunting and delayed bone age. They were not absorbing minerals or protein normally, and could not grow bone as expected. The FDA has issued a warning about elevated fracture risk in adults using reflux medicines. The same problem has been noted in children.
Talk to your doctor about weaning off reflux medicine if your child has used it for more than a month. There are many ways to improve digestion and diminish reflux without drugs. Changes in foods and use of herbs can gently enhance your child’s digestion while you wean off a reflux medicine. Correcting the gut micro-biome will help as well. Do this with guidance for better, faster results.
3 – Use Magnesium.
This one is so simple. Magnesium is an easy way to pull water into the gut without toxic effects from peculiar ingredients in products like Miralax (dyes, gluten, polyethylene glycol). Magnesium oxide is a stronger laxative than magnesium citrate; magnesium citrate is stronger than magnesium glycinate. There are other forms of magnesium besides these three, and depending on your child’s presentation, there is probably a magnesium option that can help wean off Miralax. A product called Mag O7 is easily available. It’s ozonated form of magnesium that has worked well for some of the most constipated children in my practice. But take note!! The label instructions are intended for adults. This dosing is too high for most children. Safe upper limit dosing of magnesium for a 40-80 pound child is only 350 milligrams (mg) of magnesium. For smaller children, even less may be all that is needed. Check with your health care provider and pharmacist before using this product, to make sure it can be safely used.
Besides drawing water into the colon, magnesium is calming. It can help with sleep, mood, muscle cramps, or may even fix heart palpitations or arrhythmias. This is great, but too much is sedating and may slow heart rate. It’s best to use magnesium with guidance, especially for infants or young toddlers. I choose which product and what dose, based on each child’s case. There are liquids, powders, and capsules of various magnesium products. One of the most popular is Natural Calm, available on many supermarket store shelves. A two teaspoon gives 350 milligrams of magnesium citrate. This is too much for a baby or toddler, but may be perfect for a school age child weighing more than 40 pounds. More than two teaspoons daily is not likely to be necessary and may be too sedating for any child. If you have any questions about using these products, especially if your child takes other medications, ask your pharmacist or pediatrician.
These three ideas are only the beginning. From foods to herbs to drug-free options, there are many ways to clear constipation that are not only non-toxic, but more effective than Miralax – and they create better overall health by replenishing nutrients, building a healthier gut microbiome, and eradicating the cause of constipation. For even more help, check out my e book on Milk Addicted Kids (another constipation situation!) and stay tuned for Peaceful Pooping, my upcoming e book and protocol on getting off Miralax. Thanks for stopping by!
Mar 16, 2015 | Autism & ADHD, Food Allergies & Sensitivities, FPIES, Infection, Illness & Nutrition
Eczema can be healed naturally. Finding the right foods to emphasize, foods to withdraw or only use sometimes, and restoring gut health are key to naturally healing eczema. Sometimes, background infections need clearing too – but even for this task, babies and kids may not need prescription drugs. While you use soothing with skin treatments (which can help a lot by easing pain and itching), heal the underlying causes.
Eczema can hurt more than your child’s skin. Eczema can mean that inflammation is active systemically – that is, all over the body, inside and out. These widespread reactions can mean your child has more anxiety, more behavior problems, a pickier appetite, or more frequent infections. Where to start?
1) Plan on 3-4 months to see full improvement. Repair takes time. Painful eczema may mean the immune system is reacting to something deeper than skin, from the inside out. Identify the suspects, and you can repair and heal the skin. This takes good, non-inflammatory, nutritious food. Antibodies to trigger foods stay in the blood for at least three to six months after you stop eating that food. Every time your child eats even “a little” trigger food, the immune reaction is amplified. For best results, avoid the worst offender trigger foods completely. Remember, kids need food to replace what is withdrawn, and it must be of equal or greater nutritional value. Just withdrawing foods only to eat lesser ones can weaken growth and delay repair of healthy skin.
2) Get proper testing. If you’ve already tried months of eliminations and food rotations, and your child still has eczema, get properly tested. Food allergy tests may not show the type of reaction that is active when a child has eczema. So if you’ve been to your allergist, and the tests looked normal, you may need a different test for food sensitivities. Many MD allergists believe these reaction don’t trigger skin changes, but some research tells a different story. I can concur that in my 20 years clinical experience, I have consistently seen that IgG food reactions can drive eczema. I often start with testing this in my own practice, when the trigger foods remain a mystery. This lets families sort and prioritize what to eat.
Wheat/Gluten Reactivity and Autoimmunity Panel (click “Array 3” here) – Gluten (wheat protein) is so often a culprit, and so often incorrectly assessed – even by specialists in pediatric allergy and gastroenterology – that this is the panel I go to if I need an emphatic, clear, and detailed picture of exactly how a child’s body responds to eating gluten.
ELISA IgG Food Antibody Profile – Several specialty labs offer this test. I like using these labs best because they have developed a way to sample dozens (93 to be exact) of foods with a very small amount of blood, which is good for kids (who we all know hate to go for blood draws). There is even a method that uses just a few drops of blood from a fingerstick – so you can collect the sample at home and mail it in (nice option for teens or older kids).
There are many other tests out there. I review these options with my patients. Bottom line: Get tested if your child still struggles with eczema and you’ve done everything else you can.
3) Look at the gut. Emerging evidence supports the scenario that eczema starts inside, in the gut, and not outside, on the skin. Your allergist probably told you to get rid of carpet, launder sheets twice a week with hypoallergenic laundry soap, use natural fabrics only, or consider returning your dog or cat to the SPCA. Again, if the eczema is still there, or your child’s skin remains tender and highly reactive to even a puppy’s cuddle, it’s time to go deeper for answers. Humans evolved with microbes and the latest news is that these microbes are expert traffic directors for our immune systems. They may actually teach our immune systems what to react to and what to ignore, especially at the level of the gut wall. They exchange genes with us – potentially helping us write the software for our immune systems. The possibility is that this relationship with microbes gives kids an opportunity to reboot the software.
Here’s what to do: Clear any constipation, diarrhea, or bowel infections with high dose probiotics, a better diet without sugary and processed foods, and with herbs or even prescription medications to clear and balance microbes in the gut. Elimination diets can fail if this step is skipped, so don’t overlook that gut health piece. Need help? Work with me to do this safely and effectively.
4) Build with the right protein for the job. If you take out a protein source, put back a different one of equal or better value. Make sure it isn’t inflammatory – this is where testing is useful. For example, don’t replace cow’s milk with rice or almond milk. They both lack protein. Those are fine as a milk replacement as long as you add a protein powder blended into a shake, or add a protein food, like egg, meat, nuts or nut butters if allowed, quinoa with legumes, and so on. Kids need this protein to build and repair! Another example: Don’t switch soy milk, tofu, and soy yogurt in for milk either. Both have protein, but soy is often as triggering as cow’s milk. You may even get better results with elemental (amino acid based) protein products; many are available, but knowing how and when to use them is the key. Another great tool is collagen from chicken bone broth or beef. This is often hypoallergenic.
5) Add natural anti-inflammatories. Herbs and supplements, topically and orally, can be great add-ons or even good primary strategies. Skin salves can be great soothers, and herbs abound for this purpose. A favorite resource of mine for this is Rebecca’s Apothecary in Boulder. They can ship, and answer questions for you. For oral use, some of my favorites are turmeric, curcumin, fish oils, nettles, quercetin, vitamin C in higher doses (use a liposomal form to avoid the laxative effect), calendula, calcium lactate, and lots of healthy fats from coconut, organic eggs and grass fed meats, and tolerated nuts or seeds.
Long short, eczema can be healed naturally. Your child doesn’t have to suffer. Some kids have so many food reactions that they can’t possibly remove all of them from their diets and they need special supplementation until they get well enough to safely eat those foods again. I routinely navigate these options for my clients, so contact me if you need help!