How to Treat Reflux in Children with Diet

How to Treat Reflux in Children with Diet

November 1, 2019 5 By Jose Scott


“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.