A Wholistic Hack to Defeat Colic Part II

GOT MILK? – ACT TWO

If you think the structural issues were complicated, I am sorry to say that the rabbit hole only runs deeper. Before we get technical, we must first consider and rule out two basic things. Now, the following may seem obvious, but it is important to note nonetheless that at least 10% of “colic,” AKA “fussy” baby cases that I see derive from the following basic problems:

Not enough milk – If you are a little person who is hungry all the time, the only thing you can do is to cry to express your upset and hunger. How you know if your infant is getting enough is if they have at least 6 very wet diapers a day, or your pediatrician has confirmed that they are effectively gaining weight. If you have any doubts, please consult with your pediatrician.

Too much milk – On the opposite side of this spectrum is milk abundance with an overactive let down. In some cases, moms have so much milk that their infants are gulping for their life, occasionally choking and, in the process, swallowing tons of air. An overactive letdown can cause a similar picture to infants who have lip ties with the clicking, where they are constantly passing gas and uncomfortable because of the excess air they have swallowed. A few simple things you can do to help with an overactive let down is to feed above the level of the breast and to feed only on one side at a time (avoid pumping the other side if possible to minimize milk stimulation, but do be careful of mastitis from clogged milk ducts). If you have any doubts, consult with a qualified lactation consultant.

With these basic issues aside, let’s now delve into the more complicated milk issues. Have you ever eaten something that just did not agree with your body, and you consequently spent the next day with stomach cramps and gas? Now, add to this situation a very sensitive stomach and then you have an unconscionable mess with a whole lot of hurting.  In my former life at Loma Linda University, I was heavily involved in treating adults with irritable bowel syndrome (IBS). In some ways, colic is the little person’s equivalent to IBS. So, what is the deal with IBS, and what does this disease have to do with colic? So after a few years, I gleaned that IBS is a combo mess, except you don’t get fries and drink with this. People with IBS have an intolerance to various foods and bacterial imbalances, as well as an odd distortion in how they process pain. In a similar fashion,  all of these factors are applicable to colic. I will address the issue of pain perception in section four. With IBS and colic, the digestive tract lacks the ability to effectively digest and process the foods that are consumed. Obviously, whatever mom eats, baby eats. Breastfeeding moms know to avoid spicy foods, gas-causing vegetables, legumes and other such foods. But what if you are avoiding all of these foods, and your baby is still screaming his or her head off? ☹ This provokes a greater question: how do you know if your baby is having a hard time digesting foods? Assuming that there isn’t any lip/tongue tie, and that let down is normal, if your baby is super gassy and/or has explosive/watery poops (“sharts”), or can only have a bowel movement every 3-5 days, then you likely have some type of food reaction/digestive issue. Another sign of compromised digestion is a red rash around the baby’s rectum. When foods are not appropriately digested, they sit in the intestinal tract and basically become acidic, which can then cause irritation/redness as it comes out. On occasion, you may also see a rash on the skin with red bumps or even overt eczema.

As a major pizza lover, I only wish I could say that foods like gluten, dairy, etc. are not an issue. But, alas, they are. They do a number on my system, and likely on 30-40% of other human beings’ (small or large!) systems, too. Sadly, because of some not-so-smart alterations to our food supply, some of the foods we consume today are just not very easy to digest. Let’s take a look: 

Dairy: About 20 years ago, American farmers realized that certain types of cows could produce more milk. As a result, they started to breed and raise cattle that produced the greatest amounts of milk. It turns out that the A1 casein protein that these specific “new world cows” produce is far more difficult for the human body to digest than the A2 casein protein produced by “old world cows.” Europe, for instance, still has mostly “old world cows,” and for this reason  many people find they can tolerate dairy in Europe, but not here in the US. If you are curious, please read the book Devil in the Milk. If that was not enough, we also decided to feed our cattle mostly corn and soy, which are both less expensive and promote faster growth. However, this decision has compromised the quality of the milk, causing it to become harder and harder to digest. Add a little bit of stress hormones from the cows that spend their lives often in overcrowded living spaces, and then you also have a milk that is the opposite of friendly to the intestinal tract of the little human who is trying to digest it.

Gluten: Yes, we are talking about the delicious pasta, bread and foods you love to eat (ketchup included). I used to live off of pizza and my body was unknowingly paying a huge price. Everything from my mood to my energy were tanked. Through the wise (or not so wise) movement of genetic engineering, we have figured out ways to massively increase the wheat yields from the same plants (by upwards of 30-40% by some standards). It turns out that in this process we have also managed to change the protein makeup of gluten. Gluten today (like dairy) is not what gluten was 30 years ago! Check out the work of MIT researcher Stephanie Seneff regarding glyphosates for more information on this. So, glyphosate is the primary chemical found in the herbicide (Roundup) that is heavily sprayed onto gluten (and other crops) to prevent weeds and to help produce higher yields. One of the “wonderful” things glyphosates do is to compromise gut integrity AND mitochondrial functioning. Ever heard of “leaky gut”? Glyphosates really help make that dream come true! I only wish I could say that these compounds could NOT impact the digestive tract of the infant, but the most likely reality is that they do. If you think this blog is a joy-kill, imagine my poor wife’s experience. There are those naysayers who think all of this is hogwash; I would love for them to offer a better explanation to the rampant rise in food intolerances we see in children in particular. For the adults who think this entire gluten-free discussion is a hoax, I strongly encourage you to explore the brilliant work of Dr. David Perlmutter, particularly his book entitled Grain Brain. He is perhaps one of the most brilliant neurologists in the country, and he has some wise words to share.

Almonds, corn, oats, soy: I would say that 50-60% of the food-related digestive issues usually stem from gluten and dairy. Without getting into painful detail, other potential problem foods/triggers listed in relative order of priority are as follows: eggs, citrus, almonds (including almond milk), soy, oats, corn, strawberries, tomatoes…. Some moms have found that even foods like green beans and chicken are also problematic.

So, what do you do now? Well, I actually suggest a lot of caution in getting too carried away with elimination diets. 1) They only work 30-40% of the time. 2) I have seen too many moms become consumed with eliminating everything from their diets that they become calorie- and nutrient- deficient and collapsed their milk supply. The only thing worse than a colicky baby is a baby with failure to thrive because they are not getting enough milk. So please proceed with caution, and gauge how much you eliminate based on the likelihood of diet being a cause of colic (remember the entire “sharts” conversation?), severity of colic symptoms and your ability to easily change up the foods you are eating.

The easiest place to start is with eliminating dairy and, ideally, gluten by 90-95%. For some of you, this may sound crazy! How can you live without bread and dairy? Trust me, it is doable! Fortunately, in today’s age there are a million different websites, blogs, and books on how one can eliminate these two food groups while eating delicious and satisfying foods. In addition to benefiting the baby, I have had countless parents come back and tell me how dramatically better they feel once they stopped eating these foods. The comments, “I feel lighter” have come up hundreds of times. Why is that? I mentioned in passing that glyphosates disrupt mitochondrial functioning. Eating gluten for some, in addition to the gut issues, is like pouring sludge into your system. Once gluten is eliminated, the sludge is cleared and your entire processing of energy starts running in a dramatically different way.

Within one to three weeks, you should start seeing a nice change in your baby. If you have seen no change, then consider eliminating other foods one at a time. Only in rare cases of very severe colic, with obvious digestive issue problems, would I suggest a more aggressive elimination diet. To implement such a diet, I suggest obtaining the help of your physician, qualified dietician or nutritionist to ensure you are receiving the nutrients and calories your body requires.

THE LITTLE GUYS – ACT THREE

A decade ago when I was pushing probiotics, people saw me as the weird doc who was chasing some fad. Nowadays, you cannot escape the discussions surrounding the gut microbiome (the community of bacteria within our intestines). Researchers are rushing to understand how these little critters can influence everything from obesity and diabetes to cancers and heart disease. When it comes to colic, researchers have found that babies with colic tend to have “altered” microbiomes, with insufficient “good” bacteria and too much “bad” bacteria. These “bad” bacteria can cause intestinal inflammation and even disrupt how the intestines function and move. Many of you may think, “Holy cow, Dr. K! What if this inflammation is why these poor babies suffer?” If we could just find the right probiotic combination, then we should “fix” colic! Right? Well, there are many researchers thinking just that, with published studies showing a “significant reduction” in colic symptoms when specific probiotics, like Lactobacillus reuteri, are used.

I only wish it were that simple! To say the least, I have been interested in gut microbiome for over a decade. At one point, I even got carried away enough to publish a medical paper pertaining to why adults suffer from IBS. Guess what I learned in my OCD pursuit? Just like with babies with colic, adults with IBS also have altered bacteria with excess “bad” critters. These little guys cause gut inflammation and even disrupt intestinal permeability (leaky gut). Does this sound familiar? Turns out, leaky gut worsens inflammation, which then worsens the leaky gut. No bueno!! It also turns out that the gut inflammation and the changes to the bacteria can change how we experience pain! What? Yup! Those little critters can literally CHANGE your brain’s functioning.

It is weird how much similarity colic and IBS have when you look at them closely. They are each other’s ugly cousin. Let’s pick apart IBS for a moment to better understand colic in babies. During the midst of all my research on IBS, an odd question became evident: if bacterial imbalances and gut inflammation were sufficient to cause IBS symptoms, then why the hell don’t all people with funky bowels have horrible pain? How do many adults have gnarly diarrhea – all the time – and it’s no thing for them? How many adults can take antibiotic after antibiotic and NEVER develop any type of IBS? How many babies spit up and have sharts like it is going out of style, and they never fuss? If it is just the bacteria, then why do babies that are born vaginally and never have had antibiotics develop colic? Is this mom’s fault? Did she give the baby the wrong bacteria? Poor moms have enough guilt and, fortunately, I don’t believe this has anything to do with mama!  

I hate to say this, but I think we as a society have gotten a little carried away. I only wish that colic could be as easily explained as an imbalance of the bacteria and/or gut inflammation. Now don’t get me wrong, I LOVE probiotics. But as you will hear over and over again, while every piece matters, there is no piece that is the master to all. Understanding the little critters in our intestinal tract is understanding one piece to the colic puzzle. So why do the bacteria in the intestinal tract matter, and how do they pertain to colic? It’s actually really simple: we know that the bacteria can influence our ability to digest and, to some extent, how the bowels move and how much gas is produced (this is totally different than air getting sucked in due to a latch/feeding issue).

Infants are born with essentially no bacteria in their intestinal tracts, and a few months later, they have a microbiome that is similar to a young child’s (well, kind of). So in 2-3 months we go from a few bacteria to trillions of bacteria. As this process unfolds, funky things can happen and we can get distortions in the types and numbers of bacteria present within the intestinal tract. Guess who or what can influence what types of bacteria flourish within our bodies? Wait for it. No seriously wait for it…  it is US!! As much as we are obsessed with understanding how these critters screw with us, a not-so-commonly discussed piece of this puzzle is that WE influence how these little critters grow by the hormones and chemicals WE secrete in the intestinal tract. This is similar to a lawn, where depending on the fertilizer you use, you can encourage the growth of one type of grass and prevent certain weeds and other grasses from growing. Consider that c-sectioned babies don’t get the healthy lactobacilli found in the vaginal tract of the mother, but they don’t necessarily develop colic.

It is interesting to see that the previously mentioned colic article by Tintore talks about how these babies have more “bad” bacteria like clostridium and E. coli. So check this out! It turns out that the stress hormone, norepinephrine (adrenaline) is pretty awesome in helping E. coli grow at body temperature. Yup! Might as well go and buy some E. coli fertilizer and just dump it into the intestinal tract. You know those pesky clostridium they point out? Guess what? These stress hormones also seem to influence the behavior of these bacteria.  By the way, much of this latter conversation extends into the world of autism…. I will be posting additional blogs and videos to discuss in greater detail this amazing interaction between the bacteria and us.

Now the point of this entire microbiology lesson is not to say the bacteria don’t matter. They matter a lot and can cause some serious problems. They cause intestinal irritation and distorted digestive functioning. They can even influence the nervous system. But as I said in the beginning, colic is far more complex than the presence or absence of a few bacteria. Babies with colic have real gut problems, and that is why we started off with a discussion about diet. Probiotics are awesome and can definitely help colic symptoms. I think it is wonderful for all infants with colic to get a probiotic with Lactobacillus reuteri, as it can only help. When choosing a probiotic, you want one that has between 2-5 billion colonies (CFU) per dose. Too high a dose will cause your baby to get more gassy and uncomfortable. Avoid any probiotics that have inulin or other types of prebiotic. While prebiotics are great for helping to support good bacterial growth, they cause horrible gas in infants and should be avoided especially in cases of colic. While probiotics can be helpful, let’s realize that each of these items are just pieces of a complex puzzle. If you see anyone (including a company) who is selling the “magic” probiotic “cure” for colic, run as fast as you can!!!

Alright, time for a break! Take some deep breaths and let all this craziness settle in. We are about to run deeper into the rabbit hole. If you thought the rabbit hole had an end, sorry!