Baby Colic

A couple years ago, my wife’s friend was having issues with a colicky newborn.  The baby was born via C-section and one of the recommended treatments was the administration of antacids.  In an effort to help her out, I tried to compile some of the relevant information I had come across into an email for her. 

My cousin just recently had a baby who is also having problems with colic.  Thinking that this might be of help to her, I dug up the old email and thought I may as well put it up here for future reference if it’s ever needed again.

I tried to tell a story by cutting and pasting the important parts from the articles referenced.  Hopefully it makes sense:

From Mark’s Daily Apple:

Until we’re born, the fetal gut is sterile. It’s just sitting there, accepting pre-digested nutrition from the mother, taking up space and generally living the slacker’s dream. But it works. The fetus doesn’t need a teeming, active gut, because all the work is done by mom’s gut flora. They’re breaking down the polysaccharides and the sugars, converting it into usable fuel, and diverting a portion of it all to the child. In a way, then, the kid is dependent on gut flora, just as much as you or I are. Once he (or she) is out of the womb, the child needs his own intestinal team. He’ll be eating, which requires digestion, and good digestion (especially of carbohydrate) just doesn’t happen without gut flora. He needs gut flora, and he needs it relatively quickly. That’s where the birthing process comes in. Traditionally, birth allows the passage of microbes from mother to the sterile infant gut, a relatively quick process. Gut colonization isn’t exactly a “feature” of the birthing process, however, and it’s not like there’s a specific pathway designed for the flora to travel from mother to child. No, gut colonization arises organically. It’s common sense, really, if you consider what child birth actually is: a somewhat chaotic, unsanitary event, where fluids are being exchanged, stuff is sloshing around and mixing together, with this vulnerable baby in the midst of it. You’ve got a helpless infant sporting a fecund, totally accessible gastrointestinal tract and a perpetually open mouth. He’s just kind of lying there, maybe crying a bit, but he’s incredibly open to suggestion. To gut flora, this is prime real estate, ripe for the taking. By the time the cord is snipped and the infant’s butt’s got a handprint on it, the baby’s upper gastrointestinal tract has been partially populated with bacterial strains derived from the mother’s feces and the surrounding environment (the air, others in the room, etc). Breastfeeding provides another ongoing source of bacteria. It takes about a month for a newborn to establish a solid population of gut flora, and another year for it to resemble an adult’s gut contents. (Any wonder why C-section, bottle-fed babies might get off to a slow start?)

From Wikipedia:

Some reports have associated colic to changes in the bacterial balance in a baby’s intestine. They suggest treating the crying with daily doses of probiotics, or “good bacteria” (such as Lactobacillus acidophilus or Lactobacillus reuteri). In a 2007 study,[64] 83 colicky babies given the probiotic Lactobacillus reuteri had reduced crying time. After one week, treated babies had 19% less crying time (159 min/day vs. 197 min/day). By 4 weeks, treated babies had 74% less crying (51 min/day vs. 197 min/day). In a 2010 study conducted with the same probiotic strain, similar benefits were seen in colicky infants.[65] However, another study found no reduced colic in over 1000 babies who were given a mixture of four other probiotic strains from birth.[66]

In 2009, a University of Texas study observed that colicky babies had a higher incidence of mild intestinal inflammation and a specific intestinal bacteria, Klebsiella.[67] But, a commentary in the same journal, noted that the inflammation and bacteria were most likely just an exaggerated variation of normal.[68]

From ChrisKresser.com:

We’ve only recently begun to understand the extent of the gut flora’s role in human health and disease. Among other things, the gut flora promotes normal gastrointestinal function, provides protection from infection, regulates metabolism and comprises more than 75% of our immune system. Dysregulated gut flora has been linked to diseases ranging from autism and depression to autoimmune conditions like Hashimoto’s, inflammatory bowel disease and type 1 diabetes.

….

Unfortunately, several features of the modern lifestyle directly contribute to unhealthy gut flora:

  • Antibiotics and other medications like birth control and NSAIDs
  • Diets high in refined carbohydrates, sugar and processed foods
  • Diets low in fermentable fibers
  • Dietary toxins like wheat and industrial seed oils that cause leaky gut
  • Chronic stress
  • Chronic infections

….

When the intestinal barrier becomes permeable (i.e. “leaky gut syndrome”), large protein molecules escape into the bloodstream. Since these proteins don’t belong outside of the gut, the body mounts an immune response and attacks them. Studies show that these attacks play a role in the development of autoimmune diseases like Hashimoto’s and type 1 diabetes, among others.

Researchers have identified a protein called zonulin that increases intestinal permeability in humans and other animals. This led to a search of the medical literature for illnesses characterized by increased intestinal permeability (leaky gut). Imagine their surprise when the researchers found that many, if not most, autoimmune diseases – including celiac disease, type 1 diabetes, multiple sclerosis, rheumatoid arthritis and inflammatory bowel disease – are characterized by abnormally high levels of zonulin and a leaky gut. In fact, researchers have found that they can induce type 1 diabetes almost immediately in animals by exposing them to zonulin. They develop a leaky gut, and begin producing antibodies to islet cells – which are responsible for making insulin.

In Step #1: Don’t Eat Toxins, I explained that one of the main reasons we don’t want to eat wheat and other gluten-containing grains is that they contain a protein called gliadin, which has been shown to increase zonulin production and thus directly contribute to leaky gut.

But what else can cause leaky gut? In short, the same things I listed above that destroy our gut flora: poor diet, medications (antibiotics, NSAIDs, steroids, antacids, etc.), infections, stress, hormone imbalances, and neurological conditions (brain trauma, stroke and neurodegeneration).

From Pubmed.gov (Paper #: 9867098):

Presence of high levels of non-degraded gliadin in breast milk from healthy mothers.
Chirdo FG, Rumbo M, Añón MC, Fossati CA.

Center for the Investigation and Development of Cryotechnology of Foods, Dept. of Immunology, School of Exact Sciences, UNLP, La Plata, Argentina.

Abstract
BACKGROUND: Secretion of dietary antigens into breast milk has been extensively documented. The presence of these antigens is of relevance because they could be involved in the modulation of the immune response in neonates. The objective of this study is to determine the gliadin concentration in milk, colostrum, and serum samples from healthy lactating mothers on a normal diet. Gliadin levels in milk samples from a group of six mothers after a brief period of gluten restriction were also determined. The molecular weight of secreted gliadins was also analysed.

METHODS: Gliadin concentration was determined with a highly sensitive competitive enzyme-linked immunosorbent assay, modified so as to eliminate anti-gliadin antibody interference. The level of gliadin/IgA anti-gliadin immune complexes in milk, colostrum, and serum samples was determined.

RESULTS: Gliadin was detected in all 49 milk samples. Its concentration varied between 5 and 1200 ng/ml (mean, 178 ng/ml). In colostrum (n = 14) gliadin levels were higher (range, 28-9000 ng/ml; mean, 883 ng/ml), not being detectable in one case. Gliadin was detectable in 14 of 31 serum samples, in which levels were lower than in milk and colostrum samples (mean, 41 ng/ml). Neither a correlation between gliadin levels in milk, colostrum, and serum samples from the same subject nor a relation between gluten intake and gliadin concentration in milk samples from six subjects under a 3-day gluten-free diet could be found. Higher levels of immune complexes were observed in colostrum samples than in milk and serum samples. No correlation was detected between gliadin concentration and the level of immune complexes. The analysis of milk and colostrum samples by immunoblotting showed bands of immunoreactive gliadin presenting Mr similar to those of native proteins from wheat extracts.

CONCLUSIONS: Very high levels of gliadin were detected in milk samples from healthy mothers on an unrestricted diet. Gliadin levels were higher than those reported for dietary antigens in other studies. Breast milk contained non-degraded gliadins and gliadin/anti-gliadin IgA immune complexes.

PMID: 9867098 [PubMed – indexed for MEDLINE]

From ChrisKresser.com:

The low pH (high acid) environment of the stomach is one of the major non-specific defense mechanisms of the body. When the pH of the stomach is 3 or lower, the normal between-meal “resting” level, bacteria don’t last more than fifteen minutes. But as the pH rises to 5 or more, many bacterial species can avoid the acid treatment and begin to thrive.

Unfortunately, this is exactly what happens when you take acid stopping drugs. Both Tagamet and Zantac significantly raise the pH of the stomach from about 1 to 2 before treatment to 5.5 to 6.5 after, respectively.

Prilosec and other PPIs are even worse. Just one of these pills is capable of reducing stomach acid secretion by 90 to 95 percent for the better part of a day. Taking higher or more frequent doses of PPIs, as is often recommended, produces a state of achlorydia (virtually no stomach acid). In a study of ten healthy men aged 22 to 55 years, a 20 or 40 mg dose of Prilosec reduced stomach acid levels to near-zero.

A stomach without much acid is in many ways a perfect environment to harbor pathogenic bacteria. It’s dark, warm, moist, and full of nutrients. Most of the time these bacteria won’t kill us – at least not right away. But some of them can. People who have a gastric pH high enough to promote bacterial overgrowth are more vulnerable to serious bacterial infections.

A recent systematic review of gastric acid-suppressive drugs suggested that they do in fact increase susceptibility to infections (PDF). The author found evidence that using acid stopping drugs can increase your chances of contracting the following nasty bugs:

Salmonella
Campylobacter
Cholera
Listeria
Giardia
C. Difficile

Other studies have found that acid stopping drugs also increase the risk for:

Pneumonia
Tuberculosis
Typhoid
Dysentery

Not only do acid stopping drugs increase our susceptibility to infection, they weaken our immune system’s ability to fight off infections once we have them. In vitro studies have shown that PPIs impair nuetrophil function, decrease adhesion to endothelial cells, reduce bactericidal killing of microbes, and inhibit neutrophil phagocytosis and phagolysosome acidification.

Additional Information:

Chris Kresser provides an excellent discussion in his 9/5/12 podcast starting at the 35:05 mark.

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