Hypersensitivity reactions to dairy products even in those who test negative for cow’s milk allergy.
How to Treat Reflux in Children with Diet
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
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 positive on allergy tests. So, they 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! 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 enables 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. 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. Okay; 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.
Please consider volunteering to help out on the site.
- Baird DC, Harker DJ, Karmes AS. Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children. Am Fam Physician. 2015;92(8):705-14.
- Iacono G, Carroccio A, Cavataio F, et al. Gastroesophageal reflux and cow's milk allergy in infants: a prospective study. J Allergy Clin Immunol. 1996;97(3):822-7.
- El-hodhod MA, Hamdy AM, El-deeb MT, Elmaraghy MO. Cow's Milk Allergy Is a Major Contributor in Recurrent Perianal Dermatitis of Infants. ISRN Pediatr. 2012;2012:408769.
- Dehghani SM, Ahmadpour B, Haghighat M, Kashef S, Imanieh MH, Soleimani M. The Role of Cow's Milk Allergy in Pediatric Chronic Constipation: A Randomized Clinical Trial. Iran J Pediatr. 2012;22(4):468-74.
- Jirapinyo P, Densupsoontorn N, Kangwanpornsiri C. Anal fissures in infants may be a pathognomonic sign of infants with cow's milk allergy. J Med Assoc Thai. 2013;96(7):786-9.
- Nielsen RG, Bindslev-jensen C, Kruse-andersen S, Husby S. Severe gastroesophageal reflux disease and cow milk hypersensitivity in infants and children: disease association and evaluation of a new challenge procedure. J Pediatr Gastroenterol Nutr. 2004;39(4):383-91.
- Kagalwalla AF, Amsden K, Shah A, et al. Cow's milk elimination: a novel dietary approach to treat eosinophilic esophagitis. J Pediatr Gastroenterol Nutr. 2012;55(6):711-6.
- Kruszewski PG, Russo JM, Franciosi JP, Varni JW, Platts-mills TA, Erwin EA. Prospective, comparative effectiveness trial of cow's milk elimination and swallowed fluticasone for pediatric eosinophilic esophagitis. Dis Esophagus. 2016;29(4):377-84.
- Rowe PC, Marden CL, Jasion SE, Cranston EM, Flaherty MA, Kelly KJ. Cow's milk protein intolerance in adolescents and young adults with chronic fatigue syndrome. Acta Paediatr. 2016;105(9):e412-8.
- Scrimshaw NS, Murray EB. The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance. Am J Clin Nutr. 1988;48(4 Suppl):1079-159.
- Silanikove N, Leitner G, Merin U. The Interrelationships between Lactose Intolerance and the Modern Dairy Industry: Global Perspectives in Evolutional and Historical Backgrounds. Nutrients. 2015;7(9):7312-31.
- Vandenplas Y, Hauser B. An updated review on gastro-esophageal reflux in pediatrics. Expert Rev Gastroenterol Hepatol. 2015;9(12):1511-21.
- Caselli M, Lo cascio N, Rabitti S, et al. Pattern of food intolerance in patients with gastro-esophageal reflux symptoms. Minerva Med. 2017;108(6):496-501.
- Caselli M, Zuliani G, Cassol F, et al. Test-based exclusion diets in gastro-esophageal reflux disease patients: a randomized controlled pilot trial. World J Gastroenterol. 2014;20(45):17190-5.
Image credit: maxximmm via adobe stock images. Image has been modified.
Motion graphics by Avocado Video
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
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 positive on allergy tests. So, they 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! 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 enables 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. 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. Okay; 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.
Please consider volunteering to help out on the site.
- Baird DC, Harker DJ, Karmes AS. Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children. Am Fam Physician. 2015;92(8):705-14.
- Iacono G, Carroccio A, Cavataio F, et al. Gastroesophageal reflux and cow's milk allergy in infants: a prospective study. J Allergy Clin Immunol. 1996;97(3):822-7.
- El-hodhod MA, Hamdy AM, El-deeb MT, Elmaraghy MO. Cow's Milk Allergy Is a Major Contributor in Recurrent Perianal Dermatitis of Infants. ISRN Pediatr. 2012;2012:408769.
- Dehghani SM, Ahmadpour B, Haghighat M, Kashef S, Imanieh MH, Soleimani M. The Role of Cow's Milk Allergy in Pediatric Chronic Constipation: A Randomized Clinical Trial. Iran J Pediatr. 2012;22(4):468-74.
- Jirapinyo P, Densupsoontorn N, Kangwanpornsiri C. Anal fissures in infants may be a pathognomonic sign of infants with cow's milk allergy. J Med Assoc Thai. 2013;96(7):786-9.
- Nielsen RG, Bindslev-jensen C, Kruse-andersen S, Husby S. Severe gastroesophageal reflux disease and cow milk hypersensitivity in infants and children: disease association and evaluation of a new challenge procedure. J Pediatr Gastroenterol Nutr. 2004;39(4):383-91.
- Kagalwalla AF, Amsden K, Shah A, et al. Cow's milk elimination: a novel dietary approach to treat eosinophilic esophagitis. J Pediatr Gastroenterol Nutr. 2012;55(6):711-6.
- Kruszewski PG, Russo JM, Franciosi JP, Varni JW, Platts-mills TA, Erwin EA. Prospective, comparative effectiveness trial of cow's milk elimination and swallowed fluticasone for pediatric eosinophilic esophagitis. Dis Esophagus. 2016;29(4):377-84.
- Rowe PC, Marden CL, Jasion SE, Cranston EM, Flaherty MA, Kelly KJ. Cow's milk protein intolerance in adolescents and young adults with chronic fatigue syndrome. Acta Paediatr. 2016;105(9):e412-8.
- Scrimshaw NS, Murray EB. The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance. Am J Clin Nutr. 1988;48(4 Suppl):1079-159.
- Silanikove N, Leitner G, Merin U. The Interrelationships between Lactose Intolerance and the Modern Dairy Industry: Global Perspectives in Evolutional and Historical Backgrounds. Nutrients. 2015;7(9):7312-31.
- Vandenplas Y, Hauser B. An updated review on gastro-esophageal reflux in pediatrics. Expert Rev Gastroenterol Hepatol. 2015;9(12):1511-21.
- Caselli M, Lo cascio N, Rabitti S, et al. Pattern of food intolerance in patients with gastro-esophageal reflux symptoms. Minerva Med. 2017;108(6):496-501.
- Caselli M, Zuliani G, Cassol F, et al. Test-based exclusion diets in gastro-esophageal reflux disease patients: a randomized controlled pilot trial. World J Gastroenterol. 2014;20(45):17190-5.
Image credit: maxximmm via adobe stock images. Image has been modified.
Motion graphics by Avocado Video
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Title
How to Treat Reflux in Children with Diet
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
The video I mentioned was Treating Reflux in Babies with Diet.
I previously covered the maternal diet effects on breast-fed babies in Treating Infant Colic by Changing Mom’s Diet and Infant Seizures Linked to Mother’s Spirulina Use. Of course, breast is still always best. See The Best Baby Formula and Formula for Childhood Obesity.
For more on dairy and child health:
- Cow’s Milk Casomorphine & Crib Death
- Cow’s Milk-Induced Infant Apnea
- Autism & Casein from Cow’s Milk
- Does Casein in Milk Trigger Type 1 Diabetes?
- Does Paratuberculosis in Milk Trigger Type 1 Diabetes?
- Does Bovine Insulin in Milk Trigger Type 1 Diabetes?
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