Treating Reflux in Babies with Diet

Treating Reflux in Babies with Diet
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Treating the cause of infant reflux with maternal cow’s milk elimination.

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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.

There has been a longstanding problem among zookeepers of the gorilla. Latin name: Gorilla, gorilla gorilla.

The problem is that they were throwing up all the time. We’ve never seen wild gorillas barfing, but it had “unfortunately been accepted as” routine by many zoos. What were they feeding them? Well, you know they’re big strong animals, so they made sure to feed them lots of protein; ya know, cottage cheese, meat, eggs, milk—until a zoo in Germany got this radical idea to try giving them their natural diet. And? “The change…following the alterations to the diet was astonishing.” I mean before, the poor silverback was “regurgitating and vomiting during most of the day.” But by the third day eating what they were supposed to eat, he and the rest were all miraculously cured. Even just “removing milk from captive gorilla diets” led to significant improvements. Cow’s “[m]ilk was historically considered an essential item in the captive gorilla diet,” but they showed that “removal of milk from the captive gorilla diet may reduce [such] undesirable behaviors…and may be a step toward better approximating [their] natural diet.” I mean, giving an animal milk after weaning? Giving an adult animal milk? Milk is for babies! And then giving milk from a bovine to a primate? What were these crazy zookeepers thinking? Doesn’t make any sense!

Reminds me of this landmark study. Eighty-one children presenting with reflux, gastroesophageal reflux disease, so they were given drugs, and two-thirds got better, but 27 kids still did not. So, they tried eliminating cow’s milk from their diets, and within one month, all 27 were cured. 

“Symptoms of acid regurgitation, heartburn, or both, occur at least once a week in 10–20% of adults [in] the western world”—and, in about up to 25 percent of all infants. Now, it’s normal for babies to spit up occasionally—that’s not what we’re talking about. It can actually get quite serious. Up to a quarter of infants “present with regurgitation severe enough for parents to seek medical help,” and it may just be that they’re sensitive to cow’s milk. “The symptoms of [cow’s milk protein allergy] overlap…or may coexist or complicate GERD” or reflux. Even if there’s no formal dairy allergy per se, there appears to be some kind of cow’s milk “hypersensitivity” among many infants and children with severe reflux.

There are all sorts of invasive tests you can do, like stick pH probes down the poor baby’s throat, but probably “the most practical test in routine [pediatric] practice” is just a trial of a cow’s milk protein-elimination diet for two to four weeks in infants with reflux.

The gold standard is what’s called an “elimination and re-challenge protocol,” where you see “full resolution of symptoms via a strict elimination, followed by recurrence [of the symptoms] on reintroduction of cow’s milk protein.” And, when you do that, take 200 or so infants diagnosed with reflux and then not only put them on a cow’s milk-free diet, but then do the challenge tests. Eighty-five of the 204 infants with reflux were actually suffering from a cow’s milk allergy, or at least hypersensitivity or something.

What we think is happening is that our immune system attacks the bovine proteins as understandably foreign, triggering an inflammatory response, which like irritates the nerves lining your digestive tract, and that results in abnormalities in the rhythmic contractions of the stomach, triggering the regurgitation. And, we’re not just talking about formula-fed infants. Cow’s milk protein allergy “can occur in exclusively breastfed infants, as intact cow’s milk proteins can be secreted in breast milk.” If the mom drinks milk, or eats eggs, it can get into her baby. “Cow’s milk protein and other [foreign] proteins [can] pass into human breast milk. So: “Breast-fed infants with regurgitation and vomiting may therefore benefit from a trial of withdrawal of cow’s milk and eggs from the maternal diet.”

And indeed, that is now the consensus recommendation of both the North American and European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Anytime you see reflux, let’s first try “a therapeutic trial” of either a cow’s milk protein–free formula, or, “for infants who are breastfed, a maternal strict [cow’s milk protein] elimination diet.” And so, then we can potentially treat the cause “without using unnecessary medications,” and certainly before you start considering performing any anti-reflux surgery on the poor kid.

Please consider volunteering to help out on the site.

Image credit: noranorakatonamona via Adobe Stock photos. 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.

There has been a longstanding problem among zookeepers of the gorilla. Latin name: Gorilla, gorilla gorilla.

The problem is that they were throwing up all the time. We’ve never seen wild gorillas barfing, but it had “unfortunately been accepted as” routine by many zoos. What were they feeding them? Well, you know they’re big strong animals, so they made sure to feed them lots of protein; ya know, cottage cheese, meat, eggs, milk—until a zoo in Germany got this radical idea to try giving them their natural diet. And? “The change…following the alterations to the diet was astonishing.” I mean before, the poor silverback was “regurgitating and vomiting during most of the day.” But by the third day eating what they were supposed to eat, he and the rest were all miraculously cured. Even just “removing milk from captive gorilla diets” led to significant improvements. Cow’s “[m]ilk was historically considered an essential item in the captive gorilla diet,” but they showed that “removal of milk from the captive gorilla diet may reduce [such] undesirable behaviors…and may be a step toward better approximating [their] natural diet.” I mean, giving an animal milk after weaning? Giving an adult animal milk? Milk is for babies! And then giving milk from a bovine to a primate? What were these crazy zookeepers thinking? Doesn’t make any sense!

Reminds me of this landmark study. Eighty-one children presenting with reflux, gastroesophageal reflux disease, so they were given drugs, and two-thirds got better, but 27 kids still did not. So, they tried eliminating cow’s milk from their diets, and within one month, all 27 were cured. 

“Symptoms of acid regurgitation, heartburn, or both, occur at least once a week in 10–20% of adults [in] the western world”—and, in about up to 25 percent of all infants. Now, it’s normal for babies to spit up occasionally—that’s not what we’re talking about. It can actually get quite serious. Up to a quarter of infants “present with regurgitation severe enough for parents to seek medical help,” and it may just be that they’re sensitive to cow’s milk. “The symptoms of [cow’s milk protein allergy] overlap…or may coexist or complicate GERD” or reflux. Even if there’s no formal dairy allergy per se, there appears to be some kind of cow’s milk “hypersensitivity” among many infants and children with severe reflux.

There are all sorts of invasive tests you can do, like stick pH probes down the poor baby’s throat, but probably “the most practical test in routine [pediatric] practice” is just a trial of a cow’s milk protein-elimination diet for two to four weeks in infants with reflux.

The gold standard is what’s called an “elimination and re-challenge protocol,” where you see “full resolution of symptoms via a strict elimination, followed by recurrence [of the symptoms] on reintroduction of cow’s milk protein.” And, when you do that, take 200 or so infants diagnosed with reflux and then not only put them on a cow’s milk-free diet, but then do the challenge tests. Eighty-five of the 204 infants with reflux were actually suffering from a cow’s milk allergy, or at least hypersensitivity or something.

What we think is happening is that our immune system attacks the bovine proteins as understandably foreign, triggering an inflammatory response, which like irritates the nerves lining your digestive tract, and that results in abnormalities in the rhythmic contractions of the stomach, triggering the regurgitation. And, we’re not just talking about formula-fed infants. Cow’s milk protein allergy “can occur in exclusively breastfed infants, as intact cow’s milk proteins can be secreted in breast milk.” If the mom drinks milk, or eats eggs, it can get into her baby. “Cow’s milk protein and other [foreign] proteins [can] pass into human breast milk. So: “Breast-fed infants with regurgitation and vomiting may therefore benefit from a trial of withdrawal of cow’s milk and eggs from the maternal diet.”

And indeed, that is now the consensus recommendation of both the North American and European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Anytime you see reflux, let’s first try “a therapeutic trial” of either a cow’s milk protein–free formula, or, “for infants who are breastfed, a maternal strict [cow’s milk protein] elimination diet.” And so, then we can potentially treat the cause “without using unnecessary medications,” and certainly before you start considering performing any anti-reflux surgery on the poor kid.

Please consider volunteering to help out on the site.

Image credit: noranorakatonamona via Adobe Stock photos. Image has been modified.

Motion graphics by Avocado Video

Doctor's Note

Maternal diets can have a direct effect on breast-fed babies, as I previously covered in Treating Infant Colic by Changing Mom’s Diet and Infant Seizures Linked to Mother’s Spirulina Use.

But, for mothers who are able, breast is still always best. See The Best Baby Formula and Formula for Childhood Obesity.

For more on dairy and infant health:

If you haven’t yet, you can subscribe to my videos for free by clicking here.

37 responses to “Treating Reflux in Babies with Diet

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  1. Dr. G., I’m so glad you’re doing a video about this important subject. I just found out I’m pregnant! Can you imagine? And at my age too!

    April Fool. :-)

  2. Regarding the first part of this video, when dining out and friends see me ordering exclusively plant based dishes, they invariably ask, “Where do you get your protein?”. My favorite response is: “The same place gorillas get their protein.” Then comes the silence and blank stares :-)

    Conclusion: Modern society needs a lot of “Un-brain-washing”, especially in the area of nutrition.

    1. Agreed, Hal. I love your response!

      Maybe I’ll try something similar next time… “Where do you get your protein?” …”The same place your protein gets theirs'”

      1. Haha, he’ll definitely thank you for it one day, CK! It’s not as though “eat lots of veggies to avoid coronary artery disease” is a compelling argument to a 5 year old, after all lol.

  3. Considering that rBGH increases IGF-1 which has been linked to cancer cell proliferation (as well as the amount of puss in milk), why would anyone give their newborn child cow milk? And do not think that your favorite company is not using it because they put ‘from cows not treated with rBGH’ on the carton, the FDA does not even have a program in place to verify AT ALL and unscrupulous dairy producers know this.

    1. Jumbo, it’s because very few people even know what rBGH is, let alone IGF-1. But they sure do remember the “got milk” & “milk does a body good” ads.

    2. JImbo, being a vegan for years I don’t pay much attention to “milk purity” so I actually had no idea that the FDA has no program to verify cows are not treated with rBGH. I’m actually surprised simply because of the labels and we just assume there has to be validation behind them, kind of automatically in our minds so often. But for obvious reasons, I’m also not surprised. Thanks for pointing this out, though!

  4. My son is 10 months old and we just might squeak by without using any formula, but I’m preparing myself just in case. Do you have recommendations for non-CMP formula? Anything to look for specifically when it comes to the soy formulas? And also, once he turns one – what do you recommend instead of cow’s milk (soy? almond? do they need to be fortified?) Although my son’s pediatrician is supportive of feeding him a plant-based diet, she doesn’t necessarily have many answers to these kinds of questions.

    1. Hey Lindsey, he does mention your question indirectly in the video. Once a child is weaned off of milk, they no longer need milk. Just follow natures course, once breast feeding naturally comes to an end, the child moves to solid foods. Milk is no longer needed, nor is it even beneficial going forward. Water will be their new drink for optimal health.

      An excellent video, by the way!

    2. Lindsay – I replied to you with a idea I had for some plant-based “milk” replacement. But here is another idea: If you go to PCRM (Physician’s Committee for Responsible Medicine), you can check their website to see if they have any replacement options that would work for WFPB families. If they don’t have anything immediately available, try writing them. I know that they have at least one and perhaps more Registered Dieticians on their staff who might have a few formula suggestions for you – either make your own or perhaps one that you can purchase already prepared that they recommend. I’m guessing you aren’t the only one who would love to have this information.
      If you do happen to get a response I’d love it if you would share what you find out with us. Best of luck!

    3. Hello Lindsey,

      It’s great that you’re focusing on plant-based nutrition for your son and that your pediatrician is supportive!
      If it does become a necessity to switch from human breast milk to formula, the American Academy of Pediatrics (AAP) states that soy-based formula is the nutritional equivalent of cow’s milk formula, and may be used. For further information on soy formula, I have linked the AAP Statement below.

      If after the age one you want to feed your child plant milks, then I don’t believe there is a right or wrong answer; however, soy milk tends to be the most nutritious. By no means, does your child need to consume any of these milks, but after age 1 it can be considered safe. Furthermore, most commercially available plant milks are already fortified with calcium and other vitamins/minerals.

      While Dr. Greger does not have many answers to these specific questions on nutritionfacts.org, I would recommend continuing to discuss with your pediatrician and getting in touch with Dr. Jackie Busse from https://www.plantbasedpediatrician.com/.

      I hope this helps,

      Matt, Health Support

      https://pediatrics.aappublications.org/content/121/5/1062

  5. Wouldn’t it be nice to see an in depth study done of the health outcomes of kids breastfed by WFPB moms? Even an observational study would be illuminating. Lucky kids who have this advantage at the beginning of life!

    1. plant_this_thought, So true. Along those same lines, it would be nice to see more studies done on exclusively WFPB eaters when single nutrients are being studied. Take a food like green tea. Would the benefits of green tea consumption be as dramatic when taken by WFPB eaters as opposed to SAD eaters? I would think the beneficial effects would be greater for the SAD eaters than the WFPB eaters who already have a pretty good diet.

      1. Hal,

        I agree with you.

        I also feel like there are so many times when studies use “vegan” and I have no idea what that means.

        It makes it harder for me as someone who is trying to do WFPB to understand risks and benefits.

      2. WFPB-Hal, I would like to see more of that as well.

        Certainly, though, while dramatic benefits might be measured in people with less than optimal health, antioxidants are so protective that they would still build up in a healthy WFPB dieter’s body. I would imagine this would just make their body that much more resilient. Even to skin, take the spf factors from certain foods. There was the study on tomato paste and the study on green tea showing that consumption over a period of weeks resulted in a built up of a natural spf of about 4 (going by memory), so imagine someone eating and drinking these things long term in addition to a diet incredibly high in antioxidants. I would think that maybe unique results might be found in someone who doesn’t just consume one or two things to improve their health, but builds their whole diet around it. I would personally imagine that while the outcome might not be as dramatic in increasing overall health, the benefits would be even greater.

    2. plant_this_thought, YES! That would be awesome!

      I would also wonder if children from mothers who were long term WFPB who got plenty of omega-3’s from whole food (plant) sources, without supplementing with DHA/EPA had a difference in IQ compared to mothers who are either or both on WFPB diets and/or SAD who do supplement with DHA/EPA. But I realize it would be unethical to withhold a beneficial supplement from nursing and pregnant mothers, though I’m sure there are some who choose not to regardless of any recommendations.

      It’s difficult with some of the studies that exist because most of the subjects are on standard westernized diets.

  6. Hi Lindsey – I thought I’d share this information with you in case you find it of interest. Here is the composition of Human mother’s milk:
    “Mature human milk contains 3%–5% fat, 0.8%–0.9% protein, 6.9%–7.2% carbohydrate calculated as lactose, and 0.2% mineral constituents expressed as ash. Its energy content is 60–75 kcal/100 ml. Protein content is markedly higher and carbohydrate content lower in colostrum than in mature milk.”
    Highest in carbohydrate, then fat, then protein. Here is the link so you can see the entire report: https://www.ncbi.nlm.nih.gov/pubmed/392766

    Now, look at this link for potato (red baked with skin):
    https://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2552/2
    And this one, human Mother’s milk:
    https://nutritiondata.self.com/facts/dairy-and-egg-products/95/2
    Notice the amino acid profile for both are very similar: 124 for Mother’s milk and 92 for potato. Both are excellent with full amino acid profiles (look at the box that says “Protein Quality” with the blue fan-shaped display that indicates that both have excellent amino acid profiles).
    If you look at the “Nutrient Balance” pie chart on the Mother’s milk and the potato links, you will see that the potato actually has more nutrition than Mother’s milk does. The pie slices in white are the minerals and the pie slices in pink are the vitamins. The one little blue slice is protein and the yellow are cholesterol, saturated fat, and sodium. The slice in green is Dietary Fiber.

    Also, take a look at this man who ate potatoes for 1 whole year. His blood work improved while he lost over 100 lbs. Scroll down and you can see his before and after photos: https://spudfit.com/
    This man chose to eat potatoes for a year because he wanted to eat something that was healthy and would meet his nutritional needs. He was followed by his doctor while his health improved. He still eats a potato diet.

    I don’t think I would have any problem giving my child potato “milk” made at home with a little soy milk added for thinning.
    Just a thought . . . .. :-)

    1. Ruth, the protein in the potatoes may be adequate. But the nutritional profile of a potato and human milk is quite different.
      Potato has way too many carbs, (58.6 vs. 17), overwhelming the pancreas. And almost no fat.

      The baby has a developing brain, needing a lot of fat. Note a potato serving has only .4 gm. of fat, total, and that is in 299 grams of potato. That is a lot of potato!
      The breast milk has 10.8gm of fat per serving. 4.9 of that is saturated, 4.1 monosaturated, 1.2 polyunsaturated with 128 mg of omega 3’s.
      No way can a potato substitute for breast milk without starving the baby’s brain. A baby is meant to get most of his energy from fat.

      1. Marilyn – I get where you are coming from. This is why I suggested adding soy milk to the mix. Tofu is approximately 55% fat. One could also add in a little avocad as well o if they were concerned about the fat amount. The point I was trying to make is that there are plant sources that can easily replace the macronutrients in Human (as opposed to cows) Mother’s milk – Mature human milk contains 3%–5% fat, 0.8%–0.9% protein, 6.9%–7.2% carbohydrate calculated as lactose, and 0.2% mineral constituents expressed as ash. Both tofu as well as soy milk (27% fat) and avocado more than meet any fat requirement.
        Also, Lindsay stated that her child is about 10 months old – an age when babies are generally already eating baby food. So the milk replacement idea of my suggestion was not for the newborn and not to perfectly replace (human) Mother’s milk but for the supplement idea she was looking for. I’m not trying to make perfection be the enemy of the good (enough).

  7. Twenty years ago my son had such severe “colic” that he ended up weighing the same weight at 6 months as he was st 3 months.
    He was fully breast fed. He would fall asleep and then wake up 20 mins later screaming . I would have to sit with him upright on my shoulder.
    Finally a specialist suggested I go on a dairy free diet and what a difference .
    He eventually went onto a dairy /lactose free diet and thrived .
    He has no symptoms or problems since and can tolerate milk etc.
    I truly believe alot of “colic” which is just a name for a group of symptoms and not actually a disease or a diagnosed condition, is brought about from lactose intolerance.
    My son was born a month early and I often wondered if his digestive system wasn’t quite developed enough to handle the harsh cows milk that he was getting second hand from me .
    Funnily enough originally the Drs kept urging me to keep breast feeding him and I was told to drink more milk !

    1. Wow, Wendy, what a powerful story! Thanks for sharing!

      Second-hand dairy is a concept I have never heard of before.

      Interesting!

  8. Dr G. Could you please summarize or conclude your videos with some clear cut advice. I feel like some videos are difficult to interpret by people because they are multi layered and could benefit from a one liner that puts the whole thing in perspective for practical matters. It will not always be possible to use your RED, YELLOW, GREEN symbols but something similar for videos that are multi dimensional, right now this is not always being done. Thanks you, keep up the good work.

    1. In this video, Dr Greger did summarize in one sentence. Last paragraph, second sentence.. “Anytime you see reflux, let’s first try a “therapeutic trial……”

  9. While I eat a WFPB diet and I am a huge fan of Dr. Greger, there are many babies whose reflux is not helped by elimination of dairy in their mother’s diet. They should be checked for a lip tie or tongue tie, i.e., the tissue attaching the upper lip is too tight to the gum line and/or the tongue is too tight to the floor of the mouth,. When these conditions occur, the baby is an able to suck without swallowing copious amounts of air, which mess up their G.I. system and cause reflux symptoms, such as choking and gagging spitting up, extreme gas and sometimes projectile vomiting.
    I am a laser dentist in the Boston area and have limited my practice to helping these babies. Usually, immediately after release of the ties, the baby is able to get a deep latch, stay on the breast better, transfer milk more efficiently, all without causing discomfort to mom or baby. Babies that have been failure to thrive come back for their follow up one week later and have often gained a pound!

  10. Hello,
    I know this is not really related to babies but I need an advice on acid reflux and nausea in grown ups.
    I have been struggling with it all my life, amongst other problems. I have switched to plant-based diet about 2 years ago and I do feel a lot better in other aspects but my acid reflux and nausea are still here. Less but not gone. It’s really inconsistent on what causes it… From avocado, oatmeal, coffee, peanut butter, onions (raw or cooked) some spices… I am concerned about it… Please help

  11. Hi, Nina McCarty! I am glad you are feeling better on a whole food, plant-based diet, but sorry to learn you are still suffering with nausea and acid reflux. If you have not already seen it, you might want to check out this video: https://nutritionfacts.org/video/diet-and-gerd-acid-reflux-heartburn/ You can find everything related to nausea here: https://nutritionfacts.org/topics/nausea/
    Many people find ginger and/or the herb meadowsweet (dried ginger root and/or meadowsweet herb may be brewed, separately or together, like a tea) to be helpful with dyspepsia. Eating smaller amounts, eating slowly, and chewing thoroughly may help. If a person is overweight, losing weight may alleviate GERD symptoms. Remaining upright after eating is also advised. I hope that helps!

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