The Important Role of Breastfeeding on Infant Gut Development

by Dr. Alexander Rinehart, DC, MS, CCN, CNS

Do you have to breastfeed

During the first few weeks of life, an baby’s immune system is almost entirely dependent on the mother’s breast-milk for immune protection from its environment. Breast-feeding during the first weeks and months of life is now recognized as an important strategy to ensure a healthy balance of good bacteria in an infant’s gut.

You may not be aware that your gut is actually the center of 60-70% of your immune system and may play a crucial role in the development of chronic disease. The gut plays such an important role because it is a primary defense between the “outside” and “inside” worlds. When good bacteria line the gut, they prevent potentially harmful bacteria from lining it instead.

Because of increased awareness of these findings, organizations are starting to turn their heads to the nutritive power of breastfeeding for your child…

Breastfeeding Recommendations

The World Health Organization now recommends exclusive breastfeeding for at least 6 months to promote health. Additionally, the nutritional committees from the American Academy of Pediatrics, Euopean Society for Pediatric Allergology and Clinical Immunology, & the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition ALL recommend exclusive breastfeeding for food allergy prevention (1; 2).

Many nutritionists recommend feeding babies breastmilk for 18-24 months as hypoallergenic foods are introduced one at a time starting at 6 months. More allergenic foods such as  corn, wheat, dairy, soy, peanuts, eggs, & shellfish should only be introduced when the child is older and their immune system is more developed.

Some practitioners recommend that mothers avoid these allergenic foods as well to prevent passing sensitivity on to their children.

Infant symptoms such as a atopic eczema can actually disappear upon a lactating mother’s removal of allergenic foods from her diet. If a mother is looking for a supplement to her own breastmilk, she can take probiotics during pregnancy and breastfeeding which has been shown to promote infant immune health (3).

The Infant Immune System & Gut Health

Immunity is passed from the mother through her breast-milk which contains antibodies against specific antigens present in the immediate environment. Demonstrating the unique bond a lactating mother has with her baby, a baby’s saliva actually communicates with the mother and literally affects the composition of the milk based on the baby’s unique needs!

Mother’s breastfeeding can help prevent and support gut problems (4) and research suggests that breastmilk can help re-establish a healthy balance of bacteria and antibodies even after use of antibiotics (5).

Unfortunately, the process of re-establishing healthy levels of infant bactera through breastfeeding may take as long as 2-4 weeks (6; 7)!

How Can Infant Gut Health Become Altered?

Because of high c-section rates and feeding with cow or soy milk formulas, “natural” infant gut development can be altered. Mothers who breastfeed may help reduce potential complications. For instance, research has shown that breastfed infants have a more acidic environment in their gut during the first six weeks of life. Their tiny guts become naturally full of healthy bifidobacteria and naturally low in potentially harmful bacteria such as E. coli, Bacteroides, Clostridia, and Streptococci. Not a bad trade-off at all.

In addition to healthy bacteria, infants depend on something called sIgA from their mother’s breastmilk as a passive form of antibody protection that lines an infant’s GI tract and protects them from potentially harmful antigens in their immediate environment.

sIgA continues to be the primary gut immune defense as we age…decreasing with physical, emotional, and chemical forms of stress. When sIgA levels are disrupted, we may become more susceptible to IgE and IgG reactions associated with food allergies, sensitivities, and intolerances to those with genetic susceptibilities.

Introducing allergenic foods too early & failing to breastfeed may “turn on” genes that make us susceptible to allergies later in life. Genetic susceptibility of gluten allergy alone may be present in up to 81% of Americans (8). These low-level food reactions can contribute to “leaky gut” – a condition where your intestines absorb proteins that the body sees as “foreign”, initiating delayed immune reactions.

Disadvantages of Formula Feeding

Within as little as four days of life, the presence of bifidobacterium in the guts of breastfed infants can be over 300% higher than in formula-fed infants. Pathogenic bacteria tend to make up the dramatic difference in bottle-fed babies (9).

Supplementing breastmilk with even just a little bit of formula can affect the acidity of the gut environment, possibly promoting the presence of harmful bacteria and threatening the integrity of the gut lining (10; 11 )!

Just one bottle of dairy formula may sensitize a susceptible infant to milk allergy (12; 13).

C-Sections and Infant Gut Health

Proper development of the immune system depends on a healthy array of bacteria in your gut.

Did you know that a c-section delivery can actually affect the types of bacteria found in an infant’s digestive tract?

It’s true. Gut bacteria in infants born by c-section delivery may be disturbed for up to 6 months (14). This increase of pathogenic bacteria compared to healthy bacteria is referred to clinically as small bowel intestinal overgrowth and over time, may contribute to the development of chronic disease.

Think of your immune system as a triage unit with some factors serving as general, primary defense, and other immune components as special forces. When these also fail, the immune system will make more dramatic shifts, which may possibly account for the autoimmune diseases seen 10-20+ years later.

Feeding with infant formula has actually been suggested to play an important role in the development of type 1 diabetes, an autoimmune reaction to the pancreas (15; 16; 17)! It is interesting that autoimmune diseases such as Celiac disease, Crohn’s, or Hashimoto’s Thyroiditis, tend to show up around 25-35 years of age. Research suggests that autoimmune conditions may be related to disruptions in gut integrity and the balance of immune system.

These disruptions and alterations may actually be related to feeding practices during infancy!

Mother-Baby Bonding

It is important not to forget the incredible bond that is formed between mother and baby during the months that she is nursing.

Many women remark that breast-feeding is a part of their pregnancy that they tend to miss the most! They fear that the incredible bond developed over the first few months will wisp away over time, but they soon learn that it is only the beginning of a deep bond they will share over a lifetime.

Special thanks to Marsha Walker, RN, IBCLC for compiling much of this breastfeeding research and educating women and the public on these issues for over 25 years!

{ 39 comments… read them below or add one }

Margaret June 9, 2012 at 1:36 pm

If I have bad gut flora, will my baby still have good gut flora when I breastfeed? I was not breastfed as a baby, I think I am gluten intolerant, I have autoimmune hypothyroidism, and so I probably have a not so great gut. I am worried it will effect my baby’s gut flora. I breastfeed him exclusively and he is 8 mo. old. I just started him on some fruit today…avocado. Where we live, it is routine to give the baby formula in the hospital. I did not have a choice about that. Makes me mad! They did not even give him to me for 8 hours after my son was born. The first thing his little gut got was formula! Very upsetting and these are medical professionals??!! I live overseas in Eastern Europe.

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admin June 11, 2012 at 11:12 am

C-section births, formula feeding, and antibiotic use are the biggest culprits I see to infant gut imbalance. Now I have had a number of cases where the mother eats dairy and then their infant develops a rash, so the antibodies and lack of protection from sIgA can increase susceptibility to sensitivity reactions. Next is being mindful of not introducing potentially allergenic foods like dairy and wheat too early (if at all). In the majority of cases, the health benefits of breastfeeding outweigh many risks.

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Margaret June 9, 2012 at 2:03 pm

One more question. My now 7 year old daughter was breastfed until she was 2 and a half years old. However, she did receive some formula while in the hospital when she was born. At the age of 2 years, she started to have very bad breath. At the age of 4 she started to have some facial tics. The tics come and go, but it seems that the trigger for them is milk, at least as far as we can tell. How do you think this is all related? Are facial tics a symptom of milk allergy? Why would she have bad breath at the age of 2. We never figured it out. She appeared very healthy. She had no congestion or sinus infections. Could this all go back to her being fed formula in the hospital?

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admin June 11, 2012 at 11:18 am

I don’t know if the tics are related or not related, as it depends on why they are there. My work focuses on the greater patterns involved, and so it’s not out of the realm of possibility that they could be related as nerve inflammation can be linked to food allergies/sensitivites – but out of context it’s impossible to figure out underlying cause vs. triggers.

Just one bottle of formula can disrupt the gut balance if not balanced with a protocol of gently removing the bad, adding back the good, and giving the cells the fuel they need to repair and grow. I see this in adults where they go on a strict “Paleo Diet” that is hypoallergenic (except eggs, tree nuts, shellfish), but still experience gut problems despite feeling better in other ways. Bad breath is often an indication of some deeper gut imbalance going on, or a diet high in sugar and/or difficult to digest foods.

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Renee McLeod November 5, 2012 at 6:47 pm

I have been researching gut flora in babies because our son has a CHD and he is not gaining weight as fast as he should and I am receiving a lot of pressure to add formula to his exclusively breast fed diet.

I have been told that I should just give him formula leading up to surgery and that afterwards, he can be exclusively breast fed again and that his stomach flora will change back to what it should be within 2-4 weeks.

My question is this: has there been any studies on this more recently than 90 years ago? I think that formula must be completely different today than 90 years ago and that this information cannot be pertinent as it is not new enough to be relevant any more!

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Alexander Rinehart, MS, DC, CCN November 5, 2012 at 8:41 pm

Formula tends to only focus on the major macro and micronutrients, when breastmilk contains lots of immune factors and other factors that you will not find in formula. It is currently recommended that mother’s breastfeed exclusively for 6 months and then be mindful of common food allergens like wheat, corn, dairy, tree nuts, peanuts, shellfish, and soy until the infant’s immune system is more developed.

Enfamil contains nonfat milk, whereas breastmilk is full of healthy fats like lauric acid which may help support the infant’s immune response while the immune system is still developing. These fats are often left out of formula. Out of formula options, a rice milk-based formula is preferred over soy and dairy but does carry risk of dental cavities since it’s higher in sugar. Also, I’m concerned about Bisphenol A exposure in canned formula which is banned in baby bottles in many other countries.

Unfortunately, I cannot comment specifically with regards to infant pre-op care as it’s outside of my training and would need to do some of my own research, unfortunately all bets are off sometimes when it comes to medical interventions.

But my personal guess is that the recommendation is more on protecting liability and being able to show they did their due diligence on all variables before operating since malpractice costs in that field are extremely high. With the addition of formula they could come back and claim they ensured that the infant was strong enough, etc if any complications were to arise. I also feel the companies behind these products have had high influence on the nutritional guidelines that are published with regards to these issues.

For every week of formula, it does take something on the lines of at least 2 weeks of breastfeeding and/or probiotics to replenish bacteria as you were counseled. As a parent, it is ultimately your choice similarly to vaccinations and other “controversial” subjects.

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Renee McLeod November 7, 2012 at 2:29 pm

Thank you!

Our son is 4.5 months old now and has met & is now exceeding their minimum weight requirement of 5kg (11 lb) for his heart surgery, but he is growing slow, with usually half the weekly weight gain recommended by WHO of exclusively breast fed babies. So, the pressure to keep him growing at that minimum 140g/week is mounting as we wait for our surgery date which will be in the next month, hopefully sooner. The bigger he gets, the more symptomatic he will be, the slower he’ll gain so, it is all a balancing act.

He is strong and healthy and I feel the biggest concern is that he keeps growing and getting the calories he needs for optimal brain/organ/physical development. He’s still gaining weekly so I will continue NOT giving him formula, as I don’t feel it’s the best thing. I am also “skimming” my breast milk for him; pumping off, waiting 24 hours for it to settle and then taking the skim milk off the bottom and dumping it, so he’s getting more high fat milk (160ml/day). I have also started adding 2tsp of olive oil per day to his breast milk supplement. The olive oil seems more natural and whole than formula, but, again, I don’t know how this is affecting his gut flora. As humans, we’re notoriously terrible at reproducing what nature has perfected, so I’m not keen on man made formula which is nothing like human milk! I have also been denied access to human milk fortifier: being told it is specifically designed for preemies, not full-term babies … even though I know it’s high calorie composition would be perfect to keep him gaining weight and it’s human milk so, less to be concerned about.

He’s awake, alert, happy, meeting all his milestones, sleeping well, nursing well and everything you’d see in a healthy child, just not gaining as fast as he “should.” With that said, he will still double his weight between 5-6 months, so why the panic?

I know that this is all ultimately my choice but that does not make it any easier! As a mom, I’m worrying constantly that he’s not growing fast enough, that I’m retarding his growth, or hurting him in some way! It’s awful! In my heart, I know that after his surgery, he’ll gain like crazy and this will all be over!

In regards to this part of your response: “For every week of formula, it does take something on the lines of at least 2 weeks of breastfeeding and/or probiotics to replenish bacteria as you were counseled.” Do you have or know of any “current” research that supports this information? I cannot make a decision based on information that is 90 years old and I have been unable to find any other references supporting that research or any studies more current. I know that formula has changed a lot over the last 90 years so, that information may not be accurate any more, but I see it referenced over & over.

Now, as far as starting solids, does food effect the gut the same way? And if so, will his gut go back to a breast fed gut without it when he’s back to just breast feeding? I would prefer to add whole natural food to his diet, if I have to to keep him gaining, than to give him formula, but I’m not sure where to start.

Thank you, again, for your quick response and all the wonderful information on your site!

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Alexander Rinehart, MS, DC, CCN November 7, 2012 at 5:35 pm

The two references with regards to restablishing infant bacteria over 2-4 weeks are:

1.) Brown EW, Bosworth AW. Studies of infant feeding VI. A bacteriological study of the feces and the food of normal babies receiving breast milk. Am J Dis Child; 23:24
2.) Gerstley JR, Howell KM, Nagel BR. Some factors influencing the fecal flora of infants. Am J Dis Child 1932;43:555

Further discussion can be found in bulleted points and references here: http://drjaygordon.com/pediatricks/startingout/supplement.html

Just because a study is 90 years old does not make it invalid…in fact much of alternative healthcare is coming back to natural therapies turned to 1000′s of years ago.

Complex/Allergenic foods when introduced too early can affect the gut similarly as it’s the under-developed immune system in the gut reacting to “foreign” antigens or due to proteins that the infant is not yet capable of digesting properly.

When this integrity is lost, the healthy flora can be disrupted. You’ll need to work with someone who has worked with infant nutrition more specifically and knows your son’s case more comprehensively to judge when he is ready for certain categories of food.

I believe ChrisKresser.com and his http://www.healthybabycode.com may offer some more specific direction. I receive no benefit for recommending his product.

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Rusti December 17, 2012 at 11:42 am

Hi Renee,

I was just curious as to how your son is doing? My daughter just hit the 7-month mark and at her 2-month well baby visit (at 9.5wks old) our doctor discovered a heart murmur which ended up being a large and several small holes in her heart which required open heart surgery 11 days later (at 11wks old) – one of the indicators for us was also failure to gain weight, and she had started fussing at the breast. Her gain has slowly been increasing since her surgery, until in the last 2months she has finally started packing on weight. She is just under 14lbs now but chunky, healthy and happy. She is exclusively breastfed (she gets bottles of expressed milk at daycare) and we haven’t started solids yet – which her doctor is just fine with. I just wanted to let you know that I’m thinking of you and hoping your little Heart Warrior is doing well. We Heart Moms have to support each other :)

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Danelle November 7, 2012 at 8:43 pm

My daughter is almost 8 weeks old. In the hospital after her birth, she went from 8 lbs to 7.9 lbs in about 36 hours. She wasn’t sleeping well, and it seemed she wasn’t really getting colostrum either so we were told to give her formula. we finger fed her formula a few times until my milk came in around day 5. I have exclusively breastfed her for a few weeks here and there but was told to supplement with formula by her doctor every time the doctor found out because she seemed dehydrated and wasn’t gaining weight. A few weeks ago I started pumping breast milk to feed baby, but I do not produce enough milk. Currently I’m only getting 5 to 10 ounces a day. I try to breastfeed baby here and there but she gets really frustrated because of the whole bottle issue. What I am wondering is if and how the breast milk that I bottle feed her is being negatively affected by the organic cow’s milk formula we are supplementing with. Breast feeding advocates say any breast milk is better than none, but is it actually somewhat harmful or inefficient to mix breast milk and formula, either in the same bottle or different bottles through out the day?

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Alexander Rinehart, MS, DC, CCN November 7, 2012 at 9:01 pm

Hi Danielle,

I also agree that any breastmilk is better than none, sometimes the baby may prefer the taste of formula over breastmilk due to the sugars and so forth, but the breastmilk would not be harming her because of the cow’s milk and mixing should pose no more harm than alternating between breastmilk and cow’s milk.

Sometimes what a mother may lack in milk volume, she can make up for in frequency, so feeding more frequently may be helpful and help increase your total production.

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Danika December 4, 2012 at 12:22 am

Hi, I exclusively breastfeed my 14week old son.I have had two courses of antibiotics so am now taking probiotics. Is that enough to benefit my son. I have read that some feel it does not pass through my milk therefore my son should also take probiotics? Any advice greatly apprecia
ted.

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Alexander Rinehart, MS, DC, CCN December 4, 2012 at 8:39 am

Hi Danika, I cannot offer advice with regard to the prescription antibiotic usage, but I can say that antibodies can be passed on to an infant and so if a woman has any sensitivities to wheat, milk, etc and they breastfeed, the infant can sometimes get rashes, colicky, etc and i’ts coming from the mom’s immune system, not the infant’s. Probiotics are supportive for normal immune health and although the specific strains may not be passing over, the indirect effect of supporting gut and immune health can have a positive effect.

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Alexander Rinehart, MS, DC, CCN December 4, 2012 at 8:42 am

Also, you would need to check with your pediatrician/family doctor/wellness practitioner with regards to a recommended probiotic and correct dosage for your son

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Danika December 4, 2012 at 5:27 pm

Thank you very much for taking the time to reply! I have been dairy free for 5 days now to see if that helps as he still hasn’t ‘settled’.I know it takes a few weeks for protiens to clear my system, so probably a coincidence, but he has had a few good days of sleep.Fingers crossed! Thanks again

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Danielle Culler January 16, 2013 at 8:32 am

If a woman has a c-sec do you recommend a longer breastfeeding timeframe to help the little one establish proper by gut flora? If so, how much longer? I was thinking another 6 months. Also, I already take pre and probiotics but there are “immunity boosting” supplements being sold on the market. ..do you believe a breastfeeding mom should introduce them into her diet to benefit the baby even if she is already taking the recommended vitamin/mineral intake? Thank you in advance!

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Dr. Alexander Rinehart, MS, DC, CCN January 2, 2014 at 3:30 pm

It is a case by case decision and dependent on many variables. Exclusive breastfeeding should occur for at least 6 months which is a standard recommendation. You can supplement with breastmilk up to 24 months and longer. 18 months would be a nice timetable in my opinion, 12 months as a personal minimum, 24 months would probably be the upper end of what’s natural. Longer can only help, but there may be a law of diminishing returns after that 18-24 month mark. There are opinions all across the board on this issue, but that is my take.

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Reesa Graham March 30, 2013 at 9:24 am

Quick question, you state in your article that “a baby’s saliva actually communicates with the mother and literally affects the composition of the milk based on the baby’s unique needs!”. Can you tell me where the research on that is? I would love to see how that works. Thanks!

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Dr. Alexander Rinehart, MS, DC, CCN March 30, 2013 at 9:37 am

Hi Reesa,

One of the most commonly cited reports is “Examining the Evidence for Cue Feeding of Breastfed Infants”: http://ezzo.info/Aney/cuefeeding.pdf.

Additionally the fancy term for it is “diathelic immunity” which appears as early as 1957, it is the theory that bacterial organisms are transferred from the infant’s saliva to the mother, who then produces antibodies that are then delivered to her baby via breastmilk.

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Jennifer M May 6, 2013 at 2:08 pm

I am disappointed to find out that I will have to be on an antibiotic during the delivery of my baby, due to Group B strep. I was really hoping to avoid that, so that she could benefit from good gut flora during delivery. Given that, how long will it take for my breast milk to start to be beneficial to her, and provide her with the proper good bacteria she is going to need to ward off chronic conditions?

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Alexander Rinehart, DC, MS, CCN, CNS May 9, 2013 at 11:26 am

You would need to check with your physician as per the safety of breastfeeding while on certain medications and if a specific probiotic is recommended for you and your baby, but your breastmilk is likely to be beneficial from the start due to the wide variety of immune factors present in the milk.

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Kavitha May 14, 2013 at 6:19 am

Hi,

Both my kids were born by c-section. How can I improve my gut flora and the infant / toddler’s gut flora ?

As a cultural practice, breastfeeding mothers are not allowed to eat yogurt for the first 2 months.

Appreciate your advise.

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Dr. Alexander Rinehart, MS, DC, CCN May 15, 2013 at 11:09 am

Breastfeeding alone can be very helpful to promote a healthy balance of gut flora as well as being mindful of allergenic/sensitive foods (in both the breastfeeding mother and child) and how soon a child is introduced to wheat, dairy, etc. Also consider working with a functional medicine minded health professional to recommend a specific probiotic for your infant/toddler, with the limitations of my professional license, I’m unable to recommend specific products outside of a consultation. If you wish for me to help direct you to a health professional near you, please feel free to message me privately.

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Jennifer January 2, 2014 at 12:29 pm

Hi, I exclusively breastfed my son until he was a month old and then gave him one bottle of formula because I was uninformed about the risks. Later, I read about the gut flora and he’s been exclusively breastfed since. He is 4 months old now.

My concern is, that because I gave him formula, he wont get the benefit of breastfeeding like he should. Mainly, the prevention of allergies and access to my antibodies because his gut closed after the formula feeding.

Besides those two benefits, are there any other health benefits of breastfeeding even after he was mistakenly introduced formula? I always here that it’s still good but specifically how?

Thank you!

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Dr. Alexander Rinehart, MS, DC, CCN January 2, 2014 at 3:21 pm

Hi Jennifer, he will absolutely get all of the benefits of breastfeeding. Even though just one bottle of formula can cause issues. The research suggests that even with the vast changes caused by an antibiotic…normalization can occur in as little as 2-4 weeks with re-administration of breastfeeding.

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Jessica January 9, 2014 at 11:24 pm

How long do the effects of probiotics “kick in” for baby once a breastfeeding mother starts taking them? Unfortunately, I had to be on antibiotics during my labor and four weeks after delivery because of mastitis. How long will it take for my baby to “recover” from that? Will the antibiotics have any negative long term effects for her?
Thanks! P.S. Great information!!

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Dr. Alexander Rinehart, MS, DC, CCN January 10, 2014 at 5:15 pm

Hi Jessica, the effects would begin immediately, but as mentioned above it can take 2-4 weeks to re-establish normal flora. I would not be concerned about negative long-term effects.

I was formula-fed and delivered by c-section. I had a parent that smoked. I ate sugar-laden cereal, pizza, ice cream, candy, fast food, etc as a child, and I turned out okay. Freeing yourself from worry will have its own health benefits for you and your baby. :)

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Julie February 7, 2014 at 10:08 pm

Hello,

I am breastfeeding my 4 year old son and he is reacting to almost everything in my breastmilk! I have been on an elimination diet for months now and his reactions are so inconsistent with no specifics being identified (prior to milk removal at 1.5 months).

He is pitiful, screaming, rashes, tightening stomach, stretching out, some blood in stools, etc. It breaks our hearts. We just got probiotics at the health food store.

The doctors here are clueless! We tried hydrolyzed formulas to no prevail. I wish we would not have tried them but it is so hard seeing him feel this weay after eating (within 1-2 hours but sometimes immediately).

Is it possible he is not reacting to specifics and everything hurts his belly due to damage of the gut flora? We do not know where to go from here. We want him to feel better so bad and I want us both to meet the nutritional requirements. I was going to start the GAPS diet tomorrow but just not sure yet.

Is breastfeeding still better with these reactions? Is the breastmilk causing permanent damage? His reactions today were not as severe but still had rashes, abnormal stool and one episode of inconsolable crying/projectile spit-up/stiffening out/bad gas after eating. He is also on Zantac 1ML 2x/day. Thanks.

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Dr. Alexander Rinehart, DC, MS, CCN, CNS February 10, 2014 at 12:22 pm

Julie,

From an educational perspective, I have worked with some clients where identifying food sensitivities in the mother such as soy, wheat and milk (not that it is limited to just the most common allergens either) and removing them from the mother’s diet had helped with her infant’s symptoms even when the child was not eating those foods directly on his or her own. So my guess would be that there may still be an unidentified food trigger despite the elimination diet and some lingering imbalances with the flora as you have suspected.

There may also be something deeper going on that would be outside of my expertise in this area and may need more diagnostic follow-up for you and your son. It would be unfair of me to comment directly without knowing full details of your case and not having personal experience with this level of severity.

I have some resources on finding holistic minded practitioners listed at the end of this post that I hope can direct you to someone in your area: http://dralexrinehart.com/stress-benefits/what-is-functional-medicine/

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Brittany February 11, 2014 at 7:45 pm

Hi Dr. Rinehart

When my daughter was about 2 months old she started to be very colicky, and developed eczema on her face. At the same time I started having digestive issues. Two-months before she was born I broke out in a rash and blisters and was afraid I had cholestasis. My doctor brushed it off and told me I had varicose veins on my arms. Anyway, through research online, I decided to eliminate dairy from my diet. My digestive issues got better and her colic went away quickly. She still had eczema so I took wheat out of my diet, her eczema cleared and I felt like a brand new person.
I ended up going Paleo and I still am. I’m also afraid to add dairy into my daughters diet or especially wheat. She still has eczema flares with dairy and I believe she is reacting to something else. I stopped breasfeeding her around 18 months. My doctor considers me celiac since I have bad reactions to wheat, and after I glutened myself a few months ago I cannot even tolerate any dairy anymore. I also had genetic testing done which shows that I carry both celiac genes, so my daughter has at least one. I have HLA DQ2 and HLA DA8. Since I took gluten out of my diet, we didn’t test antibodies so DNA didn’t eliminate the possibility. I believe I am celiac due to my reactions and I just figure out that my skin rash during pregnancy was celiac related dermatitis. It’s kind of funny I was using an oatmeal bath to help my rash! As I found that I react to oats as well!
Anyway, my concern is that my daughter still has eczema and reacts to dairy, and something else, and I’m afraid to give her wheat out of fear that she carries at least one celiac gene and she already has allergies. We’ve been off and on probiotics but I’m currently going to give her florjen4kids for at least 6 months straight, does she still have leaky gut? Should I do an elimination diet on her? Any advice?

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Dr. Alexander Rinehart, DC, MS, CCN, CNS February 12, 2014 at 10:12 am

Hi Brittany,

It seems as though you already identified wheat and dairy as triggers, are you trying to identify additional foods? Antibody testing can be tricky in younger kids until they are a little older (rough guesstimate 5-6 years old) so elimination diet may be best. Especially since kids can respond and bounce back really well when triggers are identified. You can’t have a food sensitivity without leaky gut, so it’s best to identify triggers and go from there in my opinion. A leaky gut diagnosis isn’t really helpful beyond knowing that you want to look to see what’s triggering it…food/stress/hidden infections/SIBO, etc

Research has shown that if an immediate family member or sibling has the HLA markers, they have a 2000% increased relative risk of celiac disease (referenced in article listed below). Aside from celiac disease, non-celiac gluten sensitivity is also a very real thing and something that many doctors still don’t “believe in” based on “standard of care” with what they’re taught regarding gluten testing, as well as food allergies and sensitivities, so you may need to push for the right testing and do more research as a consumer of you and your child’s own healthcare.

I’d say you already identified some main triggers (dairy, gluten…) and may want to look into cross-reactive foods like oat, rice, corn, tapioca starch etc such as found in a panel offered by Cyrex Labs. You would want to work with a doc familiar with the testing and I believe you can search practitioners directly on Cyrex Labs’ website. They can help decide whether the ~$400 investment for testing is necessary in the first place or whether there are other things going on that may need to be addressed or sought out foremost.

You may find some value in my article “Should You Go Gluten Free?”: http://dralexrinehart.com/nutrition-benefits/celiac-disease-blood-tests/

Thanks for your question and as stated on my website, this does not replace advice given to you by you or your child’s doctor who would know more about your specific case. This is just for educational purposes of the general options available out there and based on information already shared by yourself in the comment.

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Brittany February 12, 2014 at 8:08 pm

Thank you for your swift response Dr. Rinehart! I looked at the cyrex gluten related cross reactive panel and there were a few food items on there that she consumes quite frequently. She drinks pacific brand hemp milk that is sweetened with brown rice syrup daily- about 18 ounces. The juice she drinks has ascorbic acid in it which is made from corn. So there’s three: hemp, rice, corn. She also eats eggs and potatoes (not paleo, but we eat them since I’m small) just about daily. So there’s two more. I feel that her leaky gut is food related, possibly SIBO related, as I have been having IBS issues since I was glutened badly a few months ago. I’ve been on a ton of antibiotics as well, growing up, reaccurent strep infections. If I have SIBO then I can imagine she does, would this be true? I would like to add that she flaired badly and was sick for a little over 2 months off and on after I was glutened, I also allowed her to eat the cookies as well not knowing they had gluten in them. How exactly do doctors treat SIBO? Antibiotics?

I’ve thought about doing autoimmune paleo in hopes that my IBS type issues can resolve and to help figure out what’s causing my daughter to flare up. Would Autoimmine paleo help with the SIBO, combined with lots of probiotics?

Also I read that you said any of my primary relatives would have a 2000% increase in risk of having celiacs disease, since I have it. I looked at the article and it said 20% increase risk, is that compared to the general population of 1 in every 100 ppl? Basically, I’m asking for you to explain the math. I’ll catch on but I’m a bit confused which happens often! Hahaha I thought my grain brain would go away.

Take care and again thank you so much for caring, not just about what my daughter and I are going through, but thank you for caring about other peoples well being. It’s a quality that you should be proud of and I’m sure you are. We need more doctors like you, or even just, more people like you!

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Alexander Rinehart, DC, MS, CCN, CNS February 12, 2014 at 8:26 pm

Thanks for your kind words! As you may know any one of the issues you mentioned could be blogs of information to share. Look to simplify out of all of the complexity, there’s a lot of specificity and subtlety but you can get 80% of the results with just small pieces of the information out there. For instance, just because gluten cross-reactivity exists doesn’t mean that it exists for you. The key is to identify and be consistent with gluten-free first, and then get more specific once you’ve mastered the first steps. As with anything you must learn to crawl before you walk, and to walk before you run. So start with the basics and get more technical and specific only when necessary, otherwise you can make your head spin.

SIBO can be structural (intestinal blockages, low motility etc), it can be related to antibiotic usage, it can be high sugar/starch, it can be food sensitivities, it can be a unique combination of all of the above. Some approach with antibiotics, some approach with diet, some approach with botanicals and supplements; some approach with all of the above. It comes back to patient goals, specific patient circumstances/preferences, and things like elimination diets, gut protocols, and functional testing can all play a role.

As for autoimmune paleo and so forth, it depends on if and why there is an autoimmune process in the first place and affected by things like stress, heavy metals, hidden infections like SIBO etc.

Don’t get as caught up with the specific names and syndromes, it’s like finding a needle in a haystack. Instead focus on improving function and foundational wellness. When you do that, the specifics point themselves to you. You can go as deep as you want with this type of care but 80-90% of the results are very easy to accomplish with the basics. Just find the right doc when you find yourself in 10-20% that aren’t responding or having residual issues…that’s when it pays to spend money on these panels etc, but don’t go for the expensive technical stuff until you’ve given the easy stuff it’s fair attempt.

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Alexander Rinehart, DC, MS, CCN, CNS February 12, 2014 at 8:34 pm

1-2% of the population is known to have Celiac disease, those with the markers have a 20% risk. So the “up to 2000%” is the relative difference in risk, not absolute risk and I tried to be careful with the distinction of relative vs. absolute. The article even suggests that if you have 2 siblings that carry the markers, the absolute/relative risks of 20%/2000% are even greater.

I will also mention that there are scores of individuals who have celiac but do not have symptoms and/or have not been diagnosed. Additionally there are individuals who are gluten sensitive but not celiac. So you can see how deep this can go with semantics/statistics and how various stakeholders can play with them.

This comes back to “non-celiac gluten sensitivity” which is increasingly recognized in academic and clinical circles, but takes time to spread through the standard of norms for conventional medicine. The only difference between gluten sensitivity and celiac is really damage to the intestine. I am on the side that asks, why wait until intestinal damage is present to do something?

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Brittany February 15, 2014 at 11:26 am

Dr. Rinehart

I do occasionally stress myself out with all the information but I’ve come to realize that one step at a time will improve my life and my daughters life, staying positive, helping others going through the same thing, and de-stressing help out a lot!!

I actually have an appointment with my OSU integrative practitioner in a few weeks to check my nutritional status. I plan on asking about a course of rifamixin (to see if it helps clear any intestinal infection that is causing my IBS symptoms) coupling that with long term probiotics and seeing if she would consider prescribing low dose naltrexone. I had asthma from birth to 5, I was on the verge of hyperthyroidism from 20-25, when I change my diet due to Celiacs my thyroid normalized. (I found out that autoimmune thyroid issues can be caused by Celiacs, this is common medical knowledge but my regular doctor never thought to test me). Terrible diet, vaccinations, antibiotic use growing up didn’t help out my autoimmune issues, so I’d like to see if LDN could help my immune system regulate.

I’m also going to do an elimination diet with my daughter. Over the past couple of days I’ve been watching her flares and I believe eggs, chocolate, rice and/or hemp to be contributing factors but without a TED, there is no clear cut way to know for sure. The tough part is finding a quality probiotic now that does contain any allergenic fillers, as florajen has rice maltodextrin.

Thank you for clarifying the math behind celiac likelihood in families. Completely off topic but I’ve heard conflicting information about celiacs not only reacting to wheat, but all grains. Though I do know that most the grains/seeds/legumes that we consume are not properly prepared and I may look into quinoa from a quality source and see if it is something we could incorporate into our diets, prepared properly of course. I’m willing to try different things that could possibly work for us, as you’ve stated, some things work for some people that don’t work for others.

I also believe that improperly prepared grains/seeds/legumes and over processed grains are not good for overall population health and that our food pyramid needs to be completely reworked! Especially for those people in our population that carry the genes that predispose them to autoimmune issues, such as Celiacs, and from what I’ve read, that’s AT LEAST 40% of the population. Prevention should be key and a better understanding of the factors that can contribute to autoimmunity developing in those predisposed. But that’s completely off the topic!!

I’m just so passionate about giving people the option of quality life. I’m sure you know what I mean and again I appreciate people like you helping others who want to help themselves get better. I believe preventive medicine should be the go to way of treating patients medically. What if it were policy to do genetic testing on all patients? For better understanding of the overall possible outcomes of their health. Giving people the choice to do what’s right for and by their bodies. I sure would have loved to know what I was genetically predisposed to and how I could have taken better charge of my own health early on by eating better nutritionally, stay away from gluten/grains, ect. Heck, I thought I was eating healthy 6 years ago abiding by our food pyramid. 8-10 servings of grains a day definitely doesn’t sound like a good idea for some with two celiac genes ;) Maybe we will get there one day, one step at a time right? Thanks again!

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Allie March 2, 2014 at 4:19 am

Dr. Rinehart,

I am currently writing this at 4am after being up all night long with my 5 month old. She is covered from head to toe in red oozing eczema and it has now started to severely affect her sleep. We are so desperate to help her and have been trying everything under the sun to alleviate her itch and although her case has gotten better the more I learn about eczema, something is still going on.

My question is: how can I help rebuild her gut to heal her eczema when she is sensitive to lactos, and it appears all probiotics have dairy in them?

Also, if you have more insight on eczema and gut health in infants I would appreciate any information you can share with me as we are just learning now about this!

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Dr. Alexander Rinehart, DC, MS, CCN, CNS March 4, 2014 at 11:57 am

I use Metagenics UltraFlora Balance which is dairy free despite being cultured on a milk medium, also there are soil-based organisms with a product by the name of Prescript-Assist. Lastly, there are things like non-dairy kefir’s and yogurts that can offer benefit without dairy. Unfortunately due to limiations of my licensure I cannot comment directly as to dosage. I am sure there are more options available as well beyond the brands mentioned.

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Nonu March 14, 2014 at 12:07 am

Hi
My 2 week old baby was recently hospitalized due to RSV and given three courses of antibiotics – the doctor thought it was pneumonia. I am exclusively breast feeding. Would my baby recover good gut flora if I continue to breast feed or shall I supplement with probiotics as well?

Thanks!

Reply

Alexander J. Rinehart, DC, MS, CCN, CNS March 17, 2014 at 9:33 am

Hi, the short answer is both. Your baby would recover gut flora with exclusive breastfeeding, but adding probiotics wouldn’t hurt. The type and dosage would need to be managed by a health professional familiar with your case.

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