This week we answer your questions on yeast overgrowth, nutrition for stroke prevention and recovery, and treating reflux and painful gas in infants. I also discuss the background and reasoning behind the High Cholesterol Action Plan, my new program launching next Wednesday, September 12th.
In this episode, we cover:
2:03 Why I decided to create the High Cholesterol Action Plan
14:16 Can yeast overgrowth cause heartburn?
19:22 Diet tips for stroke prevention (and stroke recovery)
35:05 Treating reflux and painful gas in infants
Links We Discuss:
- Lauricidin – anti fungal remedy
- NOW Foods MCT 100% Oil
- Klaire Labs – Ther-Biotic Infant Probiotic
- Metametrix Stool Test
- Organic Acid Urine Test
Full Text Transcript:
Steve Wright: Hi, and welcome to another episode of the Revolution Health Radio Show brought to you by ChrisKresser.com. I’m your host, Steve Wright from SCDlifestyle.com, and with me is integrative medical practitioner, licensed acupuncturist, and healthy skeptic, Chris Kresser. How are you doing, man?
Chris Kresser: I’m pretty good, Steve. I like the new intro! Did you cook that up at AHS?
Steve Wright: Thanks! I’ve been working on it.
Chris Kresser: All right. Yeah, I’m good. I have a little bit of a cough. When I got home from AHS, my wife Elanne and Sylvie and her parents who were staying here while I was gone were all sick, so I was pretty run down actually from AHS, as you know since you were there, Steve. It was a good time, and there was a lot of stuff to do, and I didn’t get my normal beauty rest that I usually get!
Steve Wright: Haha, yeah, I think I needed, like, a whole 24 hours just of de-stressing and just chilling.
Chris Kresser: Yeah. Those conferences are always kind of a whirlwind for me, and I love it. I love meeting new people, and you know, I got to meet a lot of my patients. I got to meet a lot of blog readers and radio show listeners, and then of course, I got to meet people that I hadn’t even met in person but that I feel like are friends and I’ve had a lot of contact with on the phone and over the Internet, like Mat Lalonde and Stephan Guyenet. So it was a great time, but I was pretty tired after it, and I think my immune system was a little weak, so a little bit of a cough. Hopefully that’s not too distracting during the show. But on the other hand, I’m really, really excited lately because I’m just putting the finishing touches on the High Cholesterol Action Plan, which is a new program I think I mentioned before on the show. And I thought we’d start the show today just by talking a little bit about why I’m doing it, because I’ve had some questions actually from people saying that they’re a little surprised that I was releasing an action plan for high cholesterol because they said: Well, isn’t high cholesterol nothing to worry about? You know, what’s happening there? So I thought it would be good to just talk a little bit about the reasoning behind this program, why I’m doing it, and what I’m trying to accomplish. And then right now I’m targeting a launch date for September 12, so I think that’s gonna happen. I don’t see any reason that it won’t unless, haha, I collapse from sheer exhaustion!
Steve Wright: Protect that immune system, man!
Behind the scenes of the new High Cholesterol Action Plan
Chris Kresser: I’m feeling better, and so I think it’ll happen. And right around the launch date, I’m gonna release another short, little radio show clip that gives you a sneak peek of what’s inside and goes into a little more detail about the content. But for now, I just want to talk a little bit about the background. So as some of you may know, people who have been following my work for a long time, I actually got into this whole health and wellness field writing and speaking about cholesterol and its relationship to heart disease. Way back in the day when I started my blog, The Healthy Skeptic, before it became ChrisKresser.com, I was still a student, a graduate student, and I just started the blog to kind of keep track of my thoughts, and what I was thinking about at that point was cholesterol and heart disease. I was in a class on nutrition, and we had to do a report/presentation for this master project, and my grandfather had passed away a few years back from complications due to heart disease, and I think his treatment was horribly mismanaged, so I was still feeling sad about that and wanted to kind of dive further into that issue and see what I could learn about it. So I chose cholesterol and heart disease as the topic and started to do a lot of research. And really the whole reason I started the blog was just as a way to keep track of my research. I had no intentions of other people reading it or no idea what it would become. It was basically like a research journal for me. And I started writing about cholesterol just to keep my thoughts straight, and I was pretty shocked when the first person left a comment on one of the articles because I hadn’t advertised it or anything. I still have no idea to this day how they found it!
So I’ve had a long-time interest in this subject even before that, and that was five or six years ago, and over that time my understanding has evolved a lot. When I look back at the articles that I wrote five or six years ago at the beginning of the blog, it’s not that they’re wrong. They’re still mostly right, but I would say that my understanding of the topic and its nuances and complexities has evolved quite a bit, and as that understanding has evolved, I, of course, want to share that with my patients and with my listeners and readers. So that’s the primary impetus for doing this product is just that my knowledge has expanded, and my understanding of the topic has grown, and I really want to get that information out there because I see a lot of misunderstanding on both sides of this debate.
There are kind of two polarities, I think, in the discussion on cholesterol and its role in heart disease. On the one hand, you have the cholesterol warriors, as Chris Masterjohn likes to call them, or cholesterol believers, as we might call them, and that side is kind of represented by the dominant paradigm, and they think that cholesterol is an evil nutrient and it causes heart disease and we should get it as low as we possibly can with drugs and whatever other means we have at our disposal. And then on the other side of the spectrum, you have the cholesterol skeptics who are represented by a lot of people in the low-carb community and the paleo community now and primal community, and then the International Network of Cholesterol Skeptics, which is Ravnskov and a bunch of other people who have written books on the topic. And there’s a diversity of opinion there, but the more extreme version is that cholesterol has nothing to do with heart disease, and we shouldn’t even bother measuring it, and we shouldn’t think about it at all. It shouldn’t even be on the radar screen.
So I think that this polarization of the debate has done patients and consumers, readers, listeners — whatever you want to call them — a big disservice because, as is often the case with complex issues, the truth lies somewhere in the middle. And I think the pendulum has actually swung a little bit too far back in the other direction in the cholesterol debate. You know, people have forwarded me posts. I don’t ever really go visit PaleoHacks, but occasionally someone will send me something from there, and I’ve seen people go on there and say that their total cholesterol is 350 or 375, and then I see some other people saying: Well, don’t worry about it; cholesterol is not the cause of heart disease. Or maybe they’ll say: Well, yeah, but you’re in pattern A, so that’s not a problem. And that’s an example right there of somewhere where our understanding has changed over the past year or two even.
The early studies on particle size suggested that particle size was a really significant risk factor, and if you had small, dense particles they were more likely to oxidize and cause heart disease, and if you had large, buoyant particles you were relatively protected. And I wrote about that myself, and I believed that from the research that I had seen. But recently some newer studies have come out that controlled for particle number, and they found that when you control for particle number, the association between particle size and heart disease disappears.
So that’s just one example of how much things can change in this landscape and how we need to stay on top of it and keep learning and keep being willing to alter our viewpoint and change our perspective, because for me, I kind of start this work with the assumption that I don’t know and that I’m gonna be continuing to learn and that I’m gonna be wrong and that I gonna change my viewpoint as my knowledge evolves. And I know that’s frustrating for some people. It’s frustrating for me, of course, but I know that people get frustrated because it’s like: Well, you told me to do this a year ago, and now you’re telling me to do that. And I can certainly empathize with that. But I would rather be wrong and continue to learn and keep an open mind than stay stuck in an old paradigm of knowledge. So that’s basically the choice that I’ve made and where I’m coming from, and I know I’ll lose some readers and listeners because of that, but so be it. It’s important for me to continue to learn. That’s half the reason I do this. I love to learn. I love this continual pursuit of knowledge. It’s one of the things that I enjoy most about the work that I do.
Yeah, so putting this program together was, for me, an effort to really catalyze and synthesize all of this research I’ve been doing over the past five or six years and put it into a really easily accessible format that’s appropriate for both practitioners and people who have a scientific and medical background and for just the average person who is not a scientist and doesn’t have a medical background. Because I get questions every day, you know, people coming to Facebook, Twitter, through my blog, podcast, or even family members and friends. They go to their doctor. Their cholesterol comes back high, and they don’t know what to do about it. And there’s so much conflicting information out there that people are still confused even after being exposed to a lot of different opinions on all sides of the issue. And I just realized that I didn’t have one thing that I could point people to. I mean, I had a whole bunch of articles on the site, you know, probably 15, 17, maybe 20, but the reality is that most people aren’t gonna read that much stuff, and also they weren’t organized in any kind of logical fashion that takes people through step-by-step, OK, here are the underlying causes of heart disease, here’s how heart disease develops, here’s what tests you need to get, here’s how to interpret them, here’s a diet and lifestyle that’s actually heart-healthy in contrast to what’s often recommended by groups like the AHA, here’s the deal with statins, here are some natural alternatives to preventing and treating heart disease, and here’s a way to put all the information together into an action plan. I didn’t have anything like that on my site or anywhere else. And I couldn’t even direct friends and family members to something like that.
So that’s where the idea for this High Cholesterol Action Plan came from, and I’m really excited about it. It feels like it’s been a real labor of love to put it all together, and I think it’s gonna help a lot of people . I’m really excited about it not just for my patients and readers and listeners but for people they’re connected with. I did it as much for that as anything else, because a lot of people who read my stuff or listen to the show, they might know what I think about all of this, but it might be hard for them to describe it to somebody else, and that someone else might need a little bit more to go on than just a couple of sentences from someone they know. So yeah, that’s a few weeks ago, and I hope it’s as useful and helpful to all of you as I think it will be.
Steve Wright: Well, I’m pretty excited for it, and I think I can speak for a lot of people and say we appreciate the way that you approach research and the way that you synthesize ideas and the fact that you’re willing to be wrong, so we hope that you continue it. And I’m gonna save my questions about all this for our next show, because we want to get to some Q&A today, but I think there are a lot of people that are gonna get a lot of help from a product like this.
Chris Kresser: Great. Yeah, let’s do some questions here. We have some really interesting ones this week.
Steve Wright: OK, well, I know you’ve got a cough, so get some water. I want to tell everybody about Beyond Paleo. Beyond Paleo is a similar project that Chris worked on in which he put together his top tips and tricks for losing fat, boosting energy, and preventing and reversing disease without drugs. It’s an email series where, I think, once or twice a week, 13 of them in total, Chris is gonna deliver to your inbox his top tips and tricks. Over 10,000 other people have already signed up, so if this is something you’re interested in, go over to ChrisKresser.com, look for the big red box, and put your name and email in there and get signed up.
All right, Chris, you ready to rock and roll?
Chris Kresser: Sure, let’s do it.
Can yeast overgrowth cause heartburn?
Steve Wright: All right, our first question comes from Ryan: “A little over a year ago, I started to get pretty severe heartburn after drinking beer.” In parentheses, he’s saying that his chest tightens and acid feels like it’s slowly coming up his esophagus. “This was never a problem before. My first thought was that it could be an alcohol allergy, but wine does not cause the same reaction. I started to think that it could be the yeast in Belgian beers because these seem to cause a worse reaction. Yesterday I experienced the same reaction after drinking kombucha tea for the first time, which has plenty of yeast floating in it. Is there a reason for the sudden reaction to yeast? Is there a potential way to overcome it?”
Chris Kresser: Yeah, well, it’s hard to tell, but the first thing that comes to my mind is some kind of fungal infection in the gut. When you have an existing fungal infection, most people will be more sensitive to yeast-containing foods. So one thing to do would be to get a stool analysis from a place like Metametrix and maybe a urine organic acids dysbiosis profile, which we talked about on a previous show that can be used to test for SIBO, small intestine bacterial overgrowth and also fungal infections. So I would probably do a little bit of testing to see if that’s present. If that testing is not available or if it is and you find out that there is any yeast overgrowth, you could try some basic antifungal strategies like Lauricidin, which is a monolaurin extract we’ve talked about before and we’re gonna talk about it again in a later question, and undecylenic acid is another antifungal remedy that I like in addition to some probiotics could be helpful in that situation. So it’s really hard to tell what could be causing that, especially something that came on suddenly. Gluten, of course, came to my mind when he was talking about beer, but it sounds like he had the same reaction with kombucha, which doesn’t have any gluten in. So yeast does sound like the culprit, and the most likely explanation in that case would be some kind of fungal infection or not necessarily a fungal infection, but any kind of gut infection or increase in intestinal permeability perhaps could cause that.
Steve Wright: Yeah, if he was under some stressful circumstances and just was in a state of inflammation, maybe that kind of caused a quick reaction.
Chris Kresser: That’s right. It’s so hard — you know, as a little side note here — It’s so hard sometimes to figure out a single causative factor in a disease process. And I understand the desire to do that, and I played that game for a long time in my illness when I was trying to figure out what was happening. But eventually I came to the realization that it’s extremely rare that is a single causative factor because even if you took 10 people, for example, and you gave them a vial that contained parasites, let’s say, to swallow and they all swallowed it, you wouldn’t see 10 exact replicas of presentation of symptoms. Everyone would manifest a different presentation. Some people might be completely fine and not even develop any symptoms at all if they have really strong immune defenses and gut flora. A few other people might get ill temporarily, and then their immune system would win the battle and they would be fine. A few other people might get kind of ill and chronically ill at a low level, and then maybe a couple people would become seriously chronically ill because we’re not all the same. We’re all unique, and we have different environmental circumstances, different backgrounds and histories, different genetics and epigenetics, and so how we react to something is gonna vary based on all of those factors. And even though it appears that something came on suddenly, for example, like this reaction to beer, what’s more likely is that there was something kind of brewing — haha, no pun intended — all along and it just came, you know, there was some event, like you said, Steve, like stress or some other stimulus that kind of pushed it over the edge.
Steve Wright: Yeah, hopefully he wasn’t just getting back from AHS as well, but I mean, something that he can test again, I would test the kombucha not the beer, probably leave that out. But like you said, there are so many different things there that he probably has an underlying condition, and at the same time, you know, if he really wants to drink the kombucha, he might be able to test it again and find out that he handles it fine now.
Chris Kresser: Yeah, so get some testing if you can, and you could also just do a therapeutic trial of undecylenic acid and Lauricidin, some antifungal stuff and see how that works.
Diet tips for stroke prevention (and stroke recovery)
Steve Wright: OK, great. Let’s move on to the next question from Ashley. This is sort of a two-parter here, two different things, but they are related. She wondering if you have any tips, Chris, for people recovering from a stroke and wanting to prevent future strokes from happening. Should they adopt a ketogenic version of the paleo diet? Any advice on how to lower blood pressure and stay healthy with as little meds as possible?
Chris Kresser: This is a good question, and I want to kinda take a step back and talk a little bit about ketones and ketogenic diets. I know we’ve talked about on the show quite a while back, but for some new listeners, I think just some basics are a good place to start, and then we can get into specifics. Ketones are small water-soluble compounds that are metabolized like fats, but unlike fats, they don’t need carnitine, which is an amino acid, to transport them into the mitochondria. That’s normally how fats are burned for energy. They have to be shuttled into the mitochondria and oxidized to produce usable energy. But in the case of ketones, that doesn’t have to happen, so they can be used for energy by every human cell type. And they’re especially important to neurons, which can only consume glucose or ketones. So if something’s wrong with glucose metabolism, as it often is in metabolic disorders, ketones can be the sole usable energy source, and this turns out to be why a ketogenic diet can be so effective in a lot of different neurological conditions like Parkinson’s, Alzheimer’s, dementia, and then even behavioral mood disorders like depression, and of course, blood sugar disorders like diabetes, which involve defects in glucose metabolism.
So the benefits of ketogenic diets have been well known for a really long time. I think 70 or 80 years they’ve been used in clinical practice. But they’re often not used because the way that they’re typically employed, they’re difficult to sustain, and of course, with the fat phobia of the dominant paradigm that’s, I think, reversing a little bit now, clinicians were reluctant to use ketogenic diets for any length of time because of their concerns about heart disease with a high-fat diet. So there is evidence supporting a ketogenic diet for stroke prevention and for dealing with the sequelae of stroke. In fact, there’s at least four or five studies that I’ve seen and probably more, and the idea is that the protection of neurons results from the enhanced energy reserves that neurons would have because of the presence of ketones, which in turn improves the ability of neurons to resist metabolic insults or metabolic challenges. And a ketogenic diet may also have antioxidant and antiinflammatory effects. So there is a range of possibilities as to why a ketogenic diet may help.
In terms of how to actually implement this and avoid some of the challenges of long-term ketogenic diets, which are usually under 20 grams of carbohydrates, I like Paul Jaminet’s approach, which he calls, I think, the Perfect Health Ketogenic Diet, and that’s a way of using MCT, medium-chain triglycerides and an amino acid called leucine, which is ketogenic, to make the diet ketogenic even with a higher intake of carbohydrates. And so the intake of carbohydrates on this approach would be 50 grams, which generally would be way too high to produce ketones. You wouldn’t go into ketosis normally if you’re eating 50 grams of carbohydrates, but 50 grams of carbohydrates from starchy tubers and fruits can prevent some of the problems associated with ketogenic diets and can make them easier to tolerate over the long term.
So, if you’re eating 50 grams of carbohydrates, you’re gonna need to do two things usually to get yourself into ketosis. One is to increase your intake of medium-chain triglyceride, which is a type of fat and it’s a type of fat that’s ketogenic, and there are a couple ways to do this. One is coconut oil, which is about 50% MCT. You’d have to eat a lot of coconut oil to go into ketosis when you’re eating 50 grams of carbs, something like 8 to 12 tablespoons per day to achieve a moderate level of ketosis. And this is gonna vary, of course, from person to person, so the best way to find out how much you’re in ketosis is to buy Ketostix at the drugstore, which is a strip you can use to test your urine to determine where you’re at in terms of ketosis. So another option — and you can do this in conjunction with the coconut oil — is MCT oil, which is 100% pure medium-chain triglyceride. It’s hard to find in local stores, but you can get it online, and because it’s 100% medium-chain triglyceride versus 50%, you need half as much to get into ketosis, so 4 to 6 tablespoons of MCT oil is about the amount that most people need. Or you could do maybe, like, 2 tablespoons of MCT oil and 4 to 6 tablespoons of coconut oil, some combination of both. Some people really don’t care for the taste of MCT oil, some people like it, but since it’s a liquid oil, one of the advantages to using it is you can put it in salad dressings and things like that, which you can’t really do with coconut oil.
In addition to the MCT and coconut oil, you want to take about 5 grams of leucine per day. Leucine is an amino acid, and some amino acids are ketogenic, and some are glucogenic. And leucine is ketogenic. So 5 grams a day of leucine plus the MCT will generally put people into ketosis even if they’re eating 50 grams of carbohydrates a day. And the leucine, you’re probably gonna need to get a powder because capsules generally only have a few hundreds milligrams, so you’d be swallowing a whole bunch of capsules in order to get to 5 grams per day.
Steve Wright: Is there any timing on that that matters? Like, do I need to take the leucine on an empty stomach in the morning, take the MCT before noon?
Chris Kresser: The timing for the MCT doesn’t matter so much. Generally it’s recommended to take amino acids on an empty stomach, but you may need to split up the doses because taking 5 grams of leucine on an empty stomach might be a little hard to do. Some people will get nauseous and have some other symptoms. So you could split that into divided doses on an empty stomach.
So, as Ashley implied in her question, controlling blood pressure is really crucial for stroke prevention, so these are definitely closely related. There are, luckily, some natural ways to control blood pressure that also will have other stroke prevention benefits. And maybe I should just mention one of the myths about blood pressure that we recently covered in a series on the blog, and the series was about salt and the myth that salt causes hypertension. In fact, in most studies, when you look at the data, you find that salt intake is not very closely correlated with hypertension. There are some hyper-responders who tend to be what we could call salt-sensitive, so they are more likely to experience a rise in blood pressure with salt intake, but even then, it’s pretty mild.
So, it turns out that potassium, as I discussed in that article, is strongly associated with blood pressure. So one of the first things you can do is increase your potassium intake. Starchy tubers are among the highest sources of potassium in the diet. And then other fruits like bananas and papayas and other vegetables are pretty high as well.
The next step after increasing potassium intake would be losing weight if you’re overweight because overweight and obesity are definitely major risk factors for stroke and for blood pressure. And any method of weight loss will have the effect. And you know, this isn’t the time or place to get into a discussion on weight loss methods, which we’ve talked about before, but just know that regardless of how weight is lost, it will improve blood pressure.
Steve Wright: Hold on a sec. With potassium, you just told us about how ketogenic is probably gonna help, but then you said the best place to get the potassium is probably from very carby starchy tubers, so if someone is gonna do the ketogenic approach, could they do a potassium supplement? Is that possible?
Chris Kresser: Good question, Steve. Well, there are some non-starchy vegetables that are pretty high in potassium, but yeah, your point is well taken. If someone’s on a ketogenic diet, probably a combination of non-starchy vegetables that are high in potassium and supplement. I like the potassium gluconate form, and the dose would depend on how much you’re getting from food, but they usually come in 99 mg tablets, and you might try doing one three times a day or two three times a day. You don’t want to go overboard with potassium supplementation because all the minerals should exist in a balance in our body. If you take too much of any one mineral for too long, that can cause some difficulties, and if you are supplementing with potassium, you probably want to make sure you’re supplementing a little bit with magnesium too, which I recommend for most people anyhow because it’s pretty hard to get from the diet.
OK, potassium, weight loss… exercise is really important for blood pressure. I’m sure most people know that. One thing to note with exercise is blood pressure can actually go up at first when you start a new exercise program or just after you exercise, but over time, you would expect blood pressure to go down.
Next would be improving sleep. The quality and quantity of sleep both can impact blood pressure, and one thing that’s really strongly associated with high blood pressure is sleep apnea. So you probably want to get checked for sleep apnea if blood pressure is an issue for you, especially if you’re overweight.
Hibiscus tea is a little-known natural treatment for blood pressure, and there are actually double-blind, placebo-controlled studies on this that show it’s quite effective, and I love it. I think it tastes delicious both hot and cold. It’s used as a kind of summery iced tea, and the studies that I’ve seen used about three 8 ounce cups per day to get the beneficial effect. So to me, that’s kind of a no-brainer because it’s extremely safe, no side effects, tastes good, and it has a proven effect on blood pressure.
Steve Wright: Yeah, do you have a preferred brand for that?
Chris Kresser: I don’t. The local health food store here that we shop at has loose hibiscus, which is really nice. I don’t even know what brand it is. But you know, any health food store will probably have a good hibiscus tea.
Some of you will be very happy to learn that dark chocolate has actually been shown to reduce blood pressure in clinical studies. It’s gotta be above 70%, though, and of course, you have to balance the blood-pressure-lowering effects of dark chocolate with any potential negative effects of eating too much sugar. You don’t want to go overboard with it. But certainly some moderate amount of dark chocolate that’s above 70% can be helpful, and that’s probably due to the polyphenol content of chocolate, dark chocolate especially.
Steve Wright: I don’t know why you have to laugh every time you tell people that it’s OK to eat dark chocolate.
Chris Kresser: I just think it’s good news to share.
Steve Wright: OK.
Chris Kresser: A lot of people are complaining that I’m always talking about things they can’t do, so I’m happy to tell them things that they can do that they like to do!
Steve Wright: Yes.
Chris Kresser: So the last thing is acupuncture. And I’ve seen some really impressive results anecdotally with acupuncture. There are some studies, too, that suggest that acupuncture may be helpful. There’s a debate about whether it’s placebo or a true treatment effect. But in the end, I don’t really think it matters. I mean, if you go to acupuncture and you feel good while you’re receiving it, it relaxes you, and your blood pressure goes down, then to me it doesn’t really matter what the actual mechanism is because there are very few side effects or risks associated with it, and most people find it to be really pleasurable. So I always recommend that to patients with blood pressure issues, and usually it works pretty well, and it has mostly beneficial side effects. People feel relaxed and calm, other symptoms that they didn’t necessarily expect to improve started improving, and it actually often can be a really potent stress-management tool for folks as well.
So, those are several different ways of controlling blood pressure, and then the ketogenic diet we talked about. I think that’s a really good place to start for stroke prevention and then dealing with the aftereffects of stroke.
Steve Wright: Are there any supplements for the aftereffects of stroke, like acetyl-l-carnitine or anything that might be an antioxidant in the brain?
Chris Kresser: Yeah, I mean, some of the specific brain nutrients like acetyl-l-carnitine may help, or ginkgo improves blood flow to the brain. Huperzine can have beneficial effect on the neurons. Glutathione support can help prevent oxidative damage. So, there’s a lot of that sort of stuff, but generally I recommend working with a practitioner on that because some of the brain nutrients can be really beneficial, but some of them can be a little bit hard to work with too, so I would definitely start with all the diet and lifestyle stuff, and then if that’s not doing the job, you could take the next step beyond that.
Steve Wright: Awesome. Well, that was a lot of tips. I think Ashley got her money’s worth on that, and I learned a lot.
Treating reflux and painful gas in infants
Let’s move on to the next question from Kelly: “Chris, could you please discuss what you think about reflux and excess gas in infants? My firstborn and I lost so much sleep the first two years because he was suffering from discomfort in his guts and/or belly, and now my second born is having less intense, but similar problems. It seems that many, many babies suffer from this to varying degrees, which is so sad because they really so suffer and maybe it could be easily fixed. I started eating Kresser-style paleo halfway through my second pregnancy and currently give my infant baby probiotics. I stopped eating all dairy except ghee when he started having reflux symptoms.”
Chris Kresser: This is a really good question, and the honest answer is there’s a bit of mystery to it still. I mean, I’m gonna talk about what I think are the two top causes of this problem, but I’ll also say that I’ve seen it happen even in situations where these two causes really don’t seem to be present. So I think there are other things at work that we may not fully understand at this point, and I know also I’ve heard from lots of parents whose babies had that kind of reflux and then just one day it stopped and they completely outgrew it and they didn’t have any gut problems later on. So yeah, I mean, it’s very troublesome when it’s interrupting your sleep, and it’s painful for the baby, and that can cause behavioral issues, temper tantrums, things like that. So I know it’s really hard as a parent to be in that position, but it doesn’t necessarily mean that something is gonna be really wrong with that child’s gut for the rest of his or her life, so I just want to put that out there.
The two top causes, I think, of this that I’ve observed in parents and babies is there’s something in mom’s diet that’s causing a reaction. And interestingly, this may not be anything that mom reacts to, so it’s not necessarily a food intolerance that mom has, but it’s something in mom’s diet that the baby is responding to. And then the second one would be poor gut flora colonization in the baby. And we’ll talk about each of those.
So in terms of mom’s diet, there are, of course, a number of foods that are known to have a tendency to cause allergies or sensitivities, and dairy is the number one culprit. Usually, though, in the case of babies, it’s not the lactose that the baby is intolerant to. It’s the casein, the protein. Babies naturally have evolved to be able to digest lactose quite well. I mean, that should make sense, right? Because they’re breastfeeding and breast milk has lactose in it. There is a rare condition, I think, called galactosemia that affects about 1 in 30,000 births. It’s a genetic condition where the baby is lactose intolerant right from birth, and they don’t develop properly and they have clear signs of malabsorption and dehydration, so you would know that if your baby had that. It would be obvious pretty quickly, and it requires pretty urgent medical intervention because it can be fatal. So lactose intolerance is not probably an issue for most babies, but casein intolerance can be. Other potential culprits for a food allergy, which I’m sure many of you are aware of, are eggs and corn, pork, fish and shellfish, peanuts, tomatoes, some of the brassicas like onions, cabbage, sulfur-containing vegetables, berries, nuts, spices, and citrus actually I’ve seen be a pretty big problem for some babies. And then chocolate.
Steve Wright: Grains too?
Chris Kresser: Yeah. I’m actually talking just within the context of a paleo diet right now. I kind of assumed that. Or a paleo-type diet. I probably shouldn’t. But I would say grain is less of a problem if mom is tolerating them okay and they’re properly prepared, but I have seen that, for sure. And one of the first things that I do with parents that are experiencing this is we remove dairy if they’re having any dairy. And then if that doesn’t do it, we might remove eggs and nightshades, kind of like an autoimmune protocol. And then if that doesn’t do it, I’ve been lately trying the FODMAP diet, which is a diet that’s often used for digestive issues in the parent, but I’ve actually seen it be pretty helpful. Garlic and onions tend to be one of the biggest offenders that I’ve seen that babies seem to be sensitive to, even if the parents aren’t. So I would first try removing dairy. Then I would try removing eggs and some nightshades. I would try removing citrus. And then I would try doing the FODMAP approach if none of that works.
Something else that’s worth pointing out is that some babies seem to be really sensitive to foods that have been exposed to chemicals while they’re grown or raised, so choosing organic produce and meat whenever possible is also a good idea.
Steve Wright: In the short term while you’re doing all this testing and trying to figure out what the culprit could be, would you recommend that these babies get antacids? Because I’ve heard of a lot of parents who’ve gotten that from their doctor.
Chris Kresser: Yeah, I worry about that because as I’ve discussed in my series on GERD and on the show, the problem with antacids is they reduce stomach acid production, and stomach acid is required to absorb nutrients. A growing baby has a real need to absorb as much nutrients as they can from breast milk and the food that they’re eating. And if you give a baby a PPI or something else that strongly suppresses stomach acid production, then I get concerned about how that’s gonna affect development. So I mean, it may be necessary in some cases, but it’s not something that I would resort to without trying a bunch of other stuff first, personally.
The second thing is that more and more nowadays, I think, the babies are being born with fairly compromised gut flora, and their gut flora is not developing properly. And I want to be very clear in not assigning blame when we talk about this, because the fact is we’re all affected by these variables that are worsening our gut flora, and some of it is outside of our control. For example, the baby’s first exposure to bacteria is in the vaginal canal, and so if a woman has to have a C-section because something goes wrong in birth, the first exposure to bacteria will be the bacteria in the hospital environment, not the bacteria in the mother’s vaginal canal. So obviously that’s gonna be less desirable, and there are a lot of studies now, mostly prospective epidemiological studies, so we have to be careful when drawing conclusions from them, but there’s a fairly robust literature now connecting C-section with a number of problems, metabolic problems like obesity and diabetes later on in life. C-section babies tend to be more overweight by the time they’re 3 or 4 years old, for example, than babies that are vaginally born. And as I said, we can’t know that there’s a causal relationship for sure, but there are certainly mechanisms that make it plausible, and there is a lot of epidemiological data. So of course, even though some women do choose to have a C-section electively, that’s not the usual thing, but most women who have a C-section are doing it because it’s some kind of emergency. So that’s just one of these unfortunate things that can happen, and it’s nobody’s fault necessarily. It’s just something that we have to respond to. So that’s one possibility.
Another possibility is that mom’s flora is not so great. And this is increasingly common, of course. So let’s say mom has some gut issues or she has a long history of antibiotic use, which a lot of people in my generation do. You know, they took antibiotics. They were giving antibiotics out for acne and just about everything else when I was growing up, and a lot of people in my age group have taken a ton of antibiotics. It’s true for women and men. And that can really adversely affect gut health and the balance of flora in the gut. So, if a woman has been on a lot of antibiotics or has gut issues, a history of gut infections, whatever, and then she gives birth, the baby’s gut flora is probably not gonna be optimal. And that’s unfortunate too, because in a lot of cases mom has done everything she could to try to address that, but it’s not always 100% in our control. And in some cases, some of the changes that can happen from taking antibiotics when we were younger are not reversible. So there are just some factors here that are thorny and, like I said, not completely in our control, and I think that the end result of that is that a lot of babies are being born with gut issues and issues with their gut flora more now than ever before.
So what to do about that. Well, one of the things is, of course, for mom to really focus as much as possible on her gut health even after the baby has been born, so if mom can eat fermented foods and take probiotics and really focus on improving her flora, some of that’s gonna be translated into the breast milk, and that will benefit the baby. And then, of course, if the baby isn’t 100% breastfed, then you can give a probiotic infant formula, like Klaire Labs has their infant formula. It’s important to use an infant formulation before the age of 2 because the specific strains that they need are different than what kids need after 2 years old. And then if the baby is starting to eat solid food, then they can, of course, eat probiotic-rich foods themselves, like sauerkraut and kefir if they’re okay with dairy, water kefir perhaps if they’re not, or other fermented vegetables. Actually, one of Sylvie’s favorite foods is sauerkraut! She just gobbles that stuff down like nothing else. It’s kind of amazing to watch. It surprises me. It seems kind of unlikely for a baby to really love that, but she just lights up when we bring it out.
Steve Wright: That’s awesome.
Chris Kresser: Yeah, so sauerkraut and fermented cod liver oil are her two favorite foods, which is really weird.
Steve Wright: I’m gonna withhold comment, but that is a little weird.
Chris Kresser: It’s awesome! And meat, actually. She will eat any kind of meat. So yeah, fermented foods for the baby once the baby starts to eat food. And if all of that stuff doesn’t work, there are some more mechanical things you can try, like positioning during feeding if you’re still breastfeeding a lot. And the La Leche League is a really good resource for breastfeeding issues, including a lot of what we’ve been talking about. You can Google them, and they have a whole section on some ideas for positioning during breastfeeding that can reduce reflux and colic, and they include even certain special kind of props and pillows that you can use to make supporting the right position easier. So, lots of stuff to try there. Give that a shot and report back to us and let us know how it does.
Steve Wright: I’m still thinking about cod liver oil on top of my sauerkraut.
Chris Kresser: Haha.
Steve Wright: I’m just stuck on that.
Chris Kresser: Yeah, she doesn’t put it on top, but I’m sure she would probably like that too. Maybe we should give it a shot.
Steve Wright: That’s so cool that she loves all that stuff. I love it.
Chris Kresser: I don’t understand exactly how this would work physiologically, but I know Elanne ate a lot of sauerkraut during her pregnancy and took a lot of fermented cod liver oil, so maybe that has something to do with it.
Steve Wright: Oh, interesting.
Chris Kresser: Yeah. I think it’s probably good to stop there.
Steve Wright: All right, well, thanks for listening to the podcast today. Please continue to send us your questions at ChrisKresser.com using the podcast submission link. If you enjoyed listening to the show, please head over to iTunes and leave us a review. It helps to get the message out and bring the show to other people that could really use the information that we talk about. Thanks, and we’ll talk to you soon.
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