RHR: How to Treat Acid Reflux in Babies without Drugs
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RHR: How to Treat Acid Reflux in Babies Without Drugs

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Revolution Health Radio podcast, Chris Kresser

In conventional medicine, they start with the symptoms. So for example, if a baby has acid reflux, they prescribe a drug that just suppresses that symptom, without doing any investigation into why the reflux is occurring in the first place. There are so many problems with that approach. One of the main ones is that drugs don’t just have intended effects, they also have unintended effects. If a drug suppresses acid production, what else is it doing that may not be beneficial? What are the effects of acid that are beneficial?

Note: The Prescript-Assist supplements discussed in this article are no longer available. Please click here to learn more about a substitute, the Daily Synbiotic from Seed.

In this episode, we cover:

9:43  The causes of reflux
13:17  Four risk factors for reflux in infants
19:16  Why acid-suppressing drugs (PPIs) may not be the best treatment
29:06  How to prevent reflux and GERD in babies
32:24  How to address acid reflux and GERD

Links We Discuss

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Steve Wright: Hey, everyone. Welcome to another episode of the Revolution Health Radio show. This show is brought to you by ChrisKresser.com. I’m your podcast host Steve Wright from SCDlifestyle.com. With me is integrative medical practitioner, New York Times bestseller, healthy skeptic, Chris Kresser. Chris, how are you doing?

Chris Kresser: Hey. I’m doing well, Steve. It looks like you’re in a different location there. I see a guitar on the wall, a beautiful picture. What’s happening?

Steve Wright: I just came out to visit our producer Jordan Reasoner, my business partner and great friend. I’m out here in Bozeman, Montana in his crib.

Chris Kresser: Nice. What are you guys going to get up to?

Steve Wright: We are going to just hang out with his kids and do some brainstorming together. Then we’re headed out into the woods this weekend to go elk hunting, four days, three nights. We’re going to backpack it way back into the Montana Mountains. We’ll just do some man stuff.

Chris Kresser: Awesome. You guys are doing the whole hunter-gatherer thing to the hilt?

Steve Wright: Yeah, we’re really both trying to get more in touch with the food chain.

Chris Kresser: Nice.

Steve Wright: Personally, my mission this year is to get an elk back in Colorado, and really honor the animals—from their habitat all the way to my plate.

Chris Kresser: It sounds awesome. Have fun.

Steve Wright: Thank you. What have you been up to?

Chris Kresser: A lot. 14Four, the new diet and lifestyle change program, is coming along really well. It looks like it’s going to be an October 14 or October 21 launch. We’ll talk about that more soon. I’m really excited about it. I’m also taking a lot of steps forward with the clinician training program, which I’m super excited about. It looks like we’re targeting a spring launch for the first module in the program, but there will be other modules that come after that. The more I do this kind of work, the more I see the need for that. I get e-mails from people almost every day, asking about clinician training and what kind of opportunities there are to learn a Paleo-oriented approach to functional medicine. There just aren’t many right now. So I figured, why not make one? I’m really looking forward to teaching people how to do this work. There’s such a huge need for it, as you know, Steve, and there’s not a lot of options out there. So look for that, if you’re one of those people who are interested, keep an eye out on the blog and e-mail list. We’ll keep you posted as that unfolds.

Steve Wright: Yeah, that’s really awesome. I know that people have been requesting that from you for many years now. There’s a huge gap there, and a lot of training needs to be developed. I’m very excited for this.

Chris Kresser: We have a great question today that I think a lot of parents are going to appreciate, in particular. Let’s give that a listen.

Lila: Hi. I was wondering if you could weigh in on the prevalence of acid blockers being prescribed to infants for GERD. This is commonly done in the pediatric practice that I work in as a nurse, and I kind of find it concerning. In addition to that, if you have any alternative theories on what the diagnoses and treatment should be for the GERD, that would be helpful. For instance, I don’t know if it’s possible for infants to develop SIBO or if it’s just gut dysbiosis, or what it is. But I have a hard time believing that we have an epidemic of GERD in newborn babies. Thanks.

Chris Kresser: This is a really good question, as I said. It’s one that I think a lot of parents will be interested in, as well as a lot of healthcare providers who work in pediatrics, work with kids. I definitely agree that we’re not seeing an epidemic of PPI deficiency in babies all of a sudden, after several thousand generations of getting along just fine without PPI. It’s pretty safe to say that we haven’t developed a PPI deficiency in young babies.

Steve Wright: What did we do before PPIs? I don’t know.

Chris Kresser: Well, it’s probably true that babies have had colic for a very long time. But to me, this question really gets at the deficiencies of conventional medicine. It’s funny that we were just talking about clinician training for functional medicine. This is really kind of a prime example of why we desperately need training for functional medicine, and we need to change our healthcare system. That’s because in the conventional model, all too often, they work from the outside in. What I mean by that is, in a functional medicine perspective, we look at the core underlying causes of problems—we can call these mechanisms. Then as we move out from a mechanism like blood sugar dysregulation or a gut issue like SIBO or leaky gut, that then leads to certain disease patterns like maybe diabetes or hypothyroidism or IBS—you know, all the diseases that we hear about. Then from there, we go out to symptoms, like gas and bloating in the case of IBS; agitation and mood swings with diabetes and blood sugar issues; or high blood pressure. In functional medicine, we start at the core. We address the underlying mechanisms and the environmental triggers that cause those mechanisms to happen, and that’s how we deal with the symptoms.

In conventional medicine, it often goes the other way around—they start with the symptoms. So for example, if a baby has acid reflux, they prescribe a drug that just suppresses that symptom, without doing any investigation into why the reflux is occurring in the first place. There are so many problems with that approach. One of the main ones is that number one, drugs don’t just have intended effects, they also have unintended effects. If a drug suppresses acid production, what else is it doing that may not be beneficial? Or even, what are the effects of acid that are beneficial? You know, there’s very little in our body that’s just there for the heck of it. It’s not like the only reason we have stomach acid is to make us suffer when we have reflux or GERD. There’s a reason we have stomach acid. So what happens when you prescribe a drug that reduces stomach acid production? It might alleviate the symptoms of reflux, but what else is it doing? We’re going to find out what it’s doing, and it’s not good.

The other problem with this conventional approach is if you take a drug that suppresses a symptom without ever investigating what causes that symptom, then that underlying cause is just going to persist and probably even worsen over time, which can then lead to other symptoms. Then you end up taking a drug for that other symptom. That drug causes a side effect, and wouldn’t you know, there’s a drug for that too. So you’re playing Whack-a-Mole, taking drugs for all these different side effects and then by the time the average person is 65 years old, they’re on four or five different medications. Some people are on up to 12, 13 different medications at that point in their life. This is the system that we’ve created, and it’s completely broken. This is why there’s such a desperate need for functional medicine and new practitioners that are practicing this style of medicine, and also, current practitioners in the conventional system that are starting to integrate some of these principles into their practice. So that’s a little tangent as to why I’m so excited about the functional medicine training. This is actually a really good example of how that is needed.

Steve Wright: Oh, it really is. Your enthusiasm is well-appreciated and I think that what we’re diving into today is going to be hitting home for a lot of people. Because I know even the people that have kids around me right now, some of them, I’ve watched their kids go through this exact scenario. And now they’re dealing with—you know, all of a sudden, they’re five, and now they have to put tubes in their ears. They have really crazy febrile seizures that seem like it’s just a kid who’s super sensitive. But when you back up and go right back to infant stage, already, right now, there’s kids presenting with a, “Hey, everything’s not okay yet.” So yeah, this is really important for young kids, all the way to old people.

Chris Kresser: Let’s first talk about the causes of reflux. Then we’ll talk about risk factors for reflux in infants. Then we’ll talk about why PPIs, acid-suppressing drugs, might not be the best choice. We’ll talk about what might be a better choice.

The Causes of Reflux

I have a whole eBook on GERD and heartburn on my website. It’s available for free. If you haven’t read this, I really encourage you to do that. Go to ChrisKresser.com. Go to “LEARN” at the bottom of the page. There’s a drop-down menu there that says “eBooks.” Click on that, and you’ll find the heartburn eBook. I go into a lot of detail there about what the real causes of heartburn are, so we’re not going to spend too much time on that now.

Essentially, what you need to know is that heartburn is rarely caused by excess stomach acid production. Heartburn is caused by a dysfunction of the lower esophageal sphincter (LES), which is what separates the esophagus from the stomach. Normally, that sphincter is supposed to stay closed. It opens when food goes down, when we eat food and swallow it, so that the food goes into the stomach. Then it’s supposed to shut, so that acid and bile don’t reflux back up into the esophagus. But what happens with reflux and GERD is that the competence of the lower esophageal sphincter is impaired. So it starts to open at inappropriate times, and acid reflux is up into the esophagus. That’s why acid-suppressing drugs can still work, even though the cause of heartburn is rarely excess stomach acid production. The PPI suppress acid production almost to nothing, in some cases, if the dose is high enough. So if you don’t have any acid at all in your stomach and your sphincter is still opening inappropriately, you’re not going to experience heartburn and reflux, because there is no acid left to reflux into the esophagus. I just want to clarify that, because sometimes people say, “Well, if heartburn is not caused by too much stomach acid, how come taking an acid-suppressing drug works?” That’s basically the answer.

The next obvious question is, what causes this dysfunction of the lower esophageal sphincter? Again, there are a lot of different answers that I cover in the full eBook. But one of the main ones is actually SIBO—small intestinal bacterial overgrowth. This leads to an overproduction of gases in the small intestine and the stomach, which can then put pressure on the lower esophageal sphincter and make it open inappropriately. Any kind of dysbiosis anywhere in the gut can contribute to this as well.

Another potential cause could be food intolerances. So if the infant is young enough and they’re being exclusively breastfed, this would be things that they might be exposed to like gluten in mother’s milk, if the mom is eating that and the baby is sensitive to it, or possibly dairy proteins, other food antigens. It’s less clear what gets into the mother’s milk or what doesn’t, but as I know, many mothers listening to this program can attest, the maternal diet does influence the baby in many ways. If a mother eats spicy food, for example, they might notice that their baby is really colicky or has digestive upset after that. Certainly, looking at the mom’s diet is a potential issue for infants that aren’t eating solid food. Then of course, for infants that are starting to eat food, we want to look at what they’re eating. Those are the basic underlying causes of reflux in infants. Again, there may be others, but these are the ones we’re going to focus on today. So what are the risk factors for reflux in infants?

Four Risk Factors for Reflux in Infants

One of the biggest ones is maternal antibiotic use during pregnancy. This can happen for a number of reasons: to deal with group B streptococcus (GBS), other infections that a mother might get, or even maternal antibiotic use prior to pregnancy. What we know now is that the mother’s gut flora profoundly influences the baby’s gut flora. Researchers used to think that the baby’s gut was completely sterile until they are born essentially, until they moved down the birth canal, where their first exposure to bacteria is in the vaginal canal—the baby gets exposed to both the vaginal microbiota and feces, and that was the initial colonization, and that totally determines the kind of imprint of gut flora that the baby gets. But there’s actually some recent research that suggests colonization of the baby’s gut actually happens in utero, or it begins in utero. So the status of the mother’s gut health, both prior to pregnancy and during pregnancy, is providing that initial imprint of the baby’s gut flora. So for people who are planning to conceive, women who are planning to conceive, it’s really crucial to do everything that they can to optimize their own gut microbiota prior to conceiving. That’s in an ideal world. Of course, not everyone knows this or has the opportunity to do this, so we always have to just start from where we can. But it’s never too late to pay attention to this.

The second thing would be the method of birth. We know from many, many studies now that Caesarean birth, that kids born via C-section, have different gut flora and less optimal gut flora than kids who are born vaginally. The reason for that is what I just mentioned. Whether or not colonization of the gut begins in utero, we know without a doubt that a major aspect of how the gut flora develops in the baby is from that exposure in the birth canal. And in a C-section birth, that obviously doesn’t happen. The baby is removed surgically and the first exposure that that baby is going to get is to basically ambient bacteria in the hospital environment, which is very different than the bacteria they’d be exposed to in the birth canal. They’ve done lots of studies, and found that babies that are born via C-section are more likely to develop obesity, diabetes, and other problems later in life. Of course, many women don’t go into the birth process saying, “Gee, I want to have a C-section.” C-sections happen. They’re lifesaving, in some circumstances, for both the mother and the baby. I’m not condemning emergency C-sections at all, but I am suggesting that elective C-sections are not a good idea, which are on the rise. You know, women choose to have C-sections because of the convenience of knowing exactly when their delivery date will be. And I am suggesting that there may be ways, by optimizing nutrition—like we talk about in The Healthy Baby Code—to minimize the risk of C-sections, by making sure that the birth process happens as naturally and optimally as possible.

Another risk factor would be how the baby is fed initially, so whether it’s breastfed or formula. Breast milk is the optimal prebiotic, probiotic food for infants, and that evolution over hundreds of thousands of generations has taken care of that. There’s not really any way that we can improve on breast milk. Breast milk, for example, contains galactooligosaccharides, which are prebiotic molecules that selectively stimulate the growth of bifidobacteria, which is one of the most important species of beneficial bacteria in the gut. Some formula producers are starting to get wise to this, and they’re adding some prebiotics to formula. But it’s never quite the same when you create a synthetic version. So far, I don’t think you can get the same outcome with formula that you can get from breastfeeding. Once again, there are a lot of women out there who want to breastfeed but can’t, for any number of reasons. This is not something to feel guilty about. There’s still a lot you can do to make sure that your baby’s getting what he or she needs. I’m more, again, addressing when we have a choice, when there’s a choice to breastfeed or feed formula. The research is abundantly clear, even in the conventional medical world now. Thankfully, they’ve gone back from the craziness of the ‘60s and ‘70s, where formula was the recommendation. They now pretty much universally recommend breastfeeding across the board. The World Health Organization (WHO), in fact, recommends six months of exclusive breastfeeding with no other food, and 22 months of complementary breastfeeding, which means continuing to breastfeed, at least in some level, for almost two years. Unfortunately, very few women do breastfeed for that long. But that’s what’s been determined to be optimal, even by groups like the World Health Organization.

The last risk factor we already talked about a little bit, and that’s food intolerances. Those food intolerances are typically related to these other risk factors that we’ve already talked about, like poor maternal gut flora, poor infant gut flora, and then being born via C-section and being formula fed. Those kids that fit into those categories are more likely to develop food intolerances in the first place. Okay, so now that we’ve talked about the causes, the risk factors, let’s talk about treatment and why PPIs may not be such a good idea.

Why Acid-Suppressing Drugs (PPIs) May Not Be the Best Treatment

As I’m sure almost everyone knows, who’s listening to the show, PPIs work by inhibiting stomach acid secretion. What some people may not know is that stomach acid, as I said before, is actually there for a reason. It plays some really important roles that don’t just involve making us double over in pain if it refluxes into the esophagus. Stomach acid initiates the process of digestion, when we eat protein in particular. All other foods get mixed around with stomach acid, and they become a substance called chyme, which is kind of a sludge-like substance, in a consistency that can then pass through into the small intestine, where the nutrients start to get pulled out even more. But nutrient absorption actually begins in the stomach. And there are numerous studies that show that acid-blocking drugs impair the absorption of all kinds of different vitamins and minerals. That’s not surprising when you know that stomach acid is required to absorb those nutrients in the first place. These include things like vitamin C, iron, magnesium, B12, folate, and other B vitamins. These nutrients are important for adults, but they’re even more important for developing babies. So folate and B12 in particular are needed to form new red blood cells, and they play an important role in methylation, which silences and activates gene expression, which, in turn, regulates just about anything in the body. Vitamin C is important for collagen development and the structural development of the body, in addition to immune function. Iron is also involved in red blood cell function. Without enough iron, babies will become anemic and not develop properly. Magnesium plays a role in over 300 different enzymatic reactions in the body, it’s one of the most important nutrients that we need. And all of the other B vitamins—B6; B5, which is pantothenic acid; B1, which is thamine; B2, which is riboflavin; B3, which is niacin—are all essential. Again, they’re all there for a reason. We need them. They’re all essential nutrients. And PPIs inhibit their absorption. We could potentially see an increase in things like neurological issues from B12 deficiency; problems with development, like I said, of the structural tissue in the body from vitamin C deficiency; behavioral disorders like ADHD, autism, et cetera because of folate and B12 deficiency. These things are on the rise in kids. There may not be enough kids now taking PPIs that this is making a significant contribution, but this could certainly happen if we continue with our current course.

Another important role of stomach acid is to prevent infection. We’re exposed to bacteria, viruses, and fungi all the time. They’re all around us in the environment. But a lot of times, if we get exposed to them through food or water that we swallow, the stomach acid just takes care of that. Many of these organisms cannot survive in a really low pH, acidic environment like the stomach. The stomach acid is our first line of defense against these organisms entering through our mouth and when we swallow. As you might suspect, PPI use has been associated with an increased risk of infections of all types, but particularly gut infections and something like Clostridium difficile, which is a potentially fatal gut infection. Very serious. It’s a cause of concern. It’s been shown that there’s an increased risk of community-acquired pneumonia in people using PPIs. Back to the nutrient absorption issue, PPIs have been associated with decreased bone mineral density, because calcium absorption is impaired, and also maybe the fat-soluble vitamins—like vitamin D, which plays a role in calcium metabolism, and K2.

Yeah, I know. It’s kind of ridiculous. It’s like one of those commercials, where at the end of the commercial, they say, “This drug is…” It goes on for like 30 seconds with the elevator music playing in the background. It’s like, I can’t believe anyone would buy this drug after hearing this. PPIs have been shown to increase the risk of SIBO. So that’s pretty ironic, right? SIBO is one of the underlying causes of reflux in the first place, and PPIs have been shown to increase the risk of SIBO. Then SIBO is also associated with everything from skin issues like eczema, to cognitive and behavioral issues, to malabsorption. A lot of things that show up in kids, right? A lot of kids have eczema. It’s one of the most common problems. In my work with young children, I found that eczema is almost always related to gut issues. And when we address the gut stuff, the eczema goes away. Perhaps most ironically, as I said, SIBO is associated with GERD and reflux. There’s even a paper in the scientific literature—I nearly spit on my coffee when I came across it—that was called Evidence That Proton Pump Inhibitor Therapy Induces the Symptoms It Is Used to Treat. I mean, that’s a paper you don’t even need to read, really, right? That’s such a great title. It pretty much says it all. But of course, I did read it. They talk about some other interesting mechanisms by which PPIs can actually induce acid reflux.

PPIs increase gastric pH, which means they make it less acidic and more alkaline. This, in turn, substantially increases the concentration of something called gastrin. Then gastrin promotes the release of histamine, which, in turn, provokes increased acid secretion. This will lead to a rebound effect after stopping PPIs, where more acid is produced. The gastrin actually causes a growth in the tissue that produces stomach acid. So when you stop the PPIs, you’re producing more acid than you were before you started taking them. This rebound effect has been documented, and it’s been shown to last for at least four weeks, possibly longer, because they ended the follow-up period after four weeks, and many of the patients were still experiencing symptoms at that point. We could go on, but I’ll just mention a couple other things, and then we’ll talk a little bit about alternatives.

PPIs are also associated with weight gain over the long term, in adults at least. One study in adults showed an average increase of about 10 lbs in weight in about 70% of patients that were taking PPIs over a two-year period, whereas only 9% of patients in the control group gained weight over that period. That’s pretty significant and alarming, especially given childhood obesity rates on the rise. I mean, even the FDA cautions against the long-term use of PPIs. It’s a real problem. They were never approved for long-term use. That’s an interesting little historical note about PPIs, is they were initially only approved for short-term use. They were never intended to be taken for years and years. I just got an e-mail this morning from someone who has been on Nexium for 30 years, 35 years I think he said. He’s wondering how to get off of it. That’s just a complete, huge mistake, an oversight by the FDA and other regulatory agencies, and just another problem with the way that our system is constructed. You know, doctors made those prescriptions, and people just kept taking them for years and years, with no approval for that kind of activity.

Steve Wright: Last time I checked, eight weeks was the length.

Chris Kresser: Yeah. Eight weeks maximum.

Steve Wright: Yeah, maximum.

Chris Kresser: Let’s talk a little bit about what else to do. Because one thing I want to say here is thankfully, Sylvie didn’t really ever deal with reflux or GERD. But like you, Steve, we’ve been around some friends and parents who have a baby that’s suffering from GERD, and it is not easy. It is extremely difficult to see anyone who has a kid, even just seeing a kid have a bad cold or something—it’s really hard to watch your child suffer. And it’s hard on the parents if it’s interrupting their kids’ sleep. I completely understand the desire, and the willingness, even, of parents to give their children PPIs if it will help relieve the pain and restore some sense of normalcy in the house. I’m not condemning parents for this at all. There’s just very little discussion of alternatives or the real causes in the community, which, of course, gets back to the whole thing about the need for functional medicine training. Okay. Let’s talk about how to prevent reflux and GERD for mothers who haven’t given birth yet or people who are still in the family planning stages. Then we’ll talk about how to address it if it’s already there.

How to Prevent Reflux and GERD in Babies

Not surprisingly, how to prevent it is just sort of the reverse of the triggers and how to get it, which means optimize your gut flora. There’s a study that I just read called Can Nutritional Modulation of Maternal Intestinal Microbiota Influence the Development of the Infant Gastrointestinal Tract? Translation—can what a mom eat improve the gut flora of her baby? The short answer was a resounding yes. They went through all these different mechanisms for how a mom changing her diet actually directly impacts the gut flora of her baby. So that’s number one, is making sure that mom is doing everything that she can to optimize her gut health. I talk a lot about that in my book, Your Personal Paleo Code (published in paperback as The Paleo Cure in December 2014) which is going to be relaunched in paperback as The Paleo Cure at the end of this year. There’s another free eBook on my website that’s all about gut health. You can get some tips there if you’re new.

Another thing is probiotics and prebiotics can be helpful for improving mom’s gut flora. In an ideal world, we wouldn’t need to take those. But let’s face it—we don’t live in that world, we live in a world that is hostile to gut health in so many different ways. And many of us took a lot of antibiotics when we were young. We might have been born by C-section. We might have been fed formula, especially if you’re in my generation that was raised in the ‘60s and ‘70s, where breastfeeding was kind of out. So some probiotics, prebiotics: things like Prescript-Assist, which I sell in my store, I have a lot of success with, and is a great choice; Prebiogen is a great prebiotic; resistant starch, which we talked about a lot, like potato starch; fermented foods like sauerkraut, kefir, kimchi, beet kvass. All this stuff can be really good for restoring good maternal gut health.

Another thing would be vaginal birth whenever possible. Of course, there are situations where a C-section becomes necessary, but you want to do everything you can to have a natural birth. You want to breastfeed and you want to breastfeed exclusively for six months and in a complementary way for 22 months optimally, if you can. I realize that’s hard for some women who have full-time jobs outside of the home. You know, there’s always the ideal and the actual. But those are the guidelines, that’s the recommendation. Even if you can’t breastfeed, there is an increasing number of donor milk banks available, where you can actually purchase milk from women who have a surplus of milk. This is the preferred, what I would suggest investigating first, if for whatever reason, you can’t breastfeed and you can’t pump your own milk.

Then, of course, mom needs to avoid any of her own food intolerances. If you’re gluten intolerant, you obviously don’t want to be eating gluten. If you’re dairy intolerant, you don’t want to be eating that. Then you would obviously want to remove those foods from your diet, to prevent any problems from occurring with the baby.

How to Address Acid Reflux and GERD

So let’s say you’re here, you have a baby, your baby has GERD, and you want to know what to do about it. Obviously, you would do everything that I just mentioned for prevention, it’s still a good idea to do all of those things. But in terms of treatment, there are a few different options.

Number one is there are several studies that have shown that probiotics can ease colic and reflux. One of these studies shows that babies who consumed probiotics during their first three months of life were significantly less likely to have colic in the first place. There have been other studies that have shown that probiotics have actually reduced colic, even after it exists. So some studies have found that it doesn’t, some studies have found that it does. Overall, the review papers suggest that probiotics are beneficial. One of the ones that I’ve recommended before on the show is Ther-Biotic Infant, which is Bifidobacterium infantis. It’s a probiotic that’s appropriate for kids under two years of age. Another probiotic that’s been studied quite a bit in infants is called Lactobacillus reuteri, R-E-U-T-E-R-I. That’s been shown to be effective for colic in some studies.

Another thing to consider is putting a little galactooligosaccharide in the baby’s diet. If you’re just breastfeeding, there are a few different options to get these things into your baby. You can lightly dust the nipple with Ther-Biotic Infant powder and also galactooligosaccharides. One product is called Galactomune, from Klaire Laboratories. It has galactooligosaccharides and beta-glucans. Galactooligosaccharides are in breast milk, but additional galactooligosaccharides may be helpful for increasing beneficial gut bacteria in babies that are having trouble. So you can lightly dust the nipple, or you can take some out of the container and put it on your finger, and just put your finger in the baby’s mouth. They taste neutral and fairly pleasant, like a mildly sweet taste almost, babies actually like them.

If the baby is eating solid food, you of course want to stick with a hypoallergenic, anti-inflammatory, Paleo type of approach. You want to probably try removing some of the foods that may cause problems, even if they’re healthy foods. Eggs is a big potential offender for really young babies. Even Sylvie, when she was six months old, egg yolks were one of the first foods that we introduced. She had a projectile vomiting episode after she ate her first soft-boiled egg yolk, which was pretty horrifying for us. Then we just waited. We said, “Okay, that doesn’t work.” We went on to liver, which she loved. Then we went back to egg yolks about a month later, and she had no problem then, and still has no problem with them. So sometimes kids are sensitive to foods initially. Things like eggs, dairy—all of the ones that we look for as adults are also likely to aggravate kids, in some cases. You want to do some experimentation there. Obviously, removing gluten, gluten-containing grains, grains in general, processed and refined flour, legumes, things that can aggravate poor digestion should be removed. That can often make a big difference as well. That’s where to start. Fortunately, babies and young kids in general tend to respond really well to dietary interventions and probiotics and prebiotics. They haven’t had as many years to become damaged as we have as adults. They’re easy to work with in a certain way, because they respond so quickly. They’re hard to work with in that they can’t tell you exactly how they’re feeling and what the response is, but they tell you one way or another. Anyone who’s been around a baby with GERD, they’re telling you if they have it.

Steve Wright: So what happens, Chris, if the probiotics, the prebiotics, and the dietary changes don’t work? What’s the next best step, for a parent out there listening to this?

Chris Kresser: Well, there’s not really a clear alternative to acid-suppressing drugs for the acid suppression itself. In adults, as you know very well, we do things like give hydrochloric acid (HCl) in pills. You obviously can’t do that with infants. Infants are not going to be able to swallow HCl capsules. And you certainly can’t open an HCl capsule and put it in the infant’s throat. Please do not do that. That’s corrosive. The acid will damage the esophagus. So there’s no easy way to get things into the baby that can replace stomach acid.

Steve Wright: Is there any bitters that might work?

Chris Kresser: Swedish bitters may be an option. Apple cider vinegar may be an option too. I would probably explore that before I considered PPIs. But to be honest, Steve, I’ve yet to have a baby that didn’t respond to diet intervention and probiotics and prebiotics, and also changes in mom’s food intake, probiotic, and prebiotic status.

Steve Wright: Just one last thing in this. So it’s happening right now, you can’t change the diet right now, the baby is going nuts. I know in adults, we can give baking soda, to help with the acid suppression. Is that something that might be used in a pinch for a baby? Or is that another one of the adult things that we do not use in infants?

Chris Kresser: Well, I don’t actually know the answer to that. I’ve never done that, and I would have to look into it before giving a clear answer. I don’t want to mislead anybody. But maybe we can come back to that. We can talk about that on a future show. I think ultimately, if you have to do a PPI for a period of time just to get some relief for everybody involved, you just want to minimize that as much as possible, because of the potential for rebound reflux that we talked about earlier, and because of the other issues with PPI use over the long term. And you want to make sure that they baby’s nutrient intake is adequate during that period or above adequate, because of the way that PPIs can interfere with nutrient absorption. I hope that helps. It does require a bit of trial and error in the whole process, but it’s worth it to avoid being on a long-term, acid-suppressing drug. Thanks again for your question. We’ll see you next week.

Steve Wright: Thanks, Chris. I can tell you’re pretty passionate about this subject, and it was a very informative show. Thank you, everyone, for continuing to send us your questions. In-between episodes, if you haven’t already, make sure you’re on Chris’ e-mail list. That’s where he’s going to be sending out his latest articles. If you haven’t gotten things like his heartburn book or his gut health book, you’ll want to be on the e-mail list for updates regarding that kind of thing. Then you can also just Google Chris Kresser and gut health, or Chris Kresser and heartburn, and you’ll pull up those eBooks that we referenced in the show. They’ll also be in the show notes. Lastly, if you’re not following Chris yet on Facebook, go to Facebook.com/ChrisKresserLAc and Twitter.com/ChrisKresser, if you want to be up to date on these new studies that he’s always reading and staying up to date with. That’s where to go to get the latest research. In the meantime, thanks for listening.

  1. Any reason why your podcasts aren’t updating on the iphone podcast app? Last one I have is Oct 2 🙁

  2. Chris
    What do you think about the Weston A Price recipe for formula? I can’t breast fed my 7 week old twins due to a mastectomy and I can’t afford buying breast milk. I looked into it and found it would be $9/oz and that equated to $2,700/mth! Not feasible for the average person.
    You stop at breast milk as the only option in both this article and your baby plan download you sell. What about for those of us who physically can’t breast fed and can afford to buy breast milk?
    One of my twins is suffering from acid reflux and I’m at a loss what to do. I’m currently making my own formula using the Weston A Price recipe which includes a probiotic.
    Thanks for your suggestion!

    • I think it’s a good option. I don’t recommend their liver formula, though, as I think it has too much iron for an infant.

      • Now I feel at a loss – I was going to try their liver formula bc I want to avoid giving baby milk proteins bc my first had cow milk protein allergy, though even that recipe has casein. What do you suggest for feeding if you can’t use whey or casein? Thanks!

        • Hi Chris,

          I see you say that you offered Sylvie her first solids at 6 months — I’ve always read and been led to believe that exclusive breastfeeding for the first 12 months is “ideal” (I suppose largely by other “crunchy” mamas, not any particular research) and planned on doing so with my now 6 month old son. Do you think there is any harm done in exclusively breastfeeding up to 12 months or more, if mom has a healthy diet? I would love to see any research you’re familiar with on the topic!

          • My daughter had such severe reflux caused by a severe gastric emptying delay that she had to feed every hour (small amounts). Her paed GI insisted she keep just to breastmilk because it is the most easily absorbed substance to feed babies (the quick absorption was essential for my daughter’s conditions). The paed GI told me that breastmilk is all babies need until somewhere between 12-15 months when food starts to become needed as a supplement. Before that time it’s really just to let them play with food and get them used to the idea. The only downside to exclusive breastfeeding is that the iron levels that babies need will start to drastically jump up from I believe it’s 6 months – to more than you can produce in your milk. So, you can supplement with iron and maintain the exclusive breastmilk or have blood tests done to ensure your baby doesn’t start developing anaemia. Or you can start adding high iron foods as a supplement to the breastmilk. But – I know friends/family who only think they know will tell you different but… – babies do not need more than breastmilk for the first 12-15 months.

    • As the baby travels through the birth canal it is exposed to bacteria there. During the birth process the baby is also exposed to small amounts of the mother’s feces, which of course contain gut bacteria.

  3. The biogaia drops aren’t sold any more under that brand. There is a combined probiotic vitamin d supplement called protectis. It looks like the reason is probably that Gerber licensed the probiotic, they sell what looks like the same bottle with a different label with biogaia on the label.

    • The Gerber probiotics are called Soothies. It’s a shame that a Nestle brand are selling them now.

      For what it’s worth we used the BioGaia brand with our first son and it did wonders for his fussiness. We moved on to the Klare Labs one later and my son is very rarely sick unlike a lot of his friends.

    • Apparently Gerber bought and rebranded biogaia as Gerber Soothe which they market for colic. The reason they did this is because there have been studies showing a reduction in colic with probiotic use and biogaia is one of the best on the market. I believe it is still made by biogaia though and the new product is co-branded with the old biogaia brand logo.

  4. I believe the main rise in infant GERD is due to putting babies to sleep on their backs. I watched my 1st grandchild (breastfed) pretty much drown in his own spit-up one day. He had terrible reflux problems as a baby. I convinced my daughter to put the next 2 on their bellies (firm mattress & sheet, of course) – no problems. Years ago, if a baby was found on their back in a hospital nursery, the nurse in charge was fired. It’s not rocket science folks….show me the studies that PROVE SIDS is directly caused by belly sleeping – we need to rethink our parenting advice!

    • thanks for your comment. it is highly likely that the reason sleeping prone reduces SIDS in infants is because sleeping on their tummies exposes them at a much higher rate to all those horrible flame retardants and other chemicals used on baby mattresses off-gassing. those chemicals can disrupt their thyroid and can interfere with the biochemicals signals that regulate breathing while they sleep. if you google new zealand crib mattress wrapping study, the results are astonishing.

      hope this helps someone. you don’t have to buy a fancy organic mattress if that is not in your budget, you can protect your family by wrapping mattresses in food grade polyethylene plastic. i know it isn’t ideal, but it is MUCH better than the toxic chemicals used in mattresses.

    • Recent studies are pointing to a bubble of air being trapped near the baby’s face when they lie on their tummies. Some suggestions I have been given are to use a fan to help circulate the air. Having said that… check out the tucker sling/wedge and other such reflux sleep aid devices. My daughter uses the tucker sling/wedge and it’s been a literal life saver.

  5. Hi!, I have a 7 year old who has been complaining about his stomach hurting. When I ask where does it hurts sometimes he points at the stomach and sometimes he points to the esophagus. His pediatrician recommended over the counter prevacid. Today when I open up your newsletter I was excited to hear about this topic. Are these recommendations applicable just for babies or would it work for my 7 year old.

  6. Thanks for this, Chris! You explained a lot to me about my special needs son and his GERD, particularly as a baby. The doctors frequently prescribe PPIs for my son’s syndrome, but I was able to get him off with a change in diet. Many gasped at this idea, but I don’t regret it. GERD and constipation is still a struggle because of some other issues related to his genetic condition, but the probiotics are helping. This was very helpful for me.

  7. The prevalence of reflux in babies could also be irritation of the vagus nerve during birth due to narrower pelvises. Weston Price’s work would affirm that POV. An osteopath or chiropractor could help in those cases.

  8. I would have also mentioned that often, when mom has overactive letdown, babies have symptoms of reflux. So, if the baby is breastfed, I’d 1st look into that potential issue.

  9. Just one more comment – for babies with GERD – babies who do not have a good functioning sphincter between the stomach and the esophagus usually outgrow that problem by age 1. The problem resolves.

  10. I ate paleo for 2 years before pregnancy, then during my pregnancy I slipped a little eating more carbs than usual, but still staying off gluten and dairy. We eat really clean and have for years. I was diligent about my supplements and probiotics throughout my pregnancy. We had planned to have a home birth but had an emergency c-section instead. I gave my son probiotics immediately after birth and backed off when he started eating sauerkraut around 8 months old. He had absolutely horrible spitting up for 7 months. It never seemed to bother him, it didn’t smell acidic, but he threw up copious amounts of milk (he was exclusively breast fed until we started solids). I was eating more strictly paleo again after he was born, still doing supplements and probiotics. I decided to try an elimination diet to see if something I was eating was the cause and instead, in 2 days, my milk supply completely dried up. I panicked, reintroduced everything I had eliminated and my supply came back a day later. I decided his throwing up was better than my supply disappearing. I know he still has dysbiosis despite all my efforts and we are still working on it. This is all just to say that sometimes, even all the right things don’t work, but it will pass and I’m sorry for anyone else that has to go through all this!

  11. What a misleading title: drugs in babies with acid reflux! Really!
    What baby do you know who was treated with drugs? I have never heard of that.

    This is what WebMD says is treatment:

    For infants:

    Elevating the head of the baby’s crib or bassinet
    Holding the baby upright for 30 minutes after a feeding
    Thickening bottle feedings with cereal (do not do this without a doctor’s supervision)
    Changing feeding schedules
    Trying solid food (with your doctor’s approval)

    • There are hundreds of babies being treated with PPIs. I saw this first hand in the pediatric GI clinic I worked in as an intern. It’s a growing problem over the past 10+ years: http://www.medscape.com/viewarticle/751973

      FYI, giving an infant cereal in its bottle is a TERRIBLE idea. Same goes for solid food under the age of 6 months. Shocking that WebMD would make such ill-informed recommendations.

    • My grand daughter had very bad reflux when she was born. She was prescribed Prilosec by her pediatrician and took it for a least a year. I was very worried about her taking this medication and asked my daughter if she would give her probiotics for infants to see if it would help. She asked her pediatrician and she said absolutely no probiotics could be used for the baby. She felt even probiotics for mom was questionable. This pediatrician said she gave her own infant Prilosec. This was a very well respected doctor in the community. I felt I could not argue against the doctors recommendation, but my grand daughter is now 15 months old and I still worry about the effects of a medication taken for such a long time.

      • My daughter’s paediatric gastroenterologist recommended my daughter go on biogaia because of her reflux. Your grandsons paed might not be well-informed about probiotics.

    • Loads of babies are being treated with PPIs – including my own. You must not have had a baby with severe reflux… I’ll explain:

      Elevating the head of the baby’s crib or bassinet – This only partially works at night – my child still experienced choking episodes and broken sleep even when on a 35 degree angle.

      Holding the baby upright for 30 minutes after a feeding – this only partially works and the idea is to have held them up until the biggest portion of their meal is digested. My daughter kept vomiting (including projectile vomit) even 1.5-2 hours after a feed. She had to be held up every minute of the day until she could sit up on her own and even then her leg position was squeezing her stomach and still causing reflux.

      Thickening bottle feedings with cereal (do not do this without a doctor’s supervision) – First and foremost you don’t HAVE to use cereal or rice to thicken feeds if that is what you really want to do. You can use any puree to thicken the feeds even if it is a vegetable puree. Second and MOST IMPORTANT is that studies have shown that thickening feeds only works in SOME babies but not in all. It is a CHANCE that it will work not a guarantee. Additionally, if you have a baby that has a gastric delay that is causing the reflux (like I do) then this method IS DISASTROUS as they are already having trouble digesting breastmilk which is the most easily digested substance so adding a difficult to digest substance will just make the situation SO much worse.

      Changing feeding schedules – very frequent small amounts every 1 to 2 hours day and night still didn’t work for my daughter…

      Trying solid food (with your doctor’s approval) – see my note on thickening the feed above.

    • Joyce,

      Research does not support solids introduced to infsnts under 6 months and most definitely, not rice cereal added to a bottle. Babies who spit up, even projectile vomit, are probably fine as long as they are gaining weight well and not in extreme discomfort. “Happy spitters” is a label given to the babies who cause large quantities of laundry from their spitting up. It truly is very uncommon for a baby to have actual GER. Acid reflux refers to excess acid returning up the esophagus…this would be painful. Because the infant has a weak lower esophageal sphincter, the flap that opens erroneously to allow reflux, they can spit up easily and often. Blocking acid will not treat this issue.

      Parents of reflux (perceived) babies should work with a lactation professional as they are trained specifically in infant breastfeeding matters. Medications to block acid just aren’t the answer for babies in nearly all cases.

  12. Great article. I would like to add that it is important to make sure that it is really reflux. When my daughter was an infant of about 3 months she was having distress while nursing or taking a bottle and was diagnosed with “silent reflux.” The pediatrician suggested antacid drugs. I didn’t want to give her those drugs and did exhaustive research and found references to using chiropractic for similar symptoms. I was unfamiliar with chiropractic and nervous about using it on an infant but I found a chiropractor who specializes in treating children. After one extremely gentle treatment the symptoms were about 75% better and after a couple more the symptoms were gone. Turns out what the pediatrician had diagnosed as reflux was really her cervical spine out of alignment, which apparently happens frequently in the birth process, especially if there is a C-section. As a result her vagus nerve was being impeded, which affected her swallowing and eating.

  13. Glad you are tacking this topic, but don’t forget about milk transfer. Babies who are tongue tied, for example, gulp air. The symptom of this is reflux and another symptom is “colic”. Tied babies may later have food intolerances if they have the MTHFR gene mutation(s) as well. Mother’s milk flow can be too fast, baby can have a bad latch and there can be other oral deficiencies that contribute to reflux. It is not very common for mom’s diet to be the cause of infant reflux. Suggesting an elimination diet before ruling out all oral factors is 1) inefficient because it is more likely to be an oral factor and 2) harmful practice because eating (self care) is already difficult for a new mom. Adding this other stressor, the colicky baby, she needs to have all potential causes examined before a plan of action is given. Still happy to hear you tackle this though. You’re on the right path.

  14. This came at a perfect time! My one month old was recently hospitalized with a fever of 101.3 and antibiotics were given. He is breastfed but struggles with gas due to forceful letdown. We suspect reflux issues as well. Am going to pursue the probiotics. What would you recommend for dosage and duration for a 5 week old weighing 13lbs?

  15. What if the GERD is so severe that it is causing ALTEs and then investigations show the fundamental cause is a severe gastric emptying delay? Would extended PPI use be justified then? Or… is the use of PPIs (used as a reflex to reduce the ALTEs) known to cause a gastric emptying delay – even if the food is exclusively breastmilk?

  16. I give my daughter the pre&pro biotic cereals made by Happy Bellies. She had to have her first antibiotic this last month due to a long standing ear infection. Since the antibiotic she has had a significant increase in “spit-up” I’m wondering if it is problematic to add additional pro or pre biotics on top of what she is already getting?

  17. Great article. Just one small point, though. There is no way that someone has been on Nexium for 30-35 years. It has only been on the market for 10-11 years. I used to work for a health insurer, and when it came out, we had to tell people they couldn’t get it covered until they had tried another PPI first.

  18. hi chris

    just wondering if parasites can cause GERD as well and your thoughts for adults on Surgery if theLES is not working properly despite all your recommendations.

  19. As I’m no longer a baby, I downloaded and read your ebook on GERD, and I was surprised you didn’t mention the effect of caffeine on the LES. Almost 20 years ago, I figured out that I got reflux when I ate wheat, which I gave up, and I was reflux free for about 10 years after that. Then it came back, especially when I drank lots of black coffee, so I researched that, and caffeine is known to reduce the tone of the LES.

    I had an upper GI done, and it showed I essentially had no LES, that is, it was 100% open when it should have been closed. I don’t know if that could be reversed by giving up coffee entirely, but I’ve given up enough. So I can use an acid reducer and accept the resulting risks or scar my esophagus with acid and accept the resulting risks from that or give up coffee and be miserable for whatever remains of my life.

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