Category Archives: GERD

“You’re Just a First Time Mom”

“You’re Just a First Time Mom”

Have you ever heard this? How did it make you feel? Were you quietly seething inside or did this finally convince you that someone else knows your baby better than you?

This is one of the most dangerous statements I feel a professional can use. It’s dismissive. It’s belittling. Yet it’s rampant in our culture. Why?

mom-calming-crying-newborn

Is it us?

Are all of us new mothers accepting this statement and all it implies instead of politely correcting it?

Is it the professionals?

Have they forgotten their medical school training to trust the parent’s instincts and observations?

Is it society?

Too many social network blog articles that tell you how to be with your baby because you must not intrinsically know? Too much social sharing/emphasis on the What Could Go Wrong instead of an awareness of how the majority of babies are born healthy and thriving?

I would venture to say it is a combination of the three that has perpetuated this                      ‘First Time Mom = Idiot’ stigma. How can we abolish this inappropriate, inaccurate portrayal of motherhood?

First, let’s explore the history…

Since the dawn of civilization, mothers have been the direct caretaker of their newborns.  There was usually a support team of other women as guides during labor and breastfeeding, but they did not replace the Mother’s caretaker role. And babies know this. They have done countless studies to prove that babies can locate their own mother’s voice, heartbeat, and breast. Mothers are also able to identify their own newborn baby’s unique cry. Have you ever watched a Breast Crawl YouTube video? Amazing! That healthy newborn baby that doesn’t even have head control or open eyes just crawls to its mother—not the OB, or the nurse, or any other female hanging between your legs that also has breasts. Baby crawls to you, the mother. Your baby knows you have what he needs.

Second, let’s see where it goes wrong…

Baby is born and put skin to skin with Mom. You have a regular delivery and stay in the hospital 24 hours before heading home. How many times does a well-intentioned professional (doctor, nurse, lactation, the friggin hospital photographer) tsk tsk you and laugh if you ask a question or note a concern? Why are we dismissing moms who are concerned that their baby is crying? “Babies cry. You’re just a First Time Mom, you’ll get used to it soon.” Then you head home and a well-intentioned relative laughs when you bring up your concerns, “You’re Just a First Time Mom.”

Let me see if I understand… Mothers are dismissed and belittled over concern for baby crying because All Babies Cry. So how are we to distinguish the difference between a healthy crying newborn and one that is crying because of newborn encephalitis or severe reflux if not by their cry? Many a lawsuit has been won by a parent whose concerns were dismissed by hospital staff only to find out the child had a serious issue that could have been prevented or minimized had parent concerns been addressed in a timely manner.

From a Behavioralist viewpoint, we are conditioning mothers to stop voicing concerns.

Mother voices concern > Concern dismissed = reinforced that behavior (voicing concerns) to stop.

But Baby doesn’t stop causing concern for the Mother.

So Mother again voices concerns > Concerns dismissed= behavior is reinforced to stop.

Repeat until either a) Concerns acknowledged or b) Mother seeks new source to voice concerns.

Mother holding baby, using cellphone and laptop

Wonder why all these concerned mothers have taken to social media Mom’s groups? Do you think the recurrent theme is that their Pediatrician truly listens and pursues their concerns? No. And then the dreaded eye roll when we confess our source of information comes from a Facebook group of *gasp* mothers.

But we need our medical professionals’ trained eye. And there are tons of fantastic, highly-educated professionals that are also great listeners. We need to understand what appropriate expectations for our professionals are, and then hold our professionals accountable to them.

Ways to reshape our view from ‘First Time Mother = Idiot’ to ‘First Time Mother= Expert on her Baby’

  1. It should not be up for discussion or dismissal whether Mom should be concerned. She either is or she isn’t. If she is, it is the provider’s role to then identify possible causes in the mother-baby dyad. If it is beyond their skill set, refer to the most appropriate specialist. Using language such as, “I am concerned and need your help to get to the bottom of this” is more effective than questions such as, “Is this any cause for concern?”
  1. Mothers should be politely correcting any and all professionals that suggest we are something other than an Expert on our child. I am not a cardiologist. I am not a Lactation provider. But I have an advanced degree in My Child. I know how many farts he had this last hour. I know the color and texture of his poop. I know if the latch is right because only I can feel what my nipple feels like. How can someone presume to tell me it’s a good latch or ‘weight is not an issue because he is maintaining his growth curve’ when they are not the one feeding my child 12 times per day? We must understand the parameters of each expert’s scope of practice. Doctors should not be commenting on the latch just as Lactation should not be prescribing reflux treatments just as I should not be interpreting x-rays. Understand what your scope of practice as an Expert Mother is, and what your professional’s scope of practice as an expert in their field is.
  2. Give your professional the opportunity to identify their role on your baby’s team. After all, baby is new to them too. They may need a little time to find out how best to support you (caveat: babies with feeding issues need immediate supports). There are parents out there that want to be told exactly what to do by professionals. Some parents become defensive when being told what to do. Professionals are not mind readers. Clarify with them how you like to receive support best, and be clear in articulating what expectations you have about your role on your baby’s team. And if you have given your professional ample time and instruction to support your family best, but it’s still not working, cut your losses. Consider yourself lucky to have identified that you were paired with a Dismiss-er when your baby is still young. Go on to find a better match.
  3. Take some time to acknowledge the many ways you are an expert on your child. Use that to strengthen your resolve as your baby’s mother and advocate when issues arise. Feel empowered by the awesome role you have in Baby’s life.

 

I leave you with an affirmation:

“I am a First Time Mom. And that makes me brilliant. My maternal instincts are powerfully attuned to my baby’s body and needs. It makes me my baby’s voice. It makes me confident in my abilities to care for my child. First Time moms, like me, are amazing!”

A Reflux Revelation

Gastroesophageal Reflux Disease (GERD)

  • Sixty percent of the adult population will experience some type of gastroesophageal reflux disease (GERD) within a 12 month period and 20 to 30 percent will have weekly symptoms. 1
  • Approximately seven million people in the United States have some symptoms of GERD. 2
  • In 2004, approximately 20 percent of the United States population reported reflux symptoms that occurred at least weekly. 3
  • Primary or secondary GERD diagnosis increased by an unprecedented 216 percent or from a total of 995,402 individuals diagnosed in 1998 to 3,141,965 in 2005. 4
  • Children with GERD symptoms who were hospitalized with a primary GERD diagnosis increased by 42 percent in infants and 84 percent in children between the ages of two and 17. 5
  • There are approximately 64.6 million prescriptions written for GERD medications in the United States on an annual basis. 6
  • It is estimated that worldwide, approximately 5 to 7 percent of the total population has symptoms of GERD, which is most commonly reported as heartburn that occurs on a daily or frequent basis. 7

gutinflammation
Ask the average person what they think causes heartburn, and they will probably tell you it’s stomach acid. While largely unproven, this conclusion has been widely accepted and likely derived from the ‘burning’ sensation, and success with treatment using proton pump inhibiting (PPI) medications like Nexium, Prevacid, and Prilosec. PPI medications reduce gastric acid by blocking the gastric pump of stomach parietal cells, so one would naturally assume the reduction in acid is to credit for the relief in our associated ‘burning’ GERD symptoms.

However, what most people don’t realize, is that PPI medications can also serve as powerful anti-inflammatories. 8 In fact, a published study review concluded that PPI medications potentially have beneficial effects in any number of inflammatory diseases, gastrointestinal or extra-intestinal, in which acid has no role, and a positive clinical response to PPIs should not be interpreted as proof of an underlying acid-peptic disorder. 9 The review goes on to suggest that patients may be mistaking their symptom improvement on PPI medications as acid reduction, when in fact it is a reduction of inflammation within their gastrointestinal tract. 10

And there is further compelling evidence bringing into question the presumed etiology of GERD, from a recent study done on 12 patients being treated with PPI’s for their reflux esophagitis. 11The study concludes that the damage done to each patient’s esophagus was not caused by stomach acid, but by an inflammatory immune response. 12

So, let’s review: For some of us, the pain we know as ‘heartburn’ potentially has nothing to do with the gastric acids produced by the stomach, and instead is the result of immune inflammation and aggravation within the upper gastrointestinal tract/esophagus. PPI medications are anti-inflammatories so they are potentially reducing the inflammation, thereby eliminating the associated pain. Sounds like the perfect treatment solution, right?

That is, until you consider the risk of side effects – especially with long term use of PPI medications. Adequate stomach acid is a necessary and relevant part of the metabolic process, and there are adverse consequences to habitually reducing/eliminating it. PPI use has been linked to the predisposal of certain infectious diseases, dementia, kidney disease, heart attacks, stroke, vitamin deficiencies, bone fractures, and gut dysbiosis – just to name a few. 13 14

But there is an alternative option: Determine what is triggering the immune inflammation in your GI tract and eliminate it. It will cost you nothing, except some time and effort, there is no risk of any adverse side effects, and you may end up eliminating other cryptic inflammatory symptoms you did not even realize were associated to the exposure.

My advice? Start by removing some of the top allergen offenders from your diet one at a time, and see if you notice a difference in your GERD symptoms. And start paying attention to what you’ve been exposed to recently when your symptoms are at their worst. Did you suffer with heartburn all night after eating a bowl of ice cream? That should raise dairy up to the top of your suspect list. With time and practice, your allergen detective skills will improve, but try to keep it simple initially. And bear in mind that there may be multiple allergens contributing to your symptoms, and the sources may potentially include environmental triggers (lotions, detergents, soaps, pollen, cat dander, etc.), in addition to food or medication.

InfantGERDThere is another chapter to this story we have not yet explored: Infant gastrointestinal reflux disease, and this is where things become slightly more complicated. There is no question that the use of PPI medications in infants and young children is skyrocketing. One large study of about 1 million infants revealed prescriptions for one of the PPIs, made in a child-friendly liquid, rose 16-fold between 1999 and 2004. In addition, there was an overall 7-fold increase in prescriptions for PPIs for infants, and of the prescriptions written for children under 1, about half of those were for infants younger than 4 months of age. 15

But – what exactly are we treating our infants for, with PPI medications? The clinical symptoms associated with infant GERD (depending on who you ask), can range from excessive/inconsolable crying, frequent vomiting/spit up, trouble latching and swallowing, loss of appetite, failure to thrive, diarrhea, blood/mucous in stool, gas, constipation, etc. Those hardly seem like a list of symptoms that can all be attributed to acid ‘burns’ resulting from regurgitation, and not all babies with GERD symptoms regurgitate (a condition known as ‘silent reflux’).

Not surprisingly, there is mounting evidence demonstrating that a wide range of gastrointestinal pain, motility and oral motor dysfunction symptoms, including those listed above, can all be attributed to various stages of gastrointestinal immune aggravation and inflammation. 16 17 18 19 20 21

In addition, there is plenty of evidence to suggest that identifying and eliminating food and environmental sensitivities is as effective as medications for treating gastrointestinal immune inflammation symptoms in children (with one particular study indicating cow’s dairy, soy, and wheat at the top of the list of offenders). 22 23 24

A few pointers regarding identifying and eliminating allergens in infants and young children.

  • You may find that most pediatricians will focus on cow dairy as the sole problematic component, and recommend a partially hydrolyzed (hypoallergenic) or fully hydrolyzed (super hypoallergenic/elemental) infant formula. However, nearly all powder infant formulas use corn as a sweetener so you may inadvertently end up replacing one potential allergen with another.
  • Given the extensive list of ingredients on the average can of infant formula these days, you will probably find a trial and error elimination of allergens from a breastfeeding mother’s diet to be easier and more accurate. (Not to mention, you get the added benefit of the immune modulating properties inherently found in breastmilk to potentially help battle the underlying hyper-immune conditions). 25 26 27
  • Research has demonstrated that gastrointestinal immune inflammation and activation can contribute to dysphagia (trouble swallowing), neuro-muscular dysfunction, intestinal motor abnormalities, and GI dysmotility. 28 29 Consequently, you may find that seemingly unrelated issues with latching, nursing, and the bowels may magically improve and/or resolve once the underlying immune inflammation is addressed.
  • Infant and young children’s metabolism is much faster than an adult’s, so you will typically see clinical improvement quickly once you identify and removing the offending allergen(s).

Allergen Sensitivity

  • According to the American Academy of Allergy, Asthma & Immunology, sensitization rates to one or more common allergens among school aged children are currently approaching 40%-50% worldwide.
  • One in five people in the U.S. currently have allergy or asthma symptoms.
  • 55% of Americans test positive to one or more allergens.

But for all our efforts to subdue the villainous stomach acid, the statistics are not getting any better. But perhaps that’s because we have been chasing the wrong villain. We know that This study, published just last month, strongly suggests that acid is not the underlying cause for the ‘burn’ in heartburn. Instead, an inflammatory immune response is. That’s right – your undiscovered dairy, gluten, corn, egg, or soy sensitivity may be entirely to blame for those pesky GERD symptoms you have been popping Nexium to treat. 30

But that does bring up an interesting point, if acid is not causing the burn then why are PPI (Proton Pump Inhibitor) medications like Nexium, Prevacid, and Prilosec so effective at treating the symptoms? We know that PPI’s reduce gastric acid by blocking the gastric pump of stomach parietal cells, so we would naturally assume the reduction in acid is to credit for the relief in our associated ‘burning’ GERD symptoms. However, it turns out that PPI medications have another, more relevant function in this scenario.

Recent research has demonstrated that PPIs also serve as powerful anti-inflammatories, independent from their function of blocking acid production. A published study review concluded PPI medications potentially have beneficial effects in any number of inflammatory diseases, gastrointestinal or extra-intestinal, in which acid has no role, and a positive clinical response to PPIs should not be interpreted as proof of an underlying acid-peptic disorder. 31

Notes:

  1. Gastroesophageal Reflux Disease (GERD) Hospitalizations in 1998 and 2005 – HCUP-US Home Page. Retrieved March 5, 2012, from: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb44.jsp
  2. Gastroesophageal Reflux Disease (GERD). (n.d.). Office of Medical Informatics – College of Medicine – University of Florida. Retrieved March 5, 2012, from: http://medinfo.ufl.edu/~gec/coa1/gerdfaq.html
  3. Digestive Diseases Statistics for the United States – National Digestive Diseases Information Clearninghouse. (n.d.). Home – National Digestive Diseases Information Clearninghouse. Retrieved March 5, 2012, from: http://digestive.niddk.nih.gov/statistics/statistics.aspx#specific
  4. Gastroesophageal Reflux Disease (GERD) Hospitalizations in 1998 and 2005 – HCUP-US Home Page. Retrieved March 5, 2012, from: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb44.jsp
  5. Gastroesophageal Reflux Disease (GERD) Hospitalizations in 1998 and 2005 – HCUP-US Home Page. Retrieved March 5, 2012, from: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb44.jsp
  6. Gastroesophageal Reflux Disease (GERD) Hospitalizations in 1998 and 2005 – HCUP-US Home Page. Retrieved March 5, 2012, from: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb44.jsp
  7. GERD Costs America Nearly $2 Billion Each Week in Lost Productivity – International Foundation for Functional Gastrointenstinal Disorders. Retrieved March 5, 2012, from: http://www.iffgd.org/site/news-events/press-releases/2005-1125-gerd-costs
  8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035917
  9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035917
  10. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035917
  11. http://jama.jamanetwork.com/article.aspx?articleid=2521970
  12. http://jama.jamanetwork.com/article.aspx?articleid=2521970
  13. http://www.webmd.com/heartburn-gerd/news/20160608/proton-pump-inhibitor-health-risks
  14. http://www.webmd.com/heartburn-gerd/news/20141125/could-popular-heartburn-drugs-upset-your-good-gut-bugs
  15. http://www.livescience.com/16636-acid-reflux-drugs-overused-babies.html
  16. http://www.ncbi.nlm.nih.gov/pubmed/26022877
  17. http://www.ncbi.nlm.nih.gov/pubmed/17053446
  18. http://www.ncbi.nlm.nih.gov/pubmed/18713339
  19. http://www.ncbi.nlm.nih.gov/pubmed/25808260
  20. http://www.ncbi.nlm.nih.gov/pubmed/25845555
  21. http://www.ncbi.nlm.nih.gov/pubmed/26194403
  22. http://www.ncbi.nlm.nih.gov/pubmed/26022877
  23. http://www.ncbi.nlm.nih.gov/pubmed/25808260
  24. http://www.ncbi.nlm.nih.gov/pubmed/25845555
  25. http://www.ncbi.nlm.nih.gov/pubmed/27183772
  26. http://www.ncbi.nlm.nih.gov/pubmed/20485331
  27. http://www.ncbi.nlm.nih.gov/pubmed/21444329
  28. http://www.ncbi.nlm.nih.gov/pubmed/18713339
  29. http://www.ncbi.nlm.nih.gov/pubmed/26194403
  30. http://www.ncbi.nlm.nih.gov/pubmed/26022877
  31. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035917

Infantile GERD and DNA Methylation

infantrefluxCould infantile GERD be at end of a long chain of of events caused by impaired DNA Methylation?  First things first; what is DNA Methylation?  Without launching into a rather long and technical description, let’s just suffice it to say that it is critical to many fundamental cellular processes and it’s very bad when DNA Methylation does not function correctly.  How bad?  Impaired methylation has been implicated in the incidence of Rheumatoid arthritis, osteoarthritis, severe food allergies, cancer, HIV, mitochondrial disorders, Multiple Sclerosis, Parkinson’s, migraines, heavy metal accumulation, hormonal deficiencies, low thyroid, and infectious overgrowth such as viruses and Candida, as well as various Neuroimmune Disorders such as Autism, depression, and  ADHD.

Of the myriad of symptoms which now seem to plague our infants, Gastroesophageal reflux disease (GERD) seems to remain among the most prevalent.  And since we still don’t know the cause of infantile GERD, I thought I would investigate the potential link between it and DNA Methylation compromise.  What a surprise when I discovered a number of studies which found that the treatment of GERD with melatonin, and a particular blend of vitamins and amino acids (all of which support methylation), improved GERD more effectively than the PPI medication Omeprazole (Prilosec)!  And all without the side effects associated with suppressing one’s stomach acid.

Coincidence?  Maybe, but I doubt it.  I would certainly welcome additional research into this intriguing development.  Perhaps infantile GERD may serve as an early-warning indicator of this silent, sneaky, and often debilitating condition.

Rheumatoid arthritis and osteoarthritis, severe food allergies, mitochondrial disorders, Multiple Sclerosis, Parkinson’s, migraines, heavy metal accumulation, hormonal deficiencies, low thyroid, and infectious overgrowth such as viruses and Candida can all be impacted by impaired methylation – See more at: http://www.betterhealthguy.com/methylation#sthash.lPJaQYZb.dpuf
Rheumatoid arthritis and osteoarthritis, severe food allergies, mitochondrial disorders, Multiple Sclerosis, Parkinson’s, migraines, heavy metal accumulation, hormonal deficiencies, low thyroid, and infectious overgrowth such as viruses and Candida can all be impacted by impaired methylation – See more at: http://www.betterhealthguy.com/methylation#sthash.lPJaQYZb.dpuf
Rheumatoid arthritis and osteoarthritis, severe food allergies, mitochondrial disorders, Multiple Sclerosis, Parkinson’s, migraines, heavy metal accumulation, hormonal deficiencies, low thyroid, and infectious overgrowth such as viruses and Candida can all be impacted by impaired methylation – See more at: http://www.betterhealthguy.com/methylation#sthash.lPJaQYZb.dpuf