Saturday, May 5, 2012

Musing on Elimination Diets

Ahh, the elimination diet. The first thing that many moms suggest when someone's baby has so much as a painful toot. We Americans are obsessed with food. Some with eating it, some with not eating it. It's become the most popular trend in 'crunchy' circles to blame everything on food and insist everything can be cured with it. A lot of people have great success and improved health discovering what they are intolerant or allergic to and removing it from their diet and that's great. Others seem to be nothing but miserable and even unhealthier while on their special diets and eventually abandon them for their sanity.

This has trickled down to babies at the breast. For some babies, an elimination diet is a lifesaver--both for the baby and his parents! However, when it's the go-to for pretty much any upset tummy or rash, are we doing more harm than good?

Courtesy stockxchng

Many studies have come out in recent years that suggest that our clean, sterile environments and avoidance of allergens may be contributing to (or causing!) our poor health here in the US. For instance, a study of babies who ate peanuts earlier in infancy vs. those who wait until after a year as guidelines have recommended showed that the babies with earlier exposure are less likely to be allergic to peanuts! Autoimmune diseases are being linked to clean (sterile) environments, calling for an end to things like Clorox wipes. Pets, once considered a cause of childhood allergies, are now suggested to actually reduce the risk by over half (and kids raised on farms have less allergies, too).

Children learn about the local diet that they are going to be eating through amniotic fluid that they sample in the womb and the milk they drink at mother's breast. It makes sense, then, that places that have diets heavy in fish, such as Japan, have nearly no fish allergies (something I envy, as salmon, tilapia, sardines and several other fish all slam my throat shut like an angry teenager's bedroom door) and announcing you have such an allergy leads the people there to wonder how you can even live, as surely, you must starve if you can't eat fish! So, what does it do to a nursling's expectation for a mother to drastically change her diet to something that does not reflect what the child will grow up eating (or eat when grown up)?

courtesy stockxchng
Now, moving past studies into my own personal experience. My first daughter, Lilly, had a lot of gas. "She could toot so loud," I joked, "that the neighbors blamed the dog." Her poop was nuclear green and on and off frothy. She spit up a lot. A lot. There were few to no signs of pain, but still, I thought that I didn't want my daughter to be ill, so I considered a dairy elimination. Then I considered all the new information about exposure being related to a reverse allergenic response and I decided to try the opposite: I increased my dairy consumption. Of all things, her symptoms disappeared.

I should note that at the same time, I also started adjusting for my overactive letdown/oversupply. Her poop remained green (I did not produce much foremilk, however, I believe due to my poor hydration habits), but she still had no signs of pain, the frothiness disappeared and the gas even took a step back. So, clearly, her problem was not dairy.

With my second, I didn't even think of food allergies when confronting her myriad of nursing problems. I got through them all without ever touching on the subject.

With my most recent, Kat, again, I was looking at a baby who had the symptoms of a dairy intolerance (these, by the way, are also the symptoms of overactive letdown, which is a known problem for me, so I took that into account). When blood appeared in her green, mucousy stool and she cried in pain at every bowel movement (and quite a few toots) while breaking out in an unexplained rash, I decided that I would try an elimination diet.

While I was doing this, I also worked on my overactive letdown and started pumping off some of my early milk to slow the flow (and noted that my foremilk/hindmilk was well balanced). I also forced her to block feed (she was quite opposed, but eventually allowed me to do this). The blood vanished from her stool and it started appearing seedy and turning butter yellow while losing the foul smell.

For the rash, I took all of her clothes and rewashed them in the detergent that I use for myself (Era). Voila, the rash disappeared (it recently reappeared and now I believe it was either a reaction to cinnamon or clove, as that was heavily present in my diet when the first rash appeared as well as the new one--but she also tried on clothes that were washed in the original rash-giving detergent, too! Oy!). Her diaper rash problem was solved by adding baby powder to our diapering routine.

My elimination diet was a failure, however, as I did not realize that my coffee creamer had dairy in it! I had switched without checking, as the other creamer I had been using was dairy free, so it didn't occur to me. None of her symptoms remained or returned when I reintroduced regular dairy back into my diet.

With Kat's symptoms, an elimination diet was even recommended by my pediatrician and was most definitely warranted. However, it turned out that it was not caused by a food allergy, but rather, my milk ejection reflex and laundry detergent. Had I only attempted the elimination diet, she would have continued suffering.

Right now, it seems that the first (and often only!) answer given to any nursing mother with a baby displaying digestive issue symptoms is to eliminate food. Dairy, soy, wheat, corn, eggs... there are lists available to check off one food after another in an attempt to find what's wrong with the baby. Personally, I think that LCs (no matter how many letters precede those two) need to remember to bring up other common problems as well. "Food sensitivities in breastfed babies are not nearly as common as many breastfeeding mothers have been led to think." -- Kellymom.

Elimination diets are a great tool for babies who truly do have sensitive systems, but more than simply gassiness or fussiness must be present before we go recommending that Mom cuts out what may be one of the primary sources of protein for her (we're talking milk, cheese, yogurt--all of that and more, for a dairy elimination). A dairy intolerance is not 'lactose intolerance,' but rather, difficulty processing cow milk protein.

First, as far as straining and pain with passing gas and stool: babies have to learn basically everything. That includes how to fart and poop. They do not know how to relax their sphincter and often get in their own way attempting to simply eliminate. This can cause pain and frustration. Typically, it's outgrown after a few weeks and they learn to relax instead of fighting to have a bowel movement or pass gas.

Green poop: This can be a sign of a lot of things, from allergy to letdown to hindmilk/foremilk imbalance. All of these should be considered. Blood in the stool can be caused by all of these problems as well. The position in the stool tells you whether it's internal (inside the poop, meaning it got there before being passed) or anal (outside the poop--caused by anal fissures from straining).

Symptoms of food intolerance include: fussiness and crying for extended periods, sudden waking accompanied by cries indicating pain, rash (particularly a red ring around the anus--how I identified a food allergy to strawberries in my first and spinach and broccoli in my second), hives, eczema, congestion, vomiting and unusual stools (green, mucousy and/or bloody). These area also all symptoms of other problems, so experimentation may be needed.

If baby displays these symptoms within four to twenty-four hours of you eating a new food, there's a good chance that baby is experiencing a reaction to the food. Usually, symptoms will pass within a few hours if it is a new food. Symptoms that are ongoing indicate a regular food in mom's diet.

In closing, my thoughts are that while elimination diets have their place, like any other treatment or tool, they can and are being abused by well-meaning mothers and their breastfeeding counselors. I think that starting an elimination diet without real symptoms (just over normal baby developmental issues) is not the best idea and may actually be doing baby a disservice when it is used as a first recourse. 

I am not calling for an end to elimination diets--far from it. Babies who are diagnosed 'lactose intolerant' (a pet peeve of mine) or 'allergic to human milk' (flat out impossible, however while galactosemia and similar conditions obviously exist, they are not an 'allergy') would definitely benefit from mom figuring out what it is in her milk that is causing the reaction. And mothers are good at identifying that something is 'wrong' (far better than society gives them credit for). These are just my observations that I wanted to share as an alternative 'food for thought.'

Did an elimination diet help your baby? Did you try one and have it fail? Did you wish that you had been given more options?


  1. I have 2 whom I've had to do elimination diets with. My first was dairy all the way. I had a screaming baby almost constantly and then took away dairy (ALL of it) and she was almost instantly a different baby! I also had to eliminate chemicals in detergents, soaps, etc a while later as those gave the eczema. She has, however, outgrown that sensitivity. My 2nd, nothing, didn't give up or change anything and he was fine! #3 has all kinds of issues! His green poop was due to oversupply and I knew that off the bat as he had no other symptoms of food issues. It wasn't until around 2-3 months that his eczema developed and we watched it, creamed him, changed soaps, etc. Noticed around 3 months that milk (not cheese, yogurt, etc) made him puke so I went off all dairy hoping that was the eczema trigger as well. No dice... saw a homeopath and had him allergy tested. A myriad of things showed up and I eliminated them all... now, at 6 months, I am adding back. Dairy, coffee, beets/beet sugar are all ok so far. I have had 2 small bites of wheat and am watching (taking that one REALLY slowly). Although, if I have too much dairy or milk in coffee or something like that, he spits up more so I am limiting it again/still. Anyway... I do suggest foods as triggers for digestive issues ALONG with oversupply/overactive letdown and I suggest them for skin irritation too ALONG with chemicals in cleaning products. I wouldn't have known with my oldest about the dairy thing save for a very wise woman (my mommy) suggesting it!

    1. Our Growing Family--I'm glad someone was able to help you! Yes, even my pediatrician recommended a dairy elimination with my third and it seemed like quite the right answer for her. So it was definitely right to try, but did not turn out to be her problem. However, as you shared, it can be a variety of problems, INCLUDING a sensitivity and it's good you had help identifying what you could do to stop the problems. May you enjoy your dairy again some day ;) And it's a relief that so many early sensitivities are outgrown (although definitely not always!).

  2. Very interesting points! I'm glad I never considered an elimination diet for my first, fussy baby … because, um, I really like all those things they tell you to cut out. ;) In fact, I was trying to remember when babies are "allowed" to eat shellfish because my husband's always sneaking shrimp to the baby, so I looked it up — and they now recommend that babies start eating fish and shellfish right away, to prevent allergies later. It's things like that that make me more confident that introducing potential allergens and "problem" foods to babies (assuming no specific symptoms of an intolerance, as you mentioned) is a good idea rather than a bad.

    1. Lauren--I attribute my food allergies to having food introduced too soon more than what was introduced. On the other hand, I don't seem to have any allergies to what I WAS given, so who knows?

  3. Wow! Elimination diets definitely do seem like a huge trend right now. My son (and my daughter before him) only poops once per week. His poop has taken on a serious stink, but he is only suffering minor discomfort when he poops. It is a lot of work... but only once per week. Honestly, the rarity could be the culprit for the stink, too. He can get fussy for a day or two before he poops, but even then - nothing major.

    My toddler poops on a more regular schedule, but seems so very emotional, I found myself wondering if I should try eliminating... something from her diet. I really hate the idea of the dietary difficulty, though. (Read that line as: lazy)

    All that to say - your post is refreshing. Thank you for sharing it!

    1. Haha, Momma Jorje! I understand the laziness (although with all we do as moms, I think it's just not wanting to add to the work load more than traditional laziness!). It's a lot of work and just when you think you've got it down, you get a contamination and everything can go to hell.

      Elimination diets definitely have their place. And yes, some babies are weekly poopers, some daily. It varies quite greatly!

      I'm glad you enjoyed my post :) I do hope that you get things sussed out!

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  5. I agree with a lot of what you've written, and I was SO reluctant to try an elimination diet with both kids. But for us, it truly was the way to go(And I wish I could keep Kieran off dairy now that he's found out how good it is.)
    For Ailia, it's even more painfully obvious. Right now we're out of town, and I'm the crazy vegan who asks to read bread labels before eating anything. And then they brushed my bun with butter to toast it and I didn't notice until it was almost gone. Later that night? Dairy reactions galore. (sigh)
    (By the way, Jorje sent this to me - I said you'd be tickled to know it was shared ;))

    1. Dionna--ugh, two kids in a row? You just can't catch a break, huh? I'm saying, contamination is freaking HARD to avoid! :( It was how I figured out that wasn't Kat's problem. (BTW, I tried cinnamon again recently and no rash, which means I've narrowed down her allergy to clove, I think!)

  6. My newborn (7 weeks today!) has had a rash almost since birth. We switched detergents but that didn't seem to help. Then I cut out major sources of dairy (not all, just milk, cheese, yogurt- the major ones) and we went to disposables so that we could really lay on the heavy diaper rash creams and it went away! I was hoping it was still our detergent, so I stripped my cloth dipes (again) and we went back to cloth, using a different mild detergent, and I went back on dairy. Immediately her rash came back. So it's off dairy again for me. 3 days in and her rash is disappearing. I do believe that it isn't an allergy she will always have. She is just new and sensitive. I will probably try to slowly reintroduce the major dairy (I MISS CHEESE) every couple months and see what happens. I also think that elimination diets are over used, so I desperately wanted it to be a detergent issue. No such luck :)

    ...although I almost might have an overactive letdown? I might look into that more... would that cause a rash? She does get fussy at night before she goes to sleep, but her poops are always yellow.

    1. Lacey Jane--I'm not sure that it would cause a rash. You can check Kellymom for ways to help with that:

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