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?

Don't Fear the Microwave

photo courtesy stockxchng

There is a human tendency to fear or demonize anything poorly understood and especially anything new. While this is an excellent survival mechanism, unfortunately, it lingers beyond its usefulness in many circumstances. Fear is an excellent tool of control, so very often, it is encouraged by those in authority (or those desiring authority).

What does this have to do with microwaves? Quite a bit! Since no one is trying to control us through microwaves, it would seem people would get over this irrational fear, but instead, it continues to perpetuate itself through the very mystery of microwave technology itself.

I believe we can largely blame x-rays for this. For 30 years, we were assured repeatedly that x-rays were safe: so safe, women of money received them at every prenatal visit and they were available in shoe stores to see the fit of your foot inside the shoe, to ensure a proper and healthy fit.

Of course, we know now that x-rays cause cancer, infertility, pregnancy complications, fetal mutations and birth defects. Why the hell would we trust that any technology is safe after that? Well, you can either be a technophobe and take that route (why are you using a computer then? Electromagnetic radiation is coming off your screen right now!) or you can do your best to study the information available and make as informed a decision as possible.

Now, the microwave. People have many fears about this device. The first is safety--are microwaves just pouring out of the oven as it goes? No.1 Not 'pouring out'. Yes, they do leak a tiny amount of microwaves, which are non-ionizing and rodent studies have repeatedly found no damage, even from nearly an entire lifetime of chronic exposure--more than you would be exposed to even if you stood in front of one and cooked in it every day. The material that the microwave is made out of protects you. The risk from microwaves is burns--which you have to find a way to keep the door open to be exposed to (or be inside one).

Now, that brings us to how microwaves cook in the first place: "Microwave ovens cook food with waves of oscillating electromagnetic energy that are similar to radio waves but move back and forth at a much faster rate. These quicker waves are remarkably selective, primarily affecting molecules that are electrically asymmetrical — one end positively charged and the other negatively so. Chemists refer to that as a polarity. Water is a polar molecule, so when a microwave oven cooks or heats up food, it does so mainly by energizing — which is to say, heating up — water molecules, and the water energizes its molecular neighbors."2

It basically bounces around the interior of the microwave in irregular patterns, heating what it comes into contact with. So, it's not like waves pouring around inside and it's why microwaves heat unevenly much of the time.

So, okay, you either are convinced with the science or you're not, that the microwaves are well contained and even when not, they are not cancerous, due to their nature.

 

pic courtesy of stockxchng

The latest myth about microwaves, however, comes from the raw foodists. In pushing their agenda (as we all do), they have perpetuated partial study results that showed that nutrients are leeched in microwaves during cooking. This is true! They are also leeched, in greater amounts, in oven, stovetop, steam and grill cooking, due to the slower nature of the cooking methods. Nutrients are leeched during any cooking at all into the water it's prepared in.

So, raw foodists have that on their side. But that's not the message that got spread to the public (nor is it the whole story by any means). If you're a raw foodist, good for you. I'm not. I, like all generations of homo sapien before me3, like my food cooked. So, for those of us who cook our food, what is the real story here?

"Several studies have shown that microwave cooking, if properly used, does not change the nutrient content of foods to a larger extent than conventional heating. In fact, suggests that there is a tendency towards greater retention of many micronutrients with microwaving, probably due to the shorter preparation time. Does not describe non-thermal effects. The main problem with microwaving is the uneven heating of the food, which has raised concern regarding microbiological safety. Microwaving infant formula and breast milk has become increasingly popular. The content of nutrients and antibacterial factors in milk are maintained unchanged provided the final temperature does not exceed 60°C." 4

In fact: Spinach retains nearly all its folate when cooked in a microwave; in comparison, it loses about 77% when cooked on a stove, because food on a stove is typically boiled, leaching out nutrients. Bacon cooked by microwave has significantly lower levels of carcinogenic nitrosamines than conventionally cooked bacon.5 Steamed vegetables tend to maintain more nutrients when microwaved than when cooked on a stove top. Microwave blanching  is 3-4 times more effective than boiled water blanching in the retaining of the water-soluble vitamins folic acid, thiamin and riboflavin, with the exception of ascorbic acid, of which 28.8% is lost (vs. 16% with boiled water blanching).6

So, in conclusion: microwave cooking is not for every food, certainly (broccoli retains more flavanoids when steamed, for example, but if you're not going to steam it, it will retain more nutrients by microwaving than boiling on the stove--it's best eaten raw, however, for maximum nutrition: but it still contains plenty of nutrients even after cooking), but it is a valuable tool and shouldn't be as feared as it is. At the very least, don't feel guilty about using it once and a while. It's not hurting your food any more than any other method of cooking.