Montana Whole Health https://www.mtwholehealth.com Better health for your whole self - Better health for your whole family Fri, 09 Aug 2019 19:31:36 +0000 en-US hourly 1 https://wordpress.org/?v=5.1.3 /wp-content/uploads/cropped-color-mark-32x32.png Montana Whole Health https://www.mtwholehealth.com 32 32 41469247 Why the Mediterranean diet may improve your chances of pregnancy /2019/04/why-the-mediterranean-diet-may-improve-your-chances-of-pregnancy /2019/04/why-the-mediterranean-diet-may-improve-your-chances-of-pregnancy#respond Fri, 12 Apr 2019 16:08:53 +0000 /?p=5889 Here at Montana Whole Health we have been big advocates of the Mediterranean diet for fertility patients for years.  Well now we have some really good […]

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]]> Here at Montana Whole Health we have been big advocates of the Mediterranean diet for fertility patients for years.  Well now we have some really good research supporting this diet! 

Two strong studies now show that eating a Mediterranean diet regularly improves fertility rates!  

The first study shows that patients who stick to a Mediterranean diet carefully increases pregnancy rates in IVF patients. The second study shows that men who consume a Mediterranean diet have better sperm counts, including total sperm counts, motility and morphology.  (Morphology is a measurement of how healthy the sperm looks, and motility is a measurement of how well the sperm swims.)  

What is the Mediterranean diet?

Let me be clear here – a Mediterranean diet is NOT eating spaghetti with red sauce and drinking a glass of wine.  LOL!

Here are the basics of the Mediterranean diet:

  1. Lots of olive oil.  Meaning copious amounts!  Olive oil should be the main source of fat.  Contrary to popular belief, increasing fat consumption is NOT likely to cause weight gain.  In fact olive oil in particular seems to help satiety, which is the sensation that we are full.
  2. Protein sources primarily from fish and beans, with minimal intake of red meats.
  3. Colorful fruits and vegetables in abundance.
  4. Whole grains in moderation.
  5. Moderate use of red wine – about 3 oz daily for women, 5 oz daily for men.

I have patients aim to be 80-90% on the Mediterranean diet.  This means you can eat other foods than fish and veggies, just limit them!

My basic guidelines to be Mediterranean diet-friendly:

  • Aim to make at least 1/2 your plate fruits and vegetables.  Yes, this includes breakfast! 
  • Aim to make 1/4 of your plate include anti-inflammatory protein, focusing on fish, nuts and beans.  
    • I consider wild game to be “okay,” since it tends to be an anti-inflammatory meat.  You should always check your iron levels (ferritin), however, because high iron meats like wild game can increase inflammation if your iron stores are too high.  (This is typically not the case for most women, who tend to have low levels of iron if they are having regular periods, which depletes iron.) 
  • Aim to make 1/4 of your plate whole grains.  Note not all patients tolerate grains well, and some patients feel better eating a diet more similar to Autoimmune Paleo, which is similar to a Mediterranean diet but without grains.  

Other bonuses with the Mediterranean diet:

No diet can guarantee having a baby. But the Mediterranean diet is great because it has other benefits as well.  Here are some of them:

  1. Decreased risk of type II diabetes.
  2. Decreased risk of heart attack and stroke
  3. Decreased risk of dementia in old age
  4. Decreased rates of depression and anxiety

 

When in doubt have half your plate be fruits and vegetables and load up on olive oil!

What else can I do to increase my chances of having a baby?

I always recommend getting thorough labwork done if you are having issues conceiving.  This includes a hormone workup for women, and a semen analysis for men.  Here in Missoula we recommend using NW Cryobank to analysis semen samples, since the Cryobank does such a great job analyzing not just total count and motility, but other important markers like morphology, presence of white blood cells and more.  Men who have low total counts should have a more thorough workup and bloodwork of their own.  

Remember that total sperm counts that are now considered “normal” would have been considered infertile 75 years ago.  This is how much male sperm counts have dropped in the last century!  Here at Montana Whole Health we calculate chance of conception using not just total sperm counts, but factoring in morphology, motility and unidirectional motility.  And YES there are many naturopathic and evidence-based options for improving sperm counts!

For women we assess markers of inflammation, hormones at specific times of the month (this is very important!), ovarian quality, thyroid health, iron status, and screen for autoimmune disease.  Every patient is unique and every patient receives a personalized treatment plan.  Both Dr. Krumbeck and Dr. Dalili have specialized training in naturopathic fertility treatment. 

 

References:

Karayiannis D, Kontogianni MD, Mendorou C, Mastrominas M, Yiannakouris N. Adherence to the Mediterranean diet and IVF success rate among non-obese women attempting fertility. Hum Reprod. 2018 Mar 1;33(3):494-502. 

Karayiannis D1, Kontogianni MD1, Mendorou C2, Douka L2, Mastrominas M2, Yiannakouris N3. Association between adherence to the Mediterranean diet and semen quality parameters in male partners of couples attempting fertility. Hum Reprod. 2017 Jan;32(1):215-222.

 

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/2019/04/why-the-mediterranean-diet-may-improve-your-chances-of-pregnancy/feed 0 5889 How to do wet wraps for eczema (atopic dermatitis) /2018/10/how-to-do-wet-wraps-for-eczema-atopic-dermatitis /2018/10/how-to-do-wet-wraps-for-eczema-atopic-dermatitis#respond Sat, 20 Oct 2018 16:13:28 +0000 /?p=6001 It sounds weird, it feels strange, but of all the options for severe eczema treatment my favorite is wet wraps! Do you know how to do […]

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It sounds weird, it feels strange, but of all the options for severe eczema treatment my favorite is wet wraps! Do you know how to do wet wraps for your child with eczema?

What is eczema?

Eczema is also called atopic dermatitis.  It is a red, scaly rash that is intensely itchy.  Most kids who develop eczema get their first rash under the age of 5. (Often kids get eczema when they are still babies.)  In my office I usually see kids develop eczema somewhere around 4 months of age, with it progressively worsening in the first year of life.  By age 2-3, however, many (but not all!) kids are starting to outgrow their eczema and food allergies or sensitivities.

When to use wet wraps for your child’s eczema

In my office I typically start with some very simple supplements and dietary changes to help heal eczema from the inside out.  I list several in my article Allergies, asthma and eczema: The Th1/Th2 story

If these simple supplements are not helping, or if the child’s eczema is severe to the point of scratching nightly then I will typically recommend the family to start wet wraps as well.

Why wet wraps? (That sounds gross…)

One of the main issues with eczema is that the skin loses its ability to retain moisture.  When the skin dries out severely then it leaves tiny cracks or breaks in the skin, which makes the skin more susceptible to infection.

In the past we used to recommend children to avoid bathing because soaps strip the skin of natural oils, making eczema worse.  Now the recommendations have changed, we now recommend kids to bathe daily or even up to four times daily to rehydrate the skin.  Wet wraps after the bath help seal and lock in the moisture so the skin has a chance to heal naturally before it begins to “crack” and dry out again.

How to do wet wraps for eczema

1. Have your child soak in warm (but not too hot!) bath water for at least 15 minutes.

Do NOT use detergent-containing soaps.  In fact we recommend using NO soap until you can find a hypoallergenic, mild moisture-rich soap that your child does not react to.  Be aware that when eczema becomes severe some children will begin to react to many or all plant-based products.  For now it is best to skip the soap all together.  If the child has eczema on his/her head then periodically pour warm water over the head or put a wet washcloth on the head to increase moisture to the affected area.  Disinfect the bath and bath toys frequently to avoid spreading infection!

2. Help your child out of the bath and gently towel dry.

Use a clean, dry towel and a gentle patting motion.  Make sure you keep those towels clean by washing them often (2+ times per week) in hot water and hypoallergenic, unscented laundry detergent or other laundry soap.  For more information about detergent sensitivity see SolveEczema.org.

3. If your child has been prescribed a topical steroid or compounded medication apply this quickly only to the severely affected areas.

(Your child’s doctor will tell you which areas really need it.)  Next week we’ll share our article about when/why children should use a topical steroid.  (Hint: only when it’s severe!)

4. Immediately apply topical barrier moisturizer to the rest of your child’s skin.

Your child’s physician should be able to help you decide on which topical barrier cream, ointment or salve is best for your child.  My favorite “natural” cream is Weleda White Mallow Lotion.  But be aware that some children react to even this lotion, and will need to use a hypoallergenic petroleum-based product instead, like Vanicream or Aquafor.  (Yes, yes, I know, petroleum products are NOT natural! But for some kids it is literally the only option.)  Try to make sure you get your child lathered in moisturizer within minutes of getting out of the bath.  Use a thick layer of moisturizer and don’t bother to rub it in all the way.  You should be able to visibly see the lotion as a thick layer on the skin.  Do NOT use moisturizer over the topical steroid or compounded medication (which would probably spread the steroid around and/or dilute it).

5. Keep the moisturizers / creams / lotions clean!

If you are using a tub (e.g., Vanicream) always use a clean spoon to scoop out ointment.  Do NOT use your fingers in the tub!  Do NOT double dip! This prevents the spread of infection to healthy skin.

6. Apply antibiotic/antifungal medication to infected areas last (if needed).

7. Soak 100% cotton clothes in warm water.

For children with widespread eczema you can use fitted pajamas.  For children with eczema only on their hand or feet or small affected areas you can use 100% cotton socks, gloves, gauze or strips of cloth.   Wring out the excess water (so it is damp) and apply the damp clothes or help your child into the wet pajamas.  Kids hate this step, I know! Heavily bribe or encourage them with sticker charts for rewards, or screen/tablet time (which is a great motivator for a lot of kids).   https://www.adrescuewear.com/ sells wet wrap pajamas if you have a hard time finding some near you.

8. Immediately cover the wet layer with a dry layer.

Many parents use fleece or flannel footsie pajamas to completely cover their child.

9. Keep your child in the wet wraps for at least 1 hour, preferably overnight.  Keep your child warm!

How often? How long?

Wet wraps work best when you apply them daily (nightly preferably).  Yes, I know, I know, some kids really hate them!  If you can’t get them to stay in it overnight then I recommend doing wet wraps in the morning or mid-day and then keeping them in it as long as possible.  Sometimes kids will be distracted by toys or screen time.  (I don’t love screen time for young kids, but if eczema is really severe and this is the only way to get them to keep the wraps on for an hour then it’s worth it!)

Eczema typically gets better within 2 weeks of regular use.  Keep it going as long as possible!  Some parents will be able to reduce the frequency of the wet wraps to a few times per week as “maintenance” therapy.

Final notes

If your child is using topical steroids to manage his/her eczema please be aware that they may get rebound eczema if you abruptly discontinue them.  Many times wet wraps make the eczema so much better that parents stop the steroids all at once and are then surprised when the wet wraps suddenly “stop working.”  I highly recommend slowly discontinuing topical steroids over the course of weeks rather than stopping all at once.  Your child’s doctor should be able to help you figure out a way to “wean” off of topical steroids.

How to do wet wraps for #eczema

 

Find unbiased information about vaccines

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Why this naturopathic doctor recommends introducing solid foods at FOUR months. /2018/03/naturopathic-doctor-recommends-introducing-solid-foods-four-months /2018/03/naturopathic-doctor-recommends-introducing-solid-foods-four-months#respond Wed, 21 Mar 2018 18:56:05 +0000 /?p=5894   First of all, I want to say I am SO excited to get back to blogging. I’ve spent the last year working on my Vaccines […]

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First of all, I want to say I am SO excited to get back to blogging. I’ve spent the last year working on my Vaccines Demystified course, and then the My Infant Health Binder, plus seeing patients (my real job!), plus editing Naturopathic Pediatrics.  All this to say – I had to take a major break from blogging.  Not to mention last year at this time I was still pretty heavily sleep deprived (I was never blessed with good sleepers). So now that my kids are (gulp!) six and two (!) I’m super excited to start regularly sharing with you again.

It feels SO good to be back!

Why introduce solid foods at 4 months?

Yes, yes, I am completely aware that the guidelines suggest exclusive breastfeeding until 6 months of age. And no, I promise, I’m not being irresponsible by suggesting that infants should be exposed to complementary foods “early.”

Here’s why:

New research shows that infants who are exposed to potentially allergenic foods early (often even before 4 months) are less likely to develop serious allergies. Much of the research has involved peanut products, eggs, or milk. These are the most common serious allergens in children.I do want to be very clear – not all the research is consistent, and many of the studies used different parameters. Here is a good summary of the research. But there is a very strong trend here that early solid food introduction is important to prevent allergies, particularly with peanut products.

Do not wean early!

I HIGHLY and I cannot say this strongly enough – HIGHLY recommend continued breastfeeding even after the introduction of solid foods. In fact, this whole idea of “early” solid food introduction actually depends on continued breastfeeding for good immunity. Breastfeeding provides super important nutrients that simply cannot be found in commercial formula or with solid foods.

The whole reason that most pediatric authorities continue to advocate “exclusive breastfeeding” to 6 months is to extend the duration of breastfeeding as long as possible. They know that when parents hear “introduce solid foods” many parents think that this is an acceptable time to start weaning from nursing. So again, I am NOT saying to wean your baby at 4 months. The World Health Organization recommends breastfeeding until age 2, and I highly agree. Remember that breastmilk should be the primary source of calories until age 1. (From age 1-2 breastmilk is supplemental, and solid foods should be the primary source of calories.)

Babies in developing nations, or in areas with LOW likelihood of allergies should continue exclusive breastfeeding (with no solid food introduction) until at least 6 months to reduce the risk of infections.

And this is not to place blame or lay guilt on any of you who were unable to continue to breastfeed. I know that many women in my office tried so hard to continue nursing, and have a lot of guilty feelings for being unable to continue.

What we used to do (and why it doesn’t make much sense)

Okay so here is how we used to introduce solid foods: “Wait.  Wait.  Wait.  Wait.  Wait.  Okay – you can have as much as you want!”  Basically there was some “magic” age of 6 months (regardless of whether the child showed any signs of food readiness), and parents were given the go-ahead to introduce solid foods in virtually any amount.  We even advocated introducing one food at a time, often waiting in between foods to see if there was a “reaction” to the introduced food.

This virtually guarantees food allergies and intolerances in susceptible children.  Why?  The immune system has no warning; it is bombarded with a foreign substance in large amounts – it isn’t surprising it creates antibodies to foods it hasn’t seen before! Furthermore, the digestive system is suddenly overwhelmed by complex carbohydrates, fiber and sometimes proteins or fats it has never had to digest or absorb before.

And worse, in the past parents were sometimes advised to wait to introduce potentially allergenic foods like peanuts and shellfish until after 12 months of age.  It turns out this actually increased the risk of allergies!  In early infancy the immune system is rather flexible – we can often “tell” it what is safe and what is not safe by exposing it to little tiny amounts.  But if we miss that window of opportunity the immune system sets, and is much less flexible.

How this naturopathic doctor recommends to introduce solid foods.

I consider the time between 4 and 6 months to be the “tasting” time. So hear me out, you guys, I do NOT recommend taking your 4 month old home and feeding her an entire jar of baby food. In fact, this is exactly what is likely to cause problems.

So here’s what I recommend: I recommend letting your 4 month baby “taste” everything that you eat! Simply dip your finger into whatever you are eating and let him lick it off. You don’t need to puree your food, it’s just going to be a “taste.”  Continue nursing (if at all humanly possible), especially around the time of those little licks (either before or after is fine).

Why “tastes?”

Tasting small amounts of food primes the immune system and the digestive system.   Having small bits of food – especially small bits washed around with lots of breastmilk and saliva – helps the immune system know that a certain food is “safe.”   Small amounts of food allow the digestive system to slowly release more and more digestive juices (good enzymes, stomach acid, and hormones that tell the gall bladder and stomach what to do).

Tastes are also super fun because it means the baby can be a part of the family mealtime.  The baby gets to lick the finger or spoon and feel like he’s a part of the family! This is a very important part of raising a healthy eater!

Finally, I find that babies that are introduced to solid foods early seem to make the transition from drinking to eating.  By about 9 months of age it becomes extremely difficult for Moms to produce enough milk to keep up with their infant’s higher caloric demands.  I have seen a few exclusively breastfed babies also struggle with eating solid foods because they have issues with textures or tastes, so greatly preferring to consume all their calories from Mom.  Early solid food exposure seems to help those very picky breastfed babies transition more easily.  This is very important as babies become toddlers and need to eat all different types of foods. (Like crunchy veggies, fibrous grains, etc.)

How to progress after 4 months

By about 5 months of age I tell parents they can start feeding spoon-sized portions, rather than just licks and tastes.

At six months you can then assess true “food readiness” to see if the baby is ready  to progress to 1/4, 1/2 or full “jar-sized” portions.  (Jars are a convenient measuring device, though I usually prefer families to make their own food or move on to Baby Led Weaning quickly.) I usually use purees for the first 1-2 feeds at 6 months, simply to assess if babies are ready. (It is easier to see with purees.)  Signs of food readiness: sitting up on her own, reaching for food, no longer spitting out food. (I.e., the baby has lost the tongue-thrust reflex that causes her to spit out all food placed on her tongue. This is super important and is easier to see with purees than Baby Led Weaning.)  If your child does well with the first 1-2 feeds with purees then please feel free to move on to Baby Led Weaning!

Remember that a “one-size-fits all” approach is not always appropriate.  Make sure you talk this through with your child’s provider before you try the Dr. Erika method.

What NOT to let her taste:

  • Honey or corn syrup (until at least 12 months of age. This is due to a concern about botulism in infants).
  • Anything chokeable. At four months it should truly be a “taste” – no chunks or bites of any kind.
  • Soda, juice or caffeinated beverages. I think this should be obvious, but you guys, do NOT give your infant any of these. Ever. They have no nutritional value and are likely to lead to obesity and multiple health problems.

What do YOU think?

Does this make sense?  It’s always easier to explain in my office when I really have a family sitting in front of me. Let me know your thoughts and how you approached solid food introduction for your kids!

Some fun studies:

https://www.ncbi.nlm.nih.gov/pubmed/25420475
https://www.ncbi.nlm.nih.gov/pubmed/28597536
–  Children that were introduced to solids right after 6 months exclusive breastfeeding and continued to receive breastmilk (≥12 months) were less likely to become overweight/obese (OR: 0.67, 95% CI [0.51, 0.88]) compared to children that discontinued to receive breastmilk.
https://www.ncbi.nlm.nih.gov/pubmed/28410085 (Here’s full text) http://www.jpeds.com/article/S0022-3476(17)30163-4/fulltext

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7 Types of Baby Cries – How to Tell What Your Baby Needs /2016/03/7-types-of-baby-cries-how-to-tell-what-your-baby-needs /2016/03/7-types-of-baby-cries-how-to-tell-what-your-baby-needs#respond Sun, 06 Mar 2016 22:05:58 +0000 /?p=5704 Have you figured out your baby’s cry language? Did you even know your baby had his very own language? Usually by 3 weeks or so most […]

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7 types of baby cries: how to tell what your baby needs

Have you figured out your baby’s cry language? Did you even know your baby had his very own language?

Usually by 3 weeks or so most parents have figured out the basic cues from their child.  But with all babies, just as soon as you think you’ve figured them out, something changes.  They go through a growth spurt, they get teeth, they go through a wonder week, they learn how to poop (lol).

I hope this guide will help out another Mom or Dad in the middle of the night when you just don’t know – is she scared? Is he Mad? Is she Hungry? I just don’t know! Here are 7 types of baby cries and full descriptions to help you figure it out.

1. Hungry

The very first cue you will have to tune into is the hunger cry. When you’re in doubt, at least in the early weeks, always assume it is hunger first. In my opinion this cue is one of the easier ones to figure out if you’re paying attention.

Early signs of hunger

Early signs of hunger don’t involve crying at all.  They can include opening the mouth, sucking on fingers, toys, clothing, etc.

Intermediate signs of hunger

After the early signs babies will quickly progress to intermediate signs, including rooting and and squirming.  Most babies will try to wiggle themselves into nursing position.  Shortly after this they will start fussing.

Late signs of hunger

By the time your baby starts crying they have already been showing signs of hunger for a while.  Late signs of hunger include moving the head side to side, crying, furiously rooting or sucking.  Some babies will grab or punch the breast to try to stimulate a let-down.

Remember that after the first few weeks sucking may no longer be a reliable indicator. As they discover their hands they will begin sucking on them continuously.

2. Tired

Again it is important to catch this one before your baby is overtired, as it becomes not only more difficult to tell the difference, but also considerably more difficult to get her to fall asleep.

Early signs of fatigue

Early signs include avoiding eye contact, turning away from a stimulus, yawning, and rubbing their face.  (Remember that newborn babies and small babies cannot reach their faces so you will miss this sign in that 0-3 month age range.)

Late signs of fatigue

Crying is a late sign of fatigue.  The “I’m tired” cry often has a cough-like sound in it.  It may sound a bit like this: “wah, wah, WAH – cough – WAH – cough – WAAAAAAH!” Late signs also include furiously rubbing the face/eyes/noise.

Wondering if your baby is tired?  The biggest predictor of fatigue is the length of time they have been awake.  Here is a handy chart for you:

Age of baby Max length of “awake” time (from wakeup to beginning of next nap)
0-1 month 5-40 minutes, at the most.  (Remember that newborns are characteristically “sleepy” and may only have a few minutes of active:alert time before sleeping again)
1-2 months 40-60 minutes, or awake the duration of their last nap.
2-3 months 60-80 minutes or duration of their last nap
3-4 months 60-90 minutes or duration of their last nap
4-6 months Duration of last nap, up to 1 hour 45 minutes max
6-8 months Up to 2.5 hours
8-10 months 2-3.5 hours
10-12 months 2.5-4 hours (often longer awake times in the morning and shorter in the afternoon)

3. Discomfort

Usually the “I’m uncomfortable” cry also includes squirming, fussing or arching. Discomfort cry typically doesn’t improve much when you’re holding your baby. Try a diaper change first, then clothing change. If no improvement look for a diaper rash, coat her bum thoroughly with diaper cream to be on the safe side.  I like Weleda Calendula Diaper Care, that’s an affiliate link 🙂

If there is still no improvement you can look for rashes elsewhere or tags on clothing that may be irritating her skin.  Then consider changing diaper brands or switching from disposable to cloth or visa versa.  If you’ve been using cloth diapers for a while now may be a good time to strip them (this gets rid of the built-up ammonia).  Also consider changing soaps or washing only 1-2 times per week to prevent skin irritation.

4. Pooping

Bodily functions can be frustrating for little people, especially when they don’t have the benefit of gravity working in their favor. The poop cry is usually accompanied by a red face and sometimes grunting. Some babies poop easier when they are lying on their belly or held upright in the knees to chest position. Pooping can be especially frustrating for newborns who don’t quite understand which muscles to push yet.   Most babies will figure that part out between 3-6 weeks of age.

5. Mad

This one is often specific from baby to baby. It is usually VERY loud, sometimes with a grunt or a grimace.  The eyes are typically half open (but sometimes closed if the baby is mad and tired at the same time).  Mad cry is most well known when trying to sleep-train (or sleep “coach”!) your baby.  See below, it is very, very important to learn the difference between Mad cry and Scared cry before attempting sleep training.

6. Pain

Pain cry is usually very high pitched with a harsh quality.  This is the type of cry that gives you goosebumps and waves of adrenaline.  It is virtually impossible to stay relaxed when you hear a baby’s pain cry.  According to these researchers babies who are in pain typically close their eyes, which is the clue-in to whether a baby is angry, scared or in pain.

Look for anything that would cause pain. Arching usually means gas or reflux.  Look for hairs that may be wrapped around a finger, toe, or penis for boys.  Inspect the skin carefully and look for lacerations (cuts).  A baby who is drawing his legs to his chest and has red, mucousy poops may have intussusception and should be taken to the hospital.  A baby with a bulging or shrunken fontanelle may have a serious illness and should also be evaluated immediately by a physician. Screaming after laying the baby down is sometimes an early sign of ear infection.  Babies who scream in pain and then become lethargic or withdrawn should also be checked out quickly.

7. Scared

Scared cry can be like pain, but often the eyes are wide open. It is a loud, harsh, sudden cry.  Context is everything for this one: was there a loud noise? New person holding her? Sudden Bright lights?

Why is it important to differentiate at scared cry? If you are planning on any type of sleep training it is incredibly important to learn the difference between your baby’s Scared, Mad and Pain cries.  Sleep training often involves some type of crying (though I strongly believe that babies should “fuss it out” and never “cry it out”).  A baby who is scared or in pain should never be left alone or forced to cry it out.  First, because it is simply cruel, but also because a scared or hurting baby will not learn to sleep on his own!

I hope this list was helpful to you!  Good luck on your parenting journey, I promise you’ll learn what your little one needs, but sometimes it just takes time!

 

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Herbs to increase milk supply: a guide to galactagogues /2015/07/herbs-to-increase-milk-supply-a-guide-to-galactagogues /2015/07/herbs-to-increase-milk-supply-a-guide-to-galactagogues#comments Wed, 15 Jul 2015 19:58:37 +0000 /?p=5655 Worried about low breastmilk supply? This post will cover herbs to increase lactation.  Herbs that increase breast milk production are called “galactagogues.”  (“Galacta” = milk, “-gogue” […]

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Worried about low breastmilk supply? This post will cover herbs to increase lactation.  Herbs that increase breast milk production are called “galactagogues.”  (“Galacta” = milk, “-gogue” = producer or supplier)

Is your milk supply actually low?

But first before we get started – is your milk supply actually low?  Many women mistakenly believe that their breast milk supply is low when it is not.  See this wonderful article from kellymom.com about breastmilk supply issues.  There is no need to supplement with galactagogues if breastmilk supply is normal!

Second – it is incredibly important to address the underlying cause of insufficient breastmilk supply first!  Most mothers do not need herbs to stimulate milk production – instead they need rest, relaxation, hydration, nutrition, and a baby who has an excellent latch and sucking reflex.  Especially focus on hydration – remember that it is impossible to make sufficient milk if you are dehydrated.  

Again, I recommend reading KellyMom.com for more information about breastmilk supply issues and how to uncover the underlying cause.  KellyMom has an amazing number of articles discussing everything from perceived low milk supply, to improving latch, to pumping and more.  

Okay – with all that said, if all of the above is normal or has been addressed and you still need to increase milk supply – then check out the rest of this article! 

Herbs:

Below are listed the herbs in “monograph” form.  The monograph lists the part of the plant used, the constituents, actions of the plant, the dose used, and and relevant safety data.  It is very important to pay attention to all these details!  Pay attention to “Part of the plant used” – for most herbs the active constituent is found in only one part (e.g., the root or the seed).   “Constituent/s” refers to the plant chemicals that affect the human body.  I promise I’ll write a guide to plant constituents soon!

Note: “Solvent” refers to the combination of water and alcohol used to extract the plant constituents (NOT chemical solvents, that would be stupid).  Some plant constituents are best extracted in low alcohol (high water) combinations, whereas some are best extracted in medium or very high alcohol (low water) combinations.  This is very important if you are making your own tinctures; remember that 80 proof vodka, for example, is only 40% alcohol and would be a bad choice for making a Hops tincture.

ALWAYS consult a knowledgeable physician or herbalist before using herbs medicinally.  This is especially true if you are taking medications, are pregnant, or are nursing (which you probably are if you’re reading this post).

 

Galega officinalis – Goat’s Rue

1024px-Galega_officinalis_002

 Part of the plant used: above-ground parts (not roots)

Constituents:  alkaloids and related nitrogen-containing compounds

Actions/Use For: Goat’s Rue is a potent galactagogue.  It is also insulin-sensitizing and hypoglycemic – Naturopathic Physicians often use this for diabetic patients to lower blood sugars.  Because of this it can cause low blood sugar even in non-diabetic patients which can be uncomfortable for some people.  Goat’s rue is also a phytoestrogen, is mildly anti-bacterial, and may increase lipolysis (fat burning). 

Dose/form: tincture (1:3 ratio of herb:solvent in 30% alcohol) 1-2 ml three times per day.  Capsules: 500 mg four times per day.

Safety: use with caution in pregnancy – insufficient information on use in pregnancy.

Drug interactions: use extreme caution if patient is diabetic, may interact with oral hypoglycemic medications (like Metformin).

 

Trigonella foenum-graecumFenugreek (seed)

Fenugreek galactogogue

Part of the plant used: seed

Constituents: complex carbohydrates, fatty acids, alkaloids (bitter – note de-bitterized fenugreek is not active)

Actions/use for: Fenugreek is a powerful galactagogue. It is also a carminative, which means it eases intestinal cramping and gas.  It is traditionally considered cardioprotective.  It can also lower lipids and blood sugars.  It is often used by herbalists and Naturopathic Physicians for diabetes and high cholesterol.

Dose/form: must use food-level doses for Fenugreek to be effective (50-100 grams per day).  Best given as a powder mixed with food (in curry spices, etc).  In capsule form it must be taken in high doses and frequently: 1200 mg four times per day – this usually equates to 2 capsules of powdered herb four times per day.  Can be combined with other herbs as well.

Safety: generally very safe. Contraindicated in early pregnancy in excessive doses.  Can be somewhat stimulating to the gastrointestinal system, so do not use if the patient has an active peptic ulcer or increased stomach acid.  Side effects may include stomach upset or symptoms of low blood sugar – these may be bothersome enough to stop using the herb.

 

Humulus lupulus – Hops

Hops galactogoguePart of the plant used: the strobile (the scaly fruit)

Constituents: resin, flavonoids, prenylated chalcones, iso-alpha acids.

Actions/use for: Hops are a moderate galactagogue.  They are a powerful phytoestrogen and moderate nervine.  (Nervines are herbs that act upon the nervous system – usually this means they are sedating or calming, as in this case.)  Hops are also anti-viral, anti-neoplastic (anti-cancer), and can lower blood sugar.  Hops are frequently used for menopausal patients with hot flashes and vaginal dryness.  Note that men should not excessively consume hops because it can cause gynecomastia (breast tissue growth). 

Dose/form: Tincture (1:3 ratio of herb:solvent in 50-75% alcohol.  Must use high alcohol-content to fully extract the active constituents.  This makes this herb very “strong” tasting in tincture form because the tincture is quite boozy.  Water down with a little water or “burn off” the alcohol by place the dose in a little boiling water, then cool to drink.)  3-5 ml three times per day, or 3-5 ml 30 minutes before and at bedtime for insomnia.  Pillows filled with dried hops can be slept on to improve sleep as well.  Other forms: beer!  Craft-brewed beer, especially IPA is high in hops.  Of course one would need to be extremely careful about beer consumption while nursing. Remember that there is no need to “pump and dump” after drinking alcohol, you just need to wait until all the alcohol is out of your system before nursing your baby. 

Safety: generally safe.  Chronic overdose may cause estrogen-overdose symptoms like low libido, irritability and edema.  Side effects are nausea/vomiting.  Do not give to patients who have gallstones, acute infectious diarrhea, or active peptic ulcer. 

 

Urtica dioica – Stinging Nettles

Urtica_dioica_001Part of the plant used: LEAF.  PLEASE NOTE: use the LEAF, not the ROOT or the SEED! Urtica root and Urtica seed are amazing as well, but they do something completely different.  Read the label of your tincture/capsule/tea package carefully to make sure it says LEAF. 

Constituents: flavonoid glycosides, caffeic and malic acid, minerals, vitamins, chlorophyll, sulphur, protein.

Actions/use for: Nettles are truly an amazing herb.  They have a diuretic quality without depleting potassium, are inflammation modulating, and are nephrorestorative (kidney function restoring).  Freeze dried nettle capsules are amazing for allergies.  Nettle tea is considered “nutritive” as it is very high in minerals.  (The original multivitamin!) Nettles have been traditionally used for malnourishment, nerve pain, strengthening of the musculoskeletal system, and for systemic inflammatory diseases.  Best of all – they also stimulate milk production.  (Maybe simply because they are so nutritious!)

Dose/form: Tincture (1:2 or 1:3 herb: solvent ratio in 25-30% alcohol, or as a glycerite 1:2 or 1:3 in 75% glycerine) 4-6 ml three times per day.  For lactation I highly recommend consuming in tea form (this will extract the most minerals): 5 grams of tea steeped in 8 oz hot water for 10-15 minutes, drink 1 cup three to four times per day.  Tastes delicious mixed with lemon balm and spearmint teas, and can also be mixed with other lactation-supporting herbs like alfalfa, red raspberry leaf, fennel, oat straw and others.  Raw fresh nettles can also be cooked in soups and stews (best to use springtime nettles that are tender and delicious).  Remember if you harvest fresh nettles to use thick rubber gloves to avoid the sting. 

Safety: contraindicated (not to be used) in patients who have blocked ureters (severe kidney stones).  Otherwise very safe, considered by most herbalists to be safe throughout pregnancy and breastfeeding. 

 

Foeniculum vulgare – Fennel

Foeniculum_vulgare_003Part used: seed

Constituents: volatile oils, phenolic acids, furanocoumarins, fixed oils

Actions/use for: Fennel is a tasty moderate galactogogue.  It is also a mild expectorant (good for thick, sticky coughs).  It is antispasmodic and great for colic, gas and irritable bowel-like symptoms.  It is a great phytoestrogen and has been traditionally used to treat women’s menstrual symptoms like amenorrhea (absent monthly flow), small breasts (!), and low libido. 

Dose/form: Tincture (1:2 or 1:3 herb:solvent ratio in 50-70% alcohol) 2-4 ml three times per day, or 2 ml up to 5 times per day.  Mixes well with other herbs in a formula because it is so tasty! (Note: when using in a formula you would decrease the total dose – consult an herbalist or Naturopathic Physician if you are making your own formula.)

Safety: contraindicated in GERD/heartburn – it relaxes the lower esophageal sphincter which can make reflux symptoms MUCH worse.  This is true for infants with reflux too (products like “Colic Calm” with Fennel will make reflux symptoms worse).  Do not use fennel essential oil internally, overdose could be toxic. 

 

Silybum marianum – Milk thistle

Silybum_marianum_0003Constituents: Lignan – silymarin including silibin, silychristin, silydianin. 

Actions/use for: Milk thistle is probably best known for its liver protective (hepatoprotective, hepatotrophorestorative) effects.  It is also a cholegogue and choleretic, meaning it helps stimulating bile production and elimination.  It is a potent antioxidant and is antiviral.  Milk thistle is the backbone in any treatment plan that includes detoxification (especially heavy metal and solvent detoxification), as it prevents liver damage when toxicants are mobilized.  (This is why you NEVER do a detox without consulting a physician, moving heavy metals and solvents out of tissues has the potential to create irreversible tissue damage).  There is a lot of good research about the use of Milk Thistle to prevent liver failure after ingestion of toxic mushrooms (Amanita or “toadstool” mushrooms).    Milk thistle is also a reasonably good galactogogue as well! 

Dose/form: milk thistle does NOT tincture well.  I highly recommend avoiding tinctures of milk thistle.  Instead use tea, capsule or whole ground herb.  Tea: 1/2 teaspoon per cup hot water, infuse 15039 minutes, drink 1/2 – 1 cup of tea three times per day.  Can also take 400-500 mg standardized Milk Thistle Extract (70% silymarin) per day (capsule form).  With capsules you really want to take a high quality, reputable product that you get from your physician or nutritionist – there are many knock-off products that claim to have Milk Thistle in them and instead are capsules of asparagus.  What a waste of money!!!

Safety: generally safe, but definitely avoid in patients who have a gallstone of unknown size, as it can cause a severe gallstone attack (which is potentially life-threatening if it lodges in the wrong place).  Side effects can include diarrhea or nausea from increase bile production/flow.

Conclusion (and other ideas)

There are many, many more herbs that have “galactogogue” effects.  Honorable mentions: Borage, Caraway, Coriander, Dandelion, Dill, Garlic, Red Raspberry Leaf, Marshmallow Root, and Red Clover.  These definitely aren’t my favorites, for various reasons (Red Rapsberry leaf is quite astringent, for example, and actually has the potential to decrease supply, Garlic can increase colic in babies, etc, etc).  Chaste Tree Berry is also listed as a galactotogue, but this is only at very low dosages, I would use with great caution as a known effect of Chaste Tree Berry is to decrease prolactin levels, which is exactly the opposite of what we want for a nursing Mom.

Last Honorable Mention: Oats! (Avena sativa)  Oats are an excellent galactotogue, and though they can be used in herb form (milky oat seed tea, for example), they taste much better eaten as oatmeal or oatmeal cookies.  Yum!  There are lots of fun “lactation cookies” you can purchase or find recipes for.  Frankly, it’s probably a LOT cheaper to make your own regular ‘ole oatmeal cookies at home.  Make sure to choose gluten-free oats if you have a sensitive stomach (or sensitive baby).

So what does Dr. Erika recommend?  My favorite tea blend is Traditional Medicinals Mother’s Milk Tea.  I like the company because they ensure really high quality herbs, and because the teas are tasty.  (No, they didn’t pay me to say that, though that is an Amazon link.)  The trick is to drink a LOT of tea – one cup per day just isn’t going to cut it.  It also helps Moms stay hydrated and keep up their minerals, which I think is a double bonus.

Good luck my lactating friends!

Image credits:

Galega officinalis 002” by H. Zell – Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons.
Junger Bockshornklee” by Yak. Licensed under CC BY-SA 3.0 via Wikimedia Commons.
Humulus lupulus“. Licensed under CC BY-SA 3.0 via Wikimedia Commons.
Urtica dioica 001” by H. Zell – Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons.
Foeniculum vulgare 003” by H. Zell – Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons.
Silybum marianum 0003” by H. Zell – Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons.

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Treatment for Children’s Constipation without Miralax /2015/04/treatment-childrens-constipation-miralax-alternative /2015/04/treatment-childrens-constipation-miralax-alternative#comments Thu, 16 Apr 2015 20:01:48 +0000 /?p=5662   In January of this year the FDA announced it would fund research into the safety of the very popular constipation medication Miralax. Though Miralax has been […]

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In January of this year the FDA announced it would fund research into the safety of the very popular constipation medication Miralax.

Though Miralax has been approved for use in adults and adolescents for less than 7 days, it has never been approved by the FDA for use in children.  Despite this Miralax has been a mainstay treatment by conventional pediatricians for use of constipation in children.

Polyethylene glycol 3350 (PEG 3350) is the active ingredient in Miralax.  Just so we are on the same page, ethylene glycol – or antifreeze – is not the same as polyethylene glycol.  Though polyethylene glycol is simply a string of ethylene oxide molecules, it is supposedly non-toxic and non absorbable, having no effect other than to loosen stool (poop).

So what’s the problem? The problem is that when the FDA tested batches of Miralax they found small amounts of actual antifreeze: ethylene glycol and diethylene glycol.  Not to mention that intestinal absorption of Miralax has never been studied in children, which is very concerning. The FDA has even received reports of psychiatric problems linked to the use of Miralax – specifically tics, tremors and obsessive-compulsive behavior.  This would suggest that at least some component of PEG 3350 is systemically absorbed, and we are not sure what the long term consequences are.

I’ve seen countless kids in my office with a chief complaint of chronic constipation, many of whom have seen conventional pediatricians and walked away with a prescription for Miralax.  I’m not blaming them – Miralax works extremely quickly and is an easy recommendation to make (we know it will work!) – but it also fails to truly address the underlying cause of why a child is constipated.

One of the main principles of naturopathic medicine is called “Tolle Causem” or Treat the Cause.  For kids to have permanent change in their bowel habits we first need to find out why they were constipated in the first place.  Read on!

First – how do we know they are constipated?  What “counts” as constipation?

Here’s a little guideline of what is normal for kids:

  • Babies 1 week old or less usually have 4 or more bowel movements (poops) each day.  They are usually liquidy or extremely soft.
  • Babies 3 months old or less can have bowel movements as often as several times per day, or as infrequent as once per week.  Breastfed babies tend to have less frequent poops because breastmilk is highly absorbable, which doesn’t leave much “left” to make a poop with.  If babies are very uncomfortable when passing stool (poop) then I still consider them to be constipated even though it is technically normal to go up to a week. (If it is bothering them, I think it is a problem!)
  • By age 2 most children have at least 1 bowel movement per day.  They should be easy to pass, formed, no blood in the stool, not pellet-like.   Though it is “normal” for kids to skip a day in between bowel movements, I aim for 1 per day. (1,2)

If your child doesn’t meet the guidelines listed above, or is having painful stools or behavior changes around the time of defecation, then I would consider them to be constipated.   Rather than just give a laxative, let’s try to figure out why they are constipated.

Lack of dietary fiber

This is by far the most common cause of constipation I see in my office.

To understand why fiber works we have to understand a little about the anatomy and physiology of the intestines.  Food is supposed to be digested by the stomach and then further digested and absorbed in the small intestine.  Everything that can be absorbed should be by the end of the small intestine – everything else gets dumped into the large intestine. Dietary fiber forms the bulk of “food” that cannot be digested and absorbed – this leaves extra material for the large intestine (or “colon”) t0 squeeze together and form into stool (poop).  This dietary fiber is incredibly important because it is what the good gut bacteria (“happy bugs”) live off of.  These “happy bugs” provide lots of awesome nutrients for our colon and help regulate our immune system.  They also help stimulate the nerves that squeeze the colon and physically push out a poop.

No fiber = nothing for the colon to push against!  No fiber = no happy bugs.  (No happy bugs = unhappy immune system and no stimulation of the nerves.)  No fiber = no poop!!!

The general recommendation is for children to consume 5-10 grams of fiber per day plus the child’s age. 3) (e.g., a 2 year old should have 7-12 grams of fiber.)  That’s great, but most families have absolutely no idea what that means.

In my office I like to do a drawing of a plate – here we can use the image from Harvard Public Health.  The most important thing to notice about the plate is that half the plate is fruits and vegetables.   If you are making macaroni and cheese as your main dish (or falafel, or rice and beans, or quinoa and chicken, or chicken nuggets, or hot dogs, or whatever) – your main dish should fill up no more than half the plate.  The other half needs to be filled with fruits and vegetables!  This is the easiest way to guarantee having enough fiber.

 

Harvard Healthy Eating Plate

 

The other method I like to use in my office is to write a side-by-side list of all the foods the child is eating in a day, comparing constipating foods to non-constipating foods.  If the constipating foods list is longer than the non-constpating foods list then we have a real problem.

Your child should eat equal number of servings of constipating and non-constipating foods in order to have normal bowel movements.  Here is an example chart of all the foods a 3-year old ate in a day:

Constipating Foods Non-Constipating Foods
Banana Oatmeal
Bread and creamy peanut butter Carrot sticks
Burrito with tortilla and cheese Lettuce
Meat Frozen berries
Pasta
Milk
Cheddar crackers

See your physician for help going over a list of constipating vs. non-constipating foods, or check out the full list of foods in the Pediatric Constipation Handout in our e-book/e-handout store.

Please note that I do not recommend over-the-counter fiber supplements like metamucil or fiber gummies to increase fiber.  Dietary fiber needs to come from the diet – not supplements! Also, I see a lot of kids (and adults) have bad reactions to wheat-based fiber supplements like metamucil.  We know that some sensitive kids and adults can end up with Irritable Bowel-like symptoms from use of wheat-based fiber supplements.

Lack of hydration

Drink, Drink, Drink!  Yes, yes yes!  When you increase fiber it will automatically draw water with it – this means that kids who are increasing their fiber intake need to drink more than they did before.  Without increasing water intake there is a chance that increasing fiber will actually make constipation worse!

Make sure your child is not consuming any caffeinated beverages (sodas, energy drinks or coffee drinks).  Kids should drink 4-8 cups of water per day – preferably one big glass with each meal.1)  Kids who are dehydrated may need to simply drink more water in order to have their constipation improve.

Eliminate Food Intolerances

The first food I recommend eliminating is cow’s dairy.  We know that greater than 1 in 3 children with constipation are dairy sensitive. 4) Kids with dairy sensitivity are more likely to have a runny nose, skin rashes and asthma than other kids. 5) If this is your child I highly recommend switching to a non-dairy milk like Almond, Flax, Hemp or Rice milk.  (I do not recommend soy milk unless it is in rotation with other dairy-free milks, as there is a concern that the phytoestrogens in soy could alter hormones in both boys and girls.)

Remember that even in non-sensitive kids excessive cow’s milk intake will lead to constipation eventually.  Kids need no more than 1 cup of milk three times per day to meet calcium requirements (and there are lots of other ways to get calcium that are dairy-free).  That translates to 1 milk for each meal.  I often see problems with kids who sip on cups (or sippy cups) of milk throughout the day. Remember that excessive cow’s dairy can also cause iron deficiency anemia, which is a huge problem for development. 6) (Iron deficiency anemia can be hard to detect in kids; sometimes the only symptoms are behavioral problems, ADHD, or problems in school.)

Next frequent food intolerances include gluten, soy, eggs, yeast, bananas, nightshades and corn.  For more information on how to do a food elimination challenge/diet please see the Naturopathic Pediatrics Elimination/Challenge Diet Handout.

Stimulate normal peristalsis

Peristalsis is the movement of the entire gastrointestinal system from “top” to “down” (esophagus to rectum).  It is what pushes food in a downward direction.  Peristalsis causes the intestines to squeeze in a normal snake-like manner, so that a lump of food travels through the tube.  See an awesome video of peristalsis in the large intestine.

Children with constipation often have – or develop – abnormal peristalsis.  The normal “wave” that should push food down and out in a bowel movement becomes impaired, which makes it difficult to defecate.

Things that stimulate normal peristalsis: probiotics, especially high-dose probiotics. Probiotics have been shown in infants to increase number of evacuations per day and reduce colic. 7) Specifically L. reuteri has been shown to be helpful in infants.  For older children and adults probiotics have been shown to speed transit time of the gut (how fast things move through our intestines), and reduce constipation. 8) For older children and adults Bifidobacteria have been shown to be most helpful.

Remember that most over-the counter probiotics are notoriously terrible – many brands have been studied and were shown to contain no active, alive strains – or worse, some were shown to have the wrong strain of probiotic.  The only brands I recommend are Pharmax HLC series (HLC neonate, HLC high potency, or HLC intensive.  There are also other specific HLC strains), Seroyal/Genetra HMF series, Culturelle, or Klaire Labs probiotics (Ther-Biotic infant, Ther-Biotic child, Lactoprime Plus SCD compliant probiotic, or ABx support).  Personally I use Klaire Labs probiotics in my practice, either Ther-Biotic infant, Ther-Biotic child, or Lactoprime Plus if we suspect gut dysbiosis or SIBO.  I have no affiliation with the company.

Because probiotics have so many other truly beneficial effects – possibly preventing colds & flu’s, preventing asthma, decreasing allergic responses – I highly recommend this therapy.

Other options:

Ginger has been shown to speed gastrointestinal motility. 9) Older children can take over the counter ginger capsules, younger children can try ginger chews or ginger tincture drops – but please consult your physician for dosage guidelines and safety. Ginger can (and often does) cause upset stomach or burning, and definitely should be used under physician guidance.

Acupuncture has also been shown to improve constipation by speeding gut motility. 10), 11)  Acupuncture is helpful for so many things, especially relaxation and decreasing the “nervous” response.  Make sure to find an acupuncturist who is very experienced with children.

Herbs which are under the category “Bitters” can also be helpful for atonic constipation.  Herbal bitters like Yarrow, Gentian, Blue Flag, Dandelion, and Berberine-containing herbs (like Oregon Grape and Berberis) may all be helpful.  Please please consult an experienced herbalist or naturopathic physician – most bitters are contraindicated in pregnancy, breastfeeding and early infancy, and can cause significant harmful side effects if dosed improperly.  When used properly these herbs can be very powerful, however.   They should be administered in drop doses, preferably mixed in a synergistic formula.

 

Bowel Retraining

Bowel retraining is the most important step in permanently curing constipation.  Bowel retraining involves changing behavior and stimulating normal peristalsis at normal times of the day.

Have your child sit on the toilet at least daily. 1) (Some physicians recommend several times per day, preferably after meals.)  At a minimum I recommend setting the child on the toilet at the same time each day, preferably in the morning (either upon waking or after breakfast).  It is normal and physiologic to wake up and need to have a bowel movement – I prefer to encourage a morning bowel movement to mimic nature as closely as possible. This is especially important for school-aged children who often hold stools during the day to avoid using a public bathroom.

Here is the key: toilet time must be highly reinforced with positive encouragement and rewards.  It must be a positive experience each and every time the child sits on the toilet.  Oftentimes children need to be bribed or rewarded heavily – use sticker charts, reading favorite books, favorite treats/snacks, watching TV or playing games on the phone – whatever works.  (It’s okay to throw out the “parenting rules” a little bit – at least at first.)  Remember that many kids have very negative associations with the toilet when they become severely constipated, and we need to completely change that association. Make sure to not punish the child for bathroom accidents or inability to have a bowel movement.

Stimulating a bowel movement as a part of bowel retraining

Obviously I prefer to not use laxatives in children, but many times it is necessary to artificially produce a bowel movement to get the bowel retraining process going.  There are several options here (starting with the least invasive, least force):

1. Physical activity and knee-to-chest positions.  This has not been shown in children, but in older adults physical activity has been correlated to a decrease in constipation. 12)  Overweight children and adults are more likely to have constipation, possibly due to lack of exercise and poor parasympathetic tone.   General exercise is key here (get them up and running around). For younger children you can sometimes stimulate a bowel movement by placing the child in a knee-to-chest position, which places pressure on the bowels and relaxes the rectum/anus.

2. Castor oil abdominal massage. Abdominal massage has been shown to improve constipation in disabled children. 13) It is gentle, feels great, and is a wonderful bonding time.  Dr. Harpster wrote an excellent article here about how to do a castor oil tummy massage for your little one.  Castor oil has a mild laxative effect when used topically (do not give internally to children, castor oil is considered a “cathartic” and stimulates a massive, sudden, and often painful bowel movement).  Any over-the-counter castor oil is fine.

3. Prune juice or other sorbitol-containing juice.  Prunes are high in fiber, but it is actually the sorbitol content that makes them a mild laxative. 1) Sorbitol is a sugar alcohol (but not alcoholic – no worry about giving this to your child) and is absorbed very slowly by our intestines.  Sorbitol tends to draw water into the gut which relieves constipation. You can do over-the-counter prune juice (organic please), or try Fruit-Eze paste.  Remember that kids with gut dysbiosis will tend to worsen on sugar alcohols like xylitol or sorbitol – if that is your child then I highly recommend contacting your naturopathic physician for a stool test.

4. Magnesium citrate or magnesium glycinate as a laxative. 1) If stools are still not soft enough to have a bowel movement then it may be time to consider a laxative to help get the process started.  I typically recommend magnesium powder mixed in water or juice.  Magnesium has the added benefit of being calming and reducing stress in kids, which can be a huge component of stool holding and constipation.  Start with 1/10th to 1/4 of the typical adult dose (depending on the child’s size), and increase the dose daily until it trigger a loose, borderline watery bowel movement. Most children will need to continue to use the laxative for a period of a few weeks to potentially months until they establish normal bowel habits.  Always consult a physician before use.  Magnesium or any other laxative should not be given if the child has true fecal impaction – it is potentially dangerous.

5.  Senna tea or another “stimulating laxative.” 1) This is one of my least favorite treatments for constipation because patients often end up dependent upon the laxative to have a bowel movement.  In other words – it is very difficult to stop treatment and maintain normal bowel health.    Adults can drink 1 cup of “Smooth Move Tea” – older children should have 1/2 a cup of tea, and younger children should have a dose proportionate to their body weight (1/10th to 1/4 cup of tea).  Always consult a physician before use.  Overuse of stimulating laxatives can cause pseudomembranosis colitis.

6. Glycerine suppositories. 1) These can be helpful in infants or young children who have fecal impaction. 1) The glycerine hydrates the stool which makes it easier to pass.  Remember that these can also be habit forming, especially in younger children and infants.  (Many infants who require disempaction with a rectal thermometer will learn to only have a bowel movement when the thermometer is inserted – it becomes a conditioned response.)

7. Saline enema.  1) If fecal impaction is present then sometimes an enema is the only way to loosen the stool and remove the impaction. 1)  It is incredibly important to use enemas correctly – they may be uncomfortable, but they should not cause pain for the child.

Directions for administering an enema: Have your child lie on his stomach with knees pulled under him, or in a hands and knees (crawling) position. Place plenty of towels underneath the child in case of leakage.  Remove the protective cap and lubricate the tip of the enema with KY jelly or another lubricant.  Gently slide the tip past the anal sphincter, pointing the nozzle in the direction of the child’s belly button.  Push gently and follow the path of least resistance.  Push the tip or nozzle 1-2 inches into the rectum.  STOP if the child is in distress.

I recommend squeezing no more than a few tablespoons of solution the first time you try an enema.  Squeeze the enema tube very gently to give a small, slow stream of solution into the rectum.  Remove the enema tip and place the child on the toilet. If they are unable to have a bowel movement within 15 minutes then try again with another enema, using slightly more solution.

Enemas should not be used in infants unless otherwise directed by your physician.

What to do when this is not enough:

If these tricks don’t work then it is time to do a more thorough work-up with your physician.

Other causes of constipation to discuss with your doctor:

Celiac disease (relatively rare – I recommend all children to be screened for celiac disease at least once in a lifetime.  Many children have few or no symptoms.)

Hypothyroidism

Lead poisoning

Rare congenital anomalies

Dysbiosis – several studies indicate gut flora imbalance leading to constipation.  Bacteroides, clostridia spp and pseudomonas spp seem to be particularly involved.  Naturopathic physicians can order stool microbiology testing to check for uncommon dysbiotic organisms.

Go to the doctor if:

There is severe pain along with the constipation

There is blood in the stool

After trying an enema the child still does not have a bowel movement and you suspect the stool is impacted

The child has a fever that started as the constipation started

There is a sudden change in how your child is having bowel movements (e.g., a baby usually goes every 2 hours, suddenly stops going for 2 days)

A newborn who does not pass meconium within 48 hours of birth.

References

1) Manu R Sood, FRCPCH, MD.  Functional constipation in infants and children: Clinical features and differential diagnosis. UpToDate. Web. 18 March 2015.

2) Fontana M, et al. Bowel frequency in healthy children. Acta Paediatr Scand. 1989 Sep;78(5):682-4.

3) Williams CL, et al. A new recommendation for dietary fiber in childhood. Pediatrics 1995; 96:985.

4) Irastorza I, et al.  Cow’s-milk-free diet as a therapeutic option in childhood chronic constipation. J Pediatr Gastroenterol Nutr. 2010 Aug;51(2):171-6. doi: 10.1097/MPG.0b013e3181cd2653.

5) Daher S, et al. Cow’s milk protein intolerance and chronic constipation in children. Pediatr Allergy Immunol. 2001 Dec;12(6):339-42.

6) Paoletti G, et al. Severe iron-deficiency anemia still an issue in toddlers. Clin Pediatr (Phila). 2014 Dec;53(14):1352-8. doi: 10.1177/0009922814540990. Epub 2014 Jul 2.

7) Indrio F, et al. Prophylactic use of a probiotic in the prevention of colic, regurgitation, and functional constipation: a randomized clinical trial.  JAMA Pediatr. 2014 Mar;168(3):228-33. doi: 10.1001/jamapediatrics.2013.4367.

8) Dimidi E, et al.  The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2014 Oct;100(4):1075-84. doi: 10.3945/ajcn.114.089151. Epub 2014 Aug 6.

9) Micklefield GH, et al.  Effects of ginger on gastroduodenal motility. Int J Clin Pharmacol Ther. 1999 Jul;37(7):341-6.

10) Qin QG, et al.  Acupuncture at heterotopic acupoints enhances jejunal motility in constipated and diarrheic rats. World J Gastroenterol. 2014 Dec 28;20(48):18271-83. doi: 10.3748/wjg.v20.i48.18271.

11) Zhang T, et al. Efficacy of acupuncture for chronic constipation: a systematic review. Am J Chin Med. 2013;41(4):717-42. doi: 10.1142/S0192415X13500493.

 12) De Schryver AM et al.  Effects of regular physical activity on defecation pattern in middle-aged patients complaining of chronic constipation.Scand J Gastroenterol. 2005 Apr;40(4):422-9.

13) Bromley D et al. Abdominal massage in the management of chronic constipation for children with disability. Community Pract. 2014 Dec;87(12):25-9.

 14) Shukla R et al. Fecal Microbiota in Patients with Irritable Bowel Syndrome Compared with Healthy Controls Using Real-Time Polymerase Chain Reaction: An Evidence of Dysbiosis. Dig Dis Sci. 2015 Mar 18. [Epub ahead of print]

15) Zoppi G et al. The intestinal ecosystem in chronic functional constipation. Acta Paediatr. 1998 Aug;87(8):836-41.

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Announcing the launch of NaturopathicPediatrics.com! /2014/09/announcing-launch-naturopathicpediatrics-com /2014/09/announcing-launch-naturopathicpediatrics-com#respond Sat, 20 Sep 2014 20:21:19 +0000 /?p=2003   A note to my wonderful patients and readers: I haven’t disappeared off the face of the earth, I promise!  I realize the Montana Whole Health […]

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A note to my wonderful patients and readers:

I haven’t disappeared off the face of the earth, I promise!  I realize the Montana Whole Health blog hasn’t been updated recently.  This is for good reason!

I never anticipated my practice website (mtwholehealth.com) to gather so many readers from around the country and the world.  It has been so fun to watch the site grow and attract so many interested readers. However, last year as the site began to grow I realized that my practice site, which is meant for my own Missoula-local patients, is not the ideal place for readers around the world to gather information and connect.

Thus the idea for NaturopathicPediatrics.com was conceived.  And boy, with the busyness in my practice, managing my Montana Whole Health blog, and trying to build a really super duper awesome site – it took me a LONG time (much longer than I anticipated) for the site to be birthed.

So, long story short – check out the new site! I built it myself (my first WordPress site from start to finish, thanks to a little extra help from ThemeForest).   You will notice an amazing natural health encyclopedia – your naturopathic version of WebMD® – with many articles for common children’s health conditions. (More articles are being added every week.)  We have pediatric specialist naturopathic physicians from across the U.S. and Canada who are our special contributors.  There are e-books and handouts for sale, and lots of awesome informative articles that are totally free.

If you are already a subscriber to my Montana Whole Health newsletter I highly encourage you to subscribe to the Naturopathic Pediatrics newsletter as well (either unsubscribe to the mtwholehealth newsletter, or keep both active).  Subscribers to the newsletter will be considered “members” and will have access to exclusive content, links to webinars, and coming soon a membership-only forum.  Come join us! 

Here are some screen shots – but make sure to check out the whole site, which is much more fun live.

Naturopathic Pediatrics About Us Naturopathic Pediatrics articles Naturopathic Pediatrics home Naturopathic Pediatrics home

 

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Tips for Eating Healthy on the Road /2014/07/tips-eating-healthy-road /2014/07/tips-eating-healthy-road#comments Tue, 22 Jul 2014 18:07:19 +0000 /?p=1990 Summer vacation season has officially arrived. One of the most common questions I get from parents in my practice is: How do I get my family […]

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Family on vacation eating healthy

Summer vacation season has officially arrived. One of the most common questions I get from parents in my practice is: How do I get my family to eat healthy meals on vacation?

Short answer: It’s not easy, and it requires some planning.

What to Expect When Eating on the Road with Kids

First, I want to say that vacation is vacation, and to expect to eat 100% farm-fresh organic home-cooked meals is just not realistic for most families. So lets all take a deep breath and give ourselves some grace to expect that things will not be perfect.

My priority for families on vacation is this: 1) to avoid artificial colorings and flavorings, 2) to avoid lots of sugary junk food, 3) to plan for at least one healthy, nourishing, protein-rich and colorful meal per day.

There are the obvious reasons for avoiding artificial colorings/flavorings – the fact that they are cancer-causing chemicals, neurotoxins, affect gut flora, etc., though once a year this is pretty unlikely. But really the reason I make this priority for parents on vacation is because I don’t want their vacation ruined. Many kids who eat pretty healthy meals at home end up extremely sensitive to artificial colorings and flavorings. These are the kids who either act like zombies or bounce off the walls when you introduce these chemicals. Vacations can be quickly ruined by a child with a day-long tummy ache, headache or disastrous behavioral problem.

So the solution is to plan ahead.

Tips for Eating Healthy While Traveling

1. Make sure you have plenty of food for the first day of vacation commuting – whether it be a plane ride or car trip. This will avoid the unnecessary trips to fast food restaurants or convenience stores when the whole family is famished. Try to make a trip to the grocery store on the second day of your vacation, or when you first arrive. Stock up on healthy snack foods and breakfast items (if necessary).

Bring snacks in reusable bags that you can use over and over on the trip like this sandwich bag from Lunchskins. Offer each child the option of choosing a reusable bag to use on the trip and personalize it.

2. Set clear boundaries and guidelines for treats on vacation. It may help to say something like “since we’re on vacation you get a treat every single day.” Then tell your kids when to expect the treat – it may involve a special trip for ice cream, a dessert at dinner, or a trip to the candy store. This way your children won’t expect to get a treat when they pass every single ice-cream truck or candy stand. Try to bring as many of the treats with you as possible. Fresh fruit that can travel well, like apples, firm bananas and oranges are great to have on hand for a sweet treat.  Shellable peas are a fun veggie to have at the park or beach.  Lettuce wraps with cheese, deli meat and humus are great snacks that a relatively shelf-stable and don’t require an ice cooler.  (No mayo for those hot days!)

3. Plan for at least one healthy meal per day. Scope out all the restaurants or eating options ahead of time. Try to pick restaurants that have options for side dishes that include veggies, side salads or fruit rather than chips or french fries.  Encourage your kids to continue to “eat the rainbow” even on vacation.

I hope this helps!  Good luck on vacation, and most of all – enjoy yourself!

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The ABC’s of skin cancer /2014/05/abcs-skin-cancer /2014/05/abcs-skin-cancer#comments Wed, 28 May 2014 20:13:46 +0000 /?p=1975 Everyone knows that sun exposure can lead to skin cancer. But did you know that there are several different types of skin cancer?  Most people equate […]

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Sunbathing woman

Everyone knows that sun exposure can lead to skin cancer. But did you know that there are several different types of skin cancer?  Most people equate skin cancer with big, weird-shaped moles, but that is not the only thing to look for.

It is very important to understand the difference in types of skin cancer so you can know how to look for and how to prevent it.

Types of Skin Cancer

Basal cell carcinoma is the most common type of skin cancer, and also the most benign (least dangerous). Basal cell carcinoma are associated with age and UV light exposure. They typically do not look like regular “moles,” but rather an open sore, pink growth with a rolled border, or most commonly a shiny bump. Basal cell carcinoma are treated by removing the cancer; the sooner this occurs the less scarring and damage to underlying tissue.

Squamous cell carcinoma is the second most common type of skin cancer, and also rarely causes problems when caught early. Squamous cell carcinoma is associated with long-term UV light exposure, immune deficiencies and environmental exposures. It is also treated by removing the skin cancer. Squamous cell carcinoma does not look like a “mole” and can vary in appearance, sometimes looking like a scab or lump, but usually scaly or wart-like.

Melanoma is the least common but most dangerous type of skin cancer. Melanoma usually (but not always) has a pigment, varying from red to brown to black. Melanoma can usually be recognized by the ABCDE’s:

  1. Asymmetry: Cancerous “moles” are usually not symmetrical.
  2. Border Irregularity: Melanoma usually has an uneven border with uneven area of shading from pigment to normal skin color.
  3. Color: Cancerous growths usually have multiple shades of tone (flesh-toned, black, brown or red).
  4. Diameter: Melanoma is typically more than 6 mm in diameter.
  5. Elevation: This type of cancer often is raised with an irregular shape (not smooth or dome-like).

A general check of all easily visible skin should be done at every annual exam in your physician’s office. Though most malignant melanomas follow the “ABC’s”, many do not or look like something completely different.

Any suspicious mole, flesh-colored growth or area of pigmented skin should be checked by your physician at least once. And because melanoma spreads quickly, schedule an appointment with your dermatologist or primary care physician if you have any new growth or mark, or any change in an existing mole, or if you are concerned about your skin.

Some experts suggest that 65 percent of skin cancer is caused by ultraviolet sun exposure. Lifelong sun-exposure can contribute to basal and squamous cell carcinoma, but it is primarily childhood sun-exposure that predisposes to melanoma. Children and teens should avoid sunbathing for the purpose of tanning, especially in artificial tanning salons.

Adults and children alike should practice safe sun habits. Because the sun is a primary source of vitamin D (itself cancer-fighting), sun exposure should not be strictly limited. However, no burn is a good burn.

Guidelines to Prevent Excessive Sun Exposure

  1. Shade and protective clothing are nature’s best non-toxic way of preventing UV exposure. A wide-brimmed hat and tight-weave cotton clothing can be cooling as well as sun-protective.
  2. Stay out of the sun during mid-day hours (10 am to 4 pm).
  3. Be aware of the effects of elevation and water or snow reflection. Take extra care to cover-up in these conditions.
  4. When shade or protective clothing are not appropriate or available, choose a sunscreen with azinc-oxide base and very few artificial ingredients. Many sunscreens with organic and natural ingredients are available at health food or supplement stores. Remember that many toxic ingredients can be absorbed by the skin, and the long-term effects of these are unknown.

Alba Botanica SunscreenHow to Choose a Sunscreen

I highly recommend checking with the Environmental Working Group to pick the best, most non-toxic sunscreen. It is incredible the amount of chemicals included in many sunscreen products. Remember that the skin can absorb many toxic chemicals.
Environmental Working Group’s database on safe cosmetics and skin care products can be found at: www.cosmeticsdatabase.com.

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What to do when the GAPS diet fails /2014/04/gaps-diet-fails /2014/04/gaps-diet-fails#comments Mon, 14 Apr 2014 22:31:28 +0000 /?p=1963 A decade ago Dr. Natasha Campbell-McBride published her now-famous book titled Gut and Psychology Syndrome: Natural Treatment for Autism, Dyspraxia, A.D.D., Dyslexia, A.D.H.D., Depression, Schizophrenia. A […]

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What to do when the GAPS diet fails

A decade ago Dr. Natasha Campbell-McBride published her now-famous book titled Gut and Psychology Syndrome: Natural Treatment for Autism, Dyspraxia, A.D.D., Dyslexia, A.D.H.D., Depression, Schizophrenia. A few years ago I started noticing a huge trend in parents trying the GAPS diet on their own, either after reading the book or getting advice from friends or other health or mom bloggers.  I have recommended the GAPS diet (or more commonly, the Specific Carbohydrate Diet) to some families as well.

But what happens when the GAPS diet fails?

This blog post will address some of the most common reasons why the GAPS diet doesn’t work.

So first, a little background behind GAPS.  The diet originated with the Specific Carbohydrate Diet, popularized by Elaine Gottschall in her book Breaking the Vicious Cycle.  (For more information, I highly recommend reading the whole book: Breaking the Vicious Cycle: Intestinal Health Through Diet.)  Dr. Campbell-McBride slightly modified the SCD diet, further restricting certain foods and focusing on healing nutrients.  The aim of the GAPS diet is to reduce intestinal dysbiosis, limit carbohydrates or starches that feed gut dysbiosis, and simultaneously provide gut-healing nutrients.  Her experience has been that healing the gut provides beneficial effects in the nervous system, which reduces symptoms of autism, ADHD, depression and schizphrenia.  (I second that experience – I have seen many patients where healing their intestines helps significantly with some of these other psychological symptoms.)

I should pause here a little bit and give a side note.  The GAPS diet has never been scientifically validated for “curing” schizophrenics, autistic children, depressed patients, or those with ADHD.  There are many doctors concerned about the GAPS diet, saying it lacks certain essential nutrients, and that it is not a long-term healthy diet.

I agree.

So why do I recommend a non-scientifically validated therapy that requires an incredible amount of work? Because when it does work it can have hugely beneficial effects.

Remember: the goal of a Naturopathic Physician like myself is to uncover the underlying cause of why someone is ill. For many children with ADHD, autism, depression, etc, the underlying cause is malabsorption, gut dysbiosis, leaky gut syndrome, or intestinal inflammation.  This may be the underlying cause for many children, but not for all!

The purpose of the GAPS diet is not to replace a normal diet.  The GAPS diet, I believe, should be used for a short to moderate amount of time (usually 1- 6 months, sometimes longer), to eliminate gut dysbiosis and inflammation and stimulate healing of enterocytes (the intestinal cells).   The goal is to completely heal the gut, discover which food allergens/sensitivities are a problem, and then progress to a long-term well-rounded diet.  (I highly recommend the anti-inflammatory diet as a long-term dietary strategy.  A lot of research has supported long-term anti-inflammatory diets like the mediterranean diet for disease prevention and health promotion.)

When the GAPS diet fails one of a few things may have happened: 1) the gastrointestinal system was not the underlying cause, or 2) the GAPS diet failed to address the gastrointestinal problem.

If the GAPS diet fails because of #1, parents and physicians need to spend quite a bit of time investigating other options.  (See my blog post about ADHD evaluation and treatment for more ideas. This can be helpful for other conditions, including autism, depression and anxiety).  I highly recommend seeing a competent physician who can order basic blood tests, including a whole-blood lead test (every child should be screened at least once in their lifetime), complete blood count (to screen for anemia), ferritin to check for low iron, thyroid, and vitamin D.

If the GAPS diet fails because of #2 – then we need to talk.

There are a lot of things I really love about  the Gut and Psychology Syndrome book.  Dr. Campbell-McBride does a great job of explaining basic anatomy and physiology of the gastrointestinal system.  She explains how enzymes work to digest our food, insulin and blood sugar, the role of the immune system in the gut, and the role of beneficial bacteria in the intestines.

There are a few things, though, that I don’t like so much about the book.

First and foremost – that it claims to be a cure-all for children with autism and other neurological disorders.  Not only does this sometimes lead to false hopes, but it also perpetuates Mom Guilt if the diet does fail.  (And you all know how much I hate Mom Guilt.)

The GAPS diet CAN work – but as I mentioned earlier, it does not work for all kids.  When trying the GAPS diet I tell parents that they should think of it as a therapeutic trial – if leaky gut and malabsorption is the cause of their child’s condition, then the GAPS diet will improve their symptoms.  If their symptoms do not improve then we need to look elsewhere.  Autism, ADHD, depression, schizophrenia, anxiety – all of these are multifactorial diseases and disorders – it is unrealistic to expect that all people will be cured with the GAPS diet.

Secondly, there are a few things that I don’t agree with in the book.  One is the idea that putting a small amount of food on the skin (she recommends the wrist) is an accurate test for food sensitivities.  There is no research to support this.  If a patient does have a skin reaction it is quite likely they will have an intestinal reaction (almost undoubtedly). But the opposite is not true at all: the absence of a skin reaction does not mean there is no food allergy.   There are several other small points in the book that I disagree with too (using aspirin for fevers, length of the diet, etc., etc), but I won’t get nit-picky here, I just want to remind readers that one book is not the be-all-end-all for health.

So here are the most common reasons I see the GAPS diet fail:

1. Failure to identify food allergens/sensitivities.  Many of my patients (if not most) do not tolerate dairy in any form, whether fermented or not.  Similarly, many patients have coconut, egg, tomato, potato or tree nut sensitivities. Some even have beef allergies! Imagine using beef broth for these patients! When these patients start adding these foods on the GAPS diet they sometimes forget to go slow and add foods one at a time.  If the symptoms do not resolve in the elimination phase (bone broth only), then something is wrong.

2. Including fermented products. What Dr. Erika???  I would say about 50% of my patients cannot tolerate any amount of fermented products, even homemade.  Obviously they are incredibly beneficial, but I believe it may be the product of fermentation – the alcohols and acids, possibly other compounds, that aggravate many patients.  Instead I use a FOS-free probiotic for my patients (my favorite is Klaire Labs SCD compliant probiotic, no affiliation).

3. Coffee, wine and vinegar. Dr. Campbell-McBride says that weak freshly-brewed coffee is okay, as is potato vodka and some wines.  I disagree.  Most of my patients do not tolerate these beverages as they seem to irritate the gut lining.  Vinegar is often better tolerated, but for some sensitive patients they just cannot handle it, at least initially.

4. Too many animal fats.  This is by far the biggest limitation of the GAPS diet for long-term health.  Animal fats are helpful in that they contain vitamin K2 and provide a much-needed source of calories on the GAPS diet.  They also provide a barrier by coating the intestinal cells to protect against many gastrointestinal irritants.  However, animal fats tend to be inflammatory. I know the Weston A. Price folks disagree with me on this one, but so far all the research still suggests that animal fats are pro-inflammatory. Granted, grass-fed and free-range beef are significantly less inflammatory (perhaps even bordering on anti-inflammatory?) than their grain-fed counterparts.  Nevertheless, I have many hesitations in recommending a long-term GAPS diet because of the high amount of animal fats.   All of the best researched and referenced diets in scientific literature are low in animal proteins and incredibly high in colorful fruits and vegetables. Remember that historically humans have consumed high amounts of foraged vegetables, and feasted on animals only when meat was available (rarely).  The Mediterranean diet, which I consider to be the best-referenced, best-researched all-purpose diet, is low in animal meats but high in vegetables and fatty fish.

For patients who do not respond to the traditional bone-broth introduction, OR have documented oxidative stress (tested through something like Genova’s Oxidative Stress 2.0 test) OR have inflammatory conditions like Crohn’s, Colitis, hypertension, atherosclerosis, asthma, thyroiditis, any other autoimmune condition (like rheumatoid arthritis, lupus, etc.) I recommend a modified GAPS introduction using vegetable juices in lieu of the bone broth.  Organic, fresh-pressed juices using copious green leafy vegetables and only a small amount of sweetener (like a 1/2 apple, one carrot, or some beets) are suggested.  Foods can be added back in according to the GAPS introduction diet, though of course there will not exactly be a “soup” to add them to.

5. Failure to add anti-microbials.  I believe this is the number one cause for GAPS-diet failure.  When I have a patient who has been on the GAPS diet and either improved only slightly or improved and then regressed I always look for gut dysbiosis.  Yeast overgrowth, overgrowth of pathogenic bacteria, or Small Intestinal Bacterial Overgrowth (SIBO) are incredibly common conditions in our era of frequent antibiotic-use and stress.

The GAPS diet is definitely designed to eliminate gut dysbiosis by “starving” bad bacteria and providing good bacteria from fermented foods.  But for people with incredibly high bacterial/yeast loads the GAPS diet simply isn’t going to be enough.  Remember, even if a patient is completely fasting there will still be some food supply for the microorganisms just from the sloughing off of dead intestinal cells.  In other words, starving out bacteria usually isn’t good enough.  (Unless you do actually starve, and I don’t recommend that!)  Even bone broth, though it is low in fermentable sugars, does contain a very small amount of food which can be just enough for dysbiotic flora to live in.

If you have improved on the GAPS diet in the past but then gotten worse as you introduced new foods or returned to a semi-normal diet I highly recommend checking for gut dysbiosis.  Naturopathic doctors often have stool culture kits in their office to check for a variety of organisms, not just the standard Clostridium difficile that most medical doctors are looking for.  Bacteria, yeast and parasites may all be present, and it is usually necessary to do more than 1 stool sample (an O&Px3 is standard for parasites, for example – meaning it checks for ova & parasites three times).

If that ends up negative and you still have gastrointestinal symptoms, especially symptoms of pain shortly after eating or significant gas and bloating with a distended abdomen then I recommend doing a test for Small Intestinal Bacterial Overgrowth (or “SIBO”).

Whether SIBO or another type of gut dysbiosis is detected there are several different antimicrobials that can be added to the GAPS regimen to help speed up the elimination of the organisms.  Though I usually use herbal antimicrobials, sometimes it may even be necessary to add in prescription antibiotics, anti-fungals or anti-parasitics if there is a very high microbial load.  This should be done carefully, obviously, so as to not cause more dysbiosis.  This blog post seems to be getting really long, so if you want another entire blog post about natural antimicrobials please request it!

Once the pathogens have been eliminated most patients will fully recover, and the GAPS diet can be resumed (if paused during treatment) to fully restore proper gut health.

Well – I hope this helps clear up some confusion about the GAPS diet.

What were your experiences with the GAPS diet? Did it work for you? Was this post helpful?

photo credit: cheeseslave via photopin creative commons license

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