How to Deal with Reflux

In light of Monday's post on reflux medications, I thought I would share some of the first options which should be looked at if you have a child who is dealing with reflux.

Reflux, also known as Gastoesophageal Reflux Disease (GERD) is very common. There are many, easy dietary fixes that work most of the time. There's a time and place for medication. But, many times an issue such as reflux is easily resolved just by changing the diet. And also looking into other health problems.

The first three things I ask when talking to someone about reflux is:

-Is the child dairy free (cow-milk based dairy products in particular)?

This is an extremely common problem. It's either a milk allergy, lactose intolerance (SO common!), casein intolerance, or the child's digestive tract just has issues digesting dairy. Cow milk-based products, in particular, are very hard to digest and cause a lot of irritation in the GI tract.

Going dairy free is really not that hard. It's nice if you can have something to replace the cow-milk dairy. We raise goats for that reason. But, there is also almond milk, rice milk and soy milk. Although, I recommend staying away from soy because of it's negative affects on the thyroid.

-Is the child gluten free (wheat, barley & rye)?

Gluten intolerances, Celiac Disease or a gluten allergy are all extremely common in both the population with DS and the general population. A gluten intolerance or Celiac Disease often times go hand-in-hand with a dairy intolerance. The proteins are very similar and therefore equally hard to digest. Gluten can cause a lot of GI issues, with reflux being one of them.

Going gluten free is a little more challenging than going dairy free. But, it's really not all that hard either. Our whole family (13 of us!) are gluten-free. Initially it was a little overwhelming, but there is so much you can do to replace gluten, it's quite easy. It just takes making things a little differently. Because gluten intolerance and Celiac Disease is so common, there are many equivalents to the regular gluten-made foods. Everything is made with rice flour, sorghum flour, potato starch, garbanzo bean flour, cornmeal, corn flour, xanthan gum, guar gum, etc. It just takes learning what to use differently.

-Does the child have any thyroid problems?

This is something that one may not initially think is involved with reflux, but it is. Especially hypothyroidism or a high TSH. This would definitely be something to look into, if you haven't already.

Taking thyroid medications is a quick way to fix the thyroid. Although, one must be careful when treating the thyroid with medications, if there is not a true thyroid problem (such as JUST a high TSH, but no other symptoms).

Coconut Oil also really helps deal with the thyroid and keep it under control. Low Zinc and Iron also play a big role in a high TSH and poor thyroid function. Those would be two other things to get tested and look into supplementing with them.

You can also go to the extreme of trying a gut healing diet, such as the GAPS diet, for dealing with reflux.
This will help with the reflux, because it will deal with healing the whole gut and get to the core of the issue, as to why there is any reflux.

Some links for the GAPS diet are:

www.gapsguide.com
www.gaps.me
www.gapsdiet.com

Personally, I'd try the top 3 things first - dairy, gluten & thyroid - and then look into doing the extreme of a gut healing diet. This is what we've done and so far, O is not on the GAPS diet. He may be on it someday, but as of right now, he is doing really well avoiding cow (& sheep!) dairy, gluten, and has a good TSH.



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Deficiencies caused by Reflux Medications

Reflux can be a common problem in people with Down Syndrome. I know it's a topic which is talked about often on many of the DS listservs I'm on. And I reference this information frequently, so I thought it would be good to do a blog post about it.

Many people end up on Reflux medications, instead of looking at possible issues in the diet & body for why there may be reflux. While reflux medications may be important for some, they cause a myriad of nutrient deficiencies, which in turn can lead to many health problems.

There are many things that can be looked at to try to figure out why there is reflux in the first place and other non-medication related ways to deal with it. I'll save that information for a separate post though!

For now, here is the list of reflux medications and all the nutrients the deplete.

List of Deficiencies caused by Reflux Drugs:

Acid-Reducing Drug Nutrient Depletion

Proton Pump Inhibitors:
Omeprazole (Prilosec®)
Lansoprazole (Prevacid®)
Pantoprazole (Protonix®)
Rabeprazole (Aciphex®)
Esomeprazole (Nexium®)

Histamine Antagonists:
Cimetidine (Tagamet®)
Famotidine (Pepcid®)
Nizatadine (Axid®)
Ranitidine (Zantac®)

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Vitamin B12 (1, 10,11,12)
Depletion of vitamin B12 includes: Fatigue, Peripheral Neuropathy, Tongue and mouth irregularities, Macrocytic anemia (abnormally enlarged red blood cells), Depression, confusion and memory loss (especially in the elderly), Poor blood clotting and easy bruising, Dermatitis and skin sensitivity, Loss of appetite, Nausea, and Vomiting.

Beta-Carotene (1, 13)
Beta -carotene depletion may cause a weaker immune system , and cancer.

Vitamin B12 (1, 2)
Anemia, tiredness, weakness, peripheral neuropathy, tongue and mouth irregularities, enlarged red blood cells (macrocytic anemia), depression, confusion, memory loss, poor blood clotting or easy bruising, dermatitis, skin sensitivities, loss of appetite, nausea, vomiting

Folic Acid (1, 3)
megaloblastic anemia, birth defects, cervical dysplasia, elevated homocysteine, headache, fatigue, hair loss, anorexia, insomnia, diarrhea, nausea, increased infections

Iron (1, 4)
Menstrual bleeding, pagophagia (consuming large quantities of ice), hypochlorhydria, diarrhea, intestinal inflammation, hair loss

Calcium (1, 6, 7)
Rickets, osteoporosis, magnesium deficiency, intestinal inflammation increased phosphorus ingestion (with soft drinks etc.), increased caffeine intake, excess dietary fat and fiber, lack of exercise.

Vitamin D (1, 8)
Rickets, low dietary Vitamin D intake, limited sun exposure, kidney or liver malfunctions, osteoporosis, osteomalacia, hearing loss, muscle weakness, severe tooth decay, phosphorus retention

Zinc (1)
Acne, impaired sense of taste and smell, delayed wound healing, anorexia, decreased immunity, frequent infections, depression, photophobia, night blindness, skin, hair, and nail problems, menstrual problems, joint pain, involuntary eyeball movements (nastagmuas).

1.Pelton R., La Valle JB, Hawkins EB, et al. Drug Induced Nutrient Depletion Handbook. 1999-2000. Lexi-Comp,Inc. pp. 250-53, 262-69, 294-97, 300-07, 404-410, 426.
2.Force RW, Nahata MC. "Effect of H2-Receptor Antagonists on Vitamin12 Absorption." Ann Pharmacotherapy. 1992. 26(10): 1283-86.
3.Russel RM, Golner BB, Krasinski SD , et al. "Effect of Antacids and H2 Receptor Antagonists on the Intestinal Absorption of Folic Acid." Journal of Laboratory and Clinical Medicine. 1988. 112(4): 458-63.
4.Campbell NR, Hasinoff, Meddings JB, et al. "Ferrous Sulfate Reduces Cimetidine Absorption." Digestive Disease and Sciences. 1993. 38(5): 950- 54.
5. Partlow ES, Campbell NR, Chan SC , et al. "Ferrous Sulfate Does Not Reduce Serum Levels of Famotidine or Cimetidine After Concurrent Investigation. Clinical Pharmacology and Therapeutics. 1996. 59(4): 389-93.
6.Bo-Linn GW, Davis GR, Buddrus DJ, et al. "An Evaluation of the importance of Gastric Acid Secretions in the Absorption of Dietary Calcium." Journal of Clinical Investigation. 1984. 73(3): 640-47.Â
7.Merenich JA, Georgitis WM, and Clark JR. "Failure of Cimetidine to Reduce Postoperative Hypocalcemia in Patients With Primary Hyperparathyroidism Undergoing Neck Exploratory Surgery." Surgery. 1993. 133(6): 619-23.
8.Bengoa Jm, Bolt MJ, and Rosenberg IH. "Hepatic Vitamin D 25 Hydroxylase Inhibition by Cimetidine Isoniazid." Journal of Laboratory and Clinical Medicine. 1984. 104(4): 546-52.
9. Lacy CF, Armstrong LL, et al. Drug Information Handbook. 1999-2000. Lexi-Comp, Inc. pp. 174, 424, 480, 512, 585, 1239.
10.Bellou A, Aimone-Gastin I, De Kowin JD, et al, "Cobalamin Deficiency With Megaloblastic Anemia in One Patient Under Long-Term Omeprazole Therapy," J Intern Med, 1996, 240(3):161-164.
11.Mercuard SP, Albernaz L, and Khazanie PG, "Omeprazole Therapy Causes Malabsorption of Cyanocobalamin," Ann Intern Med, 1994, 120(3):211-5.
12.Termanini B, Gibril, Sutliff VE, et al, "Effect of Long-Term Gastric Acid Suppressive Therapy on Serum Vitamin B12 Levels in Patients With Zollinger-Ellison Syndrome," Am J Med, 1998, 104(5):422-30.
13.Tang G, Serfaty-Lacrosniere C, Camillo ME, et al.  "Gastric Acidity Influences the Blood Response to a Beta-Carotene Dose in Humans,"  Am J Clin Nutr, 1996, 64(4):622-6.




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A New Path: Gluten Intolerance or Celiac Disease?

I've started to blaze a new research trail. A trail I never looked at or thought about much until the last few days.

As I've mentioned before, Osiyyah has struggled with reflux problems since he was a baby. When we started him on Nutrivene, his reflux greatly reduced. Then we realized cow dairy caused a problem for him. Once we removed cow's milk, his reflux reduced even more. And his "silent" (in that he didn't vomit, but you could certainly feel & hear the reflux) refluxing episodes were few & far between.

Lately though, he has had them more frequently. And it has gotten worse. Worse in that he cannot have anything that is made from cow's milk. No cheese, no ice cream, no sherbet, not even a salad dressing that contains cheese products (like ceasar dressing with romano & parmesan in it). We read labels and if it contains any cow's milk product, we don't give it to him. That helped some, but he has still had a bit of reflux problems here and there with all the cow dairy cut out.

So, something else must be causing this and it's time for us to make some drastic changes to his diet. The next most common allergy is Celiac disease or gluten intolerance (they are different, but very similar). The more I read & talk to people, the more I'm convinced that this is what we are dealing with in Osiyyah. Gluten is found in wheat, barley & rye. Oats often times are cut out of the diet as well and at times added back in at a later date, since they are processed with gluten many times.

Milk intolerance is commonly associated with gluten intolerance. Celiac disease is very common in kids with DS. Those two things right there make me think all the more that gluten intolerance or celiac disease is what we are dealing with.

To quote Kirstin from whattofeedyourkids.com (I'm sure she doesn't mind ;)),

Also, when you have celiac, the villi in the intestine are damaged. The lactase enzyme to break down milk is produced by the villi. When the villi are damaged you don't produce the lactase to break down the milk.

That quote right there makes me believe we may be dealing with Celiac rather than just a gluten intolerance. Especially since Osiyyah's milk intolerance has gotten worse over the last few months. If the villi in his intestine is being damaged more & more, it would make sense that he cannot tolerate an ounce of cow dairy.

I've read a lot the last day about this and am coming up with a plan of action somewhat slowly, but surely.

I'd really like to do the celiac disease screening done asap so that we can start him on a GF diet soon. If we can get the celiac disease screening & gluten intolerance tests done, hopefully it'll show which we are dealing with - celiac or gluten intolerance. Even if all tests come back inconclusive, we will still start Osiyyah on a GF diet in the hopes that it will take his reflux problems away.

Here are some helpful websites that I've come across so far. I will keep you all updated with information & research, as usual :).

http://whattofeedyourkids.blogspot.com/ - LOTS of good information here!

http://whattofeedyourkids.blogspot.com/2008/11/there-are-several-ways-parent
s-can.html

http://gfcf-diet.talkaboutcuringautism.org/gfcf-in-10-weeks.htm - while this site is specifically referring to Autism, there is a lot of helpful info about doing a Gluten free diet.

www.drdahlman.com/gluten-free-products.shtml

www.glutenfree.com/home.aspx

www.celiac.com - this website has tons of info on it and I haven't even scratched the surface!

http://www.cryingoverspiltmilk.co.nz/Food/Glutencancausegastro-oesophagealrefluxdisease!.htm - this article is very fascinating, especially in light of Osiyyah's reflux problems.

http://gfcf-diet.talkaboutcuringautism.org/gfcf-food-list.html - GFCF food list! Very helpful!

http://stewartdehart.stores.yahoo.net/gfsugr.html - My mom found this book, a GFCF shopping guide.

That's all for the moment!
Qadoshyah