Saturday, September 17, 2011

Reflux: Treating the Problem Not the Symptoms

Both Jett and Oliver had silent reflux and I didn't know it until Jett was 5 years old and Oliver 2 years old! Of course I feel terrible! Many of their symptoms I attributed to other things so they suffered, silently for years. Neither child has slept a full night through EVER -- but, last night -- they both slept through the night for the first time! 

Keeping in mind that acid reflux is because of LOW stomach acid and bacterial overgrowth, the cure is so simple. I just added a tablespoon of apple cider vinegar in their straw cups with lots of coconut water and a bit of stevia so it wasn't so sour. And they SLEPT THROUGH THE NIGHT!! I'll be adding a tablespoon of ACV in their drinks so that they can sip it throughout the day. Most people make sure their child drinks ACV an a hour before every meal. To address the overgrowth, probiotics are important. I list my favorites below. The last step is reducing carbohydrate intake. (See Get rid of GERD forever in 3 steps for details.)

Poor thyroid function is also a common reason for those with DS to have reflux. For Jett, his thyroid was properly treated so I had to go to the next steps. 

How did I miss this?

Jett's clues:
  • Displeasure when placed in a reclining position (One of his reflexes wasn't integrated so when I fixed that, he seemed fine on his back.)
  • Arching neck and back after eating (Most noticeable at restaurants because at home, I didn't think about "how it looks from the outside" as I did in a public.)
  • Poor sleeping habits – typically with frequent waking
  • Arching neck with head back during sleeping (Thought maybe it helped open his airways to breath better at night.)

Oliver's clues:

  • constant crying as a baby (attributed it to his PTSD)
  • irritability (PTSD)
  • frequent hiccups early on (the hospital said it was nothing--I thought maybe stress)
  • frequent waking (PTSD)
  • wanting to eat constantly because that helps soothe/decrease the pain (thought it was his mycoplasma infection or candida overgrowth)
  • Swallowing problems – gagging/choking/coughing (again, PTSD, was able to fix with an MNRI technique)
  • Arching neck and back during or after eating 
  • wanting to nurse all night long/ drink constantly because that helps soothe/decrease the pain (thought it was his PTSD)
  • occasional blood in his stool :(
What damage can reflux do?

In addition to wanting to get rid of the above symptoms, which are uncomfortable or downright painful, reflux can actually do some damage so it needs to be treated right away. Eventually it can cause inflammation and bleeding in the esophagus.  

Nutritional Ways to Treat Reflux  
As I mentioned, here's a great step by step guide.

And an excerpt from Weston. A. Price:  
Cultured foods and beverages will support the development of a healthy intestinal flora, and help break the candida cycle; these lactofermented foods will also supply enzymes to support digestion. Often, however, those suffering from acid reflux and related digestive problems find that they need additional help, especially at first. There are many fine probiotic and enzyme supplements that you can take to get you started in your healing journey.
Products Andi likes

Fermented foods are an easy way to add healthy microbes into your child's diet. Jett loves fermented ketchup, beet sauerkraut and raw goat keifer. Oliver like "salad" sauerkraut and coconut milk keifer and coconut or raw sheep's milk yogurt.  These are the enzymes and probiotics I like:

Nutrivene Daily Enzymes
Digest Spectrum
TriEnza Enzymes


Prescript Assist

Nature's Way Primadophilus Reuteri

Dr. Mercola's Complete Probiotics

Get $10 off your first VitaCost vitamin order

Learn More

The following is by guest blogger, Kris Benson, mom to Chase, 9 months old who is doing very well. In fact, he started crawling on hands and knees at 7 months old! But Kris has also had to face many challenges that come with the diagnosis. One of which is reflux. Lucky for us, Kris has taken the time to share what she has learned in two informative blog posts. Oh, and she happens to be a professional writer! Be sure to check out part one: Reflux in Down syndrome.

Reflux is not CAUSED by excess stomach acid

Everyone associates reflux with excess stomach acid. And if that is the cause, then it makes sense that if you take medication to reduce stomach acid, you should reduce reflux. But it really only addresses the pain/discomfort associated with reflux.

A better way to think about this is reflux is (usually) CAUSED by the LES muscle not closing when it should. By reducing the stomach acid, you are not treating the cause of the reflux (failure of LES to close properly), but merely the consequence of reflux (stomach acid/food forced back into the esophagus). The reasoning for the antacid medication is that less stomach acid in esophagus = less pain and less chance of damage.

And that might be fine – if your child’s LES problem resolves quickly and everything starts working great. A short term reduction of stomach acid will most likely prevent the pain and damage caused by the reflux. However, the acid reduction may be causing more problems than it is preventing.

Low stomach acid is a problem too

At 3 months old, my son was diagnosed with “Silent Reflux” and put on Zantac with a TBD end date. When that stopped controlling his pain, they switched him to Prevacid and he has been on that for almost 6 months already with no end in sight. It seems to control his pain well and when it doesn’t, I have found that Mylanta and/or Mylicon treat his immediate pain.

At 9 months, he is only 14 lbs, rarely hungry, doesn’t sleep through the night, has severe constipation, and feedings are a constant struggle. He only eats 4-5 oz at a time, so I have to fortify his breastmilk with powered formula and must continue the night feedings in order to get enough calories into him each day. He’s been diagnosed with failure to thrive twice (for both times the doctors upped his reflux medication and threatened us with a feeding tube, which is major surgery and just a band-aid – it does not treat the cause of the poor feeding at all – and often causes severe feeding aversion and other complications.)

I believe that it is actually the acid reducing medication my son is on that prevents him from being able to properly digest his food.

This is causing a cascade of problems:

· He’s not hungry often enough. If his food is not fully digested in a timely manner, then food stays in his stomach longer, making him feel full longer, so he’s usually just not hungry. That makes he doesn’t eat enough and every feeding becomes a struggle.

· Gas build up causes pain and reflux. This bad digestion also causes gases to build up in his stomach causing extreme bloating, cramping, and pain that is easily mistaken for reflux and can also help cause reflux. He is constantly trying to stretch his torso – throwing his head back and arching his back to try to relieve the pain. This makes feeding painful and increases feeding problems. It also makes him wake up frequently and not want to be placed on his stomach or back. He has started sleeping on his side because of this gas problem.

· Nutrient absorption is reduced. Once the improperly digested food does leave his stomach, nutrient absorption is reduced because they have not been released from the food. This adds to slow growth and insufficient nutrient levels and calorie uptake.

· Increases constipation. Also, the poorly broken down food takes longer to travel through the intestine, causing more water to be absorbed from it making my child “super” constipated. This makes the whole system backed up and he’s uncomfortable, starts “holding it” because it hurts to poop, and can cause even more problems.
All of these compounding problems result in a poorly functioning GI system that could be causing my son’s eating and growth problems.

Treating the Problem Not the Symptoms

I do not believe that he is still suffering from reflux, but rather low stomach acid that is causing symptoms that present like reflux. Even though he’s been on the Prevacid for so long, he still has some symptoms of reflux and I l have to treat occasionally with Mylanta. Interestingly, Mylanta is an antacid and anti-gas medication. I think that I may have been treating gas problems that have presented like reflux.
Over the past month, I have slowly weaned my son off of the Prevacid. He has been free of antacid medication for over a week now. I have added 1 tsp of Miralax 3x a day to treat his severe constipation and keep things going through his system more quickly. (Note: Kris doesn't use Miralax anymore, she uses Vitamin C, if necessary, see Constipation: Causes and Cures ). I have also added an increased dose of Nutrivene digestive enzymes – 1/2 to 3/4 capsule 2-3 times a day – to help him digest his food more completely and more quickly. 
He tends to get gas build up in his stomach extremely easily and quickly. I let him stretch out across my body when feeding and give him Mylicon as necessary. Just today, I was trying to figure out why his diaper seemed to be gigantic on him and realized it was because his bloated budda belly was finally gone!
He is starting to be hungrier more often and is eating more at each meal. I am hoping that this will lead to better sleep at night and more rapid weight gain and make him a happier and healthier boy in general.

Note: Overexpression of GABA, a common problem in people with DS, can cause reflux, both acid and nonacid in the esophagus.  Taking ginkgo to control overexpression of GABA may therefore help with reflux. See Ginkgo: The Hows and Whys for Down Syndrome for details. -Andi


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