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Tuesday, November 8, 2011

Gut Integrity- NEC

Gut integrity -- nothing in the gut except breastmilk for 6 months. The thought amazes me. The life LONG benefits of optimizing sealing your baby's gut with nothing but breastmilk so the intestinal lining seals and matures.  Sealing your gut would promote natural flora and keep proteins from being absorbed that shouldn't get absorbed by the gut. In turning possibly causing digestive problems and inflammation.

I am not sure many of our full-term healthy babies get nothing BUT BREASTMILK for this long. There is too many tempting tastes, religious customs, grandma's treats, tylenol for vaccines and fevers, Vitamins, and early use and misused formula given. I don't know that a drop of something that is absorbed in the mouth ruins gut integrity, but you get the idea.

I believe in gut integrity. I trust that if we keep doing research we will one day have all the Science to back it this up- NOTHING BUT BREASTMILK.

Neonatologist at the conference don't agree on what to supplement the NICU micropremie with. I say UNPASTURIZED mother's own milk is best without supplement if it's available. Someone else's premie milk is second best. Third best is donated milk from the bank regardless of age. I actually like the idea of unpasteurized milk even if it's screened donor, but it is assumed that all milk from a donor will be pasteurized. I am bothered by the thought that the live enzymes needed to seal and protect the gut are going to be killed... but better than formula. Formula offers know immunity.

The current practice in most places is using a cow protein based fortifier. Adding fortifier to milk is better than the worst option (just formula).  There is some research being done on human milk fortifier. This is an all human product being added to mother's milk. But why add it? just give breast milk. In general, the studies  show the more breastmilk / the less fortifer the less NEC (necrotizing enterocolitis- the problem that keeps neonatologist up at night in the NICU). This is a serious bowel ischemia. Think about it. Nothing belongs in the gut but mother's breastmilk. Of course these little premies should still be protected by the placenta in the womb, but why put cow's milk protein or anything but mother's milk in the premies intestines? Just to fatten them up quicker and make them "look good."

Despite all the time and energy on  research being done on fortifier use in the premie, it is going to take me a lot of convincing that any fortifier is necessary.


Rixa said...

I wonder if something like Vit D drops would affect gut integrity. Formula is a no-brainer, of course, but think how much other "stuff" babies put into their gut systems through picking up toys/dirt/whatever. Would a drop of vitamins affect this integrity? I don't know...In any case, my D levels were a bit low, so I've been taking 8000 IUs/day to bring them high enough to pass on through breastfeeding. I just went back to 4000 since my baby's 8 months and, while she hasn't started on solid foods yet, she's definitely old enough to have the drops without any worries.

Denise Punger MD IBCLC said...

If the Vit D drops are all absorbed orally, not likely to interfere with gut integrity. I can't help think that daily Vit D dosing would effect the gut if given shortly after birth.

I am not a big fan of mylicon, gripewater and other homeopathics given orally to babies. Even though small doses are used, I never questioned whether they got into the gut. I just thought they did. Giving treatments for reflux, constipation, colic etc...doesn't fix the breastfeeding issue which is usually the the underlying reason. I always like the breastfeeding to be addressed first. Than if there is no resolution go on to another treatment approach.

Also important to try babywearing to calm a baby.

TopHat said...

My son has a very sensitive gut and gets diaper rashes all the time from foods. My daughter was not like that at all. I believe the big difference is that he and I had thrush for weeks starting at week 1 with everything from white patches in his mouth to the thrushy diapers. I think his system didn't get the good gut-sealing that it should have because of that (whether from the thrush itself or from the diluted GSE I would swab in his mouth and on my nipples), so when we started offering solids, he would have the worst diaper rashes. He held off of solids until 10 months after that and it's better, but he still is very sensitive to foods and he spends much of the day diaperless because of the rashes. He's 15 months now.

Anyway, long story- do you think my guess about thrush as affecting the gut to be possible?

TopHat said...

Just re-read my comment and need to clarify. We didn't hold off for 10 more months, we held off on solids until he was 10 months old.

Denise Punger MD IBCLC said...

Yes, I believe that thrush affects the lining or disruption the seal can lead to increase chance of candida. Definitely related. I apologize for not being up on your birth story and the early events of nursing to see what all may specifically have lead to the thrush.(maybe your Q will inspire me to look back for the details)

GSE is generally a good choice for restoring balance.

Many of my local mothers like garden of life probiotics, or have probiotics custom made, or make cultured food or use kefir grains.

Are you or your son using probiotics? How is your digestive health?

The good news is with lifestyle choices (nutrition, probiotics, digestive enzymes, greens, quality grains, etc...) I see excellent improvement in digestive health.

I enjoy hearing from both of you TopHat and Rixa. You both are doing a great job caring for your family and informing all of us (including me)!

The Natural Mama said...

What is the adverse reaction to human milk? Why do the hospitals think that it is not good enough, or would they even be open to TRYING it to see how a preemie would do. I am always baffled when I see people (usually guys!) be so afraid to touch human BM, no less use it medicinally. But its ok to use/drink milk from a cow or goat? haha! Question on the gripe water? I did use it once when baby had "colic" from (what I suspect) was me eating spicy sausage (what was I thinking?! haha) I really don't think it was from over supply, because he never had it again. Would you suggest trying to hold off from the Gripewater until it passed, if you think its food related? I didn't notice a huge difference, but since he had been screaming all day, I was desperate and called a friend to borrow some. By the time I gave it to him, I think the "spicy" had passed from my milk because a few hours later he stopped crying and never had this problem again...

Denise Punger MD IBCLC said...

My IBCLC student, pointed out to me that human milk fortifier is not a human product, but rather it is a play with words... a concentrate to ADD to human milk.

About Gripe Water.... I don't find myself recommending it or reaching for it. Maybe someone can enlighten me if I should be. The oversupply/fast let down issue doesn't respond to it. Does it do anything for colic or upset stomach? Maybe but I don't seem to get much feedback about that. I tend to think it is overused too much just like mylicon (which doesn't help) is used too much.

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