• franceswalker@thefoodinto

Low FODMAP reducing colic in breast fed babies.



Excessive crying and fussing in babies for unexplained reasons is not an uncommon occurrence in otherwise thriving babies, especially in the first 12 weeks of life. Despite many years of study, until now we have know very little about causes and ways to reduce colic in babies.


A land mark Australian trial (1) published in October 2018 has demonstrated that reducing the FODMAP content of the mothers diet can significantly reduce colic in their breast fed babies. Despite this trial being small, the high quality design (double blinded randomised controlled) and the magnitude of the results means the findings hare worth taking notice of.


What is colic?

Colic is described as bouts of crying or fussing for unexplained reasons that can occur in otherwise thriving babies (2, 3). Excessive crying is estimated to occur in up to one third of babies 3 months and younger (4) although often spontaneously resolves by age 3‐4 months without intervention.


There is even a set of criteria to define colic: the WESSEL CRITERIA. To medically term a baby as suffering from colic, the the following criteria needs to be met:

  • crying episodes lasting for more than 3 hours per day

  • for three or more days per week

  • and for three or more weeks (3, 5).

What the study showed

The Australian FODMAP and colic study included 13 mothers and babies with colic who were provided with a low FODMAP diet for around 10 days followed by a typical Australian diet for the same length of time, or the other way around.


As a control, 7 mothers with babies without colic followed the same protocol except followed their normal diet and not given dietary advice.


The babies were all 9 or less weeks old.


While colic was shown to reduce over time, the reduction with the low FODMAP diet was greater than that with the typical Australian diet:

  • Colic was reduced by a median of 32% during the low FODMAP diet

  • Some of this reduction would happen any way as shown by the reduction of 20% on the typical Australian diet

  • This extra level of colic reduction with the low FODMAP diet is significant.

The study highlighted that both severe and mild colic tends to reduce over time with or without intervention but also debunked some common beliefs:


Incredibly, excessive crying & fussing were found NOT to be due to babies being overstimulated, awake for long periods of time, ‘over‐tired’ due to not enough sleeper hungry!

How a low FODMAP diet may reduce colic

This is unclear, especially as it is thought that FODMAPs from the mothers diet cannot pass into the breast milk.


There are a few thoughts as to why this may happen, although it is far from clear.


FOOD CHEMICALS in breast milk

A low FODMAP diet will also reduce other allergens and/or food chemicals such as salicylate amines and glutamates. However, in this study it is less likely as this was taken into account in the design of the diets. The low FODMAP diet and the typical Australian diet used supposedly included food chemicals and potentially allergenic foods in comparable amounts.


BACTERIA in breast milk

It is presumed that the microbiota of breast milk will influence the baby's gut microbiota. In animal models, the mother's gut bacteria can migrate into the breast milk but this has not been established in humans (6). If this is the same in humans, then feasibly changing the maternal diet FODMAP content may mean the breast milk bacteria is also changed and passed onto the baby.


FODMAPs in breast milk

Breast milk naturally contains FODMAPs such as lactose and hundreds of human oligosaccharides unique to breast milk and very different to the oligosaccharides found in food (6, 7). Of interest is 2′‐fucosyllactose which accounts for more than 30% of total human milk oligosaccharides (8) and low levels have been linked to higher rates of diarrhoea in breastfed infants (9). The significance of this requires further studies.


METABOLITES in breast milk

The break down of FODMAPs may produce other chemicals as a by product (called metabolites) which could be passed into the breast milk. For example, eating garlic has been shown to result in a garlicky smell oil breast milk within 2-3 hours (10). This is not caused by the garlic aroma chemicals directly passing into the breast milk but the break down products (metabolites) which are able to cross over into the breast milk. In a similar fashion, other metabolites from the breakdown of FODMAPs may be transferred to breast milk.


Any ways to modify or reduce colic in a baby is a very attractive option for mothers dealing with excessive crying in a baby.


Before undertaking such restrictions, the following may need to be considered

  • When breast feeing, it is really important to eat a diversity of foods to meet nutritional needs.

  • Breast feeding requires extra energy, with an extra 2000kj required each day in addition to normal requirement.

  • A low FODMAP diet can seem overwhelming at first so to avoid unnecessary restrictions seeking professional support and minimise necessary restrictions

  • Other restrictions such as dairy or soy protein restrictions increases the level of complexity and places a nutritional risk due to a high level of diet restriction

  • The low FODMAP diet is not a wheat or gluten free diet, avoidance of wheat or gluten in conjunction can significantly increase impact on the nutritional content of the diet.

Any diet changes can negatively affect the mother's nutrition at a time when extra nutrients and calories are needed. So while this diet could be implemented for babies with colic, care needs to be taken to ensure a variety of nutritional alternatives and overall nutritional adequacy. This is really important if there are other dietary restrictions in place.


REFERENCES

1. Barrett JS, Craig SS, Gibson PR, Iacovou M, Muir JG, Yellard GW. Randomised clinical trial: reducing the intake of dietary FODMAPs of breastfeeding mothers is associated with a greater improvement of the symptoms of infantile colic than for a typical diet

for a typical diet. Alim Pharmacol & Theur. 2018. https://onlinelibrary.wiley.com/doi/10.1111/apt.15007?fbclid=IwAR3rfXukimK3uly6UA_k5nUCuV3e8N8onxbHbtLCNPgahxXihZXFXC6UmZE&

2. Forsyth, B.W., J.M. Leventhal, and P.L. McCarthy, Mothers' perceptions of problems of feeding and crying behaviors. A prospective study. Am J Dis Child, 1985. 139(3): p. 269-72.

3. Jarman R, Sewell J. Common behavioural and developmental problems. Oxford: Blackwell; 2000. 144-5.

4. 63.Halpern, R. and R. Coelho, Excessive crying in infants. J Pediatr (Rio J), 2016. 92(3 Suppl 1): p. S40-5.

5.Wessel, M.A., et al., Paroxysmal fussing in infancy, sometimes called colic. Pediatrics, 1954. 14(5): p. 421-35.

6. Fernández L, Langa S, Martín V, et al. The human milk microbiota: origin and potential roles in health and disease. Pharmacol Res. 2013;69:1‐10.CrossrefCASPubMedWeb of Science®Google Scholar

7. Gnoth MJ, Kunz C, Kinne‐Saffran E, Rudloff S. Human milk oligosaccharides are minimally digested in vitro. J Nutr. 2000;130:3014‐3020.CrossrefCASPubMedWeb of Science®Google Scholar

8. Lee WH, Pathanibul P, Quarterman J, et al. Whole cell biosynthesis of a functional oligosaccharide, 2’ ‐fucosyllactose, using engineered Escherichia coli. Microb Cell Fact. 2012;11:48.CrossrefCASPubMedWeb of Science®Google Scholar

9. Morrow AL, Ruiz‐Palacios GM, Altaye M, et al. Human milk oligosaccharides are associated with protection against diarrhea in breast‐fed infants. J Pediatr. 2004;145:297‐303.CrossrefCASPubMedWeb of Science®Google Scholar

10. 36.Caubet, J.C., et al., Non-IgE-mediated gastrointestinal food allergies in children. Pediatr Allergy Immunol, 2017. 28(1): p. 6-17.


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