The Virgin Gut?

As many of you who have read my blog in the past know, I am a big proponent of breastfeeding.  It is the one topic that I have written about the most on my blog.  New parents are constantly being given the message these days that "breast is best."  We hear about the usual benefits which include among other things:  "a protective effect against respiratory illnesses, ear infections, gastrointestinal diseases, and allergies including asthma, eczema and atopic dermatitis. The rate of sudden infant death syndrome (SIDS) is reduced by over a third in breastfed babies, and there is a 15 percent to 30 percent reduction in adolescent and adult obesity in breastfed vs. non-breastfed infants."  Organizations such as the World Health Organization and the American Academy of Pediatrics recommend exclusive breastfeeding for the first six months of life.  Despite these recommendations, many mothers still choose not to breastfeed and give formula to their baby instead.  Mothers may have legitimate reasons such as not having adequate breast tissue or not producing enough milk.  However, I think with our society's portrayal of breastfeeding, many mothers simply choose not to attempt it.  It is tiring and a lot of work.  

In the event of a mother not entirely convinced that "breast is best," there is yet another reason to attempt breastfeeding and that is the case for the "virgin gut."  This is something that I had not heard about with my first baby but am hearing more about with my second baby.  I first heard about it on some of the message boards that I frequent so I began doing some research.  I came across the following blog and an excellent paper written with lots of scientific citations.  Both of these are worth reading and go into great detail (better than I could do with my limited time for blogging) about the "case for the virgin gut."

I will do my best to "summarize" the theory.  A baby is born with a  "sterile" gastrointestinal tract.  "The gastrointestinal tract of a normal fetus is sterile. During the birth process and rapidly thereafter, microbes from the mother and surrounding environment colonize the gastrointestinal tract of the infant until a dense, complex microbiota develops."  The type of colonization is influenced by delivery (vaginal vs. cesarean) and perhaps most importantly by the method of feeding the baby (formula vs. breastfeeding). The gut flora of a formula vs. a breastfed infant is different.  It is believed that the flora that is established with breastfeeding can have protective effects for the baby throughout their lifetime.  Some believe that even one bottle of formula can upset this balance and may take weeks of exclusive breastfeeding to undo.

A part of this theory also addresses the "open gut."  Essentially, when a baby is born, their gastrointestinal system is "immature."  As a result, there are openings in the gut which allow large, potentially allergy causing proteins and disease causing pathogens to pass directly into a baby's blood stream.  It is theorized that mother nature "intended" for these openings for large maternal antibodies to pass into the baby's blood stream to protect the baby from disease.  The antibodies will also coat the lining of the gastrointestinal tract to confer passive immunity to a baby.  Feeding formula (which many contain cow's milk protein) or introducing solids before the age of six months is believed to increase the likelihood of the development of food allergies or illness.  It is believed that the "closing" of the gut occurs around six months which is why food should not be introduced until after a baby has reached six months of age.  This is especially important in babies with a family history of food allergies.  It is also believed that a baby is less likely to get sick after six months when a baby begins to produce their own antibodies and do not have to rely as much on passive immunity from the mother.

I had always been a believer in exclusive breastfeeding for the first six months of life.  My older son received one tiny bottle of formula when he was four days old since my milk was slow to come in because of a bad latch.  My second baby who just turned six months old yesterday has not had a single drop of formula.  He has only had breastmilk and nothing else (not even water) to drink.  Breastfeeding with either baby has not been easy but after reading about the "virgin gut," I am more than happy that I did.  I had a lot of pressure from well meaning family and friends to give my babies formula or start them on solids before six months of age.

I had a lot of allergies as a kid.  There are pictures of me getting solid foods at two months old (which was apparently common in the 1970's).  So far, with my older child, he does not appear to have any allergies.  This includes foods that I was allergic to.  I am hoping the same will be the case for my younger son.  Since he is past the six month mark, we will start introducing solid foods to him in a few days.  It will be the beginning of an exciting new chapter for us.  We are keeping our fingers crossed that this may help us get some much needed rest.

So what if you cannot breastfeed?  This something that I know really torment a lot of women.  If you cannot breastfeed, there are different ways to go about getting breastmilk for your child.  Unfortunately, in today's society, many people would opt for formula before exploring some of these alternatives.  However, if you're really determined, I think the following are good choices.  There is wet nursing.  This was something done long ago before the advent of formula and it seems to be enjoying a resurgence in recent years.  There are even websites which show you how to become a wet nurse if you so desire.  Another option is through peer to peer sharing through organizations like human milk 4 human babies.  You can literally look this organization up on facebook in your area to post an ad or look for ads posted by mothers in your area who are looking or willing to donate their breastmilk.  If you want breastmilk that has been tested for diseases (much like blood donations are), then a milk bank is another option.  You can look up a milk bank in your area.  Since this milk is tested and pasteurized, there is usually a fee associated with getting the milk.  In my area, a prescription from a physician is required and it costs $3/ounce (shipping not included).  Since a prescription is required, some insurance companies will pay for the use of banked milk.

It is nice to know that there are alternatives to formula should you choose to preserve the "virgin gut."

Cereal in the Bottle?

I starting hearing about parents putting cereal in their baby's bottle so they can sleep longer through the night.  I don't plan on giving the baby a bottle of anything for a few more weeks to make sure breastfeeding is firmly established.  However, since I am up every 2 hours to nurse, I decided to do a little research to determine if this has been proven to work.

The American Academy of Pediatrics does NOT recommend giving cereal in the bottle until a baby's digestive tract is ready to process solid foods at around 4-6 months of age.  At that time, they should get the cereal from a spoon and not from a bottle.

Prematurely adding cereal to the bottle can cause the baby to aspirate (inhale into their lungs) the cereal and it can also activate any allergies a baby may have.  I have also written a blog post about breastfeeding and foods to avoid which touches on the American Academy of Pediatrics position of no solids before the age of 4 months.  If you're breastfeeding, it should be done exclusively (without solids or formula) for at least 3 months to protect against wheezing early in life.  If you are using formula, then there is evidence that extensively hydrolyzed formula without cereal is best for the prevention of atopic disease (allergic disease).   Adding cereal to the bottle may cause a baby to "overfeed."  "Putting cereal in the bottle is considered by some to be a form of force-feeding that can cause babies to “overdose” on calories."

I don't believe with a lot of things Dr. Sears has to say but he does break it down in an easy to understand manner why you should not feed your baby solids before 4 months.  Aside from the issues mentioned above, he gives an excellent description of the tongue-thrust reflex.  "In the first four months the tongue thrust reflex protects the infant against choking. When any unusual substance is placed on the tongue, it automatically protrudes outward rather than back. Between four and six months this reflex gradually diminishes, giving the glob of cereal a fighting chance of making it from the tongue to the tummy."  My mom fed me solids when I was 2 months old.  She took pictures and at the time said that is what the doctor told her.  You can clearly see that my tongue-thrust reflex was in action at that age.

This is another great post from a pediatrician who advises against cereal in the bottle because of the issues with overfeeding that this may cause.  "A major study looking for the causes of obesity found that short-circuiting young children’s self-regulation of how much they eat is a major cause of later obesity."   "Cereal in the bottle does just that.  Babies that are fed this way may appear to be unaffected – but those few weeks of added convenience may result in a lifetime of struggles with weight. This common practice may have contributed to our being the most obese generation in history.  And it doesn’t even work. Scientists at the Cleveland Clinic studied the effect of cereal on sleep and found that adding the cereal did nothing at all to speed up the age of sleeping through the night. That first uninterrupted 6-hour stretch of sleep came no earlier in those who took cereal early."

After reading more about the issue, I think putting cereal in the bottle is one thing I will not be doing to my baby in the hopes of making him sleep longer during the night.