*UPDATE* Total Elimination Diet plus Comprehensive Stool Analysis results

[OSUvet]

As I know there are many here who have BTDT, I would appreciate some advice!

A little history: My DS (now 7 mo) was "colicky" from day 1. I have been dairy free since he was 4 weeks but saw little improvement. Eventually around 10 weeks I realized that reflux, especially silent,  was a problem and after trying mylanta and zantac, he started on prevacid and things improved. He became much  happier and was sleeping 3 hour stretches, waking only to peacefully nurse right back to sleep. Stools were never really yellow and seedy, more greenish brown and sometimes mucusy, but never with blood, and always very regular (7am every day! Makes EC a cake walk :). I noticed restless, wakeful nights whenever I consumed corn, peanuts, or occasional dairy, so those were cut out.

Fast forward to 5 1/2 months and he was still happy during the day, but he quit sleeping. I am lucky to get more than one 2 hour stretch at night and more than 45 min for naps. He is also very restless/wiggly between wakings, cries and often arches rigidly when he wakes, and seems generally uncomfortable. (he sleeps on a pretty steep incline on his left side, nurses as upright as possible, etc). He also wakes at the same intervals and in the same way if I prop myself up in bed and hold him upright on my chest all night! At first I thought nothing of it - babies go through spurts. But weeks later we are in the same place but very, very tired!

First we tried increasing the prevacid dose on my ped's recommendation. At first it seemed like it was helping for 3 days or so but now I definitely see no difference.  He is still on the higher dose for now but I want to stop if it is not helping, especially if he could be allergic to or having a reaction to the medication. We are going to see a GI specialist whenever we can get an appointment (my ped said probably 3 weeks) to look into the reflux and rule out any other GI issues that seem possible. I have actually noticed him doing the coughing/choking/gulping silent reflux thing occasionally recently, which I haven't seen since he was 3 months old. 

Since I had already suspected some foods as being a problem, my ped suggested a 10 day elimination diet of only lamb, leafy greens, and brown rice. I have also been using coconut oil and a little non-iodized sea salt (mortons brand) and black pepper. He is still on the prevacid (I need to look up the inactive ingredients!), and I am taking no supplements or anything else. He has had a few solids (reacted to some, others ok) but was not eating much and I stopped to simplify this.

This is the 4th day and the last couple nights it has been difficult to tell if we are seeing an improvement because BOTH lower incisors are currently erupting at the exact same time, and that is definitely causing him some discomfort at night and complicating things! He is still waking quite frequently but it seems to be a little less, and he seems to be sleeping more peacefully between waking. I plan to continue at least the 10 days, but have a couple questions:

Do you think this is likely related to food sensitivities, just reflux, just teeth (this whole time?!), or just DS?? (my instinct says it is either food and/or reflux mainly and that he is uncomfortable, not just wanting to wake up/in a habit)

After 10 days if we see no improvement on my TED, what would you do? I know some things take longer to eliminate from my system/milk, especially dairy but we have been essentially dairy free (including watching labels) for months already. I don't want to go through all this and then give up too early. I am thinking of switching out the rice for quinoa and/or the greens for sweet potato at some point, does this seem like a good idea? How long would you stick with each thing before deciding it did or didn't help? I have read Dr. Sears info about his TED and I know it is said to add one food every 4 days to look for a reaction. So is 4 days enough? 

I definitely don't want to keep DS on medications or put him through any kind of invasive testing if I can at all avoid it (especially since he is growing and developing well, and is happy when awake), and I also don't want to try to "wean" him from waking at night if the reason is that he is truly uncomfortable and not behavioral. 

Thank you for reading my long novel and for your insight, this seems complicated and we are getting frustrated. It is hard to function on so little, broken sleep!

[OSUvet]

I just found the ingredients list for his Prevacid tabs: mannitol, methacrylic acid, hydroxypropyl cellulose, lactose monohydrate-microcrystalline cellulose sphere, triethyl citrate, crospovidone, polyacrylate, magnesium carbonate, aspartame², glyceryl monostearate, hypromellose, magnesium stearate, citric acid, titanium dioxide, talc, artificial strawberry flavor, polyethylene glycol, polysorbate 80 and ferric oxide. (yucky :( I don't want him taking all this stuff...)

The citric acid could be a problem, right? Not sure about anything else...

[kjbrown92]

Citric acid is almost always corn, unless it says specifically something else. What's the source of the "lactose monohydrate"? Is it milk? If so, that could be your problem as well. In my limited experience (my two kids with food intolerances), their reflux went away as soon as we figured out and removed the trigger foods. For me, yes it sounds like a food intolerance, but again, that's because my experience is coloring my view. If you don't get to baseline after the 10 days, I would switch the foods out one at a time - turkey for lamb, quinoa for rice, etc.

When you said you removed corn, did you remove all corn? Because it's in a TON of things. There's citric acid everywhere, and dextrose, maltodextrin, etc. (we avoided corn for over 3 years, that's how I know).

[SweetSilver]

You can google a list of corn-derived ingredients, though I don't remember where I found it.  Is he happy when he nurses during the day?  That wouldn't rule out an allergy but the severely allergic babies I've met (including my own) were extremely agitated nursing most of the time.  (Night time was more peaceful for us, but not great.)

[OSUvet]

Thank you so much for your reply! 

From a quick search, it looks like the lactose monohydrate is probably from milk and could definitely be a problem. For that matter it seems that the "strawberry flavoring" could possibly also contain a milk ingredient.  

As for removing ALL corn, no I definitely did not do that (until the TED). I was avoiding obvious sources because the reaction was apparent, but never even really avoided corn syrup or corn starch. 

Initially I honestly didn't think he could possibly be THAT sensitive. I was a bit naive, being someone who has never had food or any other allergies. But now I see that it could definitely be  a problem for him!

I decided to talking to my pediatrician about stopping the medication for a few days while on the TED to see what happens. I figure if things improve or there is no change, great! He can be off the drug! If things get worse but aren't TOO bad, I could start switching foods out to see if that helps. If things get a lot worse we may need to give the meds again, we'll see. I really hope we can get this figured out AND get him off the medication! Thanks again!

[OSUvet]

Before I start adding foods in after the TED, I will definitely look up the list of corn ingredients.

Actually, although he is quite happy all day long, the ONLY time he is fussy is when nursing. He ALWAYS has been, and will never nurse for more than a couple minutes at a time during the day, or take more than 2-2.5 oz at a time from a bottle. Often he nurses very little during the day (or when I am working may take only 5-8 oz during a 10 hour period), and this adds to his waking at night because I know he must be hungry. He does usually nurse a bit more peacefully at night but then will be wiggly/agitated, and fussy when waking frequently. 

[SweetSilver]

Our peaceful nighttime nursings were probably due to the fact that pain receptors are sleepy at night, too.  In fact, ours got so bad that eventually my daughter would never nurse unless she had just fallen to sleep.  (Unfortunately I had some bad advice from our first nurse and didn't investigate allergens in breast milk until long after the fact.  Talk about guilt!)

[OSUvet]

So, it's been 5 weeks since I started the elimination diet and I thought I would update and see what you experienced mamas make of the pattern we have so far:

Ok: lamb, brown rice, leafy greens, turkey, quinoa, carrots, eggs, coconut oil, salt, pepper, herbal mothers milk tea, stevia

NOT ok: apple (the worst!), blueberries, brown sugar, plain greek yogurt (thought this was fine until he didn't poop for 4 days and gradually got more uncomfortable w/ constipation)

He is still EBF but I am hoping to add a food for him this coming week. Suggestions? Of course the GI doc says cereal... 

Also, my pediatrician ordered a stool analysis and we saw the GI doc today but he said the test was "alternative" not "conventional" and he didn't know how to interpret it 

If anyone has any thoughts on these results while I wait for my pediatrician to call, I'd be interested:

High eosinophil protein X (34.8, ref: <7) - allergy, right??

low n-butyrate (<0.11, ref: > 2.5)

low pH (5.1, ref: 6.1 - 7.9)

low beta glucuronidase (225, ref: 337 - 4,433)

low secondary bile acids (both LCA and DCA <0.11, ref: 0.65 - 6.76)

No parasites, yeast 1+, no Candida

Beneficial bacteria: Lactobacillus 3+, E. coli 4+, Bifidobacterium 4+ (good)

"Additional bacteria": alpha hemolytic streptococcus 4+, gamma hemolytic streptococcus 4+, Klebsiella pneumoniae 3+

(these are all marked as "non-pathogenic" but I don't think they are good! Can an overgrowth of these cause some of his diet-responsive gassiness???)

Thanks for your thoughts!

[SweetSilver]

Sorry I can't  help with the test results.  I might add fruit like soft ripe pear or a starchy vegetable like sweet potato, both in cubes.  If he's showing signs of allergies, I'd personally wait on the cereals, even rice, for a while longer.  Solids at this age still should be for fun and experimentation, not for filling bulk.  

[mytwomonkies]

I'm not a doctor by any means but I would think the high eosinophil proteins could point toward eosinophilic esophagitis or eosinophilic gastroenteritis, may want to ask your doc about this. The rest I'm not sure about.

As for the solids, I would personally hold off until you have more clarity. If you're EBF then solids aren't really necessary. We didn't start solids until somewhere between 9 and 10 months because of the elimination diet. But, if you're really wanting to add in solids I agree with what sweetsilver said about fruits and veggies. I would definitely not start with cereal, grains are hard enough for adults to digest much less an infant.

Hopefully your ped will call soon! :)

[changingseasons]

Eosinophils in blood and stool are not indicative of an eosinophilic disorder; they are usually a sign of an allergic reaction and/or parasite.

[periwinkle 88]

The Klebsiella pneumoniae is an opportunistic bacteria.  It apparently thrives on sugars and carbs, so rice (and other carbs and sugars) may not be a great idea until you get it under control. I also read that it loves iron supplements and FOS. I don't know about the other bacteria you mentioned.  I just got my Metametrix GI Effects test results back, and I have very high Klebsiella too (8+).  In my case it appears that my pancreas is not producing enough enzymes to digest food, so the Klebsiella have had ample food to proliferate.  I have been taking betaine HCL and pepsin, which got rid of my candida overgrowth, but apparently isn't helping with the Klebsiella.  My doctor has prescribed antibiotics for the klebsiella, but I may try Tanalbit and Viracin first, plus add in a pancreatic enzyme.  Good luck!