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The Link Between Gallbladder Disease and Gluten Sensitivity

December 1, 2012 in Beyond Paleo, Gut Health

(Created as a guest post for Paleo Parents.)

Celiac disease is estimated to affect approximately 1 in every 100 people, but only 5% of these people receive a positive diagnosis 1.  This is, in part, because celiac disease often doesn’t present with what are thought of as the classic symptoms (abdominal pain, bloating, intermittent diarrhea, weight loss).  In fact, more often, celiac disease presents as a collection of symptoms that many physicians don’t associate with the disease (irritability or depression, anemia, stomach upset, joint pain, muscle cramps, skin rash, mouth sores, dental and bone disorders such as osteoporosis, neuropathy, and/or micronutrient deficiency) 2.  However, the recognition and understanding of celiac disease is improving and more and more people with the disease are receiving positive diagnoses.

The same is not so true of gluten sensitivity, which includes immune reactions that are currently tested for (IgE, IgG or IgA antibody formation against gluten), immune reactions that are not currently tested for (IgM antibody formation, T-cell activation and/or immune complex formation), and non-immune reactions (increased zonulin production and/or gut dysbiosis resulting from deficiency of appropriate digestive enzymes).  Gluten intolerance (where antibodies are formed against gluten) is thought to affect upwards of 20-40% of the general population 3-4.  There are no estimates of the percentage of people who are sensitive to gluten in other ways.  Genetic tests (HLA-DQ, DR, etc.) exist but it is still unknown if current genetic tests accurately identify all individuals who are gluten sensitive 4.

A wider and wider range of health issues are being linked to gluten sensitivity and/or celiac disease.  This is a positive development in medical research because it is starting to bring more focus on how detrimental these grain proteins are in the human diet.  One such health issue is gallbladder disease, although the link between gallbladder disease and gluten sensitivity/celiac disease has not permeated through the public knowledge.  Because so many people are unaware that their gallbladder problems might be linked to gluten in their diets, it seemed like a good idea to write a post about this topic!

Let’s take a step backward and first talk about what exactly a gallbladder is.  The gallbladder is a little pear-shaped sac, nestled toward the front and a little underneath of the liver.  It has a very simple job:

  • store bile (which is produced by the liver) between meals
  • concentrate bile by reabsorbing water
  • release bile into the small intestine when there’s food that needs to be digested

Bile is composed of water, bile salts, bile pigments (products of red blood cell breakdown that are normally excreted in the bile), cholesterol, and various electrolytes.  Bile salts are the only components of bile that actually have a digestive function.  Bile salts are not the same as digestive enzymes (which are produced by the cells that line the stomach and by the pancreas).  Instead, bile salts aid the actions of digestive enzymes and enhance the absorption of fatty acids and fat-soluble vitamins.

The most important action of bile salts is that of an emulsifier.  In essence, bile salts break up fat globules in the small intestine into tiny droplets that are able to mix with water.  The enzymes that break fat up into fatty acids (lipases) can then perform their function more effectively.  Bile salts also aid in the absorption of fatty acids and cholesterol (some of the cholesterol released into the small intestine in the bile is reabsorbed).  Fat-soluble vitamins (such as A, D, E, K1 and K2) are also absorbed.

If the gallbladder is not functioning properly, fats cannot be properly digested (fats are essential for survival and health) and fat-soluble vitamins cannot be effectively absorbed, leading to micronutrient deficiencies.  Gallbladder health is critical for digestive health and overall health.

As is so often the case with research linking gluten sensitivity to other health complications, the research is strongest in the context of celiac disease.  Approximately 60% of celiac disease sufferers are known to have liver, gallbladder, and/or pancreatic conditions 5.  While some of these conditions may be a result of the malnutrition and/or directly linked to the gut damage that occurs in celiac disease, others are thought to share common genetic factors or have a common immunopathogenesis (i.e., the condition originates from the same immune system attacks on the small intestine also attacking these organs) 5.  Specifically, primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune forms of hepatitis or cholangitis are thought to have a common immune system/inflammation origin as celiac disease itself—and that means gluten.

What does this mean?  In celiac disease (and in non-celiac gluten sensitivity, albeit to a lesser extent or perhaps just in a slightly different way), gluten triggers an autoimmune response.  The body’s own immune system attacks the cells that line the small intestine, resulting in the characteristic shortening or pruning of the intestinal villi (microscopic, finger-like projections of small intestine wall tissue made of columns of gut epithelial cells).  As you can imagine, this creates a very leaky gut, which also stimulates the immune system, causes inflammation, and allows toxins and foreign proteins into the body.  In the majority of celiac disease patients, the immune system does not limit its attack to the cells that line the small intestine.  This is why second and even third autoimmune conditions are so common in celiac disease.

When you eat, the cells that line the duodenum (the first segment of the small intestine) detect the presence of fat and protein and react by releasing a hormone called cholecystokinin.  This hormone stimulates both the release of digestive enzymes from the pancreas and bile from the gallbladder.  It also signals to the stomach to slow down the speed of digestion so the small intestine can effectively digest the fats.  When the gut is damaged (whether from celiac disease or other gut pathology), the cells that line the small intestine (called enterocytes or gut epithelial cells) are less able to secrete cholecystokinin.  This means there is not enough signal to the gallbladder that it’s time to release bile salts into the duodenum.  Reduced cholecystokinin release is reported in celiac disease and may be one of the key causes of the gallbladder malfunction that occurs concomitantly with celiac 6-8.

Importantly for this discussion, the dominant gallbladder symptoms that might be caused by gluten sensitivity is cholecystitis (inflammation of the gallbladder) or malfunctioning gallbladder, and not gall stones (reported in 20% of elderly celiac patients, but only 2.5% of the more general celiac population).    The frequency of liver and gallbladder conditions suffered by celiac disease patients has allowed researchers to make the converse argument.  It is now recommended that those with unexplained liver and/or gallbladder symptoms be evaluated for celiac disease 9-11.  If you have been diagnosed with gallbladder disease (especially if it is not gall stones, but don’t rule out this possibility if it is), it is important to investigate gluten sensitivity or celiac disease as the possible cause.  No one has yet studied how frequently someone with gallstones actually has undiagnosed celiac disease (or gluten sensitivity) and there is a feeling within the celiac community that this may actually be quite frequent.

What if you test negative for celiac disease and gluten intolerance?  Unless you had the DNA test done for gluten sensitivity, these tests actually are embarrassingly inaccurate in the sense that the false negative rate is very high (false negative means that you do have celiac but the test showed that you don’t).  There are a variety of ways that false negatives can occur and no one likes to put a number on just how likely they are.  But, if you remember from the beginning of this post, these tests generally only test for antibody formation (and a biopsy only looks at one very small piece of your small intestine).  The best way to be sure that gluten is not the problem is to eliminate it completely from your diet for several months (those with celiac disease can take up to 5 years to heal from the damage caused by gluten 12).  It is not enough to eliminate gluten however, as antibodies that your body may have formed against gluten may also recognize proteins in other foods.  This means that even if you aren’t eating any gluten, your body still thinks that it is (see this post for a complete explanation and list of foods to avoid).

The take home message?  There is a strong link between gallbladder health and celiac disease.  In fact, a failing gallbladder may be your first symptom of celiac disease.  Of course, I believe that a grain-free, legume-free, dairy-free, refined sugar-free, modern vegetable oil-free diet is optimal for our health in every way; however, if you are suffering from gallbladder problems, then I recommend addressing your diet as soon as possible.  The earlier you adopt an anti-inflammatory diet that prioritizes gut health, the more likely you are to save your gallbladder.

1 Lohi S et al. “Increasing prevalence of coeliac disease over time.” Aliment Pharmacol Ther. 2007 Nov 1;26(9):1217-25.

2 http://www.mayoclinic.com/health/celiac-disease/DS00319/DSECTION=symptoms

3 http://www.gastroendonews.com/ViewArticle.aspx?d=In%2Bthe%2BNews&d_id=187&i=October%2B2010&i_id=672&a_id=16015

4 http://www.glutenfreesociety.org/gluten-free-society-blog/the-many-heads-of-gluten-sensitivity/

5 Freeman HJ.” Hepatobiliary and pancreatic disorders in celiac disease.” World J Gastroenterol. 2006 Mar 14;12(10):1503-8. http://www.wjgnet.com/1007-9327/full/v12/i10/1503.htm

6 Masclee AA et al. “Gallbladder sensitivity to cholecystokinin in coeliac disease. Correlation of gallbladder contraction with plasma cholecystokinin-like immunoreactivity during infusion of cerulein.” Scand J Gastroenterol. 1991 Dec;26(12):1279-84. http://www.ncbi.nlm.nih.gov/pubmed/1763298

7 Fraquelli M et al “Gallbladder emptying and somatostatin and cholecystokinin plasma levels in celiac disease.” Am J Gastroenterol. 1999 Jul;94(7):1866-70.

8 Nousia-Arvanitakis S et al.  “Subclinical exocrine pancreatic dysfunction resulting from decreased cholecystokinin secretion in the presence of intestinal villous atrophy.” J Pediatr Gastroenterol Nutr. 2006 Sep;43(3):307-12. http://www.ncbi.nlm.nih.gov/pubmed/16954951

9 Biecker E et al “Autoimmune hepatitis, cryoglobulinaemia and untreated coeliac disease: a case report.” Eur J Gastroenterol Hepatol. 2003 Apr;15(4):423-7. http://www.ncbi.nlm.nih.gov/pubmed/12655265

10 Parfenov AI et al “Asymptomatic celiac disease in patient with chronic acalculous cholecystitis” Eksp Klin Gastroenterol. 2011;(3):122-4.

11 Galán Bertrand L et al. “Acute lithiasic cholecystitis as an exceptional presentation of celiac disease” An Pediatr (Barc). 2006 Jul;65(1):87-8. Spanish

12  Rubio-Tapia A “Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet.” Am J Gastroenterol. 2010 Jun;105(6):1412-20.

 

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Gluten Cross-Reactivity: How your body can still think you’re eating gluten even after giving it up.

October 4, 2012 in FAQ, FAQ, Foods in Moderation, Gut Health, The Autoimmune Protocol, The WHYs of the AIP

NOTE:  An updated version of this post can be found here.

For those 20% of us with celiac disease or gluten-intolerance/sensitivity (whether diagnosed or not), it is critical to understand the concept of gluten cross-reactivity.  Essentially, when your body creates antibodies against gluten, those same antibodies also recognize proteins in other foods.  When you eat those foods, even though they don’t contain gluten, your body reacts as though they do.  You can do a fantastic job of remaining completely gluten-free but still suffer all of the symptoms of gluten consumption—because your body still thinks you are eating gluten.  This is a very important piece of information that I was missing until recently.

Proteins are made of long chains of amino acids (small proteins may only be 50 amino acids long whereas large proteins may be 2000 amino acids long) and it is the specific sequence of these amino acids that determines what kind of protein is formed.  These amino acid chains are folded, kinked and buckled in extremely complex ways, which gives a protein its ‘structure’.  This folding/structure is integral to the function of the protein.

An antibody is a Y shaped protein produced by immune cells in your body.  Each tip of the Y contains the region of the antibody (called the paratope) that can bind to a specific sequence of amino acids (called the epitope) that are a part of the protein that the antibody recognizes/binds to (called the antigen).  The classic analogy is that the antibody is like a lock and a 15-20 amino acid section of a protein/antigen is the key. There are 5 classes (or isotypes) of antibodies, each with distinctive functions in the body.  The IgE class of antibodies are responsible for allergic reactions; for example, when someone goes into anaphylaxis after eating shellfish. The two classes IgG and IgA are critical for protecting us from invading pathogens but are also responsible for food sensitivities/intolerances.  Both IgA and IgG antibodies are secreted by immune cells into the circulation, lymph, various fluids of the body (like saliva!) and tissues themselves.  And both IgG and IgA antibodies are found in high concentrations in the tissues and fluids surrounding the gut (this is part of why the gut is considered our primary defense against infection).

The formation of antibodies against an antigen (whether this is an invading pathogen or a food) is an extremely complex process.  When antibodies are being formed against a protein, the antibodies recognize specific (and short) sequences of amino acids in that protein.  Depending on how the antigenic protein is folded, certain amino acid sequences in that protein are more likely to be the target of new antibody formation than others, simply because of the location of that sequence in the structure of the protein.  Certain sequences of amino acids are more antigenic than others as well (i.e., more likely to stimulate antibody formation).  This is also part of why certain foods have a higher potential to cause allergies and sensitivities.

Understanding that antibodies recognize short sequences of amino acids and not an entire protein is key to understanding the concept of cross-reactivity (and molecular mimicry, but that’s a topic for another post).  It also is the reason why many different antibodies can be formed against one protein (this redundancy is important for protecting us from pathogens).  Many different antibodies can also be formed against one pathogen or, more relevant to this discussion, one specific food.

So what happens in cross-reactivity?  In this case the amino acid sequence that an antibody recognizes is also present in another protein from another food (in the case of molecular mimicry, that sequence is also present is a protein in the human body).  There are only 20 different amino acids, so while there are millions of possible ways to link various amount of each amino acid together to form a protein, there are certain amino acid sequences that do tend to repeat in biology.

The take home message:  depending on exactly what antibody or antibodies your body forms against gluten, it/they may or may not cross-react with other foods.  So, not only are you sensitive to gluten, but your body now recognizes non-gluten containing foods as one and the same.  Who needs to worry about this?  Any of the estimated 20% of people who are gluten sensitive/intolerant or have celiac disease, i.e., have formed antibodies against gluten.

Cyrex Labs offers a simple blood test that tests for cross-reactivity to the most common culprits (Chris Kresser vouches for the high quality tests done by this company, which is good enough for me!).  Here is the full list (some of these are obviously not paleo, but you might consider them cheat foods, which is why I mention them):

  • Rye
  • Barley
  • Spelt
  • Polish Wheat
  • Oats
  • Buckwheat
  • Sorghum
  • Millet
  • Amaranth
  • Quinoa
  • Corn
  • Rice
  • Potato
  • Hemp
  • Teff
  • Soy
  • Milk (Alpha-Casein, Beta-Casein, Casomorphin, Butyrophilin, Whey Protein)
  • Chocolate
  • Yeast
  • Coffee
  • Sesame
  • Tapioca (a.k.a. cassava or yucca)
  • Egg

Just like trace amounts of gluten can cause a reaction in at least those with celiac disease (the threshold for a reaction has not been tested in non-celiac gluten sensitivity), even a small amount of these foods can perpetuate inflammation and immune responses.  This is important when you think of the small amounts of soy used in so many foods and even the trace milk proteins that can be found in ghee.

If you have autoimmune disease (which has a very high correlation with gluten-sensitivity), celiac disease, gluten-sensitivity, or are simply not seeing the improvements you were hoping for by following a standard paleo diet, one or all of these foods may be the culprit.  You have the choice of either cutting these foods out of your diet and seeing if you improve or get tested to see if your body produces antibodies against these foods.  For me, it’s a no brainer (because it just all makes so much sense now!): I have to stop eating chocolate (sniff), fermented foods like sauerkraut and kombucha (because of the yeast content), eggs, and tapioca.  I am very happy to report dramatic improvement in my lichen planus lesions in just four days! (and as much as I miss chocolate and kombucha, it’s worth it!)

A great overview of proteins and antibodies (and source of protein folding image): http://publications.nigms.nih.gov/structlife/chapter1.html

A fairly technical review of food IgG-mediated food sensitivities:  http://www.usbiotek.com/Downloads/information/criticalReview.pdf

Cyrex Labs Array 4:  http://www.cyrexlabs.com/CyrexTestsArrays/tabid/136/Default.aspx

Image of antibody binding taken from http://classes.midlandstech.edu/carterp/Courses/bio225/chap17/ss2.htm

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How Long Does it Take the Gut to Repair after Gluten Exposure?

September 27, 2012 in FAQ, FAQ, Featured Posts, Gut Health

This is a very relevant question for those who are just embarking on their gluten-free journey.  But, it’s also extremely important for anyone who has been following a paleo/primal/gluten-free diet for a while, but has been inadvertently exposed to gluten.  It sometimes feels as though the longer we avoid gluten, the more sick we feel after accidentally eating some.  This is in large part because the body stops protecting itself from gluten (for example, there may be less mucus in the gut) so when we do consume some, we are defenseless.  It may also be because we forget how we used to feel and are so used to feeling so much healthier.  Whether you are new to paleo or have been eating this way for a while, a common question is:  how long does it take the gut to heal after gluten exposure? 

I have talked about the irritation, inflammation and damage to the lining of the small intestine that can be caused gluten (I promise I will go back and add references to this post soon) and I have mentioned that it can take up to 6 months for the body to fully heal after a single gluten exposure.  After delving into the research more thoroughly, I have discovered that this statement is simultaneously a gross understatement and an overstatement.  Just like the extent of damage that gluten causes varies from individual to individual (see this post for a little bit more on variability in tolerance), so does the length of time it takes to recover.  And it’s not as simple as the more damage you have, the longer it takes to recover.  There are factors that control how sensitive you are (genetics, overall health, diet, stress, nutritional-deficiencies, gut microflora) and there are factors that affect how quickly you heal (okay, it’s the same list of factors, but it’s more complicated than A+B=C).

The cells that line the gut, called enterocytes or gut epithelial cells are organized into hills and valleys (to help maximize the surface area of the gut), forming finger-like columns of cells called villi separated by valleys called crypts.  The enterocytes are constantly regenerating themselves (a pool or resident stem cells supplies the new enterocytes).  As the cells age, they migrate higher up the villi and are eventually shed into the gut to be redigested (yes, we are constantly cannibalizing ourselves).  This is called the “turnover” of the gut epithelium.  In the normal healthy gut, the enterocytes migrate to the top of the villi in in 1-4 days, meaning that all of the villi cells are replaced with new cells every 3-5 days (this gets slower as we age) 1,2,3.  The cells that migrate toward the bottom of the crypts have a longer lifespan of 2-3 weeks.  What does this mean?  A healthy person has an entirely new intestinal lining every 2-3 weeks.

Repairing the intestine following injury (whether that is caused by ingested toxins, infection, or some other injury) is a more involved and complex process that is tightly regulated and controlled by the body (for a detailed understanding of this process, see reference 4).  The healing time varies depending on the extent of injury and studies trying to understand the role of the resident stem cells of the gut show that repair of the crypt and villi structure of the intestinal wall after injury can take anywhere from 2 to 12 weeks (depending on whether the stem cells themselves are injured) in the absence of confounding factors 4,5.

What does this mean?  For healthy individuals without celiac disease or gluten sensitivity (where their bodies are producing antibodies against gluten), the damage to individual cells and the junctions between them that can be caused by gluten is relatively fast to heal, anywhere from a few days to 3 weeks.  For these healthy individuals, most of this time is likely asymptomatic.  Many people report symptoms that only last from a couple of hours to a couple of days after gluten exposure.  This also means that healthy individuals should be able to heal their guts completely after following a 30-day paleo challenge such as a Whole30.

For those with confounding factors, healing is slower. Confounding factors are numerous and include gluten sensitivity (where the body is producing antibodies against gluten which increases inflammation and slows healing), celiac disease (an autoimmune condition), uncontrolled inflammation in the gut (which could be caused by food allergies, food sensitivities or diseases such as Inflammatory Bowel Disease), nutritional deficiencies (which can be caused by having a very inflamed and damaged gut, but slows healing because not all of the raw materials needed to repair are available), gut dysbiosis (the wrong type, amount and/or location of microorganisms in the gut), infections, stress, body-wide inflammation, and chronically elevated insulin.

How much do these confounding factors slow healing?  The extreme end of the spectrum is those with Celiac Disease, an autoimmune condition triggered by gluten exposure.  One hallmark of Celiac Disease is a shortening or blunting of the intestinal villi which is observed by performing a biopsy of the small intestine (they are typically 3-5 times longer in healthy individuals than those with Celiac Disease).  For those with celiac disease, one study showed that only 66% of patients had a normal intestinal biopsy after 5 years on a gluten-free diet 6.  This means that even after 5 years, 34% of Celiac Disease sufferers had not recovered.  There are no good similar studies evaluating intestinal repair in people with non-celiac gluten-sensitivity, but medical professionals who specialize in treating gluten-sensitivity report time frames of approximately 1½-2 years 7.

It’s probably worth mentioning here that current reports suggest that both Celiac Disease and gluten-sensitivity are ridiculously underdiagnosed.  It is estimated that 1 in every 100 Americans suffer from Celiac Disease but only 5% are ever diagnosed 8.  This means that there is something like 2.5-3 million Americans with celiac disease that have no idea that they have it (when you extrapolate this statistic globally, it’s even scarier!).  Gluten intolerance is estimated to affect 15-20% of the population 9.  The take home message here?  Even if you have never been diagnosed with celiac disease or gluten intolerance, you may have one of these conditions which could be contributing to slowed intestinal repair after switching to a paleo diet or after accidental gluten exposure.

How much gluten can cause a problem?  This is highly individual.  For those with Celiac disease (whether confirmed or undiagnosed), even a minute amount of gluten can cause significant damage to the small intestine in the majority of sufferers 10.  Interestingly, a not unsubstantial percentage of these people (22%) will have significant damage to their small intestine but not suffer any gastrointestinal symptoms.  For healthy individuals, the threshold amount to suffer symptoms is highly variable.  Unfortunately, you don’t know until you test it on yourself.

So, how long does it take the gut to repair after gluten exposure?  Once again, like so many topics I cover on this blog, the answer is “it depends”.  For healthy individuals, healing likely takes only a couple of weeks.  For those with celiac disease (and perhaps autoimmune diseases in general), fully healing the lining of the small intestine may take years.  The rest of us can be anywhere in between.

1 Creamer B et al. “The turnover and shedding of epithelial cells–Part I The turnover in the gastro-intestinal tract”. Gut 1961 2: 110-116

2 Lipkin M et al. “Cell Proliferation Kinetics In The Gastrointestinal Tract Of Man. I. Cell Renewal In Colon And Rectum” J Clin Invest. 1963 June; 42(6): 767–776.

3 Godlewski MM et al “Into the Unknown–The Death Pathways in the Neonatal Gut Epithelium”  Current Pediatric Reviews. 2011. 7(4):337-345

4 Blikslager AT et al. “Restoration of Barrier Function in Injured Intestinal Mucosa” Physiol Rev 87:545-564, 2007.

5 Booth C and Potten CS “Gut instincts: thoughts on intestinal epithelial stem cells” J Clin Invest. 2000;105(11):1493–1499.

6 Rubio-Tapia A “Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet.” Am J Gastroenterol. 2010 Jun;105(6):1412-20.

7 http://glutendoctors.blogspot.com/2010/04/healing-time-after-removing-gluten.html

8 Lohi S et al. “Increasing prevalence of coeliac disease over time.” Aliment Pharmacol Ther. 2007 Nov 1;26(9):1217-25.

9 http://www.gastroendonews.com/ViewArticle.aspx?d=In%2Bthe%2BNews&d_id=187&i=October%2B2010&i_id=672&a_id=16015

10 Lähdeaho ML et al. “Small- bowel mucosal changes and antibody responses after low- and moderate-dose gluten challenge in celiac disease.” BMC Gastroenterol. 2011 Nov 24;11:129.

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Gut Health for Kids

July 31, 2012 in For Babies, For Older Kids, For Younger Kids, Gut Health

(Created as a guest post for The Paleo Parents)

Gut health is essential for overall health.  A healthy digestive tract is efficient at absorbing nutrients from your food, protecting the body from foreign invaders including mounting appropriate immune responses when required, and at regulating a wide variety of hormones.  A growing number of health conditions are being linked to poor intestinal health.  As you already know, the foods you eat can have a powerful influence on your gut health (for more information on how grains, legumes and dairy contribute to a ‘leaky gut’, read this post, this post, and this post).  So, what about kids?  A paleo diet is a fantastically healthy diet for kids, as we consume only the most nutritionally-dense foods (I am very fond of the nutritional analysis presented in The Paleo Diet).  It is also a great starting place if your child requires a focus on healing the gut. 

Many of the recommendations for optimizing adult gut health (as outlined in here and here) are appropriate for babies and younger children.  However, getting a child to eat what you know is good for them can be a challenge!  Also, many of the supplements recommended to promote healthy digestion are inappropriate for children (such as digestive enzyme, hydrochloric acid, and apple cider vinegar supplementation; other supplements such as L-glutamine and quercitin should only be given to your child under the supervision of a medical professional).  So what can you do to help them?  Whether you are looking for strategies to heal your child’s confirmed or suspected leaky gut or are looking for ways to protect your healthy child from developing a leaky gut, here are some ideas for promoting a healthy gut for your child (including some practical tips for pulling it off!).

1. Start Them Off Right:  Breastfeeding your baby is the best way to ensure that their digestive tracts develop a healthy diversity of beneficial bacteria.  However, if you face insurmountable obstacles to breastfeeding or have gut dysbiosis yourself (or if your child requires antibiotic treatment), you may want to supplement with a source probiotics to help their digestive tracts establish this essential probiotic diversity.  I chose to supplement with a small amount of acidophilus for a couple of months before starting my youngest on solid foods (I didn’t know any better for my oldest and I still regret it).  I bought acidophilus/bifidus supplements in capsule form, broke open the capsules and put a tiny pinch of the powder in her mouth before nursing a couple of times a day, starting at about 3 months old.  I bought the highest diversity/quality probiotic supplement I could find and changed brands every time I bought a new bottle (I was taking it for myself at the time, so I went through a small bottle fairly frequently).  Other people achieve the same using fermented foods (for a baby or toddler who can’t chew raw sauerkraut, a little of the “juice” around the sauerkraut can be given on a spoon or mixed in with other foods).  It also helps not to start solid foods too early (typically, the digestive tract isn’t really ready for solids until about 6 months old).  I am a big fan of “baby-led weaning” which essentially means that you don’t start your baby on solids until they are ready to self-feed.  For both of my girls, that was around 7 months old (they could pick up small pieces of cooked vegetable or soft fruit, put it in their own mouths, chew and swallow), but many babies aren’t ready until older than this, and that’s okay!  If you are wondering what foods to introduce first, check out my post on paleo baby foods (this post is written for traditional introduction of solid foods, but the information is also relevant to baby-led weaning).  Don’t worry if your child is older and you missed your chance, because you can still…

2. Sneak Some Probiotics Into Their Diet:  Even after your child is eating solids, a continuous supply of good bacteria and yeast in their diet is good for them, especially if you are trying to restore gut microflora diversity after illness.  You can introduce these in the form of kombucha, yogurt and kefir (I’m a big fan of homemade coconut milk yogurt and kefir), fermented vegetables like raw sauerkraut and homemade pickles, and/or acidophilus supplements (you can continue to break open acidophilus capsules or switch to chewable tablets once your child is old enough).  Frequent small doses are more effective than one large dose, so 1 Tbsp of homemade kombucha or coconut milk kefir mixed in with your child’s food or beverage daily is a great way to go (do keep in mind that regular kombucha does have a small amount caffeine).  This is especially important after any infection requiring antibiotics or steroids and after stomach bugs.  Is this important to do if your child is healthy and you are just looking to prevent problems?  The answer is yes and no.  If your child is healthy now, they almost certainly have a healthy diversity of bacteria growing inside them now.  There is no added benefit to including a probiotic supplement in their diet.  Fermented foods however, are still beneficial as these help feed the good bacteria growing in their guts in addition to adding a much greater variety of beneficial bacteria than typically found in supplements.

3. Include some healing foods in their diet.  Homemade bone broth is rich in glycine, which is very important for healing the lining of the gut and reducing inflammation (for more information, see this post).  My 2.5-year old loves to drink plain bone broth, but it can also be added to mashed vegetables, smoothies and even homemade popsicles! Organ meats like liver (especially if grass-fed) contain Vitamin D, tons of vitamin and minerals, and more glycine than muscle meat.  Just because you don’t love liver, doesn’t mean your child won’t.  It’s a soft meat and many young kids find the texture more enjoyable than muscle meats.  If your child isn’t a big fan, check out my recipes for hidden-liver meatloaf and hidden-liver Turkish meatballs.  Oily cold-water fish is not only rich in omega-3 fatty acids (the highest omega-3 fish are salmon, mackerel, sardines, herring, kipper, anchovies, trout, fresh tuna, and carp) which helps resolve inflammation, but is also high in vitamin D and selenium.  My 2.5-year old loves brisling sardines and both my kids love poached or baked salmon.  There are dozens of neat seafood recipes out there, from salmon cakes to fish sticks (which could be made with haddock, cod, hake, halibut, sole, flounder, bass or perch which are all moderately high in omega-3), which may entice your child to eat them.  The medium chain triglycerides (MCTs) in coconut oil are known to have anti-microbial and anti-inflammatory properties.  Extra virgin coconut oil also contains a large amount of Vitamin E and other anti-oxidants and is wonderful for cooking just about anything, from paleo baking to scrambled eggs (or even just eating off a spoon!).  Coconut butter can be eaten by the spoonful or added to soups and curry dishes.  Full-fat coconut milk (which can be easily made at home) can be added to smoothies or used to make homemade kefir or yogurt.  Grass-fed meat (and butter and ghee from grass-fed diary) is rich in conjugated linoleic acid (CLA), a fat known to promote healing, as well as providing plenty of vitamins, minerals and having a balanced omega-3 to omega-6 ratio.  My kids love anything made with ground beef, from Swedish meatballs to tacos!

4. Avoid gut irritating foods, including foods you child has a sensitivity to:  Avoiding grains, legumes, dairy, processed foods and refined sugar will go a long way to improving your child’s gut health.  However, if your child is facing an uphill battle with health, there are some other culprit foods worth eliminating as well.  If your child has signs of Small Intestinal Bacterial Overgrowth (SIBO), you’ll want to limit starchy vegetables (see this post for a guide on which vegetables are okay for SIBO and which are better to avoid).  Another class of vegetables that can cause issues for some people are those high in types of sugar that qualify as FODMAPs (Fermentable, Oligo-, Di-, Mono-saccharides and Polyols).  Continued digestive symptoms after following a paleo diet may indicate SIBO or FODMAP-sensitivity (also known as fructose malabsorption).  There is a high degree of overlap between vegetables that are avoided to address SIBO and those that contain FODMAPs.  If you aren’t sure, try an elimination diet approach where you avoid all vegetables which may be problematic for 3-4 weeks and then slowly try reintroducing them one at a time to see if they cause digestive symptoms.  In addition to these vegetables, other foods may be problematic due to development of food sensitivities (this is common in children and adults with severely leaky guts).  You can evaluate whether or not these foods are problematic for your child using an elimination diet approach (where you leave the suspected foods out of your child’s diet for 3-4 weeks and then add them back in one at a time).  Sensitivities to eggs, nuts, seeds, and vegetables from the nightshade family (tomatoes, eggplants and peppers) are common.  Alternatively, you can find a naturopathic physician or chiropractor who can order a food sensitivity blood test (IgG and IgA).  Any foods that your child tests positive for in a food sensitivity test should be avoided completely for at least 6 months, after which you can reintroduce small amounts to see if the sensitivity persists (many sensitivities will disappear after the gut has fully healed).

5. Play and Have Fun:  Kids need both structured and unstructured play time, both active play and quite, focused play time, and both independent and social play time (with other kids and/or with adults).  Having this mix of different types of play is important for the developing brain, but also helps regulate hormones (like stress hormones, which are particularly important to gut health) and helps tire kids out for a good nap and a good night’s sleep (also critical for healing and staying healthy).  And making sure to take time to have fun with your kids is good for your stress levels too! 

6. Get them outside:  If you read my post on the importance of sunlight, you’ll remember just how important it is to be outside for a good amount of time every day.  For kids, it also provides space to run around and a stimulating environment for their developing brains to explore (you get to play and get sun exposure! Yay for efficiency!).  I aim to have my kids outside for at least 1-3 hours every day, weather permitting (I am a big supporter of playing outside in just about any weather as long as you’re dressed for it!).  Beyond the benefits of fresh air and exercise, sun exposure on their skin is essential for the formation of Vitamin D (you don’t want to let them get sunburned, of course).  Vitamin D is very important for healing and reducing inflammation.  If getting outside is not possible for you and/or your child or if you feel that your child may deficient in Vitamin D, it is worth talking to your doctor about a Vitamin D3 supplement.

7. Provide an environment conducive to sleep:  Sleep can be more or less of a challenge depending on your child.  One book that I really like for gentle sleep strategies for babies is The No-Cry Sleep Solution (also available in a toddler through preschooler edition).  The tips that have been most helpful for me and both of my non-sleepers are:  have a rock-solid routine (not just at bedtime but consistent structure throughout the day), put your kids to bed earlier rather than later (they will often sleep longer if they go to bed earlier), and have kids sleep in a cool, very dark room.  A white noise machine may also be helpful. 

8. Don’t make food a battle:  However you chose to introduce food to your child, whether or not you chose to give your child options or only give them what everyone else is eating, don’t make meals a battle.  This means having a realistic expectation of what and how much your child might eat, of how long they might sit up at the table, and of age-appropriate table manners.  Even if you are taking a firm stance, don’t argue or raise your voice.  Stress and food just don’t mix.  And stress can hinder healing.  Keep in mind that, when given a variety of healthy foods, the vast majority of children will naturally eat what their bodies need.  The two most important things that you can do to help your child learn how to eat healthily is do so yourself and present them only with healthy options. 

As a final thought, I believe you are already doing the most important thing you can to help your child get/stay healthy by learning about how food affects the human body.  If you are unsure how to apply any of these recommendations or whether they are appropriate for your child, please discuss them with your child’s doctor or alternative healthcare provider.

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