Study and debate on Probiotic for colic. Italian Study said it was good for colic in babies.
Ever had a child with colic–terrible experience, late in the afternoon in the 3rd or 4th month they scream and cry and they are inconsolable. We have to teach parents to walk away to prevent anger and violence, the kid has what you might call an energy/behavior disorder, runs in families. You want to think they have cramps, be my guest. People take the child for a ride, put them on the dryer, anything to stop the crying. The only thing good about colic is that it stops just about as abruptly as it starts.
Probiotic is a method of introducing benign intestinal bacteria to provide good flora.
Some people think it’s great, can’t hurt if your have had an intestinal problem or recent illness or antibiotics.
American pediatricians, as might be predicted, are cautious–they are a cautious bunch in my experience and conservative about interventions.
http://acsh.org/2014/01/can-probiotic-drops-ease-colic-doctors-think/
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There is a synopsis on wikipedia with a bunch of citations.
http://en.wikipedia.org/wiki/Fructose_malabsorption
I understand your skepticism, John. A few years ago I would have laughed at such a notion.
Fructose intolerance was first noticed in children. Children have one advantage over adults, in that when they complain about their tummy hurting, the pediatricians actually take them seriously. Most of the time it is assumed that the children have lactose or gluten intolerance, but some children did not have problems when challenged with lactose or gluten. A few enterprising pediatricians started going over the food diaries kept by the kids’ moms, and started seeing a pattern with fructose.
And health food stores are out-of-luck with this one. The only “cure” is to avoid fructose. In some cases, it is possible to just “cut back” on eating fruits and vegetables, or eat very small amounts several times per day. If you search for “fructose malabsorption diet” there are a few food items other than just fruit and vegetables that some of the more severe cases need to avoid. At this point, it is trial-and-error for each individual to figure out what they can tolerate. Oh, and most of the ‘health food” that is supposed to be so good for everyone is on the list of forbidden foods: Yogurt and whole grains being at the top of the list, along with probiotics and prebiotics.
I sincerely wish this was just a ‘fad’ or “junk-science”. About every six months I try eating a very small amount of fruit which is supposed to have very small amounts of fructose, but I always get rather painfully ill. I keep hoping this will just go away.
In my amateur opinion (emergency physician, not pediatrician) and from paying attention to pediatriccians, I would say colic is a behavior/energy thing, kind of like restless legs and insomnia and maybe even related to ADD ADHD hyperactivity disorders.
This assertion about fructose intolerance is not supported by reliable evidence. And I assure you I have never seen or heard of a patient with a disease like fructose intolerance. There are lactose intolerant and gluten intolerance people. Fructose is relatively simple disaccharide.
Consider the impact on populations if this claim about fructose were true.
Only health food stores would attempt to make claims like this, to sell some new and improved digestive aid.
Anyone that has fructose malabsorption should not take probiotics or prebiotics. It is estimated that 1 in 3 people have fructose malabsorption, and that half of those (1 in 6) have active symptoms. Just something to keep in mind, especially in cases (either children or adults) where severe pain seems to come on very quickly.
Interesting debate about colic. All three of my children had ‘it’. Not sure what else it was. Screamed for hours, nothing would placate them. I just rode it out. Walking around with them until it, whatever ‘it’ was, passed.
My ex is a GP and he called it colic.
My only explanation was that they were all premature. My daughter was 8 weeks premature and she definitely had something that gave her misery for a good 18 months to two years.
Other than that, they were great kids. Never felt like committing child abuse but then I was a very calm parent, considering. Had to be. Took everything in my stride. If I had to walk around with a screaming child for hours on end then I just did it, without worrying about what anyone else thought. Being in public was difficult, but I just took myself away from people as best I could.
My mother had issues with it as well as other family members – something in the line of that I was “a bad mother” – but I did everything really well and I never made an issue of anything. I took in my stride.
I don’t know what is meant by “energy/behaviour issues” but even all these years later it would be good to get an explanation, if that is even possible.
As for probiotics, it seems debatable. I had stomach swelling a lot, tried probiotics and found no difference. So I looked at what I was eating and how I ate. Slowed down, ate smaller meals and it certainly helped a great deal.
But having said that, my GP has prescribed Pariet (rabeprazole sodium) and it’s a winner!
A cautious bunch, indeed. I remember serious adults in white coats quarrelling over whether my tonsils needed to be removed. They continued to quarrel, either face-to-face, or by proxy, until I grew up and left their domain with “chronic tonsillitis”. Which meant, from my perspective, that my tonsils were a constant source of pus, even when not inflamed. They swelled and developed painful abscesses several times a year and remained in that condition for several days to several weeks, ignoring any attempts at medical intervention.
One night, I woke up from pain in the throat and realised I was suffocating and could not see well. With the help of a mirror and by probing with my fingers, I determined there was a huge abscess blocking the airway. I stabbed it with a scalpel; it drained and it let me breathe again. I did not seek help then — there was nobody around and I was unable to speak.
During the next summer break, I went to Novgorod, where a relative was practicing as a paediatrician. She was the conservative type and had always argued against tonsillectomies. She spent a lot of effort investigating trying to fix my tonsils therapeutically. She gave me all sorts of drugs and lavage and we tried physiotherapy of all sorts, microwave, UV, and what not. I felt really good after most of those procedures. The lavage, in particular, made me feel like I never had any problems — for a few hours. By the end of each day, the usual symptoms returned. After a month, we gave up and I was referred to the regional ENT centre, where they did tonsillectomies on an industrial scale. They laughed at me. “Hey! Come check out this fellow. He came on his own feet!”
When I inquired what was so funny to them, they explained that their regular patients were delivered by ambulance unconscious in near-death condition. Most had massive complications requiring thoracotomy, temporal bone resection, or other arcane surgery, and they calmed many of those cases were complications from untreated tonsillitis or ear infections. The survival rate there wasn’t great at all. Many of those emergency patients requiring extensive clean-up died in the OR or failed to recover post-op. So my condition did appear laughable to them, especially as my tonsils looked tightened up thanks to my relative’s efforts. They wondered why she had referred me to them instead of doing it herself. I guess she wanted the best care for me, and we did get it. They did a great job, and while I was there, they also fixed my ear problems.
By the way, they didn’t scrape of my tonsil tissue. I reckon, 10-15% of it is still in place. I only discovered that later and so was unable to ask about the rationale for it, but I guess it reflects the uncertainty about the utility of tonsillectomy. I faced that uncertainty again talking to a paediatric surgeon in Naperville about my daughter’s tonsils, which by then were in about the same condition as mine had been when I had them removed. I knew that tonsillitis could kill and was very concerned. The good doctor spent almost an hour extracting from me an unequivocal statement of what I wanted him to do. He told me about all known pros and cons, but refused to take responsibility for the decision. I asked him to go ahead.
My response to those who say there are no benefits: have you included the deaths from complications of tonsillitis in your benefit analysis?
Aside from that, both my daughter and myself had immediate benefits following the procedure. We do get sore throat once in a while, but not nearly as often as before, not as bad, and when we do get it, we enjoy a certain level of confidence that it is not going to kill us.
For all the anti tonsillectomy evidence you might point to, I would point out that pediatricians don’t do tonsillectomies and the indications for tonsillectomy have changed significantly and you read the professional naysayers who would criticize the rate of tonsillectomy anytime anywhere.
My experience is that there is such an effort to avoid tonsillectomies and adenoidectomies that kids suffer.
You read what you see in the media and the media is always looking for some negative voice. Trust me on that, I’m a doctor and have absolutely no dog in the fight about doing and getting rich on tonsillectomies. In fact i see tonsillectomy patients in two situations, patients who have had a series of cases of tonsillites and are mad as hell they can’t get rid of em, and the ones who had their tonsillectomies and are having post problems because they underwent tonsillectomy when they were older or they had realy bad big tonsils that were more prone to post op bleeding.
You might recall that Jahi had her tonsillectomy when she was 13, I had mine when I was 4. Me and my brother same day. He’s a senior general surgeon and a hell of an athlete still.
I am less an athlete but handsome and intact.
Might be that we had our T and A surgery a little early, but we didn’t bleed and both of us are just fine.
I return to my point. Pediatricians are the ones fighting the battle to reduce tonsillectomies. That’s the way they are and your comment does not reflect the way pediatricians practice at all. They are wonderful people who, in my book go straight to heaven for dealing with obnoxious mothers.
Colic is a nebulous, poorly defined condition. Like many of today’s “diseases” colic is defined by its symptoms rather than actual pathology. If a pediatrician fails to find a cause for the child’s distress then the diagnosis is colic by default. There’s no reason to believe that all, or even most cases share a common cause.
Marketers love a good diagnosis of exclusion. If the experts can’t tell you what’s causing a condition, how can they claim to know what will or won’t be an effective treatment? After a few days or weeks of constant misery, a parent is willing to give anything a try as long as it isn’t known to be harmful. That “known” part is the problem, though. Fad treatments tend to skirt the edges of regulation. The word “probiotic” is poorly defined and not well understood by the masses that get most of their information on the subject from yogurt commercials. The study specifically singles out Lactobacillus reuteri DSM 17938 but most publicly available probiotic supplements aren’t that specific. I can’t immediately find fault with the study methodology, but the unintended consequences of a headline promising relief to exhausted parents that don’t understand the difference between the treatment given in the study, and a cup of “live culture” yogurt might be problematic.
The worst thing I see coming from this is parents attempting off-the-shelf probiotic treatments before taking a child to the pediatrician. The key to diagnosis of exclusion is actually taking the time to exclude everything else. There are a lot of other reasons for a baby to cry. I do wish the article had expounded on William Muinos’ warning of potential harm.
Looks like they are replacing laxatives as the cure-all on TV advertising.
I wonder whether C. tetani might be a normal symbiont and its toxin actually useful for something. Koch’s postulates were ignored when it was classed as a pathogen and it was officially declared “an exception”. It is way too common for a pathogen, and its occurrence in soil and manure, for example, is no different than that of other commensals. You don’t normally find weapons-grade stuff in every pile of dung.
There are over 1000 known species of bacteria, fungi, yeasts, etc. that can thrive in the human digestive system. It is fair to say that most of what we ‘eat’ actually feeds the critters inside us, and what we absorb as food is their wastes and the residues of their dead cells. Recent research is examining these commensals more closely, and much is being learned. For example, one common Gram-negative bacteria, Enterobacter cloacae, has been implicated in chronic inflammation because its dead cells release toxins that we absorb which trigger inflammation of the bowel, arteries and veins. It has also been confirmed (using Koch’s postulates!) as a cause for obesity.
“American pediatricians, as might be predicted, are cautious–they are a cautious bunch in my experience and conservative about interventions. ”
The last sixty years have produced a mountain of anti-tonsillectomy evidence that doctors seem to ignore:
http://boingboing.net/2012/01/10/tonsillectomy-confidential-do.html
Faecal transplantation proves to be effective in adults, even against Crohn’s. Some refined formulations of the stuff are euphemistically referred to as “ecobiotic”.