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TWO CONTRIBUTIONS:
Contributed by Christy McCulloch (here) & by M. C. (click here for M.C’s page)
Christy Mculloch writes:
Our Story
Each step of the way, my son’s Pediatric Gastroenterologist assured me that he’d outgrow his silent GERD at 6 months, then 12 months, then 1.5 years. This reassurance was given despite our many failed attempts to wean him off of a very high dose of omeprazole.
She mentioned that “most” (she would not commit to a statistic) little ones outgrown anatomical GERD by 1.5 years and 98% outgrow it 2 yrs. As he turned 1.5 years old, and still wasn’t able to tolerate reducing one, of three, daily doses of ppi (proton pump inhibitor) by just 2-3 mgs, I started questioning the treatment he was receiving from his allopathic doctors.
As a mother with a child with silent GERD, you question yourself. My son had never had any tests (no scopes or ph probes); he was just diagnosed based on symptoms alone (which isn’t unusual) and it made me doubt. His allopathic doctors resisted testing him, and had no explanation for THE CAUSE of his chronic GERD. He was on a high dose of ppi for over a year at that point and standard dosing for an additional 6 months, and I said to myself, “this can not be good, ppis are only supposed to be taken for 6 months!”
As his 2nd birthday approached, I refused to believe that he was in that 2% with ongoing strictly-anatomical GERD, my strong intuition told me that something other than anatomy was to blame. So, I did some research and got some good suggestions from GERD forum parents. Out of pocket, I decided to hire a Bastyr University trained Naturopathic doctor (ND) and sought to uncover the true cause of his unremitting issues. The ND first did an IgG 96 food panel blood test (for food intolerances) and found he mostly reacted to corn, gluten and dairy which, according to Lyn Patrick (authored ND/ GI specialist), are the top 3 allergens for little ones. Although technically he was negative on the IgG, our ND said with little ones you must multiply results times three, as they haven’t yet had enough exposures to pop positive, in the traditional testing range.
The digestive expert (Lyn Patrick) our ND consulted with questioned if my son ever had silent GERD in the first place. She believed instead that he may have suffered from LOW stomach acid and gut inflammation, based on his history. Her theory for why the ppi had worked was, if his gut is inflamed, any reduction in stomach acid would help via less agitation.
TheTreatment Plan
To cure his GERD, and get him off of a ppi, our ND recommended (in this order): the 4Rs of gut health
Step 1) Remove.
While still on the high dose of ppi three times a day, we cut out corn and gluten for 3 months. He’s been diary free since infancy. This was based on his IgG and the fact that these 3 foods are the top offenders. 2-3 months is how long it takes for cell repair/rejuvenation, reportedly. If this didn’t work, then our plan was to try more drastic diet changes such as the GAPS or SCD diet.
Step 2) Repair.
We used L-glutamine, aloe vera, DGL/licorice and omega 3s/fish oil.
Step 3) Restore.
Restore optimal gut flora via probiotics.
Dr. Chris Kresser says kefir is one of the best ways to do this.
We were told to introduce a good probiotic, but slowly, to avoid die-off. Our ND recommended Klaire Labs Kids chewable. I only did 1/2 every other day for a week then a whole tablet every other day.
Step 4) Replace.
Replace digestion. We did this via increasing stomach acid and addressing low magnesium levels (specifics are below).
The Results and his Unique Wean
His constipation resolved, which was the sign our ND said we would be looking for, to see that progress was being made. After doing the first 3 steps for 3 months we started to wean him off of the ppi. However, every time I tried to reduce his ppi dose by more than 1.11mg, he had screaming night-wakings (exactly like other failed weans). To make weaning easiest, I was given prescription omeprazole 10mg caps with 9 beads inside that were 1.11mg each (they are all white capsules manufactured by Kreme and marked “KU 114”). These were very easy to measure and enabled us to wean ultra slowly. Eventually, we were able to completely take him off the ppi. The process took around 7-8 months, at the 1.11mg per week pace, and I used some Thorne Research brand GI encaps at night to get him through night time acid rebound, since that was always his worst time (more info below).
I reduced and dropped each ppi dose equally (meaning I dropped the a.m. dose by 1.11mg one week, then noon dose by 1.11mg the next week, then p.m. the next week), vs dropping one full dose at a time, like most do. During that time, I also let him start eating corn, which made no difference. But, if he cheated with gluten, he wouldn’t have a bowel movement for 3 days. Our ND thought this was a significant sign, so we cut gluten out entirely again. Now it was made clear, only via 100% elimination for 3 months and reintroduction, that the gluten had been a missing piece of the puzzle.
Conclusion
In retrospect, I think what helped us wean was (in no special order):
1) Identifying his subtle gluten intolerance and cutting that out (although Dr. Chris Kresser and Sarah Ballantyne argue that food intolerances are the result of not the cause of GI issues),
2) Weaning off the ppi ultra-slowly. He needed to wean off the ppi far slower than any other child I know. I may’ve mistaken other wean attempts as failures, that were in fact just acid rebound/i.e. a sign that he needed a slower wean.
3) A gut healing protocol was needed prior to weaning off of the ppi.
I highly recommend hiring a Naturopathic DOCTOR (not naturopath) if you can afford it. Clearly, what worked for us may not work for your individual child and a well trained ND can assist with tailoring the intervention directly to your child. Our ND took much more time to listen and was clearly far more vested in solving the underlying issue as compared to our Pediatric Gastroenterologist. I truly believe my now 2.5 year old son would still be on a ppi, were it not for our amazing Naturopathic doctor! Here’s more information about specific natural GERD remedies and the gut healing protocol, recommended by our wonderful naturopathic doctor, Lena Kian. And, here’s a link to try to search for NDs in your area.
Supplements [*I am not endorsing or prescribing these products*]
Our gut healing protocol consisted primarily of omega 3s, L-glutamine and plant extracts:
Metagenics brand “glutagenics” (L-glutamine, aloe and DGL ie licorice) was recommended for my son at ½- 1/4 tsp daily, or every other day for 3-6 months. It’s a fine powder, so I just put it in 4-6 oz of his cold almond milk once per day. The glutagenics is good and, from what I hear, not as gritty as other glutamine. Luckily my son drank anything; it does taste like black licorice.
For Omegas 3s, we used Nordic Naturals Omega Jr 3.6.9, which I used per directions and put in his cold almond milk once per day.
We used Thorne Research brand “GI encaps” during weaning off of a ppi. Our ND said ideally you want to use it sorta like a tea so I opened and sprinkled ½-1 cap in 4-6oz warmed nondiary liquid (almond milk was our choice) at bedtime, in place of an antacid or H2 blocker. Reportedly, it both coats the esophagus to protect against reflux and also heals the GI tract lining. The ingredients are all natural and include aloe, licorice (DGL), slippery elm and marshmallow root. Just a word of caution though, we had to do some gut healing for 3 months before we could transition to the gi encaps because my guess is they’re for mild GERD. If I skipped one night, he would wake screaming with reflux several times, so I’m certain they worked for us.
“Iberogast” We bought this as a back up plan if my son didn’t take the GI encaps in order to address mild GERD/rebound while weaning off of the ppi,. The bottle says it’s safe for 3 month olds or older but we never used it so I’ve no idea about efficacy either way.
I gave him magnesium towards the tail end of his wean, to replace lost minerals from long term ppi use and ramp up stomach acid. I alternated between an epsom or magnesium chloride flake bath every 2nd night. I added 1/4 cup baking soda (NOT baking powder) and then ½-1 cup of the salts.
OR, some nights instead of magnesium baths, I just put magnesium oil (also mag chloride) on the bottoms of his feet at night. I used health and wisdom brand. This really helped my son to sleep better and he was also calmer after starting this ritual. I’ve heard the epsom is detoxifying but if you get a laxative effect, lower your dose.
Testing
HTMA: hair analysis for mineral deficiency and metal exposure. Reportedly 80-85% of people are deficient in basic minerals and some of these minerals are thought to be impossible to get via diet alone. I preferred to order my test via a professional who can help with interpreting the difficult to understand results (www.gotmag.org). The reason this test was so important to me is because it’s currently thought that GERD may be related to low stomach acid due to mineral deficiencies AND acid lowering medications can also reduce magnesium levels.
Food Testing: As I said above, we did an IgG blood test for food intolerances and our ND multiplies the result times 3, essentially because it’s felt the standard reaction range isn’t accurate for little ones. BUT elimination of a particular food and then trialing reintroduction while food journaling, in my opinion, is the best method for identifying food issues. Even if you get the IgG, which of course does help to narrow things down, you still then usually will do an elimination trial.
Recommended Reading
Chris Kresser’s ebook GERD/Heartburn is spot on in my opinion about most all aspects of GERD. It’s a free download you can get via a simple google search. I was afraid to give him my email address but I never received spam and read he doesn’t sell your information.
[the following are earlier drafts – infantrelfuxorg will work on getting all the links below up into the main body of the top, recent article]
Christy Mculloch writes:
Each step of the way, my son’s Pediatric Gastroenterologist assured me that he’d outgrow his silent GERD: At 6 months, then 12 months, then at a year and a half. This reassurance was given us despite our many failed attempts to wean him off of a very high dose of omeprazole.
She mentioned that “most” (she would not commit to a statistic) little ones outgrown anatomical GERD by 1.5 years and 98% outgrow it 2 yrs. As he turned 1.5 years old, and still wasn’t able to tolerate reducing one, of three, daily doses of ppi (proton pump inhibitor) by just 2-3 mgs, I started questioning the treatment he was receiving from his allopathic doctors.
As a mother with a child with silent GERD you question yourself. My son had never had any tests (no scopes or ph probes); he was just diagnosed based on symptoms alone (which isn’t unusual) and it made me doubt. His allopathic doctors resisted testing him, and had no explanation for THE CAUSE of his chronic GERD. He was on a high dose of ppi for over a year at that point, and I said to myself, “this can not be good!”
I just didn’t believe, in my gut, that he was in that 2% with ongoing strictly-anatomical GERD, as his 2nd birthday approached. So, I did some research and got some good suggestions from GERD forum parents. Out of pocket, I decided to hire a Bastyr University trained Naturopathic doctor (ND) and sought to uncover the true cause of his issues. The ND first did an IgG 96 food panel blood test (for food intolerances) and found he mostly reacted to corn, gluten and dairy. Although technically he was negative, our ND said with LOs you must multiply results times three, as they haven’t yet had enough exposures to pop positive, in the traditional testing range.
Our ND also consulted with a digestive expert, who questioned if my son ever had silent GERD in the first place. She believed instead that he may have LOW stomach acid and gut inflammation, based on his history and present state of health. Her theory for why the ppi had worked was: if his gut is inflamed, any reduction in stomach acid would help, via less agitation. While still on the high dose of ppi three times a day (MARCI dosing), we cut out dairy, corn and gluten for three months (this is how long it takes for cell renewal reportedly) and did a gut healing protocol (more info below).
His constipation resolved, which was the sign she said we would be looking for, to see that progress was being made. We then started to wean him off of the ppi. However, every time I tried to reduce his ppi dose by more than 1.11mg, he had screaming night-wakings (exactly like other failed weans). We had rx omep 10mg caps with 9 beads inside that were 1.11mg each (manufactured by Kreme, marked KU 114), which was very easy to measure and wean slowly. Eventually, we were able to completely take him off the ppi. The process took around 7-8 months, at the 1.11mg per week pace, and I used some Thorne Research brand GI encaps at night to get him through, since that was always his worst time (more info below).
I actually reduced and dropped each ppi dose equally (meaning I dropped the a.m. dose by 1.11mg one week, then noon dose by 1.11mg the next week, then p.m. the next week), vs dropping one dose at a time, like most do. During that time, I also let him start eating corn, which made no difference (corn didn’t seem to be affecting him). But, if he cheated with gluten, he wouldn’t have a BM for 3 days after. The ND thought this was a significant sign, so we cut gluten out entirely. He’s been dairy free since infancy.
In retrospect, I think what helped us wean was 1) Identifying his subtle gluten intolerance and cutting that out, 2) Weaning off the ppi ultra slowly: He needed to wean off the ppi far slower than any other kid I know and, I may have mistaken other wean attempts as failure, that were perhaps just in fact acid rebound/i.e. a sign that he needed a slower wean. 3) A gut healing protocol was needed too prior to weaning.
I highly recommend hiring a Naturopathic DOCTOR (not naturopath) if you can afford it. They take much more time to listen and are vested in solving the underlying issue, which sadly was not my experience with my Ped GIs. I truly believe my now 2.5 year old son would still be on medications, were it not for our amazing Naturopathic doctor!
Here’s more information about specific natural GERD remedies and the gut healing protocol, recommended by our wonderful naturopathic doctor, Lena Kian[this link works! There is a bug crossing out the word! sorry]:
1) We used Thorne Research brand “GI encaps“ opened and sprinkled in warmed milk at bedtime, in place of an antacid or H2 blocker. Reportedly it both coats the esophagus to protect against reflux and also heals the lining. We do 1/2-1 cap but this dose is for a 2 yr old, 32 lbs toddler. The ingredients are all natural and include: aloe, licorice (DGL), slippery elm and marshmallow root. Our ND said ideally you want to use it like a tea. My 2.5 yr old took it fine in about 4-6 oz warmed almond milk at bedtime, but the licorice can be strong tasting. Just a word of caution though: we had to do some gut healing for 3 months before we could transition to the gi encaps because my guess is they’re for mild GERD. Amazon has them for sale online if your local supplement/health food store doesn’t carry them. These were prescribed by my naturopathic doctor, while weaning off the ppi. If I skipped one night, he would wake screaming with reflux several times, so I’m certain they worked for us.
2) “Iberogast“ is another good natural product; it’s our ND’s ‘back-up’ recommendation for natural treatment of GERD . Iberogast is safe for infants 3 mos or older and dosing information is on their website . I believe it’s used a lot in Europe for GERD. Iberogast is also on Amazon.
3) Gut Healing Protocol: We were told to introduce a good probiotic, but slowly, to avoid die-off. Our ND recommended Klaire Labs Kids chewable. I only did 1/2 every other day for a week then a whole tablet every other day.
Metagenics brand “glutagenics“ was recommended for my son at 1/4 tsp daily, or every other day. It’s a fine powder, so I just put it in 4-6 oz of his cold almond milk once per day. The glutagenics is good and, from what I hear, not as gritty as other glutamine. (Luckily my son drank anything; it does taste like black licorice).
For Omegas 3s, this was recommended, which I again put in his cold almond milk and gave once per day.
4) Towards the tail end of his wean, to replace lost minerals from long term ppi use, I alternated every other night with two kinds of baths (yes, in the bath tub): (1) epsom salt (magnesium sulfate, both of which are essential minerals many are deficient in nowadays) and (2) magnesium chloride bath salts baths (chloride is an essential mineral and not related to chlorine).
Add 1/4 cup baking soda to the bath first, to neutralize chlorine in the water, OR buy a shower head filter that eliminates chlorine. Then add 1 to 2 cups epsom or mag chloride flakes per full bath tub (I started with 1/2 cup initially though and worked up slowly). The brands I used are hyperlinked, above, OR, some nights instead of mag baths, I just put magnesium oil (also mag chloride) on the bottoms of his feet at night. This really helped my son to sleep better and he was also calmer after starting this ritual. The epsom is also detoxifying. If you get a laxative effect, back down some. If you child gets hyper from epsom, I’ve been told it’s either due to 1) a severe deficiency in sulfate or 2) due potentially to a certain gene variant (i.e. the CBS gene SNP) that makes some sensitive to sulfates.
Testing:
1) HTM: In terms of testing for little ones, I also highly recommend you try a HTM test, which is a hair analysis for mineral deficiency and heavy metal exposure. You can get it for $85 thru Amy Yasko. The reason this is important is because it’s currently thought that GERD may be related to low stomach acid due to mineral deficiencies (easy to be deficient when you have a leaky gut that doesn’t absorb well) AND ppis also reduce magnesium levels.
2) Food Testing: As I said above, we did an IgG blood test for food intolerances and our ND multiplies the result times 3, essentially because it’s felt the standard reaction range isn’t accurate for little ones.
BUT elimination of a particular food and then trialing reintroduction while food journaling, in my opinion, is the best method for identifying food issues. Even if you get the IgG, which of course does help to narrow things down, you still then usually will do an elimination trial.
Christy Mculloch writes [Updated February 2015]:
Our story
Each step of the way, my son’s Pediatric Gastroenterologist assured me that he’d outgrow his silent GERD at 6 months, then 12 months, then 1.5 years. This reassurance was given despite our many failed attempts to wean him off of a very high dose of omeprazole.
She mentioned that “most” (she would not commit to a statistic) little ones outgrown anatomical GERD by 1.5 years and 98% outgrow it 2 yrs. As he turned 1.5 years old, and still wasn’t able to tolerate reducing one, of three, daily doses of ppi (proton pump inhibitor) by just 2-3 mgs, I started questioning the treatment he was receiving from his allopathic doctors.
As a mother with a child with silent GERD you question yourself. My son had never had any tests (no scopes or ph probes); he was just diagnosed based on symptoms alone (which isn’t unusual) and it made me doubt. His allopathic doctors resisted testing him, and had no explanation for, THE CAUSE of his chronic GERD. He was on a high dose of ppi for over a year at that point, and standard dosing for an additional 6 months, and I said to myself, “this can not be good; ppis are only supposed to be taken for 6 months!”
As his second birthday approached, I refused to believe that he was in that 2% with ongoing strictly-anatomical GERD; my strong intuition told me that something other than anatomy was to blame. So, I did some research and got some good suggestions from GERD forum parents. Out of pocket, I decided to hire a a Bastyr University trained Naturopathic doctor (ND) and sought to uncover the true cause of his unremitting issues. The ND first did an IgG 96 food panel blood test (for food intolerances) and found he mostly reacted to corn, gluten and dairy which, according to Lyn Patrick (authored ND/ GI specialist), are the top three allergens for little ones. Although technically he was negative on the IgG, our ND said with little ones you must multiply results times three, as they haven’t yet had enough exposures to pop positive, in the traditional testing range.
The digestive expert (Lyn Patrick), with whom our ND consulted, questioned if my son ever had silent GERD in the first place. She believed instead that he may have suffered from LOW stomach acid and gut inflammation, based on his history. Her theory for why the ppi had worked was if his gut is inflamed, any reduction in stomach acid would help, via less agitation.
The treatment plan
To cure his GERD and get him off of a ppi, our ND recommended (in this order) The 4Rs of Gut Health:
Step 1) Remove. While still on the high dose of ppi three times a day, we cut out corn and gluten for three months. He’s been diary free since infancy. This was based on his IgG and the fact that these 3 foods are the top offenders. 2-3 months is how long it takes for cell repair/rejuvenation, reportedly. If this didn’t work, then our plan was to try more drastic diet changes, such as the GAPS or SCD diet.
Step 2) Repair. We used L-glutamine, aloe vera, DGL/licorice and omega 3s/fish oil (more below).
Step 3) Restore. Restore optimal gut flora, via probiotics (more below). Dr. Chris Kresser says kefir is one of the best ways to do this.
Step 4) Replace digestion. We did this via increasing stomach acid and addressing low magnesium levels (specifics are below).
The results and his unique wean
His constipation resolved, which was the sign our ND said we would be looking for, to see that progress was being made. After doing the first 3 steps for 3 months we started to wean him off of the ppi. However, every time I tried to reduce his ppi dose by more than 1.11mg, he had screaming night-wakings (exactly like other failed weans). To make weaning easiest I was given prescription omeprazole 10mg caps with 9 beads inside that were 1.11mg each (they are all white capsules manufactured by Kreme and marked “KU 114”). These were very easy to measure and enabled us to wean ultra slowly. Eventually, we were able to completely take him off the ppi. The process took around 7-8 months at the 1.11mg per week pace, and I used some Thorne Research brand GI encaps at night to get him through night time acid rebound, since that was always his worst time (more info below).
I reduced and dropped each ppi dose equally (meaning I dropped the a.m. dose by 1.11mg one week, then noon dose by 1.11mg the next week, then p.m. the next week), vs dropping one full dose at a time, like most do. During that time, I also let him start eating corn, which made no difference. But, if he cheated with gluten, he wouldn’t have a bowel movement for 3 days. Our ND thought this was a significant sign, so we cut gluten out entirely again. Now it was made clear, only via 100% elimination for 3 months, and then reintroduction, that the gluten had been a missing piece of the puzzle.
Conclusion
In retrospect, I think what helped us wean was (in no special order):
1) Identifying his subtle gluten intolerance and cutting that out (although Dr. Chris Kresser and Sarah Ballantyne argue that food intolerances are the result of, not the cause of, GI issues).
2) Ultra-slow weaning off the ppi. He needed to wean off the ppi far slower than any other child I know. I may have mistaken other wean attempts as failures, which were in fact just acid rebound/i.e. a sign that he needed a slower wean.
3) A gut healing protocol was needed prior to weaning off of the ppi.
I highly recommend hiring a Naturopathic DOCTOR (not naturopath) if you can afford it. Clearly, what worked for us may not work for your individual child and a well trained ND can assist with tailoring the intervention directly to your child. Our ND took much more time to listen, and was clearly far more vested in solving the underlying issue, as compared to our Pediatric Gastroenterologist. I truly believe my now 2.5 year old son would still be on a ppi, were it not for our amazing Naturopathic doctor! Here’s more information about specific natural GERD remedies, and the gut healing protocol, recommended by our wonderful naturopathic doctor, Lena Kian. Here’s a link to try to search for NDs in your area.
Supplements *I am not endorsing or prescribing these products*
Our gut healing protocol consisted primarily of omega 3s, L-glutamine and plant extracts.
Metagenics brand “glutagenics” (L-glutamine, aloe and DGL ie licorice) was recommended for my son at ½- 1/4 tsp daily, or every other day for 3-6 months. It’s a fine powder, so I just put it in 4-6 oz of his cold almond milk once per day. The glutagenics is good and, from what I hear, not as gritty as other glutamine. Luckily my son drank anything; it does taste like black licorice.
For Omegas 3s, we used Nordic Naturals Omega Jr 3.6.9, which I used per directions and put in his cold almond milk once per day.
We used Thorne Research brand “GI encaps” during weaning off of a ppi. Our ND said ideally you want to use it sorta like a tea, so I opened and sprinkled ½-1 cap in 4-6oz warmed, nondiary liquid (almond milk was our choice) at bedtime, in place of an antacid or H2 blocker. Reportedly it both coats the esophagus to protect against reflux and also heals the GI tract lining. The ingredients are all natural and include aloe, licorice (DGL), slippery elm and marshmallow root. Just a word of caution though, we had to do some gut healing for 3 months before we could transition to the gi encaps. My guess is because they’re for mild GERD. If I skipped one night, he would wake screaming with reflux several times, so I’m certain they worked for us.
“Iberogast” We bought this as a back up plan if my son didn’t take the GI encamps, in order to address mild GERD/rebound while weaning off of the ppi. The bottle says it’s safe for 3 month olds or older, but we never used it, so I have no idea about efficacy either way.
I gave him magnesium towards the tail end of his wean, to replace lost minerals from long term ppi use and ramp up stomach acid. I alternated between an epsom or magnesium chloride flake bath very 2nd night. I added 1/4 cup baking soda (NOT baking powder) and then ½-1 cup of the salts.
OR, some nights instead of magnesium baths, I just put magnesium oil (also mag chloride) on the bottoms of his feet at night. I used health and wisdom brand. This really helped my son to sleep better and he was also calmer after starting this ritual. I’ve heard the epsom is detoxifying but if you get a laxative effect, lower your dose.
Testing
HTMA: hair analysis for mineral deficiency and metal exposure. Reportedly 80-85% of people are deficient in basic minerals and some of these minerals are thought to be impossible to get via diet alone. I preferred to order my test via a professional who can help with interpreting the difficult to understand results (www.gotmag.org). The reason this test was so important to me is because it’s currently thought that GERD may be related to low stomach acid due to mineral deficiencies AND acid lowering medications can also reduce magnesium levels.
Food Testing: As I said above, we did an IgG blood test for food intolerances and our ND multiplies the result times 3, essentially because it’s felt the standard reaction range isn’t accurate for little ones. BUT elimination of a particular food and then trialing reintroduction while food journaling, in my opinion, is the best method for identifying food issues. Even if you get the IgG, which of course does help to narrow things down, you still then usually will do an elimination trial.
Recommended Reading
Chris Kresser’s ebook GERD/Heartburn is spot on, in my opinion, about most all aspects of GERD. It’s a free download you can get via a simple google search. I was afraid to give him my email address, but I never received spam and read he doesn’t sell your information.
Click here for: Gut Health & My Baby (Forceful Let-Down, too)
