This is the transcript (provided by www.castingwords.com) Interview with Dr. Joneja.

Warning – this is over 3,000 words.

Just listen to the Podcast of the Interview with Dr. Joneja.

BD:  Hello and welcome to podcasts from the Boogordoctor.com site. I’m Russell Faust, author of this blog. This is an inaugural interview for what I hope to be a series of interviews and discussions with experts in the field of pediatric airway ‑ meaning asthma, allergies, rhinitis, sinusitis, reflux, and related topics.

I’m very proud to have as my first guest, Dr. Janice Joneja, expert in food allergies and food intolerance. Dr. Joneja, first let me welcome you to my medical education blog, Boogordoctor.com.

Dr. Joneja:  Thank you so much. I’m delighted to be here.

BD: Thank you so much for generously agreeing to chat with me today. I sincerely believe that listeners and readers of the blogs, yours as well as mine, will find your insights to be very valuable. Before I ask you about your experiences, I want to take just a moment to introduce you to our listeners. Let me first say that more details can be found on my site with links to your site for those folks who might want further counseling or have questions for you.

There are two main reasons that I wanted to invite you to be the first expert to be interviewed here for these blog podcasts. The first is that, and I’ll speak to my listeners here, she has impeccable scientific credentials. The second is that as a mother of a sick child she was frustrated by what the world of science and medicine had to offer to help care for her child.

So let me just first review some of those scientific credentials and her background a little bit and then open it up. Dr. Joneja is a researcher, an educator, an author, and a clinical counselor with over 30 years of experience in the area of biochemical and immunological reactions involved in food allergy and food intolerance. She holds a Ph. D. in microbiology and immunology, has been a member of the academic faculty of the University of British Columbia and other universities.

Currently she’s adjunct professor in the faculty of agricultural sciences at the University of British Columbia and an honorary research fellow in the School of Biosciences at the University of Birmingham, England. Dr. Joneja is also a registered dietician. She is very well published with more than a dozen articles in scientific and medical journals, has authored six well‑reviewed books including two recent editions that focus on food allergies.

You can find more information about these on the website. As an expert in her field, she has also authored articles in popular magazines and has been a frequent guest expert on radio and television. As you listen to her, you’ll understand why she’s been such a popular speaker.

Finally and perhaps most importantly in her development of her expertise, Dr. Joneja is also a mother. Clearly as she has great scientific credentials she knows her stuff, but she also brings a unique perspective to the world of food allergy, the experience of a mother with an ill child. That is why I’ve invited her here to share her experience and wisdom with us. She is one of the early integrators and pioneers in this field.

She practices in integrative allergy and nutrition counseling, just returning from a workshop where she’s giving a workshop in Oregon. Dr. Joneja joins us from British Columbia this morning. Dr. Joneja, welcome and can you please give us a little bit about your background and your experiences that led you to look beyond what you had learned as a scientist?

Dr. Joneja:  Indeed I can and thank you so much for inviting me. This is a delightful experience for me. I’m really happy to be able to share my experience, as you said, as on both sides of the desk if you like. We can look at it that way. I started my career as a research scientist. I did a doctorate in medical microbiology/immunology and started in at the University of British Columbia as an assistant professor.

My field was focused actually in oral microbiology/immunology and the immunology of mucosal surfaces, which is actually the very point where we see the coming together of the external world with the internal world. Of course there’s nothing more important than that, than the external world of food that becomes internalized in our bodies.

My research was focused on science. Literally, I was a laboratory scientist, and the mechanisms of the immunology of allergy were really where I started in immunology because I did my training in the department at the University of Birmingham where the immunological processes of allergy were actually discovered and delineated.

My background as far as allergy was concerned would probably be as much as was known in those days, and I’m talking over 30 years ago now. As a scientist I knew as much as there was to know about the mechanisms responsible for allergy, but it wasn’t until I had a child of my own with really perhaps the greatest number of allergies that I’ve ever seen in my practice as in the field of clinical allergy. I’ve seen over 4,000 families now.

My son, when he was born actually, had eczema. He very quickly developed quite severe asthma, and even as early as two years of age he was given prednisone and became steroid dependent, a steroid dependent asthmatic. He became anaphylactic to peanuts, and later on in his teenage years started to develop severe migraine headaches.

His father is a neurologist, and so he had every test that was available to find out the origin of his migraines, and nothing was discovered. Now when I was seeing him I could see definitely that he was responding to different foods. So I would speak to his pediatrician about this and discuss it with his respirologist and was told in no uncertain terms there’s no such thing as food allergy. It’s a product of a neurotic and in my case overprotective and overeducated mother. [laughs]

BD: Even 30 years later, now I’m sure many of the listeners are familiar with this response in medicine.

Dr. Joneja:  Oh, dear. I’m really sad to hear that. Now we have so much more research to guide us, but nevertheless you’re absolutely correct because I hear the same thing from the patients who come into my office.

BD: Sure.

Dr. Joneja:  So what was I to do? I knew the mechanisms. I knew what was going on my child, no doubt, and no one was available to help me. I looked to dieticians. They were absolutely uneducated in the field because nobody wanted to consider this as part of traditional medicine. So what happened of course was that he moved into the field of alternative medicine.

It seems that the traditional scientists and the traditional clinicians even today will shy away from a field that is considered fringe medicine unfortunately. So there was not a lot of scientific basis for us to even move into knowing what was going on. So me being what I usually do is, “OK, there’s no one out there to help me. I’ll do it myself.” [laughs]

I went back to university, became a registered dietician by taking all the courses required for registration, doing an internship, and then moving into the field to apply what I knew as a scientist in the field of clinical dietetics. In other words, trying to apply in a practical way all that I’d learned as a scientist to enable other people to help their children and themselves in managing what they knew were adverse reactions to foods.

Now having said that, I would like to at least say that since that time more and more traditional scientists and clinicians have recognized that food allergy is indeed a very important aspect. A lot of this is fueled by the anaphylactic societies who recognize the real danger of food to a sensitized individual because in the most extreme case we have of course a life‑threatening situation.

That itself has fueled tremendous research into the field, which I am happy to say now is what is guiding us in our practice.

BD: And how did things turn out for your boy?

Dr. Joneja:  Ah! [laughs] Well, he’s now in his thirties. He has a child of his own.

BD: Congratulations.

Dr. Joneja:  Thank you. A very small one, but it’s delightful.

[laughter]

Dr. Joneja:  Well, I think, as we experience, because I wasn’t able to intervene at the very early stages where we now see the possibility that we can perhaps reduce if not prevent the onset of food allergy.

Unfortunately he really did get into a very stressful situation where he was in status asthmaticus several times, which is of course an extremely frightening situation for everyone, including his pediatrician. He was steroid dependent, and do you know prednisone at high levels for a young child of six years of age can be devastating?

BD: Oh, yes.

Dr. Joneja:  And with the migraine headaches again, well, that one he solved himself. He decided at the age of 13 that he was going to become vegan. He said, “Mommy, every time I eat anything that is made of meat, it makes me vomit.” And it did. He became a vegan. We took out every animal source from his diet, which I was able to do, thank goodness.

In spite of being anaphylactic to peanuts, his diet was all legumes, no problem. That of course showed me that food allergy is species specific and that the old idea of food families being… I mean we could do a session on that alone of course, Russ.

BD: Sure.

Dr. Joneja:  But it doesn’t mean that you’re going to be allergic to everything in a food family. That is the old‑fashioned idea before we had the new molecular science to guide us on this structure of allergens.

BD: Right.

Dr. Joneja:  He became a vegan. His migraine headaches cleared up instantly.

BD: Amazing.

Dr. Joneja:  And I finally discovered after my methods of elimination and challenge, number one, he was very allergic to pork. We used to eat quite a bit of that in all sorts of forms, bacon and ham and so on. He was allergic to beef also. He was allergic to milk protein and on top of all that, which is very, very common in a steroid‑dependent asthmatic, he was sulphite sensitive. With that knowledge he was then able to, number one, control his migraine headaches. It did to some extent reduce his severity of asthma, because as you know sulphite sensitivity and exposure to sulphites can exacerbate asthma.

BD: Sure.

Dr. Joneja:  And so he’s still asthmatic. He still needs quite a bit of medication, but he does not need steroids. Inhaled steroids yes, but not the systemic steroids.

BD: Not systemic. Right.

Dr. Joneja:  So he doesn’t suffer from the migraine headaches, but he does have an aura. And aura for your listeners is sort of a ‘before headache symptom’ where he may have visual disturbances that would indicate that a migraine may be coming on.

He doesn’t have the migraine headaches. He doesn’t have the severe asthma, it’s controlled. He still has eczema. He never did outgrow that, although he outgrew quite a few of his early food allergies. With eczema we do see the impact of environmental allergens later on where they gain access to the lower tissues through the braided skin of eczema.

BD: Sure.

Dr. Joneja:  Dust mite, mold spores, animal dander and sometimes pollen spores will exacerbate his eczema. But he grew beautifully; he’s six feet four inches.

BD: So not malnourished.

Dr. Joneja:  Not at all, not at all. I make sure of that.

BD: That leads me to ask and there will be listeners who are facing similar situations with their children. It must be very frustrating to have a child, an infant, who is significantly limited, and who has many food allergies. For example, your son, not only being a vegan, but also being limited on even that diet what he could have.

So give us some sense of how you successfully nourished him, raised him. How did you manage to get enough protein into him so the little guy would grow? That’s hugely challenging.

Dr. Joneja:  It is a challenge and it was a challenge because being vegan is very difficult when they start in adolescence and he was very well nourished as far as his legume intake. Interestingly, although he was allergic to peanuts he was not allergic to all nuts. He was allergic to some nuts.

BD: Right. But not all tree nuts?

Dr. Joneja:  No. No.

BD: OK.

Dr. Joneja:  Because as we know, as long as a person is not allergic to a pan‑allergen… We might discuss that in a future series too. He isn’t allergic to all nuts, but we found out he is OK with almonds, he was all right with Brazil nuts, a variety of seeds he was fine with, so I could utilize those in the flours and increase his protein from that source and fortunately, later on he was not allergic to egg and so I was able to introduce that later.

BD: I was going to ask.

Dr. Joneja:  Yes.

BD: So you were able to maintain a fairly high quality breadth of amino acids and proteins to keep him well nourished.

Dr. Joneja:  Indeed.

BD: Yeah. Quite the challenge.

Dr. Joneja:  Which was fine, which was perfectly fine until he went away to school and university and that was where the problem started. In fact, there was a time when unfortunately the way he was eating in the university and he went to boarding school, the way he was eating there. He would vomit after a meal, after most meals. He lost a considerable amount of weight at that time, so this was where the challenge arose for him, when he was away from home.

BD: I think children who can be maintained at home, when this sort of care, meticulous investigation into their diet and elimination and reintroduction, this sort of meticulous care is taken, really do run into trouble when they’re out in that environment, when they go away to school or they go away for a job or something. It’s a huge adjustment.

Dr. Joneja:  Definitely. That is the problem. With young people, young men particularly, they want to be part of the social scene. They don’t want to be seen as different. He did suffer, I must admit, he did suffer a lot.

BD: Sure.

Dr. Joneja:  Young men like to go to the bar and so on and so forth and for a person with his sensitivities as far as fruits and other ingredients, it became really a big problem. It really was. Yes.

BD: Over what sort of time would you say that you began to not only recognize based on your scientific background recognize what was going in your son, but really to work it out, to develop kind of a detailed sense of what he was reacting to and what was safe for him since you didn’t receive a lot of assistance from his pediatricians? You did all this on your own?

Dr. Joneja:  Absolutely. In fact, one of his pediatricians told me to go and find another pediatrician because she couldn’t deal with me anymore.

BD: Oh, that’s so sad.

Dr. Joneja:  Oh, it was terrible. It was his respirologist, the doctor that was helping, or should’ve been helping, with his asthma that literally told me there’s no such thing as food allergy. In those days, in fact, I don’t know whether you would be aware of this, but in the early days of allergy teaching in medical school, asthma and eczema were not considered to be allergic diseases. The only real allergic disease was considered to be hay fever.

BD: Right. Allergic rhinitis.

Dr. Joneja:  Rhinitis. Exactly. And it was denied. In fact, we have research papers in those days denying the allergic component to asthma and eczema.

BD: Unbelievable.

Dr. Joneja:  Then the early papers would say intrinsic and extrinsic asthma, sort of claiming, “OK, we’ve got extrinsic asthma that may be triggered by pollen and animal dander and mold spores” and intrinsic asthma was considered to be just an idiosyncratic response of the body.

BD: Right. An odd physiological response.

Dr. Joneja:  Not to food. Certainly not to food or food components. No. That was completely denied in research papers.

BD: Amazing.

Dr. Joneja:  And then of course I believe there is still within the world of dermatology practitioners who deny the allergic component of eczema. Yeah we know atopic dermatitis and OK, we’ll sort of say that, but fortunately there’s another group of scientists showing quite clearly the triggers in foods that are associated with the onset and the exacerbation of eczema with food and pollen.

BD: Certainly in my field, there’s a recent convergence between pulmonologists and allergists, immunologists, ENT, ear, nose, throat, and otolaryngologists toward the so‑called unified airway theory, which states that the lining of the aerodigestive tract is all the same basically and it’s all exposed to the same toxins or pollutants or allergens and irritation in one area of that tract stimulates in the body various cytokines and other stimulants that can be systemic and irritate the entire tract.

Dr. Joneja:  Precisely. We see that very clearly in two conditions that are being recognized more and more now. They’re usually of adult onset, but we do see them occasionally in children, that would be ‘oral allergy syndrome’ where the initial trigger for IgE, that’s the antibody that mediates allergy, is pollen. So we start with a pollinosis, which would be cedar birch, older pollen and then we see oral symptoms as a result of consuming raw fruits and vegetables and have a very similar structure and can in fact release the mediators from our cells that were not actually sensitized initially by the food.

BD: Were not the original allergens.

Dr. Joneja:  And we also see that with latex allergy, where that can become systemic. The initial trigger is latex. There are many different antigens in latex.

BD: Right.

Dr. Joneja:  And these trigger IgE. Sometimes we’ll get them through the hands where there’s sort of an eczematous reaction to the latex, or even inhaled which would be the powder from latex gloves, become systemic. The IgE is systemic and then a person consumes foods that have similar structures within the protein in the food and then can in fact have an anaphylactic reaction to the foods, although they’re not initially sensitized to the food.

BD: Scary.

Dr. Joneja:  This is where we see that too. As you said, the integration between all of the mucosal surfaces of the body, although they are different. Because we’ve got what we would say the mast, the mucosal associated lymphoid tissue of the respiratory tract and the vault, which is the gut associated lymphoid tissue of the digestive tract, which are very different immunologically.

Yet they’re both mucosal tissues and therefore can respond in the same way and contain very similar cells, particularly mast cells, which can release the mediators that cause allergy. So I think it’s absolutely essential that the integration of these systems is recognized from a scientific point of view.

BD: Absolutely. For listeners, I hope that you’ll return to listen to more from Dr. Joneja regarding food allergies, food intolerance, food reactions, and things like eczema, childhood behaviors. I hope we touch on at some point and other interesting topics and I think that will wrap it up. Thank you so much.

Dr. Joneja:  Thank you.

_______________________________________

Transcription by CastingWords.com.

Transparency and Comment: I have no financial or other relationship with CastngWords.  CastingWords provided excellent service, for a reasonable price, to transcribe my recordings of interviews. I would recommend them highly, and without reservation.

_______________________________________

Hi, I’m Russell Faust, author of this medical education blog.

Let me know what topics are important to you and your child’s respiratory health.

Join the conversation by leaving a comment / reply below, or email me any time.

Thanks for visiting, see you here later.

In invite you to subscribe to this blog (it’s FREE).

Be sure to type in your best email address (the one that you actually use).  You will then receive an email with a “confirmation link” – click on that link to get weekly updates from this blog in your email.

It’s free, it’s convenient, it’s an easy way to stay up-to-date on information to keep you and your family healthy.  You can un-subscribe at any time.

Stay informed.

Stay healthy.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

There are now several well-written reviews about managing allergic rhinitis during pregnancy. “Why should that be a special problem?” you may ask. Well, ANY time a woman who is growing a person inside of them is exposed to medications, there is the potential for harm to her fetus – that little peanut in the ultrasound pic, above. So the question of how to best treat allergic rhinitis during pregnancy poses some special considerations.

I have listed 4 well-written, erudite (scholarly) reviews below, under the Resources heading at the end of this article. Take a look if you are interested.

Allergic? Really?

There is only one problem with treating Rhinitis of Pregnancy as simple Allergic Rhinitis: most often the rhinitis that women experience during pregnancy is NOT from allergies. It’s not Allergic Rhinitis. So those guidelines may not be useful for the severe nasal congestion that you experience during pregnancy.

So, what exactly IS Rhinitis of Pregnancy?

What is causing that severe nasal stuffiness?

Those Pesky Hormones 

My peanut playing on beach (same peanut in the ultrasound, above)

In a word … hormones. The same thing that is causing most of those other changes that you experience during pregnancy. The same hormones that help increase vascular supply to your growing fetus can also cause vascular changes to the nasal lining, causing swelling of the nasal lining, and nasal congestion.

And, according to published studies, rhinitis of pregnancy may affect nearly a third of pregnant women. When severe, rhinitis of pregnancy can cause complete nasal obstruction.

I’ve said before, but it bears repeating – especially if you are pregnant and you are experiencing severe nasal congestion: the best remedy is daily nasal saline rinsing.

Saline rinses are the simplest, most effective remedy for Rhinitis of Pregnancy, but there are others. Things like reducing your exposure to dust, toxins; eat healthy (duh), get plenty of rest (good luck). Re-visit an old post on the Rhinitis of Pregnancy: What it is, What to Do About It? for more tips.

Also visit Nasopure.com for the best nasal rinse system available (the one that I use for my family, and recommend for my patients), and some great videos. There is a popular video there of a three-year-old girl doing nasal rinses. (It’s pretty difficult to whine about doing them once you see a little girl doing them without complaint.)

This topic – Rhinitis of Pregnancy – is THE most popular topic on this blog site. Let us know about YOUR experience. What, if anything, has worked for you? Leave a comment below so that we can all learn from each other.

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Resources

Treating Asthma and Comorbid Allergic Rhinitis in Pregnancy: A Review of the Current Guidelines. Posted on Medscape Today. In the journal, Journal American Board of Family Medicine. 2007;20(3):289-298.
Link: http://www.medscape.com/viewarticle/558444

Treating allergic rhinitis in pregnancy. In the journal, Current Allergy & Asthma Reports. 2006 May;6(3):232-8.
Pubmed Link: http://www.ncbi.nlm.nih.gov/pubmed/16579874

Treatment of allergic rhinitis during pregnancy. In the journal, American Journal of Rhinology. 2004 Jan-Feb;18(1):23-8.
Pubmed Link: http://www.ncbi.nlm.nih.gov/pubmed/15035567

Treating allergic rhinitis in pregnancy. Safety considerations. In the journal, Drug Safety. 1999 Apr;20(4):361-75.
Pubmed Link: http://www.ncbi.nlm.nih.gov/pubmed/10230583

_______________________________________

Hi, I’m Russell Faust, author of this medical education blog.

Let me know what topics are important to you and your child’s respiratory health.

Join the conversation by leaving a comment / reply below, or email me any time.

Thanks for visiting, see you here later.

In invite you to subscribe to this blog (it’s FREE).

Be sure to type in your best email address (the one that you actually use).  You will then receive an email with a “confirmation link” – click on that link to get weekly updates from this blog in your email.

It’s free, it’s convenient, it’s an easy way to stay up-to-date on information to keep you and your family healthy.  You can un-subscribe at any time.

Stay informed.

Stay healthy.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

I want to recommend 2 great sites for soon-to-be mothers, mothers of newborns, and mothers of babies in their first year of life (Dr. Greene’s site is for all children, too):

• www.HealthTap.com

• www.DrGreene.com

Ron Gutman is founder and CEO of HealthTap, “your Home for Health”. The site officially just launched last month, April 2011. Before HealthTap, Ron co-founded Wellsphere, another pretty cool source for general healthcare information. Wellshpere was acquired in early 2009.

So, it stands to reason that he might put together a pretty cool healthcare site. He has done successfully it before.

Let’s talk a little about the site, HealthTap.com

Image: HealthTap Logo

HealthTap strives to develop a Home for Health that personalizes health information so that you can understand your health, and make the best evidence-based decisions (of course, that appealed to me immediately).

Other features that appealed to me about HealthTap:

• unbiased expert knowledge
• shared insights and experiences from the community
• ability to “rate” the experts, by voting up their answers to your questions
• it’s FREE
• the people who work there are passionate about making this a valuable resource
• that includes the physicians and other experts who volunteer as resources
• you can use it anonymously – your questions are seen only by your username (anything you like)

How to use the site?

Go to www.healthtap.com and click on “Member Sign up”. You can also watch their video on the home page (easily enough, click on “Watch our video”). They don’t ask for much personal info, and it is safe! It’s pretty easy, and the answers to any of your questions are top-notch. And, like Twitter or Facebook, you can “follow” the experts that you seem to feel a connection with.

Right now, the Beta release of the site, launched in April 2011, is focused on pregnancy and the first year of your baby’s life. The site is so great, so successful, that it will likely grow to cover other areas of your healthcare.

Also, be sure to check out the blog too: HealthTap Blog - http://blog.healthtap.com/

Transparency: I am one of the “Founding Medical Experts” for HealthTap. What does that mean? I simply login when I can, spend a few minutes answering your questions, perhaps write a healthcare tip, and connect with people. It’s sort of a sophisticated Facebook for your medical questions.

This is a volunteer position. I do it because I believe in the potential of social networks to improve our healthcare. And because I have profound respect for the Medical Director for HealthTap – Dr. Alan Greene, Pediatrician and Founder of the DrGreene.com site for natural pediatric healthcare. Be sure to check out his site too!

Image: Dr. Alan Greene's Website

Dr. Alan Greene is a Pediatrician at Lucille Packard Children’s Hospital at Stanford in California. He is author of some great books, including Feeding Baby Green (Earth-Friendly Program for Healthy, Safe Nutrition), and Raising Baby Green (Earth-Friendly Guide to Pregnancy, Childbirth, and Baby Care). Dr. Greene is passionate about keeping your pregnancy and baby safe from toxins, and being kind to our environment – a passion that we share.

More about Ron Gutman: Ron is also an angel investor and advisor to early stage technology companies, an advisor to Harvard Medical School’s SMArt Initiative, a host of health “hackathons,” and serves as the curator of TEDxSilicon Valley.

Speaking of TED Talks, take a look at Ron’s own TED Talk on the Hidden Powers of Smiling. It will make you smile. And like nearly every TED Talk that I have watched, this one is inspiring, and worth the few minutes it takes to watch. (this one is less than 7 1/2 minutes)

In Summary

If you are an expecting mom or dad, or parent already, check out these two sites, you won’t be disappointed.

_______________

Hi, I’m Russell Faust, author of this blog, and I appreciate your comments and questions.  Keep ‘em coming.  Please, “be excellent to one another.”

I invite you to subscribe (it’s FREE) to this blog for weekly updates – you won’t be swamped by updates, I simply cannot write for the blog everyday.

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Stay Informed.

Stay Healthy.

Best of health and success to you and your families.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)

What Causes Reflux?

Let’s start the answer by saying “we don’t know”. The rest is mostly speculation, educated guessing. At the bottom of the esophagus (swallowing tube) there is a tightening of muscle where it enters the stomach (called the “lower esophageal sphincter”). This muscle is affected by many things. As you might imagine, anything that loosens that muscle will allow reflux to worsen. Some things that loosen that muscle include caffeine, alcohol, tobacco, mint teas, tight clothing (pressing on the stomach externally), lying down, and even obesity. Some medications also worsen reflux. Let’s assume that your infant isn’t smoking cigarettes, drinking alcohol or coffee. You can see that most of these factors should not be a problem for babies or children, although obesity is becoming more of a problem in children. The biggest factor for reflux in infants is position – they spend most of their time lying down.

What To Do About It?

General Considerations

1. Manage stress. Stress and emotional turmoil will crank up the stomach acid, and have other negative effects. Too much can contribute to reflux, GERD. As always, to the best of your ability, provide your child with unconditional love, emotional support, and a safe and secure home environment.
2. Consider an Elimination Diet protocol. Some specific foods or food groups may be causing reflux or respiratory symptoms (asthma, rhinitis, etc.). Eliminating your child’s symptoms may be as simple as getting rid of a food from their diet. This topic deserves a LONG post all by itself. Take a look at Dr. Jonega’s site (www.allergynutrition.com), take a look at her books (on my Amazon Store here), and search the web for “elimination diet”.
3. Exercise. For children (adults too), make certain they are active. This will benefit their general health. It will help eliminate reflux. Get them up off the couch, pry them away from the video game and the TV, get them outside!!
4. Supplement with a multi-vitamin that contains zinc. Zinc is necessary for a healthy GI tract.
5. Consider using a probiotic for any child who is being treated for reflux (any treatment – conventional or alternative).

Infants

Simple things can help: after feeding try to keep them upright for awhile. If sleeping, try to place them on a slight incline, or prop up their bedding slightly under the head of the crib. Thickening their feedings can help them keep from refluxing. Rice cereal is a good thickener. For this to help, the formula or milk needs to be as thick as stage 1 baby food or tomato sauce (NOT paste!). Note that breast milk contains an enzyme that breaks down the cereal, so it will be good and thick to start, but thins out a few minutes later. You may want to thicken only an ounce at a time to prevent this from happening. Also note that thickened formula will not come out of a regular bottle nipple. Most bottle manufacturers have cross cut nipples and variable flow nipples. Ask your pharmacist to order some for you. Finally:  Not ALL reflux will be cured by thickening.

What Other Treatments Are Available?

For starters, “conventional” medicine uses something that is over-the-counter for adults (considered relatively safe):

Zantac (generic: Ranitidine)

I have had good results with this in my pediatric patients with  asthma, rhinitis, sinusitis, and otitis. It is a prescription for children. I use this mostly as a diagnostic technique: if I suspect reflux as a key factor in a child’s asthma, rhinitis, sinusitis, or otitis, I will place them on Ranitidine. If they clearly improve, we have our diagnosis. We then try to reduce the reflux without drugs. Keep reading …

Natural Alternatives

Here are some “natural” alternatives to consider (see my previous article, A Few Words on Being Natural (http://wp.me/pR4iB-k5) for my thoughts on whether “natural” is always better):

DGL

In the 1940’s licorice was discovered to be effective in treating peptic ulcers. Unfortunately, side effects included high blood pressure, potassium loss, and fluid retention (just another example of “natural” not always being a universally positive remedy). Over time it was discovered that these side effects were caused by a chemical in licorice – glycyrrhizin. The solution is called “de-glycyrrhizinized licorice”, or DGL, where about 97% of the glycyrrhizin has been removed. Research has shown that DGL is a good anti-inflammatory. It has been effective against the esophagitis and other symptoms caused by GERD. How to use DGL? It usually comes as a chewy tablet, kind of like a gummy-bear. Chewing the tablet helps activate the DGL by mixing with saliva.

NOTE that safety information for DGL in children are not available. Dosing information is not available for children. Therefore, this option is only available for treating adult reflux. If you use DGL, store it out of reach of children – the gummy-bear resemblance to candy can be appealing to children.

Barley Grass

That’s a pic of barley grass above (credit, Matt Lavin). Barley grass consumption by humans dates back at least 7,000 years, and active cultivation of barley dates back to Mesopotamia, to about 2500 BC. Barley has amino acids and chlorophyll, and seems to contain effective anti-inflammatory ingredients. In addition, it has 11 times the calcium of cow’s milk, more than 4 times the iron from spinach, 7 times the Vitamin C of oranges, and is loaded with Vitamin B1. Sounds impressive. There has been very little scholarly research on the effects of Barley Grass in humans. It is used as an anti-inflammatory for reflux, similar to DGL. How to use Barley Grass? Dried barley grass is usually boiled and consumed as a tea, or mixed into water or juice.

Melatonin?

You’ve heard of Melatonin? Helps us sleep. This mostly speculation, but some integrative and holistic docs who are pretty smart speculate that our Melatonin also helps reduce reflux. How? Melatonin increases the muscle tone in the Lower Esophageal Sphincter. This might reduce upward flow of gastric contents. That is, increasing the tone in the LES might reduce reflux. Still speculation, but it makes sense that the natural hormone that helps us sleep would also help reduce reflux while we are lying down.

Histamine?

No – don’t give histamine to treat reflux. Reduce histamine to reduce reflux.

For my own reflux, Dr. Joneja’s histamine-restricted diet has made a huge difference! Check her site under Resources, below. It is a GREAT resource for those with food allergies, intolerance, and reflux. She has many free downloads. She has an amazing site! Check it out!

Quercetin

Quercetin is a bioflavonoid. It inhibits release of both histamine and leukotrienes. As a result, it is a strong anti-inflammatory agent. It occurs naturally in onions, garlic, and many dark-colored fruits and vegetables. Ask your pharmacist or naturopathic doctor (ND) about dosing for children. Even better, simply include natural sources in your child’s diet (in your diet too, while you’re at it). As a general principal, it is always better to get your nutrients directly from the source – your food.

Acupuncture

As good at managing reflux as powerful proton pump inhibitors (PPI’s) for difficult-to-treat reflux. I don’t use PPI’s in my patients. To find a Licensed Acupunturist near you, contact the American Academy of Medical Acupunture (see Resources, below).

Nutritional Supplements

There are studies suggesting that magnesium and other elements play a role in histamine release. Be certain that your little tyke has as well-rounded a diet as possible (see Littlestomaks.com for suggestions). The goal, of course, is for them to obtain all of their nutrients from a well-balanced diet. This is a huge challenge, especially in toddlers. Supplement with a good multi-vitamin to be sure. This simple step will help minimize reflux, and help keep them healthy in general. Be certain that the multi-vitamin includes Zinc. Nearly all of us are deficient in Zinc, and it helps the lining of the GI tract to heal, to repair itself. Ginger can have a “gastro-protective” effect – it protects the stomach. BUT: Caution should be taken when using ginger (Zingiber officinale), as some studies have found increased GI distress with high doses or prolonged use. So: if you have reflux, don’t over-do the ginger. Finally, ask your doctor – naturopath, pediatrician, or pediatric ENT. Check the website of the American Board of Integrative Holistic Medicine to locate an integrative healer near you: http://integrativeholisticdoctors.org/D/locate_physician.html

Surgery

As a LAST resort: For those children with life-threatening complications of reflux – failure to thrive, severe asthma, recurrent pneumonia from aspiration, etc. – and these other approaches just are not working – surgery may be a consideration. The most common and most successful is a procedure that tightens the lower esophageal sphincter, the muscle surrounding the esophagus where it enters the stomach. I do not personally perform this procedure, and can only say that some of my patients have experienced life-changing success from surgery to stop their reflux. Beyond that, ask your doc, search the web. . Reminder: the goal of these articles is to educate and inform. This is not medical advice. All treatment should be undertaken with the advice and guidance of a physician who has knowledge of your full medical history, your physical exam and any laboratory test details. See disclaimer: http://wp.me/PR4iB-r Future posts will examine the studies showing how reflux affects rhinitis and sinusitis, and what we can do about it. . I appreciate your comments and questions.  Keep ‘em coming.  Please, “be excellent to one another.” I invite you to subscribe (it’s FREE) to this blog for weekly updates – you won’t be swamped by updates, I simply cannot write for the blog everyday. Click here to subscribe for free weekly updates: (http://eepurl.com/FGnP) Type in your best email address (the one you actually use).  When the confirmation email from boogor doctor arrives, click on the link to give your okay to receive free weekly updates, occasional book or product reviews, without needing to visit the website. It’s free, it’s convenient. No ads. No spam. You can un-subscribe at any time.

Stay Informed.

Stay Healthy.

Best of health and success to you and your families. Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)

Resources

American Academy of Medical Acupunture.  Tel: 323-938-5514. Website:  www.medicalacupuncture.org

Dr. Janice Joneja, PhD, RD (Registered Dietician): http://www.allergynutrition.com/)

This is an outstanding resource for allergy and nutrition information, including food allergies and reflux.

I owe a great debt of gratitude to Dr. Robert Ivker for helping to eliminate chronic sinusitis and reflux from my life.

Refer to his site for further details on steps that you can take: www.physicianhealer.com He is an outstanding resource for Respiratory Health.

Of note, he is an original founder of the American Board of Integrative Holistic Medicine.

Image Credit: Image by Matt Lavin, Flickr:  http://www.flickr.com/photos/plant_diversity/

From this blog:

Is Reflux Causing Your Child’s Asthma? http://wp.me/pR4iB-uV

Things You Should Know About Asthma: http://wp.me/pR4iB-7k

A Few Words About “Being Natural”: http://wp.me/pR4iB-k5

Reflux and Otitis: Does GERD Cause Ear Infections? http://wp.me/pR4iB-fZ