Wheat vs Gluten Allergy vs. Sensitivity WHAT THE HECK IS THE DIFFERENCE??

Often when it comes to figuring out sensitivities, a common problem is wheat and/or gluten.  However, wheat sensitivity and allergy is different than gluten sensitivity.  Let’s try to figure this out now...

Wheat sensitivity is exactly as it sounds.  When you or your baby consume wheat, you get symptoms that suggest a reaction such as rashes, gas, funky stools and mucous.  It’s not life-threatening nor does a sensitivity show up in traditional allergy testing.  People that are sensitive to wheat should avoid wheat including products that say “may contain wheat.” 

A wheat allergy occurs when the immune system becomes sensitized and over-reacts to wheat.  The body’s immune system puts up a fight to attack the allergen and this shows up in a variety of symptoms including rashes, hives, nausea, vomiting, diarrhea, asthma, and anaphylaxis.  To test for an allergy to wheat, a skin-prick test or a blood test which measures IgE antibodies in the blood are most commonly used by allergists.  A wheat allergy is potentially life-threatening and needs to be managed by avoiding all sources of wheat and wheat contamination.  Some people may even require the use of an epi-pen or other medicines to mitigate against serious reactions.

A non-celiac gluten sensitivity occurs when people eat gluten products and have reactions similar to a wheat sensitivity but do not have the autoimmune response in the body that a person with Celiac Disease has when they eat gluten.   In addition, people with gluten sensitivity have to avoid more than just wheat.

If we think of these sensitivities in a hierarchy of consequences, a wheat allergy stands on its own because allergies are different than sensitivities and allergies can be life-threatening..  When it comes to sensitivity, the hierarchy will be wheat sensitivity, followed by gluten sensitivity, followed by Celiac Disease.  Celiac Disease is an autoimmune disease where the immune system attacks the body in response to eating gluten and it is THE reason for the gluten free lifestyle.  People with diagnosed Celiac Disease have great consequences on their health than those with wheat or gluten sensitivities.

Avoiding gluten is a bit more challenging than just avoiding wheat.  Unlike wheat, which is a top 8 allergen that must be identified on food labels, you will not find labeling on a food package that says “this product contains gluten.”  So when shopping, you really need to be familiar with what gluten is and where it could be found in food.  People that are sensitive to gluten must avoid wheat, barley, rye, spelt, triticale and other wheat and barley derivatives such as couscous, farina, farro, durum, barley malt.  There is a host of hidden ingredients that may indicate gluten and nearly 80% of processed food items contain gluten.  It is found in the most unexpected places including chocolate and other candy, dressings, soy sauce and other condiments, seasoning mixes and the list just goes on and on.  Here is a link for ingredients to be avoided when on a gluten free diet.  http://www.celiac.com/articles/182/1/Unsafe-Gluten-Free-Food-List-Unsafe-Ingredients/Page1.html

We often see on our board, “What grains are safe for someone avoiding gluten?  Gluten sensitive people can still eat rice, quinoa, corn, buckwheat, sorghum amaranth, millet.

Another common slip up is oats.   Read this: Oats are gluten free.  I repeat oats are gluten free.  That said, people avoiding gluten or wheat should be purchasing certified gluten free oats.  This is because oats are commonly contaminated by wheat and the only safe product for those avoiding wheat and gluten is certified gluten free oats.

So how do you avoid wheat and gluten and make wise shopping choices?  The easiest is to first choose foods that are already naturally free of these products including butcher meats, fruits, veggies, gluten free grains, beans, legumes, nuts, eggs and dairy.  These items are on the outside perimeter of your grocery store.  Remember, many processed foods contain gluten.  The second is to read all labels carefully.  If a product says “may contain wheat” avoid it for now.  Third, if you must want to find a suitable substitute for your favorite bread or pasta, choose a labeled gluten free food.  For a food to be labeled gluten free, the gluten content in the product must be below 20ppm.  This means it’s a safe product for those with Celiac Disease.   Fourth, avoid choosing items in bulk bins.  Flour flies!!  Bulk bins are a major source of contamination for other allergens.  Fifth, if you don’t recognize the ingredient or can’t remember all the potential sources of gluten, just avoid the product and make another choice. 

Julia's Elimination Journey

I’m no stranger to screaming babies. All four of my children are sensitive to common elements of the standard American diet.  So much of what brought me to the world of dietary elimination while breastfeeding and specifically the development of this Elimination group was my third baby, Elizabeth.  From birth, things were different.  Her latch was awful.  She screamed around the clock.  Even while sleeping, she would fuss and make awful faces.  Everyone assured me that she was fine.  She was gaining weight.  She was just fussy.  Having dealt with two previous “fussy” babies, I knew that this baby was different.  At seven weeks, things went from bad to worse.  Elizabeth contracted RSV and pneumonia.  She was hospitalized for a week.  The pneumonia was a double strain and required intense antibiotics that I was told might make her tummy “a little off” for a few days after we got home.  She was also unable to nurse for more than a few moments due to her labored breathing for over a week. 

We brought our baby home and expected things to go back to normal.  We hit a new normal of shrieking screaming, bad, BAD diapers when she would have a bowel movement, less sleep and further nursing problems.  I didn’t even know where to begin.  My pediatrician offered formula after I mentioned that my older kids seemed to have dairy issues.  One night, when Elizabeth was 15 weeks, I almost gave up.  I was having vasospasms.  She hadn’t pooped in three days and her last diaper was pure mucous.  My husband just cried with me.  He told me he’d support whatever I needed to do. 

I decided to try a full elimination diet.  I was already dairy and mostly soy free.  I went to our local health food market and talked to the nutritionist there.  We came up with a game plan based on Elizabeth’s very specific issues: Eczema, inflamed bowels and extreme colic.  Let me be clear here:  I had no other options.  This was extreme.  Nothing was working.  My baby was broken.  I started off with bone broth, steamed carrots, grass fed beef and free range chicken, steamed pears and apples. I took a high powered probiotic and gave Elizabeth one, as well. I added fruit juice sweetened gelatin after a week.  That was it.  It wasn’t overnight.  It wasn’t even over a week.  After two months of a very extreme diet, we had a somewhat normal diaper.  (I totally took a picture and sent it to my husband at work.)

I called it a success, but we weren’t done yet.  At seven months, our nursing issues came back with teething.  So did extreme mucous.   I knew I couldn’t eliminate anything else from my diet.  I had just added raw fruit and vegetables back in.  A fellow admin had just had her daughter’s lip and tongue ties revised.  I sent her a picture of Elizabeth’s mouth.  She was MAJORLY tied.  I made an appointment for the following week.  Post revision, she spit up twice.  And never again.  Our nursing issues ended and we had much better diapers. 

In the end, I learned that elimination isn’t a one size fits all shirt.  We had combined extreme issues with Elizabeth.  As a whole, our kids are allergic to diary and cannot digest eggs.  Our girls can’t handle wheat.  Elizabeth has an anaphylactic allergy to peanuts.  While nursing Elizabeth’s baby sister, I have to remain free of soy, dairy, corn, peanuts, wheat, eggs, and pecans.  We’ve done extensive testing.  We work with a fantastic team of doctors to maintain Elizabeth’s health and wellbeing and that of her siblings. 

This can be done.  It’s never easy.  It is seldom fun.  We’re all a team and here for each other.  Ask me anything, ladies!  

Does My Baby Have A Sensitivity?

Getting Started:
Elimination can easily go overboard when we expect immediate results. Many times, one bad day leads us to believe that WE are doing something to harm our babies through our breastmilk.  Babies, like their mommas, are entitled to feeling off and cranky.  Let’s explore some reasons to eliminate foods while breastfeeding.  

·         Consistent fussiness or colicky behavior:  This means several days – sometimes growth spurts or teething can really look like a major issue when they are a normal part of infancy.

·         Eczema:  While it can be managed or treated with creams or lotions, often times, eczema is a result of a food sensitivity. 

·         Blood/Mucous diapers:  Mucous is a sign of inflammation.  If it happens one day and not for another month – it’s not an issue.  If it’s an everyday thing, there is likely an issue that needs uncovered.  Blood is always alarming and I take it very seriously.

·         Reflux/spit up: You’d be surprised what a little elimination in your diet can do for your wardrobe, ladies. 

·         Sibling history:  You have had a baby with reactions to something in the past and suspect it may happen again.

And here are some reasons NOT to eliminate:

·         Baby is not sleeping through the night:  Some babies do.  Some babies don’t.  It’s not a food sensitivity if your baby is having normal night waking.

·         Occasional spit up:  Again, sometimes, this just happens.

·         Baby wants to nurse frequently:  This is very normal infant behavior. Growth spurts, developmental leaps or comfort nursing are a huge deal for infants. Also, I don’t like to eat on a schedule and some days I’m hungrier than others.

·         Occasional mucous in an older, previously unbothered baby:  Usually a result of teething or maybe a little post nasal drip.

Believe it or not, there are some other issues that could LOOK very much like food issues.  Before you start living on unicorn tears, double check the following:

·         Do you have oversupply?  Oversupply can cause all KINDS of funky diapers.  Lime green, frothy poops are a hallmark of oversupply.  Oh, and a VERY fussy baby.

·         Has your baby been evaluated for a lip and/or tongue tie?  Unfortunately, so many health care providers are only familiar with an anterior tongue tie.  Spit up, mucous and green poop can all be signs.  Poor weight gain is a big one, too. 

·         Are you taking supply boosting herbs, such as fenugreek?  They are notorious belly achers!  

We really strive to make elimination diets user friendly.  Make sure to check out our “First Steps to Elimination Survival!”

First Steps to a Successful Elimination Diet and Breastfeeding

Breastfeeding is natural.  It’s beautiful.  It’s also hard work.  Add in suspected food sensitivities and you’ve got double the work and often times, none of the pizza!

Here are a few tips to get you started and make it a bit more streamlined:

·         START SMALL:  We usually advise dairy and soy elimination first.  By far and away, these are the MOST common offenders.  They can take a while to clear out, so we like to start there for that reason, also.

·         KEEP A FOOD JOURNAL:  I can’t stress the importance of this enough.  We like to start small with eliminations here – but a food journal can be so helpful if we need to dive deeper into elimination land! Be exacting.  Brands, times, everything!  Make sure to add any vitamins or drinks, also. 

·         CHECK EVERYTHING:  Vitamins.  Gum.  Candy. Bread. Soap.  Lotion.  It’s everywhere, friends.  If your baby is sensitive to it, you’ll find it even more places than you imagined. 

·         PINTEREST AND GOOGLE ARE YOUR NEW BFFS:  Need a recipe that’s dairy free?  Need a substitution for eggs?  Fire up those search engines!

·         IF YOU THINK YOUR BABY IS SENSITIVE, DON’T PARTIALLY ELIMINATE IT:  Here’s why  -it takes twice as long to figure out.  If you think your baby can’t handle dairy, don’t play around.  Just eliminate it.  You can always trial it in baked goods later!

·         DON’T GET CAUGHT UP:  Slow and steady will win this race.  You may have to eliminate a ton of food.  You may have to eliminate one food.  But don’t jump in headfirst.  Your baby deserves a sane mother! 

·         IF YOU NEED HELP, ASK:  We’ve been there.  We’ve done that.  We’re still alive.  We’re here for you! 

·         IS IT WORSE?  IS IT THE SAME? IS IT BETTER?  This goes with the food journal – keep track of perceived reactions and what they are.  It’ will help down the road.

·         STAY STRONG!  It’s really not worth the pizza.  

Help! My Baby Isn’t Gaining Weight

It’s a story that has been told time after time. A mom leaves her pediatrician’s office in tears. “My baby isn’t gaining weight, they told me I have to use formula” is often the phrase we hear. Moms are often upset, sad, angry, and confused. “I thought everything was fine!” “she acts so happy” “he’s hitting all the milestones!” 

So what is a mom to do if she is told by her pediatrician her baby isn’t gaining weight?

This shows an example of a baby
who has stopped gaining weight

Step 1: Evaluate your baby’s weight gain from birth to current.

The first thing to do is look at a detailed weight history. Look at the scales and other factors when all weights were taken. Was baby naked? Was it a different scale? Remember that birth weight can sometimes be inflated, it is best to go from the lowest recorded weight when looking at weight gain.

Is your pediatrician using a correct growth chart? Often times a pediatrician will use an incorrect growth chart when assessing a baby’s weight. Remember that the WHO growth chart is to be used for breastfed babies. Sometimes a pediatrician will say there is a problem when there is none just because of this factor.

Is your baby staying on their growth curve? This is important. Some pediatricians feel a baby should “catch up” and get to the 50% even if they are born in the 5%.  This simply does not happen typically. A baby should stay in the same % range and follow a growth curve. A baby in the 5% who stays in the 5% is fine. A baby who starts in the 50% and drops to the 5% suddenly is a concern.

Has anything changed between the last visit and now? An illness? A change in behavior?  Did mom go back to work?

Evaluate how often your baby is nursing. Is your baby under 6 months nursing at least 8 times a day? Are you offering both breasts each time you nurse? Before 6 months a baby should be nursing at a minimum 8 times a day and be offered both breasts each time.  While a baby may not take both breasts, they should both be offered.  A baby struggling with weight gain needs to be nursing more: 10 – 12 times at least.

A breastfed baby should gain 5 – 8oz per week in the first 4 months of life. From 4 – 6 months a baby should gain 3 – 5oz, and from 6 – 12 months 2 – 4oz per week. http://kellymom.com/bf/normal/weight-gain/ Gaining outside of this range would be a cause for concern and further investigation.

So, you have determined there is an issue. Your baby is not gaining weight appropriately for their age. They are falling off their growth curve. What do you do?

Step 2: Meet with an IBCLC

Most pediatricians are NOT trained in lactation. In fact some may have never taken a single class. While a pediatrician is great to help you with general health questions, for breastfeeding concerns you need to be working with an IBCLC. You can locate one near you using this website: http://www.ilca.org/i4a/pages/index.cfm?pageid=3432

A good IBCLC will do a variety of things. They will watch you nurse,  assess latch and transfer, and do a weighted feed. They also should check for a lip or tongue tie and if they are concerned refer you to a specialist for further help.

What is a lip or tongue tie? This site from Breastfeeding USA explains it nicely: https://breastfeedingusa.org/content/article/tell-me-about-tongue-ties Ties are often the reason for poor weight gain in a baby. They can cause poor milk transfer which means that even if you are nursing enough your baby may not be transferring milk well. Many times mom think if a baby doesn’t gain it must be the milk, but often times that is simply not the case. This is especially true with a baby who shows a sudden drop in weight gain around 4 -6  months.  At this point supply regulates so baby has to work harder for the milk. It also means that your supply has regulated to what your baby is taking, and if there is a tie they are not transferring efficiently. If your LC doesn’t check for a tie or you still have concerns of a tie, get a second opinion. Signs of a tie could include poor weight gain, clicking whe nursing, a shallow latch, extreme nipple pain, cracked bleeding nipples, and a lip stick shaped nipple. This facebook group is an excellent resource: https://www.facebook.com/groups/tonguetiebabies/ The procedure to correct a tie is quick and minor and can be done in a matter of minutes in a doctor office.

But what can I do in the meantime?

Step 3 – NURSE NURSE NURSE

Sometimes you may not be able to meet with an IBCLC right away. There could be a waiting period of a few days. The same is true of a specialist to check for ties. In the meantime, there are a few things you can do to help your baby get more milk.

1 – Nurse. Nurse every 2 – 3 hours in the day and at least every 3 hours overnight. Sometimes babies who don’t gain well are sleepy to conserve energy. They need to be woken to eat. Make sure to offer both breasts each time you nurse.

2- Pump. Pump after every nursing session.  If your baby isn’t gaining well and an IBCLC suggests you need to supplement, you can do so with your own pumped milk. Remember: Pumping .5 – 2 oz combined after nursing is totally normal. If your baby is older and you haven’t pumped recently you can expect to get less. Make sure your pump is working correctly and your flanges fit right. Over time your body will produce more to feed the pump.

3 – Do breast compressions while you are nursing or pumping. Breast compressions help get the most milk out. If your baby can’t latch and transfer well, it helps make it easier for them.

The take away here is that poor weight gain is a serious issue. Sometimes it is quickly resolved with more nursing sessions and offering both breasts each time. Other times the issue is related to transfer, latch, or in rare cases true low milk supply.  In very extreme cases a baby may have a medical disorder that prevents them from gaining weight. Often moms who have a baby gaining slowly are told “Its normal” or given advice to just “take X supplement”. While the advice means well, it does not help identify the underlying issue. If your baby is not gaining appropriately for their age you need to be working with your doctor and IBCLC to come up with a plan to help your baby gain. Weight gain in infants is crucial for brain development. It is a serious concern and needs to be addressed with medical professionals. 

All About Working and Pumping!

All About Working And Pumping!

Going back to work after having your baby is daunting enough, but throw pumping in the mix and it can be downright anxiety inducing! Here are some things you can do before you even return to work.

1. Make a plan before you return to work. Inform your boss and HR rep that you will be pumping at work upon return. Inform them you will require a 20 - 25 minute break every 2 1/2 to 3 hours. Try and come up with suggestions of how to make this work so you can come in and say "I can pump at X time in X place". This may be harder if you are the first one to work and pump at your company! 

2. Know the law! Check state and national laws covering pumping!http://www.ncsl.org/issues-research/health/breastfeeding-state-laws.aspx 

3. Invest in a good pump! Many insurance companies are now covering double electric pumps. Call your insurance company and ask what they will cover. 

4. Invest in a hands free pumping bra. You can purchase them online or make one from an old sports bra. This will make it not only more comfortable for you, but also give you the freedom to do something else while pumping! 

Paced bottle Feeding:

All the time you hear people talk about “paced bottle feeding”.  What is this and why is it important?

First, let’s talk about how babies nurse. Unlike a bottle, a baby has to work for the milk from the breast: they control the flow. With a bottle there is a constant stream of milk, when nursing sometimes baby is sucking for comfort and not getting any milk at all. This means that a baby who is nursing is used to getting milk, then the milk stopping while they stimulate another letdown, and then continuing to nurse. Also throughout the nursing session the flow of the milk will change. The initial letdown is usually stronger. This is why when your baby nurses you will notice different suck patterns.

But what does this have to do with bottles? When you give a baby a bottle there is no work for the milk and no way for them to control the flow. This means a breastfed baby can quickly chug down milk, 4 or more oz, and then still cry for more. If more milk is offered this can cause overfeeding and an upset stomach. Think of it as when you eat a meal too quickly, overeat, and then feel off later.

So, first off, make sure your bottle size is appropriate. Most breastfed babies take bottles of 2 – 4oz every 2 – 3 hours. Your care providers should PACE the bottles.  They should take 5 mins to feed each oz of breastmilk.  So a 3 oz bottle should take 15 mins to feed a baby, a 2 oz bottle should take 10 mins.  In order to do this, they should try to mimic the breastfeeding pattern—give an oz of milk, then give a paci, or finger, or toy, or washcloth, or WHATEVER he will suck on, and then once 5 mins have gone by, then give another oz of breastmilk. Here is the link for a handy print-out you can share with your care provider about the best way to pace bottles: http://www.cuidiudsw.ie/wp-content/uploads/2012/03/Paced-Bottle-Feeding.pdf

Make sure the baby is napping well. An overtired baby will seem hungry and want to nurse because they are tired.  Most babies under 6 mos will be awake for an hour or two hours tops before it's time for another nap. If you notice your care provider offering bottles every 45 minutes to 1 hour, chances are they are missing the sleep ques for your LO and baby is overtired.

Encourage our care provider not to feed the baby after a specific time of day. For example if you will pick the baby up at 4pm ask that a bottle not be given after 3pm or provide a small bottle (1 or 2oz) to be used after that time. If a large bottle is given right before you pick up the baby they may not be interested in nursing right away. Nursing as soon as you can after being separated will help you add extra nursing sessions in when you are together and will help to keep your supply up. 

As your baby gets older many care providers, especially those not familiar with breastfed babies, will say things like "your baby needs bigger bottles" or "you need to move to a faster flow nipple". Most of the time this is not true. Breastfed babies should take the same size bottles at 9 months as they do at 3 months. During a growth spurt they may need a small increase in milk, but it should only be a temporary increase over the course of the growth spurt. The same can be said for a faster flow nipple. The speed they get milk at the breast doesn't change, they don't need a faster flow nipple as they get older either. 

If your care provider starts asking you to provider larger bottles try providing fewer larger bottles. For example if you had sent 4 3oz bottles try sending 3 4oz bottles to be given father apart. 

When you are together: NURSE!

Babies need to drink about 25-35 ozs of milk per day--which is an oz-oz and a half per hour.  http://www.kellymom.com/bf/pumping/milkcalc.html Therefore the rule for daycare is always to send 1 – 1.5oz per hour (minimum requirement, you can send more if you can keep up with the pump, but an oz per hour is enough as long as you nurse on demand at home).  If you are away from the baby for 7 hours, you should send them with 7 - 10ozs. 

However, this means that you need to nurse frequently during the time you are together to make up the rest of the milk that they need for the day.  Breastfeeding (as oppose to pumping) is also important for keeping up a good supply--it is never preferable to pump and give a bottle.  Nursing directly from the breast is ideal.

Ideas to help keep up nursing at home:

1.  Co-sleep so that baby can nurse frequently at night.

2.  Offer to nurse frequently (every 2 hours or less) when you are together.

3.  Nurse AT the daycare--when you get there to drop off and when you get there to pick up, or else in the car.  This can help especially if you are even having trouble pumping enough milk after initiating all these strategies.

Note that it is very normal for a baby to go through a mini nursing strike right after you return to work, especially if a baby is being overfed or bottles aren't being paced. They may protest or fuss more at the breast because they do not get the same instant gratification they do from a bottle. In this case the best thing you can do is keep offering the breast and NOT give a bottle. Try hand expressing a little milk first to achieve letdown and latch the baby on. Most babies will quickly realize that when mom is around they nurse and when they are at daycare they will get bottles. 

Make Sure To Pump When Apart!

Pump at the same times every day and pump for a set amount of time. DO NOT WAIT TO FEEL ENGORGED TO PUMP.   Pumping is all about routine and consistency.  Ideally you will pump in the same place(s) and at the same time(s) every day (while listening to the same music, or watching the same show or reading the same sort of book or whatever your pump routine is).   Some Moms are helped by looking at a pic of their baby while they pump, listening to a recording on their phone of the baby crying, or smelling a piece of the baby's clothes. 

When you add a new pump session or begin a pump routine, you might pump almost nothing at first.  This is normal.  Give yourself at least a week of pumping at the same time/place before you can expect to see much milk. The same applies to changing your pump. If you sudden switch to a different pump it can take your breasts time to adjust to the different suction.

But how often should you pump? Every 2 – 3 hours you are separated from your baby. Make sure to start the clock after your last nursing session! So, if you nurse your baby at 7 and return to your baby at 5 you would want to pump at least 3 times, ideally at 930, 12, and 230. Make sure each time you pump you are pumping for at least 20 minutes. While the milk may stop flowing at 10 minutes, most moms will get more letdowns over the course of the pump. Some moms report letdowns at the 25 minute mark! Remember pumps are not as efficient as babies, so  even if your baby only nurses for 10 minutes, make sure to pump for at least 20. If you are finding it difficult to get so many pump sessions in, we can help you come up with creative solutions. Many moms pump in the car on the way to and from work.  Even adding a 5 min session (in the bathroom/at your desk/in the car/someplace fast and easy) between your more significant pumps would make a huge difference. Ensure that you are doing breast compression while pumping! This extra stimulation can help get out more milk than just pumping alone. Using a hands free pumping bra will make this easier.

Remember if you are still not pumping enough, there are troubleshooting tips. First off, check your pump parts to make sure they are working correctly. Ensure you are using the correct size flange. Often times moms just use the flange that comes with their pump, which may not be the correct size for them. Make sure to do hands on pumping! http://www.nancymohrbacher.com/blog/2012/6/27/to-pump-more-milk-use-hands-on-pumping.html This can make a huge difference in output. Consider renting a hospital grade pump to  use at work.

Helpful links from Kellymom:

 How to Bottle-Feed the Breastfed Baby:  http://kellymom.com/bf/pumping/bottle-feeding.html

 How Much Expressed Milk Does Baby Need:http://www.kellymom.com/bf/pumping/milkcalc.html

 How Often to Feed Baby: http://www.kellymom.com/bf/start/basics/hunger-cues.html

Hands On Pumping: <a href="#" role=button>http://www.nancymohrbacher.com/blog/2012/6/27/to-pump-more-milk-use-hands-on-pumping.html </a>