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Colic Formula fed microbiome IS different

Summary:  Colicky formula-fed baby?  You now have DNA proof that a colicky formula-fed infant needs HELP.   Every parent having an infant with colic needs to read this post.  Current new parents are fortunate because you can do something about your baby’s colic.  Take this Oct. 2016 study to your pediatrician and push for an answer because a baby’s colic formula fed microbiome is very different compared to that of formula-fed infants that do not have colic.  A SUPER EASY answer, may be a probiotic.  Talk with your doctor.  This post links to the infant colic microbiome studies as well as the studies looking at safety of probiotics in infants having colic. Parents of children that had colic as infants, noodle around the implications of an altered microbiome for your child.  Think about implementing the American Gut findings for the factors that optimize the microbiome as a good place to start. 

It is very likely your doctor may tell you, for colic:

“The pathogenesis of infantile colic remains elusive despite decades of research. It appears that multiple independent origins might be involved: amongst them infant’s difficult temperament, inadequate mother-infant communication or maternal anxiety, transient lactase deficiency, exposure to cow’s milk, abnormal gastrointestinal function, maternal smoking during pregnancy or after delivery.”  This  is excerpted from the clinical trial, ClinicalTrials.gov Identifier: NCT01541046, looking at supplementing probiotic L reuteri for colic:   Lactobacillus Reuteri DSM 17938 Versus Placebo in the Treatment of Infantile Colic.

Don’t let them off the hook so easily!

Here is WHY early life diet, colic, and its impact on the microbiome is important.

Infantile colic is one of the most commonly reported medical problems within the first three months of life causing appreciable distress for both parents and pediatricians. The reported incidence of infantile colic ranges from 3% to 28% in prospective studies and up to 40% in retrospective surveys.  Recent studies have suggested that changes of intestinal microflora of a newborn may play an important role in pathogenesis of infantile colic. Therefore, dietary supplementation with probiotics has been proposed for the improvement of this condition.  ClinicalTrials.gov Identifier: NCT01541046,  Lactobacillus Reuteri DSM 17938 Versus Placebo in the Treatment of Infantile Colic.

Early life diet → infant colic → probiotic supplementation???→ consequent microbiome → colic symptom reduction.  

No doubt, there are many questions that need to be answered concerning how early diet impacts health including:

  • How does diet in early life influence the microbiome?
  • How does the microbiome influence the child’s nutritional status?
  • How do differences in microbiome structure and function affect nutritional outcomes during the first 2-3 years of life?
  • What are the long-term health and developmental outcomes?  Many diseases are now understood to have signature microbiome skew.

The microbiome is plastic, impacted by many variables and changing with age.  Check out the slides below.  Everyone wants to better understand why the current disease epidemics are what they are and how to avoid being one of those statistics.  Going back to the beginning and learning the microbiome connection behind your birth and feeding mode, which establishes your microbiome with maturity around 27 months, is a start to answering those questions.

Folks always ask if there is a difference in the microbiome of formula fed infants compared to breast-fed, so I’ll answer that first.  

Well… there is, but the results are mixed.

  • In breast fed,  Bifidobacteria dominated the microbiota (n=606 (that is a large cohort); Fallani et al., 2010).
  • In that same study, formula fed infants had higher proportions of Bacteroides and members of the Clostridium coccoides and Lactobacillus groups (n=606; Fallani et al., 2010).
  • In this small cohort formula fed microbiome study, infants had increased richness of species, with over-representation of Clostridium difficile, but no difference in Bifidobacteria compared to breastfed infants  (n=24; Azad et al., 2013).

Some key differences in formula vs breast milk.  Infant formula contains easily synthesized oligosaccharides called galacto-oligosaccharide.  They were thought to be similar to the oligosaccharides found in breast milk.  Bode and others:  We now know better:  Their structure differs greatly and their promotion of the growth of beneficial bacteria and protection against certain pathogens additively falls way short compared to that of the full spectrum of oligosaccharides found in breast milk.  This post explains that breast-milk is rich in prebiotics, selects for persistence of beneficial bacteria and limits colonization of harmful ones.  The strong selective pressure of breast milk is demonstrated by the lower diversity of microbes in the gut of breastfed infants than in the gut of formula-fed infants. 

A good 2013 PowerPoint showing the microbe studies in breast milk, the role of breast milk, the microbiomes of breast fed vs formula fed, and microbiomes of infants following first introduction of solid foods, can be found here and is from UC Davis. It is by Dr. Kathryn G. Dewey, PhD, Distinguished Professor Director, Program in International and Community Nutrition Department of Nutrition University of California, Davis.


Now for the colic formula fed microbiome study

The Oct, 2016 microbiome comparison study of colic vs no colic in formula-fed infants is: Comparison of formula-fed infants with and without colic revealed significant differences in total bacteria, Enterobacteriaceae and faecal ammonia. 

The study found significant differences of total bacteria, Enterobacteriaceae and faecal ammonia. The study supports future 16S metagenomic sequencing studies to learn how more tailored dietary approaches may alter the microbiome and reduce colic.

The cohort:  In Italy, fecal samples from 38 formula-fed infants under 16 weeks of age with colic and 39 formula fed infants under 16 weeks of age without colic were collected and compared.

The findings:

  • Faecal ammonia was significantly higher in the colicky infants than the controls (483 versus 216 μg/g, p <0.05).
  • The FISH counts of total bacteria were lower in colicky infants (1.8E10 ± 1.5E10) than the controls (3.4E10 ± 3.0E10) (p < 0.05).
  • The relative abundance of coliform bacteria was significantly higher in colicky infants (p< 0.05).
  • No differences were observed for the bifidobacteria and lactic acid bacteria counts between the two groups.

Here are the Probiotic Studies in exclusively breastfed infants for L reuteri DSM 17938 and Bifidobacterium longum subspecies infantis 35624

This double randomized control trial (the best kind) found that probiotic L reuteri DSM 17938 [10(8) colony-forming units] given to exclusively breastfed colic infants reduced the total average crying and fussing times throughout the study (from baseline to day 21) compared to the control group. We are talking that on day 21, there was 50% OR MORE LESS CRYING TIME!  That study is: Probiotics for infantile colic: a randomized, double-blind, placebo-controlled trial investigating Lactobacillus reuteri DSM 17938, Jan 2015.  The details of the clinical trial itself, is found at Lactobacillus Reuteri DSM 17938 Versus Placebo in the Treatment of Infantile Colic.

Safety of this protocol was found in this Feb 2016 trial, with a larger phase II-III trial now ongoing, and it looked at using two probiotics in exclusively breastfed infants:  Safety and acceptability of Lactobacillus reuteri DSM 17938 and Bifidobacterium longum subspecies infantis 35624 in Bangladeshi infants: a phase I randomized clinical trial. The study explains the choice of these two probiotics:  Lactobacillus reuteri DSM 17938 has been safely used in infants [10] and adults in the US and Europe [11] and recently in adults in the Peruvian Amazon [12] and has been reported to prevent or reduce diarrhea and gastrointestinal and respiratory infections [1315], reduce pathogen colonization and alter microbiota composition[16, 17], reduce infant colic and crying time [1820], suppress Helicobacter pylori and gastric symptoms [21], relieve constipation [22], control reflux and abdominal pain [23], and improve infant weight gain [24].  Bifidobacterium longum is commonly found in both breast milk [25] and healthy infant stools [4].


In Conclusion:  

IF your doctor says this about colic, don’t let them off the hook easily:

“The pathogenesis of infantile colic remains elusive despite decades of research. It appears that multiple independent origins might be involved: amongst them infant’s difficult temperament, inadequate mother-infant communication or maternal anxiety, transient lactase deficiency, exposure to cow’s milk, abnormal gastrointestinal function, maternal smoking during pregnancy or after delivery.”  This  is excerpted from the clinical trial itself, looking at supplementing probiotic L reuteri for colic:   Lactobacillus Reuteri DSM 17938 Versus Placebo in the Treatment of Infantile Colic.

Instead, print out these microbiome studies and take copies to your pediatrician.  Talk with your doctor for more insight into colic and probiotics.  Your pediatrician needs to be current in these microbiome studies.  Advocate for your infant because they are doing their best to let you know their pain due to the diet, and the microbiome studies are confirming the WHY behind their pain.  The long term implications are great given that early life feeding is a major player establishing your infant’s microbiome.  This is the face of an exclusively breast fed infant’s first sip of water, lol, 21 years ago.  Seems a bit confused to say the least!  Early life feeding matters. 

Best of health thru awareness,

Signature2

 

 

 

 Last updated: November 16, 2016 at 11:09 am for SEO to correct the URL which did not automatically convert.

One thought on “Colic Formula fed microbiome IS different”

  1. A Fix for Colic? Formula Reduces Infant Crying from 3 Hours to 30 Minutes, 2017, http://www.gastroendonews.com/Web-Only/Article/05-17/A-Fix-for-Colic-Formula-Reduces-Infant-Crying-from-3-Hours-to-30-Minutes/41323/ses=ogst?enl=true

    New test formula: Low lactose + prebiotics + probiotics reduced crying time by 2.7 hours (from 3.2 hours to 0.5 hours). While the control group’s crying time also decreased, the reduction was only 1.5 hours (3.5 hours to 2.0 hours).

    The formula, consisting of a partially hydrolysed (meaning “pre-digested”) whey protein with reduced lactose that also combines prebiotics and probiotics, decreased the length of unsoothable crying episodes by 85 percent and significantly improved the overall quality of life reported by parents.

    This new formula was effective in reducing infantile colic, at least in a subset of infants, and improving the quality of life for parents and child. We are presenting this promising new development at Digestive Disease Week 2017 (abstract 498).

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