A warning: I’m not an integrative medical practitioner. This is my interpretation of the vast amounts of information I’ve been given by our doctor over the past several months, re-voiced into layman’s terms. I hope it is of use.
Infant Reflux – A BioMedical Approach
What is it? When is it worth thinking about? The pros and the cons.
This article does not seek to endorse a biomed or conventional approach but to try to explain the differences in order provide a pathway for those wishing to explore it further.
What is a BioMedical doctor?
Biomedicine is an integrative approach to healthcare. Although most general practitioners would say they too take an integrative approach, an integrative practitioner attempts to be almost be a specialist in whole body systems. They take a systemic approach to a suite of health problems rather than operating within the specialist fields that have developed as medical professionals specialise in one field of medicine over another. They are not gastroenterologists, ENTs or sleep specialists, they take a primarily biochemical approach to looking at problems that develop in the body and trying to figure out the causes of systemic problems.
They are fully qualified doctors, often GPs in the first instance, who have done additional training. They tend to use diet and supplements first before using pharmaceuticals. They will use pharmaceuticals when required but generally only to address symptoms while simultaneously healing whole body systems that are the cause the condition.
A biomed doctor looking at a child with gastrointestinal issues will want to know a fair bit about the child’s family history, your pregnancy and the birth of the child plus their biochemistry and intestinal flora and the initial consultation will often take several hours. While some of the tests commonly requested by a biomed doctor are covered by Medicare or insurance many are not. Further, consultations with a biomedical doctor tend to be quite lengthy due to the comprehensive nature of the appointment. For this reason a biomedical approach can be quite expensive – prohibitively so for many people.
The kinds of tests undertaken can include:
- screening for the kinds of gastrointestinal flora present in the gut and in what proportion (i.e. looking for overgrowth and undergrowth of certain species) like this test offered by HealthScope or this by BioScreen
- screening for common parasites
- blood testing to assess levels of acidity, alkalinity and various vitamins and minerals
- hair testing to determine the type and quantity of toxins being excreted by the body
- intestinal permeability testing to determine the integrity of the gut lining and
- testing for small intestinal bacterial overgrowth (SIBO)
Many of these tests can also be done through a regular GP but many wouldn’t routinely ask for these tests to be done. Biomed doctors tend to believe that infant reflux can be caused by a number of additional factors than those explored by a more mainstream approach. Of particular interest is the impact of overgrowth of particular kinds of bacteria in the gut. Certain gut bacteria can themselves produce large amounts of acid when present in large numbers in the gut. Many of these are acid-producing in the presence of certain foods. So in addition to the acid produced for digestive purposes by the child, they argue that there is additional acid produced by overgrown bacterial strains. This excess acid production can contribute to reflux and gastrointestinal discomfort in numerous ways.
Firstly, it may explain why certain types medications that target the body’s own production of stomach acid don’t work completely to control reflux in numerous cases – or only when used in very high doses. Because if the theory is correct, the acid isn’t being produced by the child, rather by the overgrown bacteria in the gut.
Secondly, the presence of constantly high levels of acid can interfere with the proper functioning of the sphincters that are supposed to close off the stomach at the top (lower eosophageal sphincter (LES)) or bottom (pyloric sphincter). A drop in acid levels is required to allow the sphincters to close so if acid levels never reduce, sphincters will be unable to close and function properly.
Thirdly, this excess acid may contribute to lack of adequate digestion. Acid plays a role in breaking down food in the stomach and turning it off can impede digestion. Additionally though, the pancreas plays an essential role in digestion by dumping an alkaline substance into the duodenum (first part of the bowel) once food passes through the stomach and acid levels drop. When acid levels don’t drop due to the presence of an overgrowth of pathogenic bacteria, the pancreas never gets the signal to dump the alkaline substance essential to the breakdown of food and absorption of key nutrients. This may be why various mineral counts in children on PPIs (Proton Pump Inhibitors) are notoriously low – particularly in relation to iron and B12.
Further, the acidity or alkalinity of the gut also impacts on the motility of the bowel. Many children with reflux also have impaired bowel function – they are easily bloated and find it difficult to clear their bowel. This may be because lactic acid producing bacteria produce nitric oxide (NO) in the presence of many foods and nitric oxide is a powerful vasodilator and very important in many cellular functions in the right amount. In larger amounts though it may be responsible for impeding peristalsis (the rhythmic, wave-like squeezing process by which food and waste products are transported from mouth to bot) and keeping sphincters (valves) that should otherwise be shut (at the top and bottom of the stomach for instance) open rather than closing when they should. Much of this is still under investigation but it seems to have theoretical “legs”.
Biomed doctors may also look at intestinal permeability – colloquially known as “leaky gut”. Other members of the medical community are less convinced by the role of leaky gut in contribution to other disorders. The gut lining is only one cell thick and but it is essential to providing a barrier between the contents of the gastrointestinal system and the blood stream. Obviously some nutrients, once appropriately broken down, are meant to be able to pass through to the gut wall into the blood stream, but if the junctions between the cells gets too big, larger proteins can make it through into the blood stream. Imagine a sieve getting bigger and bigger holes in it. A whole lot more gets through than was originally intended by the finer sieve. The theory goes that the immune system then recognises these larger proteins as foreign, creates antibodies against them and attacks. The immune system goes on high alert. This may be (a very simplified explanation) of the reason for food allergies or intolerances in some children.
Similarly, as the immune system starts to have to work harder and harder to protect the body, it is theoretically more likely that it will tip over into an auto-immune state where the immune system “goes rogue” and starts to attack its own cells.
The possible causes of “leaky gut” include anti-biotic use, exposure to certain foods and chemicals, stress – conjecture is around a number of factors.
Of course also, if some pathogens (nasty bugs) are overgrown in the gut, there is the possibility that these too can pass through the gut wall and cause problems including permeating the blood brain barrier.
While evidence exists to support this approach, it is early days for some of it and a more conventional approach would require a pile of research papers to be a bit higher before it would become a more accepted theory and practise.
So the biomed doctor will often go about testing to see if the gut lining is more permeable, try to get a handle on what pathogens, viruses and parasites might be floating around the system, what toxins might also be having an impact on the body and trying to assess how hard the nervous system, immune system, circulatory system and mitochondrial functions are working and if there has been any impact on how effectively they are working.
They will then go about trying to repair the lining of the gut, rebalancing the bacterial balance in the stomach and intestine and thereby trying to reduce the reliance on acid blocking medications that also impede optimal digestion and intestinal function.
The Pros & Cons
Its a very in depth process, which depending on your disposition can be either very confronting or quite fascinating. It can be a lot to take on and usually at a stressful time. Anecdotally it seems that people attempt a biomed approach when they are at the end of their tether or reached a crossroads. This means that the shift in mindset quite aside from the confronting list of supplements and timings can be quite daunting.
It is an expensive exercise. The consultations are far longer than a regular appointment, the testing isn’t covered by medicare and supplements can also be expensive.
Those who’ve had positive experiences argue that, while it has been a large up front cost, it has saved them a lot in the long run, including avoiding surgery or ongoing costs of a vast array of other specialists.
The more conventional practitioner would argue that this approach could be more concerning in fragile children. Some have cited endoscopy results where supplements have exacerbated already severe conditions. Some also have concerns about the veracity of some of the testing used.
As with all things, you should try to be an informed buyer. Make sure you have recommendations for the practitioner you intend to see. As with most professionals, not all are created equal. Try to get a handle on the costs you can expect at a first consult and the kinds of tests likely and their costs. This will help you get a handle on what to expect. It may also be useful to ask anyone else you know who has gone through this process to be better informed about costs and assess whether it is right for you and your family.
For more information or to find a practitioner in your area, a good place to start is the MINDD Foundation website http://mindd.org
So that’s the theory. If you want to know what we actually did, read on at Part 3: What we actually did and used.
Jo and Charlotte’s Biomed Journey: Part 1: Our story
References:
Dr R Cosford; “Infections, Anti-biotics, Dysbiosis and MINDD: Feeding our bugs“; Presentation to the MINDD International Forum on Children; 15-19 May 2009
Rapin JR, Wiernsperger N (2010). “Possible links between intestinal permeability and food processing: A potential therapeutic niche for glutamine”. Clinics (Sao Paulo) (Review) 65(6): 635–43. doi:10.1590/S1807-59322010000600012. PMC 2898551. PMID 20613941.
Fasano A (Jan 2011). “Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer”. Physiol Rev. (Review) 91 (1): 151–75.doi:10.1152/physrev.00003.2008. PMID 21248165.
Heyman M, et al. (Sep 2012). “Intestinal permeability in coeliac disease: insight into mechanisms and relevance to pathogenesis”. Gut (Review) 61 (9): 1355–64. doi:10.1136/gutjnl-2011-300327.PMID 21890812.
Festi D, Schiumerini R, Eusebi LH, Marasco G, Taddia M, Colecchia A (November 2014).“Gut microbiota and metabolic syndrome”. World J. Gastroenterol. (Review) 20 (43): 16079–16094. doi:10.3748/wjg.v20.i43.16079. PMC 4239493. PMID 25473159.