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Subject:
From:
Margery Wilson <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 26 Feb 1997 12:06:52 -0500
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Recent discussions of introducing solids and treatment of
reflux made me remember an article I read on the Internet by
Dr. Borowitz.
(http://avery.med.virginia.edu/~smb4v/tutorials/reflux/ger.htm)
I mentioned it on Lactnet previously but saw no discussion. I
am hoping this time to glean wisdom from the collective
Lactnet brain.
(I have his permission to quote the following excerpt from the
Internet article)

"Many parents are instructed to thicken their infants feedings
with cereal as a way of lessening reflux. By thickening the
feedings with cereal, the milk is physically heavier, and thus
less likely to come back up. There are however, some
problems with thickening feedings with cereal. It is not
possible to thicken feedings if the baby is largely breast fed.
Also, many infants with reflux are very vigorous or voracious
feeders. When the milk is thickened with cereal, the baby
has to suck harder to get the milk through the nipple. This
may cause the baby to fill their stomach with air which can
actually worsen the symptoms of reflux.

"Many parents find that their babies keep solid foods down
more effectively than liquids. This may simply be because
solid foods are heavier and thus less likely to come back up,
but also, solid foods are emptied out the stomach differently
than liquids are. In any case, there is no evidence to suggest
that feeding young infants solid foods with a spoon or from an
infant feeder is harmful. In many cultures around the world,
infants have been fed solid foods in the first month of life for
centuries without any problems. There is no evidence to
suggest that early introduction of solid foods predisposes to
allergies later in life. "

I wrote to Dr. Borowitz to question his references for the
above assertions and received the following response:
- - - - -excepted in full without editing - - - - - - -

"Thanks for your comments . . . I really appreciate them.  As
for data on early introduction of solids predisposing to
allergies, there are no data specifically concerning solids,
and theoretically, I can't think of any reason why solid foods
would be antigenically different from liquid or baby foods!
Most of the studies you cite are relatively old and most of the
literature looks at the incidence of "allergic" symptoms in
breast fed versus formula fed infants.  There is reasonably
convincing evidence that in infants with a significant family
history of atopic disease, prolonged breast feeding lessens
the risk of atopic disease, however without a family history,
the benefits are marginal at best (BMJ 330:837, 1990, J of All
Clin Immunology 89:709, 1992, BMJ 330:11, 1990) . . .
moreover, in numerous rural cultures solids are introduced in
the first month of life (Hervada and Newman, Current
Problems in Pediatrics, 1992) and have been for generations
and if anything, their incidence of allergic disease is
dramatically less than in ours.  There is a recent long-term
study suggesting that prolonged breast feeding (i.e. beyond
six months) lessens the risk of atopic symptoms
independent of whether the child is fed other foods.
Teleologically, early introduction of foreign antigens makes
lots of sense to me.  In fact, many dietary proteins appear in
breast milk intact . . . they are actively transported across
the breast!  This includes numerous cow's milk proteins.
There is much evidence to suggest that foreign antigen
exposure prior to weaning is important in development of
tolerance to foreign antigens, and in fact, atopic disease may
be a break in tolerance! IgA may be important in presenting
foreign dietary antigens to intestinal lymphoid tissue in a way
that induces tolerance rather than an immune response . . .
tolerance is a very active process whereby the immune
system actively recognizes foreign proteins and then
selectively doesn't respond to them . . . we are beginning to
take advantage of this process to treat a number of diseases
. . . there are convincing animal data and no some pilot
human data that feeding myelin basic protein suppresses
multiple sclerosis.
Similarly, feeding motor end plate/receptors is beneficial in
animal models of myasthenia gravis, and many people with
rheumatoid arthritis improve when they are fed collagen!
There are some very exciting clinical trials to prevent or
ameliorate diabetes by feeding insulin or ground up
pancreas.
As for the data regarding diabetes and cow's milk, as well as
Crohn's disease, follow-up studies have failed to reproduce
the initial results, moreover, most current evidence indicates
both diseases are immunologically mediated and directly
related to a specific "hole" in the immune system . ..in
diabetes there seems to be a problem that results in
development of autoantibodies to a glutamic acid
decarboxylase . .. in Crohn's disease there are recent data to
suggest the immune defect predisposes to an immunologic
response to normal intestinal flora. .

Anyway, thanks for your comments
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Dr. Borowitz gave me permission to share his comments on
Lactnet saying he would "welcome constructive comments."
So, 'netters -- any comments?

Margery Wilson, IBCLC
Massachusetts Institute of Technology
Medical Department
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