Soothing tiny tummies: the maternal diet-colic connection

A study published earlier this year suggests that adjusting a mum’s diet may help bring relief to colicky, breastfed infants. Study author and ION graduate Belén Vázquez – a specialist in baby colic who works exclusively with children’s nutrition and craniosacral therapy – shares key insights from the study, along with her own experiences supporting colicky babies in her clinic.

What is infant colic?

The diagnostic criteria for infant colic is recurrent and prolonged periods of crying, fussing or irritability that occur without obvious cause. Colicky babies often present with a persistent high pitch cry or excessive fussiness without a known cause, that tends to be aggravated in the evenings and is often accompanied by arching of the back and other gastrointestinal symptoms such as excess bloating.

What inspired you to conduct the study?

It was mostly in response to what I was seeing in my own clinic. As a nutritional therapist doing a Master’s in Personalised Nutrition, the mums coming to my clinic with their colicky babies would often ask whether they should or shouldn’t change their diet, or they’d say, ‘my baby’s colicky and I changed my diet and saw an improvement’.

I already had a database and so I knew I wouldn’t have to look for people for the research. I thought let’s see what mums have to say, because there had been very little research published to date on that – most of the studies were done on formally-diagnosed colicky babies, so they would change the mum’s diet and study the baby. But there was a gap in terms of what mums, the breastfeeding women, think. I really wanted to collect mums’ experiences and bring in a new dimension.

How does colic link to the gut?

Colic is not just about a baby crying – more research is pointing to the role of the gut, and they’ve even identified a colicky baby microbiome. So, there’s an inflammatory dysbiosis, with more pro-inflammatory bacteria and less beneficial bacteria such as bifidobacteria. They’ve also found inflammatory markers, so more cytokines such as interleukin-6, in colicky babies versus non-colicky babies.

Research from Italy has also shown high breath hydrogen levels in colicky babies, indicating that the sulphur-reducing bacteria are higher in colicky versus non-colicky babies, which explains the bloating, the windiness and all those things. So, to me, colic is looking very much like a baby IBS [irritable bowel syndrome].

What were the findings of your study?

With our research, we noticed that different colicky babies benefited from the removal of different foods. The combination of foods that the mum had to stop eating was different for every mum and baby pair. So, it was very personal – and this is where personalised nutrition comes in. Just like with IBS, not everyone does well on a low FODMAP diet [Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols], and we now know that there are different types of IBS: IBS-diarrhoea (IBS-D), IBS-constipation (IBS-C) or IBS-mixed (IBS-M).

So very much like IBS, I suspect that colic is a type of IBS where there are different subtypes of colicky babies. I haven’t been able to prove that, but just from the responses of mums: one would say ‘my baby did well when I stopped cauliflower and all the brassicas [i.e., broccoli, cabbage, kale, etc.], garlic and onions’ and another would say ‘my baby did well when I stopped dairy, but I was okay with the onions’. I would now love for a research team to study this more in detail to understand the mechanisms behind it.

When the dietary changes worked, mum felt she understood her baby better, she felt more confident, and she knew what she needed to do

What does this mean for parents?

As nutritional therapists, we can help mums make dietary changes, identify the [problematic] foods, recommend a trial elimination, find suitable replacements for this period, and then monitor how they do. We can then help to reintroduce the food(s) when the time is right.

By eliminating the problem foods, we’re giving the colicky baby’s gut a break and allowing early colonisation [of microbes] to happen; then as the gut matures, it’s able to break these foods down, so they can be reintroduced progressively. This process works great for me in clinic.

Current government guidelines do not recommend maternal dietary changes for colic relief. But that’s because there isn’t enough evidence – which is true, because there’s no money in this, there’s no financial reward in making mums change their diet. But absence of proof is not proof of absence!

Modifying a breastfeeding mum’s diet won’t put the mum or baby’s health at risk if done under the supervision of a nutrition expert, but it can provide relief – and it can also give the mum a boost in confidence, which is another amazing and unexpected finding from our study. When the dietary changes worked, mum felt she understood her baby better, she felt more confident, and she knew what she needed to do – and this allows mums to breastfeed for longer, because one of the main reasons for early cessation of breastfeeding is having a colicky baby.

Does the quality of breast milk impact colic?

Yes! Often lactation support focuses on the mechanics of breastfeeding – so positioning, latching, etc., which can put a lot of pressure on mums. Mums think their baby’s colic might be because they’re not latching well, but there’s no research to support this – it’s a myth.

Instead, we should be looking more at breast milk composition and colic. We know from research on breast milk composition that breast milk is not always as good as it should be because mums are not eating the right things – and this is where nutritional therapists can provide support.

What I’ve seen from some of my own clients’ test results is that the higher the content of DHA [docosahexaenoic acid, an essential fatty acid] in breast milk, the less fussy the baby. This connection between breast milk quality and colic is another avenue for research, as we know that high polyunsaturated fatty acids like DHA help to seal the gut, they help with gut permeability, and they’ve also been shown to have a signalling effect to help healthy bacteria grow in the gut too – we don’t know this specifically from babies but from other populations, and I suspect the same happens in younger children.

So, my approach is to identify potential offending foods but also to make sure there’s plenty of healthy fats in the diet – from my clinical experience, women are not eating enough healthy fats postpartum.

How do women get these fats?

This would always be personalised and would depend on the type of diet they’re following. For example; from the animal world we know fatty fish is good, a tin of sardines, smoked salmon, or some green salad with mackerel for lunch, or some eggs, things like that. And then for vegetarian mums it would be walnuts and flaxseed, etc. Sometimes I also recommend supplementation, too.

An increased intake of healthy fats has been shown to increase DHA content of breast milk within three days, so it’s really quick, which just shows how mum’s body prioritises those healthy fats for the baby!

Does the way a baby is born affect their risk of colic?

We used to think that vaginal delivery and breastfed was best; but in our survey, we didn’t find any association between colic and mode of birth, mode of feeding, gender, order of birth, or anything like that.

Of course, with a vaginal delivery and breastfeeding, the gut maturation process should be easier. But there’s some interesting research on newborns that looked at their first pass meconium [the first poo] and their daily stool samples up to three months, and they found they were able to predict who developed colic from that first pass meconium. This indicates that there’s a possibility that colic can be staged in utero, so prenatally. In other words, there are things that can happen during that time in the womb that can make a baby predisposed to colic – and that makes sense from all we know about colic, that there isn’t a single postnatal factor that affects colic massively.

We used to think that a baby was born sterile and was seeded after birth, but that’s not true because now we know there is a microbiome in the placenta and in the umbilical cord, and there’s bacteria in the amniotic fluid – and the baby is swallowing everything!

What about colic in formula-fed babies?

Babies can react to formula too, in which case it can sometimes be helpful to switch to formula made from smaller animals, like goat’s milk. But there’s also a question of whether it’s the milk protein or the lactose. In the last 10 years or so there has been an over-diagnosis of cow’s milk allergy – the incidence is around 0.1%, but up to seven percent of children have been diagnosed.

A lot of the time it’s more to do with the lactose content in the milk, so moving to a formula that breaks down the cow’s milk protein can help, but at the same time I also support the baby with the breakdown of the lactose.

For example, bifidobacteria helps break down lactose, and as the baby’s gut matures and there is more bifidobacteria in the small intestine, the ability to breakdown lactose improves. So, if you give a baby probiotic with a good combination of bifidobacteria, and maybe some prebiotic fibre for the bacteria, that can help with the digestion of lactose, rather than switching a baby onto an amino acid-based formula which tastes horrible!

To help support digestion and soothe the gut, I also use fennel which does has some randomised control trials, as well as a few other things like baby probiotics. But there are many things we can do with nutrition to help a bottle-fed colicky baby.

Do you have any plans to do more research in this area?

I would love to, but as part of a team. It’s very hard to do everything, to be the clinician and do the research; but colic is such a widespread disorder – affecting one in four babies – and we don’t have a solution for it, the guidelines are outdated, and there is so much suffering. So yes, I would like to continue but as part of a larger team!

About Belén Vázquez

Belén holds a MSc in personalised nutrition from CNELM/Middlesex University and a Diploma in nutritional therapy from the Institute for Optimum Nutrition (ION). She is a registered nutritional therapist and craniosacral therapist. A published researcher, Belén’s expertise in natural health solutions for children’s gut health and behaviour is supported by 20 years of clinical experience and extensive training in multiple complementary health modalities. She works from her clinic in Malahide, Ireland, in person and online.

belenoptimumhealth.com