Food Allergies and Sensitivities in Babies and Toddlers
Episode 43: Food Allergies and Sensitivities in Babies and Toddlers with Dr. Trillitye Paullin
If you have ever had a baby with food allergies, chances are you experienced many challenges with feeding your baby. This week Rachael is joined by Dr. Trillitye Paullin, a molecular biologist and mother of two. Rachael and Dr. Trill discuss food allergies and sensitivities in babies and children.
Here’s what they discuss inside this informative episode:
Dr. Trill’s personal experience with infant food allergies
Find out how proteins from breastmilk transfer to babies
The different types of formula available and the reasons WHY your baby may need a certain formula
Guidance for parents on when and how to switch formula
Looking for food reactions in your child
The difference between food allergies and intolerance
The symptoms of food reactions in toddlers and older children
Whether or not your child may grow out of an allergy
How to find support resources available for navigating feeding challenges
And so much more!
Dr. Trill Paullin is a molecular biologist and mother to two beautiful daughters who had severe infant food reactions to proteins transferred from her diet to breast milk. While struggling through elimination diets to continue breastfeeding, she discovered that many parents experience the same troubling situation. Dr. Trill wanted to create a place for parents to find answers to their questions about infant food reactivity and empower them to reach their feeding goals. Her online platform Free to Feed was born to provide the research, resources, and support she wished they had early on. They have started this mission by creating an educational support package, tracking app, personal consultations, and an allergy friendly postnatal multivitamin. Free to Feed’s team is working hard towards launching an at-home test kit that will allow parents to analyze their breast milk for allergens.
Mentioned in this episode:
Instagram: @free.to.feed
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Rachael is a mom of 3, founder of Hey, Sleepy Baby, and the host of this podcast.
Listen to the full episode
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Welcome to the No One Told Us podcast, where we tell the truth about parenting and tell you about all the things you should have known before having kids. I'm your host, Rachael Shepard-Ohta, and today I'm speaking with Dr. Trill, molecular biologist and mother of two beautiful daughters who had severe infant food reactions to proteins transferred from breast milk. So While struggling through the elimination diets to continue breastfeeding, Dr. Trill discovered that many parents experienced the same troubling situation. She wanted to create a place for parents to find answers to their questions about infant food reactivity and to empower them to reach their feeding goals. Her online platform, Free2Feed, was born to provide the research, resources, and support that she wished she had had early on. Free2Feed has started this mission by creating an educational support package, a tracking app, personal consultations, and an allergy -friendly postnatal vitamin. Free2Feed's team is working hard to launch an at -home test kit that will allow parents to analyze their breast milk for allergens.
And as a mom who dealt with this with my first baby as well, I am just so, so glad that your expertise and information is getting out there because it can be such a difficult journey. So Thank you so much for being here. I'm so excited to ask you all of our questions today.
Yes, thank you so much for having me, Rachael.
So can you tell us, I just mentioned it a little bit in the intro, but can you tell us a little bit about your personal experience with allergies or reactions through breast milk and how it led you to where you are today?
What is spot on for your podcast is that when we had our daughters, I had no idea that things that you ate to transfer to the breast and elicit a larger response. So that was a big shock when our oldest daughter was born. She was absolutely beautiful and amazing and wonderful and she would not stop screaming. She was inconsolable and we took her in and I said, you know, I don't know what's wrong, but there's got to be something wrong. All she does is scream and eat. And that is it.
And I was told, you know, yeah, your baby has colic. Good luck with that. High five, sent home. And we navigated that for a few weeks when at only three weeks old, then we woke up to find her completely covered in eczema from head to toe overnight with a massively bloody diaper.
Oh my God.
And so at that stage, I panicked, right? I took her immediately back to the pediatrician and said, Well, I feel like I know why she's been screaming at me for the last three weeks. I think she's been in pain. What do I do now?
And even at that stage when I felt like this was like a big emergency, you know, it's not normal for people to have bloody stool, especially her diaper was almost entirely blood. I thought this was like a huge deal. And even then, I was told, yeah, you know, it may be that your baby has some kind of reactions to something in your diet, consider removing cow's milk protein.
And to give some backstory, at this stage of my life, I am at the last year of my grad degree program, getting a PhD in cellular molecular biology focused on protein analysis. So like, the irony is strong, I was going to say, that is just like, perfect, this perfect storm. And so even to even as somebody who like, that was my whole life was studying proteins, I had no idea that food that I consumed could transfer to my breast and cause any kind of issues with any child.
And so I said, you know, okay, I will be the first to admit I love cheese.
And so I was a little heartbroken. And I was like, okay, what does this mean for me? Got it. I got to remove all cow's milk protein from my diet. And it was still kind of just that was it though. I was I was really expecting a lot to come of this like lots of tests and, you know, more information and answers and just like, hey, take cow's milk out of your diet and go home was really what I was told.
And maybe if you wanted to not do that, you can switch to a specialized formula. And so it really felt, you know, at three weeks, we had finally gotten our training wheels off of our like, like, lactation journey. Like, I finally felt like we were figuring it out together. So I said, okay, I'm gonna take cow's milk out of my diet. And she started to get worse really quickly.
Oh no. And eventually, we had this little baby whose skin was weeping and infected, whose stool was just entirely blood. All that came out of her little body was blood. And I was a shell of a human at this stage. And we eventually got admitted to the hospital, because I went to a GI doctor and was like, I don't know what to do. And somebody's got to pay attention. This, this isn't okay. And this entire time she's been screaming inconsolably this whole time so I am I am whatever version of me is left and we get to the room we get to the hospital room and she gets hungry.
And so I whip out a boob as one does and start feeding her and a provider walked in and gasped and was like, I can't believe you would poison your baby like that. And that was the beginning of what was then a starvation diet was what they called it. They put her on IV only for 24 hours, which is torture for you and the baby when you're like literally the food, right?
Oh my God. And so I remember pumping in the stairwell of the hospital because if I pumped in our room, she got really upset and they didn't have another space and It was awful. It was truly truly awful…… on the other side of this. They said Yeah, she has food allergies. We don't know what it's to we can't test her. And we can kind of get into to why as we do we discuss So here's your hypoallergenic formula and at that stage, you know absolutely nothing against the formula at all. But at that stage, I would have fed her the dust bunnies after under the hospital bed like just feed my child anything, please. And then the other kind of shoe dropped in that our insurance wasn't going to cover the formula and it was going to be 50 bucks a can every couple of days.
And I was a grad student and my husband's an artist and so we were like, where are we going to come up with the funds to feed this child? So I went from in one moment feeling like I was feeding my baby something that hurt her to like I wasn't gonna be able to afford to feed her at all. And I asked this question then in the hospital of like, "Okay, I'm a protein expert, this is what I do, like there's gotta be something. If you can make a hypoallergenic formula, can I make a hypoallergenic breast milk technically?" And the answer was a hesitant, maybe…. here's a laundry list of things that she could be reactive to literally just dozens.
There's just this laundry list of things she could be reactive to. Try taking those out of your diet and pump like a mad woman for a few weeks while your milk quote unquote clears, which wasn't necessary, not backed by science. And because our milk doesn't contain foods that we eat for that long. And see what happens. And that was it. We were shimmied out the door. And so the rest of that journey and all encompassing was one year of me being on a really strict elimination diet. And it had a lot of impact on my mental and physical health.
I was able to successfully breastfeed her, successful for her, less successful for me. And when our second daughter was born was when I popped my head out of the sand and was like, All right, where's all the resources and the research and the scientists that have got to be focused on this, right? And there's got to be more people now. And what I found were lots and lots of families and very little else.
And that's when I started Free to Feed. Free to Feed was born about four weeks after our second daughter who also has food allergy issues. And we navigated that with her with the goal of creating everything that I wish I had when I was navigating it with my children.
Wow, that is such an incredible story. And I'm so sorry that you went through all of that. It sounds just so devastating on so many levels. How long ago was this? How old is your oldest?
My oldest is now eight and my youngest is five.
Okay, wow. And the fact that you started this platform while postpartum and a mom of an older child is just so tiring and so amazing that you've been able to help so many other moms going through this. So you mentioned screaming and like those quote unquote colic symptoms that sometimes we see and you mentioned the bloody stool, which is of course never normal. What are some other common symptoms that you see with babies who are allergic to something in breast milk?
That's a great question. And when I think about the symptoms, I like to first think like outside to inside and then top to bottom and so on the outside oftentimes what we'll see is any kind of rash response and so that can be eczema, that can be red, angry or flaky. You might see high responses which are kind of raised and can be itchy and then all the way to then internally when we get top to bottom we'll see chronic that we can see issues with swallowing. We can see issues with vomiting, reflux, silent reflux. Then down in the tummy area, we can have issues with gas. Then as we get lower, we get into the lower GI tract, which is really where the most common symptoms lie for these kiddos. And that's where we'll get the diarrhea, the constipation, mucousy stool, bloody stool, and similar. And those are all what I just explained are what I would call primary symptoms, like this is, the vomiting is a direct response to a protein that they're reactive to, or the mucus stools are direct response to a protein.
And then you get all the secondary symptoms. And those are the inconsolability, the feeding refusals, the just all of the things, right? The weight gain issues. And what's really important to mention anytime that I'm talking about symptoms is that it's important to know that most babies don't present with all of the symptoms. I mean, like, thank goodness for small favors. But it also means that many times parents will be dismissed because they aren't checking every single box. And what I mean by that is like, my oldest had skin issues and lower GI reactions mostly.
So the eczema and the bloody stool were mostly her issues. My youngest though was what's called, she had F -pies, which is a vomiting response. And so a vast majority of her reactions were upper GI. She had no skin issues whatsoever. And so oftentimes we'll hear parents say like, "Yeah, I was told that my baby doesn't have reactions because there's no blood in stool." But that just means that that's not the area of the body in which that reaction is occurring.
Okay, that makes a lot of sense and that's really helpful to know. And I'll add too- sleep. A lot of babies like this have a really hard time sleeping because they're so uncomfortable. And I think it's really, it's hard, especially for a first time parent who has nothing to compare it to. It can be hard because some of these, and there is a problem with people just saying like, "Oh, it's colic like it's normal, they'll grow out of it." And some of this stuff can be normal and can be common and isn't necessarily a food allergy thing.
Like some babies are, you know, they just have a tougher temperament and they are a little bit fussier. You know, there are other breastfeeding issues that could cause some of these things like, you know, latch issue or tongue tie or something like that that will cause symptoms that look like this. So it can be really hard and confusing. So I just want to validate that for parents that like sometimes it's not so obvious. So if you've missed something like this, don't feel bad because it's just it's really hard to tease out, right?
And not only is it hard to tease out, but also it's not something that many of these things aren't items that are regularly discussed in this space for parents. For example, many parents come to me with, you know, mucousy stools and they had mucousy stools for really long time to the point where it would be really concerning. If you knew what like regular baby poop looked like and to like give you all of the grace in the world, it would be strange if you did know what the baby poop looked like. Unless you grew up with a bunch of babies around you and all of that, like it would be more strange if you did know,
but totally. And so 100%, right?
And we had symptoms probably at day one with our oldest especially but we didn't know because those are things that are regularly talked about and very frequently yes when you say I'm exhausted and then there's this you know what stereotype of like that exhausted mother right and like oh yeah that's just normal you'll just get to the other side of it and knowing where the line is is hard even for people who have been the stage forever mm forever. It's so true.
So what is it about the proteins? I'm going to ask you to get a little sciency. What is it about the proteins in the breast milk that are transferring to baby and causing that reaction? And like you mentioned, you know, the proteins don't necessarily last for days or weeks. So what would kind of be like the first step to determining A, what the allergy is, and B, do you need to go out of an elimination diet? How long do you have to be on it for? I know this is like a huge question and three questions in one.
But yeah, this is my favorite topic. So my focus on the research side has really been molecular components in human milk and like, how are we transferring these fragments of proteins to the breast and how much do we transfer what portion in order for us to get to the point of being able to detect it, right? So what we found in our research and other labs as well is that when we consume a protein, like let's say for example, cow's milk protein is really, really common for being a trigger for kiddos. If your child has food reactivity, about 90 % of those children with food reactivity will be reactive to cow's milk. So it's super, super high probability.
Now, that doesn't mean everybody. So definitely want to not eliminate cheese if we don't have to eliminate cheese. But let's say, for example, we think about cow's milk protein. What's important to note is that all of the foods that we eat, oftentimes because we're thinking like fat, carb, and protein, we're thinking that it's like one type. But in reality, all of these foods that we eat, they have multiple proteins that make up that food. And so in cow's milk, for example, we have beta lactic globulin and we have alfas and casein and we have black dialbumin and they're all of snazzy crazy words and names, titles to them.
But all to say that there's dozens, sometimes hundreds of different proteins that make up any one food that you might eat. A peanut has lots of different proteins that make it up. Now What's really fascinating is that then when you consume that food, like cow's milk, you're going to take all of those proteins and you're going to significantly break them down into smaller fragments of themselves. And the best way that I like describing this to listeners is like if you were to visualize the alphabet.
So oftentimes when we think about a protein that we're consuming, or any protein really, it's made up of amino acids. And oftentimes in the science world, as we get nerdy, amino acids for us, we like to label with just a letter, right, A, B, C, D, so on and so forth. So then picturing the alphabet in front of you is a really good way to think about like the whole entirety of a protein, A to Z. Now, if I were to consume that alphabet, and let's say that's data lactogoblin of cow’s milk protein, as we're like going down this kind of funnel, if you will. When we all consume that protein, we're going to break it down into smaller versions of itself and all of us are transferring the same fragment of that alphabet to the breast when we transfer.
So if you take 100 people and you give them all beta -lactoglobulin through cow's milk, about half of them will transfer at any given time and we all will transfer at some point. And when we do transfer, we all transfer, let's say, like the LMNOP of that entire alphabet. So most of the alphabet, we don't transfer. Most of the protein, we don't transfer, but we will transfer a small fragment of it. So in order for us to have a reaction for our kiddo, that means that when anybody has food reactivity of any sort, they are typically reacting to a fragment of a protein. So of the entire alphabet, they're reactive to A, B, C, D, E, or L, M, N, O, P, for example.
And so in order for us to have a reaction through the breast, the stars have to align. And the portion that we all transfer has to match the portion that your particular baby is reactive to. What that means then for us is that some of us are just really lucky and those things all align and we find that when when we consume the food and we transfer baby reacts because those two things are the same. Versus some parents can eat cheese all day every day and you and I can be like, "darn you" And then the first time that they give cheese to baby, there's a big reaction, it's a huge surprise, right? They're like, "I eat cheese constantly, what gives?" That's weird, I never had an issue, which is lovely and I'm really happy for you.
But that means that your baby was then reacted to a different portion of that alphabet, if you will, a different portion of that protein, the ABCDE, instead of the LMNOP that we all transfer. And so, then when we get down to like, thinking about that LMNOP, that now what we would call a peptide fragment or a protein fragment of what's left over after our gastrointestinal system is done with it, a couple of things that I think is really interesting and important to note is that one, we are supposed to only break them down to the fragments that they then transferred to the circulatory system.
So oftentimes in this space, parents are blamed. And they're told, like, this is your fault because you, I don't know, had too many happy meals when you were younger or you haven't drank enough kombucha or whatever it may be. We get blamed. And in reality, we are all supposed to keep certain fragments of the proteins that then transfer to our circulatory system 'cause they have biological functions in the circulatory system.
They're supposed to be there. And anything in the circulatory system can wind up in the breast. So this is a normal biological function and it allows us to expose our babies to the things that we're consuming. And we hear that in other spaces, right? We hear like, yeah, it's great to have a varied diet 'cause your baby's gonna be exposed to all have anoints, right? And the same thing is true for these protein fragments.
In fact, now we have more research that shows that it can actually reduce the likelihood of food allergies for some of the proteins. So it's a good thing. It's a good thing for most of us, until we have a baby with food reactivity, where that thing they're getting exposed to causes them reactions already, right? So then when we think about how long that protein is in the breast, which is the next part of that question. And for me, one of the most important parts of the questioning, because oftentimes in this case, there's a lot of confusion about when you consume something, how long is it going to be contained inside your breast. And the research shows, and it's well -established in the scientific literature, that proteins Follow the same pathway and timeline very similar to flavonoids and alcohol and most medications unless they're meant to stay in your body for a really long time.
All of those things peak really quickly within a couple of hours and then clear really quickly. The difference between proteins to like alcohol, for example, because alcohol is like more of a chemical compound. Alcohol, there's more cellular metabolism where you don't have to pump in order for the alcohol to leave your system. Whereas with proteins, there is some cellular metabolism that will remove the proteins without having to remove milk. The milk removal is the number one thing that's going to remove proteins from your breast because there's only so much the cellular metabolism can do to break that down.
So what's important to note then is that one, we all transfer in some way, shape, or perform to when we do transfer, it peaks within a couple of hours and the fastest that research has seen it in the breast is 15 minutes.
Wow. So it's really fast. So it peaks within a couple of hours, steadily decreases from there and is typically gone within an eight hour window if we're regularly removing breast milk.
Oh my God. And almost always within 24 hours.
Oh my God. My chin is like on the floor right now because you see all this information about you have to go on like a two -week elimination diet to clear everything out into…. oh my god that's wild.
And I was told that too and so for any parents that may be listening that are like you know feeling a little bang head here um against the nearest wall….. I was told that too when I was um you know eight years ago in the hospital with my daughter I was told you have to go to this hypoallergenic formula while you pump like a mad woman for the next two weeks and then you just hope that your baby goes back to the breast after two weeks of formula bottle feeding and it was a nightmare.
It was a total nightmare and then I had this freezer full of milk and many parents will will toss that milk and please for the love of everything don't do that….
Oh my god no that's heartbreaking.
It is heartbreaking. And then the other factor to this is that then parents are the amount of stress that puts on you that anything you put in your mouth could be in your breast for two weeks on end. What do you do when you accidentally get served something that has a slice of cheese on it, right? Or you accidentally get fed something, you get dairy-ed, as we like to say. And it's in it's an accident. You're like now. Now what do I do? Do I have to switch to formula for two weeks and my you know my hurting my baby for two weeks?
And so what's important to note is that it's not true and it is It actually quite frankly doesn't even now looking back make a whole lot of sense that something that we eat would be in our breasts for two weeks on end Right.
My breasts would just be entirely made up of Ben and Jerry's ice cream I think.
Same. So now looking back I'm like oh yeah that that doesn't even make sense things aren't in our system like that for so long but in the moment right in the moment you're just I'll do anything just… yeah you'll do anything I just want some sleep and I want my baby to feel okay yeah and so I think part of the confusion comes in that there's three different timings that we have to consider in this journey.
The first is our transfer, which is taking within a few hours, clearing typically within eight hours. And then the second is baby's reaction timing. So there's two different bodies and two different things happening. On baby's side of the journey, they're going to be exposed to that food and then they're going to either have an acute reaction, which just happens fast and heals test for a chronic reaction where it takes a little bit longer to happen and it takes a little bit longer to heal.
If your baby is bleeding, that's a wound in the gastrointestinal system and it's not just going to be, for some of us, many of us, it's not just going to be better the next day. So even though my daughter was, my oldest was switched to a formula for two weeks, she continued to bleed because there are literal wounds in the GI tract that have to heal. It's not because she was continued to be exposed to the food that was somehow lurking in my breast, it was that wound had to heal in her gastrointestinal system.
And that is, I think, part of the reason why there's confusion around timing, because for that chronic reaction, it's not that the cow's milk is still in your breast forever and ever, it's that baby should be healing day over day. And that's the third timing, the healing timing. And that's dependent on how severe the reaction was to start with and what type of reaction it was.
Okay, that is such helpful information to know. Thank you so much for explaining that so well. We are going to take a quick break and when we come back, I want to hear more about some other potential things that babies could be allergic to and how to tell the difference between an allergy and just an intolerance will be right back.
Okay, we are back with Dr. Trill and we were, before the break, just kind of talking about some of the things to look out for, symptoms. And you mentioned that for lots of babies, they're reactive to cow's milk protein. And that's how my first born was as well. He had terrible eczema and reflux. And I had to stop eating dairy for the whole year plus, that I breastfed him, and it was the biggest sacrifice of my entire life.
But I have a couple questions about that. So first is, can babies grow out of these things as they get older? And two, if it's not cow's milk, what are some of the other most common things that they might be reacting to?
Yeah, so those are fabulous questions. The first place that I will go to kind of tee this up and answer both is that what we know now and what we've discovered between my two children is that in 2017, there were new diagnostic codes that were set out for what's called non -IG -emediated food allergies. So when we think of a food allergy, Stereotypically, we think of little Timmy having a peanut, going into anaphylactic shock, needing an EpiPen, and needing to go to the hospital, right?
Because he's not able to breathe. And that is what would be called an IgE -mediated food allergy. Well, there's this other category now that has diagnostic codes, which are non IgE -mediated food allergies. And it's essentially all those symptoms we just got done talking about, each of them and some of them grouped together have now different categories. Everything from f -pies, allergic recticulitis, and more that fit under this non -Ig -emediated food allergy umbrella.
And so what's important to note there is that that means that almost all of the kiddos who have been told that or families that have been told that their kiddo has an intolerance, that's not actually what it is. And intolerance is when your body is unable to produce the right enzymes, when in reality, their baby has a non -Ig -emediated food allergy. And that's actually a good thing. I know it doesn't sound like a good thing because, again, when we think of an allergy, we think of awful things happening.
Instead, what's important is that with an intolerance per literature, intolerance is when your body doesn't make an enzyme that properly breaks something down. And once you have that, that's lifelong. Your body doesn't like start making the enzymes later on in life. Instead, our kiddos have non -ig-emediated food allergies, which are almost always outgrown.
Hallelujah. So the numbers change a little bit depending on which category you fall under, what types of symptoms you're experiencing. But when our kiddos have non -ig -emediated food allergies, which are any of those symptoms we talked about earlier, the mucousy stool, bloody stool, reflex vomiting, most of the rashes, that about half of them will outgrow it before they turn one, about, I want to say it's around 87 % by age three and 90s, high 90s by age five.
So the scary news that, you know, it sounds scary is that almost all of us have babies that have food allergies, the good news is that they're all also, almost always going to outgrow it. And the downside of a non -IGE mediated food allergy is that when you do an allergy test with your allergist, it's only looking for IGEs.
And so it's going to come back negative every time because that's not the pathway in which the body is responding. So you can go in, do a blood or skin test, it'll come back completely negative and then you'll be like, "Well, what gives? I know that my baby vomits when I have cow's milk because that's just not the pathway in which the body's responding.
Oh, wow. That's so good to know. And yeah, for us, luckily, my son seemed to grow out of it and now just loves cheese and yogurt and all that stuff. So there definitely is hope for parents out there. The second part of the question that I asked you was, if it's not cow's milk, what else could it be?
So I think most of the time parents hear about cow's milk, but there are some other sneaky things that we might not be looking for when we're looking at these types of reactions. So what are some of the other most common foods that you see causing reactions in babies?
Yeah, so by and large, like we mentioned, cow's milk protein is a really, really common trigger. From there, the next most common trigger is soy. So soy, about 50 % of kiddos who are reactive to cow's milk will be reactive to soy. And then the next two most common that kind of tie for third are egg and wheat. And then from there, that's where we kind of get into the weeds a little bit where when we think of a common allergen and oftentimes, you know, parents will reach out to me and say, I've removed all of the allergens. But the top allergens as we think about them are the foods that are most likely to cause IgE mediated allergic It's not the top foods that are most likely to cause non -IGE mediated responses.
And so, free to feed is really focused on the research behind like, okay, what are those triggers then? And what we find is that the top triggers are really dependent on symptoms, right? You're more likely to be reactive to egg if you have eczema. You're more likely to be reactive to oats and rice if you have vomiting.
Oh, okay.
And so we see foods that are, you know, not part of the "top list" for IGE mediated allergies, like oats, rice, legumes, beef, chicken, right? These foods that are, for many of us, families will come to me and say, "I've been living off of rice and chicken "and my baby keeps vomiting." And I have to be like, one, I'm so sorry, that sounds not fun. And two, let's talk about and really discuss the science behind why that diet is probably not working for you.
And that's even stuff that you can find online, like, yeah, I did this diet that I saw online and it's all rice and chicken. And so what's really important as kind of a closing on that is that we are in the throes of publishing a peer -reviewed journal article that dives into symptom -based triggers. So we polled over 550 lactating individuals who experienced food reactivity through the breast and we are partnered with Stanford University to publish the findings so that we can provide this this data, we actually utilize the database with our consults so that when you meet with any of our providers, we have this database, we can say, we can plug in, we're experiencing symptom A, B, and C, and then we get a top list of these are the foods most likely to cause those specific symptoms.
Oh, wow. That's going to be so helpful. Oh, my gosh. Because, yeah, I mean, just like we were talking about earlier, there are so many different symptoms, And there are so many different foods. So how do you kind of like parse out which food might go with which symptom? That's so cool, I love that. So, excuse me. So you just mentioned that lots of babies who are allergic to cow's milk protein are also allergic to soy. So are there other combinations of things that go together often or is that the main one?
That's the biggest one. There is a lot of other kind of cross -reactivity is what it's most often called and what happens in cross -reactivity and this is what's happening in soy and cow's milk especially is that that that alphabet that we talked about earlier that LMNO P portion that we transfer is almost exactly the same between these two foods. And so even though like our body sees it very differently like our body sees cow's milk and soy very differently.
But when we break it down to just that little portion of the fragments of proteins, instead what we transfer to the breast almost looks identical. And so the little baby's immune system is unable to differentiate between them. And that's really what's happening in general is that our baby's immune system is responding in this way because they have not gotten to the point where the immune system can differentiate, like, oh, this is a benign food. it's not actually a threat to me and instead, it treats it just like it would treat a virus or bacteria or parasite in response accordingly. This is a threat. I need to freak out about it.
And eventually, the immune system develops enough to the point where for a non -IG -muted food allergies, the body realizes, "Oh, actually, that's not a threat. That's a peanut. I'm fine. We're good." Um, so some of the others that have that kind of comorbidity with cross -reactivity issues are several like the tree nuts. There's four categories that tree nuts fall under and so certain ones have really high cross -reactivity to each other. Two that probably people can like visualize and imagine would be like pecans and walnuts, right? Those two are very, very similar in structure.
And then ones that are that seemingly shouldn't be like cross -reactive like avocado and banana.So avocado and banana are both really high trigger foods for vomiting responses and those two foods have very similar specific portions of them that are almost identical to the rubber tree that we make latex out of. And so they're considered a high latex reactivity food just because there's a fragment of that and that looks almost identical to another protein.
That's so fascinating. And so I would imagine that there are similar proteins, although I have no idea what I'm talking about. There's got to be proteins in formula as well, right? So we've been talking mostly about breast milk and the transfer to breast milk. But what about a baby who's formula fed right from the beginning just for whatever reason? Would they be looking for the same types of symptoms, how do you go about elimination when you're dealing with formula? What do parents who are formula feeding need to know?
Yeah, absolutely. And I think it's important to note, too, that at Free2Feed, we help parents who are utilizing all feeding modalities. So, breastfeeding, formula feeding, pumping, solids, you name it, and every combination of it. We're in the thick of all of that. So, When we're thinking about formula, yes, it's ingredients, right? They're food ingredients. They typically contain cow's milk protein. They may have goats. They may be made out of corn or soy or others. And there's typically a really big list of ingredients that are on the side of a can of formula.
And so what is most important as we think about formula and formula feeding with food reactivity is that one, yes, the symptoms are the same. The difference is the timing may be a little bit different because you're not waiting for that transfer to the breast. So as we were talking about earlier with the three timings, the transfer, the peak reaction and the healing, instead now you just have the peak reaction and the healing, right? The baby's getting it directly.
And so the other piece then is while the symptoms can be exactly the same, they may also be a little bit more severe because your body is not breaking that protein down first. So if you think about cow's milk and you consuming the cow's milk and then going through your gastrointestinal system and you're only transferring that LMNOP, in the case of formula, if the formula is not broken down, which we'll get into that in just a second, if the formula is not broken down, they're getting the whole alphabet, right?
They're getting the protein in its whole entirety. And So you may see a smaller reaction through the breast than what you would see directly, and that's the same for solids too. If they get that food in its whole form, then you're more likely to see a bigger response. Now, there are kind of three levels, and this is getting more nuanced now with formula manufacturing, but there's two basic levels of formula and how they break the proteins down for your baby to increase the likelihood that they're gonna be able to consume it and that their immune system's not gonna see it and say, oh, you're a threat, I'm gonna react to you.
So the first level is just like your base level, that the whole alphabet is what your baby's getting of cow smoke or whatever ingredients are in that formula. The next level is gonna be your hydrolyzed and this can be broken up into two, there's partially hydrolyzed and extensively hydrolyzed formula. And that's essentially, if you think back to the alphabet, imagine you're cutting it into like five parts, right? So it's being cleaved between the M and N and the P and that the, you know, Z at a few different places in the alphabet.
So now it's like these five different fragments of itself. And then if your baby has reactivity to that protein, essentially, you're, you're hoping that the portion that has been cut or cleaved, and the And the schnazzy word for those who want to get extra nerdy is denaturing. So if you slice this alphabet up into smaller fragments, you're hoping that that slice happened right where your baby's reactive. So it cuts it like in half, for example, and then the immune system doesn't see it anymore because it's not connected any longer.
So if you think about that baby that's reactive to LMNOP, if we cut it right at the middle of that little section, their immune system no longer sees it and thinks it's a threat. So the more you clean it, the more likely you are to hit that part for your baby. So that's why in many cases, for parents who have kiddos who have a little bit more mild symptoms, they'll be told to kind of start with the partially hydrolyzed and then eventually get to the extensively hydrolyzed and eventually go to the third tier, if you will, because the more hydrolyzed you get, the more you break the protein down, the more expensive the protein, the formula becomes.
Now the third tier of that, so the first being kind of a base, the second being hydrolyzed, the third is elemental or amino acid -based formulas. And that's where, if we think about the alphabet again, it's individual. It's A by itself, B by itself, C by itself. Every single amino acid is all by itself. And so that means that it's highly likely to be a pass because we're breaking those proteins down all the way down to individual amino acids.
Now, the caveat to that is that the thing that we're breaking down is the main source of the protein. So if that's corn or if that's soy or if that's cow's milk, we're breaking that particular protein down. That doesn't mean that the rest of the ingredients are broken all the way down to their individual amino acid forms. So if your baby is reactive to soy, for example, and that formula contains soy oil, and their FDA has shown that some soy oils do contain proteins, that can elicit allergic response, you may still have a reaction to a hydrolyzed, extensively amino acid based formula and many parents will be told like nope, you know It's not possible if you can't react to amino acid formulas because they're all the way broken down and that's true for the You know standard based protein that it contains.
It's not true for the rest of the ingredients so the more broken down you get the more likely you're to cleave that area where your baby is seeing the protein and race bonding. And then of course, the other piece is, you know, timing for that is, when should I switch to a different formula? What formula is the best next to navigate? How do I try all those formulas? Those are all things that we work with families with one on one.
And also, you know, what if I'm doing both? How do I navigate an elimination Yeah, on top of a formula. So that's those are like the nuance cases that we help with.
Yeah, I could imagine that the parents would need a lot of guidance figuring all that out because it makes my head spin just to think about it. We're going to take one more quick break. And when we get back, I have a question for you about toddlers and bigger kids. We'll be right back.
Okay, so Dr. Trill before we wrap up I have a question about toddlers because I know many parents that are listening have little babies But also a lot of parents who listen have toddlers and maybe they didn't even realize that this was going on with their baby… But now they're thinking back and they're like, oh my god. Maybe that's what it was. So are there symptoms that are different with older babies or toddlers or children, or is it pretty much all the same?
I know you mentioned many kids do grow out of it, which is so wonderful, but some kids don't. So what would be the things that you'd be looking for in a toddler or an older kid?
Yeah, I think the first thing that I would mention here is that it's important to know that these food reactions can start at any time. So it's very, very possible, and that can be so confusing. It's most often that we see the first symptom around month three and four. And so that means that like, you're trekking along eating cheese every day.
And then all of a sudden, three months old, you see the first bloody stool. And you're like, I haven't done anything new. I haven't done anything different. And that's because the immune system is continuously developing. And so you may get several months into your feeding journey before you see that first response. Some of us are extra lucky and see it on day one, but you also technically, you can start having food reactivity at any age, right?
You can be 99 and start all of a sudden reacting to strawberries and be like, "What gives?" So that's important to note because that can be confusing for parents. And for those who have older kiddos, it's absolutely possible for like your first reaction to happen later. It's also possible that you've been and having reactions up to this point you may not have noticed, right? Like you kind of mentioned for those of us with older kiddos. And so freedom feed works with kiddos who are five and under.
So in all of those feeding modalities and the reactions are essentially the same. The thing that changes is sometimes the severity. So as the baby's outgrowing, you all start to see the severity go down. So maybe we trial back cow's milk for example and last time we saw a really big bloody stool but this time six months later we see like some mucousy stool but it's not nearly as bad as it was.
That's really common as the immune system slowly outgrowing this. You may also get to a point where you trial back and it's just completely gone which is also fabulous and can also happen you may not see the progression because the progression happened while you weren't consuming it. The other thing that you may see is the confusion around like other milestones, right, as it relates to food reactivity. And so what I mean by that is, let's say you're at a certain milestone with your kiddo that impacts your sleep, and you trial back a food, and you're like, is this just, you know, where we are right now with our sleep progression.
Yeah. Or is this food, right? And so navigating that can be a struggle as you get into older kiddos too. Or for many of us, the kiddo has started solids, and they may be eating all kinds of fun things. And all of those things can really impact the consistency of stool. And so you may, you know, maybe maybe a toddler now, living off of bananas because toddlers do what they want. Do not care about our agendas. And you're like, wow, this is this diaper is like really extra mushy. I can't tell. Is it just because we're living off of bananas right at this moment? Or because we're having reactions again.
And so that like solids kind of middle ground can be hard to which is where we've retired on creating really good resources for parents to like see examples, right? Because again, it would be weird if you knew what like a mushy banana poop looked like. So we're here for you.
I love that. Well, thank you so much for all of this information. It's going to be so helpful for so many parents I know. And I hope it reaches people early enough so that they don't have to go through two week elimination diets of cheese for no reason.
But one thing I want to ask where we close is because I asked this of all parents and thank you so much for sharing your personal story with us at the beginning of the episode too. Is there something that you wish you knew before becoming a parent and it could be related to this or something totally different, but is there something that like you just felt completely unprepared for that no one told you about before you became a mom?
I wish that someone had really set me down, maybe even myself like my future self or anybody else had set me down and explain to me how much I would know before I realized it. Like how well my instincts would be that, like, you know. And especially before my first kiddo was born, you know, and when she was screaming and I was like, this just doesn't feel right. Like it just in my gut, like it feels like something is very wrong and no one's paying attention to me.
So having that like a little bit of extra grace for myself and having a little bit of extra faith in my knowledge and my skills as just a brand new parent would have really helped me be able to feel like I could advocate better for her earlier and faster and on things that you know that I was told or not told and that's the thing that that's the gift I would give myself as a as a new parent to say like listen to your instincts… they're not wrong and even if they even if you they don't tell you exactly what's wrong or even if you don't have all the answers if your instincts are telling you to keep pushing you should keep pushing.
Yeah, that's so huge. And I think that's something that parents are scared to do. And that actually leads me to one more question that I wasn't planning on asking. But since you brought it up, I think it's such an important point. Like, what do you do if you're just being brushed off about this with your doctor? Who do you go to next? What, how do you advocate for your baby?
Yeah, yeah, I want to first mention that, you But having additional avenues to push is something that comes with a lot of privilege. The very first instinctual thing to say is to go find another provider. But there also is a lot of privilege involved in being in a place geographically, financially, and otherwise, where you can even go find another provider. So if that is accessible to you, finding another provider.
If you're talking to someone who doesn't respect you as a parent, as a person, as a human, if you're talking to someone who is unwilling or unable to have conversations with you like an adult, then finding another provider if you can is my top recommendation. And then from there, I would say that there are so many more free resources than I realized getting started.
And so, you know, going to social media, finding other parents who have navigated similar situations that you are going through, many of these spaces have very, very beautiful, tight communities, right? 'Cause we've been through some ish, right? And we've got, We've got bags under our eyes that are now permanent, if you will, all the way to these horror stories at the hospital. And those who have already lived it are almost always willing to say, this is a place that I went, that I saw results, or that I got really amazing help. Go follow this person. Go DM that person.
And you'd be surprised, the willingness in these communities, the parent communities, to help each other. Yeah, that's a really good point. And you, your page is such an amazing resource. So can you share for us where people can find you and all of your incredible resources? Yeah, so free to feed .com is the place where you can find our consults, our education, we have courses and more.
Also, our blog is completely free and it has a ton of helpful information and there's a search bar there so you can literally go to the search bar and you're like I want to learn about wheat and gluten because I don't get it. Type in wheat into the search bar and that's going to come up and you can deep dive into it. And all of our resources have peer reviewed publications that are referenced so that you can go to there too. We're very nerdy here. I'm a PhD, that's the lifeblood of the company.
And then on the social channels, we're most active over on Instagram and that is me. It's free to free .to .feed and my DMs are always open. I'm willing to look at diaper pictures. I'm happy to help any way that I can let you know if I think that, you know, a console is probably best for you. And our number one resource that we have is our that's free to feed dot com slash diaper. It has dozens of stool example pictures and a deep dive into the latest research and science behind what is normal mucus in stool? When should I be concerned?
You know, what does, you know, bell pepper look like on the back end of baby? And is it an issue? So those are those are the main resources that we provide in addition to our app that is free in the app stores for tracking parental and infant both intake and symptoms.
Perfect. Oh my gosh, so many helpful things for parents and you have generously given our listeners a code for 20 % off of any of your resources and the code is Sleepy Baby and I will put all of that information and all of those links and stuff in the show notes so that it's really accessible for people.
Dr. Trill, thank you so much for joining us. You are such a wealth of information and I really appreciate what you're doing for parents. Thank you so much for having me.
