Carob Bean Gum Reduces Reflux, Regurgitation in Infants
Infants with recurrent reflux and regurgitation improve when fed a formula thickened with carob bean gum, according to a new study in Pediatrics (2003;111:E355–E359).
Reflux and regurgitation are common occurrences in infants. In gastroesophageal reflux (GER), a portion of food that has entered the stomach moves up into the esophagus before proceeding to the small intestine. Regurgitation, sometimes called spitting up, occurs when this portion of food reaches the top of the esophagus, and is expelled by mouth.
Although some reflux and regurgitation are normal in infants and usually resolves by the age of 6 to 12 months, the esophagus can become inflamed and damaged from frequent exposure to overly acidic stomach contents, potentially leading to scarring and thickening. Recurrent regurgitation can affect nutritional status and result in poor growth. Chronic regurgitation and GER can also affect the airways and breathing. Treatment options are limited, as changes in feeding and post-feeding positions have not been found to be consistently helpful, nor have medications demonstrated consistent benefits. Several studies suggest that allergies to cows’ milk may play a role in a significant number of cases of recurrent GER and regurgitation in infants. In one study, the use of a hydrolyzed cows’ milk formula, in which proteins that might trigger allergy are broken down, was beneficial. Surgical interventions are a last resort.
Thickened formulas are believed to be helpful to infants with recurrent GER and regurgitation, although previous studies have been inconclusive, and some have suggested that fibers used to thicken infant formulas can decrease the availability of minerals such as calcium and iron. Rice cereal and carob bean gum, a fiber extracted from the carob bean, are both used to thicken infant formulas. Rice cereal is partially broken down by saliva, but carob bean gum maintains its thickening ability even in the stomach and one study found it to be somewhat more effective than rice cereal.
Fourteen healthy infants with recurrent regurgitation participated in the current study. Each infant received two formulas alternately over six feeding periods. One of the two formulas was thickened with 0.4% carob bean gum, but they were otherwise identical. GER and regurgitation were evaluated by monitoring acidity and direction of movement of food at various levels in the esophagus. GER and regurgitation were both significantly reduced following feedings with thickened formula compared with regular formula. Of all of the episodes of GER, 45% occurred following feedings with the thickened formula and 55% followed regular formula feedings. Furthermore, reflux of thickened formula reached significantly lower heights in the esophagus than reflux of regular formula, resulting in fewer and smaller episodes of regurgitation.
The results of this study show that the use of infant formula thickened with carob bean gum effectively reduces frequency and severity of reflux and regurgitation in healthy infants with recurrent regurgitation. Due to concerns about mineral availability in thickened formulas, future studies need to examine the nutritional status of infants using such formulas.
Maureen Williams, ND, received her bachelor’s degree from the University of Pennsylvania and her Doctorate of Naturopathic Medicine from Bastyr University in Seattle, WA. She has a private practice in Quechee, Vermont, and does extensive work with traditional herbal medicine in Guatemala and Honduras. Dr. Williams is a regular contributor to Healthnotes Newswire.
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