How to Know if Baby Is Digesting Milk

Several readers have emailed me to ask about babies' ability to digest starch. Hither's one:

"I have noticed you recommending cereals for babies several times.  I am sure that y'all are aware that many people expect at feeding a baby grains before the age of one or even two equally if yous have offered your child strychnine. One of the reasons cited is that they supposedly do not have amylase to assimilate grains earlier that time. I have oft wondered what exactly is happening to the cereal if it is not being digested, but the only statement I could detect is something almost information technology "rotting" in the gut.

I would love to get data from a scientific point of view on this topic.  Everything I accept been able to discover thus far has been very biased towards one point of view or another. Either "cereal is the perfect beginning food. Easy to assimilate and enriched with iron" from the baby cereal companies or "Cereal is junk.  No infant should e'er swallow grains. It is not natural or traditional and they tin't digest it" from online parenting sites.

I need a piffling clarity and common sense."

~Hope

I love the skepticism in Hope's email, and I can as well understand with her frustration virtually how difficult it is to observe good information about a seemingly elementary question: Tin babies digest starch? If you lot search for the respond to this question online, y'all will run into dire warnings of the dangers of giving starch to babies. Just these sites might prepare off your woo detector – as they should. So, after receiving multiple emails well-nigh this question also as seeing it mentioned in discussions on the Science of Mom Facebook page, I figured it was time to put some show-based information about babies and starch digestion on the Internet.

Researching this question has given me an excuse to read some classic nutrition physiology papers harkening back to the 1960's and 1970'south, and it's brought dorsum memories of years in the lab, exploring food digestion and metabolism. And starch digestion in infancy, information technology turns out, is a really neat story.

Let's showtime with some nuts near saccharide digestion.

What is starch? How is it digested?

Starch is a blazon of complex carbohydrate. Made from lots of glucose molecules bonded together in long, branching bondage, it is a establish's way of storing glucose – production of photosynthesis and source of energy – in a stable form. Nosotros discover starch in grains, root vegetables, winter squashes, beans, and some fruits, like bananas. Starch is an of import storage depot for the plant, and it also makes for tasty staple foods for cultures around the world.

A chain of 3 glucose molecules, like a tiny section of starch.

Glucose is the major fuel for the cells of the body. When nosotros consume starch, nosotros have to suspension the bonds in those chains of glucose molecules, liberating them to be captivated from the small-scale intestine into our blood. Starch digestion begins in the mouth, where salivary amylase starts chopping upward those big glucose chains. When this partially digested starch gets to the minor intestine, amylase made and secreted by the pancreas jumps in to exercise more than bond-breaking and is responsible for most of starch digestion in adults. A suite of enzymes produced by the cells lining the small intestine, including sucrase, isomaltase, maltase, and glucoamylase, work on the remaining brusk chains, finishing up the job and making glucose available for assimilation.

Starch Digestion in Infants

Infants get through some incredible nutritional transitions in the beginning months of life. Prior to nativity, their growth and development is fueled almost entirely by glucose from mom, absorbed across the placenta. After birth, they take to abruptly transition to an exclusive milk diet, which is high in fat and lactose, nonetheless a relatively uncomplicated saccharide. As they start solid foods, babies have to adapt to a much more circuitous and varied diet. Around the world, starch is a major source of free energy in the diets of children and adults alike. But when infants are first introduced to starchy foods – often in the class of cereals and porridges – starch is a novel nutrient to their digestive tract. They need to plow it into glucose, but are they equipped to practice this?

It's true that infants have low levels of pancreatic amylase, the workhorse of starch digestion in adults. Research in the 1960's and 1970's showed that pancreatic amylase activity, measured in samples of fluid from the pocket-size intestine, is almost non-existent in newborns.^1,2 Activity starts to increase within the first six months, however, and continues ramping up throughout childhood.¹ By four to six months, when many babies are introduced to starch in the form of cereals, there is some pancreatic amylase activity, but still much less than that found in older children and adults.

Looking at these results, scientists questioned whether babies could handle starch very well. Just they didn't throw upwards their easily and declare, "No starch for babies!" They kept asking questions and seeking answers. They must have been puzzled past the fact that babies appeared to digest starch just fine. For case, think of the experience of those who are deficient in another carbohydrate-digesting enzyme, lactase, which allows u.s. to digest lactose, the carbohydrate in milk. What happens if they drink a glass of milk? They have obvious, uncomfortable symptoms of diarrhea, nausea, cramping, bloating, and gas. These symptoms weren't credible in young babies eating infant cereals, which in the U.S. in the 1970's, were unremarkably introduced to babies past 1-2 months of age.³ My mother-in-law recorded my hubby'southward first teaspoon of doctor-recommended rice cereal in his baby volume at four weeks, yet her careful records didn't include whatever concerns about a sudden onset of diarrhea.

Baby volume, ca. 1975

And this approach to infant feeding wasn't that unique to the U.Due south. Ethnographic reports are filled with examples of starchy first foods ^four for young infants around the earth: Millet flour at 3 months in Tanzania; corn porridge at 3 months in Republic of zimbabwe; beans and rice at 4 months in Brazil; a little butter and flour at 3 days in Bhutan; rice mash at iii weeks in Nepal; and prechewed taro root at 2 weeks in the Solomon Islands. If babies were eating starch this immature, with no credible clinical signs of malabsorption, there must be more to the story.

The studies of pancreatic amylase activeness had only measured its activeness in a exam tube in the lab. Side by side, researchers took a more than holistic approach and measured starch digestion in the babies themselves. A 1975 Italian study ⁵ added starch from dissimilar sources (potato, tapioca, corn, wheat, and rice) to i-three-month-old babies' formulas and so checked to see what came out at the other end –- in the babies' poop. It turned out that very picayune starch ended up in these babies' diapers. When they were given between 1 tablespoon and ½ of a cup of starch per twenty-four hour period, they appeared to digest more than 99% of information technology. The researchers then tried a larger dose, giving several 1-month-olds a total cup of rice starch. Three of these infants absorbed more than 99% of this corporeality. 2 captivated just 96%, the other 4% ending up in their diapers, along with some diarrhea. In other words, within the kickoff few months of life, babies can assimilate small amounts of starch merely fine, but give them too much and you'll see some diarrhea. (And no, I'm not suggesting that nosotros feed 1-month-olds cereal – this was just the research at the time.)

How is this digestion of starch possible if babies accept so trivial pancreatic amylase at piece of work?

There are probably several mechanisms at play:

1. Babies brand lots of salivary amylase. Although newborns secrete little salivary amylase, production increases quickly ^half-dozen in the start few months after nascency [PDF],⁷ reaching well-nigh adult levels past 6 months of historic period. Salivary amylase appears to survive ^eight the acidic weather of the stomach reasonably well and is protected by both the presence of starch and breast milk.⁹ Once it is dumped into the pocket-size intestine, where pH is more neutral, information technology resumes its work of breaking down starch.

ii. Human chest milk has lots of amylase, 25x that establish in raw moo-cow's milk.^ten Interestingly, it is highest in colostrum,¹¹ and decreases slowly during infancy, every bit salivary and pancreatic amylases are increasing. Like salivary amylase, breast milk amylase retains at least 50% of its activity ¹² fifty-fifty after several hours of exposure to the low pH of an infant'due south tum, passing into the small intestine ready to get to work.^xiii Information technology also seems to be protected by proteins in chest milk. One researcher estimated that the amylase in 100 ml of breast milk was capable of digesting 20 grams of starch (equivalent to ii/3 cup of dry rice cereal) in one 60 minutes.¹⁴ This is i proficient reason to apply breast milk to make up cereals for young babies, and studies show that amylase is stable in breast milk for hours even after repeated freezing and thawing.^eleven

iii. Glucoamylase helps out in the small intestine . Glucoamylase is an enzyme made by the cells lining the walls of the small intestine. Like amylase, it breaks the bonds between glucose molecules in starch and shorter glucose chains. Just dissimilar pancreatic amylase, glucoamylase is very active in infants, reaching adult levels as early as 1 month of historic period.^15,16

All of these sources of starch-digesting enzymes – salivary and breast milk amylase, as well as glucoamylase in the small intestine – appear to work together to aid babies digest starch to glucose. Only that isn't the cease of the story.

Studies have shown that a meaning fraction of dietary starch isn't digested in the small intestine of babies but passes on to the large intestine.^17,18 Is this where information technology "rots" in the gut, every bit the alarmist blog posts claim? Not and then fast. Leaner in the colon ferment (quite a different process from rotting) these undigested carbohydrates as part of the good for you symbiotic relationship betwixt our gut microbes and u.s. humans. Information technology happens in adults, too. Even with their full activeness of pancreatic amylase, some starch escapes digestion in the small-scale intestine, as does dietary fiber.¹⁹

These undigested foods help feed the microbes, who kindly do good us in lots of means. The end products of microbial fermentation in the colon are short chain fatty acids, which can improve nutrient assimilation, enhance gut health, and even be used equally a source of free energy for both the microbes and the human host.^xx Babies and toddlers may actually take faster colonic fermentation of starch than adults, which might stand for an important pathway for them to fully capture the nutrients in their food.²¹ The improver of complex carbohydrates, including starch and cobweb, to the diet of older babies and toddlers might help to develop those healthy microbes.²²

OK, so maybe babies can handle starch but fine. But is in that location any damage in waiting a year or two to introduce it, only in case?

I can think of a few reasons why we should exist careful nigh limiting starch in a baby'due south diet:

ane. Waiting as well long to innovate grains to your baby could finish up increasing the risk of developing celiac disease, Type ane diabetes, and wheat allergy.^23–25 There seems to be a sweet spot kind of window in mid-infancy – probably between well-nigh 5 and seven months, where introduction to a variety of foods, including grains, decreases babe's risk of developing chronic affliction and allergies later in life.

2. Eliminating starch can brand information technology more than difficult for babies to go the nutrients they need. Infant cereals are fortified with iron, one of the nutrients most likely to be limiting to infants, even in the developed earth. They are stable for long-term storage, and information technology's convenient to mix up only a tablespoon of cereal at a fourth dimension. You can certainly meet the nutrient needs of babies without cereals, but information technology takes more work and experimentation. When Cee was a baby, she was not at all interested in eating fortified baby cereals, and I institute other sources of iron for her. But if your babe likes cereals, I wouldn't hesitate to include them equally one of a variety of foods in his nutrition. Also, this concern about starch digestion and amylase tends to be focused on avoiding grains, just remember that legumes and many fruits and vegetables as well have lots of starch. If you truly tried to avoid starch, you would really be limiting your infant'southward opportunities to gain nutrients and experience with different tastes and textures.

iii. There may be negative consequences to being anxious and restrictive about food with young children. Nosotros seem to have an ongoing obsession with restrictive diets. It used to be all about restricting fat, and so all carbohydrates, and at present grains are getting a bad rap. I don't think this is good for you. Barring allergies or intolerances, eating a variety of foods from all the nutrient groups pretty much ensures that you lot'll see your nutrient requirements without even trying. It allows you to relax and enjoy your food with the people you love, which is really what eating should be about. When yous first eliminating food groups, y'all increase your risk of nutrient deficiencies, increase anxiety about nutrient, and arrive more hard to share nutrient. It's 1 thing to make this choice as adults, but in my opinion, to impose it unnecessarily on our kids isn't fair. When a two-year-old isn't allowed to take a cupcake at a birthday party, he might feel different and deprived, and he'southward lost a chance to practice eating treats in moderation. Parents of kids with nutrient allergies have to piece of work carefully to manage these situations, but for the rest of us, this kind of brake is unnecessary.

The bottom line is that it is safe to feed babies starchy foods. They tin digest them, and they are one part of a varied, balanced diet for babies that are ready to begin eating solid foods. I'll exist writing more about the transition to solid foods in the next few weeks.

Want to know more than about feeding babies cereals? Check out this more recent post on the blog: The Whole Truth About Infant Cereals: seven Science-Based Tips

What data did you lot go virtually introducing grains and other starchy foods to your baby? What did you really do?

References:

1. Hadorn, B. et al. Quantitative assessment of exocrine pancreatic part in infants and children. J. Pediatr. 73, 39–l (1968).
2. Zoppi, One thousand., Andreotti, G., Pajno-Ferrara, F., Njai, D. K. & Gaburro, D. Exocrine Pancreas Office in Premature and Full Term Neonates. Pediatr. Res. half-dozen, 880–886 (1972).
3. Fomon, Due south. J. Infant Feeding in the 20th Century: Formula and Beikost. J. Nutr. 131, 409S–420S (2001).
4. Pelto, Yard. H., Levitt, E. & Thairu, L. Improving feeding practices: current patterns, common constraints, and the design of interventions. Food Nutr. Bull. 24, 45–82 (2003).
5. De Vizia, B., Ciccimarra, F., De Cicco, Due north. & Auricchio, Due south. Digestibility of starches in infants and children. J. Pediatr. 86, l–55 (1975).
6. Rossiter, M. A., Barrowman, J. A., Dand, A. & Wharton, B. A. Amylase Content of Mixed Saliva in Children. Acta Pædiatrica 63, 389–392 (1974).
7. Sevenhuysen, G. P., Holodinsky, C. & Dawes, C. Development of salivary alpha-amylase in infants from birth to five months. Am. J. Clin. Nutr. 39, 584–588 (1984).
8. Murray, R. D. et al. The Contribution of Salivary Amylase to Glucose Polymer Hydrolysis in Premature Infants. Pediatr. Res. xx, 186–191 (1986).
9. Rosenblum, J. L., Irwin, C. L. & Alpers, D. H. Starch and glucose oligosaccharides protect salivary-type amylase activity at acid pH. Am. J. Physiol. 254, G775–780 (1988).
10. Shahani, Grand. One thousand., Kwan, A. J. & Friend, B. A. Role and significance of enzymes in human milk. Am. J. Clin. Nutr. 33, 1861–1868 (1980).
11. Jones, J. B., Mehta, N. R. & Hamosh, M. Alpha-Amylase in Preterm Human Milk. J. Pediatr. Gastroenterol. Nutr. 1, 43–48 (1982).
12. Heitlinger, Fifty. A., Lee, P. C., Dillon, West. P. & Lebenthal, E. Mammary Amylase: a Possible Alternate Pathway of Carbohydrate Digestion in Infancy. Pediatr. Res. 17, 15–18 (1983).
13. Lindberg, T. & Skude, G. Amylase in human milk. Pediatrics 70, 235–238 (1982).
14. Hegardt, P., Lindberg, T., Börjesson, J. & Skude, 1000. Amylase in human milk from mothers of preterm and term infants. J. Pediatr. Gastroenterol. Nutr. iii, 563–566 (1984).
15. Lee, P. C., Werlin, S., Trost, B. & Struve, G. Glucoamylase activity in infants and children: normal values and relationship to symptoms and histological findings. J. Pediatr. Gastroenterol. Nutr. 39, 161–165 (2004).
16. Lebenthal, Due east. & Lee, P. C. Glucoamylase and disaccharidase activities in normal subjects and in patients with mucosal injury of the minor intestine. J. Pediatr. 97, 389–393 (1980).
17. Shulman, R. J., Wong, W. Due west., Irving, C. S., Nichols, B. Fifty. & Klein, P. D. Utilization of dietary cereal past young infants. J. Pediatr. 103, 23–28 (1983).
18. Christian, M. T. et al. Modeling 13C Jiff Curves to Determine Site and Extent of Starch Digestion and Fermentation in Infants. J. Pediatr. Gastroenterol. 34, 158–164 (2002).
19. Stephen, A. et al. The role and requirements of digestible dietary carbohydrates in infants and toddlers. Eur. J. Clin. Nutr. 66, 765–779 (2012).
20. Wong, J. Thousand. Due west., de Souza, R., Kendall, C. W., Emam, A. & Jenkins, D. J. Colonic health: fermentation and brusque chain fatty acids. J. Clin. Gastroenterol. xl, 235–243 (2006).
21. Christian, K. T. et al. Starch fermentation by faecal bacteria of infants, toddlers and adults: importance for energy save. Eur. J. Clin. Nutr. 57, 1486–1491 (2003).
22. Scheiwiller, J., Arrigoni, Eastward., Brouns, F. & Amadò, R. Human faecal microbiota develops the ability to degrade type iii resistant starch during weaning. J. Pediatr. Gastroenterol. Nutr. 43, 584–591 (2006).
23. Norris, J. K. et al. Run a risk of celiac disease autoimmunity and timing of gluten introduction in the diet of infants at increased hazard of disease. J. Am. Med. Assoc. 293, 2343–2351 (2005).
24. Norris, J. M. et al. Timing of initial cereal exposure in infancy and risk of islet autoimmunity. J. Am. Med. Assoc. 290, 1713–1720 (2003).
25. Poole, J. A. et al. Timing of Initial Exposure to Cereal Grains and the Risk of Wheat Allergy. Pediatrics 117, 2175–2182 (2006).

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Source: https://scienceofmom.com/2013/11/08/amylase-in-infancy-can-babies-digest-starch/

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