The liver and gut health are intricately related. Many food borne infections pass from gut to liver. If the normal flora of gut is disturbed, then harmful bacteria grow and affect liver through direct infection or released toxins. Unbalanced diet and infections play a major in causing liver injury in kids. Hepatitis viruses A, B, C, D and E can cause acute and chronic infection of the liver and millions suffer worldwide annually.

 

 

 

The liver and gut have bilateral flow of substances through three tracts namely biliary tract, portal vein and the systemic circulation. The substances that pass from liver to gut are bile acids, Immunoglobulin A, antimicrobial molecules. The substances that pass from gut to liver are dietary products. Since alcohol also passes from gut to liver and is harmful, it is strictly avoided in children even in small quantities.

Diarrhea is too frequent, often too precipitate passage of poorly formed stools. It is a major cause of morbidity and mortality worldwide. More than 5 million children under the age of 5 years die every year due to diarrhea. The common causes of intestinal infection are virus (rotavirus, etc), bacteria (Typhoid, E. Coli etc), parasites (threadworm). Non-infectious causes of diarhea include antibiotic use, indigestion of milk, wheat, milk protein allergy, stress.

The possible mechanisms behind diarhea could be:

·       Osmotic Load within the intestine resulting in retention of water within the lumen e.g, malabsorption

·       Excessive secretion of electrolytes and water into the intestinal lumen e.g, ETEC, Cholera

·       Exudation of the fluid and protein from the intestinal mucosa e.g, Ulcerative colitis

·       Altered intestinal motility resulting in rapid transit through the colon e.g, IBS, DM

Basic investigations usually done to find cause and severity of diarheas are:

·       Na and K

·       Urea and creatinine

·       pH/ Bicarbonate

·       Urinalysis

Specific investigations include:

·       Stool microscopy and culture

·       Serodiagnosis

·       Abdominal imaging

·       Endoscopy

·       Histology

Most of these infections can be simply prevented by drinking cleaner water and eating nicely cooked foods especially while travelling. Antibiotics are needed only if stools contain blood or there is proven typhoid or Clostridium difficile infection. Antibiotics have no role in other mild bacterial infections, viral infections and non-infectious diarheas. Medicines must be administered to children after thoroughly considering its benefits against risks. Gut of children does not tolerate medicines well. The medicines get absorbed into the liver and cause damage to it.

Fluids like Oral Rehydration Solution etc must be administered to children after every motion and vomiting. Fluids easily available at home and can be administered during diarheas include:

Accepted drinks	Non accepted drinks
Plain water	Coffee
Coconut water	Aerated drinks
Plain buttermilk	Lassi with sugar
Milk in moderation	Fruit juice with sugar
Thin daal
Fruit juice without sugar
Lassi without sugar

 

Children are born with natural immunity. Their immunity increases with breastfeeding and decreases with use of antibiotic and some other medicines. Once the gut immunity is lost, probiotics and medicines cannot restore it completely. In fact effect of probiotics has been found to be temporary.

Breastfeeding is important because it:

·       helps child to develop good oral motor skills, facial muscles and teeth alignment

·       helps child's overall growth and development

·       helps build the immunity of the baby

·       strengthens the bond between mother and baby

·       is comforting for your child and is relaxing for mom

·       helps child build sense of trust and security

·       is always ready at the right time and temperature and is environmentally friendly, convenient and free

Breastfeeding is the best nutrition for a newborn. It has easy-to-digest proteins and natural immunoglobulins that help build child’s immunity.  It nourishes the baby adequately and protects them against disease and infection. Colostrum, the milk that is produced at birth, is not only dense in nutrients, but is rich in natural antibodies that protect babies from bacteria and viruses that cause infection.

Studies also show that breastfeeding promotes health long after childhood - adults who were breastfed as babies often have lower blood pressure and lower cholesterol, and are less likely to be overweight and develop type-2 diabetes. Breastfed children are shown to perform better on IQ tests.

Infant formula does not have immunoglobulins and fails to provide the protection against common childhood diseases. Using unsafe drinking water for constitution of formula is also linked to waterborne illness. Breast milk is free, available on-demand and nutritious whereas formula can be costly and less nutritious.

Natural foods and naturopathy should be promoted for general well-being of population at large.

 

Written by Dr Vaishalee Punj