Researchers examined whether providing a low FODMAP diet to breastfeeding mothers could help reduce colic in infants… and the results suggest it could

While avoiding “windy” foods is common among breastfeeding mothers, therapeutic diets for infantile colic lack evidence, say the researchers, who published their data in Alimentary Pharmacology and Therapeutics.

The study involved 20 breastfeeding mothers with babies under nine weeks old with and without colic.

Thirteen mothers whose infants showed significant signs of colic were monitored on a typical Australian diet, before being placed on a 10-day low FODMAP diet.

The mothers kept a diary, recording infant crying, fussing sleep and awake times. A control group of seven mothers of babies without colic continued with their normal diet.

Each diet comprised three main meals, one mid-morning and one afternoon snack, and one supper meal or snack.

The participating mothers were responsible for supplying their own fresh fruit and vegetables, and provided with a detailed list of suitable items, plus drinks and alternative meals.

“The primary ingredients (eg, protein source of fish, chicken, tofu), the names of dishes and the colour and texture of all meals were similar,” the authors wrote.

“Ingredients were also disguised either by hiding them in sauces and baked foods or by keeping flavours consistent. For instance, there were low‐FODMAP and a moderate‐high FODMAP versions of stir‐fries, pasta dishes, fish meals, savoury muffins and breakfast muesli.

“Onion and garlic (both high FODMAP) were replaced with garlic‐infused oil, chives and/or the green part of spring onion (all low‐FODMAP). Herbs and spices remained consistent throughout.

“Vegetables such as snow peas, pumpkin, cabbage and mushrooms (all high FODMAP) were replaced with low‐FODMAP vegetables of the same colour or texture such as, green beans/green capsicum, carrots and bean sprouts.

“Wheat‐ and rye‐based flours/breads (high FODMAP) were replaced with spelt‐sourdough breads/flour (low‐FODMAP and contain gluten) and a mixture of corn‐, quinoa‐ and potato‐based flours.”

Participants were considered to be compliant when 90% of intake, regardless of quantity, was appropriate to that dietary intervention arm.

After 10 days on a low FODMAP diet, the study reported a 32% reduction in crying and fussiness associated with infantile colic.

“Mean crying‐fussing durations were 91 min/d in seven controls compared with 269 min/d in 13 colicky infants (P < 0.0001), which fell by median 32% during the low‐FODMAP diet compared with 20% during the typical‐Australian diet (P = 0.03), confirmed by a two‐way mixed‐model analyses‐of‐variance (ƞp2 = 0.719; P = 0.049) with no order effect,” the authors wrote.

“In breast milk, lactose concentrations remained stable and other known dietary FODMAPs were not detected.

“Changes in infant faecal calprotectin were similar between diets and groups, and faecal pH did not change. Median maternal anxiety and stress fell with the typical‐Australian diet (P < 0.01), but remained stable on the low‐FODMAP diet.”

Lead researcher Dr Marina Iacovou, from Monash University’s Department of Gastroenterology, said the significant improvement matched results of a pilot study of 18, published in Journal of Human Nutrition and Dietetics.

“These findings suggest that a low FODMAP diet for exclusively breastfeeding mothers could significantly improve crying and fussing durations of infants with colic, when compared with a typical-Australian diet,” Dr Iacovou said.

“Interestingly, we also found that infants were awake for longer and more content  following the low-FODMAP diet.”

Dr Iacovou, a practising dietitian, said a lack of evidence prompted this first randomised controlled feeding-trial of a low FODMAP maternal diet.

“It is very common for breastfeeding mothers to change their diet – on the grounds of old-wives tales and common beliefs,  but therapeutic diets for infantile colic lack evidence,” Dr Iacovou said.

“The findings could help nursing mothers monitor and adjust their diet to help reduce the severity of their infant’s colic, but it’s important they seek the advice of their GP or qualified dietician before undertaking any new diet regime.”