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Why removing tonsils is not usually the answer for children who do not breathe easily by Dr John Briffa on 2 February 2007 in Children's Health, Food and Medical Politics, Specific conditions
Enlarged tonsils and adenoids are quite common in children, and may make breathing difficult. One way that this may manifest is as snoring and something known as sleep apnoea ” basically where breathing is so obstructed that it can stop for short periods during sleep. Surgical removal of tonsils and adenoids is a common strategy adopted by affected children. Like a lot of conventional medical care, tonsillectomy and adenoidectomy (or ‘T and A’ as it is known in the trade) is assumed to work, but does it? In a recent edition of the Journal of Pediatrics, doctors at the University of Louisville, in Kentucky, USA, tested the breathing of children before and after T and A operations [1]. The long and short of it is that only about a quarter of children were significantly benefited by the procedure. This is a classic example of where a close look at our medical practices reveals just how limited the effectiveness of modern medicine can be. I’m writing this, though, not to have (another) go at conventional medicine, but to explore why T and A’s aren’t that effective. If I were to use one word that I think explains this phenomenon, it would be DAIRY. Here’s why: Sensitivity or intolerance to dairy products is common, and in children commonly causes mucus, enlargement of the tonsils and/or adenoids, and general ‘congestion’ in and around the ears, nose and throat. What this means is that surgically removing the tonsils and adenoids doesn’t necessarily clear the airways sufficiently to prevent obstruction and sleep apnoea. I’ve seen a legion of these kids in practice: the tonsils and adenoids may be gone but they usually still have symptoms like nasal congestion, post-nasal drip and a bit too much phlegm generally. They may have other symptoms of food sensitivity to, such as dark circles under the eyes. My advice to parents of these children is to get dairy products out of the diet, and see how they go. Almost always, they are a lot better without it. The same is true of children with enlarged tonsils and/or adenoids who are yet to go under the knife. Just coming off dairy products is usually all it takes to spare them from surgery. It seems that not all dairy products are equally likely to cause problems. It is believed it is the protein molecules, such as casein, that cause the sorts of problems we’re discussing here. Butter contains hardly any protein, as is rarely a cause of food sensitivity. And yoghurt is generally better than milk, as the protein molecules are broken down as bit by the bacteria used to make yoghurt, which makes them less likely to provoke problems. Also, goat and sheep products are generally better tolerated than those that come from cows. When I write about ability for dairy products to cause food sensitivity problems I not uncommonly have communication from the Dairy Council here in the UK who tell me how mistaken I am. I have also been asked for ‘proof’ for my contentions. I’m not against science (some of you may have noticed that I draw from it quite a lot), but it has limits. One obvious limitation is that some treatments and approaches that might have merit have simply not been studied, and there is therefore no proof or evidence either way. Many researchers and doctors seem to take absence of evidence as evidence of absence, and believe that something only becomes valid once it has been ‘proven’. Curiously, these individuals often suddenly lower this bar for ‘accepted’ medical practice, most of which has never been proven to be of benefit at all [2]. And why many in the scientific community believe that health care should be ‘evidence-based’, does that mean that ‘experience’ has to go out of the window? Do I need some piece of research, for instance, to be able to suggest that drinking some water each day is to be recommended? And do I also need a study, for instance, to warn people against smashing themselves in the face with a polo mallet? And I sometimes wonder why it is that when individuals demand the ‘evidence’, they so often make assertions as though they are fact, but which are not supported by any published ‘evidence’. This soft of double-standard and hypocrisy is rife in science and medicine. The reason that I advise who are suffer from nasal and upper airway congestion look to get dairy products out of their diet is because, in my experience, this often dramatically reduces and sometimes completely resolves their symptoms. And I will not be desisting in recommending other approaches that have not been studied but I find highly useful in practice. And to those who would ask me to ‘prove’ the benefits of the advice I give, I say Prove it ain’t so.
References 1. Tauman R, et al. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr. 2006;149(6):803-8. 2. http://www.clinicalevidence.com/ceweb/about/knowledge.jsp
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41 Responses to Why removing tonsils is not usually the answer for children who do not breathe easily Margaret Dolbaczuk 3 February 2007 at 1:16 am # I fully agree with this approach of elimination of dairy for a child or anyone with nasal congestion, enlarged tonsils etc. It is a fairly easy treatment to implement. My own daughter had nasal congestion for the first three years of her life and within three days of removing cow’s milk from her diet and replacing it with goats’ milk, her nose stopped running and the congestion stopped! It is one of those easy treatments to do and far less traumatic than having any surgery. Having seen hundreds of children having T & A’s while working on Paeds for years…I know that the children would likely prefer not drinking cow’s milk to having surgery!!! REPLY
Dee 3 February 2007 at 10:42 am # My eldest son and I are both lactose intolerant, though he is far more sensitive than I. We now use A2 milk–with a different natural casein–and have no hmm-hmming or other symptoms from it. http://www.a2corporation.com REPLY
Janet Alton MNIMH 3 February 2007 at 2:25 pm # I couldn’t agree more. I too find the advice to eliminate dairy extremely useful in practice, not only in nasal congestion but also all forms of eczema. I think it is nothing short of wicked that many doctors deride advice like this, leaning on ‘evidence-base’ because their training doesn’t include courses in nutrition, and thus depriving people of a relatively simple way to improve their wellbeing. Dietitians hate taking milk out of the diet because they have been taught that it is positively dangerous (calcium deficiency), so you have to be responsible and make sure you inform people about what constitutes a healthy diet – but this is not a reason not to at least try eliminating dairy – even doing it for a short time (I tell people, two weeks) will show you whether it’s an issue for you or not. REPLY
Neil 4 February 2007 at 9:14 pm # I’ve read about the different forms of casein on Anthony Colpo’s website. He said that the A2 form is found in goats milk, and that from Jersey or Guernsey cows. His piece came from the angle that there may be an association between milk protein and heart disease. Personally I drink Channel Islands milk for the higher fat content and taste, but was pleased that as a bonus, it contains A2 casein. The downside for me is the 4 – 5% carbohydrate content of milk. Still, there’s usually double cream in the fridge! I don’t have a problem with ‘ordinary’ milk, but I would certainly experiment with total elimination if I thought it was giving me a problem. REPLY
Dr John Briffa 4 February 2007 at 10:07 pm # I feel I need to get a bit of an education about the A2 casin ‘story’. I remember reading about it a couple of years ago but it didn’t ‘lodge’ with me. So, thank to Dee and Neil for raising my awareness about this again – I’m going to take a look at this issue and may well blog about it in due course. Regards. John. REPLY
Christy Stylianides 2 May 2007 at 10:16 am # My daughter started getting nasal congestion from the age of 9 months. Eventually saw an ENT consultant at 18 months who said “T & A” was the only way to go because of large tonsils and adenoids. I’ve managed to stall on this for the last 3 years. We switched to goat’s milk about 2 years ago and that seemed to make a difference, but not much. My daughter has now had swollen glands in her neck for 5 months. Doctors don’t seem to think it’s anything serious, but she seems to be constantly fighting infection somewhere in the ENT area. I still want to avoid surgery, but now I’m thinking I’m being selfish. Does anyone have anything to suggest? REPLY
Anni 13 September 2007 at 12:15 am # Reading this article – all I could think was YES! My children and I are 100% proof. NO MILK products = no more tonsillitis, no more asthma, no more earchaches, no more sore throats, no more coughs, no more runny noses, no more colds. Yet, no specialist will agree. They scoff and tell you that they are the expert. I find that infuriating. Luckily, I’m not so silly to trust what they say when I see the evidence for myself. We don’t see doctors anymore – we don’t need them. (We do backtrack sometimes and have some degree of milk products – which results in sore throats and runny noses. We NEVER EVER have icecream, which for some reason is the worst of all for us. In case anyone thinks it may be the coldness of the icecream that is the problem – not so. We can all eat non-dairy iceblocks or soy ‘icecream’ until the cows come home (no pun intended) with no effects at all. I love the way it is put in the above article: “Absence of evidence is evidence of absence” for most of the researchers and medical profession. It is so true. The worst thing is that so many children are having these unnecessary operations, and suffering through so many earaches and illnesses each year. It doesn’t have to be this way. Anni & family REPLY
Rob Brady 11 October 2007 at 11:47 am # Hello Dr, Would like your opinion on the possible connection between soy products and the protein in milk. A very credible forensic pathologist advised me (very emphatically) to remove all soy products from my 7 year old’s diet. I had contacted him regarding a completely different reason (chemicals in bedding) for my sons constant attacks of tonsilitis and gagging problems at night (mucus???). He followed my original inquiry with an email stating the above – he did not say remove dairy and soy – just soy. Could this be because of soys antinutrient properties which apparently interfere with enzymes which break down protein ie casein in dairy? Your opinion would be greatly appreciated. Rob Brady REPLY
jim bartley 2 March 2008 at 8:33 am # The evidence is there if you look for it in the literature. Forty-four of the 65 children (68 percent) had a response while receiving soy milk. Anal fissures and pain with defecation resolved. None of the children who received cow’s milk had a response. In all 44 children with a response, the response was confirmed with a double-blind challenge with cow’s milk. Children with a response had a higher frequency of coexistent rhinitis, dermatitis, or bronchospasm than those with no response (11 of 44 children vs. 1 of 21, P=0.05); they were also more likely to have anal fissures and erythema or edema at base line (40 of 44 vs. 9 of 21, P