What is Lactose Intolerance?
Lactose intolerance is the inability to digest significant amounts of lactose, the predominant sugar of milk. This inability results from a shortage of the enzyme lactase, which is normally produced by the cells that line the small intestine. Lactase breaks down milk sugar into simpler forms that can then be absorbed into the bloodstream. When there is not enough lactase to digest the amount of lactose consumed, the results, although not usually dangerous, may be very distressing.
Common symptoms include nausea, cramps, bloating, gas, and diarrhoea, which begin about 30 minutes to 2 hours after eating or drinking foods containing lactose. The severity of symptoms varies depending on the amount of lactose each individual can tolerate.
Some causes of lactose intolerance are well known. For instance, certain digestive diseases (i.e. gastro-enteritis) and injuries to the small intestine can reduce the amount of enzymes produced. In rare cases, children are born without the ability to produce lactase. For most people, though, lactase deficiency is a condition that develops naturally over time. After about the age of 2 years, the body begins to produce less lactase. However, many people may not experience symptoms until they are much older.
How is Lactose Intolerance Treated?
Fortunately, lactose intolerance is relatively easy to treat. No treatment exists to improve the body’s ability to produce lactase, but symptoms can be controlled through diet.
In older children and adults: -
Most older children and adults need not avoid lactose completely, but individuals differ in the amount of lactose they can handle. For example, one person may suffer symptoms after drinking a small glass of milk, while another can drink one glass but not two. Others may be able to manage ice cream and aged cheeses, such as cheddar and Swiss but not other dairy products. Dietary control of lactose intolerance depends on each person’s learning through trial and error how much lactose he or she can handle.
For those who react to very small amounts of lactose or have trouble limiting their intake of foods that contain lactose, lactase enzymes are available without a prescription. One form is a liquid for use with milk. A few drops are added, and then after 24 hours in the refrigerator, the lactose content is reduced by 70 percent. A more recent development is a chewable lactase enzyme tablet that helps people digest solid foods that contain lactose. Three to six tablets are taken just before a meal or snack.
Lactose-reduced milk and other products are available at many supermarkets. The milk contains all of the nutrients found in regular milk and remains fresh for about the same time or longer if it is super-pasteurised.
In infants and young children: -
Congenital Alactasia is an extremely rare condition whereby babies are born without any lactase (the enzyme needed to break down milk sugars), making human milk unsuitable for the baby, precluding breastfeeding. These babies must be fed a special lactose-free formula to survive (soya formula, or dairy based but lactose free).
Functional Lactase Deficiency describes a thriving breastfed baby who has multiple loose watery stools. The baby may be irritable and may pass flatus frequently. Low fat feeds result in rapid gastric emptying leading to large quantities of lactose being presented for digestion. Thus the ability of lactase to digest the lactose may be overwhelmed. The amount of fat being consumed at any feed should therefore be maximised to delay gastric emptying. This can best be achieved by optimising hind milk intake by:
• Encouraging the infant to finish the first breast before offering the second breast.
• Spacing feeds. Aim for three hours between feeds. If the baby demands again in less than this time offer the “empty” breast again.
As lactose is the main form of carbohydrate in all mammalian milks (including human milk), lactose production at the breast occurs independently of dietary changes. Reducing the amount of lactose in the diet of a breastfeeding mother does not alter lactose production at the breast. It is present at a constant level throughout a feed and throughout a day.
Primary acquired lactase deficiency is an age-related condition and occurs after weaning and before the age of six years. Young children with this form of lactase deficiency should not eat any foods containing lactose; weaned infants require a lactose free formula (soya formula, or dairy based but lactose free).
Secondary acquired lactose intolerance occurs as a result of damage to the small intestinal mucosa that commonly in infants is due to gastro-enteritis. This is treated by the introduction of a lactose free formula to the infant’s diet.
Depending on the severity of the illness partial breastfeeding may still be possible. If the infant has recently had gastro-enteritis average recovery time is four weeks. Weekly challenges with breast milk should be attempted until it becomes tolerated.
Milk Protein Allergy
What is Milk Protein Allergy?
A food allergy exists when a body has an abnormal reaction to food. A person who is allergic to dairy is normally reacting to one or more proteins found in cow’s milk. Typical reactions to milk protein(s) allergy involve problems associated with the skin, the stomach/intestines and or breathing.
Allergies to milk protein are more common in infants and children, and are usually to casein. Generally, adults milk reactions are caused by lactose but adults have been known to be allergic to milk protein. Milk protein allergy in infants can be detected as early as 9 days.
Dietary Therapy for Milk Protein Allergies
The dietary therapy approach to this allergy is to remove ALL obvious and hinder sources or dairy in the diet. This sounds like a simple idea at first until you realise the many forms animal milks take in modem foods. But with dedication to the task and armed with a few new basic shopping and cooking hints, a list of dairy ingredient names and often a good pair of glasses anyone can totally remove dairy from a person’s diet. To be honest it takes two months of focused dedication to adjust your lifestyle and feel comfortable with the changes that are required. But the nice thing is you will see very positive changes in your special child’s or adult’s life within a week or so.
Dietary Therapy for Milk Protein Allergy in Infants
If weaned, usually soy based formula, although 25% of infants allergic to milk are also allergic to soy. These babies are put on pre-digested formula e.g. Pregestimil or Nutramigen, which have all the properties and carbohydrates hydrolysed (broken down).
If breastfed, the mother may need to go on a dairy free diet herself to eliminate the possibility of milk products reaching the baby through her breast milk.
Tips for parents of food allergic / lactose intolerant children
• If you buy a specific brand of food you know contains no dairy, you should still check the label every time you purchase it. Several companies add dairy without changing the artwork on the packaging!
• If your child has been diagnosed with “colic”, question the possibility that he/she cannot tolerate dairy, eggs, peanuts, wheat, dyes or more!
• When filling prescriptions for your child, be sure the medication contains no dairy products. Your pharmacist may need to call the manufacturer to obtain a list of inactive ingredients. Some common caplet/tablet medications use lactose as a binder or sweetener.
• Be careful when purchasing children’s vitamins, which often contain lactose.
• If your child is egg allergic, you can substitute a mixture of 1 1/2 tablespoons water + 1 1/2 tablespoons oil + 1 teaspoon baking powder, mixed together, for one egg. For two eggs, just double this. Also, 1 heaped teaspoon of arrowroot powder to each cup of flour in non-dairy, non-egg baking in addition to the egg substitute will keep your baking product firm and crisp!
• Many children become hyper or aggressive when eating food additives such as dyes, MSG, sulfites and phosphates. Hydrolysed Vegetable Protein is 40% MSG. If your child tends to be “hyper”, try to stay away from these additives.
• It is important to have a good physician or allergist who can guide you on your allergic child’s health and diet.
Laureen Lawlor-Smith BMBS IBCLC, Carolyn Lawlor-Smith BMBS IBCLC FRACGP – Lactose Intolerance
National Digestive Diseases Clearinghouse – Lactose Intolerance
Non Dairy: Something to Moo About – Newcomers Guide
Children with Milk Allergies and other Food Allergies
Other useful links:
Cows Milk Allergy – An Update on Adverse Reactions – http://www.allergyclinic.co.nz/guides/43.html
Everybody Allergy Centre:- Understanding allergy
Milk Free Diet for Breastfeeding Mothers – Crown Public Health
© Gastric Reflux Association for the Support of Parents/babies (GRASP) and Crying Over Spilt Milk Gastric Reflux Support Network New Zealand for Parents of Infants and Children Charitable Trust (GRSNNZ) 2004. Used and edited by GRSNNZ with permission.
Page may be printed or reproduced for personal use of families, as long as copyright and Crying Over Spilt Milk‘s URL are included. It may not be copied to other websites or publications without permission and acknowledgement. This information (unedited) was also provided (by GRASP) to health professionals in New Zealand to use ” to continue to support and inform families with babies/children with Gastro-oesophageal Reflux.”
The December Newsletter is due out. Is there anything that you want to see in it? Is there anything you want to contribute? A tip or a story?
Safe sleep day is all about promoting safe sleep for babies, so that every sleep is a safe sleep. Mata ki te rangi, i tōna moenga motuhake Back to sleep in baby’s own bed The safe sleep campaign is a national campaign focused on raising awareness about safe infant sleep practices. By positioni...
Hi Ladies, my 12 week old has silent reflux, was put on neocate with suspected milk intolerance but symptoms never went away untill we suspected reflux was put on gaviscon, helped alot, still wouldnt sleep in the day would wake crying so was put on losec, been on this for three weeks and stil no improvement. And he has started to spill now with every feed. Im wondering if the neocate isn't right for him and considering normal formula. Or would that make things worse?? Any ideas :) Thanks
Did you know that gastro-esophageal reflux disease can present as a behaviour disturbance?
Hi, im after some advice/help. I have a 7 week old son that has been diagnosed with servere reflux and colic.( he also has a upper lip tie and doesnt feed well anyway) We were prescribed infant gavison to help with the reflux but it has blocked him up horrendously. we were told to stop it and have been given a laxative to help clear him out. yesterday the doctor was talking about prescribing him an entensively hydrolysed formula (pepti Junior) and trialing before we can look at the Neocate as she thinks he may have a cows milk allergy. Today she has rung and said there is a new formula out from Karicare. Its called Karicare Plus comfort which is partially hydrolysed. And that i need to pick one and trial it. Im so confused and googling all this info has confused me even more. HELP PLEASE
Hi ladies, is it ok to give a reflux baby infacol wind drops?? Or will it make his reflux worse??? Thanks
The most efficient way to speak to one of the Gastric Reflux Support Network NZ staff is to text a message to 022 585 5935. Include your name, phone numbers or email and a brief explanation of why you are contacting us. We will contact you as soon as possible. Gastric Reflux Support Network NZ for Parents of Infants and Children Charitable Trust (GRSNNZ) appreciates your donations so that we can continue to support families coping with gastric reflux. http://www.givealittle.co.nz/org/GRSNNZ
Can you get samples of Neocate or similar from anywhere?
Does anyone know if there is any kind of parents support page for kids with allergies? Sorry not entirely reflux related but since they often go hand in hand thought id ask here. Thanks :)
The most efficient way to speak to one of the Gastric Reflux Support Network NZ staff is to text a message to 022 585 5935. Include your name, phone numbers or email and a brief explanation of why you are contacting us. We will contact you as soon as possible.
Hi there, I have just today searched for & found your page as I am desperate to find some relief for my 7.5 week old who is in pain & discomfort. My 7 week old was born 4weeks early via c-section & we are seeing a cranio-osteopath for a number of the interventions she needed during & post birth. After the last 2 treatments she has what seems like reflux symptoms, last time (3 weeks ago) was for 6 days, this time we are on day four. She screams for hours after feeds in pain, no holding position really works better than others, we just fluke a good position which may only offer a few minutes relief or she goes into an exhausted pained sleep. She can't sleep on her back in bed during the day (have tried propping it) so I either put her on her tummy (works sometimes) or hold her upright tummy to tummy at varying degrees on me in the ring sling, we need to sleep like that at night sometimes too. She used to wind well & was spilly at times but it didn't seem like an issue. Now she often doesn't burp or spill at all, gets tense & upset instead. Also her saliva gets so thick & it sounds like she's choking & struggling to breathe past it in her throat. I have tried shorter feeds more often but it doesn't really help - and how does this work if she is screaming for 2-3+ hours (more feeding makes it worse) then going to sleep? How will she get enough if every feed is smaller? I don't want to wake her as it all starts again & we both need to recharge too. Any advice much appreciated, I don't know what to do for her & it's so distressing!
http://www.medscape.com/viewarticle/812388?nlid=35583_2047&src=wnl_edit_medn_peds&uac=76049AV&spon=9 :-) - Conclusion is also that it is likely to do no harm either.
Studies vary too widely in products and dosages used to permit definitive conclusions, investigators say.
HAMILTON people - how many of you are out there and reading this post??? I'm just replying to a message regarding our COGS Funding Application for the Hamilton area. As our Trust has just moved from the Hamilton area to the Canterbury area, they want to know how many people we are supporting in Hamilton on a weekly basis. I know how many members we have in Hamilton, but of course we support more via our website and this Facebook page. Please LIKE this post if you are in Hamilton and reading this BUT only if you are in Hamilton. :-) Many thanks for your help. Roslyn National Coordinator Gastric Reflux Support Network NZ for Parents of Infants and Children Charitable Trust
Constipation with infant gaviscon...just wondering if baby's system "gets used to it"?
Sorry but need to vent...my daughter who is now 18months had a pre-op check today for her grommet procedure on Monday, met with another new doctor today who obviously only briefly read her file and noted reflux she then proceeded to check her arms and state how chubby she was and that would make inserting a drip harder and because she is reflux there is a chance the mask could make her sick - she then stated 'obviously she hasn't got bad reflux because she is still quite chubby!' um, well obviously you haven't been her doctor for the last 18months and have no idea of the ordeal the reflux actually has been fir her or our family...this made me wild! Anyone else encountered this attitude??
To my Gastric Reflux Support Network NZ email address "I am interested in buying some of your products for our clients in Manila Philippines.While surfing for some purchases online,I came across that your company stocks some of our required goods and could help provide this items..." LOL what do they want to purchase??? Screaming sounds, vomit, curdled milk, preloved stained carpets... ;-)