Lactose Intolerance vs. Milk Protein Allergy

Lactose Intolerance


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.

Milk Protein Allergy Reactions: -
Skin reactions:
Itchy red rash
Eczema
Hives (urticaria)
Swelling of the lips, mouth, tongue, face or throat
Allergic “Shiners”
Stomach and intestinal reactions
Abdominal pain
Vomiting
Diarrhoea
Gas
Cramping
Nose, throat and lung reactions:
Watery and/or itchy eyes or itchy nose
Runny nose (rhinorrhea: heavy discharge from nose)
Sneezing
Coughing
Wheezing
Shortness of breath
Other more long-term symptoms can include:
Depression
Anxiety
Lethargy and fatigue
Migraine
Sleeplessness
Irritability
Inattentiveness
Children may have a ‘glazed’ look
Hyperactivity in children
Bed-wetting in children


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.

Milk related ingredients and dairy free food items list

References
Web sites:
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/cows_milk_allergy.htm
Everybody Allergy Centre:- Understanding allergy
Food 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.”

  • I'm hoping someone here can share their experience with me as I'm at my wits end. My daughter is nearly 11 months old and has had chronic vomiting since she was about 5-6 months old (full feed vomits till there was nothing left, gagging, up to 9 times in 24hrs). After no doctors taking me seriously, and seeing 3 different doctors we finally got a barium swallow test done after taking her to the hospital out of desperation and it showed that she has severe reflux. I have accidentally eliminated gluten which has helped immensely but we still get 2-3 vomits a day. I'm waiting to hear from a paediatric doctor at the hospital for a follow up after the test but I'm just curious if anyone else has experienced this and what eventually helped? Or was it a case of managing it until they grow out of it? She was given liquid omeprazole a week ago but that only made it worse so i stopped giving it to her. Thanks in advance x

  • My sons 3 months, we've been in hospital his whole life but hoping to go home in next couple of days. He has liquad omeprozol via NG, i've heard that you have to pick it up from the pharmacy really reguarly be because once made up it looses it effectiveness quickly. How often do i need to get it made up?

  • This may need adapting a bit for infants and of course remember to think about allergens but some great advice: http://www.drlibby.com/stress/nutrients-herbs-help-children-calm-relaxed/?utm_campaign=December+Newsletter&utm_content=control&utm_medium=email&utm_source=vero&utm_term=Newsletter&vero_conv=365086097

    So often I hear parents exclaim that their children are wired and hyperactive, and it is usually late afternoon when parents are trying to run errands, cook dinner or get home from after-school activities. Quickly, wired children become grizzly and tired. Parents know the difference between when the…

  • can I please be added to the laryngomalacia page

  • My 7 week old has reflux. We went to see the paediatrician yesterday and he gave us Pepti Jr to try. Im dairy free as still partially breast feeding. He also prescribed neocate as a back up. Just wondering on anyone's thoughts about pepti jr as have heard alot of people haven't had any luck on it.

  • Help please. Our 4 month old suffers from silent reflux, he's been on omeprazole for 2 months now. Initially we saw significant improvement (different baby!). Unfortunately, things have really started to plateau (worsen) over the last week. We have had 3 consecutive nights of holding him right throughout the entire night. Any attempt to move him from being held completely upright see's him wake within seconds and start screaming in pain. It's harrowing. We have been advised by our Dr to increase his dose to (20mg) he's currently on (15mg). I'm really concerned as I feel there's going to be nowhere left to go if he doesn't grow out of the reflux soon :( Has anyone switched medicine from omeprazole to something else with good results? Can anyone please recommend a good paediatrician in the Auckland area who specialises in reflux? We're feeling a bit gutted in this household as we thought things were under control but definitely not the case at the moment :(

  • http://faithtap.com/2205/whatsupmoms-blank-space-parody/?v=1
    Just for some fun. We can all relate to parts of this.

    These busy moms take some time out of their schedule and create a parody of Taylor Swift’s "Blank Space" that will have every mom relating to the sleepless nights and the need for caffeine the next day to keep going. All in good fun, these three moms from "WhatsUpMoms" will have you laughing at thei…

  • December 2014 Newsletter - It is on its way out to members.
    If you are on the old Yahoo Mailing List it has been emailed earlier this afternoon, but sometimes gets marked as spam so check your spam/junk folders for it if it hasn't arrived.
    If you are on the new custom emailing list (i.e. not Yahoo), we are sending from a new server...slowly...Currently at 136 of 235. Talking to the webhosts about how we can make this faster next quarter.

    If you should have received one and don't by tomorrow, please contact us.

    If you aren't a member and would like a newsletter, it is easy and free: http://www.reflux.cryingoverspiltmilk.co.nz/grsnnz-membership-confidentiality-agreement-form/

    Gastric Reflux Support Network NZ for Parents of Infants & Children Charitable Trust Membership & Confidentiality Agreement Form / Newsletter Admin Page First Name Last name Email Street Address City/Town Area Postcode Do you live in NZ? Country and Area if not NZ Home Phone (include area code) Part…

  • Help please! Miss 7mths was finally diagnosed with reflux 2wks ago. She was pretty god during the day, no spilling anymore, crying occasionally with what I thought was wind but must have been acid, worst was getting her settled at night, took a couple of hours. We started on Gaviscon and it was great the first few days, except neither Dr nor chemist told me of constipation side effect (still not sure if we have her constipation sorted). So last Friday saw the Dr and got omeprazole, at first it helped but have found I still have to give gaviscon at bedtime breastfeed otherwise she won't settle. Now I am concerned as I just saw on the forum a post about omeprazole in suspension not being as effective and this is what we have. Also saw the comment about giving it with milk so it isn't affected by stomach acid. Chemist told me to give it 1/2hr before her first breastfeed of the day, I usually manage to give it 15-30min prior to feed. Finding I still can't give her a breastfeed or water too close to a sleep otherwise she wakes crying (usually wakes and just chats to herself) after about 30-45min, this is worrying me with this Auckland heat and humidity that she isn't having fluids often enough during the day. Maybe this is still happening due to Omeprazole not working properly?
    Now I don't know what to do. I am not looking for medical advice as such but I don't know if I can believe the advice of the Dr and Chemist who don't seem to be very knowledgeable about reflux. Do I still give it suspension or ask for granules? Suspension with a feed or before? My other 3 kids didn't have reflux and I am feeling very lost

  • Has anyone's baby got worse with their reflux after taking Ompremazole?It seems my wee grand daughter is.Any answers would be grateful.Thank you

  • Hi Moms out there! I am in South Africa and my little girl has just turned 2 years last week!
    She was diagnosed with silent reflux about 7 months ago and is currently on Zantac. I am at wits end.. still wakes up three times a night and just can't deal right now. We feel like zombies since the day she was born. We must sound like terrible parents but the lack of sleep is unbearable and the sleepless nights are relentless. She is now eating only gluten free food but there has been no difference
    . Are there any parents out there experiencing the same thing... i am just so heart broken for my little angel! thank you

  • Time for a cuppa chamomile tea and a gingerbread star...whilst I work.
    What are you doing today?

  • Help! How long does omeprazole take to kick in? I thought I saw on here someone say that they had to use gaviscon till it started working but the pharmacist told me it should work straight away. Yesterday was miss 7mths 2nd day of omeprazole and no gaviscon and we had a terrible night last night, she was hard to settle and didn't sleep well. At 2am I gave her gaviscon and she slept about 3-4hrs which was blast nights longest stretch. Just wondering if the omeprazole isn't working at its full potential yet. Thanks heaps

  • Does anyone have a child with laryngeophyrangeal reflux? My son was diagnosed a few months ago and has been on treatment with amazing results (thank goodness). Im just wondering if there is anything else I can do for him, and also if there is an average age they grow out of it. He is 20 months now. Thankyou

  • Gastric Reflux Support Network's page has got much busier and there are more posts to the page.
    Thanks to everyone who keeps on answering. I can't keep up, but it is wonderful to see everyone coming here for support.
    Roslyn, National Coordinator.

  • Has anyone used goats formula on their wee one with a dairy allergy? Am starting my twins on it today as one has dairy allergy and am exhausted from breast feeding so going to do a couple of bottle feeds per day

  • Hello. I read on the website that it recommends the NUK brown rubber teat pacifier. Does anyone know why in particular and where to purchase? Thanks.

  • A question on giving up dairy for relux please...

    Do you need to go 100% dairy free or does cutting back help? I drink ALOT of milk (ill go through nearly 4 litres a week, bit excessive). Can I still have milk in tea/a small amount of cheese etc, or do i need to go 100 % cold turkey?

    My daughter is 2.5 weeks old and is doing alot of regurgitating, back arching/night crying, has acid smelling breath, gets frequent hiccups, coughs and gags alot and cries every time I lay her down. Shall I book a GP visit ASAP? What is usually the first treatment they try?

    Many thanks :)

  • http://www.cryingoverspiltmilk.co.nz/new-baby-on-the-way-taking-probiotics/ - New story from one of our Kiwi Health, Pregnancy and Parenting Forum users. Nice to have positive stories.

    Well I thought I would update you all on our baby. She was born on 24th August, the day before her due date and on my birthday. I was taking 3 x 2 caps of Probiotics per day in the last month of pregnancy which can seem excessive, but as I can’t overdose on them and I only get one chance...

  • Are there any breastfeeding Mums out there? My little girl is about to turn 7mths and has finally been diagnosed with silent reflux (alot of people dismissed me when I suggested it months ago). We have started on Gaviscon sachets nearly 48hrs ago and she is much better especially at settling in the evening. She is usually OK at night so haven't given her the powder when she wakes at night yet. Any tips on how to use at night? I have been mixing it up and syringing it into her mouth. Packet says not to make up in advance but I wondered if I could for nighttime so I don't have to make it up when she wakes. Thanks

  • Anyone else dealing with older children with reflux would love to hear from you my Miss 11 year old seems to be having a relapse . So after nearly 4 years losec free in this household we have it back.

  • There have been some new posts - sorry I haven't had a chance to pop on over and answer. Can anyone share their experiences? Remember, no medical advice. :-)

  • As per my post yesterday, our membership form and newsletter archive for members is now available again.

    Please consider joining Gastric Reflux Support Network NZ for Parents of Infants and Children Charitable Trust for access to our Newsletters and Private Local and National Support Networks: http://www.reflux.cryingoverspiltmilk.co.nz/grsnnz-membership-confidentiality-agreement-form/ Membership is free, and this gives you opportunities to discuss gastric reflux related issues with others in a safe and confidential setting.

    Thanks to one of our amazing webhosts http://www.webmad.co.nz/ for the smooth change-over.

    Gastric Reflux Support Network NZ for Parents of Infants & Children Charitable Trust Membership & Confidentiality Agreement Form / Newsletter Admin Page First Name Last name Email Street Address City/Town Area Postcode Do you live in NZ? Country and Area if not NZ Home Phone (include area code) Part…

  • The website our membership form is on and where are newsletters are archived is down for maintenance until late tomorrow evening - Monday at the latest.

    If you were wanting to complete a membership form, please do check back as we would love to meet you. I'll post an update when it is available again.

    http://www.cryingoverspiltmilk.co.nz is available as usual although it the server it is on is changing tomorrow evening also - hopefully there will be no disruption.

    For infant and child gastric reflux support in New Zealand: Phone/Text 022 585 5935 Phone 0800 380 517 Contact GRSNNZ via email form GRSNNZ has brochures available which explain what Gastric Reflux is, a few simple tricks, the support GRSNNZ offers and our contact details. If you are Health...

  • A question please -my daughter has twin girls aged 3 weeks.They were premature born at 35 weeks 3 days.One of them is fine breastfed and sleep.However the other one grunts and groans,pulls her legs up and sometimes cries after each feed.She does not settle well at all.Could this be reflux or what.I know it's early days but my daughter is exhausted!!Any suggestions would be great.Thanks