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/guides/43.html
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 getting the September Newsletter ready. Is there anything anyone wants to contribute? Please let me know: https://www.facebook.com/roslyn.ballantyne.rn

  • Hi there are there any formulas that you can get on prescription or financial assistance? Pretty sure my 8 week old isn't coping with his formula that he's on. He has reflux and on ranitidine but now he has green mucousy poo so im thinking he might need some different formula? But I see specialist formulas are expensive!!

  • Hi, my 5 month old has started solids and we have been ok'd to feed these before milk as otherwise he spills most of it. He takes losec granules, which was have been giving with pear 30mins before a milk feed. Can we now just give these with his solids with milk following half an hour+ later? Or not due to the higher volume of food in his stomach so it wouldn't be digested by the time he has his milk. Thanks

  • Hi. We've used the karicare thickener in our boys bottles on top of losec and neocate to control his reflux. Now he's 4 months old I was looking at using watties rice cereal to thicken his bottles before moving to solids at 6 months. Looking to find anyone who thickens with rice cereal. Advice? Thank you

  • Argh! I don't know if I'm doing the right thing for my wee girl. We discovered her reflux early 8 days old and has been on goats milk formula for 3 months. Did it help? Hard to say but she was happy enough. We were reffered to the hosp dietician by our plunket nurse and on Thursday started neocate. Its made things worse and she seems in pain.. her poops are slimy green. We gave her a few gaviscon feeds with it to help her tum cos she seems to have a sore tummy a lot. So its Sunday, we've been on it three days but I am continually second guessing myself. Should we have seen a change in her by now. Is it normal to take a few days for the tummy to get used to it? I hate putting her through all this esp if it doesn't end up working... sometimes I just want to throw it in and put her back on goats milk... would love some advice from others on neocate or just any advice/encouragement please and thank you :)

  • Hi mums I have recently taken my daughter off losec on advise from a paed to see how she went. We didn't notice the symptoms coming back and also started solids around same time with it going great. She's had a cough and cold but is over it except this nagging cough which is day and night until she eventually throws up. My question is could the cough actually be the reflux and should I start losec again.

  • A Good News Story ... http://www.cryingoverspiltmilk.co.nz/his-gastric-reflux-stopped/

    Hi Roslyn, Thanks for the updates over the past several months. I am leaving the group as my little boy no longer suffers from gastric reflux and is also no longer dairy intolerant! FYI he was on Neocate from 3 months old and had a combination of formula and my milk until he was 7.5 months. ...

  • Hi. My boy is 6.5 wks. He started screaming at 3 wks. Became unsettled for periods of up to nearly 12hrs without sleep. He's been on formula as my milk never came in. He gets about 100-200 ml breastmilk /dy I pump. He started spilling/vomiting a lot at 4.5wks old.started losec 9 dys ago-frm GP. Saw paediatriciAn 4 dys ago and started amino acid formula to check for CMA. I feel things improved a bit about 4 dys after losec started. Also he seemed great once on th amino acid formula but thn yesterday was his old really bad self - fussed all day 10am-4pm thn really distressed n frantic 4-9pm. He's been ok today.i also started adding karicare thickener 2 dys ago. His first poo day after starting amino acid formula was soft n ok but I thnk he might b constipated with th thickener. He really had to push to get yesterday's out n was very sticky. Anyone else experience this? What do you do? I've heard lactulose and prune juice etc can make reflux/ wind worse. I thought about halving th amt thickener I'm using.also his vomiting better on th new formula I think but still occasional. He vomited Sunday night n mayb brought th losec up- could 1 missed dose like thts make him bad th next day like he was? Any opinions greatly appreciated

  • 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. If you have completed a membership form previously, but never received anything further, please message me (Roslyn Ballantyne at https://www.facebook.com/roslyn.ballantyne.rn ) or comment below. The membership sign-up had been a double opt-in with a confirmation email, but as some people have had trouble with this, I've now changed it to a single opt-in. (I do still need to process applications and add you manually to your Local Support Networks though.)

    Gastric Reflux Support Network NZ for Parents of Infants & Children Charitable Trust Membership & Confidentiality Agreement Form / Newsletter Admin PageFirst NameLast nameEmailStreet AddressCity/TownAreaPostcodeDo you live in NZ?Country and Area if not NZHome Phone (include area code)Partner's NameE…

  • Hi I'm a bit confused. I filled out th membership form on th cryingspiltmilk main page. Do I need to do anything else? I see there's a forum somewhere else - kiwi health or something? Or do I just post n use this Facebook page? I'm thnking you hav th older site but most people jst use this Facebook page now yeah? Ta :) I hav a 6 wks old beautiful boy who has been in so much pain been breaking my heart but I'm jst getting things in motion now to help I thnk. Saw paediatriciAn few dys ago n hav started losec gaviscon mylanta and amino acid formula with karicare thickener

  • Hiya, I'm starting to introduce solids to my almost 6 month old and just wondering if there are any foods that any of you have found to be better than others and which ones to avoid? TIA. :-)

  • Other information here: http://www.lalecheleague.org.nz/news-a-events/lllnz-conference-2014/312-lllnz-50th-anniversary-conference-2014