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.”

  • Is infant gaviscon at all effective for 2.5 yesr old? my son reacts to ranitadine and omeprozole but has had a reflux flare up which is now resulting in vomiting after lying down in bed. He's even coughing and gaging on water during the day probably from the irritation in his throat etc. I'm having to wait quite some time after dinner to give him rice milk and again before attempting bed. It's pushing bedtime out too far with him not napping. Any suggestions? Can't pinpoint anything dietry wise that may be causing it.

  • Hi everyone. I'm after a bit of advice, my 20month old has recently commenced on liquid iron supplement (after we were told his iron levels are low from blood tests) but we've found its giving him a really sore tummy. Have tried halving the dose but I still have a tearful distressed little man on my hands. Does anyone have any ideas? Or can recommend something else.

  • Hi there, I'm wondering if someone could please advise me. I have been dairy free for 3 weeks today and introduced some back in today; just butter on one piece of toast and a splash of cows milk in 2 hot drinks. My daughter's been crying and not sleeping most of the day unless held. I've also been block feeding to try to prevent her choking etc on my fast flow, however Plunket advised I may like to rethink that now she's 8 weeks old so my supply doesn't diminish. She's a frequent feeder and I've managed to push her out to 2 1/2 hourly feeds over the last few weeks (on Plunket and Dr advice as they said her always feeding would make the reflux worse). She had been quite a bit better over the last week. Tonight I offered her the other breast at her feed as well, instead of the same one as usual and she had a good feed, so obviously needed it. But my goodness, the reflux has been really bad afterwards with lots of gagging and choking and pained crying etc etc (she's not much of a puker). I don't know if this is from having both breasts at the one feed (surely not) or she's super sensitive to the dairy? I'm wondering how long it will now take to see if there's improvement now that I've quit the dairy again? Please tell me it won't be a whole other 3 weeks again!! As I said, it was only a small amount reintroduced today.

  • Paging Rebecca who left a message on the Gastric Reflux Support Network NZ Support Answer Phone on Monday!
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  • Just trying to access the website about allowances in nz.. nothing will load?

  • In all the reading I've done about reflux babies it seems common that they don't settle to sleep to well
    During the day but will at night? Why is that?

  • I don't know if any of you have noticed, but as the website is having a lot of updates at the moment, I have started adding a blog about it to the website. The posts appear on the home page, under the Facebook Preview. Roslyn, National Coordinator.

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  • Interesting article on dreamfeeds:

    Will ‘dream feeds’ work for your baby? Dorothy Waide shares her insights on this late night option.

  • does a thickener help for Elecare formula? It seems to be so thin and my little granddaughter is spilling a lot with this formula.Would welcome your feedback thanks

  • Christchurch people - there is a new post from someone needing help finding Karicare Aptamil Food Thickener. If you know where to find it, can you please reply on their post?
    Thank you!

  • Does anyone in CHCH know where to find the formula thickener for Elecare formula?? My wee one has just been put onto Elecare and I am finding it needs to be a bit thicker as she is bringing up a lot just like the breast milk. Not all pharmacies sell it

  • After some advice, I have a 10 week old with possible silent reflux ( just started gaviscon) we are wanting to progress to help him achieve self settling. Does anyone have any methods that worked? Absolutely no comfort in patting and shushing... Or am I asking too much from my little man that finds a lot of comfort in being rocked to sleep?

  • Hi all, Just wondering if someone could confirm for me that going dairy free means you can still have non cows milk products like sheep or goat products? I read the spilt milk site and seems to be a cows milk protein issues, not other types of animal products? I just ate sheeps feta then second guessed if it's OK.

  • My 16 month old just saw an allergist today and he told me it sounded like he had reflux. He had it as an infant but around 9 months he stopped needing meds and was fine, but now this winter he has stayed sick! So I'm really trying hard to wrap my head around this... I feel like my baby has been sick for months (stuffy, sneezing, coughing, wheezing, fever.. the list goes on and on) and it's just reflux! I mean if that's the case I guess I'm relieved because that seems like a simple fix. I just feel like he's really been suffering. His pedi was thinking he had asthma and sinus infections. The allergist did swab his nose to see if anything comes back on it but for now he is just taking nexxium(sp?) and a nasal spray.

  • Ignore my previous message (If you saw it), http://www.cryingoverspiltmilk.co.nz is back!

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  • I asked for a script for infant gaviscon and was given Acidex. Whats the difference?

  • Hoping for a bit of help/more advice. My now 8 week old baby has what we believe to be silent reflux, no one has actually diagnosed her with it, but have been given meds to help. She definitely regurgitates milk, and sometimes projectile vomits (she has only started doing this recently). I am getting so lost of what to do next, we have another appointment with the GP on Thursday, but in the mean time would love any advice on what I can do to help her.

    We started out on Infant Gaviscon, which didn't help much at all. Then onto Ranitidine, which didn't help either. We got prescribed Losec by my GP to use with gaviscon. Which seemed to help for two weeks, but now she is back to being so unsettled and unhappy. From birth she could only ever drink a small amount before she got really uncomfortable and started screaming, I started expressing to get an idea of what she is really drinking, which turned out to be bugger all, this was why i was feeding her 20 odd ml every 1/2 hr to an hour. I'm doing everything I can to help her, have got the bassinet head raised, burp after what seems to be every mouthful! I wear her in my wrap a fair bit during the day for some of her naps.

    I took her to the osteopath last week, and her said she was very sore and had a very tight diaphragm. Two nights later she slept 6 hours! But the next night she was back to a couple of hours at a time. I have another appointment on Thursday.

    As I have a 20 1/2 month old toddler and, expressing got too much as I could never find the time to do it, so now have her on Karicare Formula, which i'm not 100% sure if this is upsetting her stomach aswell. She was induced at 38 weeks as they were concerned about her growth, she was 6lb 3 oz at birth.

    What would be the best formula to have her on? She is still currently on losec and gaviscon. AND how can I ease the screaming after every feed? I'm really starting to stress alot about it and find myself getting pretty emotional.

    Thanks and sorry for the long story!
    Emma

  • Hi everyone, my daughter had severe gerd up until about 9 months and was treated with losec and gaviscon and eurthymician (sp). Four about 3 months she was really good, not needing any meds at all so we weened her off them. She has been med free for about 6 months, but the past two months we are back to screaming and crying every hour each night ( was previously a good night sleeper!) very unsettled etc, but no vomit . My question is can reflux suddenly come back ?

  • Just popping in to clarify our website/forum guidelines.
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  • Please help i am desperate! My wee 9 week old is under a paediatrician forbreflux and a maybe dairy allergy. My milk supply is starring to drop and she has been given Elecare but she refuses to drink it. Have tried vanilla essence and mixing it with my breast milk but still no luck. Any help/advice will be greatly appreciated 😊

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  • Sharing for your information. Please read the whole article - there are safe options.

    A survey of portable cots for sale in New Zealand has uncovered potentially fatal safety defects - including folding mechanisms that could trap a child's neck. - New Zealand Herald

  • I don't know if this is the right site but my mum is being treated for reflux which has brought on burning mouth syndrome.
    All her food tasted awful and was wondering if anyone has any tips if dealing or getting rid of this?
    Thank you x

  • May your heart be warmed by the sweet magic that Christmas brings, and may all your dreams be fulfilled.
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