The term ‘lactose overload’ is used a lot by LC’s, IME, because if you say ‘lactose intolerance’ (even secondary), people think it is a permanent condition, not a set of symptoms from a different issue entirely. Is there some other mechanism that causes the typical diarrhea and gas associated with milk protein allergy? I’d love to learn more. Please provide details! (I’m learning something new already!)
And you are SURE that milk protien allergy does not cause this damage (short term, not long-term)? Because my son doesn’t have celiac disease that I’m aware of, but he sure as heck gets diarrhea and gas if I eat anything with cow’s milk in it. Granted, it may not be the cow protiens in particular that cause it (as noted in the hijack above - it may be a secondary process that does it), but sure has the same symptoms - explosive diarrhea, with mucous, often with blood.
Hmmm. Now, actually, that should have set off my radar before, anyway. The diarrhea in reaction to the milk protien ingestion is immediate-term (that is, it continues for a comparable span to how long the milk protien is in the body), not long-term (not weeks of diarrhea from a single exposure). So there is definitely something different going on, but it sure does cause the same symptoms…
I didn’t say SOY. I said lactose-free. They are two different categories (lactofree types are milk-based, but lactose is removed or not added). Soy has been around a LOT longer than lactose-free, and yes, there are some studies on that. I didn’t find a single long-term study of lactose-free formulas on PubMed (I checked before I posted that). Only short-term ones.
I probably should have reviewed the research on that paper more carefully. Mea culpa. And yet the symptoms of lactose ‘overload’ (more lactose than can be digested in the moment) certainly apply to babies whose mothers have suffered an oversupply - is there another reason you can give for why that would be? (as I noted, milk allergy is pretty rare, but it does have the same symptoms - often women are told to drop dairy when the real culprit is oversupply, at least when they manage their nursing behavior, it makes an immediate difference… so what you characterize as not something nursing mothers normally have to deal with is at odds with what I see in the support forums - not 1 in 10, but certainly often enough that knowing about it is useful.)
Learn something new every day. If you can point me to reasons why milk allergy would cause those symptoms, WITHOUT damage to the lactase production system, I’ll be glad to use them.
Relevant article (showing that symptoms that would easily be ID’d as lactose intolerance are relevant, and related to GI tract injury/symptoms, though we still don’t know whether the acute and chronic gastritis is first, or second in the symptomology):
(oh, and here’s my first sign that constipation can be a caused by milk intolerance, though in this case they definitely are working from the cow’s milk allergy - specific side, not the ‘lactose intolerant’ side.)
Milk allergies and hypersensitivities can cause literally hundreds of different symptoms, including both diarrhea and constipation in babies. (There is one confirmed case of alopecia - complete loss of hair - from a milk allergy.) So there is no need to postulate intestinal damage as a cause.
(there were also a few others that stated things like: "Allergy to cow milk protein is a common cause of gastrointestinal symptoms in infancy. "… but it looks like allergic reaction causes either upper or lower intestine issues (small intestine enteropathies, gastritis, colitis).
There’s a lot more out there on the topic, especially in the recent past (2003): Ann Allergy Asthma Immunol. 2003 Jun;90(6 Suppl 3):81-3. Cow’s milk allergy: a new understanding from immunology. (Suggesting that T-cell activity is the cause of the gastro-enteritis - and presumably the gastro-enteritis is causing localized damage, and that’s what causes the diarrhea… but as already noted, intestinal damage from infection (presumably also from inflammatory allergic reaction) can cause short-term lactose intolerance, so we’re back to ‘milk allergy causes lactose to not be digested properly, and then you get the diarrhea/etc.’)
Sorry, that first link didn’t do more than explain that there’s a difference between the two issues. I know that much! The second didn’t do anything more for me than the first. Nice basic stuff, very solid, but not what I’m looking for. I need more detail.
And I know that milk allergy can create many different symptoms - including ones identical to lactose intolerance.
But why? What I want to know is whether milk allergy causes temporary lactose intolerance in some cases - which it does SEEM to do, but I can’t find anything that says for sure that the gastroenteritis (etc) that CAN be a result of the allergy response actually affects the lactase production process, and therefore causes the diarrhea, or if the diarrhea is caused by the gastroenteritis itself (or something else). I just presume that if damage to the small intestine from one cause can reduce lactose tolerance, then damage from another cause can do the same thing. But that’s a big presumption.
I end up coming around to the conclusions of the (admittedly flawed) article I linked first, though for perhaps different reasons - they point to immediate brush border damage, but the most recent stuff I can find suggests T-cell inflammatory reactions instead - but is lactose involved at all? Argh.
Does my question make sense? I know there’s a difference between the two causes, but what I’m usually faced with is a mom whose baby is pooping green foul mucousy stuff and is crying a lot from apparent GI pain… being able to say WHY allergy causes diarrhea seems to provide a lot of comfort for them while they work it out (for the few who actually have a diarrhea=allergy situation - as noted, that’s still pretty rare, about 1-3% of the population).
Sigh. I should have just gone into biology, instead of being a writer. And this is now getting WAY off topic, and probably off your specialty, too (I need an immunologist who specializes in gastric symptomology!).
[QUOTE=Exapno Mapcase]
Actually the number documented in the medical journals is more like 40, but I added some because now that doctors know what to look for more are being found.
Hi, although undiagnosed I think my daughter might be case #41.
She appeared to be fine at birth. 9 # (definately not pre-mature) and breast-fed normally for about 6 weeks, gaining the appropriate amount of weight. Between 6 weeks and 9 months she basically failed to thrive while still being breast fed (gained only about 6 pounds). But during the course of this she suffered from extremely severe skin allergy’s and screamed while being fed. Her skin was basically an open wound, she used to stick to the sheets while she slept (yes it was a nightmare).
So after visiting many, many MD’s and allergists and trying to get rid of all the “bad” stuff in MY diet we finally found an allergist who suggested stopping breast feeding and subbing first soy (no help) then something called Nutramegen (an enzyme pre-digested powdered formula). Within three days of being on the Nutramegen all of her symptoms disappeared.
She still remained severely allergic to many foods. If she was kissed by her bearded dad after he had eggs for breakfast–she got hives. One time she dumped a glass of her brother’s milk over her head and developed 6 inch diameter welts all over her body and began to gasp for breath (a trip to the ER and a shot of Epinephren to the rescue). Eyes swelling shut and more gasping when her kindergarten made peanut butter even though she didn’t eat or touch it (off to the ER).
Aside from all this (and the asthma she devolped at age 2) she has always been a very healthy kid. No ear aches, no overabundance of colds or flus. Just basically a normal kid who even at the age of 22 still carries an Epi-pen with her.
Have you heard of this before. Was she really allergic to breast milk? BTW her brother was also solely breast-fed for 10 months and ended up weighing 30#. His doctor said he was the first over-weight bf baby he had ever seen.
Again, allergies are not in any way the same as lactose intolerance. Your daughter lived for six weeks on breast milk. She would have been dead for at least five weeks if she were congenitally LI.
There are no confirmed cases of allergies to breastmilk that I know of. Something from your diet was passing through your milk. You found the right allergist who did the right thing.
Not the norm, but not a one in 100,000,000 case either.
[QUOTE=Exapno Mapcase]
Again, allergies are not in any way the same as lactose intolerance. Your daughter lived for six weeks on breast milk. She would have been dead for at least five weeks if she were congenitally LI.
Actually you’re the first one who’s made any sense. I did the whole thing of removing different food groups to see what was setting her off. At the end I was basically eating brown rice. Not good for her and certainly not for me.
When we did start to introduce her to foods at about 1 year she was allergic to just about everything including bananas, beef, veal, wheat, soy, rye, pork, bison (we kind of lost our wits for a while and were trying anything). Symptoms were hives, swelling, wheazing, and vomitting. Surprisingly enough to us the allergist that got her on the nutramagen suggested we try hot dogs and ham!!! She was fine with both. His reasoning was they were pre-digested. I was kind of an earth mother person at the time and would never have given my kid a hot dog
:eek:
Thanks for the ref but the kid is now 22 and takes pretty good care of herself. Still violently allergic to bananas, milk, eggs, cheese and peanuts.
Did you come up with any way to answer my question, EM?
It also occurred to me that if lactose-free formulas seem to ‘help’ kids who have other issues (enteropathy-related), then those other issues are affecting lactase production. Whether the cause of the gastritis/enteropathy/diarrhea is strictly allergy-based it still up for grabs (most of these people have not had their kids allergy-tested, or they’d be on nutramigen or alimentum or one of the other few hypo-allergenic formulas)… but if reducing the lastose in the food improves the symptoms, then that suggests that there’s a problem with the lastase production, doesn’t it?
PictstiePat, glad your doctors had a clue. I have a friend who had to fight her doctor to get sent to an allergist, with almost exactly the same profile (failure to thrive after initial good growth, multi-system reactions, and bloody diarrhea). Her daughter is allergic to almost the same things, too - milk, beef, chicken, soy, peas, and a few other things I can’t remember (interestingly, not peanuts, even though peas and soy are related to peanuts). EM, I’m going to send her the link you added, too. Her daughter is pretty young, still, so she’s just on the beginning of the learning curve.
Diarrhea has a thousand possible causes and the inability to manufacture lactase is only one of them. Just because a milk hypersensitivity can cause diarrhea does not imply that it must do so by stopping lactase production. There is no data at all that would imply that a child with a milk hypersensitivity would be helped by a milk-based but lactose-free formula, and much evidence to the contrary. The majority of the time going on a soy-based formula is all that is needed. Nutramigen or one of the other amino acid-based formulas is rarely needed except for extreme cases of multiple allergies.
Reducing the lactose in food helps only those children with lactose intolerance. There is no evidence at all that the common secondary lactose intolerance found in children is caused by milk allergies.
I actually realized on the way in to work today (brain is slow these days, darn it all), just exactly what you said - that the reason the health orgs don’t recommend lactose-free formulas for diarrhea is probably because that’s just ONE cause of diarrhea. And the kids with milk allergies are having diarrhea in reaction to foods with just cassien, and no lactose, so there’s another situation where lactose is not to blame. Sigh. Sorry it is taking my brain so long to digest this stuff (no pun intended).
I wouldn’t be surprised if SOME of the time, inflammatory reaction in the right (or wrong) place could affect the lactase production, but then we’re talking about fractions of a percent of cases, most likely (given the vast range of where the T-cell activity targets). And even then, the cause is what you treat (allergy), not the symptom (not enough lactase). So it really isn’t worth even mentioning secondary lactose intolerance in those conditions anyway, because it distracts from the base issue (the allergy). It still applies for oversupply, just as you can overload someone’s capacity (and cause symptoms) by giving them massive quantities of lactose in a meal anyway… but again, nursing management helps that fine.
