How to do a dairy/soya challenge?

[extracrunchy]

Bear with me - this one's a bit long!

I'm ebf DD (7 weeks) and we've been dairy and soya free on GP's instruction for the last 3 weeks to see if an allergy is causing her reflux and eczema. GP said to do a trial with dairy or soya after 2 weeks to see if she reacts, then the other once she's stable again. So I have a number of questions...

1. Is 2 weeks long enough to have been sf/df for definite results? Her eczema is better but not completely gone and she still barfs (though less often). She also still has extreme gas that stops her sleeping and stretchy mucous poo. Should we exclude dairy and soya for longer or now assume they're not the issue?

1. When we do the challenge, is it sensible for me to have a very dairy or soy filled day and then see if she reacts, given it will stay in my system for a while afterwards and therefore I'll continue to make her poorly the following day? Should we challenge with a bottle of formula instead so it's only in her system?

1. If we challenge with formula, isn't it likely to make her uncomfortable and pukey anyway even if she's not actually allergic, as she's never had anything other than BM before?

Hope someone can help! GP can't seem to give us any useful info, we're still on the waiting list for a paeds appointment and google is just confusing me!

[Auntierosemary]

1. I think go for longer, won't do any harm if not necessary anyway. Sounds like she has made good progress. Think dairy stays in yr system for a couple of weeks and then eczema can take a long time after exposure to allergens to clear up, as can digestive problems. It could be that she is clear of dairy and soya but her system is still a bit upset. Couple more weeks won't hurt!
   

1. Just try a little bit of soya or dairy one day - such as a biscuit. And repeat the next day, then build up v slowly. As you say, if she reacts you won't be able to get it out of your system easily. Would it be possible to express a bit extra before the challenge, and keep it to feed her, and expressing and discarding your milk for a day, if she does react? I know, easier said than done...!
   

1. Formula is not a good idea - if she is reacting to the protein in your milk she must be v sensitive because very little actually makes it through. So to expose her to dairy formula with loads of protein in it could make her very sick if she is in fact allergic to it. Plus, it could make her even more sensitive to it thereafter.
   

Ps make sure you are keeping up your calcium if you are dairy and soya free. You need something like 1200 mg per day if you are breastfeeding (equiv to about 900mls of milk!) see this link for more info:

www.uhs.nhs.uk/Media/Controlleddocuments/Patientinformation/Digestionandurinaryhealth/Adviceforimprovingyourcalciumintake-patientinformation.pdf

[Auntierosemary]

Pps look out for hidden dairy/soya - I have recently discovered that most bread has soya protein in it in the form of soya flour. Lots of supermarkets have own-brand oat and seed loaves that are totally soya free.

[extracrunchy]

Thank you for your post
Yep I've discovered soya is in EVERYTHING!

So would you say after maybe 6 weeks sf/df if she's still getting eczema/reflux/nasty poo we're probably dealing with something other than cmpa? Hopefully we'll get a paed appointment in the next 3 weeks but at the moment it just feels like we're on our own!

[Auntierosemary]

Yes but the good news is that most soya is ok - it's the protein you want to avoid and soya lecithin (which is in everything) is ok, because it doesn't have protein in it. According to our dietician anyway... Only main sources of soya you need to avoid are soya milk, butter etc, soy beans, soy sauce etc, and soya flour. So that's anything called soya something, and most bread, but that's it.

It sounds like you are on the right tracks and have a great Gp who is willing to listen and not dismiss it as a tummy bug, which most do in my experience. My older daughter was five months old before anyone mentioned the possibility of an allergy, so you are doing really well to be this far already! And fingers crossed it isn't an allergy at all. Maybe a tummy bug? :-)

If I were you I would adopt a really bland diet until you have seen your paediatrician. There are allergies that are a lot more common than soya - like egg or gluten. And others that are common enough such as sesame, nuts and other legumes like lentils and peas. So if it is an allergy, it could be anything!

If you can bear it, try sticking to meat, potatoes and vegetables for a few weeks. You can have a very varied diet that is allergen free but it takes a bit of getting your head round, so only worth it if you really need to I reckon! Post again if you want any dinner ideas. We are currently diary, soya, sesame and egg-free in our house.

[extracrunchy]

I would LOVE some dinner ideas

[extracrunchy]

I guess we'll hear from the paediatrician (no referral to dietitian yet) about next steps if we think it's not dairy/soy - but regarding that, how did you establish yours were more than just milk intolerant? Did you do the crazy Dr Sears elimination diet and cut everything out at once then reintroduce one at a time, or did you cut one thing out at a time? I have a suspicion wheat or gluten might be involved as she's much worse on days when I eat a lot of bread (soya free!) and I get very bloated with wheat so it could possibly be inherited... But I'm pretty sure she's not celiac as she's growing well, which I understand wouldn't be the case.
(Google is a mine of brilliant info and a curse at the same time )

[Auntierosemary]

Hi I had already cut out dairy for my second daughter when I was feeding her and she only had issues after we gave her a bit of soya formula (projectile vomiting) and then I had to cut out soya too. She was fine with me eating other allergens when I was still bf her, it was only when she ate them herself there were any problems.

We had to wean her really slowly, introducing one food at a time and keeping a food diary. I'd really recommend keeping a diary - you can look back even months later and see patterns that you weren't aware of. We just kept note of all foods eaten, state of nappies, state of skin and any other symptoms, like sleeping badly or windy etc.

As for dinners, I can tell you our weekly plan straight from our shopping list! As you will seem we have quite a high fat diet for our dairy free girls. Us parents are supposed to be more healthy but haven't quite got round to that yet...

Roast chicken and chips with corn on the cob
Parsnip and carrot soup
Chicken risotto (with mushrooms, onions and peas)
Chicken fried rice (with courgette, carrots, spinach and almonds)
Pasta with pesto (asda do a nice allergen free one) and sundried tomatoes, olives and pine nuts with bake at home baguettes (you can make your own garlic bread by mixing garlic oil with pure sunflower spread and putting it into slices of bake at home baguette before putting in oven)
Sausages, chips and beans
Gram flour pancakes with ham, olives, humous and falafel

Kids will also have a couple of easy lunches like spaghetti hoops/beans on toast and for the fridge we usually make a big bowl of pasta mixed with Oatley cream, sweetcorn and a tin of tuna in sunflower oil - we tip in the sunflower oil too to keep our fats up. Yum!

Good luck!!!

[greenbananas]

Yes, allergens stay in your system for a couple of weeks, and then might take a couple more weeks to clear the baby's system. I think it's a bit soon to be trying to reintroduce things.

I basically did the crazy Dr Sears elimination thing. It was v.v. hard, I lost a lot of weight, and I wouldn't recommend trying this unless you are desperate!

In my case, I was feeling quite desperate at the time. DS was about the same age as your baby, I'd eliminated dairy and eggs and seen a huge improvement, and was keeping a very detailed food diary, but there just seemed to be too many variables and I was at my wits end with worry about him. He had odd days when he seemed quite well in himself, but he still had open, weeping, infected eczema all over his body, was often very poorly and unhappy and still occasionally had some very scary breathing problems.

I don't regret doing the elimination diet, because I did eventually identify pretty much all of his allergies this way, and he became a fairly normal little baby with perfect skin - but this is certainly NOT a thing you should undertake lightly, and of course everybody will tell you are crazy if you do it.

I think in your position, as you are already suspicious of wheat, I would try excluding that for a few weeks first. Wheat is a particularly difficult one to exclude. You might see an improvement - but then if you don't see any improvement at all you might be able to conclude that wheat is not contributing to the problem, and have the bonus of keeping on eating wheat if you do decide to proceed to the more extreme elimination diet.

It's well worth keeping a careful food diary (e.g. if you put jam in your rice-milk porridge, make a note of whether it was strawberry jam or raspberry jam). Write down on each day what your baby's eczema was like, and how well she seemed generally. That way you can go through it in weeks to come and look for patterns if necessary.

I wish you much luck with all this. So sorry this is happening... but it's great that you have a doctor who is taking you seriously.

[greenbananas]

AuntieRosemary, I like your weekly food list and will be pinching some ideas from it

Also, that whole list could be wheat free if garlic bread left off, sausages sourced carefully, pasta was the freefrom wheat-free stuff and soup was thickened with cornflour.

[extracrunchy]

LOVING the list!
And thank you greenbananas for more useful advice

[arlandria666]

2 weeks seems a bit quick...I have been dairy free since DS was 2 weeks old he lost so weight and was quite poorly until I cut out dairy. Initially I had to do a 4 week exclusion then reintroduce...I had one meal with cheese on and it affected him straight away. It takes at least 2 weeks for it to leave your system. DS is 8.5 months old now and dietician recently told me I have to be soya free too and we won't challenge until he's 1. Hope you get some answers.xxx

[extracrunchy]

I did think 2 weeks seemed quick but it seems to be what GPs are telling a lot of people
I'll definitely stick with it a bit longer (even though I am GAGGING for a Dominos!)

[Branleuse]

almond milk is the best milk substitute imo ( get the normal one, not the unsweetened) and you can use vitalite or pure for your spread.
coconut oil or creamed coconut makes a good butter substitute too.

forget about cheese. there are no decent substitutes

i cant eat dairy or soya either, but i dont eat gluten either so didnt know soya was in bread.

[extracrunchy]

Oh I'll look into almond milk. So far have had Oatly, which is very nice in the chocolate variety but the normal one is horrible in tea!

Vegan cheese is VILE.

[Auntierosemary]

Yeah vegan cheese tastes of sick. I got vitalite once but it had cows milk in it,is there a variety of it that doesn't? I love Oatley milk but it probably does take a bit of getting used to. I couldn't drink a glass of cows milk now, it is so farmyardy! I have cows milk in tea and coffee if I'm out, so as not to be a pain, but 14 months on, I really wouldn't miss it. Apparently it is far more healthy to be dairy free and a lot of people put Japan's comparative lack of cancer and heart disease down to low dairy intake. This is what I like to thnk to myself, as I get stuck in to a bottle of wine and packet of kettle chips (lightly salted of course, not cheese and onion, god forbid!).

[extracrunchy]

Haha every cloud...!

[TisforTiger]

Sorry not read the whole thread. But wanted to say our specialist and dermitologist said that to see an improvement in ezcema can take 6 plus weeks so I would be surprised at 2 weeks being long enough.

It's so tough being on a restricted diet, I had a long list a foods I could not eat while BF, lost baby weight and more (under 8st so not good).

[extracrunchy]

At the moment I'm just dairy and soya free and that's hard enough!
Her eczema is up again today and I have no idea why. It's so frustrating
Since yesterday I've had bread, pasta and a lot of tomatoes (pasta sauce and soup) so I guess it could be one of those. Would tomatoes get into bm?

[Branleuse]

it might, but wheat and tomatoes can all be allergens. tbh, id take your diet right back to basics, kind of paleo. do it for a week and see if it helps

stick to stuff like rice ans potatoes for your carbs. fruit and veg, and unprocessed meat and fish
cut out grains, dairy and junk food and after a week, add something back over the course of a few days, then one more thing. see if you can determine what it is.
it sounds a pain, but if she does have a food intolerance, its something youll have to do at some point anyway

[CouthyMow]

Auntie rosemary - soy lecithin DOES have proteins in, just far less than true soy. My DS3 still goes into anaphylaxis from soy lecithin...

[Auntierosemary]

Crikey, I didn't know that couthy. Another thing to look out for then. But I did just look it up online and allergy uk says:

"Since lecithin is a fat, soya lecithin contains very little soya protein, and most people with soya allergy can tolerate it."

So presumably it would be ok for an ebf baby's mother to have soya lecithin, but not v highly allergic people, like your son. That must be really tricky to avoid, sounds tough.

[CouthyMow]

I. Couldn't even have it when bf him - but his allergies ARE at the very severe end, he is contact anaphylactic to most of his allergens, just touching them can put him in anaphylaxis...

[CouthyMow]

For a replacement milk, have you tried Koko coconut milk? It's far nicer than oat milk , which is quite watery, and almond milk can run the risk of exacerbating a nut allergy (as we found out with DS3...).

Oatly cream and Block Stork (in the gods wrapper, NOT the one in the tub) are good alternatives to milk and butter when cooking, I can make a mean white sauce that's dairy & soy free now!

[CouthyMow]

Gods wrapper = GOLD wrapper. Bleedin' autocorrect!!

[extracrunchy]

Ooh I'll definitely look into Koko. Didn't know you could aggravate a nut allergy with almond. Scary! All of this is to be honest... Weaning is going to be terrifying!
Re soya lecithin - I'd been avoiding it, but had a bit in my multivitamin, however over the last couple of days I have had some dark chocolate with it in and also a bun at M&S. Maybe that's what's done it..? Or would it not pass through breastmilk, as it's not a protein?
Thank you all so much for your help! I'm feeling a bit overwhelmed with all this. DD is really suffering this evening and I feel powerless to help.