Q&A about lactose intolerance with Lactofree's expert and Consultant Paediatric Allergist, Dr Adam Fox - ANSWERS BACK

[RachelMumsnet]

Do you, your partner of your child suffer from digestive disorders which you think could be related to dairy? This week Lactofree's expert and Consultant Paediatric Allergist Dr Adam Fox is joining us on Mumsnet to answer your questions. Dr Adam Fox has trained in Paediatrics and then Paediatric Allergy in some of the country's leading teaching hospitals including Great Ormond St Hospital, St Mary's and the Royal Free Hospital. He is now a consultant Paediatric Allergist at Guys' & St Thomas' Hospitals as well as an honorary senior lecturer in Paediatric Allergy at King's College London. He also sits on Lactofree's expert Advisory Board, providing regular advice to their lactose intolerant community. Send your questions to Dr Adam Fox before the end of Sunday 15th May and we'll link to his answers from this thread on the w/c 23rd May.

Hi

My 3yr old DD is severely intolerant to dairy, soya, oats & barley.(sickness, diarrea (sp) or severe constipation, bloating, wind etc)

We (me,pead & dietician) have always thought she is lactose intolerant but she did not tolerate lacto free milk......

She has now been referred to C&W hospital after being seen at our local hosp since she was 8mths old.

As we have not tried her with any dairy etc for over a yr we were told (by dietician) to try her again as C&W hosp would want to know latest reaction etc...

So a couple of wks ago I gave her a tiny amount of cheese on toast (dairy/soya free bread).....no reaction!!!

She has now has cooked/baked cheese a couple of times with no reaction (tiny amounts though)

Yesterday I gave her a margarine which had milk in ingredients....no reaction

Basically where do I go from here?? What is the best way of re-introducing dairy into her diet?? And over what period of time??

Would it be too much to give her a small drink of milk or a fromage frais yogurt etc....or am I best to cook with it (ie scrambled eggs with milk in etc)

My boys (4 and 2) are both lactose intolerant, which was diagnosed by an allergist/dietiician team at the hospital.

My question is, to what extent is it a good plan to keept trying them with small amounts of 'normal' dairy (ie not lactofree, which they both do very well on)? Should I be trying to build up a tolerance by giving small amounts of lactose regularly, or is this not likely to make any difference? Their symptoms are stomach cramps, diarrhoea etc.

I didn't know that you could treat dairy products with lactase from Holland and Barrett! Does it work on plain yoghurt and cream, the two products I would like the lactofree range to include?

Dr Fox I would like lactofree cream and plain yoghurt too. If you can lobby the manufacturers of Lactofree to do some i am sure they would sell well. Having said that I have never seen the Lactofree cheese or fruit yoghurts in my supermarket - only the milk.

TheProvincialLady - if it is any help I use Alpro Soya Cream which is just fine in cooking instead of single cream and I even mixed a little cornflour with soya cream to thicken it just enough to make a nice lactofree lemon sylabub. Gelatne might have been better.

If its any help creme fraiche and sour cream have less lactose in. You can get other lactose free dairy products on certain web based retail sites too if you Google.

MoreBeta - we found Lactofree Cream this week (or my amazing Daddy did!). Brilliant for DD and Eton Mess which she hovered up with the rest of us.

My daughter hardly misses out on anything been lactose intolerant post gastic bug but Q to Dr Fox. We know she is still intolerant 1 year on (she is 2 now) as she stole some dairy pudding recently, 1 spoonful, a lot of mess an hr later!

How long should we exclude dairy or try little bits every few months??

Hello Dr. Fox,
Can you please advise us? Our DS2 aged 3.8 was diagnosed with autism approx 2 months ago now. He has always had very loose bowel movements, usually 3/4 times a day, and he has been tested for coeliac disease and was negative. I have been informed of the sunderland test through MN, and have requested a pack but haven't sent DS's sample off yet. (It is a urine test that looks at the amount of peptides in the urine, costs £60 and is done by an autism research centre at sunderland uni).

We know dairy free diets can help lots of children with ASD, and we have cut down on the dairy and DS is now doing more solid bowel movements, but not quite there yet, some can still be very soft and runny.
Can we request any similar sort of testing on the NHS? Our Dr and paed are not interested in testing further, we have not have a referral to a dietician. We are trying (without success) to toilet train DS, and he is Ok with his bladder but his bowel movements are causing us problems, and the ASD doesn't help. if he did solid poos it would be easier. Any advice please?

Maybe mumsnet could advise about the scope of the q&a? Granted the blurb at the top talks mainly about digestive issues and intolerance, but since Dr Fox is in fact a paediatric allergist, it seemed reasonable enough to ask about dairy allergies. If you could clarify, that would save both our and Dr Fox's time asking him questions that he isn't intending to answer. Many thanks!

katiebeau - where did you fird lactofree cream?

I have heaed that coeliacs can go back to lactose after a while once their gut has healed but woud like to hear Dr Fox on that point.

Hello, this is a timely webchat for me!

My DD2 appears to have some sort of dairy intolerance. She was being sick in the night from excess phlegm for about 6 weeks (since being weaned onto solids basically) and the only thing that stopped it was cutting out dairy (well, obvious dairy products). She is breast fed and as far as I know my milk isn't effecting her, it certainly isn't making her sick. I have several questions, feel free to answer the most pertinent/useful:

How do I get my GP to take me seriously? He doesn't seem to believe in dairy intolerance (amongst other things he doesn't believe in!)

How do I know if it is a CMP or lactose intolerance and does that effect the things you can/can't have or whether they are cooked etc.

The other day I accidentally gave her an omelette with parmesan and she came up in hives around her mouth, having previously had it at the beginning of weaning with no such effect. Does staying off dairy make the intolerance worse?

I'm fed up with playing food detective and have no idea where to go from here in terms of reintroducing dairy to see if it has an effect. I wish my GP would be more helpful.

Hello,
My (breastfed) DS has suspected allergy to cow's milk products after developing eczema at 4 months and reacting with vomiting and hives when weaning with dairy products. His eczema is much improved after I cut all dairy out of my diet and we have had no repeat of the vomiting/ hives with any other foods. I am hoping that he will grow out of the allergy, as I'm told this is common. If he does, what are the chances of him becoming lactose intolerant during this time? Am I at risk of becoming lactose intolerant by cutting out dairy for 6 months?
Many thanks.

To Libelulle and all those who have asked us to clarify the scope of this Q&A and whether Dr Fox is open to questions about allergies beyond lactose intolerance. We're sorry it's taken us some time to get back on this but wanted the answer to come straight from the horse's mouth so there was no further confusion. We received this message from the folks at Lactofree this afternoon:

Lactofree would like to advise that Dr Fox will be answering all questions on digestive difficulties related to dairy - in particular the confusion between lactose intolerance, cow's milk allergy, and other often misdagnosed related conditions.

Feel free to submit your questions on any of the above. We look forward to your questions

The Q&A will close at midnight on Sunday 15 May so do post your questions to Dr Adam Fox before then.

Hello Dr Fox.

My main question is how on earth do I get my children to see an allergist?
My GP surgery refuses to send any of my children to have allergy test.
My DD1, 11, has a nut allergy, to which one and how bad is a mystery so we live in fear!
My DD2, 6, has a dairy allergy which seems to be getting worse rather than better with age. Again we dont know what she is allegic to so we avoid all dairy.
My DS, 2, has had problems from birth which led me to cut all dairy from my diet as I was exclusively breast feeding. He wouldn't tolerate nutramigen. He is unable to tolerate anything with dairy in. He doesnt come out in hives but it just goes straight through him, he ends up with extremely smelly, loose bowels.

I dont go to the doctors because they are not interested in doing anything to help us!

What can I do to try and find out what exactly is wrong with my children?

Hello there Dr Fox!

My daughter was diagnosed as lactose intolerant at around 10 weeks, and was prescribed lactase enzyme (colief) to have at breast feeds as well as lactose free formula for bottle feeds (breastfeeds were very traumatic experiences most of the time). My GP was initially reluctant to prescribe these things as she was gaining weight well, but after the dramatic difference in her reaction to my milk was observed by the health visitor after having had the colief, as well as how different she reacted to normal formula compared to lactose free, he agreed to make a referral. However whoever he spoke to (not sure who, either a dietitian or a paediatrician) said that they don't tend to test for lactose intolerance any more, and the diagnosis is based on the symptoms and history, so agreed in the end to take mine and the health visitor's word for it.

Is this true? It seems a shame that there is no way to definitively test for it. I am sure that my GP was never very convinced. Miraculously, my daughter very suddenly grew out of her symptoms at 12 weeks - I would occassionally trial her without the colief if we happened to run out unexpectedly to see if she could manage without it. Every time this led to screaming, but one time it didn't, and thereafter she was fine without it. The difference was dramatic. I haven't tried her with normal formula yet as apparently cows milk has more lactose than breast milk, but now breastfeeding is less traumatic I am back to exclusively breastfeeding now anyway so this is not so much of an issue.

We had to go through 10 weeks of having a very unhappy screaming baby who was clearly in pain to get the right stuff prescribed - breastfeeding was a nightmare experience for me and I very nearly gave up, but now she is over her problems it is a dream. I have read that this transient lactose intolerance can be a common cause of "colic" in babies. It could end up being a big barrier to breastfeeding if it is not recognised and treated correctly I would imagine, as it was to me. Why can it not be tested for? Why do GPs not recognise the problem and take it seriously? Or, if they do not have the specialist knowledge, why do they not make appropriate referrals more readily? If this lactose intolerance is common, then it should be recognised so that families can be supported in continuing to breastfeed, and reassured that in many cases babies can grow out of it (although I know this is not always the case).

Also can I ask what advice you may have for me in how I should go about weaning in my daughter's case?

Many thanks.

Hi, My daughter is three and a half and has had loose bowels movements ever since we took her off Aptimil and put her onto organic cows milk. She also has a bloated tummy and I just put this down to being a toddler but now I think the two are linked. She has been allergy tested which have come back negative and she is a good weight and height for her age. However, she has been clean and dry for a year but she suffers from terrible wind and so often soils her knickers when she passes wind which really upsets her as she seems to have no control over it. I have been advised to start eliminating foods to try and see what it is that's upsetting her but this could be a long process. I am starting with milk and if there's no change in a month, have been told to cut out all dairy. Is there no faster, more accurate way of doing this? It's so frustrating....

Hi
I have a DD age 6 with low level (1 on blood test scale 1-5) milk allergy and megacolon, treated with movicol paed since age 1. We tried lactofree milk, cheese spread and yogurt last year to little outward effect so stopped after 6 months. She has since developed asthma and hayfever and eczema worsened. Additionally nut allergic.

Is it likely to be helpful to completely exclude dairy from her life?
since all we did before was replace some elements, and generally minimise her intake of regular dairy products?
Thank you

I have ulcerative collitis, which is helped by a dairy free diet

I am now 11 weeks pregnant and on a dairy free diet, though I do it lactofree yoghurt cheese and milk. I am on the equivalent of 1200mg of calcium tablets per day (Adcal D3) for low bone density. Will this all be providing enough calcium for the pregnancy

Hi Dr Fox,

Sorry for the long post, once I started I couldn't stop!

I have 3 DD's 2 of which appear to have some form of dairy intolerance.

DD1 has had problems with dairy since birth, she was a crying, screaming shouty mess until I cut diary completely out of my diet (she was EBF), when she became a calm and placid baby. (My DH developed a dairy intolerance in his 30's so the diet change was not too difficult!) We had several challenges whilst she was small with the same screamy shouty baby result. She was weaned with nutramigen and has been skin prick tested for a dairy allergy but with no positive result.

As she got older we were advised to reintroduce dairy which for a year or 2 she seemed to tolerate, then after she had been continent for a year she became constipated which soiling and unrinary incontinence The constipation is much much worse after any dairy (birthday parties etc) where she can be rolling around her bed allnight with tummy ache. We then have weeks trying to get her bowel back on track. (She has been seen by the paed continence team).

However we are now wondering if her intolerance is worsening as the frequency of constipation is increasing (she has 3 sachets of paed. moivicol a day with a firm-ish result (sorry if tmi)), and without any obvious dietary changes i.e. no obvious dairy (we have recently also removed goat cheese and goat butter, which she did previously tolerate). What would be the first food group to exclude to see if she has an additional intolerance? I ask as I understand soya is closely associated but we have been reluctant to do so until now as it is a replacement in so many of the products she can eat!

DD3 also seems to react go dairy with ezcema patches behind her knees and in her elbows when I have dairy, and has a slower poo transit time (but not constipation Yet!). She seemed to have the same bowel/ shouty baby issues initially (she is now 23mths) she is bf 2x day as she does not yet have milk (she does have goats cheese and goat butter). Would it be advisable to keep her dairy free (ish) or challenge her a little more and slowly reintroduce dairy?

To top it all our other DD has CF and has to have a high fat diet!! Food and meal planning is already a nightmare in our house!!!!

Just a cheery message to say my two are now 11 and 8 and have both outgrown their once severe intolerance to dairy.

Didn't sleep through till they were both were 18 mth old, hives, projectile vomit of any dairy, all the gastro drugs mentioned below.

They do grow out of it.

Think it might be hereditary though as my mother claims I was like that as a small child too but there was no name for it back in the 1960s

Hi Dr Fox
I'm not sure if you'll really be able to help with this as it's really more a question about colief.
My DS was born 4 weeks early and seemed to be very unsettled and uncomfortable after breastfeeding. He had cramping and very bad wind that infacol, gripe water etc, just didn't seem to help. Feeding times were very hard and emotionally draining and at 6 weeks I finally switched to formula. His symptoms didn't change much and my HV and GP were of no help, so i started looking on the internet, I read somewhere that colief was good for those type of symptoms and that premature babies will quite often react to lactose due to immature digestive system so I decided to try it.
There did seem to be a big difference and he was much happier. My problem now is trying to wean him off it. The instructions say it should be fine to wean them off it at 3 to 4 months as their digestive system learns to cope with lactose, however he's now 5 months and everytime i've started reducing the amount he seems very uncomfortable again, however he's also showing symptoms of silent reflux so GP gave us infant gaviscon to try and that has made things better.
How do I know if he definitely has a lactose intolerance rather than it just being something else (eg reflux)?
I'm scared to stop the colief completely as he seems to be uncomfortable when i try to reduce the amount given, especially for the first few days. Will his system learn to cope if I persevere with weaning him off it and get used to lactose or is it better to just keep up with the colief and keep him off lactose completely?

why, oh why, when so many children have a dairy intolerance/allergy is a cow based product the only freely available alternative to breast milk. Lets face it, cows milk is actually for cows. Why are paediatricians not pushing for the development of a formula that is nutritionally sound and not based on an animal product? (I'm not vegetarian btw)

Sorry if this is a silly question (?)

Ds1 (3) often has loose bowel movements, it just seems normal to him. He is small for his age (always has been) and has a bloated tummy, but is progressing well in all other areas. Could loose stools be a sign of intolerance in the absence of other symptoms? He was 5 weeks prem and ebf apart from the first week where I had to wean him off formula (grr at hospital pushing formula more than they needed).

Ds2 (6 months) has just started being weaned. He has always had greenish poos, but now they are thick, mucusy and he is in pain with wind, which has never happened before. Could this be a sign of intolerance as well? (He has had little bits of cheese/ egg). The green poos have been passed off as 'one of those things' by HV (which it may be).

Thanks

It's your last chance to send in a question to Dr Adam Fox and we'll be sending them all over to him in the morning. As soon as the answers are back, we'll be linking to a transcribed Q&A from this thread.

Dear Dr Fox, I noticed early on that my daughter had a reaction to some whole milk recipes. Anything with a mix of flour and milk (cheese sauce etc) brought on particuarly dirty nappies although it didnt seem to cause any pain. My daughert is now nearly 2 and I am having trouble trying to introduce cows milk as a normal drink for her. She eats probiotic yoghurts, rice puddings made with whole milk and custard without any side effects, but still has a problem with cheese sauce and drinking milk on its own. I always heat her milk to make it easier for her, but am at a loss as to know how to get over this, whether she will grow out of this seeming 'intolerance' or if there is something else I should be concerned about. Any help would be very much appreciated, thank you.

Just popped in to see if any response yet? we;ve obviously kept poor Dr Fox busy

Also wondering if there were any answers back yet? i'll keep an eye out

Looking forward to hearing from Dr.Fox.... sometime!