www.breastfeeding.asn.au/bfinfo/lactose.html
Lactose Intolerance and the breastfed baby
Joy Anderson BSc, Dip.Ed., Grad.Dip.Med.Tech., IBCLC, ABA Breastfeeding Counsellor
Lactose is the sugar in all mammalian milks. It is produced in the breast and is independent of the mother's consumption of lactose. It is present in a constant concentration in breastmilk. Foremilk, the milk the baby gets when he first starts to feed, does not contain more lactose than hindmilk, but it does contain less fat. Lactase is the enzyme that is required to digest lactose. Lactose intolerance arises when a person does not produce this enzyme (or does not produce enough) and is therefore unable to digest lactose.
The symptoms of lactose intolerance are liquid, frothy stools, and an irritable baby who may pass wind often. If a baby is lactose intolerant, the medical tests, 'hydrogen breath test' and tests for 'reducing sugars' in the stools would be expected to be positive. However these are positive in most normal babies under three months too so their use in diagnosing lactose intolerance is open to question.
There are some common fallacies about lactose intolerance that you may hear in the community:
Lactose in the breastmilk will be reduced if the mother stops eating dairy products.
Lactose intolerance in other family members (adults) means baby is more likely to be lactose intolerant.
If a mother is lactose intolerant then her baby will be as well.
A baby with symptoms of lactose intolerance should immediately be taken off the breast and fed on soy-based infant formula, or other special lactose-free formula.
Lactose intolerance is the same as intolerance or allergy to cows' milk protein.
Read on to see what is wrong with these ideas!
Lactose intolerance in babies
Primary (or true) lactose intolerance is an extremely rare genetic condition and is incompatible with normal life without medical intervention. A truly lactose intolerant baby would fail to thrive from birth (ie not even start to gain weight), and show obvious symptoms of malabsorption and dehydration - a medical emergency case needing a special diet from soon after birth.
Anything that damages the gut lining, even subtly, can cause secondary lactose intolerance. The enzyme lactase is produced in the very tips of folds of the intestine, and anything that causes damage to the gut may wipe off these tips and reduce the enzyme production, for example
gastroenteritis
food intolerance or allergy (In breastfed babies, this can come from food proteins, such as cows' milk, soy or egg, in the mother's milk originating in her diet, as well as from food the baby has eaten.)
coeliac disease (intolerance to the gluten in wheat products)
following bowel surgery
Note that cows' milk protein allergy (or intolerance) is often confused with lactose intolerance, and they are thought by many people to be the same thing. This confusion probably arises because cows' milk protein and lactose are both in the same food, ie dairy products. Also contributing to this confusion is the fact that allergy or intolerance to this protein can be a cause of secondary lactose intolerance, so they may be present together.
Secondary lactose intolerance is a temporary state as long as the gut damage can heal. When the cause of the damage to the gut is removed, for example the food to which a baby is allergic is taken out of the diet, the gut will heal even if the baby is still fed breastmilk. If your doctor does diagnose 'lactose intolerance' you need to know that this is not harmful to your baby as long as she is otherwise well and growing normally.
Occasionally it is considered preferable to reduce the immediate symptoms, by reducing the amount of lactose in the diet for a time, particularly if the baby has been losing weight. In this case, it may be suggested that the mother alternate breastfeeding and feeding the baby with a lactose-free artificial baby milk. Sensitivity of the baby to foreign protein (cow or soy) should be considered before introduction to artificial baby milk, as types other than the truly hypoallergenic ones may make the problem worse. Although commonly advised, there is no good evidence to support taking the baby off the breast altogether. In the case of a baby recovering from severe gastroenteritis, average recovery time for the gut is four weeks, but may be up to eight weeks for a young baby under three months. For older babies, over about 18 months, recovery may be as rapid as one week.
When even partially taking the baby off the breast temporarily is being considered, thought should also be given to other aspects of the breastfeeding relationship. These include:
How will alternative feeding methods affect this baby? Could it result in breast refusal later?
How easily will the mother be able to express her milk to maintain her supply?
A mother needs to be aware of exactly what is happening, and understand that this episode need not undermine her confidence in breastfeeding. Her breastmilk is still the normal and proper food for her baby in the long term.
You may have heard about giving 'Lactaid' drops to babies who have symptoms of lactose intolerance. There is no proof that these are of any value used this way. These drops do contain the enzyme, lactase, but need to be put into expressed breastmilk and left overnight for the enzyme to digest the lactose in the milk. In practice they are rarely useful for babies.
And so on...........
It drives me nuts that medical professionals don't know the difference between Lactose Intolerance and Cows Milk Protien Intolerance/Allergy. There is no need to stop breastfeeding, soya formula is far from safe and healthy, and the baby will often be intolerant to the soya protiens any way. Why do people always think that some kind of formula is the answer?
Monkies