To eat dairy even though my breastfed baby is lactose intolerant?

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I had a thread a couple of weeks ago about the baby having horrendous nappy rash and green, frothy poo. Went to the GP and had a stool sample done, so it's come back with a confirmed lactose intolerance.

But the only advice was to keep to an exclusion diet (I'd given up dairy thinking it was CMPA) and a link to what lactose intolerance is.

My dilemma is, I am a mammal, so I produce lactose. I have got some coleif lactose drops and they do seem to be helping. I have also pumped a few times and then fed from that boob (to get rid of the thin lactose heavy fore milk, or at least, that's my theory!).

But if the baby's not actually CMPA, then the advice seems to be that I don't need to follow an exclusion diet, and can have dairy.

My GP isn't very good with this stuff, I went in initially saying about lactose intolerance and was dismissed (so I feel a bit vindicated). They also insisted that lactose allergy and dairy intolerance were the same thing.

Anyone been through anything similar?

CMPA is a none ige allergy and the only way to test is to remove it from the diet and them reintroduce and observe the symptoms. If you do this you should also removed soya and the protein in similiar so many children will be allergic to both of them.

Gut inflamation from illness or an allergic reaction can cause temporary secondary lactose intolerance.

I’d suggest working on a trial and monitor response basis - differentiating between lactose intolerance and cmpa is mighty difficult through any other mechanism but the effect on the child is often pretty conclusive.

CMP definitely transfers through breastmilk based on my child as a test bunny. Even in sodding pesto.

True lactose intolerance in a baby is rare and serious. Cmpa also rare in bf babies. However temporary lactose intolerance/ overload can happen after tummy upset or associated with oversupply and other bf issues. I would recommend speaking to a bf specialist too, they may well be able to help. Cutting dairy would only help with CMPA but a good feeding assessment is essential to arriving at that diagnosis.

Coming at this from a slightly different angle. Is baby gaining weight as expected? The nappies are obviously an issue, but is baby having periods of contentment?

I'd expect a baby (bf of ff) with lactose intolerance to be failing to thrive. As it appears the OP knows, bm and standard formula is loaded with lactose.

My CMPI baby was a screaming velcro baby, with slow but just about acceptable weight gain. When I cut dairy (and I didn't eat masses anyway) he was still velcro baby, but generally content if being held. He's now a pretty skinny teen.

I'd echo trying cutting soya for a bit, and see what that does, but hear you that a gluten free, dairy free, soya free diet sounds very restrictive.

The overwhelming majority of babies with lactose intolerance, it is secondary to cows milk protein allergy/intolerance. Primary lactose intolerance is incredibly rare. 1 in a million level of rare. I would strongly encourage you to be dairy free.

My baby had CMPA. There’s an incredible amount of misinformation about. I would be asking for a copy of your actual results because I think there’s a chance of misinformation within the health system here as well.

Lactose intolerance is often a secondary issue caused by damage to the intestine from another source/intolerance. Lactose is digested by lactase, which is secreted by the villi in the large intestine, if these villi are damaged they don’t secrete lactase and lactose isn’t digested, and ferments in the gut causing gas, diarrhoea and so on. True lactose intolerance is pretty rare because breastmilk contains lactose, and it’s potentially life threatening for a baby to be unable to digest it, without treatment/prescription formula. So yes, the lactase drops may seem to help as they’ll counter the lack of lactase being secreted by the gut, but won’t address the cause.

You need to exclude the relevant allergens from your diet for 4-6 weeks before they stop impacting the baby, so if you’ve been dairy & egg free for 3 weeks you might be seeing improvement but not fully.

Your GP needs to refer you to a dietitian and a paediatrician. Testing for lactose intolerance is fairly simple, did they actually test for CMPA?

It's definitely not Primary lactose intolerance. I'm suspecting that it's more likely to be a lactose overload. Baby's a cheerful little soul, is gaining weight and growing well. It was more the continuous wet farts causing such horrendous nappy rash.

I cut dairy and saw an improvement in the sharting/wind (but this could also be in connection with baby's tongue tie being divided a few days before) but the nappy rash has still been bad until the day before yesterday when I started the lactase drops and it's almost immediately cleared up.

It definitely needs further investigation, I'm glad I'm seeing the GP already early next week because I'll ask for clarification on the results and what was actual tested for (I was under the impression it was a CMPA test) and for a paediatric dietician appointment.

I agree with this. I also think it's not a good idea to pump foremilk and not feed it to your baby at all, your baby needs it, it has unique qualities.

The only test for CMPI is removing the allergen. Allergy testing for CMPA is notoriously unreliable in babies, so the most effective test is again removing the allergen.

Could be from antibiotic use, and hopefully will end soon!