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December 8, 2014
I have had many requests for discussions on milk, milk intolerance and allergy. Here is an updated article that I wrote a few years back.
Milk has been a cornerstone of childhood nutrition for as long as one can remember. Our children are expected to drink milk at home, in school and and multiple times a day. The positive health benefits of milk have been touted by the dairy council and the federal government for years.
Now usher in modern health concerns. The world is changing faster than medical research can keep pace. Childhood allergy and food intolerance are on the rise and parents are rightfully getting frustrated with both sides of the debate regarding food avoidance. Our children cannot have peanut butter sandwiches at school or camp anymore. Many parents are living with the dread fear of childhood anaphylaxis, a severe food allergy. Babies are developing eczema and milk protein enterocolitis at increasing rates. The root cause of the problem is still under intense investigation.
My daughter had classic milk protein intolerance. From birth she was purely breastfed. By 3 months of age she developed eczema, colic and green bloody stools. My wife's sole intake of dairy was cheese on her salads. However, the cow milk protein was passing through the breastmilk to my daughter and causing an intense self destructive immune reaction. My wife promptly removed all dairy from her diet. Within one week my daughter was symptom free. Since those unsavory days, my daughter has healed her permeable gut and can now tolerate low volumes of dairy as cheese without issue. She still self selects to avoid milk and yogurt because she "doesn't like them".
These days it seems that this story is increasing in frequency and severity at our office. It is a rare week that goes by that I am not counseling a family to put their child on a three week dairy elimination challenge. The purpose of this article is to raise awareness to the symptom complex of cow milk protein intolerance and also lactose intolerance.
First, cow milk protein allergy is an IgE antibody mediated immediate reaction to a cow milk protein. The symptoms are hives, vomiting, diarrhea, wheezing, throat and lip swelling, drop in blood pressure and other signs of anaphylaxis. Cow milk protein intolerance is a much slower immune reaction usually taking days to occur. The symptoms are usually eczema, gastroesophageal reflux, diarrhea, chronic congestion and colic.
The two main proteins in milk are whey and casein. An individual may be allergic to either or both. The casein is the curd that forms when milk is left to sour. The whey is the watery fraction which is left after the curd is removed. Some symptoms can overlap between both types of reactions.
Early recognition of the intolerance symptoms can save a child many courses of unnecessary antibiotics, reflux medicines and general pain. Early recognition of milk allergy will prevent a possible life threatening event. It is paramount to think of the root cause of the illness and not seek the bandaid approach of drug suppression of symptoms.
Avoidance of all dairy is the treatment for both types of reaction. The likelihood of resolution of the allergy or intolerance improves with every year of life. Unlike peanut allergy, most milk allergic children outgrow the allergy by 6 years old and many outgrow the intolerance in the first 5 years of life.
Second, lactose intolerance is an inability for the body to metabolize the sugar in milk called lactose. This intolerance is based on the lack of production or function of the enzyme lactase. It is more common in people of African and Hispanic descent than Caucasion Europeans. The deficiency also increases with age in all humans.
The symptoms are bloating, flatulence, cramping and diarrhea. If you think that you have these symptoms after drinking milk, then you should refrain from milk for a few days and rechallenge your system with a glass of milk. If the symptoms return, then avoidance of milk is a good idea.
Now we are taught that milk is necessary for good nutrition. We are told that it's consumption is necessary for us to achieve adequate levels of vitamin D and calcium. I find the claims of the ADA and the dairy council of low merit.
The debate regarding the need for dairy should be settled by each individual based on their genetic history coupled with their nutritional needs. The time of milk for all is over as my prescription pad has been worn out writing notes to schools for countless children with milk allergy and intolerance.
I will give a few opinions based on questions I receive in the office everyday:
1) I think that recombinant bovine growth hormone, that is used to increase milk production, is unlikely to be healthy and definitely unnatural. We would never use human analogues of such hormones to routinely increase maternal breast milk. Its use is banned in the European Union, Canada, New Zealand and Australia. Look for hormone free animal products until the safety is proven without a doubt.
2) I believe that the best source of vitamin D is the sun and the best source of calcium and magnesium is from all varieties of leafy green vegetables. Judicious sun exposure that does not cause burns or significant reddening of the skin is safe. We all need to increase our consumption of greens.
3) Dairy is a major cause on constipation and recurrent congestion. If you are constipated, cut out all dairy for 2 weeks and assess your bowel function.
4) If I did consume milk, which I do not, I would choose clean, organic, local varieties. Our family drinks alternative milks in smoothies or granola. I choose coconut and almond with a vanilla flavor. Hemp and organic soy can be good choices in low volumes.
Trying to clear up muddy water,
Dr. M
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