“What is the Difference Between Lactose Intolerance & Cow’s Milk Protein Allergy” (CMPA) by Chantal Jura

We've talked briefly in my other articles about the difference between a food allergy and a food intolerance. But it is possible to have a cow's milk protein allergy and also be lactose intolerant OR intolerance to one or all of the proteins found in milk.

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What Is Lactose?

Lactose is a sugar found in all mammalian milks that helps the development of the nervous system and also helps the body absorb calcium. It is a disaccharide consisting of glucose and galacatose. Glucose is needed for brain, muscle, and fat tissues and intestinal cells. Galactose plays an essential role in the development of the brain, the maintenance of stable blood sugar, and the elimination of bilirubin.

A premature baby is more likely to be lactose intolerant, mainly because the production of lactase begins in the third trimester of pregnancy. It is pretty rare for a full-term baby who is exclusively breastfed to be truly lactose intolerant. Human breast milk itself contains about 60 g/ L of lactose, which represents 85% of the total carbohydrate content.

So what exactly is lactose intolerance? This is a reaction that occurs when there is not enough lactase, the enzyme responsible for breaking down the lactose, in our intestines. Undigested lactose remains intact in our digestive system rather than being broken down by the enzymes. Typical symptoms include stomach aches, gas, watery bowel movements and diarrhoea. Explosive stools and eczema in infants are also common. There are two types of lactose intolerances: primary lactose intolerance and secondary lactose intolerance.

Primary Lactose Intolerance, Or Congenital Lactase Deficiency

This is the most common form of adult lactose intolerance, but very rare in babies. The body doesn't produce any or enough lactase enzymes to break down the lactose found in milk. When it happens in newborns, this is called congenital lactase deficiency, which is a rare genetic mutation. The baby cannot produce enough lactase to break down even their mother’s breast milk.

Secondary Lactose Intolerance

A temporary intolerance due to the baby having a digestive disease, such as the stomach flu, in- jury, being born prematurely or being on antibiotics. Once resolved, the intolerance disappears.

Cow’s Milk Protein Allergy (CMPA)

Cow’s milk protein allergy (also known as an intolerance) is an immune response to the proteins in cow’s milk and is not caused by a deficiency of lactase. It happens often in an infant between the ages of 1 week and 2 months. Luckily, CMPA is usually transient, with most children out growing this intolerance by the age of 4 years. Up to 50% of babies who suffer from CMPA also react to soy proteins.

  • Abdominal pain and cramps
  • Constipation or diarrhea
  • Projectile vomiting
  • Greenish stools

Symptoms:

  • Rashes
  • Wheezing
  • Respiratory problems
  • Poor weight gain
  • Filaments of blood in stools

The baby’s gut is still immature and it will happen that certain proteins that were consumed by a breastfeeding mother will end up in her milk. A breastfed infant will have an IgE or a non-IgE allergic reaction to this protein.

About 5% of infants are intolerant to cow’s milk proteins during their first year of life. Up to 50% of babies who suffer from CMPA also react to soy proteins, and most babies allergic to cow’s milk will also react to goat and sheep’s milk.

A mother whose baby is diagnosed with CMPA should continue to breastfeed but adjust her diet accordingly to eliminate all cow’s milk proteins, bovine proteins and soy proteins. This is called an elimination diet.

Sources and Hidden Sources of Cow’s Milk & Bovine Proteins to Eliminate:

  • Butter
  • Beef
  • Butterfat
  • Clarified butter, or ghee
  • Buttermilk
  • Casein
  • Sodium caseinate
  • Cheese
  • Cottage cheese
  • Lactoglobin
  • Lactoferrin
  • Lactose
  • Cream
  • Cream
  • Ice cream
  • Goat milk
  • Kefir
  • Lactalbumin
  • All forms of milk (condensed, powdered, lactose-free, evaporated, skim, fat free, etc)
  • Nougat
  • Sour cream
  • Yogurt
  • Sheep’s milk
  • Veal
  • Whey

A Word of Caution ~ Ghee is not recommended for those who are intolerant to cow proteins. It is only safe for those who are lactose intolerant since it contains no lactose.

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Ingredients That May Contain Milk Proteins:

  • Chocolate
  • Natural or artificial flavours
  • Margarine
  • Sorbets
  • Delicatessen meats
  • Cereals
  • Calcium enriched juices
  • Tofu
  •  Tempeh
  • Yuba
  • Textured vegetable protein
  • Artificial butter flavour
  • Tofu
  • Soy cheese
  • Marshmallows
  • Monodiglyceride
  • Soy lecithin
  • Soups
  • Thickening agents

 

Foods that Contain Soy Proteins:

  • Soya, soybean, soy pro- teins
  • Miso, edamame
  • Bean sprouts

Foods That May Contain Soy Protein:

  • Baked goods
  • Cereals
  • Bread crumbs
  • Chewing gum
  • Processed meats
  • Sauces

If you think that your baby is just intolerant to cow’s milk proteins, you can try treating your baby’s symptoms by eliminating the obvious sources of dairy products like milk, cream, yogurt, butter, cheese, and ice creams.252656-20141107

If you suspect an allergy, you will need to eliminate all sources that contain the cow’s milk, bovine and perhaps even soy proteins mentioned in the list above. You may want to contact a nutritionist if you are unsure what proteins are safe to eat.

Be careful of cross-contamination at the grocery store when purchasing deli meats. Ask your butcher if the meat slicer has been in contact with bovine proteins such as veal or beef.

Please note it may take anywhere from 10 days to three weeks since the last consumption to completely remove all cow milk proteins from your body.

If you or your baby are experiencing allergies or intolerances to several foods or food groups at a time, the support of a nutritionist is highly recommended to avoid the risk of deficiencies or a unbalanced diet.

When Do I Reintroduce Cow’s Milk Protein? 

If your baby’s health has improved and symptoms have completely disappeared, you can start to consider reintroducing cow’s milk proteins. Reintroduction should be started by having the breastfeeding mother consume small amounts of dairy products such as yogurt, milk and cheese. If the baby being breastfed has no reaction after being breastfed with these foods in the mother’s diet, has never previously shown any serious IgE-mediated allergic reactions, and is older than 9- 12 months old, he or she can be introduced small amounts of cow’s milk protein as well.

If symptoms or reactions do occur, then the cow’s milk protein will need to be eliminated again. The majority of children can try again at around 18 months - two years old, but others may be intolerant for the rest of their lives.

Alternative Sources of Calcium and Proteins - What Can You Eat?

For the breastfed baby who shows signs of allergies or intolerance to cow’s milk proteins, their best food is still breast milk, as long as their mother continues an elimination diet of dairy products.

A breastfeeding woman needs about 71 grams of protein daily. Milk, dairy products and beef are a nutritious source, so it is important to consume other alternatives such as legumes, lamb, chick- en and turkey to make sure to get enough protein. While baby has no risk of calcium deficiency, a nursing mother needs every day.

Alternative Sources of Calcium: about 1,200 mg of calcium

  • Lentils
  • Canned sardines with bones
  • Amaranth
  • Oat
  • Wheat
  • Rye
  • Alfalfa Sprouts  
  • Sesame seeds
  • Spinach
  • Kale
  • Chinese cabbage
  • Broccoli

Other Sources of Proteins:

  • Cress
  • Figs
  • Dates
  • Almonds
  • Algae
  • Spirulina
  • Black beans
  • Buckwheat
  • Buts
  • Pea
  • Peanuts
  • Chickpeas
  • Chicken
  • Turkey
  • Tuna
  • Salmon
  • Lamb
  • Lentils
  • Quinoa

19 April, 2015

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Chantal