Cow's milk protein intolerance and breastfeeding

Professor Yaffle

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I have just had the following exchange on another thread and since I didn't want to derail it further and it's unlikely I would happen upon anyone who knew the answer there, i thought I would start a new thread to see if anyone can shed any light on it.

http://www.internationalskeptics.com/forums/showthread.php?p=3318989&posted=1#post3318989

(Me)
Turns out he was milk protein intolerant, and the OJ thing was just a conincidence - it was me eating things with milk in them that were making him vomit (and giving him eczema - which I hadn't realised was related until I stopped the milk and his eczema disappeared).

(Rolfe)
I don't get that. If you consumed the milk protein, your baby showed signs of intolerance? But milk protein you consume would be reduced to its component amino acids, or at least short polypeptides, before being absorbed by your intestine. It would certainly be reduced to its component amino acids before any of these amino acids appeared in your breast milk - as native human milk proteins. At least as I understand it. I don't see how any component of the milk you ingested could survive all the way to your breast milk secretions in a way that would still allow any intolerance to be displayed by the infant.

Unless someone can explain this to me in a differnt way, I suppose.


(Me)
To be honest I'm not sure - I hadn't thought about the proteins being broken down, so I would like an explanation too. Pretty much everything I read at the time indicated that cows milk protein could be expressed in the milk and cause a reaction in a sensitive child. While he was still breastfeeding, I pretty much worked out that me eating milk products was the problem, so I cut all of them out. So at that point I didn't know exactly what in the milk was the problem - it could have been lactose intolerance. But after he was weaned I discovered he was fine with cheese, it was only the whey portion of the milk that he was sensitive too (and that he was fine with goat's milk too) which led me to cow's milk protein intolerance. No health professionals I mentioned it to questioned the breastfeeding thing either.

Maybe I'll start a new thread on this, to see if anyone knows and prevent derailing this thread further.

Any answers?
 
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Oh, hey, sorry, I just posted in the other thread.

Lactose is lactose is lactose. It's a disaccharide of galactose and glucose. It's the same no matter where it came from. And I'd be extremely surprised if human milk in its normal state doesn't contain lactose anyway. I'd be even more surprised if it suddenly started to contain lactose just because the mother consumed some cows' milk. It doesn't make any sense. (Misconceptions on this are rife - I have a cousin who maintains he's allergic to bovine lactose but not caprine, and he's a chemistry teacher, I ask you. Explaining that the lactose is no different in cow's or goat's milk and that if he's allergic to one and not the other it must be the proteins that are doing it does no good. But then, his homoeopath diagnosed the allergy with a Vega-test machine, so what do I know?)

I simply can't see any mechanism for bovine milk proteins consumed by the mother to appear in her breast milk in that form. If anyone can explain this, I'd be grateful.

Rolfe.
 
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An example of the type of info I found when I was looking into it is below. The site also talks abut lactose intolerance, and you are right, there is no reason to cut out dairy in that case. That was just something I heard from health visitors (who I have found often don't know what they are talking about).

http://www.drgreene.org/body.cfm?id=21&action=detail&ref=836

The other component of milk that can cause people problems is its protein, which comes in two basic forms--casein and whey. The specific proteins differ slightly depending on which mammal the milk is from. The mammal whose milk most often creates digestive difficulties for humans is the cow. Intolerance to cow's milk protein follows the opposite pattern from lactose intolerance, since it is not uncommon in newborns but becomes much less common the older children get. It is estimated that between 2% and 7.5% of healthy infants have significant intolerance to the protein in cow's milk. The problem is particularly common in families with strong histories of eczema, allergies, or asthma.
Babies with this intolerance can have discomfort even if they are exclusively breast fed. The difficulty arises when the mother eats or drinks cow's milk protein. The protein passes into her breast milk and from there into the baby's digestive system. Antibodies to this protein have been found in infants who are intolerant, providing evidence of the link between the mother's diet and her baby's digestive troubles.
A study published in the January 1996 Journal of the American Dietetic Association looked carefully at infants' symptoms of fussiness or colic and how they varied with maternal consumption of 15 different foods. Maternal consumption of cow's milk was far more associated with the symptoms of colic than consumption of any other food. The study found that women who drank cow's milk were twice as likely to have infants with colic compared to other breast feeding moms. Another study found that half of women with colicky babies who dropped cow's milk saw marked improvement in their babies' symptoms. A third investigation found that there were higher levels of cow's milk protein in the mothers' milk of colicky infants than in the milk of mothers whose babies were not colicky.

And some more examples:

http://pediatrics.about.com/od/weeklyquestion/a/04_milk_allergy.htm

With a true milk allergy, it is usually the protein in milk that you are allergic to, including casein and whey. Symptoms can include vomiting, bloody diarrhea, fussiness, hives, wheezing, and/or trouble breathing, and usually occur no matter what kind of dairy product that they eat. In cases like this, symptoms can occur when a baby drinks a cow's milk based formula or a breastfeeding mother eats or drinks dairy products herself.

http://www.kidshealth.org/parent/nutrition_fit/nutrition/milk_allergy_diet.html

It is possible that your doctor may suggest switching from cow's milk-based formula to exclusive breastfeeding. Breastfeeding a milk-allergic infant should be done under the close supervision of a registered dietitian because a strict diet must be followed to ensure adequate intake of nutrients while eliminating cow's milk protein. Because the cow's milk protein in the dairy products in a mother's diet can cross over to breast milk, all dairy products must be eliminated from her diet. Working with a dietitian can help a nursing mother find alternative sources of calcium and other vital nutrients found in dairy products.
 
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And the following publication recommends the use of an elimination diet in the mother for diagnosis of CMA in the exclusively breastfed child:

http://adc.bmj.com/cgi/content/full/92/10/902

PS I have been using intolerance rather than allergy, because I could never get a straight answer from a doctor about which it was, but it eems most of the references i have found call it an allergy.
 
I'm thinking that the mechanism may be different. If the mother has an allergy to cow's milk proteins (not the same thing as lactose intolerance), she could be creating IgA antibodies, which will be passed through her breastmilk. Perhaps the kid is actually responding to the mother's antibodies.

Allergies to cow's milk are rare, but not impossible.
 
Found another abstract talking about peanut proteins being expressed in saliva this time which says:

Secretion of food allergen proteins or peptides in saliva several hours following ingestion may have important implications for delayed allergic reaction by sensitive patients. Also, due to the fact that these proteins or peptides survive digestive enzymes, become absorbed into the blood stream and are subsequently secreted in biological fluids may indicate that they are most likely the sensitizing or tolerizing agent within an allergic food.

http://www.jacionline.org/article/PIIS0091674905029210/fulltext

(I have amazed myself by how quickly I found that out - perhaps I should google more before I post a new topic in future).
 
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From the Pediatrics journal (They actually devote an entire supplement to the subject of paediatric food allergies):
Three bovine milk antigens (ß-lactoglobulin, casein, and
ggr.gif
-globulin),5052 chicken egg ovalbumin,53 gliadin,54 and peanut55 have been detected in nanogram per milliliter concentrations in most samples of breast milk from mothers, irrespective of atopic status, within 1 to 6 hours of consuming these foods. The molecular size of these food antigens in breast milk is similar to their respective allergens (Ara h1 and Ara h2), confirming but not proving their potential for sensitization.55
  1. Stuart CA, Twiselton R, Nicholas MF, Hide DW. Passage of cow’s milk protein in breast milk. Clin Allergy.1984; 14 :533 –535[CrossRef][ISI][Medline]
  2. Axelsson I, Jakobsson I, Lindberg T, Benediktsson B. Bovine beta-lactoglobulin in the human milk. A longitudinal study during the whole lactation period. Acta Paediatr Scand.1986; 75 :702 –707[ISI][Medline]
  3. Clyne PS, Kulczycki A Jr. Human breast milk contains bovine IgG. Relationship to infant colic? Pediatrics.1991; 87 :439 –444[Abstract/Free Full Text]
These correspond to refs 50, 51 and 52 above

ETA- Prof, if you PM me your email, I could send you some more stuff if youre interested.
 
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Somewhere in the dim past I remember reading that, while most proteins get broken down and absorbed as their component amino acids (and other pieces), some wind up getting directly into teh blood. The gut is so infused with blood vessels (the better to use what is there) that very minor bleeding is an all-the-time thing, and if that's true, then proteins can invade the bloodstream as well; they are much smaller than blood cells. Granted they only get in in very small quantities, but then it doesn't take many to set off an immune reaction after the pump's been primed by a previous invasion.
 
Lactose is lactose is lactose. It's a disaccharide of galactose and glucose. It's the same no matter where it came from. And I'd be extremely surprised if human milk in its normal state doesn't contain lactose anyway. I'd be even more surprised if it suddenly started to contain lactose just because the mother consumed some cows' milk. It doesn't make any sense. (Misconceptions on this are rife - I have a cousin who maintains he's allergic to bovine lactose but not caprine, and he's a chemistry teacher, I ask you. Explaining that the lactose is no different in cow's or goat's milk and that if he's allergic to one and not the other it must be the proteins that are doing it does no good. But then, his homoeopath diagnosed the allergy with a Vega-test machine, so what do I know?)
.

I know he should be fired. A chemistry teacher visiting a homeopath?

If he did it on mole day it would be perfect.
 
The other thing that has been on my mind is that all the info I could find said that goat's milk is not suitable as a substitute, but my kids are fine with it. Anyone know (before I go off on another google) what percentage of kids with CMA can tolerate goat's milk?

ETA - answering my own question again...

http://www.allergyclinic.co.nz/guides/43.html

In 1939 Hill reported that 25 of 44 infants with eczema who had positive skin prick tests to cow's milk whey protein also exhibited identical positive skin tests to the whey fraction of goat's milk. In 1983 Juntunen and Ali-Yrkko performed provocation tests in 28 children with cow's milk protein intolerance, and found 22 were also intolerant to goat's milk. The marked antigenic similarity between cow's and goat's milk protein suggests that goat's milk is unlikely to be tolerated in most children with genuine cow's milk protein intolerance.
 
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The other thing that has been on my mind is that all the info I could find said that goat's milk is not suitable as a substitute, but my kids are fine with it. Anyone know (before I go off on another google) what percentage of kids with CMA can tolerat goat's milk?

Are your kids still allergic to cows milk? Allergies in young kids can often be something that is grown out of.
 
Are your kids still allergic to cows milk? Allergies in young kids can often be something that is grown out of.

The older one (age 4) is starting to grow out of it. He's doesn't vomit anymore, and he can have small amounts without suffering from the eczema and diarrhea. The younger one is 18 months and I haven't checked how he reacts for ages. I am just going to assume that he follows a similar pattern to his brother to try to avoid unneccessary discomfort for him.

I had the same problem as a child, and milk still makes me feel a bit nauseous if I have a significant amount. The same with my mam too. I don't know if that it because I am still slightly intolerant, or if it is a psychological/conditioning effect, or because I just don't like the taste of milk that much due to not drinking any when I was small
 
That's interesting. I didn't think it was possible - or really, that the likelihood or frequency of it happening would be significant, but there you go!

You learn something new every day.

Rolfe.
 

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