Breastfeeding And Lactose Intolerance

Mothers are often told that the baby is lactose intolerant because he cries a lot, is nervous and has gas.

Many newborns spit milk, vomit, have gas, simply because their gastrointestinal tract is still immature (it takes time to learn to process breast milk). That's why breastfed babies start with small amounts of colostrum. In this way, the newborn's digestive system is facilitated and gradually shifts to receiving larger amounts of milk.

What is lactase?

Lactase is an enzyme that the body uses to process lactose (the sugar in milk). If the body does not produce this enzyme or does not produce enough of it, unprocessed milk sugar passes to the colon. There, bacteria break it down to produce acids and gases that cause stomach pain and diarrhea. Babies have loose, sometimes green, and frothy stools, as well as irritability (nervousness). This condition is referred to as lactose intolerance.

Does breast milk contain lactose?

All mammalian milks are unique and species-specific. The human is also different from any other. It contains more whey protein than casein (which gives it a "bluish" hue) and has the highest concentration of lactose of all mammals. Lactose is the main carbohydrate in breast milk and is essential for proper growth and development. The amount of milk sugar in breast milk does not depend on what the mother consumes. The milk that the baby receives when he starts feeding (front milk) contains almost the same amount of lactose as the milk at the end of breastfeeding (back milk). However, back milk contains more fat. 

Causes of lactose intolerance

This condition is more common in adults and children over 4-5 years of age from many ethnic groups. It is extremely rare in newborns. Due to:

• insufficient amount of the enzyme lactase, which breaks down lactose (milk sugar);
• damage to the intestinal mucosa - gastroenteritis, infectious diarrhea or other disorders of the gastrointestinal tract;
• oversupply of breast milk - most exclusively breastfed babies are not fed, but sometimes this can happen due to overproduction of milk. The problem in these cases is not the lactose in the milk, but the fact that the baby gets more milk (and more lactose), which their digestive system cannot process.

Lactose intolerance in infants

This is an extremely rare genetic condition in which infants are born with an inability to digest the lactose contained in all dairy products, including formula and breast milk. A baby with lactose intolerance does not gain weight and shows obvious symptoms of malabsorption and dehydration. Urgent medical intervention is needed, and the baby will need a special diet soon after birth.

Babies have an abundance of lactase, the enzyme that breaks down lactose. It begins to be produced from the 24th week of gestation and continues to be synthesized in abundance between 2.5 and 7 years of age, even more. While older children and adults often have lactose intolerance, primary lactose intolerance is extremely rare in infants.

In fact, it is so rare that most medical practitioners and breastfeeding counselors never encounter such a case in their practice. However, with age, the body can develop lactase deficiency, which is why it is more common to hear about adults and older children with this problem.

Secondary lactase deficiency is a symptom caused entirely by another problem. Your baby may have one after using antibiotics, gastrointestinal illness, or poor nutrition.

Because the enzyme lactase is produced at the very tips of the microscopic hairs of the gut, anything that damages the intestinal lining can cause secondary lactose intolerance. Examples may be:

• gastroenteritis;
• food intolerance or allergy. In breastfed infants, this may come from dietary proteins, such as cow's milk, wheat, soy or eggs, or possibly other nutrients that pass into breast milk from the mother's diet or from the food the child has consumed;
• parasitic infection such as giardiasis or cryptosporidiosis;
• celiac disease (intolerance to gluten in wheat and some other cereals);
• after bowel surgery.

Foods to which the baby is allergic or intolerant can pass into it through breast milk. In some cases, removing food to which the baby responds (such as cow's milk) from the mother's diet can help. If you want to try to remove a product from your menu due to suspicion that the baby has an allergy or intolerance, consult a specialist to guide you which foods may be an allergen, and to make sure that your diet will be nutritionally adequate. (for both you and the baby).

Allergy to cow's milk protein is often confused with lactose intolerance. And a lot of people think they're the same thing, but they're not. Confusion can occur because cow's milk protein and lactose occur simultaneously in the same food, ie. in dairy products. In addition, milk protein allergy can cause secondary lactose intolerance, which further contributes to this confusion.

Secondary lactose intolerance is temporary if the bowel damage can be treated. When the cause is removed, for example as food from the mother's menu to which the breastfed baby is allergic, the intestinal damage will be cured. If your doctor diagnoses "lactose intolerance," continuing to breastfeed will not harm your baby.

While the baby is showing symptoms of lactose intolerance, the mother may alternate breastfeeding with lactose-free foods. Experts recommend the use of lactose-free formula if the baby is not on natural nutrition; if you are very malnourished and / or lose weight. However, human milk remains the best food and will help the child's recovery. In addition, the infant's sensitivity to foreign proteins (cow's milk or soy) should be considered before the introduction of any type of formula, as regular and lactose-free milk can worsen his condition. You should seek professional advice on choosing a hypoallergenic product. The baby should be monitored by a specialist to monitor symptoms and weight gain.

Symptoms of lactose intolerance

• nervousness;
• colic;
• gases;
• bright green stools.

What can I do if my baby is lactose intolerant?

Symptoms can be treated, and breastfeeding can (and should) continue without interruption. Lactose intolerance is not an allergy to breast milk and is not a contraindication to breastfeeding. When a breastfed baby shows signs of lactose intolerance, breast milk is not a problem and switching to formula is not a solution.

Many babies will have lactose intolerance due to overproduction and oversupply of breast milk by the mother. Treating the problem of overeating should resolve the symptoms of lactose intolerance in the baby.

When the baby needs to take antibiotics or has some kind of gastrointestinal disease, the structures in the intestinal epithelium that produce lactase can be damaged. As a result, the infant may show signs of lactose intolerance while being treated. Continuing breastfeeding will lead to the fastest recovery, because breast milk is the easiest food to process, and also contains a lot of immunoglobulins and has healing properties.

It is usually better to maintain breastfeeding - feeding the baby lactose-free formula is sometimes an option, but it does not always help him feel more comfortable.

When breastfeeding, make sure the baby has completely sucked the breast (to make sure he has received the back milk - rich in fat), then offer the other breast. This often helps. The fat in milk slows down digestion so that lactose is broken down by lactase and absorbed.

Try to create a certain regimen with about 3 hours interval between meals. If the baby wants to feed before this period, offer the "empty" breast again (from which he was last breastfed).

Conclusion

As it turned out, there are several types of lactose intolerance, but it is very rare to have to stop breastfeeding due to this condition. The only exception is the rare primary type of lactose intolerance.

According to some, lactose intolerance is a term widely used to encourage breastfeeding mothers to switch to formula. In fact, very few babies really have this problem.

Before stopping natural feeding and offering an alternative, consult a healthcare professional and breastfeeding consultant. Companies that produce formula milk promote their products through advertising and easily convince frightened parents that their products are better for the baby.