Lactose intolerance, unraveling the confusion
The confusion around lactose intolerance is rife these days, with information on the internet blurring the lines of what it truly is, diagnosis and treatment. I come across so many parents that say, ‘my baby is lactose intolerant’ when this is not the case. So, to diminish this confusion and after receiving many queries about this following on from my blog ‘the why and why not of cluster feeding’, I felt it necessary to write this article. Here we will define the differences between lactose intolerance and lactose overload. We will cover how both of these occur and what treatment is needed to make the baby more comfortable, or stop it altogether. We will also, of course look at the symptoms while shining a light on the myths that exist. But to start, let’s look at the basics of what lactose is and why it is important for our newborns.
What is lactose?
Lactose is the sugar, carbohydrate, in all mammalian milks and it’s made up of two sugar molecules bound together – glucose and galactose. Lactose naturally occurs in breast milk and dairy products such as milk and cheese. It can also be found in most formulas. Lactose is synthesised in the breast by milk making cells, and while you may be told that lactose is only in the foremilk, the first milk your baby drinks, it is actually throughout their entire milk but more concentrated in the fore milk because of the high fat in the hind milk.
To digest lactose the body produces an enzyme called lactase, which breaks down the glucose and galactose in order for it to be absorbed in the small intestine. The lactase enzyme are made in the microvilli lining of the small intestine. These villi naturally recreate themselves, continually producing cells that make lactase, which then absorb the lactose as it passes through the digestive tract.
Why do we need lactose?
- Lactose helps babies to thrive as it provides them the calories they require to grow.
- Calcium and phosphorus aid bone development and lactose helps your child absorb these two essential minerals.
- Friendly bacteria are thought to develop because of lactose, giving newborns the ability to fight of unwanted bacteria, thus keeping the digestive system healthy.
- Healthy brain development and optimum growth of the nervous system is another all important function of lactose.
What is true (primary) lactose intolerance?
Lactose intolerance is an extremely rare genetic condition, which requires medical treatment to make life liveable. The medical term for lactose intolerance is Galactosemia, and from birth a baby with lactose intolerance fails to thrive, meaning they won’t place on any weight. These children require a very special diet and emergency medical treatment, with a hydrogen breath test and tests for reducing sugar in the stools undertaken for diagnosis.
Lactose intolerance occurs when a baby does not produce lactase, which breaks down lactose. Only a few people in the world have been diagnosed with this condition. The US National Library of Medicine states that, 'Classic Galactosemia occurs in 1 in 30,000 to 60,000 newborns. Galactosemia type II and type III are less common; type II probably affects fewer than 1 in 100,000 newborns and type III appears to be very rare'.
What is secondary intolerance?
This happens when villi in the small intestine have been damaged either by gastroenteritis, or food sensitivities, such as gluten, thus effecting the production of the lactase enzyme. This means the lactose cannot be broken down appropriately. Secondary intolerance is temporary since the villi are always creating more cells that produce lactase. So when the child’s gastro infection stops, or the possible food sensitivities are reduced or eliminated, lactose can again be absorbed correctly. So, if you know your child is well, doesn’t have lactose intolerance (symptoms listed below) and you are doing everything right to avoid lactose overload (information for this below), then you can try eliminating gluten.
What is lactose overload?
This is what the majority of newborns actually have but is so often, wrongly labelled as lactose intolerance. Lactose Overload is caused by having too much lactose in the system for the baby to break down, so the digestive system carries on as it should, but it can’t cope with the amount of lactose it is receiving.
The overload of lactose then moves from the small intestine into the large intestine where it draws in more water through the intestinal wall – this is called osmosis. The bacteria present then ferments the lactose producing the symptoms that are listed below. When this happens the baby, or infant actually looks to suck more. This happens because sucking is their instinctual tool to enable comfort, and lactose overload obviously creates discomfort. However, this looking to suck (the rooting reflex) is often misread and mistaught as a hunger cue only, leading to parents feeding more, resulting in more overload of lactose to produce more symptoms, and so the cycle goes.
Unfortunately, the widely taught practices of feeding from both breasts in one sitting, in quick succession, or cluster feeding creates lactose overload for our newborns, as does overfeeding. Not only because the amount of lactose the child receives is too much, but also because these feeding practices push the milk through the digestive tract too quickly, which doesn’t allow enough time for the lactose to be broken down appropriately.
I see a lot of babies and infants in my clinical work that have lactose overload and I now group these symptoms under the term Digestive Overload, since many of the Digestive Overload causes and symptoms overlap each other, and this is of course a form of overload. The great news is that lactose overload, like secondary lactose intolerance, can be healed naturally by reassessing the child’s diet and changing feeding practices. The later of these bringing remarkable results when achieved well, which I help parents do in my clinic.
Symptoms of primary lactose intolerance - galactosemia
- Poor weight gain and growth (known as failure to thrive)
- Poor feeding and sucking
- Sleeping longer or more often
- Low blood sugar (hypoglycemia)
Symptoms of secondary lactose intolerance and lactose overload
These two forms of lactose imbalance have the same symptoms.
- Irritability, grizzling, inconsolable crying, screaming.
- Bloating, intestinal cramps, excessive gas.Frequent watery, frothy and/or explosive bowel motions. Sometimes green in colour with an offensive odour. Stools are also acidic, effecting baby’s skin if left on the skin for too long.
- Wakefulness from discomfort with episodes of longer periods of sleep, but this is often from exhaustion through crying and lack of sleep rather than because they feel comfortable.
- Frequent searching for something to suck - exhibiting the ‘root reflex’.
- Weight gains that are consistently at the upper regions or beyond recommended levels, or, as described by Morris Wessel, your baby will ‘look to otherwise be thriving’.
- Arching backwards or sideways, writhing, wriggling.
- Pedalling legs.
- Gulping their food, seeming very hungry while being restless – sometimes refusing to feed, pulling off the nipple, or when bottle-fed, having flailing arms and legs with much turning of the head because of digestive discomfort.
What you can do to prevent lactose overload
- Breastfeed from one breast in one sitting
- Feed baby at intervals that work alongside their digestive function – every 3 ½ to 4 hours
- Feed your baby in accordance with their stomach capacity for each age
- Stop cluster feeding
- Take dairy out of the breastfeeding diet, or change from dairy formula to goats formula
- Learn the suck swallow ratio to help you reduce overfeeding while breastfeeding
If you have tried all of the above and baby still has symptoms of lactose overload, you can try eliminating gluten from your diet.
Aspects to be aware of if breastfeeding
If you are breastfeeding off both breasts in one sitting, breastfeeding in quick succession (within 3 ½ hour for feeds) or cluster feeding, changing this to eliminate lactose overload is not as simple as just changing your feeding pattern. Doing so may cause blocked ducts that can lead to mastitis for you, and we also must be aware of your child’s weight before making changes, because when these unhelpful feeding practices have been occurring for a while the baby can sometimes forget how to demand supply as their suck had become lazy. This is why, if you would like to make these changes to help your baby, I do advise a Let’s Chat Consultation to talk through your individual scenario, come up with a healthy plan of action for all and provide homeopathic remedies that can aid this transition for both you and bubs especially since your baby may get worse for a few days, before getting better.
Aspects to be aware of if bottle feeding
Often, when lactose overload is suspected and the baby is not being breastfed but formula fed, soy formula gets recommended as the alternative to use. However, soy formula is not healthy for newborns at all and if you know of anyone that is using it, or anyone that is eating products with Western soy in or drinking soy milk, please do lead them to my blog about soy, to learn why they should stop.
Lactose overload generally happens with formula fed babies because they are being overfeed. Many of the formula tins recommend amounts that are well and truly above what a newborn, or infant’s stomach can hold at certain ages. Thus reducing feeds to work alongside their natural digestive function is the recommended treatment.
Moving to goat’s formula rather than baby having a dairy based formula can be beneficial for lactose overload, and aside that, goat’s formula will also aid the digestive system because the proteins, casein and whey, are easier on the digestive tract than the proteins in dairy formula. The only time the baby has to have a formula without lactose is when they are diagnosed with Galactosemia. Lactose free formula’s use corn syrup and table sugar as a replacement. Lactose is essential for optimum development.
Secondary lactose intolerance and lactose overload are not the same as dairy intolerance or dairy overload. In the latter two the child is actually reacting to the proteins in dairy, casein and whey. Not the lactose. This creates slightly different symptoms but again, these can be healed naturally.
Also, the lactase enzyme only breaks down lactose. It does not break down carbohydrates, which turn into glucose and fructose (sugars). The sucrose enzyme digests this, therefore, lactose intolerance, primary or secondary, and lactose overload are not affected by how much sugar (carbohydrates) you consume. However, from the perspective of breastfeeding, the amount of carbohydrates you have should still be monitored because too much also creates more gas. The same needs to be considered when baby is having solid food.
Lactase drops are sometimes recommended as a treatment for secondary lactose and lactose overload but again, these are not necessary for treatment as we can heal both of these naturally. There is also some debate as to whether they are effective.
Last Updated: 11 December 2017