Is Lactose Intolerance Real & What Is Cow Milk Protein Allergy?

Have you ever wondered if your baby is having trouble digesting milk? 

Are you a breastfeeding mother who worries about breastmilk being the probable reason for your baby’s fussy, gassy, irritable bowel functions? 

Do you think your toddler is allergic to milk?

Do you wonder if your toddler has always been allergic to milk, probably even prior to weaning him off breastmilk?

Recent trends show that every new mother who is feeding her child milk, whether breastmilk or cow’s milk, often wonders if her child is intolerant to the milk. Add to this the sudden ‘awareness’ of lactose intolerance and an increased assumption of every gastrointestinal health problem boiling down to the consumption of milk. But, can babies and infants truly be lactose intolerant?

The true answer is NO, with some exceptions. To understand better why lactose intolerance is rare in children, it is essential to first know in-depth about lactose.

What is lactose and what is it used for in the body?

Lactose is the main carbohydrate found in human breast milk. It is a primary and essential factor needed to promote growth in a baby’s brain. It significantly contributes to the daily energy needs of a growing baby.

Present in the form of a natural sugar, lactose contributes to 40% of the breastmilk calorie composition. Human milk contains 7.5g/100ml lactose and at term, an infant can typically digest about 60-70g lactose per day, equivalent to one litre of breastmilk.

Lactose helps increase calcium absorption from breastmilk and additional unabsorbed lactose serves as a prebiotic in the baby’s body. It can be safely said that lactose has a beneficial effect on early immune development of the child. For these reasons, newborn humans cannot be lactose intolerant as it is incompatible with growth and development.

So, what is lactose intolerance and if not lactose intolerance, then what could be the real problem?

Lactose intolerance is a type of reaction to milk, where the body can not digest lactose. This inability to digest lactose occurs due to a slow decrease in the body’s production of lactase, the enzyme that breaks down lactose.

Lactose intolerance generally does not manifest before 5 years of age. Term infants express sufficient lactase to digest about one litre of breast milk daily and it is only after weaning off breastmilk that the lactase levels begin to gradually decline.

In cases of babies who are on breastmilk: 

• It is possible that the baby suffers from Galactosemia: a rare genetic condition (1 in 30,000) where the baby is unable to digest protein in the mother’s milk. Galactosemia occurs due to the lack of the enzyme needed to digest galactose in the liver. These babies cannot ingest human breastmilk and hence require supervised help with alternate feeding options. Remember, it is galactose that is the root cause of concern- Not lactose.
• More commonly, the baby may be suffering from Cow’s Milk Protein Sensitivity/Allergy (CMPA). 

What is Cow Milk Protein Allergy?

Cow’s Milk Protein Allergy is a sensitivity to the protein in cow’s milk that can make its way into breastmilk when the mother ingests cow’s milk products. In such cases, elimination of cow milk from the mother’s diet works effectively to handle CMPA in the baby. The child should then be assessed every 6-12 months to see if they have outgrown the allergy.

Remember, lactose is a carbohydrate- NOT a protein.

Cow milk protein may also be present in certain formula, look for an alternate if your child is diagnosed with CMPA.

In case of babies who have been completely weaned off breastmilk and are now on cow’s milk:

• In all likelihood, contrary to popular belief, a child below 5 years of age has higher chances of suffering from CMPA rather than being lactose intolerant. Unfortunately, most CMPA infants are thought to be lactose intolerant, and as a result, are stopped from consuming dairy products. Avoiding dairy often leads to nutritional rickets in infants as well as low bone mineral density, increasing the risks of fracture in later life. When in reality, the infant can truly digest lactose the carbohydrate and the allergy is that of protein in cow’s milk. It is essential to understand the difference between both conditions and take the necessary steps accordingly.
• In case of children over 5 years of age, lactose intolerance may be a secondary result of a primary underlying gut condition such as gastroenteritis, celiac disease, CMPA, Crohn’s disease. Diagnosis for these must be considered. In such cases, lactose intolerance is transient and resolves when the gut disorder is taken care of.

It is important to be aware but it is essential to bridge knowledge gaps and misconceptions created by partial awareness of conditions like lactose intolerance and cow’s milk protein allergy.

Do your kids have CMPA? How do you handle it? We would love to hear from you in the comments below.