Transcript:
Welcome to the Milk Minute Podcast, everyone. Hey, friends. It’s really good to be here again. I love when we get to record new episodes. It feels like, though, we have had, like, absolutely no time for the last couple we did. Yeah, no time. I’m at home today, so disclaimer. There’s two four year old girls here, very likely to be interrupted.
I’m, I had to put on my cheetah print bathrobe just to feel like I was in my robe of shalom. We’re just, we’re post vacation. You know, like the laundry is done, but my, my brain is not quite ready. I redid my family whiteboard today and found all kinds of scheduling conflicts that I was unaware of until this morning.
So I was like, okay I, I feel like that’s about to be me, Heather, because we’re just, Ivan and I are just coming off of this like wilderness camp that we usually teach at, which frankly, like, I love to do, but it just doesn’t fit in our lives anymore, you know? And I’ve like been making all these appointments for the next week, kind of like without his input, just hoping his shit is on the calendar.
And I feel like as soon as he comes home, there’s the four year old. Yep. I feel like as soon as he comes home, he’s going to be like, actually, none of that works. And I’ll just be like, great. Fuck my life. Yeah. Yeah. I can’t wait to reschedule all of that stuff. I just scheduled. It’s going to be amazing.
Yeah. Well we’re all doing our best and I want to say that I did my best with this episode, dairy elimination and cow’s milk protein allergy and breastfeeding. Okay. It is. A huge topic and obviously literally been dreading this like I feel like we’ve been having nightmares about this episode, right? I mean and I you can imagine why because it’s complicated.
It’s triggering It’s again like lack of research in a lot of ways and the research we do have is retrospective case study reviews things like that, so Yeah, and it’s also like pretty prevalent. So it’s like, wait a minute. So I wanted to do an overview today of like, what is it? What are we looking at?
What are some of the problems with how we currently manage it? And then just like a couple things to note that I found Interesting in the research. And I, and I hope this doesn’t trigger people today, you know, most of the patients who are dealing with this that I’ve seen in my practice literally have PTSD from their kids symptoms and feeling like their body has caused the problem because I think a lot of the way providers talk about this issue is very much like your body is causing your baby to bleed from the butthole and it’s like, well, like that your brain will just explode.
Bloat as a mom, when you hear that and the cure. Itself is, like, really disruptive to our lives, which is, like, eliminating cheese. Like, what? I’m sorry, no pizza? And, and, like, the, like, you know, the times moms call me and they’re like, Oh, no, I didn’t know there was dairy in this. What’s gonna happen? It’s the end of the world.
I’m like, I, I know it feels like that. I’m so sorry. We don’t know. Let’s… Let’s find out together. And then, and then of course people get upset because the real test for whether or not the kid actually has it is reintroduction. So it’s like full submersion technique. As far as anxiety goes, it’s like, Oh, you’re afraid of swimming.
Well, jump in the pool. But how about all of the issues that my kid had? So there’s just, there’s a lot of anxiety around this. And I just want to acknowledge that up top. We are going to try to make this. digestible, you know, hopefully we can, hopefully we, we’re not all bleeding rectally by the end of this episode.
I certainly do not.
On that note, if you guys need support going through this issue or any other here’s a reminder, we both do private consultation. We both offer them virtually. You can literally always find those links in our show notes and we would love to help you. Yes, we would. And also, before we get started, we would like to thank our newest patron, Crystal Crouch from Georgia.
Crystal, thank you so much for being a part of our Patreon. I hope you’re enjoying all of my pregnancy updates. I’m currently 27 weeks and you can access the Beyond the Boob, which is our other love child podcast of the Milk Minute, where we go over my pregnancy week by week. So, don’t miss it. All right.
Let’s take a quick break. We’re going to thank one of our sponsors, and then we’re going to come back, answer a really interesting question, and head right into dairy allergies. Let’s do it.
Imagine a world where you seek lactation care, and it’s easy, and someone greets you at the door, and they’re nice to you, and they give you a hot cup of tea, and let you sit on the couch and talk about all the issues, not just the breastfeeding issues. What a cozy fantasy. Is there anywhere that’s real? Oh, it’s real girl.
It’s real, and I’ve been building it for quite a long time. My business is called Breastfeeding for Busy Moms, and me and every member of my team are trained in our three major tenets, which is accessibility, kindness, and personalization. If you wanna book a consult with Heather or anyone else on her team, you should head over to breastfeeding for busy moms.com.
We do accept some limited insurance, and we’d be happy to walk you through it if you want to give us a call, and that number’s on Google. So go sit on the cozy couch with Heather at Breastfeeding for Busy Moms. Love you guys!
Alright, welcome back everybody. Today’s question was emailed to us by a listener named Melissa D. And Melissa says, Hi! I absolutely love your podcast. It saved my breastfeeding and pumping journey when times were tough. Thank you. Thank you. Thank you. You’re welcome. My little is almost three and we are down to breastfeeding once a day before bed.
I’m looking for info on breastfeeding and Phentermine. My doc just prescribed it to me for weight loss. I couldn’t find anything in LactMed. Any chance you can link me to the episode or some info before I make a decision on this medication for myself. Thanks so much. You know, I have been thinking about doing an episode on, like, weight loss medications.
I didn’t tell you Heather, but it’s not the first time I’ve gotten a question like this. And it’s a hard one because there’s so many different, like, classes of medication used on and off label for this purpose. But Phentermine is a tricky one, so infant risk has it classified as an L4, and honestly, like, one of the main things, one of the main reasons it is a higher risk medication is because it has a very small molecular weight and is more likely to have a higher dosage in milk.
Yeah, but, question, if they take it in the morning, cause Phentermine is like speed, it basically makes you really speedy. I accidentally took it one time because this crazy nurse that I worked with was like, Here, take a little vitamin for night shift, it’ll help you. And I was like, okay. I thought it was a vitamin.
I took it and I was like, oh my god! I was like, Heather on speed was crazy. But then it’s supposed to wear off by the time you go to bed, so you can go to bed. So, the half life is like 20 hours. Oh, wow. Which is, yeah, it’s really surprising. And here’s, here’s the risks, right? It’s a weight loss medication.
It can cause things like weight loss, vomiting, hypertension, irritability, issue sleeping for a baby, potentially. And, and this would be a hard choice, because yes, like, you’re breastfeeding a toddler, they’re getting a very, very small amount of milk, right, if it’s like once a day, but because of that, like, we know there’s a risk.
And it’s quite possible there’s a larger amount of this in milk. We would typically not advise using this. It’s also not the only weight loss medication. And there are some that are safer, you know, so it would be a good conversation to have with your doctor about like, okay, is there an alternative you would recommend and like looking up the safety information there, because I think if there was a safer option, I would say, you know what, maybe go with that.
And if there’s not, then, then you can, you know, make this choice. Yeah, I think that’s good advice. I mean, and there’s so many things on the market now. I mean, there’s new things on the market too, which means there’s definitely not going to be that much research for lactation, but we’ll see. Yeah. I think maybe we should do a whole weight loss episode.
Yeah. I, okay. To be honest, Heather, it’s a really hard one because I like, I don’t know. It’s like a complicated topic as far as also like mental health goes and like, you know, body image and all of that stuff. It’s. It gets really complicated and I’ve been, when I’ve thought about it, I’m like, I don’t really know how to approach this in a way that I feel like is supportive of people who do want to pursue these medications or procedures and people who don’t and like, I don’t know.
Yeah. Yeah. Hmm. Good point. All good points. I mean, we’ll get there. I mean, that’s just parenting, right? It’s just the next right decision for you and your kid as a team. Yes. Well, let’s get, let’s get into the next complicated topic. Shall we? I’m actually very excited. I’m very thankful to you Heather for putting together most of this.
I’m so insecure about it. Like you do such a good job putting together your heavy hitting episodes that I’m like, I was really stressing. I know I’m like late putting it together. And I’m like, Oh my God, I hope it’s as good as Maureen’s. Honestly, if it’s, if there’s parts that don’t make sense, you’re like, Sorry, my baby’s eating my brain.
We’ll forget. I have the placental shunting which they say is not a thing, but I think it’s lies. Whatever. I’m gonna say it’s a thing. Yeah, me too. Okay, well let’s start with the basics, right? So what is a dairy allergy? So it’s an immune system reaction to one of the 20 proteins that are found in cow’s milk.
Okay, there, it’s usually casein or whey, and there’s a bunch of different types of casein in cow’s milk. And surprisingly, from what I saw in the research, whey is the one that causes cow’s milk protein allergy most commonly, but then casein exacerbates it. Interesting, because whey, we have a much higher percentage of whey in the beginning of like the first two to three weeks of breastfeeding.
Well, and, and that’s interesting too because and I’m kind of skipping ahead, but since you brought it up, like the average, and this was a smaller study, I think there was only like 30 infants or something, but the average onset of the cow’s milk protein allergy was 14 days. Okay. Okay. Of life.
Spriggan it together. So I’m like, I’m like, okay, this is very interesting. But anyway we’re going to end up with more questions than answers at the end, which is fine because I want to do another episode where we interview an actual allergist and can ask all the harder questions. that I have, but whatever.
You know, and, and a friend of ours was just asking about like research topics that we had ideas about. So let’s just like add, we’re just going to add more to the list today, right? Yeah, of course we are. Okay. So dairy is the most frequent food allergy diagnosed in the first year of life. So there’s like 12 foods that are pretty typical, you know, like the shellfish and the wheat and the peanuts and the tree nuts and the whatever, but cow’s milk is far and above the most frequent one that we see diagnosed.
And so it affects about 0. 5% of breastfed infants, but it can be up to 5% of infants in general. And we did see that. Breastfed infants have a lower prevalence of this than formula fed infants. Okay, so we’re just, I just want to repeat that. You said 5%, so that is half of 1% for breastfed infants. Yes. This is not lining up with how often I hear about it.
We see people, though, that are having problems. Right? So we’re, we’re always going to be a little biased. And we always talk more about the bad things than the good things, but I do feel like that bears reiterating because it’s like, every time something is wrong, someone’s like, just give up dairy. It’s probably a dairy allergy.
Right, exactly. It’s a problem. And also, you know, we have to address the fact that a lot of these people that are cutting out Dairy, they’re just doing it not based on physician recommendation which means they’re not getting quite the follow up. They’re definitely not getting included in this research and who knows, you know.
So we’ll talk about that when we get to the problem section. Sorry about my child screaming. It’s that time of day. You know, it’s okay. I mean, most people aren’t going to notice because their own kids are screaming in the background, right? Sure. Sorry, everybody. Sure, sure. It’s okay. It’s okay. Okay, so the cow’s milk protein allergy occurs through both IgE and non IgE mediated responses, which is, you know, that we have lots of different types of ways that our immune system can react to things.
You know, there’s, there’s the IgM, which we get through passive immunity through the placenta, you know, so it’s basically like a pathway to how we respond to these allergens. And I mean, It’s interesting because I really think IgE mediated response, right? And IgE is like skin, respiratory, eczema, wheezing, itching, that kind of stuff.
Yeah. And that’s actually been hard from what I could tell. It’s kind of difficult for them to design research studies because of this, because half, half the symptoms that babies are experiencing for cow’s milk protein allergy fall under the IgE, which is more like. eczema and constant coughing, where they’re like, like a baby that sounds like they always have a frog in their throat or the angioedema, like the swollen eyes, like the hives, things like that.
And then the other half of the kids, the non IgE mediated, which is more GI symptoms like diarrhea, failure to thrive failure to, I feel like that’s in the diagnostic criteria. Huh. Crying, vomiting, abdominal distention, things like that, and bloody stool, of course, and mucusy stool. So, a lot of these studies are focusing on one or the other, you know, so for example, like one of the things that I saw was when you’re, say, a formula fed baby that has been on a Nondairy formula because they are trying to eliminate it and see what happens.
Then they’re going to reintroduce it, so they reintroduce a formula with dairy in it. And they are specifically looking for the IgE within like 10 minutes, 20 minutes. You know, usually within 2 hours, they’re having an IgE response if they’re going to have a response. So they’re looking for skin changes, they’re looking for any rashes, any swelling.
And you’ve got to think about it as a way, it’s like, easier to study that because you can see it. You don’t have to wait for the kid to have diarrhea, you know? Yeah. And like those GI symptoms also sometimes it like, they take a more amount of the food to trigger those, you know, like, yes, the bowels might be a little bit irritated, but maybe we’re not seeing blood in the stool yet.
Maybe it’s not vomiting yet or diarrhea yet until you have like this buildup. Right. It’s just more delayed. So from a research perspective, it’s like, Hmm. What would be easier to study? Let’s see. And also with the GI stuff, there’s so many confounding variables, you know, like maternal diet, so much, all of that.
And so the average age of onset of symptoms was day 14 of life in one of the studies that I read. I think a lot of the issues that we see also is there’s just a lot happening in the gut at that point in time. That’s usually when your milk is transitioning to be more mature milk. We have babies that are, you know, starting to think about getting on more of a pattern, possibly with eating.
There’s so much going on that it almost seems like how is anyone supposed to be in their right state of mind to even notice? Absolutely. And it’s like, when we look at the symptom list, things like, you know, the, the softer symptoms like discomfort and colic and, you know, like maybe diarrhea question mark.
Cause like, how can you tell if it’s diarrhea if all their stools are liquid and like, you know yeah, it, and, and like the poor weight gain to like, we’re, we’re kind of, it’s like almost hard to see that at two weeks, you know, we’re like only just expecting them to have regained their birth weight and yeah, I don’t know.
Two eagles are in some discomfort and, right, it’s, it’s very confusing and you know, I think also this is when you’re getting a lot more frequent pediatric follow-ups. So if you do have any of those symptoms, it’s probably getting caught a little bit earlier because you are having more frequent trips to the pediatrician as opposed to say between the two month and the four month where there’s probably a lot going on, but.
you know, your pediatrician may not catch it until four months. Anyway, these are all again, questions. But the good news is let’s, let’s shed some good light on this is that this is a cow’s milk protein allergy is typically self-limiting, which means that it eventually resolves on its own, even if you do nothing.
So like, even if you, if your baby is bleeding rectally and you are. Still eating dairy and you’re like, whatever, he’s fine. He’s gaining weight. You know, the good news is, even though they are bleeding from the butthole, most of the time, they look great. They’re healthy. Otherwise, most of the time. And I’ve definitely seen that too, or they’re like, okay, I found blood in the stool and like nothing else is wrong.
Right. And their weight gain is perfect. Right. Yeah. And it’s, it’s a hard, you know, it’s hard then to be like, okay, yes, we have evidence that there is bowel irritation, but like, are, are we really going to eliminate all dairy? Yeah, because there’s risks to that. Okay, there’s risks to that. Well, we’ll talk about that, too.
So I have seen though some studies suggesting that the rate of resolution is slowing down as more and more toddlers and adults are lactose intolerant and not able to tolerate the milk protein either, which are two different things. Interesting. The rate of adults and toddlers who are lactose intolerant is increasing?
Cause I thought, Oh, okay. So I listened to a great this podcast will kill you episode on lactose intolerance, highly recommend it. Reminder that it’s actually like the normal state for adults is to like, not. Eat lactose because our bodies don’t make the enzymes to digest it anymore. So yeah, very neat and I will say though that the study I read about this showed that 56% of kids formerly diagnosed as cow’s milk allergic Became tolerant at one year of age.
So that’s Pretty good. And 77% were tolerant by two years of age. And then as adults, less than 0. 5% of adults are reported to be allergic to cow’s milk protein. So, yeah, interesting. And the pro yeah, the proteins aren’t typically the problem as an adult. It’s the sugars, right? Exactly. So the, the resolution is slowing down, which makes me kind of wonder like, are these elimination diets limiting exposure?
Causing more allergies later, you know, like the peanuts, how everyone was like, Oh, your kid could be allergic to peanuts. And so every mom threw away all their Jif peanut butter and then the peanut allergies and kids, like school age children skyrocketed. And we were like, wait, early, early introduction of allergens is better.
So this is, these are some of the questions I have for allergists too. Yeah, I feel like this is one of those topics where, when I like. Kind of go check, like, up to date and, you know, make sure, like, my protocols are correct and everything. I’m like, oh, totally different than last time I checked. Okay, and then again in three years, oh, totally different again.
Great. Right, right. Yeah. Oh, God. So. How do we even know if they, if they have it? Because there’s no lab for it. It’s not like you can draw their blood and be like, yup, you’ve got cow’s milk protein allergy. So the one thing that I did find, which I thought was pretty helpful is like a screening tool, kind of like for PCOS, you know, like how many of these symptoms do you have and blah, blah, blah.
It’s called the. The COMIS score, so the cow’s milk related symptom score. And this is a tool that providers can use to determine if the baby has enough symptoms to fall into a category of CMPA. The current recommendation would be a cutoff of 12. So if your kid gets a 12, then we would say, okay, you know, a food elimination diet is probably worth it in your situation.
Most of the time from the couple of studies that I read where people were using this COMIS score. With food elimination, the kids that were actually positive, like they determined to be later positive, had a significant decrease in their COMIS score. So like down to like four. Instead of 12. And as far as symptoms go, parents are like, hell yeah, because I don’t want my kid to be uncomfortable or You know, spitting up and having eczema and all of these, all of these things.
So that’s kind of nice to know that it can work in kids that actually are positive. Do we have like a link to this resource somewhere? Oh, yeah, all of the research is gonna be in the show notes. Okay. Yeah, cuz I would like to look at that. Yeah, it’s pretty neat. So these Sorry, I’m like brain dead today.
The screening tool rates symptoms based on frequency. So, crying, for example. So we’re looking at colic kind of behavior. How many hours per day. And the more hours, the higher the score. Regurgitation episodes per day. So we’re talking about spit up. Stools. What type of stool? And for this they used the Bristol scale.
There is another scale. That is more in line with kids that are not toilet trained that they would like to use. But this is what they use right now. And then also respiratory symptoms, which I thought was interesting. So it is debatable whether or not respiratory stuff should be included in the cow’s milk protein because, because kids are so often sick with viral illnesses and that’s the most likely cause, but you can’t rule it out.
So, like, if you can rule out viral illness, and they are stuffy constantly, then you can be like, alright, this could be related. And then skin symptoms. So, atopic eczema, and where is it on the body. I did not realize that, like, where it’s located actually matters. And then itching. Itching. Yes or no. That’s a yes or no question.
Is they itchy or is they not itchy? And so the higher the score, the, the more we’re going to recommend a dairy elimination diet. Yeah. I mean, that’s really great that there’s some kind of objective tool. You know, it’s, it’s really hard to like unify practice across many practitioners. So these things are very helpful.
Yeah. I’m down with a good screening tool most of the time. Yeah, and it’s important to emphasize that it’s a screening tool, meaning it’s, it’s going to catch some cases of, of this issue of CMPA. It’s not going to catch everything in itself. It may not be diagnostic, right? But this is kind of like a wider, Umbrella to catch kids who might fall into the category of CMPA.
Yeah. Yep. And actually, let’s skip down to the problems that I have with all of this because you just highlighted one of them that I think is really important. So misdiagnosing cow’s milk protein allergy can be a big issue. Yeah. And you guys have heard us say that like 8, 000 times. Yeah. Yeah. So, and this goes both directions.
So, you know, we don’t want to assume it’s a cow’s milk protein allergy and miss something like necrotizing enterocolitis or like a serious infection or Hirschbron, Hirschbron syndrome or something more serious. But, we also don’t want to run a million labs and tests on a baby thinking it’s like sepsis or something really crazy.
Yeah, so much blood, like we’re not gonna do a million blood draws on this tiny human. Yeah, and so unfortunately, the go to is usually like, Well, mom, why don’t you just cut out dairy instead? See what happens. Right. That’s the easiest thing, . Yeah. But here’s the other problem is most of the time when somebody recommends that you cut out dairy, they do not also give you a nutrition referral or a dietary referral.
Yeah. And that can be a problem because a lot of us, myself included, have very dairy heavy diets, and so it’s like, Okay, what do I eat? So you know, a lot of people are eliminating food just in case it has dairy in it, you know, even though it might not. Well, and that might be all their protein, you know, like the, yeah, or like all their calcium or, you know, all the vitamin D they get might be from vitamin D enriched milk, like.
Mm hmm. Yeah, and that’s a problem because although the macronutrients of breast milk are basically all the same the Micronutrients are not and that can be based on the maternal diet And so we really need to at least acknowledge that a food elimination diet can cause a significant disruption in lifestyle Anxiety like crazy amounts of anxiety Did I accidentally eat dairy today?
Is that why he farted? I don’t know. And we never want to be sacrificing the health of the parent for the health of the baby. Like, you know, and that happens so often where we’re like, okay, you just need to wake up and feed them more. You just need to change your entire diet. You just need to make these changes and your baby will be fine and then nobody checks in on you.
Mm hmm. Yeah, it’s a problem. And then also, like, is your partner gonna be supportive of that? You know, like, it’s so hard when you go on vacation. I don’t know. It’s just, for me, before I recommend an elimination diet for anyone, I’m also looking at, like, do they have a history of anorexia or bulimia or…
Third percent. Yeah, you can send somebody into a serious tailspin with an offhanded recommendation. Oh, just cut out dairy. It’s like, yeah. And, and, you know, like I always screen for that for the clients that I begin to see in pregnancy. But, you know, it’s something that I don’t always ask initially on intake for lactation patients.
And it is really good to kind of like take those steps back and be like, Ooh, okay, here’s some patient history we need to go back and get before we dig into your diet. And you know something I do when I am recommending dairy elimination, which like, Maybe I don’t recommend it enough, you know, but it’s really rare that I do.
Is that I have my patients keep a diet log for about a week, you know, and I give them like a paper and I’m like, just, you know, to the best of your knowledge, don’t stress about it, just like write down what you eat and then come back and I like, cause I, I look and you know, most of the time it’s like, Hey, 50% of your meals have lots of dairy.
This is going to be a major change for you. Yeah, exactly. And also one of the questions that I have for somebody out there is like, And I couldn’t find this in the research, really, is it amount based or is it present or not present, you know, is it well, anecdotally, right? Like, I think you and I have seen cases where we’re like, Oh, you eat a lot of dairy.
Let’s see if we can eliminate some and just like, see what happens and things get better. But we can’t be totally sure that that’s What was going on? I don’t know. Right, exactly. And if I’m gonna go that route of just like this 50 50 thing, then I’m not that worried about the baby. You know, like for me, for me to recommend something so disruptive, that baby better actually have a pretty high comas score.
You know, they better be serious. Right, and usually that comes from the parents, right, where they’re like, they’re just so colicky and uncomfortable, but like, we see them, we’re like, yeah, but they’re gaining weight fine, they look great, everything else is great, you know, and they’re like, can I do something, please?
I’m like, well, I don’t know if you’d really want me to tell you this, I don’t want to tell you this. Yeah. You know, sometimes it’s like, I’ve had a couple of cases where people like show me like the protein smoothies they’re drinking. And I’m like, Oh, it’s like all casein. What if we just stopped those and see how it goes?
And I’m like, that gets better. So, you know, anecdotally, that indicates to me some cases might be amount based, but That’s not research based. Right, exactly. And I just, you know, we are so big on research here at the Milk Minute, and that’s why I really would like to dissuade anybody from making an off handed comment to a peer about Please, God.
About eliminating. Any kind of food, not just dairy, but like, please keep in mind that there is a whole consult that has to go into this, and you can literally just jack up someone’s entire mental world when you make an off handed recommendation like that without the time and energy and expertise to explain it.
Because we really need the pediatrician involved, like, I’m not gonna be managing this. I’m going to be pulling in a pediatrician for sure and making sure that we’re all on the same page. They’re looking at baby. I’m looking at mom a lot more. I’m like, yeah, baby looks good. But like, how are you doing?
Is this fine for you? Let me just throw out there, like, The, one of the reasons that Heather and I are so emphatic about this is because of the prevalence of eat, of disordered eating behavior. You know, there are some studies that show up to 75% of women have reported disordered eating behaviors and symptoms consistent with eating disorders throughout their lifetime.
Okay, 75, especially, you know, our generation seems to have a very high prevalence of it. You know, everyone knows the whole almond mom thing of the 90s. And you know, very small comments like that can be very triggering, can cause someone to go right back down into behaviors that maybe they’ve worked really hard to get out of or might increase things that they are dealing with currently.
And it’s just, I don’t know, we just really shouldn’t ever, like, comment on somebody else’s diet unless, you know, that’s appropriate for us as a professional, unless we’ve, like, been asked our opinion. Yeah, and then let me also just mention that weight loss or failure to stay on the growth curve is one of the things that is associated with a severe cow’s milk protein allergy, but so is having a mom who has a history Of eating disorders.
So we often see those moms tend to put their babies on more like restricted, scheduled breastfeeding plans. And then we will see a decrease in that weight. So like they are actually more at risk. If that makes any sense, so just bear that in mind and then, yeah, just take that seriously. You know, I can’t emphasize that enough, especially to the providers that listen to our podcast, the other lactation consultants and pediatricians and OBs, like really to understand the impact of your words, particularly as someone who has like given authority.
Mm hmm for sure and then be very clear about timelines too because you know one of the other issues Is that the best way currently that we have to diagnose this cow’s milk protein allergy is to? Reintroduce it into the maternal diet to see if the symptoms happen again So this is this is known this is known otherwise as a food challenge test, which just automatically is like, Oh my God, it’s like a Spartan race for babies.
It’s so stressful. And you know, so one study I read recommended the oral challenge after two to four weeks of the elimination diet, which I thought was very surprising because I can tell you firsthand that it.
Until the baby is like six months old, just in case, at least I, I see a lot of people were, you know, I’ll mention that I’m like, Hey, we, it is recommended that you reintroduce like, I, you know, obviously talk to your pediatrician about it as well, but it’s like they, I see a lot of parents who are so freaked out.
And so, you know, traumatized by like this colicky infant they had to deal with. And seeing blood in their poop and all of that, that they’re not going to reintroduce until six months or nine months or twelve months. Yeah, because they’re already tired. You know, they’re already tired, they’re like, this is working.
What if it all starts and, and if it does, then ding, ding, ding, yes, you found it. Congrats. You have a cow’s milk protein allergy. Like the, the prize at the end is not a prize. Having no cow’s milk. Yeah. It’s, it’s a super frustrating process. And you know, frankly, like all of the blood tests and skin prick tests and all of that for allergies also just like have very variable accuracy.
Right. And they don’t like to do it on little babies. They just don’t. So it’s not, it’s not usually standard to do a skin perk test on a baby. It’s so much easier to imposition the mom. Which is, ugh. Yeah, and I mean, honestly, those skin perk tests come back with lots of false positives. You know, and that is more frustrating and more challenging if that comes back and they’re like, Oh, and also here’s 12 other things your baby’s allergic to.
And you’re like, what? They’re like, in fact, don’t take your baby outside. Thanks. Yeah. And so it does also take a while to get the cow’s milk protein out of your system as a breastfeeding parent. Can we talk about this because I, you know, in our Facebook group and everywhere else we see like four weeks, 17 days, two months, like all these giant timelines.
So let’s really talk about what the research tells us here. Okay. So in one of the studies I read. We actually did see symptom improvement within 72 hours of eliminating dairy, which is interesting. Specifically the bloody stool, which is the one that freaks parents out the most. That’s the one that really brings them in to the pediatrician the most often.
That doesn’t mean that baby’s completely resolved, but we, we do see that within 72 hours we can have. some improvement, but other studies report that it does take a full week, like a full seven days of no dairy to eliminate all the casein and whey in your body. Yeah. And, and you know, the thing is, the timeline is of course going to vary because we all have different bodies and the efficacy of our digestion is different depending on your health and all of that.
It appears for the most part, Most people are going to have, like, the proteins they ate yesterday, you know, out of their body fairly quickly. But one of the things that we see with babies is their symptoms don’t just go away, like, When they aren’t exposed to this allergen for five minutes, especially with things like the bloody stool, because that’s literally like tiny little wounds in their digestive system that the body has to heal.
So that is a process that takes several days and possibly several weeks. The mucus was more persistent. You know, so the mucus is actually the lining of the intestines that has to be shed so the lining can repair and heal itself. A lot of people don’t realize that. And it’s like, that is a huge sign of inflammation and that does not go away overnight for sure.
Yeah, and we’re actually often see like an uptick in how much mucus we see. After elimination, because the body’s like, okay, we’re just going to soak everything while we repair it, because that’s how mucous membranes repair, you know? Yeah, has that ever happened to your mouth before? Have you ever had that where your mouth peels and you’re like, oh my god, like what happened to me?
Right now, this past week, for no reason that I can discern, I have like four canker sores in my mouth. Ooh, I hate that. Yeah, and they’re really painful, and I don’t really get them, so I was like, what the fuck? They’re starting to heal now, and I’m like, excessively salivating. Hahaha, sweet. Enough. Really great timing.
I’m dehydrated and dried up like a raisin, so I would love to have… Oh, a bunny just ran by. I would love to have some of that saliva in my mouth. Is that weird? Yeah, it is. Okay, moving on. The last problem I did want to address is that many parents can’t… Do the elimination diet or the stress. They just can’t do it.
They’re like, nope, this is beyond me, especially if they’ve already had other breastfeeding challenges. So they end up switching to formula and then they don’t, they don’t really realize. When they are switching to formula, that they are signing up for a hypoallergenic formula, which is actually very expensive, and it still has those proteins in it, they’re just more broken down.
It’s kind of like ABC gum, like already been chewed, you know? So their body doesn’t have to work as hard to digest it. Absolutely. Can I just say the first thing that came to mind when you were like, some parents just can’t eliminate that. I’ve, I’ve heard pushback on that when I have conversations with other professionals.
The most often I see that is when a parent is dependent on something like WIC for their groceries, which like you can only get certain kinds of food. With that program, right? And they give you a lot of milk, like a lot of milk. All the milk you could ever want. Butter and a lot of cheese. And it’s like, okay, if they’re limiting that, that’s like 25% of their allotted groceries per week.
You know, it’s just not something that I would ever recommend to somebody in that situation. Yeah. And good luck finding anything at the Dollar General. If you live in a food desert that’s frozen, that doesn’t have dairy in it. Like, even just like, the little dairy sprinkles, like the particles that they put in there for God knows what, I don’t know.
Well, yeah, and the closest places to get food to my house, right, say if I needed to walk or ride a bike, I would be able to get eggs, milk, cheese, bacon, frozen pizza. You know, like… Yeah. Let’s do it. Yeah. So let, let us just acknowledge that one more time. It’s hard. And the hypoallergenic formula is like upwards of 50 bucks a can.
It is so expensive and I just like, I would really like to know if the cost is in fact reflected by the manufacturing cost. Or if it’s jacked up, you know that too. Let’s find out. We need an investigative journalist on this. Okay, I was just going to email us at themilkminutepodcast. Gmail. com? Please. And tell us, because we would love to work with you.
Please, and also, if you know anyone that works in IgE or non-IgE mediated allergies and breastfeeding, please have them. Email us at MilkMinutePodcast at gmail. com so we can interview them on the show. We would love to, and we’ve reached out to a lot of people and we have not had many hits back and some of them were questionable.
Yeah. And it’s hard. Like sometimes when people offer us an interview, we’re like, that would be great. But like, actually your credentials don’t line up. Or like, you know, we send a lot of cold calls and emails out into the world. Just trying to find somebody that. Has the knowledge we want and also sounds good on a podcast, that’s hard, but for real fan base out there, if you guys know anybody who you know, like has a PhD in this stuff or works in a clinic where they see a high percentage of this and it’s really up to date on research, you know, kind of, kind of anything in that realm, research or clinical based, we would love to chat with somebody about, yes, a hundred percent.
Let’s take a quick break to thank a couple sponsors and when we get back we’re going to talk about potential causes of cow’s milk protein allergy and important things to note about it that I think you need to know.
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Okay, everybody. Welcome back. Heather. I am really excited to talk about causes. Can we talk about that first? I mean, yeah, we can try. So what causes this hellscape of a dietary problem? There of course, no one for sure knows, but there are some theories. So first, let me note that food allergies have increased significantly in the past 20 to 30 years.
And so people are working on this diligently trying to figure out what the heck it is. Like, is it just that we’re constantly inflamed all the time anyway because of exposure to environmental hazards and chemicals in our diet that just kind of makes our gut naturally be a little bit more reactive?
Question mark. Is it, it’s probably a culmination of a lot of those things. But one of the things that I did find that was very interesting is we do have a strong link between low vitamin D serum levels and cow’s milk protein allergy. That was very fascinating to me. Really just since I’ve been in school.
You know, since I did midwifery school, like I don’t know how long ago, seven years ago or something, we started to see vitamin D research coming out about immunotherapy and like, okay, why, why, what is the connection there? Like why are people with low vitamin D getting sick all the time? Like we just thought it made you happy or sad, you know?
Oh, vitamin D, are you depressed and tired? You probably don’t have enough. But as it turns out, it’s like, Oh, low vitamin D. Actually you are more at risk for having Like vaginal yeast infections and things like that. Vaginitis. Yeah. And, and I think really the more that we look at this, the more we realize, like, things are just so darn interconnected in the human body.
Yeah. Yeah, absolutely. And most of us, especially in the past 20 to 30 years, as you’ve talked about before, our food is deficient in vitamin D. Like, we’re just not getting enough of it because our food is grown indoors. And, you know, who takes cod liver oil anyway? Yeah. And, you know, we do have a vitamin D episode that we’ll link in the show notes, but we do recommend supplementing babies with it and yourself.
I mean, if you’re below 30. For your vitamin D level you need to be supplementing yourself for sure. Yeah, thanks for the reminder I haven’t taken mine in like two weeks. Same Same. Okay note to self where we’re gonna do that again Also note there if you have an autoimmune disease, please get your vitamin D checked like more often because A lot of the time we simply use more of it because our immune systems are just like going crazy.
Hmm, interesting. I didn’t realize that. Okay, and then also, family history. So, if we have family history of ATOP E, which is a tendency to develop allergic crap such as seasonal allergies, asthma, eczema and if it’s a first degree relative, You have a 20 to 30% chance if one of your parents has it. And if both of your parents have it, the risk climbs to 40 to 70%.
So we are seeing like parents that are inflamed and having allergic responses to things do tend to make babies that are. You know, allergic to things. It’s like, okay, they tend to make babies. I really didn’t think there was more. They tend to make babies that have allergies. Yeah. So there’s that. And so that’s why when we’re doing an intake, I remember on labor and delivery, I was always kind of confused as to why we did this in the initial intake.
Any family history of cows, milk, protein allergy. Question. Do we have any correlation between people who don’t eat dairy during pregnancy and their babies having this allergy? Okay, so this was really complicated, and I did not go down this rabbit hole very far, because I was like, holy sh I only asked because I had a patient ask me about that, and I was like, Literally no idea.
And she was like, okay, because you know, I didn’t eat dairy for the first three kids and they all have this allergy. And I did it for the last one and they don’t. And I was like, that is very coincidental. Possibly true. Girl, I don’t know. It’s, it’s very convoluted. And I’ve saw both things. Which, when I, when I saw both sides, where it was like, oh, people that don’t eat dairy then have kids that have dairy intolerance.
And then I saw, the more dairy you eat, the more chance your baby’s gonna have it. I was like, nope, I can’t. Yeah, it’s, it’s really confusing to me when I read about, like, exposure influencing allergies. Because I just feel like everything I read sounds equally true and not true. Right, and also it’s more from, and of course I’m no immunologist, but you know, it’s not IgM mediated.
It’s IgE mediated. You know, IgM is the one that crosses the placenta and we get passive immunity and things like that. So it’s really like genetics and how the baby is being… Grown and how their, their own immune system is growing, which is very complicated. And like, I, I definitely am more interested in that, but I did not have.
The brain capacity to do that today. No problem. I just, you know, we can say you did great and your baby is literally, like, reducing your gray matter, so I’m just, just gonna be impressed and that’s it. Thanks. The last thing on the problem list that I had was that the studies are sparse, truly sparse, on whether or not cow’s milk avoidance works.
So, You know, most of these studies, like I said, are retrospective chart reviews. And then also a lot of people think that they’ve eliminated dairy and they haven’t. They’re like, Nope, I eliminated all milk. And then you look at their diet and you’re like, Boo, you just ate some yogurt. And they’re like, Oh, I didn’t know Greek yogurt was dairy.
And you’re like, Yeah, and really like what I see a lot is that things like casein and whey are put in isolation into other processed foods. And, you know, you’re just not necessarily looking for those words. And granted, a lot of them are supposed to have that like allergy summary on the bottom saying that there is dairy if those are present, but not always.
Yeah, not always. So it’s kind of like, you can’t watch everybody and see everything that they’re putting in their mouth and be like, Oh, nope, sorry, Sally, that’s not supposed to. be eaten that has dairy. So it’s really kind of hard to control for it because it’s over a long period of time also. Okay. So things to note, let me tell you a couple of interesting things.
I’m noting them. Okay. It’s not likely from what I saw in the research that a preemie born less than 30 weeks can be already sensitized to cow’s milk protein. Okay. Okay. And this is because their immune systems are not fully developed at that point. Makes sense. And they’ve kind of pinpointed somehow that most immune reactions related to cow’s milk protein allergies happen after 32 weeks of gestation.
Can they have any allergic reactions prior to 30 weeks gestation? I don’t know. I don’t know. I don’t know. But they also are, because they’re preemies, they’re more at risk for GI stuff anyway. You know, like gaps in their cellular matrix, you know, that causes blood. All the, all the things, but yeah. Okay. And so just something to note.
So if you have a preemie and you’re struggling with any of these things, like, don’t just assume it’s cow’s milk protein allergy. It could be something different. Acute reactions can happen within two hours of administering cow’s milk directly. Right, not through breast milk. Not through breast milk. So, I found that very interesting.
So we sort of touched on that earlier in the episode, but, you know, for formula fed babies it’s a lot easier to do the oral challenge test, you know, because then you just give them formula that has direct dairy in it. And you kind of measure it you give them like five milliliters and then 20 and then 30 and you measure and you look at their skin and their swelling and all of these things over two hours.
And so a lot of times within two hours, they’re having that kind of a reaction, which I found very interesting. We need to talk about the milk ladder quickly. Please let’s do it. Okay. So if you don’t know what the milk ladder is, it was designed for non-IGE. Cow’s milk protein allergy. That’s the poopy one.
The poopy one. Has been used for IgE as well, just to see if it works, you know, because we throw spaghetti at the wall with this stuff. So basically it’s a 12 step approach to reintroducing dairy and they do it in a way that’s like, okay, we’re gonna do baked dairy. So the proteins are a little bit more broken down.
They’ve done this with eggs. for other kids. Yeah. Like parents who have older kids with lots of allergies will be familiar with this reintroduction method. Where it’s like, okay, we do bake stuff. Cause the, you know, the ingredients are like more broken down by the baking process. And then you introduce it in these other ways and with this other stuff and it’s complicated.
It is complicated. And also from what I saw. It doesn’t look like many people reach step 12 because of anxiety, because of crazy anxiety. Like, if you have to be on the ladder in the first place, it’s because you’re terrified your kid is having some kind of, like, really bad reaction. Yeah, it is usually used for those more severe reactions, too.
And, you know, the reason we’re using it a lot of the time is because, like, If your child is having really severe reactions to very common foods, they’re really at risk for having those reactions more often throughout their life. If we’re not trying this essentially, right? Like if we don’t get them past the allergy in some way, things like eggs and dairy are just.
Everywhere. They are. And the last thing I wanted to mention is that oral immunotherapy for cow’s milk allergy is typically done between four and five years old. So if your kid has been like positively identified as having a cow’s milk protein allergy and we’re, you know, beyond the age of one basically where it’s like, I don’t know, like this is not resolving.
They will do obviously an allergy specialist. And oral immunotherapy where you introduce dairy a little at a time and you up dose them and then there’s also a maintenance phase. So this is more in depth and this is going to be with a specialist and at a later age. Yeah, okay. I don’t know if they do that because at 4 or 5 years old your immune system is supposed to be, like 5, your immune system is more set.
It, it is, yeah. That’s what I was just thinking about, actually. And I wonder if it’s like less overreactive at that point because of maturity or not. Well, and also it might just be more specific. You know, so the more mature it gets, the more specific based on like Who knows? B cells, T cells. And, you know, to be honest with you guys, endocrinology and immunology is one of the youngest Areas of science we have.
I mean, we just found out about this crap in the 70s. Pretty much, right? The 70s? We like know the tip of the iceberg when it comes to this kind of thing. So this, we’re gonna listen to this episode someday and probably cringe and be like, what? I’m sure we will. Yeah, and whenever we produce stuff that is suddenly just like Out of date enough that we feel like we need to change it.
We do try to like throw in a little pre episode recording. We’re like, Oh, don’t listen to this one. Move on. Move on to whatever new one we’ve already recorded. All right. Well, I hope that kind of sunk in for everybody. I tried to make it. More simple. So if you’re wondering if your kid has a cow’s milk protein allergy, kind of, I hope you feel a little bit more prepared going to talk to your pediatrician about it, at least.
And if they do recommend a food elimination, ask, ask for them to do the CO MIS score with you there. That’s what I would recommend. And then I would also ask them to put in a referral for a dietician for you, because you should, you’re already figuring out enough stuff on your own. You should have some help with this.
Absolutely. All right, let’s do an award, Maureen. Yeah, let’s do an award. That was big. I feel like I need a win, you know. For sure. After all that so yeah, I have an award today for someone from our Facebook group, Danielle B. And she is celebrating meeting her six month goal of exclusive pumping, which is fucking incredible.
So congratulations, Danielle. She did say she’s not sure if she’s finished with her journey. She’s still debating it. So I wanted to throw out there that we have some episodes that might be helpful for you. Episode 76 on weaning, we give a lot of practical tips toward the end of that one. And we have some other episodes on things like reducing supply that might be helpful just in kind of figuring out how to taper down your pumping.
Hell yeah. Great job, Danielle. We’re going to give you the Goal Getter Award. It’s a mouthful, but you know, it’s exclusive pumping is not a joke and you really crushed it. So great job. You got those goals and we are going to hopefully share your picture on our Instagram story. So everyone else can give you a high five as well.
All right. And our Apple review today is from username sing like sing a song and it’s titled literally taught me to breastfeed. Four stars though. So like, okay, that’s fine. It says, most of us who are learning to breastfeed today are millennials. A generation that’s unlike any other. We want to breastfeed, but we have to look elsewhere for guidance because our boomer parents were steered away from breastfeeding and most of them didn’t have a chance to do it.
That applied to me and my mom, so I turned to this podcast to learn everything I needed to know about breastfeeding and they’ve literally taught me all of that. Hey, thanks. Oh, wonderful. Thank you. I’m so glad we taught you that . Yeah. I mean, if only I could get that extra star, you know, , I, I like still talking about it.
It’s good. It’s good. I like to know what I’m missing, what I’m doing wrong. I’m sorry. Probably ’cause of your mouth, . I’m kidding. Totally kidding. Well anyway, thanks for that review thanks for listening to this episode guys, we really appreciate that. Yep, the way we change this big system that’s not set up for lactating families is educating ourselves, our friends, our loved ones, and sometimes our providers.
And I just have to say we are very close to meeting a monetary goal on Patreon right now that I’m very excited about that’s going to give us just like a little more flexibility. So if you liked this episode, any other episode, if you want exclusive access to our second podcast, Beyond the Boob, please, please join our Patreon at Patreon.
com slash Milk Minute Podcast. Or leave us an Apple review. Any amount of stars, really, but five makes my heart happy, and we’ll read your Apple review on air. We definitely will. All right, everybody, we’ll see you next week. Bye bye.
