Lactose Intolerance or Milk Allergy

1
Lactose Intolerance or Milk Allergy?

• WIC and Nutrition Services
• Department of Health and Senior Services

2
What is Lactose Intolerance?

• Inability to digest significant amounts of
  lactose, which is the predominant sugar in milk
• A result of lactase insufficiency, the enzyme
  essential for the conversion of lactose into
  glucose and galactose

3
Types of Lactose Intolerance

• Congenital
• Very rare
• Primary
• Develops after 2 years of age
• Secondary
• Usually resolves in 1-2 weeks

4
Symptoms of lactose intolerance

• Intolerance does not involve the immune system
• Nausea, cramping, bloating, abdominal pain, gas,
  diarrhea
• Symptoms may begin from 15 minutes to several
  hours after eating food with lactose

5
Prevalence of Lactose Intolerance

• An estimated 30 to 50 million American adults are
  lactose intolerant
• 90 of Asian Americans
• 80 of African Americans
• 62-100 of Native Americans
• 53 of Mexican Americans
• 15 of Caucasians

6
What is Milk Allergy?

• An abnormal immune system reaction to proteins in
  the cows milk
• Triggered by a combination of genetically
  inherited factors and early introduction of cows
  milk or soy protein into an infants diet
• www.foodallergy.org

7
Symptoms of Milk Allergy

• An immune system reaction
• Swelling, sneezing, nausea, vomiting, hives,
  rash, itching, runny nose, coughing, difficulty
  breathing, gas, diarrhea
• Anaphylactic reaction possible
• Symptoms may begin within seconds or up to
  several hours after eating the food
• See your Doctor

8
What are the options?
9
Review the Options

• Breastfeeding is the best option for most infants.

10
Infants at risk for food allergy

• Exclusive breastfeeding is recommended
• Eliminate foods that cause infant allergies from
  the mothers diet while she is breastfeeding
• Delay solid foods until 6 months of age
• 1 year of age Introduce cows milk
• 2 years of age Introduce eggs
• 3 years of age Introduce peanuts, other nuts,
  fish, shellfish

11
Bright Futures in Practice - Nutrition

• Available in every WIC agency and at
  www.brightfutures.org/nutrition/index.html

12
Infants with milk allergy

• Breastfeeding
• Alternatives to breastfeeding
• Soy formula
• Hypoallergenic formula
• Avoid milk products or foods with milk

13
Children and Women with milk allergy

• Eliminate milk
• Casein or caseinate
• Casein hydrolysate
• Dried milk solids
• Lactolbumin
• Lactate solids
• Sweetened condensed milk
• Whey or whey solids

14
Children and Womenwith milk allergy

• Substitute other foods to provide missing
  nutrients
• Cook with alternative foods
• Alter recipes and meals
• Avoid cross-contamination
• Learn strategies for coping with restaurant meals
  and special occasions
• Conduct food challenges (with medical support)

15
Infants with lactose intolerance

• Breastfeed
• Alternatives to breastfeeding
• Soy formula
• Lactose free formula

16
Children and Women with Lactose Intolerance

• Eat or drink small servings
• Know your personal tolerance level
• Eliminating milk and other dairy foods may pose
  nutritional risks

17
Tips for Tolerance

• Experiment with gradually larger amounts
• Drink milk with a meal rather than alone
• Eat smaller, more frequent portions
• Choose aged cheeses lower in lactose
• Try dairy foods with active cultures
• Read labels
• Kosher foods that say parev or parve are
  milk-free

18
Some lactobacillus or sweet acidophilus milks are
no lower in lactose and may not be tolerated any
better than other forms of milk.
19
Special food products

• Lactose-reduced or lactose-free milk and other
  dairy foods
• Add lactase enzyme to fluid milk
• LactaidTM
• CactraseTM
• DairyEaseTM
• Chew or swallow a lactase supplement before
  eating lactose rich foods

20
Lactose-free foods

• Broth-based soups
• Plain meat, fish and poultry
• Plain fruits and vegetables
• Tofu
• Breads, cereal and crackers made without milk,
  dry milk, or whey

21
Alternative Sources of Calcium

• Vegetables cooked/raw broccoli, turnip and
  collard greens, kale, Chinese cabbage
• Fish/Seafood canned sardines and salmon with
  edible bones, raw oysters
• Calcium-fortified orange juice
• Calcium-fortified soymilk
• Tofu processed with calcium salts
• Almonds

22
Calcium 1 cup milk

• 8 cups spinach, raw
• 1 ½ cups turnip greens, cooked
• 2 ¼ broccoli, raw
• 5 cups red beans, cooked
• 3 oz. sardines, canned with edible bones
• 1 ½ cups orange juice, calcium fortified
• 2 ¼ cups soy beverage, calcium fortified

23
Calcium education

• power point presentations,
• calcium intake requirements,
• functions of calcium, and
• information regarding risks of inadequate intake
  of calcium are available at
• www.dhss.mo.gov/Calcium/education

24
Calcium-Related Health Problems

• Osteoporosis
• Colon and Rectal Cancer
• Hypertension and Stroke
• Overweight and Obesity

25
WIC Policy

• Non-contract and exempt formulas for infants or
  WIC-eligible medical foods for women and children
  require a prescription.

26
For children and women with lactose intolerance
documented by the CPA, cheese may be issued as a
substitute for milk.
27
USDA encourages programs to offer alternative
types of milk for children who are lactose
intolerant.

28
In schools and childcare settings

• Schools and childcare providers must make
  substitutions for severe food allergy.
• Schools and childcare providers may provide
  substitutions for food intolerances.
• Services funded through IDEA include
• Purchase of special foods
• Purchase of feeding equipment
• Consultation with a registered dietitian
• www.fns.usda.gov/cnd/guidance

29
Child Nutrition and WIC Reauthorization Act 2004

• Schools and childcares must offer a variety of
  fluid milk with different fat contents.
• Schools and childcares may offer flavored and
  unflavored milk and lactose-free milk.
• Schools and childcares may substitute a non-dairy
  beverage that is nutritionally equivalent to
  fluid milk and fortified with calcium, protein,
  vitamin A and D to levels found in cows milk.

30
For More Information

• STTM 2
• Calcium pg 26-27
• Food Allergies pg 113
• Calcium and Osteoporosis pg 127-130

31
For more information

• Rita Arni, RD, LD
• WICNS Child Nutrition Team Leader
• 573-751-6183
• arnir_at_dhss.mo.gov
• Jean Trae, PhD, RD, LD
• WICNS Child Nutrition Coordinator
• 573-751-6183
• traej_at_dhss.mo.gov