December 30, 2011

Got Milk (Allergies)?

There are 4 main food sensitivities that seem to affect kids the most:  milk, wheat, soy, & eggs.

I’ll spend a little time later on the wheat/gluten concerns, but for now I want to talk just a little about milk and dairy sensitivities, given that milk and cookies have pretty much formed the staple of the holiday diet.

Generally speaking, nutritional related problems fall into 2 broad categories: deficiencies and irritants.  As described in prior posts, we as a whole tend to be nutritionally deficient when it comes down to optimum health.  That slow & steady depletion, much like a slow leak, will eventually lead to health problems.  Except in extreme cases, gross, single nutrient deficiencies are relatively rare (though Vitamin D – which is technically a hormone- seems to be low in almost everyone that I test- but more on that in a later post).

With irritants, the particular food-stuff causes some sort of irritation, likely mediated through inflammation. Most people do not have a full blown anaphylactic response to dairy, but dairy is highly associated with sensitivities- which do ultimately trigger the delayed allergic response talked about previously. The usual culprit is casein, the milk protein that comprises approximately 80% of milk; the other 20% is whey.   Sensitivities are not synonymous with intolerance, the latter being associated with an enzyme deficit and the subsequent inability to break down lactase, the milk sugar.  At least one in ten people worldwide have this particular enzyme deficiency.  Fortunately, true dairy allergies are relatively rare, effecting approximately 1% of the population. However, any kind of allergic process leading to a “leaky gut” can cause you to be more susceptible to developing an allergic response to dairy and to become, at least temporarily, dairy sensitive. In fact, one recommendation when dealing with any type of allergies is to eliminate high-allergy foods from the diet, with dairy being on the op of the list.

Since milk is the first thing that babies typically eat, symptoms can manifest at a very early age. Thus, it is important get a detailed chronology of problems, even if the symptoms for which the child is being seen may have no overt connection to his diet at 3months.  Most children are not allergic to their mother’s milk, but can actually be triggered by something mom has eaten (like chili peppers or prozac), which makes detective work difficult.  If a child is dairy sensitive, the history typically includes trials of multiple formulas to find one that is tolerated.  Unfortunately, there is a lot of cross reactivity between dairy and soy.  Since diary causes a lot of congestion and mucus build-up, the history is also usually replete with multiple ear infections, often necessitating tubes.  With babies being supine the majority of the time, mucus settles in those dependent areas like the eustacian tubes, essentially becoming a petri-dish of sorts in fostering  bacterial growth.  But the mucus can occur anywhere along the GI track, from the mouth to the anus, so mucus in the stools is also a potential symptom.  Interestingly, other common symptoms that can be associated with dairy sensitivities are constipation, stomach pains, bloating and gas, sleep disturbances (usually insomnia), eczema/rashes/acne, and a limited palate. As discussed in prior posts, allergic responses can manifest in sundry psychiatric conditions; so it wouldn’t be uncommon for there to be behavioral manifestations of dairy sensitivities as well, with typical parental concerns for inattention, hyperactivity, aggression and anxiety being the most common complaints.  But as you can guess, if dairy sensitivities cause sleep disturbances, the sleep disturbances could be the main reason for the subsequent inattention and irritability. This cluster of symptoms obviously is very non-specific, but as a whole and in the context of a history replete with multiple ear infections beginning at 3 months and needing a hypoallergenic formula, dairy elimination is not a bad place to begin.  Typical elimination diets take approximately one month to completely clear the allergen from the system and any exposure to the noxious irritant can jeopardize the clearing endeavor. This is particularly true in the case of celiac disease and the gluten free diet. However, I have had children in my clinic manifest an almost immediate change with the elimination of dairy, typically with stomach pains being the first to go.  A particularly nice effect in eliminating dairy (if it is truly the etiology of the symptoms) is that the diet typically becomes more diverse and less picky.

I had one child come into my clinic this month who was having such severe stomach pains and nausea that she actually threw up during the initial interview. There was a similar history of sleep disturbances, hypoallergenic formula, constipation, ear infections, chronic congestion, and GI pains, with a behavioral health history that included diagnoses of ADHD, bipolar disorder and some form of pervasive developmental disorder (PDD NOS).    Unfortunately this 12 year-old girl was also on a laundry list of psychotropic medications from her recent residential treatment facility stay.   In addition to eliminating some of the over-sedating medications (she was only awake about 6 hours a day at intake), we eliminated the dairy and there was an almost immediate cessation of her stomach pains, no further nausea and vomiting, and a gradual improvement in her sleep routine.  Granted, some of the changes could have been from tapering her medications, but the almost instantaneous cessation of pain and nausea was enough to make mother and child believers.

It has been estimated that about 60% of children outgrow milk allergies by the age of 4, and 80% by the age of 8.  It might just be that the real condition is not so much the allergy to milk, but the “leak-gut” leading to the subsequent sensitivity reaction; thus if you repair the gut, the intolerance might just stop.