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 cow’s milk • Triggered by a combination of genetically inherited factors and early introduction of cow’s milk or soy protein into an infant’s 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 mother’s diet while she is breastfeeding • Delay solid foods until 6 months of age • 1 year of age: Introduce cow’s 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 cow’s 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@dhss.mo.gov • Jean Trae, PhD, RD, LD WICNS Child Nutrition Coordinator 573-751-6183 traej@dhss.mo.gov