Lactose Intolerance, Overload or Simply Overfeeding?

Hi, I'm afraid that this is going to be another long post but I'm hoping that it will help and reassure a lot of mothers out there who are worried that there baby is lactose intolerant. This may not necessarily be the case and there are other things you can try before you decide to stop b/f or look for a lactose free formula.

My baby had the symptoms of lactose intolerance when solely b/f, but fortunately I didn't even know I had lactose in my boobie milk otherwise I'd have probably switched to a lactose free formula there and then!! I had done some research (I do a lot of that!) and her symptoms matched what I found to be described in some indelicate terms as 'forced-poo' caused by her getting too much fore-milk.

The graphic bit: Freyja's poo was like normal new-born b/f poo at first, but within a couple of weeks she'd developed what we called 'exploda-poo' after one incident when my hubbie was changing her and it shot out of her bum like she was a water pistol. This left my hubbie in laughing hysterically and me with a poo stain over a meter long across the carpet (which was typically a nice light coloured one) and up the door.

After the exploda-poo calmed down, I was getting the hang of feeding a bit more so her poo went back to normal. However, we would occassionally get some bright green watery poo and I knew that she was getting too much fore-milk, so would just ensure she fed on one breast for much longer until it went back to normal. Soon her poo was much less frequent, down to twice a week in fact, and had the consistency of play-dough (sorry!).

Now my baby is mostly bottle-fed with boobie top ups. Being new to formula and not having had anyone to ask advice off, or internet again until lately, I was following the instructions on the can to the letter. It says I should feed her a 250ml bottle 4-5 times a day. Mostly she gets it 4 times, but depending on how awake she's been I've tried to squeeze in that extra one, thinking she'd need it because it's what the can said.

Within a day she was clearly in a lot of discomfort when feeding, twisting away, crying, screaming even, passing what seemed like really painful wind and pooing a lot. She always wanted more food and seemed extra hungry compared to before. She was also putting on weight faster than before. Occassionally, she'd be okay when feeding and other times it would be horrendous. She's also changed from being such a loving, playful, attentive, active and happy little girl to a grumpy monster who also wakes me up a million times a night (she was sleeping through). Sometimes she wakes up screaming with a sore tummy and she has also started being sick, which she never has before. Plus, I can actually hear the milk sloshing around in her tummy when I'm moving her!

The hunger and weight gain I thought were due to a growth spurt and convinced myself she was lactose intolerant. So, off I went to get some soya formula to try. Unfortunately, after a week, her symptoms remained the same - clearly not a case of lactose intolerance then!

Having done yet more research (told you didn't I?), I've realised that her initial symptoms when both b/f and later with lactose formula were both as a result of lactose overload and that the reason for the overload with formula is because of a simple case of overfeeding. That is why the symptoms have continued whilst she's been on the soya formula. Her formula is soooo much thicker than the breast milk she was used to and instead of my previous attitude to feeding (ie when I remembered she hadn't been fed for quite a while!), she's been being offered food every 3 hours whilst awake in an attempt at fitting all these feeds in.

Anyways, whilst looking all this up I realised that a lot of people who have posted saying their babies were lactose intolerant showed the same symptoms and thought it might help others if I posted my experience and what I've found out.

I figured I better put it in another post seeing as this one is already gigantic, so if none of what I've said here sounds familiar, then there's no need to read on is there? ;)

So, here goes! :D

Lactose is a sugar found in the milk of mammals - that means humans as well as cows. It's a big molecule so your body needs an enzyme called lactase to break it down into smaller sugars that your body can then digest. This happens in your small intestine where the broken down sugars are then absorbed into your blood supply so they can be used by your body.

Lactose and the sugars that it breaks down into are really important for your growing baby and also for us as adults. They help keep your intestines healthy, keep your brain and nerve tissues healthy and give you energy to grow. The two sugars are galactose (this is the one that keeps your brain and nerve tissues healthy) and glucose (this is where your energy comes from).

If you're lactose intolerant, you don't produce enough lactase and the sugars aren't broken down. This means the lactose can't be digested fully. Bacteria in your intestines will break it down to a degree, where it will basically ferment producing excess gas, bloating and pain.

For adults, this means you might suffer from bowel irritability, your tummy feeling bloated, pain in your tummy, flatulence or diahorrea. Your baby would have these symptoms, which would make them pretty grumpy and unsettled. However, they would also not be able to use glucose for energy and would therefore cease to gain weight and start to lose it.

Lactose intolerance is pretty rare within caucasian races and mostly affects Asians, Afrians, people from the middle-east or even the med and people of Aboriginal heritage. The Vic health website says that only 5% of caucasians in Australia are lactose intolerant, but 75% of non-caucasians are.

It's rare for babies to be lactose intolerant from birth and is much more likely that they will develop it temporarily after having a tummy upset or because of iron deficiency. The lactase is formed in your intestines and if you have a tummy upset, the lining of your intestines can be stripped so it can take a few weeks to recover. There are apparently temporary solutions that can be given to babies that means they don't need to stop being b/f or switch to a non-lactose formula.

For lactose overload, babies are simply not producing enough lactase to cope with the amount of lactose they are being fed. This is a temporary problem and is pretty common in the first 3 months of a babies life because their digestive systems are not mature enough, but can be seen up to 5 or 6 months. This is why it takes babies a little while before their bowels settle down.

Many healthy babies experience lactose overload when b/f because their mums are producing a lot of milk, especially in the first few weeks, or are switching sides too often (this is what I did!), so the babies don't get enough of the fatty hind-milk and a lot of the watery fore-milk. The fore-milk is lower in fat and passes through the digestive system quicker, which might be too fast for the lactase to break down all the lactose.

It is not true that a mum can reduce the amount of lactose in her milk by cutting out milk and milk products. What this would do is reduce the proteins in her breast milk that originated from those products and this would indicate an intolerance or allergy towards those proteins, not lactose.

For bottle fed babies, it may simply be a case of overfeeding, which is easy to do because they're not very good at saying they're full! We often automatically assume our babies are hungry when they're just having reflex reactions (it's instinctive to cry, root, suck and put their hands in their mouths and doesn't mean they're hungry), if they're snackers or sleepy feeders, they're thirsty or they're tired and have learned to associate feeding with sleeping, or simply because they can't cope with the amount of milk coming through the teat. The larger the feed, the faster the milk passes through their digestive tract and the less time the lactase gets to break it down.

When babies are being fed, it stimulates their intestines and causes them to contract. This is why they often poo during or after a feed! If you feed them before their previous feed is fully digested, these contractions can push some of the new milk through from the small intestine into the bowel. The lactose draws in extra water and the bacteria in the bowel go to work fermenting it and producing excess gas, resulting in cramps, bloating, frequent watery acidic stools, which can burn their little botties.

This will all case your baby a lot of discomfort and they may cry and scream when being fed, their little bodies contorting with the cramps and wind. They will also not seem to be themselves and be much more grumpy and unsettled. Also, they learn that feeding will initially give them some relief, so they'll act as if they're hungry and the whole thing cycles again.

The majority of the symptoms of intolerance and overload and the same, but the big difference is that babies with lactose intolerance will lose weight and become very ill, whereas babies with overload will be healthy and often gain extra weight. Similarly, if you are over-feeding your baby they can present the same symptoms. Unfortunately, babies suffering from lactose overload will often test positive for lactose intolerance, and as a result mothers are told to switch to lactose free formulas when better feeding management would provide relief.

If you're baby is suffering from any of the above symptoms or reflux, but is otherwise healthy, thriving and presenting no weight loss, then don't be too quick to restrict your own diet or switch to a lactose free formula - consider changing your feeding methods and patterns first.

Very interesting..... Thank you