Dear Shannon:

Wow, that's a strong reaction to the idea of a dairy elimination.  Maybe 
with three kids, she's finding it hard enough to get anything to eat, 
and so the idea of a special diet is exhausting.  Maybe you can increase 
her motivation by pointing out what heroic work she did to rebuild her 
supply, and that soy formula is even further away from human milk.

You can also agree sympathetically that dairy is really pervasive in 
many diets, especially in a lot of things that tired, busy people can 
grab easily -- the cheese stick, the yogurt tub, the bowl of cereal.  
And that sometimes it's easier to set up an elimination diet by focusing 
on what she *can* eat, and just filling the house with low-allergy food 
that's easy to grab, foods that she doesn't eat all the time.  (Because, 
sad to say, the allergen could be something besides dairy, such as wheat 
or nuts.  At least it looks like soy is ok, which opens up some 
options.)  So she roasts a turkey, or a leg of lamb, makes a pot of 
squash, green beans, greens, pears, a pot of rice, millet, quinoa, sweet 
potatoes, avocados, sunflower seed butter (a reasonable approximation of 
peanut butter) rice milk (or in her case, soy milk or maybe soy cheese 
or yougurt) rice or millet cereals, rice-cakes, There are lots of 
allergy-related websites with ideas about low-allergy foods.  She just 
uses olive oil, salt and pepper, and minimizes packaged foods so that 
she doesn't have to ponder over labels.

Sometimes it helps to present it as starting a three week experiment -- 
not a commitment.  So that she can tell herself that it's not forever, 
and that as long as there's something quick to eat, even if it's turkey 
slices and rice cakes for breakfast, she'll  be ok.  At the end of three 
weeks, she can assess what's going on -- does this seem to make a 
difference for the baby?  Is she finding it manageable?  Some mothers 
find that eliminating foods makes them feel better -- sometimes people 
are passionate about foods that don't really don't help them.   As the 
baby's digestive tract matures, she may find that she can eat foods in 
rotation without causing problems.

You can look back to lots of Lactnet discussion about healing the 
mother's gut to help her digest her food better and minimize passing 
along intact proteins.  I had previously dug up some references on using 
digestive enzymes and probiotics for the mother, so I'm just going to 
paste that in this post (sorry if the formatting gets weird)

> I'd also mentioned this journal article, of a small study, with 23 
> lactating mothers, fed peanuts, and their milk checked every hour.  
> More than half didn't pass any detectable proteins, and the ones who 
> did, did so at varying times.  That suggests to me that the mother's 
> own gut and digestion might have some influence on whether she'd pass 
> along intact proteins.
>
> http://jama.ama-assn.org/content/285/13/1746.short

> I'd mentioned that one new approach being explored for difficult 
> digestive/allergy issues for the baby is probiotics and digestive 
> enzymes for the mother,  to see if improving the mother's gut health, 
> and helping her digest her food more completely can reduce the intact 
> proteins the might pass into her breastmilk.  Below are a few 
> references if you wanted to discuss it with your doctors. Here are the 
> links   Dr. Jack Newman mentions the idea briefly in this essay: 
> http://www.kellymom.com/newman/02colic_in_bf_baby.html#foodallergy 
> This is a reference from the Journal of Human Lactation (which your 
> doctors should be able to tap) DOI: 10.1177/089033440201800108 J Hum 
> Lact 2002; 18; 50 Barbra Schach and Michael Haight Colic and Food 
> Allergy in the Breastfed Infant: Is It Possible for an Exclusively 
> Breastfed Infant toSuffer From Food Allergy? And this from a 
> gastroenterology journal: 
> http://www.jpgn.org/pt/re/jpgn/fulltext.00005176-199910000-00069.htm;jsessionid=LsSclyhtGg69mn0vqRkKC1x68v4zFGMmx8QlCMMScJz8wflJjShk!-2121125135!181195628!8091!-1 
>
> and this reference book excerpt: Breastfeeding: A Guide for the 
> Medical Profession Lawrence, 6th edition, page 522 "It has been 
> recommended by Haight that the severe cases of allergic colitis and 
> also severe gastrointestinal colic can be alleviated by treating the 
> mother with pancreatic enzymes, 25 mg 3 times a day.  It is safe for 
> the mother and often dramatic for the infant.  This is especially 
> effective when eliminating cow protein has not solved the problem." 
> The Breastfeeding Answer Book, third edition, page 443: "A new simpler 
> treatment is now available when allergic breastfeeding babies react to 
> foods in the mother's diet.  Using a digestive enzyme taken by people 
> with cystic fibrosis to help break down fats, proteins and 
> carbohydrates, the mother takes two prescribed Pancrease MT-4 strength 
> tablets with each meal and one with each snack. (Schach and Haight 
> 2002; Repucci 1999)  The effect is to break down food more thoroughly 
> than the mother's digestive system, so that the offending food is less 
> likely to pass intact into the milk."

Good luck to all.
Margaret Wills, IBCLC
Maryland

> Date:    Thu, 12 May 2011 01:24:50 -0400
> From:    "Shannon Sanford, IBCLC"<[log in to unmask]>
> Subject: Allergic to EBM?
>
> Hello, all.  Me again, seeking wisdom from the voices of experience.
>
> Permission to post: Baby #3 currently aged 3+ months.  Mom with history of two seperate low milk supply experiences, infertility only with pregnancy #2, lifetime history of menstral irregularity and diagnosis of PCOS based on life history review (no complaints of symptoms) and with no medical treatments ever prescribed.  Now, baby #3 has breast and bottle-fed formula from birth.  Reported to manifest symptoms of milk intolerance within first 24 hours (?) of birth and switched to Gentle-ease. Continued explosive loose, green stools, fussiness and large spits led to a switch to soy-based formula at age 8 days with no further problems.  Continued to breast and formula-feed for 4+ weeks without issues.  Mom had a brief, but intense viral flu-like illness.  Baby kept nursing throughout, but supply nose-dived after illness.  Following week, infant began refusing breast.  LC assistance sought.  Low milk supply issue targeted via usual methods (increased nursing, herbals, pumping, Rx, SNS, etc) and supply has responded.  Baby likes to breastfeed.  However, baby begins screaming and arching within 15-30 minutes of any breastfeeding, perisiting for hours.  If supplmented all day on soy, no issue.  When one bottle of EBM is offered, same pattern of behavior reoccurs as when breastfeeding.  Pedi has advised baby is "allergic" to mom's milk and only option is dairy elimination.  Mom is 100% certain she would rather involute and donate stored milk than eliminate any dairy from her diet.  Before she takes this drastic step, any other suggestions?
>
> Thank you,
> Shannon (in Texas)
>

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