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From:
"Glass, Marsha" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 20 Jan 2003 17:18:16 -0500
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~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Marsha Glass RN, BSN, IBCLC~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Mothers have as powerful an influence over the welfare of future generations as all other earthly causes combined.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~John S. C. Abbot~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Jan brought up a good question about how the use of lactase in the milk would help a baby who was reacting to dairy protein.  I wanted to do a little research and listen to Joan's talk again before attempting an answer, mainly because I am not clear on the whole thing myself!  What Joan discusses is
the babies whose problems with colitis began as an oversupply issue.  The increased lactose and water resulting from oversupply causes problems for the baby which can lead to gut friability, allowing larger proteins to pass through and cause problems.  She describes it as a snowball-type problem
which gets worse the longer it goes untreated.  She lists 4 things that help when a baby develops colitis.  1) correction of foremilk/hindmilk imbalance; 2) Elimination of allergens from mother's diet; 3) Reassessment of mother's or baby's meds; and 4) Lactase-treated expressed breast milk.  I am
unclear whether she is just discussing the case of one that exists because of the other or if she believes they are very often associated.  She describes cases where doctors have tried Nutramigen without success where eliminating dairy and using lactase eventually did clear up the problem.  One case
she said the baby continued to have traces of blood in the stool which they just ignored after no other intervention cleared it up anyway, but baby definitely got better on this regimen, which someone else already posted.  She also describes a case study of one baby whose mom had a hx of eczema on
her hands, older sibling of baby put on soy by pediatrician, who suffered bfrom colic, blood and mucus in stools, in 95th percentile wgt and lgth by 6 wks.  She was tx by eliminating dairy from mom's diet and lactase gtts.  By 9 wks, she had yellow stools (no curds which she says is part of this
scenario) no mucus, no blood.  By 13 wks, still using lactase gtts on tongue prior to feeds.  By 15 wks, exclusive breastfeeding, no lactase needed, yellow curdy stools.  I hope I am representing accurately what she says.  Someone set me straight, if not!  I missed the lecture (it was Saturday
morning and I was worn out and slept in.  As it turns out, I'm glad I did because I ordered the tape instead and I don't think I would ever have remembered all this stuff just from notes!).

What confuses me is why do you call it transient lactose intolerance?  All those reasons it can occur sound like reasons for rapid gut emptying which means there isn't time for lactase to digest the lactose.  Joan draws a picture of lactose bounding through the gut with lactase chasing it but unable
to catch up.  My 16 yr old daughter is truly lactose intolerant and can't tolerate ANY dairy without Lactaid and sometimes not even then.  I'm just trying to sort all this out in my mind, since I've never heard of transient lactose intolerance before.  (Wow, did I miss that from being off LN for a
couple of months or am I truly uninformed?!)
Marsha


Marsha Glass RN, BSN, IBCLC ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Mothers have as powerful an influence over the welfare of future generations as all other earthly causes combined.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~John S. C. Abbot~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




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