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Subject:
From:
Barbara Wilson-Clay <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 18 Apr 2000 18:29:42 -0500
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If a person goes through dramatic and persistant  therapies (here a 2 year
long effort!) to clear up a condition and is, in the end, no better, I'd say
logic requires a reconsideration of the initial diagnosis and a change in
the direction of the therapy.  As Einstein said:  Insanity is doing the same
thing over and over and expecting different results.

 I am curious as to whether the assessment of these nipple lesions has
included cultures to see what they grow.  Friable tissue such as Jennifer
describes does sound awfully like eczema, and the skin probably infects very
easily given the continuous breakdown of the tissue and the exposure to the
germs of the mouth of a normal child.  What sounds conspicuously absent in
the review of treatment is the standard tx which would be (in the lit.)
antibiotic therapy for the deep breast pain and the skin that can't heal,
along with strong steroid cream topically.

I am also deeply suspicious about elimination diets that go on for years in
the absence of any sign that they are helping.  Is it possible that without
adequate protein, fats and perhaps carbs too, this mother has a dietary
deficiency that is breaking down her skin? Is the diaper rash in the infant
perhaps a clue.?  Infants who are low in zinc often have terrible and very
persistent diaper rashes that improve with additions of balanced nutrients
to the diet.

Vegetarians and vegans must be very careful with their own diet and when
offering weanling foods because it is difficult to provide sufficient
quantities of protein, many nutrients, and some important vitamins.  For
instance:

 Vit. B 12 (present in animal foods, eggs, dairy prod. and some fermented
food products).  Strict vegetarians avoid most of these foods, and if she is
further restricting fermented foods due to the yeast phobia, she may be
seriously deficient.  "Infants of vit. B12 depleted mothers theoretically
would have little vit B 12 stores at birth and the only source of dietary
vit B 12 in breastfed infants would be their mothers milk.  Therefore,
breastfed infants of vegetarian mothers may be at a high risk for vit B 12
deficiency."
 Specker,B. et al, Increased urinary methylmalonic acid excretion in
breast-fed infants of vegetarian mothers and identification of an acceptable
dietary source of vit. B-12, Am J Clin Nutr 1988, 47:89-92.

Additionally:  Shinwell,E and Gorodischer,R:  Totally Vegetarian Diets and
Infant Nutrition, Peds 1982, 70(4):582-86.  discusses that vegans sometimes
experience "evidence of protein-calorie malnutrition, iron- and vit B 12
deficiencies, anemia, rickets, zinc deficiency and multiple recurrent
infections."

Now, I am certainly not anti-vegetarian.  I have a daughter who is a
vegetarian, and my husband and I have occasionally practiced vegetarianism.
What I do know is that people on restrictive diets must have education about
replacing nutrients that are so easily obtained from meat, eggs, and dairy.
If there is a chance that dietary dificiencies may be playing a role in in
skin conditions and recurrent infection, LCs must know something about
nutrition or at least know a good nutritionist or nutrition book to guide
parents.  And they must beware of instructions to further restrict diets
that may remove even more sources of essential fatty acids and nutrients for
good skin health.

And I'd consider a dermatologist.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.lactnews.com

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