The need for breast milk supplementation is not new. Before the era of modern medicine there were circumstances, just as today, which would prevent a new mom from nursing her baby. It was common then under those circumstance to employ a “wet-nurse”. A “wet-nurse” was in fact a lactating woman who would be paid to nurse other people’s babies. When a “wet-nurse” wasn’t available or wasn’t financially feasible, babies where fed milks from cows, goats, mares and donkeys (Schuman, 2003).
During the 19th century wet nursing did fall out of favour. More attention was focused towards trying to find an adequate substitute for mother’s milk (Spaulding, 1991). Cow’s milk became more of the norm for supplementation due to its ready availability. It was during this time observations were made that infants fed cow’s milk had a higher mortality rate as well as were more prone to indigestion and dehydration as compared to infants that were breastfed (Schuman, 2003).
Nowadays, the Federal Drug Administration (FDA) regulates over forty different brands and types of infant formulas in the United States (www.nlm.nih.gov). They can be milk-based, soy-based or protein hydroslysate formula (hypoallergenic) (www.mayoclinic.com); name brand or generic brand. In addition, they can be further broken down into many other categories including formulas with iron or with low iron, lactose-free formulas, nutrient-enhanced formulas, and even formulas for preventing excess spit-up (www.meadjohnson.ca). Then, if that isn’t enough, there are also ready-made, concentrate and powdered forms!
The American Academy of Pediatrics Committee on Nutrition, despite its strong endorsement for breastfeeding, advocates the use of iron-fortified formulas for non-breastfed babies (www.aap.org).
Still, differences of opinion exist with regard to the use of nonhuman milk formulas in refeeding of children with acute diarrhea (Brown et al., 1994). Northrup and Flanigan (1994) state that children on milkbased formulas may continue these formulas in smaller, more frequent feedings or diluted with cereals and other foods. The AAP (1985), Hamilton (1985), Fitzgerald (1989), Walker-Smith (1990), Richards et al. (1993), and Northrup and Flanigan (1994) acknowledge that some clinicians advocate lactose-free formulas for children with acute diarrhea, though they feel it is not routinely required. DeWitt (1989) and Laney and Cohen (1993) still advocate lactose-free formula for the first 48 hours of refeeding. Brown et al. (1994) in a meta-analytic review of studies addressing this question concluded that the routine use of lactose-free milk formula was not warranted since the increased duration of diarrhea with lactose-containing formula was not clinically significant. Brown et al. (1994) felt that lactose-free formula might be justified in children with severe dehydration on presentation, previous treatment failure, underlying severe malnutrition, or worsening diarrhea upon consumption of lactose-containing formula.
Food intolerance often is confused with food allergy since the symptoms are often the same. Food intolerance is an adverse reaction to a food that does not involve the immune system. Lactose intolerance is an example of food intolerance. A person with lactose intolerance lacks an enzyme needed to digest a form of sugar present in milk. Consuming milk products causes symptoms such as gas, bloating, and abdominal pain, but does not involve any immune system response. If a person has a true allergy to milk, the only way to avoid milk allergy symptoms is to avoid all milk products entirely.
Lactose intolerance due to loss of lactase is normal in most ethnic groups after puberty; it is only among people of northern ethnic origin that lactose persists into adult life.
More than two-thirds of the world’s population is milk-intolerant, states James Braly, M.D., in his book, Dr. Braly’s Food Allergy and Nutrition Revolution. Most of us do not realize the number of people that are lactose intolerant. Worldwide estimates suggest that two-thirds of the population have trouble digesting milk because of lactose intolerance.
Lactose intolerance is widespread in all racial groups except Caucasians; onset of the condition, however, is not common before the age of five years (Overfield, 1985, p. 52)
According to Teacher Magazine, minorities may have difficulty digesting a sugar in milk known as lactose. An estimated ninety percent of Asian Americans, seventy percent of African Americans and Native Americans, fifty percent of Hispanics, and fifteen percent of Caucasians are lactose intolerant. Hand in hand with lactose intolerance are the proteins in milk that can lead to allergies. Dr. Attwood, an author of many well known parenting books, says “. . . there are more than twenty-five proteins in milk that can lead to allergies. Approximately seven out of ten patients I see have allergies with symptoms ranging from recurrent ear infection, asthma, and various upper respiratory infections. In most cases the patient improves when taken off dairy products.” (www.vegsource.com)
When dealing with children, people say that drinking organic milk not only minimizes their potential exposure to toxic chemicals located in regular milk, but it also creates a healthier world in general. Organic farming has much less negative impact on the environment, which involves cleaner water, healthier soil, and less dangerous chemicals in the world. Not only does this have a positive impact on people’s bodies, it also contributes to the restoration of the environment in general.
“The lactase enzyme appears in the intestinal tract of infants during the last trimester before birth and peaks shortly after birth,” writes Braly. “However, sometime between 18 months of age and four years, most individuals throughout the world gradually lose the lactase activity in the small intestine, a clue that perhaps human beings weren’t meant to drink milk beyond early childhood.”
When the body is functioning normally, lactase breaks down lactose into two simple sugars, glucose and galactose, which are used by the body. But when there is a lack of sufficient lactase, the unabsorbed lactose migrates to the colon, where it becomes fermented by intestinal bacteria and causes gastrointestinal problems.
Presumably, the reason lactose intolerance occurs early in life has to do with the process of weaning. Some children are genetically programmed to stop being able to handle milk once they pass the age of breastfeeding. To be sure, “levels of the enzyme lactase do dwindle in adults as they age,” says Dr. Russell, MD, a gastroenterologist at Tufts Nutrition Center in Boston and an associate editor of Digestive Health & Nutrition, “but not precipitously” enough to cause a problem. However, he explains, certain illnesses can create a lactase deficiency later in life.
Such a deficiency, combined with the already somewhat diminished levels of lactase in older people, could be enough to tip the scales to the point that milk and other dairy foods don’t go down as easily.
Children and adults with lactose intolerance can be given lactase supplements, such as caplets that can be taken before or with a meal; drops, which can be added to milk 24 hours prior to consumption to aid in digestion; or consume lactose-reduced milk, which is found in the dairy case in most stores.
However, not all patients with lactose maldigestion experience gastrointestinal symptoms after lactose ingestion (Carroccio et al., 1998). Furthermore, patients may incorrectly assume that symptoms due to irritable bowel syndrome are due to lactose intolerance. One factor that was associated with lactose intolerance in patients with lactose maldigestion was the presence of abdominal pain in childhood (Vesa et. al, 1998). The symptoms of abdominal pain, bloating, and flatulence experienced by children in the current study are symptoms of irritable bowel syndrome. Thus, children who report these symptoms after lactose ingestion may be a subset of children with recurrent abdominal pain who are more susceptible to irritable bowel symptoms.
It is possible that the symptoms reported by subjects in this study may be due to irritable bowel syndrome and were not caused by lactose maldigestion. Indeed, some children with lactose maldigestion reported no abdominal pain or less abdominal pain while receiving lactose-containing formula. Even though lactose ingestion did not cause increased gastrointestinal symptoms in all subjects, the average decrease in abdominal pain reported during lactose avoidance suggests that dietary lactose restriction benefits selected children with lactose maldigestion.
In conclusion, it was found that ingestion of 12 g of lactose daily is associated with increased abdominal pain in susceptible children with lactose maldigestion. This increased abdominal pain occurres in children with either >10-ppm or >20ppm increase in breath hydrogen testing after lactose challenge. A trial of dietary lactose restriction is considered beneficial in reducing abdominal pain on children suffering from lactose maldigestion.
Attwood, Charles R. Calcium Without the Cow. Retrieved on January 29, 2006 from http://www.vegsource.com/attwood/milk.htm
Braly, James, M.D., and Torbet, Laura. (1992). Dr. Braly’s Food Allergy and Nutrition Revolution. New Canaan, Conn.: Keats Publishing, Inc.
Breastfeeding Initiatives. American Academy of Pediatrics. Retrieved from http://www.aap.org/advocacy/bf/brpromo.htm
Brown, K.H., J.M. Peerson, and O. Fontaine. (1994). Use of nonhuman milks in the dietary management of young children with acute diarrhea: A metaanalysis of clinical trials. Pediatrics 93 (1), 17–27.
Carroccio, A., Montalto, G., Gavera, G., et al. (1998). Lactose intolerance and sell-reported milk intolerance: relationship with lactose maldigestion and nutrient intake. Lactase deficiency study group. Journal of the American College of Nutrition, 17, 631-636.
Drug Information: Infant Formulas (Systemic) (n.d.). Medline Plus. Retrieved on January 29, 2006, from http:///www.nlm.nih.gov/medlineplus/druginfo/uspdi/202678.html
Infant Formula: The next-best thing to breast feeding (n.d.). Mayo Clinic. Retrieved on January, 30, 2006, from http://www.mayoclinic.com/health/medical/404
Mead Johnson Nutritionals. Retrieved on January 29, 2006 from http://www.meadjohnson.ca/
Overfield, T. (1985). Biologic variation in health and illness. Menlo Park, CA: Addison-Wesley Publishing Company.
Schuman, M.D., A.J. (2003, February). A concise History of Infant Formula (Twists and Turns Included). Contemporary Pediatrics Archives. Retrieved on January, 30, 2006 from
Spaulding, M. (1991). Nurturing Yesterday’s Child: A portrayal of the Drake Collection of Pediatric History. Philadelphia, BC.
Vesa, T.H., Seppo, L.M., Marteau, P.R., ct al. (1998). Role of irritable bowel syndrome in subjective lactose intolerance. American Journal of Clinical Nutrition, 67, 710-715.