Lactose Intolerance and Acid Reflux in Babies

Lactose intolerance and acid reflux in babies is very common. Lactose intolerance is the leading cause of acid reflux in babies. Acid reflux in babies is caused due to the weak or loose sphincter muscles. Most of the time intake of dairy products or intolerance to lactose causes acid reflux in babies. Infant acid reflux solutions are present either through medications or modification in daily dietary habits. As the parents are concerned with their child’s health question comes to their mind like how to help baby with acid reflux? Is reflux related to lactose intolerance? Yes, lactose intolerance and acid reflux in babies are interlinked.

According to a recent study, there are more than 30 million Americans who are going through this disorder of lactose intolerance. This condition is not life-threatening but it still is a disorder causing discomfort. This condition leads to symptoms of gas, bloating, and diarrhea just half an hour after the consumption of food containing lactose. How do you get lactose intolerance? It occurs due to the lack of lactase enzyme. People having such disorder must avoid consuming foods containing lactose or have some medication containing lactase enzyme before having that food. Lactase action continues for almost 4 hours due to very slow peristalsis of the small intestine.

What is lactose intolerance and Acid Reflux?

What is lactose intolerance? Lactose intolerance is the inability to digest a natural sugar, lactose which is found in milk and milk products. A person becomes lactose intolerant when his/ her body does not produce enough amount of lactase. Does lactase breakdown lactose? Yes, when the undigested lactose does not get absorbed in the small intestine, it moves to the large intestine where it interacts with the normal bacterial flora of your body, and milk intolerance symptoms like bloating, diarrhea, and vomiting appear. The condition is called lactase deficiency or lactose intolerance. This condition is very common in people with Asian, African, and Hispanic ancestry.

Lactose is a carbohydrate that is found in many products of our daily life including milk, yogurt, cheese, canned foods, dairy products, many kinds of cereal and bread. Dairy products cause acid reflux in babies. Lactose is a disaccharide which composed of two monosaccharides that are glucose and galactose. When we consume products containing lactose, those are broken down into glucose and galactose molecules in our small intestines where most of the digestion of our food occurs. An enzyme named lactase breaks down this sugar into glucose and galactose. In a situation where there is not enough amount of lactase present in smaller intestine to digest lactose, it does not get digested or absorbed in the intestine which leads to signs of unease, discomfort and dairy sensitivity. It is called as lactose intolerance.

Milk and Acid Reflux:

Lactose is found in a wide range of natural and processed foods and in some medications too. People, who find the consumption of lactose leading to signs of discomfort, burning sensation, Gerd or acid reflux must read the label of the product before eating it. Lactose intolerance and acid reflux are mostly caused by dairy sensitivity. If your food’s label shows any of the following names, it contains lactose:

• Milk
• Milk by-products
• Whey
• Dry milk solids
• Curds
• Cheese
• Non-fat dry milk powder
• Lactose

Lactose is found in milk and dairy products like cow’s milk, goat’s milk, yogurt, cheese, ice cream, bread, cereal, lunchmeats, salad dressings, mixes for baked goods, etc.

Lactose Intolerance and Milk Allergy?

No. Many people confuse Lactose intolerance with a milk allergy but they are completely different conditions. They might have similar signs and symptoms but they are not the same conditions or to be confused with each other. Both involve different systems of the body like milk allergy involves your immune system while Lactose intolerance is a problem of your child’s gastrointestinal tract. Both conditions even differ in the severity of the symptoms they have. Milk Allergy can be a life-threatening problem for you while Lactose intolerance causes discomfort in your digestive system along with other symptoms.

Milk allergies or dairy sensitivity show up in infants and stay forever while Lactos intolerance can first show its symptoms in toddlers into adolescence. Dairy sensitivity leads to lactose reaction. Lactose intolerane starts in your childhood and with ageing into adulthood it becomes more and more prominent.

What Causes Lactose Intolerance and Acid Reflux?

Lactose intolerance is caused by the deficiency of lactose intolerance enzyme called lactase. Negative effects of lactose intolerance; The body is not able to digest Lactose into Glucose and Galactose when the small intestine lacks enough amount of lactase, an enzyme in the digestive juice, lactase is an enzyme that breaks down lactose and helps in absorption. When there is normally enough amount of lactase enzyme in your small intestine, lactose gets broken down into glucose and galactose and the absorption of these monosaccharides into the blood is pretty simple and easy for your intestine. But if your body is lactase deficient; the lactose moves to the colon, a part of the large intestine, where there is a large natural flora of microbes. These microbes when coming in contact with undigested or unbroken Lactose, cause the condition which leads to the symptoms of Lactase intolerance. Acid reflux is caused due to weak sphincter muscles. Reflux of acid occurs toward esophagus.

There are three different types of lactose intolerance depending upon the cause or origin of deficiency of lactase in the small intestine, intestinal enzyme lactase is one of the most important lactose digestion enzymes:

Primary lactose intolerance

This is the most common type of lactose intolerance and rises because of dietary changes in infants to toddlers. People develop lactose intollerance at a very young age because of dietary changes like when we replace a baby’s milk feed with some other kind of feed that is not a dairy product. Their body starts producing lower amounts of lactase, which is enough to digest the lactose in their milk feed at that time but not at the toddler’s age. On the other hand, infants who completely depend upon milk or dairy products for their nutritional requirements need more lactase to digest it.

In infants, the body produces enough amount of lactase but with growing age and feed changes, lactase amount drops and it becomes difficult as it causes discomfort and many other symptoms that cause enough problems for you to go see a physician.

Secondary lactose intolerance

The secondary form of lactose intolerance rises because of lactase deficiency which is caused when your intestine drops the amount of lactase production in your body after some injury, illness, or surgery involving your small intestine. Diseases that can lead to the second type of lactose intolerence include the given names below:

• Intestinal infection.
• Celiac disease.
• Bacterial overgrowth.
• Crohn’s disease.

Treating these diseases will help with the symptoms but the process takes time even after the disease has been recovered.

Congenital or developmental lactose intolerance

Rarely, some cases appear with the congenital type of lactose intolerance in which both mother and father pass on the same variant of the gene for the infant to be affected by this condition. Then this disorder is passed from generation to generation in a continuous pattern of inheritance which is known as an autosomal recessive disorder. Premature childbirth can also be a cause of developmental lactose intolerance in which the child’s small intestine is not mature or developed enough to produce lactase to digest the lactose present in its feed.

What risk factors are there for your child to get lactose intolerant?

Factors that increase the risk for you or your child to get lactose intolerant are given below:

Age:

This condition is not that common in infants. It mostly appears from growing age to adulthood. So increasing age can be a risk factor for your child to get intolerant. Change in the diet of children from infants to toddlers to adulthood leads to primary type of lactose intolerance.

Geographical and environmental factors:

Sometimes some health conditions are related to a specific gene pool or geographical location which is basically because of the gene variants present in the genome of the masses living in that specific area or the environmental factors that help in the development of the particular disorder or condition. In the case of Lactose intolerance, people of African, Asian, Hispanic, and American Indian are at most risk to develop this disorder because of their gene pool and environment.

Birth:

Premature birth can put your child at utmost risk to develop this condition because in the third trimester of pregnancy the development of the digestive tract of the fetus occurs, but when the child is given birth prematurely, the cells that produce lactase don’t develop enough to work efficiently after birth. So this risk factor is very dangerous but rare.

Diseases of the small intestine:

Problems of the small intestine like bacterial overgrowth, celiac disease, and Crohn’s disease are a greater risk to make anyone get lactose intolerant. These diseases affect the cells in the small intestine that produce lactase and then the small intestine is not strong enough to produce digestive juices and therefore the patient becomes lactose intolerant.

Cancer Treatment:

When cancer patients go through radiation therapy for cancer in the stomach or intestine, such chemotherapies can cause complications increasing the risk of a patient getting lactose intolerant.

Who is at risk of becoming lactose intolerant?

A child is more at risk to get lactose intolerant if he or she:

• Is a baby that was born prematurely. This causes the developmental type of lactose intolerance which is mostly a temporary problem and goes away ultimately. It is mainly because the baby did not go through the developmental stages of the third trimester of pregnancy which gives birth to secreting cells of GIT of the fetus.
• Is Mexican American, Jewish, African American, American Indian, or Asian American.
• Has some other family members going through the same disorder. In such cases, symptoms of lactose intolerance can develop in teenage or adulthood.

What are the Symptoms of Lactose Intolerance and acid reflux?

In American children with lactose intolerance, signs of lactose intolerance appear after the age of 5 years while in African-American children, lactose intolerant symptoms start appearing at the age of 2 years. Symptoms of lactose intolerance appear after half an hour of consumption of the food containing lactose. Lactose intolerance symptoms in adults are somehow similar to the toddlers. Signs and symptoms vary from person to person. Lactose intolerance symptoms are given below:

• Upset stomach
• Discomfort
• Nausea
• Abdominal pain
• Cramping
• Abdominal Gas
• Diarrhea (loose stool)
• Bloating
• Vomiting (mostly in teenagers)

Does lactose intolerance cause gas? Yes Lactose intolerance causes abdominal gas. The severity of the symptoms of lactose intolerant depends upon the amount of lactose your child consumed and the amount of lactase that his/ her body can produce. The symptoms of lactose intolerance are easily confused with milk allergy and milk proteins’ allergies. So, you must go to see your physician instantly if your child faces such dairy intolerance symptoms after consuming milk or dairy products to know what disorder or condition is your child going through. Does dairy intolerance causes acid reflux in babies? Lactose intolerance and acid reflux in babies is correlated. Milk allergy is the most common cause of acid reflux in infants.

How to confirm if your child is lactose intolerant or not?

A simple way to check if your child is suffering from lactose intolerance or not, is to remove all the milk products from your child’s diet for about a couple of weeks and then see if his or her symptoms improve or not. If your child was lactose intolerant and drank milk lactose intolerant symptoms might worse. After that couple of weeks, add some products in smaller quantities to the child’s diet every day to see if the symptoms reappear or not. A hydrogen breath test is also helpful in such cases. So, you must go to see your pediatrician instead of experimenting on your child.

Lactose intolerance in infants:

Is everyone lactose intolerant? No, not everyone have intolerance to lactose. Lactose sensitivity symptoms are very rare to be found in infants as all children are born in full-term with enough amount of lactase in their small intestines, later the production rate of lactose in their small intestines fall after the age of 3 to 5 years, and at that age they are less lactose sensitive. The chances of lactose intolerance in infants raise when the child is born prematurely.

Prematurely born babies mostly suffer through the developmental type of lactose intolerance. This is a temporary problem that does not last for long. However, mostly premature babies can digest lactose-containing formula and breast milk.

Another type of lactose intolerance found in infants is congenital lactose intolerance. It is a very rare condition that is inherited in case both the parents pass on the gene variant. It is a recessive disorder that is passed on an inheritance from generation to generation. This condition leads to severe diarrhea. If the condition is kept unchecked and the baby is not fed lactose-free milk, it can lead to severe dehydration and weight loss.

Deficiency of Calcium:

Lactose intolerant children or teenagers do not get enough amount of calcium that their body needs because milk and dairy products are the basic sources of calcium for children at growing age. If your child is suffering from this disorder, you will need to make sure that your child gets enough amount of calcium in its diet from sources other than milk or dairy products. Calcium is necessary for your child’s growth and his bones’ strength. It also prevents many diseases related to hypocalcemia.

The amount of Calcium varies depending upon the age of the consumer:

• Babies of age 0 to 6 months need 200mg of calcium in their feed per day.
• From 7 to 12 months of age, the amount raises to 260mg of Calcium per day.
• 1 to 3 years old child needs 700mg of Calcium per day.
• While 4 to 8 years old toddlers need 1000mg of calcium per day.
• And 9 to 18 years old teenagers will be needing up to 1300mg of Calcium in their diet per day.

Here are given the non-dairy options of calcium sources that you can add to your child’s diet to make sure that he gets enough amount of calcium to avoid bone weakening or diseases related to hypocalcemia:

• Some green vegetables are a good source of calcium that include collard greens, turnip greens, broccoli, and kale.
• Fish are a good source of calcium mostly which have soft and edible bones. Examples are salmon and sardines.

Other non-dairy good sources of calcium are tofu, orange juice with added calcium, soy milk with added calcium, and breakfast cereals with added calcium. Using milk that have high-degree of lactose tolerance like soy milk.

Always consult your paediatrician before adding any synthetic or supplemental form of calcium source to your child’s diet. If the child does not get enough or the required amount of calcium in his/ her diet, the supplements must be included in the diet after consulting a doctor. The prescription will tell the right name, amount, dosage, frequency, and periods for the calcium supplements to be taken.

Deficiency of Vitamin D:

If your child has to avoid milk or dairy products to treat lactose intolerance that means he is not getting enough amount of Vitamin D in his diet. Vitamin D is found in the liver and eggs which are a good non-dairy source of Vitamin D and they are affordable too from an economical point of view. Children under the age of 1 year must have 400IU of Vitamin D per day in their diet and those with age over 1 year must have 600IU of Vitamin D per day.

Milk Substitutes:

There are so many options that can replace milk in your child’s diet which include soy, almond, rice, hemp, and oat milk if your child is lactose intolerant. Soy milk is a very popular option for lactose-intolerant children as an alternative to milk or dairy products because it contains calcium and so many proteins. Almond milk is not just a popular alternative to cow’s milk for your lactose intolerant child but also the safest option. It is also used by people as a milk substitute who are allergic to Cow’s milk protein. Although Almond is a good source of calcium and a better milk substitute it can never match the composition of cow’s milk obviously because that contains much more protein than Almond milk. Before adding any milk substitute to your child’s diet, you must consult your paediatrician about the type, quantity, and frequency of the milk substitute.

How is Lactose Intolerance Diagnosed?

If you want to achieve lactose tolerance, Your doctor will take a whole lot of family history for diagnosing intolerance to lactose in your child or infant. Following are different diagnostic tests or procedures that are helpful in the diagnosis of lactose intolerance:

Hydrogen breath test:

A hydrogen breath test is very helpful in case of lactose intolerance diagnosis. A child is fed a specific amount of beverage that contains a known amount of lactose. Then the child is asked to breathe into a container that measures the hydrogen exhaled after consumption of that beverage. Normally a hardly detectable amount of hydrogen is exhaled by a person who can digest lactose in the diet but it raises when lactose is not digested.

The pH of the stool:

When the child is too young to perform a hydrogen breathe test, the acidity of the stool is checked. When lactose is not digested and absorbed in the intestines, the stool has a very low pH i.e acidic stool. Another stool test for infants is glucose in the stool which signifies the amount of glucose in the stool. When lactose is not digested and absorbed well, there is a minor amount of glucose in the stool.

Endoscopy of the child:

If the symptoms persist and the child’s condition does not get better, a pediatric gastroenterologist (GI) is consulted for further evaluation. Depending upon the severity of the symptoms and reaction that the child is given, the gastroenterologist (GI) might perform an endoscopy on the child to measure the amount of lactose from contents directly taken from the intestine by biopsy.

How is Lactose Intolerance and Acid Reflux Treated?

Treatment depends completely upon the severity of the symptoms, your child’s age, weight, environmental conditions, and nutritional needs. No treatment is available to make your child’s body make lactase naturally. All you can do is make dietary changes to make sure that your child does not eat what he or she can’t digest. Your child will have to stop eating all foods with lactose. Some pediatricians also suggest medications containing lactase enzymes.

Here are some tips for managing lactose in your child’s diet:

• Start slowly and after restriction of milk and dairy products for a few weeks, start adding those products back in minute quantities and check what your child’s gastrointestinal tract can handle and what it can’t.
• Try consuming milk or dairy products with other meals. Try having cheese with crackers or milk with cereals. This might help your child digest it easily.
• Select those milk and dairy products that are low in lactose. Such products include hard cheese and yogurt.
• Look for lactose-free products when buying from the market.
• Ask your health care provider about lactase pills for your child.
• Always consult a registered dietitian or pediatrician about such problems. Quacks can make the situation worse instead of improving it.

Conclusion:

Problems related to our health must always be taken seriously no matter how big or small they are. No matter what causes lactose intolerance and acid reflux in babies, if it is left unchecked it can cause serious dehydration and weight loss in your child. So, if you see symptoms of dairy intolerance in your child, you must go see your pediatrician before it is too late.

References:

Douglas, P. S. (2013). Diagnosing gastro‐oesophageal reflux disease or lactose intolerance in babies who cry alot in the first few months overlooks feeding problems. Journal of Paediatrics and Child Health, 49(4), E252-E256.

Leffler, D. A., & Kelly, C. P. (2011). Celiac disease and gastroesophageal reflux disease: yet another presentation for a clinical chameleon. Clinical Gastroenterology and Hepatology, 9(3), 192-193.

Swagerty Jr, D. L., Walling, A., & Klein, R. M. (2002). Lactose intolerance. American family physician, 65(9), 1845.

Vandenplas, Y. (2015). Lactose intolerance. Asia Pacific journal of clinical nutrition, 24(Supplement).

Scrimshaw, N. S., & Murray, E. B. (1988). The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance. The American journal of clinical nutrition, 48(4), 1142-1159.

Johnson, A. O., Semenya, J. G., Buchowski, M. S., Enwonwu, C. O., & Scrimshaw, N. S. (1993). Correlation of lactose maldigestion, lactose intolerance, and milk intolerance. The American journal of clinical nutrition, 57(3), 399-401.

Ms. Tayyaba Akhtar

Doctor of Veterinary Medicine

University of Veterinary & Animal Sciences