Lactose Intolerance or

Milk Allergy?

WIC and Nutrition Services

Department of Health and Senior Services

What is Lactose Intolerance? Inability to digest significant amounts of

lactose, which is the predominant sugar in milk

A result of lactase insufficiency, the enzyme essential for the conversion of lactose into glucose and galactose

Types of Lactose Intolerance Congenital

Very rare Primary

Develops after 2 years of age Secondary

Usually resolves in 1-2 weeks

Symptoms of lactose intolerance Intolerance does not involve the immune

system Nausea, cramping, bloating, abdominal

pain, gas, diarrhea Symptoms may begin from 15 minutes to

several hours after eating food with lactose

Prevalence of Lactose Intolerance An estimated 30 to 50 million American

adults are lactose intolerant 90% of Asian Americans 80% of African Americans 62-100% of Native Americans 53% of Mexican Americans 15% of Caucasians

What is Milk Allergy? An abnormal immune system reaction to

proteins in the cow’s milk Triggered by a combination of genetically

inherited factors and early introduction of cow’s milk or soy protein into an infant’s diet

www.foodallergy.org

Symptoms of Milk Allergy An immune system reaction Swelling, sneezing, nausea, vomiting,

hives, rash, itching, runny nose, coughing, difficulty breathing, gas, diarrhea

Anaphylactic reaction possible Symptoms may begin within seconds or up

to several hours after eating the food See your Doctor

What are the options?

Lactose Intolerance

At risk of developing allergy

Milk Allergy

Infants

Breastmilk, Soy or lactose free formula

Breastmilk or hypo-

allergenic

formula

Breastmilk, Soy or prescribed formula

Children and Women

Milk as tolerated

NAEliminate milk

Review the Options

Breastfeeding is the best option for most infants.

Infants at risk for food allergy Exclusive breastfeeding is recommended Eliminate foods that cause infant allergies from

the mother’s diet while she is breastfeeding Delay solid foods until 6 months of age 1 year of age: Introduce cow’s milk 2 years of age: Introduce eggs 3 years of age: Introduce peanuts, other nuts, fish,

shellfish

Bright Futures in Practice - Nutrition

Available in every WIC agency and at www.brightfutures.org/nutrition/index.html

Infants with milk allergy Breastfeeding Alternatives to breastfeeding

Soy formula Hypoallergenic formula

Avoid milk products or foods with milk

Children and Women with milk allergy Eliminate milk

Casein or caseinate Casein hydrolysate Dried milk solids Lactolbumin Lactate solids Sweetened condensed milk Whey or whey solids

Children and Womenwith milk allergy Substitute other foods to provide missing

nutrients Cook with alternative foods Alter recipes and meals Avoid cross-contamination Learn strategies for coping with restaurant meals

and special occasions Conduct food challenges (with medical support)

Infants with lactose intolerance Breastfeed Alternatives to breastfeeding

Soy formula Lactose free formula

Children and Women with Lactose Intolerance

Eat or drink small servings Know your personal tolerance level Eliminating milk and other dairy foods

may pose nutritional risks

Tips for Tolerance Experiment with gradually larger amounts Drink milk with a meal rather than alone Eat smaller, more frequent portions Choose aged cheeses lower in lactose Try dairy foods with active cultures Read labels Kosher foods that say “parev” or “parve” are

milk-free

Some lactobacillus or sweet acidophilus milks are no lower in lactose and may not be tolerated any better than other forms of milk.

Special food products Lactose-reduced or lactose-free milk and

other dairy foods Add lactase enzyme to fluid milk

LactaidTM CactraseTM DairyEaseTM

Chew or swallow a lactase supplement before eating lactose rich foods

Lactose-free foods Broth-based soups Plain meat, fish and poultry Plain fruits and vegetables Tofu Breads, cereal and crackers made without

milk, dry milk, or whey

Alternative Sources of Calcium Vegetables: cooked/raw broccoli, turnip

and collard greens, kale, Chinese cabbage Fish/Seafood: canned sardines and salmon

with edible bones, raw oysters Calcium-fortified orange juice Calcium-fortified soymilk Tofu processed with calcium salts Almonds

Calcium = 1 cup milk 8 cups spinach, raw 1 ½ cups turnip greens, cooked 2 ¼ broccoli, raw 5 cups red beans, cooked 3 oz. sardines, canned with edible bones 1 ½ cups orange juice, calcium fortified 2 ¼ cups soy beverage, calcium fortified

Calcium education power point presentations, calcium intake requirements, functions of calcium, and information regarding risks of inadequate

intake of calcium are available at:

www.dhss.mo.gov/Calcium/#education

Calcium-Related Health Problems

Osteoporosis Colon and Rectal Cancer Hypertension and Stroke Overweight and Obesity

WIC Policy

Non-contract and exempt formulas for infants or WIC-eligible medical foods for women and children require a prescription.

For children and women with lactose intolerance documented by the CPA, cheese may be issued as a substitute for milk.

USDA encourages programs to offer alternative types of milk for children who are lactose intolerant.

In schools and childcare settings Schools and childcare providers must make

substitutions for severe food allergy. Schools and childcare providers may provide

substitutions for food intolerances. Services funded through IDEA include

Purchase of special foods Purchase of feeding equipment Consultation with a registered dietitian

www.fns.usda.gov/cnd/guidance

Child Nutrition and WIC Reauthorization Act 2004 Schools and childcares must offer a variety of

fluid milk with different fat contents. Schools and childcares may offer flavored and

unflavored milk and lactose-free milk. Schools and childcares may substitute a non-

dairy beverage that is nutritionally equivalent to fluid milk and fortified with calcium, protein, vitamin A and D to levels found in cow’s milk.

For More Information… STTM 2

Calcium: pg 26-27 Food Allergies: pg 113 Calcium and Osteoporosis: pg 127-130

For more information… Rita Arni, RD, LD

WICNS Child Nutrition Team Leader

573-751-6183

arnir@dhss.mo.gov Jean Trae, PhD, RD, LD

WICNS Child Nutrition Coordinator

573-751-6183

traej@dhss.mo.gov