Lactose overload

• What is lactose?
• Why is lactose important?
• What is lactose overload?
• Who experience lactose overload?
• What are the symptoms of lactose overload?
• What causes lactose overload?
• How is lactose overload different from lactose intolerance?
• What you can do to help!

HOW WE CAN HELP you to calm your baby and continue to successfully breast feed.

What is lactose?

Lactose is the sugar (carbohydrate) found in milk and milk products. It's present in the milk of all mammals, but is not found anywhere else in nature. Human breast milk contains around seven per cent lactose. Infant formula contains a similar amount of lactose.

Lactose is a disaccharide, (which means it's a combination of 2 sugars). In its original form as a disaccharide, it's too large to be absorbed by the body, so it needs to be broken down into monosaccarides (single sugars), glucose and galactose, by the digestive enzyme 'lactase'. Glucose and galactose can then be absorbed into the blood stream and used by the body.

Why is lactose important?

Lactose is important in our diet. It aids the absorption of calcium and phosphorus and is thought to support the growth of friendly bacteria, needed to fight undesirable organisms and promote health in the human intestine.

Galactose, a simple sugar that comes from the breakdown of lactose, is vital to a healthy brain and nerve tissues. Galactose can be found is some foods BUT for a baby, milk containing lactose may be his/her only source of galactose during this important stage of brain development. The effect of long term use of a lactose free formula (which does not provide galactose) on babies' brain development, is yet to be fully studied.

Glucose, the other simple sugar that combined with galactose is formed to make lactose in milk, provides a major source or energy (calories) in an infant's diet. Glucose is essential for growth, energy and for cell development. Without glucose in the diet a child will start to use body fat as a source of energy and will lose weight. If deprived of dietary glucose for a long period, the child will not survive. Glucose is found in most foods including lactose free milk.

What is lactose overload?

Quite simply, it's an overload of lactose due to an overload of milk - from oversupply or overfeeding.

What causes lactose overload?

When all is running smoothly, lactose is broken down into simple sugars - glucose and galactose, in the small intestines by the digestive enzyme 'lactase'. Glucose and galactose can then be absorbed from the small intestines into the blood supply, where it can be used by the body.

The larger the volume of milk, the more quickly it passes through the small intestines. Also low fat milk will passes through quicker than milk containing fat. So for a breast fed infant, foremilk will pass through the digestive system faster than hind milk (which is higher in fat).

An over supply of breast milk or frequent breast feeding patterns can result in your baby receiving large volumes of low fat milk, which pass through her small intestines too quickly to provide sufficient time for all the lactose to be broken down. The undigested lactose (which cannot be absorbed into the blood supply) then passes through into the large bowel, where it draws in extra water. The lactose is then fermented by bacteria, normally present in the bowel, which produces gas.

The end result is excessive gas, abdominal distension and frequent watery, acid stools (poop) which may scald a little bottom. As the gas and fluid build up in your baby's bowel this causes her discomfort. She then begins to act like she's hungry because she knows that feeding will provide comfort for her, which it does - but only temporarily. Unfortunately this provides another large feed, which results in more gas, more watery stools and more discomfort and the cycle continues.

Who is affected by lactose overload?

Around two thirds of healthy thriving breast fed babies will experience some degree of lactase deficiency (due to lactose overload) in their early months, without it causing them physical harm. This is due to an oversupply of breast milk or to frequent feeding pattern, which provides large volumes of low fat foremilk.

Although, less commonly seen in formula feed babies, formula fed babies can also experience gastric symptoms due to lactose overload as a result of overfeeding. The reasons for a baby to overfeed can be varied - see our article on hungry baby for examples.

What are the symptoms of lactose overload?

• Watery diarrhea
• Bloating
• Cramps
• Excessive gas
• Irritability
• Sleeplessness or wakefulness
• Baby appears hungry
• Baby gains adequate to large amounts of weight
• Baby is usually less than 3 months old
• Often diagnosed as "colicky" babies

How is lactose overload different from lactose intolerance?

Lactose overload is frequently misdiagnosed as lactose intolerance. Both conditions display identical gastric symptoms. However, unlike lactose intolerance, where the child fails to gain weight ( or loses weight) and is very unwell, an infant with lactose overload is healthy and thriving.

Lactose intolerance arises when a person does not produce enough of the digestive enzyme 'lactase' to break-down lactose into glucose and galactose, which can then be absorbed into the blood supply. For an infant, this means they are then deprived of their major source of energy (calories) provided by glucose. Along with the gastric symptoms, the lactose intolerant child will fail to gain weight or lose weight and become very unwell.

In lactose overload, the infant produces sufficient quantities of lactase to break down enough lactose to provide glucose and galactose essential for healthy growth, but does not produce enough lactase in time to digest all the lactose contained in frequent, high-volume, low-fat breast feeds (which quickly pass through the intestines). As the excess undigested lactose passes into the large bowel, gastric symptoms develop. However, unlike the child with lactose intolerance, these infants are healthy and thriving.

A baby experiencing gastric symptoms due to lactose overload will show positive results to present day tests for lactose intolerance. As a result they are commonly misdiagnosed as lactose intolerant. Unfortunately, many breast feeding mothers are mistakenly advised to wean her baby from the breast onto a lactose free formula. Lactose free formula will relieve the symptoms BUT is totally unnecessary (in most situations) as minor changes to feeding management will also relieve the symptoms - without having to wean.

For the small number of formula fed baby in this situation, lactose fee formula also relieves gastric symptoms but does not address the problem of overfeeding. The child is incorrectly labeled as 'lactose intolerant' and may spend a lifetime of unnecessary dietary restrictions, (deprived of their only or most valuable source of galactose) when symptoms may well have been reduced by correcting the problem of overfeeding.

What you can do to help

For breast fed babies

Lactose is present in consistent amounts throughout the entire breast feed. However, hind milk contains more fat. As fat is digested more slowly, a breast feed containing hind milk will slow down the speed at which the milk empties from the stomach into the small intestine, which will then allows more time for the lactose to be sufficiently broken down.

• See our article on hungry baby to read about common reasons for babies to appear hungry.
• If you are currently offering both breasts at each feeding, try to extend feeding time on each breast to ensure your baby has adequately emptied the first breast before switching sides.
• Where supply is abundant offer only one breast at each feeding.
• In extreme cases offer the same breast each time your baby wants to go to the breast within a 3 hour period. Offer the other breast for the next 3 hour period. This will mean she gets lower volume, higher fat feeds that will help to slow down the rate at which it flows through the digestive system.
• Or try spacing breast feeds to 3 hourly. Time the feeding from the beginning of one to the beginning of the next.

Facts about lactose and breast feeding

1. Lactose is produced in breast milk independent of what the mother eat or drinks. Whether she drinks milk or eats dairy food or not, the amount of lactose in her milk will be the same.
2. Foremilk does not contain more lactose than hind milk, but hind milk contains more fat.
3. Because a mother may be lactose intolerant, this does not mean her infant is also lactose intolerant. The inherited form of lactose intolerance rarely develops before the age of 4 years.

For formula fed babies

• See Estimate how much formula your baby needs to discover if you baby is overfeeding.
• See hungry baby to discover common reasons for overfeeding.
• Try to establish a flexible feeding and sleeping routine.
• Try to encourage your baby to go 3 or 4 hourly between feedings during the day. Time this from the beginning of one feeding to the beginning of the next.

HOW WE CAN HELP you to calm your baby and continue to successfully breast feed.

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See also:
Lactose intolerance
Milk allergy or intolerance

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