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Lactose Intolerance or Milk Allergy


... in Practice - Nutrition. Available in every WIC agency and at ... Child Nutrition and WIC Reauthorization Act 2004 ... – PowerPoint PPT presentation

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Title: Lactose Intolerance or Milk Allergy

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,
  • 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 cows milk
  • Triggered by a combination of genetically
    inherited factors and early introduction of cows
    milk or soy protein into an infants diet

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?
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 mothers diet while she is breastfeeding
  • Delay solid foods until 6 months of age
  • 1 year of age Introduce cows 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

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 Women with milk allergy
  • Substitute other foods to provide missing
  • 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

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

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

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

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 cows 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
  • Jean Trae, PhD, RD, LD
  • WICNS Child Nutrition Coordinator
  • 573-751-6183