As a naturopath, you can’t help but see some patterns that come up over and over again. When it comes to cow’s milk protein (CMP) intolerance, we see links to kids’ health problems like recurrent ear infections, tonsillitis, eczema and late bedwetting.
Another clear link is between cow’s milk protein (CMP) intolerance and constipation.
To the kids who love milk and their long-suffering parents, telling them that dairy could be causing their child’s suffering is hardly music to their ears (though it may be music to their rears, if you’ll pardon the pun).
I realise how difficult it can be to take kids off dairy. So I usually try other things first: probiotics, prebiotics, toilet habits, fibre, fluid, behavioural things, laxative manipulation and so on.
But often, it comes back to an overwhelming suspicion that the child is not tolerating something in their diet…
And dairy tops the list of usual suspects.
At this point, I usually suggest we do food sensitivity testing.
This is not the same as food allergy testing, so it (like all tests) is not a perfect test to rule out a problem with cow’s milk protein (CMP). But it’s amazing how often dairy comes up as a positive on this test, and how removing dairy from the diet makes a difference to the patient.
My experiences may or may not convince you, so…
What does the research say about this?
A 2014 review of ten studies found that a CMP-free diet had a 28-78% success rate in childhood constipation.
The authors recommend a 2-4 week exclusion period to test the theory.
A Russian study from 2013 on infants with constipation and dermatitis found that if probiotics were added to a CMP-free diet, the effect was more pronounced.
Adding probiotics is always a must.
Another 2013 study showed that patients with food intolerance had higher anal sphincter pressures. What is fascinating here is that the patients had anal fissures (a painful condition associated with constipation), and that healing of these anal fissures was higher in the group who were put on an elimination diet. What’s more, the fissures came back when CMP and wheat were (separately) re-introduced! The patients who reacted to these challenges had higher amounts of eosinophils in the anus, suggesting an allergic response.
So anal fissures, a notoriously difficult to treat condition, could be related to CMP intolerance as well.
A group of children placed on a soy formula instead of CMP achieved resolution of chronic constipation in another 2013 study. This study also compared the effects of A1 and A2 milk protein, and while there were better effects on the A2, this was not statistically significant.
Reflux in infants commonly overlaps with CMP allergy, and where this is the case, a 2-4 week CMP free diet can resolve the reflux symptoms, according to a 2013 review.
So how common is CMP allergy?
One study found that in a group of children with chronic constipation, 77% were CMP allergic!
And how long does the child need to remain CMP-free for?
One study looked at the “development of tolerance” – that is, the ability to reintroduce the food without causing the same reaction. It found that if CMP was reintroduced in six months, only 22% of children had developed tolerance. On the other hand, of reintroduction was at twelve months, a full 88% had achieved tolerance!
It’s sad news for the constipated kids who love their milk – like my 2-year-old patient from this week, who drinks over a litre a day. But the stats are there, and if your child suffers from chronic constipation, the time and effort taken to see if they are reacting to CMP could be well and truly worth it.