Last week I report on a study which finds that, in some people, there’s a very real possibility that plenty of fibre in their diet can cause, rather than cure, constipation and sluggish bowel movements. This week, I came across a recent study which suggests another perhaps surprising cause of constipation in the form of dairy products [1].
In this study, children aged 1-13 with constipation were randomised to one of two groups:
1. elimination of cow’s milk and any products containing cow’s milk
2. no intervention (control)
Those in group 1 eliminated all cow’s milk for four weeks. After this, cow’s milk products were introduced for 2 weeks.
Those in group 2 just ate their normal diet for full duration of the study (6 weeks).
In group 2, 47 per cent of children improved during the study period. In group 1, 80 per cent of children improved. The difference was statistically significant, which supports the idea that cow’s milk diary products are indeed a potential cause of constipation in this group.
As with all studies, the population group (actually Iranian children) may not represent other populations, and how applicable these results are to other children is not known. However, my experience in practice tells me that in a child with constipation of unknown cause, sensitivity to dairy products should at least be considered.
One of the interesting things about this study is that, in a sense, the children were screened for cow’s milk sensitivity with a test. Each had a ‘skin prick’ test – where the skin in scratched and some cow’s milk (basically) is put on the ‘wound’. This test actually tests for a specific sort of reaction which is mediated through a particular form of antibody known as IgE. This sort of reaction is responsible for classic ‘allergic’ reactions like hay fever and peanut allergy.
Only one child in the whole study had a positive skin prick test for cow’s milk.
This is important, I think, because we doctors very often judge ‘allergy’ based on this test and/or a blood test designed to assess the IgE response. And if these tests are negative, we tend to assume there is no problem with the foodstuff that has been tested.
However, the body can react to foods (and other things) through a variety of mechanisms which have nothing to do with IgE, which essentially means that the diagnostic tools we often use to assess food sensitivity are inadequate and potentially very misleading.
Other tests exist, but none (of course) are perfect. Which is why, sometimes, the best thing to do is remove foods to see what effect this has. I won’t deny that this can be a challenging and tricky process, but sometimes the rewards (e.g. elimination of constipation, asthma, eczema or ear, nose and throat problems) are worth it. Working with an practitioner who understands the limitation of standard food sensitivity testing is a good idea, I think.
References:
1. Dehghani SM, et al. The Role of Cow’s Milk Allergy in Pediatric Chronic Constipation: A Randomized Clinical Trial. Iran J Pediatr. 2012;22(4):468-74
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Do we know if the milk used was pasteurized or raw? This could make a difference.
I’ve also recently heard that calcium can be constipating in some people.
I’ve recently greatly increased the amount of raw milk and raw milk kefir in my diet (three quarts total daily) and have experienced a vast improvement in digestion and bowel activity.
Being of Swiss and Irish/English ancestry, I may be well adapted to dairy.
Cheers
An interesting post.
Certainly in autism circles (my field of interest) there is also some evidence of constipation presenting as a comorbidity in cases of pediatric autism being linked to milk consumption as per the 2003 paper by Afzal and colleagues published in Pediatrics:
http://www.ncbi.nlm.nih.gov/pubmed/14523189
To quote: “Multivariate regression analysis showed consumption of milk to be the strongest predictor of constipation in the autistic group”.
In terms of mechanism, I’m dubious of a specific IgE hypersensitivity link but can’t readily speculate on what other mechanism(s) might be at work.
My daughter suffered as a child for several years with severe stomach pains and constipation. She was eventually diagnosed by a wonderful paediatrician at Great Ormond Street Hospital for Children as having cow’s milk intolerance. Various tests done previously for dairy ‘allergy’ had been negative. Strict exclusion of all dairy products improved her health immeasurably and stomach pain and constipation no longer occurred.
A breakdown product of A1 millk is BCM-7. This has an opiate like structure. It therefore causes constipation and abdominal bloating. A2 milk has been available in a few UK supermarkets since October 2012. Changing to A2 mild relieves constipation. A1 milk also causes type 1 diabetes, heart disease and a host of other problems as described in these 2 books:
1. Don’t drink A1 Milk by Brent Bateman
2.The Devil in the Milk by Keith Woodford
I will go into more detail for those who have not heard of A2 milk. Different countries have varying rates of type 1 diabetes according to type of milk consumed. Type 1 diabetes is caused by A1 milk which is produced by most cows in Europe, America and Australia. A2 milk, produced by cows in Africa and Asia, does not have this risk. The Masai drink a lot of milk but do not develop type 1 diabetes. Thousands of years ago all milk contained only A2 beta-casein. A mutation in some European cows caused their milk to contain A1 beta-casein.
Beta-casein protein is a 209 amino acid chain. A1 beta-casein has histidine at position 67. A2 beta-casein has proline at position 67. On digestion A1 beta-casein breaks at positions 60 and 67 producing the peptide BCM-7. GLUT-2 receptors on pancreatic beta-cells have the same amino acid sequence as BCM-7. Antibodies produced against BCM-7 therefore destroy the pancreatic beta-cells leading to in type 1 diabetes.
The amount type 1 diabetes in a country is closely correlated to the amount of A1 milk consumed. Cows in France and Iceland produce more A2 milk so there is a lower incidence of type 1 diabetes in these countries. Sadly due political pressure, commercial interest and faulty research the hypothesis is not widely accepted.
Taking my family off cow dairy products has brought many improvements in health.The child with the worst allergies tested negative on the scratch test for dairy allergy twice in his life. His sneezing response (every day, dozens and dozens of times, for years) to grasses, trees, and dust has improved so much that he no longer takes over-the-counter allergy medication daily, at least in these winter months. We’ve all gone off gluten as well, but dairy seems to be a key allergy for every one of us. Cheese was a family favorite.
The testing that helped us take the leap to eliminating dairy was done by an acupuncturist using meridian stress testing. Painless, quick, and covered under my extended health plan.
While linking novel foods (such as dairy) to gastroenteral problems is a step forward, anybody should consider that food induced problems are not limited to the gastroenteral symptoms.
And yes the “allergy paradigm” is strong. If something is food induced it must be “an allergy” or it doesn’t exists. I’m afraid there are more ways than just IgE in which the human immune system can react to novel foods. As a practitioner without free access to a large lab I think the best is currently to clearly establish a link if possible (e.g. eliminate,re-challenge,re-eliminate) and don’t care much about the molecular mechanism by which a food causes a symptom. Can that link between food and symptom be established? Will removal or at least reduction of that food bring health improvement? Then that should be enough.
What I would give if I could go back twenty years, or even ten years, and have a doctor tell me to explore whether my health problems were related to food, give me some guidance what to try (and how).
One more thing, from personal observation: Once dairy has caused health problems through some reaction to cow protein, a similar reaction can be caused by cow protein in beef/veal. So if dairy elimination brings an improvement, but not complete remission (especially on a beef rich Paleo diet), it is a good idea to try to remove beef/veal as well and see if it helps.