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Dr H Morrow Brown MD
General Medical Council Registered Specialist
for Allergy and Respiratory Medicine


Milk Can Cause Gut Problems

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Bristol Stool Chart

The gut is obviously the most frequently involved organ system in childhood, frequently recovering spontaneously after infancy, thus obscuring and confusing the diagnosis of milk intolerance.

The gut can be affected from one end to the other, from apthous ulcers or oral allergy syndrome to proctitis or colitis. Diarrhoea is a common presentation of intolerance in infancy which may damage the lining of the gut leading to secondary lactase deficiency, malabsorption, malnutrition, steatorrhoea (fatty, floating diarrhoea), failure to thrive, occult bleeding and anaemia.

Rejection of a formula feed by vomiting or by diarrhoea, or projectile vomiting which may be misdiagnosed as pyloric stenosis, and may not recognised to be due to milk. Reflux is well known as a trigger for asthma and intractable cough in adults suggesting that foods may be the cause.

The Dairy Industry both here and in the USA promote milk products vigorously for health. This may be true for the majority but a minority suffer from the multiple effects of milk intolerance which are probably seldom diagnosed.

What could cause diarrhoea every Saturday morning?

A fifty year old lady wanted to find out why she had had acute diarrhoea every Saturday morning for twenty years for which she had had many expensive and detailed investigations at a teaching hospital. A careful history disclosed the answer, because it was her custom after leaving work at noon on Saturday to purchase her weekly treat. This was a cream bun she bought at the bakers and ate as she was walking home. She would just get there in time before the explosion!

A tale from the Colonies with a bad smell

ChocolateAn atopic mother who had both her children when resident in the New Hebrides Islands in the Pacific, breast fed her youngest son successfully to eight months, but when transferred to milk formula he responded with constant rhinitis, wheezing, eczema, and incessant screaming. He thrived on a soya formula, and when seen aged two it had become obvious that milk chocolate caused aggressiveness and headaches, and carrots caused diarrhoea and vomiting. He had asthma if he got the slightest trace of milk, and as time went by he began to react to dogs and horses as well. By age seven he was able to take some milk but he had chronic diarrhoea, which was aggravated by a disguised milk drink, but avoidance of milk was ineffective this time, and he had chronic abdominal pains.

Wheat, bread, milk and eggHis elder brother had also developed chronic diarrhoea, and they both had very malodorous stools which floated. Mother had concluded that males always had very smelly motions because father had the same problem, so she did not realise that this was abnormal !!. On a gluten free diet all symptoms disappeared in a week in both children, and they both began to grow very rapidly suggesting significant malabsorption had been present. Unfortunately father was still in the New Hebrides, where a gluten free regime was not possible.

The rapidity of recovery suggested that the gluten intolerance was secondary to milk intolerance, not true celiac disease. The asthma which still affected the younger boy disappeared, and his problems with reading, which had been firmly diagnosed as dyslexia, improved rapidly and finally disappeared.

Another bad smell and misbehaviour

Girl holding her nose shut with her fingersChristopher was five when he was referred with rhinitis and cough, but also had a history of projectile vomiting which ceased as the rhinitis and cough began.

He had constant wind and frequent colic, his abdomen was bloated, and he passed only two very smelly motions per week. He was very difficult to handle, resented being examined, and all skin tests were negative.

 Avoidance of milk resulted in disappearance of all symptoms in a week and his behaviour became normal. Mother commented that when she gave him test feeds of milk as I had instructed in order to prove that milk was the cause his behaviour became as foul as the smell of the huge stools which ensued a few hours later on every occasion he had milk!


Milk, Mouth Ulcers, and Wheat Intolerance

Sliced bread and eggs in a bowlLisa was twenty-three when she was referred by a gastroenterologist for skin tests. There was a significant family history again, as both her parents had had a deficiency of lactase, without which they cannot digest milk. As a baby she had had projectile vomiting, which was diagnosed as hiatus hernia but was almost certainly milk intolerance. From age six months to four years she was hyperactive with behaviour problems and tantrums, followed by an incessant cough, sputum, excessive nasal secretions, and frequent sinusitis, probably caused by milk intolerance which did not recover spontaneously as it often does.

No doctor would believe that there was a problem in spite of many consultations, so despairing of any help from conventional medicine she was taken to a chiropractor who diagnosed lactose intolerance, probably because of the family history. Avoidance of all diary products resulted in disappearance of the cough and other symptoms, and she was very much better except for the frequent mouth ulcers which had also been a problem since infancy.

While at university her abdominal pains were diagnosed at a famous Teaching Hospital as Irritable Bowel Syndrome (“IBS”) for which she was given Fybogel which made it worse. When aged 22 she was seen by a hospital dentist who suggested that the mouth ulcers could be a sign of Coeliac disease, and by avoiding gluten completely all her symptoms cleared up by the time the result of the blood test for Coeliac disease was reported to be negative. This meant that she was actually intolerant of wheat, rather than just gluten, as well as milk. All skin and immunology tests were negative.

She commented that she had had more help from the chiropractor who suggested milk intolerance and the dentist who suggested gluten intolerance, than conventional doctors whom she had seen many times over the years without obtaining either diagnosis or adequate investigation… She remains very happy and healthy with no milk, no wheat, and no medication.

Irritable Bowel Syndrome not all in the mind?

The current medical opinion regarding IBS is that it is usually all in the mind. Dr J O Hunter and colleagues in Cambridge have shown clearly that normal amounts of foods, particularly milk and wheat, will provoke symptoms of IBS in many cases.

Personal experience over many years has confirmed his views that milk and wheat can cause IBS, sometimes when the problem for which the patient had been referred was asthma or chronic cough, and no attention had been paid to the IBS. Milk sensitivity has recently been described as the key to poorly defined gastrointestinal symptoms in adults, confirming my experience. Before assuming that IBS is all in the mind it would be worth while considering a trial of a diet excluding milk, beef, and wheat to exclude these possibilities.

Unfortunately Dr Hunter’s very careful researches over many years have not been followed by many other gastro-enterologists, and the prevailing opinion is that IBS is usually of emotional origin is the received wisdom today.

Ulcerative Colitis

Milk avoidance was shown by Andreasen in 1921 and Truelove in Oxford in 1961 ago to be very helpful in ulcerative colitis, but the evidence since then is inconclusive. Occasional personal experience has been encouraging, and leads me to suggest that dietary manipulation should be introduced as soon as possible as a first approach. This is because after colitis has been present for some time definite pathological changes must appear in the colon. These changes may in time become permanent to the extent that no amount of dietary manipulation could be expected to reverse them, so that surgical removal of the colon eventually presents the only possibility of a cure. I seldom see colitis cases, but again Dr John Hunter has had success with dietary manipulation in Cambridge..

A difficult teenager with Ulcerative Colitis

A young lady of 18 who had had ulcerative colitis for three years, confirmed by colonoscopy and biopsy and treated with salazopyrin and steroid enemas, was seen in the hope of finding an avoidable cause. There was a strong family history of allergy on her father’s side. In infancy she had had problems in tolerating cow’s milk and had soya formula, was wheezy and hyperactive, and had eczema. She had positive prick tests for dust mite, and had chronic rhinitis due to dust mite. She was obviously very atopic, and with milk avoidance her bowel function became normal in two months, bleeding and anaemia ceased, and there was a very noticeable decrease in the dreadful smell of her stools which was obvious to the whole family.

Cheese and tomato pizzaHer personality changed for the better and she became more cooperative, but she had a craving for milk products. The next event was that she deliberately had a pizza with a cheese topping which caused very malodorous sto
ols next day, and then milk in her coffee was followed by blood in the stools and the dreadful smell the next day. She had such an addiction to milk that her personality deteriorated and she became uncooperative. Attempts were made to persuade her to try a wheat free diet as well because it seemed likely that wheat was also causing of her colitis, but she would not co-operate. She eventually left home to stay with the boy-friend and the outcome is unknown.

Milk was clearly a major causative factor, but she was a very awkward teenager who could not even remember to take her medication. The anti-social smell of the stools which is a feature of these cases suggests that changes in the gut flora may be triggered by milk, and the smell can point to the diagnosis.

Beef can trigger Colitis

A forty five year old man who had severe ulcerative colitis heard that milk could be a cause, put himself on a milk free diet, and improved remarkably. Unfortunately he was very fond of steak, so he ate a large rare steak to celebrate his improvement. From the next day he had a severe flare-up and he finally had to have the colon removed, probably because the disease had become irreversible

Constipation caused by Milk

Chronic constipation is an uncommon presentation of milk intolerance, but scattered references are to be found in the literature, and detailed studies have been carried out recently. The authors suggested that “removing cow’s milk from as child’s diet should be recommended as the first line of treatment before administering large doses of laxatives”

A stool as big as a milk bottle !

The most striking example was a girl aged nine who had a history of severe infant feeding difficulties, followed by chronic asthma, and also constipation so severe that she usually pass
ed a motion once in about two weeks. The product was described as being the length and diameter of a milk bottle (!), which had to be broken up to be flushed away.

A paediatrician had insisted that all her problems were due to the marital discord which had led to her mother’s divorce, but avoidance of milk products not only resolved her asthma in a week but she also passed normal stools daily for the first time since infancy,. Re-introduction of milk repeatably reproduced both asthma and constipation.

Constipated from birth!

An eight year old girl had constipation from birth. This was probably correct because it was clearly recalled that the newborn formula fed baby did not pass a motion for three days after delivery. She had been investigated in hospital for abdominal pains on several occasions without a diagnosis being made, until her mother read in a magazine that milk could cause constipation, and she came for confirmation. Avoidance of all milk products and beef abolished her pains and her constipation, and reintroduction either by accident or on purpose reproduced pains and constipation.

Beef and beef extract can cause Asthma as well as Gut Problems

It makes sense that beef, which is the source of milk, will cause problems and it is difficult to understand why dietitians often do not accept this obvious fact. There is no better example than the peak flow charts after this patient consumed a nice steak. This patient did not react to milk, so he had a specific response to some protein which was present in beef but not in milk.

The other patient complained that every time he had a Bovril drink at bedtime he had asthma in the night, and he was persuaded to prove it, but these experiments are unacceptable as they were not carried out double-blind.


Why was the baby was better on the bus tour?

The most striking case encountered where beef was important was a baby whose constant screaming and incessant watery diarrhoea created such a bad smell that the parents said that the house had become almost uninhabitable. A hospital dietitian had put him on a milk-free regime, but it was not beef free, and there was no improvement.

A joint of roast beefWhile waiting to be seen at the clinic, and in spite of these anti-social problems, his parents took him with them on a bus tour round Europe for two weeks! To everyone’s surprise and delight he was perfectly well on the bus, and was spoiled by everybody, but on return home he promptly relapsed his stinking diarrhoea.

There had to be some simple explanation for this remarkable case, where most parents would not have gone on a bus tour because of this anti-social problem. On close interrogation I discovered that they had taken with them on the bus suitcases full of infant foods from a different manufacturer. Enquiry revealed that these tins of baby food did not have a beef broth base, while the foods he had been given before the trip did.!

When beef was excluded by switching to the make of food which he had had on the bus, his symptoms cleared in a few days. Deliberate challenges with baby foods which contained a beef broth base reproduced the diarrhoea every time. In other cases less severe problems have been found to be due to beef fat incorporated in soya formula, but I believe this has been removed.



"It is a paradox that while Britain has the highest incidence of allergic disease in the world, it also has the most inadequate allergy service"

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