Podcast: Ep 26 - Breastfeeding ... and allergies - Part 1

Talking about breastfeeding and allergies with Joy Anderson

Joy Anderson talks with Emma about how dieticians help families try and find out whether there's an issue with allergies or intolerances in a breastfed baby. This episode includes information about symptoms, elimination diets, food challenges and how to get help and support..

Links to resources and information discussed in this episode:

• Information on breastfeeding your baby with food sensitivities, including allergies and intolerances.
• Lactose overload in babies information. 
• Information on lactose intolerance and the breastfed baby. 
• Breastfeeding and reflux information. 
• Information on breastfeeding a child with coeliac disease. 
• Information on crying babies, including colic. 
• Information on knowing if baby is getting enough breastmilk, including wee and poo in nappies. 
• Gastroenteritis (gastro) and breastfeeding information. 
• Information on breastfeeding and your diet. 
• Dietitians Association of Australia.
• Food Intolerance Network’s list on failsafe-friendly dietitians and other health professionals.
• Information on finding an International Board Certified Lactation Consultant (IBCLC).
• Facts about formula. 
• Breastfeeding and medications information, including contact information for the NPS Medicines Line or the Medicines Information Centre(s) in your state or territory.

Listen to part 2 here: https://www.podcasts.com/breastfeeding-with-aba-915bafc0b/episode/ep-27…

Credits: This episode is presented by Emma Pennell. Featuring Joy Anderson. Audio editing by Emma Pennell and Jessica Leonard. Show notes by Belinda Chambers. Transcription by Jessica Leonard. Produced by Belinda Chambers, Jessica Leonard and Eleanor Kippen.

JOY: If you're going to just continue eating a normal Australian diet and cut out a whole food group, then you need to know what else you need to eat to make sure that you make up for those nutrients, especially during lactation, when you're breastfeeding. Your nutrient needs are probably higher than at any other time in your life.

EMMA: Welcome to Breastfeeding with ABA, a podcast brought to you by Volunteers of the Australian Breastfeeding Association.

Breastfeeding with ABA is a podcast about breastfeeding made by parents, for parents. In this episode of Breastfeeding with ABA, we'll hear from breastfeeding and allergies expert Joy Anderson. My name is Emma and I'm a breastfeeding counsellor with the Australian Breastfeeding Association. And a mother of two children. I'm speaking from the lands of the Wurundjeri people of the Kulin nation.

I'd like to acknowledge the traditional custodians of the land on which I'm speaking and you're listening and pay my respects to elders past, present and emerging and to any Indigenous people listening. We also acknowledge the long history of oral storytelling on this country and of women supporting each other to learn to feed their babies. 

Our guest for this episode is Joy Anderson. Joy is a retired dietician and lactation consultant and a long term ABA volunteer. She lives on Whadjuk Noongar country. This is part one of a two part episode on allergies.

Part two, Amelia's story of breastfeeding a child with multiple allergies, is also available to listen to now. You'll hear some of the audio from this episode on that one as well. 

Welcome, Joy. So to start with, could you tell us a bit about what you would do when parents would bring a bub to visit you to try and find out whether there's an issue with allergies or intolerances? 

JOY: If mothers come to try and investigate what's going on with their babies, the very first thing I would do would be to take a thorough history, find out everything that's been going on since the baby was born. Even things during pregnancy for that mother. Also, her family history with the other family members. So babies, grandparents, aunts, uncles, siblings; you can get a lot of information about what might be happening by finding out what the rest of the family has experienced.

Then I definitely rule out any other causes other than diet because you don't want to start going on an elimination diet if it's really something else. So I think it's really important to rule out breastfeeding issues, medical issues and that sort of thing before. 

EMMA: So you work with other health professionals as a team then? 

JOY: Yes, I think it's important that they actually see probably both of those and I mean, it was easier for me because I was a lactation consultant as well. So, you know, I didn't really need to send them off to another lactation consultant necessarily. But certainly their GP. And for a dietician who's not a lactation consultant, then I think that's an important step. I find out, you know, if I have been to the doctor, whether there's been any tests done on the baby. Often they look at whether the baby's got any infection or any inflammatory cells that are coming out through the bowel motions which can indicate inflammation and things like that, or whether they've actually even had allergy tests.

So, you know, all of these things add up as clues. And then once I've got all this information, I explain to the mother what's involved in elimination diets, the different types there are, particularly if I've started to get an idea in my head of which direction this looks like it's going. Obviously, you know, I concentrate on that one and also take into account the mother's situation.

And what are her cooking skills like? How much time has she got? You know, can she cook from scratch, just generally what her life is like and, you know, it's pointless trying to put a mother onto an elimination diet that she just can't physically manage. So, you know, you've got to find out that sort of thing, too. 

EMMA: That's great. It's taking a really sort of holistic look at what's going on with the family and what they can practically do. 

JOY: Yes, you have to be practical. So once the mother decides that she wants to go ahead and do the elimination diet, once she has all the information she needs, I would help her carry out that diet, give her resources, give her lots of support, and she would go away and do that for a few weeks.

I would keep in contact with her by email or she could phone me if she's got any questions or problems. And then if and when the symptoms get better, if she's really noticing that things have changed and sometimes this happens around about the 3 to 4 week mark, that baby just suddenly becomes a new baby. That's the time when we get together again and organise challenges.

And that's a process where we introduce or reintroduce foods that we've taken out, in a very controlled manner. So just one at a time or one type of food chemical at a time. If it's food intolerances, so that we can determine whether that's going to cause a reaction or not. And so we go through this whole process of challenges so that the mother ends up with two lists.

One, yes, the baby reacted. And the other list. No, there was no reaction. So she knows then which foods are safe for her to eat. And then she has this list. Hopefully, it's not too long of ones that did cause a problem when she did the challenge. And the third phase is to reintroduce even these foods, trying to figure out whether she can get away with a small amount spaced out. In the case of a true allergy, a doctor would give her advice as to reintroducing those particular allergens. As a dietician, we don't really deal with that. That's really very medical. But in the case of food intolerances, the sort of less dangerous ones, I guess, we can certainly help the mother work out what she can get away with. It’s quite an extended process. It takes a number of months usually for mothers to get through, but if it's done properly it's very good and we actually get answers. 

EMMA: Okay. So I guess my next question is, what is an allergy and are there different types of allergies? 

JOY: Yeah, an allergy is by definition, it's an adverse reaction that's caused by the body's own immune system reacting to something that is otherwise really harmless. There's two types. There's the IgE mediated or antibody mediated type allergies and these are the ones that people worry mostly about because they have the potential to cause anaphylaxis.

So they actually can be life threatening. Having said that, when it's in a breastfed baby and the allergen is coming through the mother's milk, it's extremely unlikely that a baby would have anaphylaxis. I don't know whether there's any been documented in the world or not, but it's virtually non-existent.

EMMA: That's reassuring to know. 

JOY: You can test for these allergies and doctors often do these IgE tests, whether a skin prick test or there's a blood test, even then, they're not 100% accurate and they're really sort of mainly a good guide. I suppose if it comes up as positive for an allergy, you know. To me that means this is medical. You know, the mother needs to consult with an allergist or an immunologist. 

The other sort is the non IgE mediated. Sometimes It's called a cell mediated allergy. It's still an allergy and it's still the immune system, but it doesn't use the antibodies, so you can't test for it. You can only do elimination diets and challenges. It's not as dangerous.

It tends to be more delayed. With an antibody mediated allergy, if you eat the food directly, you're likely to have a very quick reaction to it. Not necessarily happens with a breastfed baby, but with a non-IgE mediated allergy, even if you eat something directly and you have this sort of allergy, it's fairly delayed, the effects. So the sort of symptoms you get with a non IgE mediated allergy are similar to food intolerances you can get in a baby.

You could get unusual bowel motions, different colours and textures and sometimes even blood in them. You can get gut symptoms like reflux, and skin symptoms, eczema and rashes and things like that. Whereas with an intolerance, this is again, we sort of go back to medical definitions. That's an adverse reaction that does not involve the immune system and it's quite wide ranging, the types of intolerances that people can experience.

My experience with babies is the most common type of intolerant tolerance is to food chemicals in just normal foods, as well as artificial additives and things like that. But they can actually have intolerance type symptoms to whole foods like dairy and soy and wheat. It's very hard to know with babies, whether it's a non IgE mediated allergy when it's one of those whole foods or whether it's an intolerance.

I think it's rather academic. We don't go sort of going, ‘well, let's have a test to see if it's the immune system’. It really doesn't matter. All we need to know is that this baby is having a reaction to these foods and we do something about that. 

EMMA: Yeah, absolutely. 

JOY: So it gets a bit messy. There are other intolerance type reactions you can get. Well, obviously, celiac disease or gluten intolerance is often talked about as an intolerance. So there's a variety of types of food intolerance. 

EMMA: So what signs might people say that could indicate an allergy or intolerance? 

JOY: I guess the major one that mothers come to us for is the baby's just very unsettled. They don't sleep well. They're not happy. They're just miserable babies.

They often have gut symptoms, like reflux is a big one. Now, a lot of people think, oh, reflux in a baby, we put them on medication and you know, everything will be fine. In fact, the medications, they're not evidenced based and they don't really work. And a lot of mothers actually find that out. But reflux is a fairly common symptom of food sensitivity of whether it's an allergy or intolerance could be either. Colic, similar, it’s just a crying baby, isn't it?

Often they have odd sort of bowel motions as well. And as I mentioned earlier, you know, they can have things like eczema, other rashes, things like cradle cap even can be a bit of a sign. And the other thing is that a baby with a serious food sensitivity often is not putting on very much weight. They're often not thriving all that well.

And then, you know, the first thing people think is, oh, they're not getting enough milk. But if you look at what's coming out the bottom end and their wet and dirty nappies, usually there's plenty, but they're not putting on weight. 

So that's where you, I think you need to have a suspicion that there's something going on with regard to an allergy or intolerance because they just, you know, their gut’s inflamed and they're not absorbing the food well. It's just sort of going in one end and out the other. 

EMMA: What might people need to know if they're thinking about trying an elimination diet? 

JOY: It's important that that elimination diet is supervised by a dietician or a doctor. And mothers don't just try and do it on their own. 

EMMA: It's certainly something that it's very tempting for mums to do. Just cut out foods from their diet to see if that helps.

JOY: Yeah. I guess if I do that and it's just very short term, then that's probably not going to cause too much harm. But often elimination diets that mothers create themselves, say they start eliminating things and then they add more and more and more and more, and they're eliminating huge numbers of foods, sometimes without any pattern to it and without really knowing the sort of theory behind it all.

So they often cut out things that they don't need to and maybe even miss the things they should be cutting out. So I think it's important that somebody who understands this whole process guides them so that they don't don't end up in a confused mess. 

EMMA: Yep. It sounds very valuable to me, for sure. 

JOY: So the important things about elimination diets, so that they are short term, they're an investigation and they're not, ‘oh, I've got to cut this out and I'll do this for the rest of the time I'm breastfeeding.’ It's got to be a time limited investigation. It just needs to be done properly. Hence the getting somebody to help. For example, if you want to just go dairy free, which is the simplest one that most mothers usually try first.

And it's true that dairy is the number one culprit usually, but it's not always the only one. And if you don't cut out other things and you still get the symptoms, then you just won't know. But with dairy, there's certain. And like there's a lot of ingredients that are derived from dairy that are put into processed products. And it's important to know which ones are okay to have and which ones are not.

When you're doing a dairy free diet and that applies to other foods too, know we have so many foods that have multiple ingredients that it can get very confusing. You also, if you're cutting out whole food groups, especially like dairy foods, you need to be able to replace those nutrients that you're missing. It's true that you can have a balanced diet without dairy, and lots of people in the world do it because lots of cuisines don't include dairy.

But in a normal Australian diet, we do rely on dairy for especially calcium. So if you're going to just continue eating a normal Australian diet and cut out a whole food group, then you need to know what else you need to eat to make sure that you make up for those nutrients, especially during lactation, when you're breastfeeding. Your nutrient needs are probably higher than at any other time, and your, in your life.

So this is why it's really important that you see a dietician because they understand, you know, all of this side of things. Another thing just to be aware of is as babies get older, they become more tolerant. Some babies will grow out of their sensitivities and even their allergies, babies who are when they're young, you might be allergic to dairy and soy and eggs and all sorts of things, but they tend to grow out of them over sometimes a period of years.

It's very variable. And even with food intolerances, they often get more tolerant as they get older. So it's really important that even if you've worked out what your baby's reacting to, that you keep doing challenges every now and again, every few months. Perhaps try eating the food and see if your baby still has a reaction because you don't want to be avoiding foods any longer than you have to.

EMMA: Absolutely. It's so much easier if you can eat everything. 

JOY: Well, yeah. You don't want to keep avoiding stuff. And also, you know, your baby, you want your baby to be eating a wide range of foods too. The other thing that I thought to mention was there's a lot of support out there for mothers doing elimination diets, in particular on social media.

But I have a bit of a warning with that. Some people go on these forums, get very enthusiastic. They know what works for their baby. But you have to remember that they're actually the expert only on their baby. And sometimes they can be very convincing and say, Oh, you should do this, you should do that. This is what worked for my baby.

But everyone's an individual. Every baby is different. And I think you need to be really, mothers need to be really careful that they don't just take advice from another mother who's got a baby with food sensitivity because it could be completely different. 

EMMA: And a lot of people ask about lactose intolerance. Can you tell us about that? 

JOY: Lactose intolerance is very poorly understood, even among some health professionals.

If we're talking about babies, breast milk is full of lactose. It's got more lactose than probably any other milk around 

Babies are designed to use lactose. And they need lactose. When a baby becomes lactose intolerant, if they truly are, then it's because there's something damaging their gut lining, because they lack the enzyme that digests lactose, (which) sits on the very tips of the folds in the intestine and anything that causes any sort of inflammation or damage to that gut lining wipes them off. 

And so they become lactose intolerant now. It's a symptom, a symptom of something else. So it's not a diagnosis in itself as such, it means that something's causing that damage and that can be food sensitivity, can be food allergy or intolerance. It also can be an infection. So gastroenteritis, it's really anything that causes the gut lining to become inflamed.

And the answer is not to take lactose out of the baby's diet, which sometimes gets recommended, like, you know, put your baby onto a lactose free formula. It's more about trying to find out what's causing the damage to the gut and fix that. Because if you can reduce the inflammation and fix whatever the baby's gut's reacting to, then lactose will be digested again.

And it will be fine. So I think this is where it gets quite confusing because if the baby's reacting to dairy protein and that's causing inflammation in the gut lining, then they become lactose intolerant. And because lactose and calcium protein are in the same food, people get very confused. And so you get people saying, oh, drink lactose free milk and then you won't have lactose in your breast milk.

We know that's nonsense because the lactose in the breast milk doesn't come from the mother's diet. It's made in the breast. So if a baby's breastfed, you cannot remove lactose from the milk. So it's the… Oh, the other thing that often happens, too, is babies getting too much milk too fast, look like they have lactose intolerance and they're very unsettled.

They have lots of wet and dirty nappies, often lots of explosive nappies. Sometimes they're green and this can be simply just too much milk, too fast or lactose overload. And that's not a medical problem. It's just a breastfeeding management issue. And if a mother is thinking that this is (what) might be what's happening with her baby, ring the Helpline and talk to an ABA counsellor and they will be able to, to give you tips on, on how to reduce this problem and have a happy baby again. 

EMMA: Fantastic. Thank you so much for sharing all of that. Joy, do you have any final words of advice for our listeners? 

JOY: Yeah, I think it's important for them to know that there's more than just doctors and allergy clinics.

If you, if you've got this sort of suspicion or problem, as I mentioned earlier, lactation consultants to help you with breastfeeding issues that could be contributing. GP for the medical issues of course, but dieticians are really the best placed to help with dietary investigation, especially if they have particular interest in this area and in breastfeeding. And many now do remote consulting sort of, over Zoom or even, even before Zoom it was Skype and phone. And the best way to find it, because not every dietician will be interested in this, but the best way to find them (is) on the Dieticians Australia website that's dietitiansaustralia.org.au. They have a search function there and you can select the area of practice. 

And so you can use that search function to narrow down a list of dieticians that, that could help. The other place to find names is the food intolerance network fedup.com.au on their home page they have a link saying ‘support’. If you look at the menu and the support right at the bottom, it has failsafe dieticians.

Now this site is mainly about food chemical intolerance, but these dieticians that are on the list, they would deal with allergies, intolerances, you know, the whole range. Not all of them necessarily will deal with babies, but many of them will. And often what's on that website will tell you whether they do or not. So that's, you know, a couple of ways of narrowing the field.

I guess the other thing that there's two main options for babies, mothers and babies with, with really serious food sensitivities. One is to wean the baby and in some cases, some actually have to. If it's a really serious sort of case, there's prescription formulas that, that allergists, immunologists, these doctors can prescribe. Unfortunately, it means you lose all aspects of breastfeeding, which we all know is so valuable.

These formulas tend to taste pretty awful. They sort of tend to make the baby smell nasty. It does free the mother up. She can go back to eating whatever she likes and also just delays the investigation because once your baby starts going on solids, then you need to find out what they're going to be reacting to. And the other option, of course, is dietary investigation, which helps, you know, especially if you go with a dietician.

They will help you avoid pitfalls and mistakes. They will ensure you have adequate nutrition and that you can do this in the most time efficient manner possible. A bit of a plug for, for dieticians. 

EMMA: Thank you so much, Joy, for speaking with me today. Make sure you listen to part two of this episode where we hear from Amelia about her experience breastfeeding a baby with multiple allergies. If you're in a position to support the work that ABA does financially, you can become a member by visiting breastfeeding.asn.au and you, and that will link you in with your local group as well. If you want to speak to a breastfeeding counsellor, call the National Breastfeeding Helpline on 1800686268. It's open 24 hours a day every day of the year. Our LiveChat service is another option. You can check the website to see when that's open. Thanks for listening. We'd love it if you can rate, review, and subscribe to the Breastfeeding with ABA podcast. Wherever you're listening.

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