lactase/breast milk- maybe a question for a LC

[SaoirseC]

Is lactase found in breast milk?
If so:
If the mom has lactose intolerance (aka, lactase deficiency), how would that impact the lactase content of breast milk?

Here's my train of thought. I believe that extended breastfeeding/night nursing can possibly increase the risk of early caries *in some nursing couples* (based on my experience with two children who had ECC). I know that a high population of lactobacillus in the mouth can lead to caries (lactobacillus produces lactic aid, which lowers the pH of the mouth, thus making the mouth more friendly towards s. mutans). Lactobacillus feeds on lactose. If there's a high amount of undigested lactose in breast milk (due to the mom's milk being deficient in lactase), maybe this encourages the growth of lactobacillus in the mouth. Are there any gaps in that little hypothesis?

[PatioGardener]

I have never heard of lactase in breastmilk. If it were, it would follow that the high lactose content would be broken down into glucose and galactose in the fridge if a mama were to pump. My understanding is that lactase is produced in the baby's gut.

[Heba]

Hmm...that's my understanding too. There have been suggestions of treating EBM with *lactase for lactose-intolerant babies (I don't think it's done very often, but I could be wrong)...anyway, presumably this indicates that breastmilk does not itself contain lactase. I could be wrong, though.

[Heba]

I've looked through the books I have...can't find any indication that breastmilk contains lactase, it's just found in the GI tract.

[Linda on the move]

I don't know, but here's my story....

I'm have no problem with diary and can consume lactose until the cows come home. (Tee hee)

My younger DD is lactose intolerant and even tiny amounts of lactose would cause her to scream for hours, so I had no diary in my diet while breastfeeding. (after the very brief period when I figured this out)

She extended nursed, often nursed to sleep, never had a pacifer or bottle, etc.

She ended up with dental carries, inspite of no lactose in my diet.

[PatioGardener]

Originally Posted by Linda on the move

My younger DD is lactose intolerant and even tiny amounts of lactose would cause her to scream for hours, so I had no diary in my diet while breastfeeding. (after the very brief period when I figured this out).

This is an extremely rare condition in babies, as lactose is the sugar that grows their brains. A baby who can't digest lactose can't comfortably be breastfed, as all breastmilk contains lactose. Usually the intolerance is to a protein in cow milk, rather than the sugar, so baby can breastfeed without pain if Mama cuts out dairy from her diet. My baby has this, and I too had to cut dairy from my diet. I totally understand about the screaming - I'm glad that cutting out dairy helped you guys out too!

[SaoirseC]

Interesting. I've been told that raw cow's milk contains lactase, so I assumed that raw breast milk would too.

PatioGardener- that logic would follow. Probably not related to this, but I could never keep my breast milk in the fridge because it would smell/taste funny after a few hours.

Lindaonthemove- maybe you're thinking of casein? That's the main "milk protein" which gives cheese its ability to melt (it's also added to some "non-dairy" cheeses). I, too, had to cut out milk for a while due to my son's milk allergy (which was healed by my colostrum produced during DD's pregnancy).

[spughy]

My recollection is that there is a small amount of lactase in breastmilk, but infants do produce it on their own. Other posters are correct that the more typical problem is cow milk proteins - babies can easily have issues digesting those (especially pasteurized; most milks contain protein-digesting enzymes like lipase that are destroyed when the milk is pasteurized. This is incidentally why some women's milk goes funky quickly in the fridge, it's an excess of lipase and gently heating the milk to deactivate most of the lipase enables it to be stored longer.)

The other problem with your theory is that lactobacillus bacteria are NOT associated with caries; it's streptococcus mutans, and there are different factors that affect how and to what extent babies' mouths are colonized, and how resilient the infant enamel is. Night-nursing can possibly exacerbate difficulties, but the primary damage is usually due to an unfortunate combination of genetics, diet, degree of colonization, oral hygiene, and enamel formation which happens in the womb and is determined by genetics and available minerals. While lactobacillus would lower the oral pH if milk were to sit around in the mouth, nursing typically does not result in milk pooling in the mouth. *Constant* night nursing, on the other hand, would result in a steady stream of nutrients that would feed both the strep mutans and the lactobacillus - in which case they would likely be in competition and a larger population of lactobacillus would likely reduce the population of strep mutans.

If you want more info, check out Dr. Brian Palmer's site. LOADS of stuff on there about nursing and caries, especially this article.

[SaoirseC]

Actually spughy, higher lactobacillus counts (specifically L. acidophilus) are associated with an increase in caries lesions and a drop in L. acidophilus count is associated with an arrest in the development of lesions. Not saying it's a causative factor, but there is a correlation. My question was really about lactose- a sugar- not a milk protein (lipase is actually an enzyme to break down fat, btw, not protein). Someone else mentioned "lactose intolerance" which morphed into a discussion about milk allergy/casein. I've heard lipase is in breast milk, but haven't actually found anything reputable to back it up. Though I know it is in "the gut" (actually produced by the pancreas).

Most night nursing (in my bed at least) does result in pooling because babe and I fall asleep before he stops nursing. So even when he stops, my nipple is still in his mouth and usually dripping somewhat.

Thanks for the article, I've read it before. The argument that breast feeding at night doesn't result in ECC is based on population studies, so it should hold true for the majority of nursing couples. On the other hand, I have done so many things right with my older two children (including extended/on-demand nursing) and they both had AWFUL ECCs. It's possible that I'm in the minority, for whom night-nursing may play a role. We hear so often that the composition of breast milk is constantly changing- month by month, day by day, from the beginning of a nursing session to the end. I think it also varies based on the woman who is producing it, as well as her diet and any possible disease/illness. As an example, maybe I have undiagnosed blood sugar issues, and I'm spilling excess glucose into my breastmilk (don't remember if S. mutans can "eat" glucose). This would put me into the minority- see what i mean? You could check out my post in "dental" about this; I'm brainstorming possible factors that might have led to the development of their dental problems in the hope that I can prevent it from happening to my baby.