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Hot Topic:
Constipation and Milk Allergy

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"Intolerance of Cow's Milk and Chronic Constipation in Children," by Giuseppe Iacano et al. New England Journal of Medicine, Vol. 339, No. 18 (October 15, 1998), pp. 1100-04.  (Also see editorial, "Constipation in Children," by Vera Loening-Baucke, pp. 1155-56 in the same issue.)

The report:
    To test whether an allergy to cow's milk was causing chronic constipation (defined as one bowel movement every 3 to 15 days) in a group of Italian children, the children received only either cow's milk or soy milk for a two week period using a double-blind study approach. The children in the study were all under 6 years old. Those with other known problems were eliminated. The study was repeated, with a future cow's milk challenge. The children had to have at least 8 bowel movements to be considered to have had a response.

    There were 65 children, split as evenly as possible into the two groups. In the first study, 21 of the soy milk children and none of the cow's milk children had a response. In the second study, 23 of the soy milk children and again none of the cow's milk children had a response. In addition, their anal fissures and pain upon defecation also disappeared.

    When challenged with cow's milk later, every child developed hard stools and discomfort after 5 to 10 days on the diet.

    First, I need to emphasize one thing: this is a study of milk allergy not lactose intolerance (LI). You are not likely to have constipation as a symptom of LI, no matter what your age.

    The causes of chronic constipation in children are not very well known. Doctors have often thought that the problem is psychological, even though modern research usually shows that the psychological problems, not unreasonably, are the result rather than the cause of the constipation. Still, few people would have thought that cow's milk would be a major cause.

    The children in this study were all veterans of doctors and clinics. They had all been given laxatives with no success. Most had developed anal fissures and other problems. For two-thirds of them to suddenly show dramatic improvement is astounding. For all of them to go back to being constipated when given cow's milk again is equally dramatic. Seldom do you ever see such clear-cut, one-way results in a medical study. And this study is a follow-up to an earlier one by the same group of doctors ("Chronic constipation as a symptom of cow's milk allergy," J. Pediatrics, 1995, vol. 126, pp. 34-9) with similar results.

    Constipation is a widespread problem, with it affecting from one-fifth to one-third of young children. Only about one in 20 children have it as a long-term problem, however. Short-term constipation can be treated with laxatives.

    Serious, long-term constipation needs a better solution. I would advise parents whose children are suffering in this way to immediately talk to your pediatrician about taking cow's milk out of their diets.

    I would caution you, however, to remember that while this study confirms the results of other studies, these are still very preliminary findings. The children included can't be considered representative of the general population. However, taking a child off of cow's milk is so easy, and so much easier on the child than using drugs and medications, that you should consider it for any child with severe, chronic constipation.

    And in fact, some other researchers cast great doubt on these findings, in a later issue of the NEJM. See this NEJM letter for a negative review.


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