The observation that constipation might sometimes be caused by milk intolerance has appeared in the medical
literature from time to time, dating back as far as 1954 (Pediatric Clinics of North America, 1954; 4:940-962). But
only recently has there been a well-designed study published showing that this is indeed the case. The results
of this study, when widely known, can set many children free to enjoy the exuberance of childhood without pain.
Researchers at the University of Palermo in Italy worked with 65 children with chronic constipation. All of these children
had been treated with laxatives when dietary measures had failed. Even with the medical treatment, these children were still
constipated, having hard, painful stools only every 3 to 15 days. Forty-nine of the their little bottoms had fissures and
redness or swelling from the hard plugs of stool.
Each child received either cow's milk or soymilk for 2 weeks, with no one knowing which was which. Next, they had a week
during which they could eat and drink anything they wanted to wash out the effects of the first 2 weeks. Then they switched
sides for 2 weeks and got the milk that they didn't get the first time. Careful recordings of the bowel habits were made.
When the secret code was broken at the end of the study, they found status quo constipation for each child while he or
she was on cow's milk. But while they were taking soymilk (which causes firmer stools in most kids), 68% of these kids were
no longer constipated! The redness, swelling, and fissures on their bottoms healed (New England Journal of Medicine, 1998;
339:1100-1104). How wonderful to finally have relief after diet and medicines hadn't worked for so long!
The results were most dramatic in kids who also had frequent runny noses, eczema, or wheezing. Nevertheless, sometimes
constipation can be the only symptom of cow's milk intolerance.
Dr Alan Greene comments:
This has broad implications. The children in this study were those with severe chronic constipation that was unresponsive
to medications. I am convinced that they are only the tip of the iceberg. There must be a much larger group of mildly allergic
children whose constipation improves with laxatives. Time may prove that it is better for these children to avoid
the offending protein by switching milks rather than being treated with laxatives.
Presumably, swelling of the intestinal lining causes the constipation. Whatever the exact mechanism, the problem is with
the protein in cow's milk, not with the fat or lactose (the sugar). Skim milk or lactose-free milk will not help with this
one. Switching to soymilk and other soy products might transform the life of your [child] in only a couple of
Unfortunately, some children are also soy protein intolerant. As it happens, this is more common in kids who are allergic
to cow's milk protein. If you don't get good results within 2 weeks, I suggest also eliminating soy from the diet for 2 weeks
as a trial. You might use Alimentum or Nutramigen (protein hydrolysate infant formulas) as the milk for these next 2 weeks
because it is much less likely to be allergic to the protein in them. If they work, you can then experiment with other sources
of calcium, protein, and fat for the future (perhaps rice milk).
It's not that common for simple changes to relieve relentless, longstanding problems. But when a child is made
miserable by an allergy, removing the source can result in a rapid, dramatic improvement in the quality of life.