Breastfeeding Mom & Baby

How to Start An Elimination Diet for Breastfeeding

The challenges of nursing a baby with MSPI or other food intolerances.

My daughter was a sweet, mellow and overall fairly easy-going baby. (And thank goodness for that because my first was quite the challenge!) Baby Bun, as I lovingly call her, is my second child and the baby girl I always knew I wanted. Her infancy wasn’t without issues though. My daughter struggled with some fairly extensive food intolerances, which resulted in me going on a Total Elimination Diet – a TED.

I have another post, which you can find here, that discusses more about our journey with infant protein intolerance and the route we took to heal my daughter’s digestive tract.

In a nutshell, my daughter was basically diagnosed with MSPI – Milk Soy Protein Intolerance. She reacted poorly to proteins in my breastmilk from foods I had eaten. However, the extent of her food intolerances covered much more than just milk and soy proteins. She was also reacting to beef, egg and gluten. Other foods that I eliminated but wasn’t positive she had a reaction to included: corn, fish, tree nuts and peanuts.

So what is a TED all about?

An elimination diet is used to discover if a person is reacting to a certain food in an allergenic way. The suspected offending food(s) are removed from a person’s diet for at least two weeks to see if their symptoms change and ultimately improve. When breastfeeding an allergenic or food intolerant child, a total elimination diet includes limiting at least all top 8 allergens. This includes: milk, eggs, soy, peanuts, tree nuts, wheat, fish and shellfish.

However, many mothers who find themselves on a TED may discover that their child reacts poorly to more foods than just the top 8 allergens.

An infant may begin showing signs of food protein intolerances in a number of ways. This could include:

  • vomiting
  • increased gastric reflux issues
  • green, mucous-like stools
  • blood in the stool
  • increased crying after feedings
  • increased overall fussiness
  • gas and bloating
  • rashes or eczema
  • hives – but is this typically a sign of an actual allergy

My daughter had reflux, occasional large-volume vomiting, increased crying after being fed, and the green, abnormal stools which eventually led to visible blood in her stools. Her symptoms began when she was just past 2 months old.

No cow’s milk for me! Or the boobie!

Her condition more closely resembled something called FPIAP, or food protein-induced allergic proctocolitis. Her digestive tract was reacting to certain food proteins a way that was causing irritation and inflammation in her intestines. After ingesting these offending foods for so many weeks without my knowing she had this condition, I was unintentionally causing her abdominal discomfort and damage that led to the blood in her stools.

Neither my daughter, nor I, have any true food allergies. MSPI and FPIAP are food intolerance conditions that are typically outgrown by one year of age. Sometimes sooner and sometimes later. There are, however, some children who develop true food allergies after having MSPI or FPIAP. FPIAP is an extremely variable condition and takes a lot of trial and error to discover the best treatment plan.

When to consider a TED?

I would never just full-on recommend a TED to any one. It’s extremely limiting and can often lead to unintended weight loss, fatigue and potential nutrient deficiencies in the mother. Before pursuing a total elimination diet, there are other options you should explore.

If your child’s doctor suspects they may have MSPI, or even just a milk protein intolerance, then the fix may be fairly easy. Breastfeeding mothers will need to eliminate dairy from their diet for at least two weeks to see if symptoms improve. If this doesn’t totally clear up your symptoms you will need to also eliminate soy protein.

It’s important that you COMPLETELY eliminate these foods. That means paying attention at all times to what you are consuming. In the US it is required that the top allergens are listed on food labels. Typically you will see them in bold type i.e. CONTAINS: MILK.

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The following is a list of ingredients you may see on a food label.

Definite Milk/Dairy:

  • Butter, butter fat, butter oil, butter acid, butter ester(s)
  • Buttermilk
  • Casein
  • Casein hydrolysate
  • Caseinates (in all forms)
  • Cheese
  • Cottage cheese
  • Cream
  • Curds
  • Custard
  • Diacetyl
  • Ghee
  • Half-and-half
  • Lactalbumin, lactalbumin phosphate
  • Lactoferrin
  • Lactose
  • Lactulose
  • Milk (in all forms including condensed, derivative, dry, evaporated, goat’s milk and milk from other animals, low-fat, malted, milkfat, non-fat, powder, protein, skimmed, solids, whole)
  • Milk protein hydrolysate
  • Pudding
  • Recaldent(R)
  • Rennet casein
  • Sour cream, sour cream solids
  • Sour milk solids
  • Tagatose
  • Whey (in all forms)
  • Whey protein hydrolysate
  • Yogurt

Other Possible Sources of Milk*:

  • Artificial butter flavor
  • Baked goods
  • Caramel candies
  • Chocolate
  • Lactic acid starter culture and other bacterial cultures
  • Deli meat, hot dogs and sausages, which may use the milk protein casein as a binder.
  • Margarine
  • Nisin
  • Non-dairy products, as many contain casein
  • Nougat
  • Shellfish is sometimes dipped in milk to reduce the fishy odor. Ask questions when buying shellfish.
  • Tuna fish, as some brands contain casein
  • Some specialty products made with milk substitutes (i.e., soy-, nut- or rice-based dairy products) are manufactured on equipment shared with milk.
  • Many restaurants put butter on grilled steaks to add extra flavor. You can’t see the butter after it melts.
  • Some medications contain milk protein.

*Not all of these foods may actually contain milk. If you are unsure, then it is best to avoid it.

Foods that look like they may contain milk but actually don’t:

  • Calcium lactate
  • Calcium stearoyl lactylate
  • Cocoa butter
  • Cream of tartar
  • Lactic acid (however, lactic acid starter culture may contain milk)
  • Oleoresin
  • Sodium lactate
  • Sodium stearoyl lactylate

The information above was gathered from this website: https://www.foodallergy.org/common-allergens/milk-allergy

Definite Soy:

  • Cold-pressed, expelled or extruded soy oil*
  • Edamame
  • Miso
  • Natto
  • Shoyu
  • Soy (soy albumin, soy cheese, soy fiber, soy flour, soy grits, soy ice cream, soy milk, soy nuts, soy sprouts, soy yogurt)
  • Soya
  • Soybean (curd, granules)
  • Soy protein (concentrate, hydrolyzed, isolate)
  • Soy sauce
  • Tamari
  • Tempeh
  • Textured vegetable protein (TVP)
  • Tofu

*Highly refined soy oil is not required to be labeled as an allergen. Studies show that most people with soy allergy can safely eat highly refined soy oil as well as soy lecithin. I personally avoided all soy during my elimination diet.

Could possibly contain soy:

  • Asian cuisine (including Chinese, Indian, Indonesian, Thai and Vietnamese)—even if you order a soy-free item, there is high risk of cross-contact
  • Vegetable gum
  • Vegetable starch
  • Vegetable broth

Some unexpected sources of soy and dairy:

  • Baked goods
  • Canned broths and soups
  • Canned tuna and meat
  • Cereals
  • Cookies
  • Crackers
  • High-protein energy bars and snacks
  • Infant formulas
  • Low-fat peanut butter
  • Processed meats
  • Sauces
  • Soaps and moisturizers

ALWAYS READ THE LABEL!

The information above was gathered from this website: https://www.foodallergy.org/common-allergens/soy-allergy

These lists are only for soy and dairy ingredients. If you eliminate these two foods for two weeks but are not seeing any improvement, or some troublesome symptoms are still persisting, then you may want to consider a TED. That is, if you’d like to continue breastfeeding. Otherwise you can look into formula.

Most mothers choose to go on a TED because their babies are having severe side effects that are not remedied by just eliminating milk and soy. (ALWAYS try just milk and soy first!) I’m talking extensive eczema or rashes, severe colic or reflux, and continued blood in the stools.

If you decide that a TED is right for you, you’ll also need to start by completely eliminating the other 6 allergens from your diet: fish, shellfish, eggs, peanuts, tree nuts and wheat. You should also avoid corn, and likely, beef.

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Unfortunately, corn is found in A LOT of foods. You can search online for more information about avoiding corn in processed foods. Here is one site to start with: http://www.livecornfree.com/2010/04/ingredients-derived-from-corn-what-to.html

How to begin?

There are two ways to begin an elimination diet, but in my opinion, only one is the RIGHT way.

Some people start by eliminating a select few foods (i.e. milk, soy, eggs) and trialing those for 2 weeks before potentially adding in others. This may work if you guessed correctly, and your baby was indeed only reacting to milk, soy and eggs. But if you were wrong, then that’s two more weeks of having the unknown offending food protein in your breastmilk.

If you have concluded that your child’s symptoms are severe enough to try a TED, then I always recommend you go all out from the start. This is due to the fact that you are likely going to make some mistakes and will have to live through a trial and error period for a bit. It’s going to take a week or two to feel like you actually “got this”. Meaning, you know what foods are safe and which contain hidden soy, and what products are allergy-friendly that don’t taste awful.

Pick a start date and make it happen. Do your research and pick up all you need from the grocery store. Shop organic as much as you can afford, but do what you can because this diet can get expensive.

Start with free-range turkey meat, veggies such as sweet potato and squash, fruits like apples, pears and avocados, rice and rice milk. You can also try coconut milk. Search for allergen free products such as Enjoy Life. Make a list of things you CAN eat because the CANNOT list will be much longer.

Buy a notebook to start tracking everything you eat and the resulting symptoms in your infant day by day. You can start trialing foods after about 2 weeks or once symptoms have mostly resolved or are at least tolerable.

If your baby is still struggling, consider also eliminating citrus fruits, chocolate, strawberries, any other meat besides grass-fed lamb or turkey, and gassy foods like broccoli and cauliflower.

Yes, I know, a TED sounds pretty awful.

It sounds too hard and nearly un-doable.

But I survived! Several MONTHS of this, I survived on a very limited number of foods. Oh, and did I mention it was also during the holiday season. Mm.

My point is, a TED is NOT for everyone. It’s extremely challenging and it’s also solely a personal choice. It was right for us though, and I’m still glad I did it and I wasn’t forced to prematurely end my breastfeeding journey with Baby Bun. Again, you can read more about that in this post.

Thanks for my milk, Mom!

Seek assistance

DO NOT pursue a total elimination diet without the guidance from your own personal doctor AND especially a pediatrician.

We also saw a GI specialist for my daughter’s reflux issues during this time. It’s extremely important to supplement yourself with a safe, high-quality multivitamin that contains calcium. And don’t forget the vitamin D drops for baby if you exclusively breastfeed. Be sure to check ingredients on any and all medications and supplements.

Other sites to check out:

Also, join the group TED Mamas on Facebook to find more resources and awesome support from other moms who have been there. There are many other Facebooks groups for allergic/intolerant infants and MSPI as well.

Have you ever been on an elimination diet? What was your experience? Share your comments below!

Disclaimer: I am not a medical doctor. This post is intended as informational only and is not to be taken as actual medical advice. Any and all medical and/or feeding concerns you have with your baby should be addressed with your pediatrician.

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