It has been well documented that allergens to pass from the maternal diet into breast milk, although the amounts are highly variable.
It has been demonstrated time and time again that after exclusion of dairy (and usually soy) from the maternal diet atopic manifestations against cow’s milk proteins in previously sensitized breastfed infants disappear (1).
Intact food allergens or peptides (more likely) in breast milk that have been documented include egg protein (ovalbumin), wheat (gliadin), peanut and cow's milk proteins (a variety of different whey and caesin proteins).
The presence of dietary peptides in breast milk provides indirect evidence that fragments of food proteins can survive the gastrointestinal digestion, pass into the bloodstream, and distribute to peripheral organs (1).
Food allergens in human milk have been reported to vary over a very wide range of concentrations from just above 0.1 to >1,000 ng/m, but low levels are probably the most realistic figures (1).
How long does it take to get improvements when first going dairy and soy free?
Impacts of dairy (and soy) exclusion from the maternal diet actually has a variable time frame in terms of bub's improvements.
Some babies respond very quickly with some very significant imporvements with common ones being: decreases in bowel motion frequency, reduction of mucous, resolution of or reduction in blood in the nappies, reduced reflux, reduced screaming and irritability, reduced wakenings in the night and resolution or reducton in eczema/rashes.
Some take seemingly forever- requiring 3-4 weeks to start seeing any noticable imporvements. It is not unusual to take a while in this phase of the dairy/soy journey.
Or there is a combination, some quick significant improvements followed by some slower improvements over time.
At the 4-6 week mark, not withstanding potential slip ups, maximal imporvement (including healing) should be achieved from dairy exclusion.
Dairy Proteins in Breast Milk Kinetics
There is not a lot of reliable data, with lots of variability in methods of detection in the different studies, and poor quality trials. Many studies have focused on whole intact proteins, but it has been shown the protein fragments called peptides need to also be measured as they are also found in breast milk from the maternal diet (1).
While it is very likely there is variation from mother to mother in terms of when the protein is first detected in the breast milk, peak of concnetration and time it takes to clear from the breast milk (and general body tissues), the lack of reliable data further muddies the waters.
Individual variarion will likley include:
individual digestion capacity
other foods consumed and their structure
altered intestinal permeability
transitory leakage at the level of the mammary epithelium.
Appearance of cow's milk protein in breast milk after maternal consumption.
A very small study (10 breast milk samples from a single doner, reference 1) showed that the dairy protein was first detected in breast milk one hour after dairy food was consumed by the mother.
Peak concentration of dairy protein in breast milk after maternal consumption
Peak concentration measurements have been reported from 1 hour- 24 hours- 7 days been quoted.
Clearance of dairy protein in breast milk after maternal consumption
In the study of one mother (1), the rapid appearance of the dairy protein in the breast milk after one hour of consumption was subsequently found to be cleared after 6 hours. Note, prior to 6 hours, the milk was not tested in this study.
BGL, which is major cow's milk protein has been measured in other studies and the results points to slower and faster clearance trends, with some women being categorized as 'rapid' metabolizers so it cleared more quickly and some women 'slower' metabolizers so a slower clearing from the breast milk (2).
With huge variation, it is very possible that comparable amounts of dairy protein in the breast milk will result in:
different levels of dairy protien in the breast milk
be cleared from the breast milk in different time frames
elicit different symptoms (and severity) in individual babies.
With all these variables, your own baby is your study.
Going dairy free versus challenging with dairy
It is a very different scenario comparing initially going dairy free and the time it takes to get maximal improvement and conducting well thought out dairy trials via breast milk.
Initially going dairy/soy free: in addition to clearing dairy from the milk, there is the additional time required for gut healing which can account for the often lengthy period to see maximal improvements post the initial exclusion from the maternal diet.
Dairy trials: trialing with dairy via breast milk is not superimporsed on top of a gut under duress, but a functioning gut that has not only healed but has further developed since the dairy/soy protein exclusion.
Careful dairy choices also means that a modified ladder approach can introduce dairy portien in smaller doses so any reaction is nipped in the bud.
This makes dairy trials via breast milk an excellent way of determing dairy tolerance and the level of restriction required in the maternal diet.
Knowing Your Baby
In my experience, it becomes very evident over time that parents become well versed in their own baby's unique pattern of peak reaction time, types of symptoms and length of time to recover.
Most babies with dairy slip ups or trials will recover relatively quickly, and cannot be compared to the original length of time it takes to recover after eliminating dairy/soy from the maternal diet.
Dairy milk protein is usually excreted from the breast milk in a matter of days so remains a very useful way of determining level of required dairy protein restriction in the mother's diet, and guaging if your baby's dairy protein intolerance is improving.
REFERENCES
Picariello G, De Cicco M, Nocerino R, Paparo L, Mamone G, Addeo F, Berni Canani R. Excretion of Dietary Cow's Milk Derived Peptides Into Breast Milk. Front Nutr. 2019 Mar 12;6:25. doi: 10.3389/fnut.2019.00025. PMID: 30931311; PMCID: PMC6424006.
Kosmeri C, Rallis D, Kostara M, Siomou E, Tsabouri S. Characteristics of Exogenous Allergen in Breast Milk and Their Impact on Oral Tolerance Induction. Front Pediatr. 2022 Mar 4;10:830718. doi: 10.3389/fped.2022.830718. Erratum in: Front Pediatr. 2022 Apr 14;10:898795. PMID: 35311039; PMCID: PMC8931296.
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