Last week I report on a study which finds that, in some people, there’s a very real possibility that plenty of fibre in their diet can cause, rather than cure, constipation and sluggish bowel movements. This week, I came across a recent study which suggests another perhaps surprising cause of constipation in the form of dairy products [1].
In this study, children aged 1-13 with constipation were randomised to one of two groups:
1. elimination of cow’s milk and any products containing cow’s milk
2. no intervention (control)
Those in group 1 eliminated all cow’s milk for four weeks. After this, cow’s milk products were introduced for 2 weeks.
Those in group 2 just ate their normal diet for full duration of the study (6 weeks).
In group 2, 47 per cent of children improved during the study period. In group 1, 80 per cent of children improved. The difference was statistically significant, which supports the idea that cow’s milk diary products are indeed a potential cause of constipation in this group.
As with all studies, the population group (actually Iranian children) may not represent other populations, and how applicable these results are to other children is not known. However, my experience in practice tells me that in a child with constipation of unknown cause, sensitivity to dairy products should at least be considered.
One of the interesting things about this study is that, in a sense, the children were screened for cow’s milk sensitivity with a test. Each had a ‘skin prick’ test – where the skin in scratched and some cow’s milk (basically) is put on the ‘wound’. This test actually tests for a specific sort of reaction which is mediated through a particular form of antibody known as IgE. This sort of reaction is responsible for classic ‘allergic’ reactions like hay fever and peanut allergy.
Only one child in the whole study had a positive skin prick test for cow’s milk.
This is important, I think, because we doctors very often judge ‘allergy’ based on this test and/or a blood test designed to assess the IgE response. And if these tests are negative, we tend to assume there is no problem with the foodstuff that has been tested.
However, the body can react to foods (and other things) through a variety of mechanisms which have nothing to do with IgE, which essentially means that the diagnostic tools we often use to assess food sensitivity are inadequate and potentially very misleading.
Other tests exist, but none (of course) are perfect. Which is why, sometimes, the best thing to do is remove foods to see what effect this has. I won’t deny that this can be a challenging and tricky process, but sometimes the rewards (e.g. elimination of constipation, asthma, eczema or ear, nose and throat problems) are worth it. Working with an practitioner who understands the limitation of standard food sensitivity testing is a good idea, I think.
References:
1. Dehghani SM, et al. The Role of Cow’s Milk Allergy in Pediatric Chronic Constipation: A Randomized Clinical Trial. Iran J Pediatr. 2012;22(4):468-74[hr]
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