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is this lactose intolerance or something more serious?


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My husband has trouble with too much dairy, we think, and last year we noticed DD was having issues with diarrhea in the mornings and it seemed to maybe correlate to having pizza plus ice-cream the night before, plus cereal and milk in the morning. We switched to lactose free milk for cereal and drinking and she's been doing much better - not sure if that is cause and effect or not. But in the last two months she has had something new, bouts of severe nausea and shaking shortly after eating/drinking. 

Episode #1: we went to the beach for the day with a group of friends/families. She was out in the sun all day, then at dinner drank a big soda and at a hamburger and tater tots and then when we left said she was still thirsty and wanted one of the chocolate instant breakfast shakes I had in the cooler. She chugged it really fast, on top of everything already in her stomach, and got very nauseous. I had to pull the car over and give her a ziplock bag to puke in. Only a little came up, all chocolate shake, and then she felt better and was fine a bit later. I chalked it up to drinking the shake too fast on a full stomach, plus heat, etc. 

Episode #2: She had a glass of chocolate milk and then drank one of those chocolate instant breakfast shakes. Same symptoms - felt like she was going to throw up, had me sit in the bathroom with her until the feeling passed. Nothing came up (but she has a hard time throwing up, like me...the stomach is willing but the esophagus clenches down or something and nothing comes up). I could hear her stomach making all sorts of noises. After about 15 minutes or longer she felt okay, and was fine later. We decided she should not drink those shakes anymore!

Episode #3: Last night she had a bowl of ice cream with a bit of whipped cream and hershey's chocolate syrup on it. She didn't even finish it and had the same thing happen. VERY nausea ,and her whole body was shaking hard. Nothing came up, but she was leaning over the toilet for at least 20 minutes or longer, then sat with a puke bucket on the couch for another half hour or longer. Was nauseous longer this time, took at least an hour to pass. She's fine today but not much appetite - possibly that is psychological. 

Thoughts? She says it feels like she ate too much, but last night she didn't even finish it all. These are the only times this has happened. We did think she had some episodes of low blood sugar a year ago, during the night, but the strips were expired when I checked her, no nausea but the same shaking then. But we ended up deciding it was just confusional arousals/sleep issues, not low blood sugar (I think we did recheck with new strips if I remember right, and she was fine). 

As of now, we are stopping any dairy products that are not lactose free, at minimum. Probably all dairy for a bit. But is this a "go tot he doctor ASAP" thing or a "see if cutting out dairy fixes it" thing? 

She was tested via bloodwork for Celiac this year due to her brother's Celiac diagnosis, and was negative. 

Only other factor worth mentioning is that she is definitely having some hormonal surges - developing breasts, pubic hair, body changing shape in general, face slimming down but hips getting wider, and has the drama to prove it. She's 9 (february birthday) and I got my period at either 10 or 11, can't quite remember. 

Edit - these are the shakes..they say they are suitable for lactose intolerance, so that kind of knocks out lactose as the issue. Plus seemed fast for lactose. She did have bouts of diarrhea and constipation last year, that seems to have improved, but maybe there is something else going on? https://www.carnationbreakfastessentials.com/products/carnation-breakfast-essentials-original-ready-drink

Edited by Ktgrok
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Celiacs causes lactose intolerance.

wait, I was thinking you were saying she was diagnosed but no?  She wasn't?

DS has crohns which also causes lactose intolerance.  If you have a sibling or parents with one of those, you are like 30-40% more likely to have celiacs or crohns. So having a bother with celiacs gives her a greater chance of having celiacs or crohns.

Edited by Attolia
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The first thing I would try would be smaller portions and have her try to eat more slowly.   She's 9...it seems like chocolate milk followed by a meal replacement drink would be too much and she'd feel very full. 

Another thought, too.  My daughter has IBS (she's been tested more than once for celiac and is negative).   Cold foods bother her...she won't even eat ice cream and I warm up pudding in the microwave for her "to take the chill off" as we say around here.   Maybe it could be something like that?

Good luck!

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A few thoughts:

1. That is a ton of sugar. For one of my kids, sudden bursts of sugar and fat cause GI issues.

2. For my kids with lactose intolerance, all of those things are no-go.

3. The puking/severe nausea make me wonder about a dairy allergy rather than a lactose intolerance.  

I would take her off of *all* dairy (man is that going to suck--sorry) for three weeks, and then reintroduce lactose free products that are low sugar and see how she tolerates it. If she does tolerate it, then I'd slowly add back to see if you can find the trigger.

There's a chocolate correlation with that as well---that'd be one of the fine points I'd work through....I'm guessing if it's not the dairy itself it's one of the binders used to create chocolate flavor. She may tolerate true chocolate rather than chocolate syrupy stuff.

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53 minutes ago, Attolia said:

Celiacs causes lactose intolerance.

wait, I was thinking you were saying she was diagnosed but no?  She wasn't?

DS has crohns which also causes lactose intolerance.  If you have a sibling or parents with one of those, you are like 30-40% more likely to have celiacs or crohns. So having a bother with celiacs gives her a greater chance of having celiacs or crohns.

Sorry, went back and clarified. She tested negative. But ugh, you are right that she's at a higher chance of Crohns due to her brother's celiac. That would suck. I think we'll drop dairy and see what happens. If it continues, at least I know a gastroenterologist now. 

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The shake on it's own is 15 grams of sugar, so not great but not a super sugar bomb. But of course it was following other food/drink each time, and obviously the ice cream was high sugar. No problem with cookies or other sugary foods though. 

It could definitely be an "other" ingredient...like carrageenan or something weird. I also wonder if there is a correlation with brand of ice cream - this was Target brand, not the normal Breyers I usually get, although we've had this before for sure. 

And yes, we chalked it up to too much in her stomach the first two times, but last night she didn't eat a lot at dinner, and then there was a while until we had the ice cream, and as I said she didn't even finish it before feeling ill. However, she MAY have eaten very quickly, I wasn't paying attention. 

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2 minutes ago, Ktgrok said:

Her older brother had issues with dairy as an infant, but tolerates it now fine. But, he's twenty. We don't know when he outgrew the issue. He got diarrhea, circles under his eyes, flushed cheeks, etc. 

If he had issues before and he doesn't know that points to a stronger likelihood of a problem with dairy with her and possibly some gut bacteria issues. Has she had a round of antibiotics in the last few years? I would put her on a dairy free probiotic for 6-8 weeks and see if you can help boost the healthy bacteria in her gut.

I mention this because after I had some heavy duty/last resort antibiotics I developed a ton of food allergies.  Over time, with a ton of effort, I've been able to heal my gut and I've only "kept" one of them.  I suspect some time in the next 20 or so years we'll discover that some food allergies are a bit more fluid than we currently think they are. (I am not saying food allergies aren't real & some are truly lifelong--my peanut allergic daughter had her first reaction at 16 months---just that our immune system isn't static.)

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I'd agree about the gut thing except it seems to happen too quickly to be a lower GI thing. It's before it hits her intestines, especially before the lower intestine is involved. Once her stomach empties she feels fine, it is definitely a stomach and MAYBE small intestinal thing. Honestly, it reminds me a lot of the dumping syndrome that post bariatric patients get if they eat too much sugar or fat too quickly and it hits the small intestine that way, except this is even faster. 

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I’d keep her away from dairy, chocolate, and sugar — all of which might  have been involved in episodes described. And also gluten . And whatever preservatives etc might be common to the ice cream, syrups, or instant breakfasts.  

Maybe try eating only Whole natural Foods that don’t include any dairy, sugar, gluten.   Maybe keep whole family that way for a month.  See if people feel any better. 

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My daughter started out able to eat dairy, but over the last 2 years has had severe reactions so she's completely off it now. Same thing--almost immediate, violent reaction. Vomiting, pain, gastro disturbance (you know).... 

I would take her off it completely. Don't forget it is casein and whey protein (or sometimes just one? I'm not sure) that are the culprits. Whey is in a ton of chips, candies, and processed foods (even some taco meat spice mixes, for example).

Edited by Chris in VA
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Episode 1:  I think this was a combination of the factors you mentioned, plus that shake was not just a drink on top of a meal, it was a meal-in-a-can.  Waaaaay too much for her tummy at that time so it came back up.   My DS tossed his cookies once (violently) after forcing himself to drink an entire strawberry custard shake after he'd decided he was full.  It did not take long at all for that shake to come back up.

Episode 2: Her tummy, tastebuds, and sensory memories are remembering the prior incident with that chocolate shake, making her feel nauseated.   I don't know about other people, but when I throw a food up, it is a very long time, if ever, that I can even taste the offending food without feeling nauseated.  DS still can't think about drinking a strawberry shake and that was several years ago.

Episode 3: In episode 2 she had chocolate milk followed by chocolate shake.  Now she's having ice cream with chocolate syrup.  Any chance the chocolate milk was made with the same chocolate syrup?   If not, the combo of ice cream with whipped cream and chocolate syrup is really not that different from a shake flavor-wise.

It might be something more serious, but I think I would start with the idea that the chocolate flavor is triggering that digestive memory and causing flashbacks and struggles.  

 

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We have Crohns, gluten intolerance and IBS in my family.

I have been dairy free most of my life. I’m just lucky like that!!

I have IBS and Lactose free products still make me sick. I haven’t had red meat in 25 years (makes me seriously ill), my crohns child can’t eat red meat  either. We try to avoid fried foods.

Sounds like IBS to me. Any meal ending with ice cream would send me running to bathroom. 

I tend to eat many smaller meals to keep the peace.

Definitely worth checking in with gastroenterologist.

 

 

 

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I have severe reflux and IBS with chronic nausea as my primary symptom, and all of that would trigger symptoms for me, not just the specific foods (specifically the sugar and chocolate) but the quantity.  If I had one of those Carnation breakfast drinks (they were kind of a life saver when pregnant, lol), a bottle would take the place of 1-2 meals for the day, not be a snack or just a beverage.  Ice cream is one of those flat-out never ever ever foods for me.  I can eat a couple chocolate chips in something like a cookie or oatmeal, but any more chocolate than that and I'm dry heaving.  I can generally only drink one sweetened beverage a day, although I feel better with none, and it has to be separate from a meal.  Water only with food and after 2-3pm.  Burger OR fries, but not both.  I know small, frequent meals is the mantra for GERD, but even that is too much for my stomach to handle.  I have to eat only when I'm sure I can eat, not just because the clock says meal/snack/dessert time or my taste buds want something, or I end up like your DD, with a heating pad and a bucket.

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Another possibility, some people have trouble with dairy fat or fats in general. 

I agree with others that there are multiple things in play. I would also say that if you've been out and about, and she's overly hot, eating before they've cooled down adequately can make people sick. That could explain the first episode. And I totally agree about the not eating things that made you sick for a long time. Sometimes years.

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Stepping in to say I would also keep an eye on her blood sugar.  My dd has type 1.  For her the symptoms came on slowly (over at least six months) and weren't until right before diagnosis, of the typical variety.  She had nausea after eating high carb foods (often breakfast foods).  She also had what we now believe were low blood sugar incidents at times.  I've read of others having low and high blood sugar symptoms pre-diagnosis and her doctors say it could have been.  Apparently sometimes as the insulin producing cells in the pancreas are dying, they can also over work and produce too much insulin, basically they are confused.  

Of course my dd also has IBS and lactose intolerance.  She had testing for celiac and crohns but we eventually figured out it's IBS.  We had to keep a food diary and also she spent a few weeks after one of her colonoscopy cleanouts just eating very bland foods.  Lots of scrambled eggs, cream of rice cereal, bland chicken, plain noodles etc.  That helped us realize it was probably food.  We already knew lactose was an issue but we also determined that high fat/greasy foods and lettuce, some veggies etc were all a big problem.

Good luck.  I'd get more test strips and start there.  Then a very bland low fat, low sugar/dairy etc diet and a food diary.  Then add foods back in.

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Test strips is a good idea, at least to have on hand if it happens again. either way, if this happens without dairy we will head to the doctor but having that info would be good. 

The shaking was really violent, and that was pretty freaky, but I'm thinking I remember that some people shake when stressed or when vomiting? Maybe a vagal nerve thing? She was very upset - she doesn't vomit well so it's really stressful for her. 

I've noticed her appetite still is a bit off, and really, it was even before that incident. I'm not sure if she's just not hungry, or nauseous, or if she's trying to eat less out of fear of it happening again, or what. Of course, there is also that fear in the back of my head of eating disorder issues as well given that she's right at that stage of maturing into a more curvy body and I don't think she's mentally ready for that. She is VERY much still a little girl in a lot of ways (kitties and unicorns and play pretend) and yet growing breasts and hips and it's all crazy. 

ugh. 

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I have one kid with lactose and one kid with a dairy allergy, but the symptoms are GI.  According to a couple of different doctors we've seen you can differentiate between them by 1) allergic diarrhea tends to contain a lot of mucous or even blood, lactose is just very loose and watery.  And 2) Benadryl will alleviate the diarrhea for an allergy but not for lactose intolerance.  The one with allergies was much more spitty as a baby than the one with the lactose issue.  Diabetes could certainly be an issue.  Keep in mind that especially with kids they can have hypoglycemia symptoms when their blood sugar is normal or even high, just because they are pumping out so much insulin at once.  If their blood sugar is lowering more quickly than they are used to they might get the shakes but have normal or even slightly high blood sugar.

If you have a regular pediatrician that you trust I think I would call the nurse there.  Mostly just to get it into her medical record that she's having a problem.   They'll have more background info on her (BMI, family history, etc) and will likely have a better idea of when she should come in for a test.  Many kids would get sick just from eating that much at once.

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I get GI symptoms, nausea, and shakiness from food allergies.  It usually starts as GI symptoms and adds on more symptoms with time or larger amounts.

I am allergic to cow's milk but tolerate sheep milk yoghurt and sheep cheese.

The GI symptoms are moderated if I take vitamin C powder during and after eating, I am allergic to so many things now I have to have it with every meal, but when I was allergic to less I found it helped after an accidental ingestion of a food I was moderately allergic to that caused GI symptoms,

Some of the other brands have things added to them that I'm allergic to, this is the powder that works the best, it really helps moderate the symptoms.

https://www.amazon.com/gp/product/B00B7V2FI6/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1

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I shake with adrenaline release, especially when hormonally driven (ie after labor).  I also suspect it might be that the first time was too much food and the next two times were taste association, but it won't hurt to cut dairy.  I would visit a gastro before cutting too many foods from a young kid's diet on speculation, though, especially one about to go through puberty.  

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