Milk Intolerance – Bovine Beta Casein Enteropathy

What Is Milk Intolerance (Bovine Beta Casein Enteropathy)?

[dropcap]B[/dropcap]ovine beta casein enteropathy is characterized by raised serum IgA antibodies to bovine beta casein found by blood testing and damage to mucosa of the jejunum found by biopsy.

The jejunum is the second section of the small intestine, between the duodenum and the ileum.

Mucosa damage is similar to damage caused by gluten.

Q: What is bovine beta casein?

A: Bovine beta casein is a protein found in cow’s milk.

An immune reaction to protein in milk is totally different from lactose intolerance. Lactose intolerance develops from deficiency of an intestinal enzyme called lactase which is required to digest lactose, the sugar in milk.

What Is Milk Intolerance In Celiac Disease and/or Gluten Sensitivity?

• Relationship between milk intolerance and celiac disease. Bovine beta casein enteropathy is an associated immune disorder in celiac disease. Celiac disease is regarded as the primary disorder.¹
• Relationship between milk intolerance and gut inflammation. A study investigating the local inflammatory reaction to gluten and cow’s milk protein in adult patients with celiac disease in remission found that a mucosal inflammatory response similar to that elicited by gluten was produced by cow’s milk protein in about 50% of the patients with celiac disease. Casein, in particular, seems to be involved in this reaction.²
• Relationship between milk intolerance and associated autoimmune disease. A study found significantly increased levels of antibodies to beta-casein in patients with Type 1 diabetes, celiac disease and in latent autoimmune diabetes in adults compared to age-matched controls. No differences were observed in beta-casein antibody titres between patients with other disease conditions (multiple sclerosis and autoimmune thyroid disease) and age-matched controls.³
• Relationship between milk intolerance and development in celiac disease. The association between celiac disease and other immune disorders may be due to the sharing of a common genetic background, such as HLA antigens. However, in a very large study, involving 909 patients with celiac disease, Ventura and his associates found that the development of immune disorders in celiac disease was clearly related to the duration of exposure to gluten.⁴

How Prevalent Is Milk Intolerance In Celiac Disease and/or Gluten Sensitivity?

• Cow’s milk intolerance was found in about 50% of the patients with celiac disease. Casein, in particular, seems to be involved in this reaction.²
• Ninety patients of the 305 studied (29.5%) who had IBS-like symptoms were diagnosed as suffering from food hypersensitivity to cow’s milk and/or gluten.⁵

What Are The Symptoms Of Milk Intolerance?

Bovine beta casein enteropathy is marked by these symptoms:

• Diarrhea.
• Failure to thrive.
• Vomiting.
• Atopic eczema.
• Recurrent respiratory infections.⁶

How Does Milk Intolerance Develop In Celiac Disease and/or Gluten Sensitivity?

• Bovine beta casein enteropathy results from an immune mechanism.

Does Milk Intolerance Respond To Gluten-Free Diet?

Yes. Celiac disease-related bovine beta-casein enteropathy responds to a casein-free, gluten free diet.

In a study by Kristjánsson et al. five of six patients reported subjective clinical improvement of symptoms (diarrhea, abdominal distension/pain or tiredness) after being informed about the results and excluding cow’ milk protein from their diet. The subjective improvement was reported to have begun after about 6 weeks.⁷

6 Steps To Improve Milk Intolerance In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both milk intolerance and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁸
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.⁹
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁹
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁹.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁹
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁹
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁹
• Cocoa and Black Tea increase blood sugar.
• Rosemary. Increases blood sugar levels and should not be used by persons with insulin resistance or diabetes. [/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4[/dropcap] Manage Your Medications Safely:

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Certain medications promote increased intestinal permeability (leaky gut) which may predispose susceptible persons to small intestinal enteropathy (active disease). Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

 This is not a complete listing.

ANTIBIOTICS disrupt intestinal permeability which complicates celiac disease.

• Gentomycin, Neomycin, Streptomycin, Cephalosporins, Penicillins deplete B Vitamins, Vitamin K, Probiotics, Vitamin C.
•  Tetracyclines deplete Coenzyme Q10, Calcium, Magnesium, Iron, Vitamin B6, Zinc, Probiotics, Riboflavin.
• Cipro depletes Coenzyme Q10, Zinc.
• Dapsone depletes vitamin K.
• Penicillins deplete Vitamin B2, Folic Acid, Vitamin B12, Biotin, Vitamin K, Probiotics.¹⁰
• Erythromycin depletes Vitamin B2, Folic Acid, Vitamin B12, Biotin, Vitamin K, Probiotics.¹¹

ANTI-INFLAMMATORIES disrupt intestinal permeability which complicates celiac disease.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Calcium, Vitamin D, Magnesium, Zinc, Vitamin C, Vitamin B6, Vitamin B12, Folic Acid, Selenium, Chromium, Phosphorus.
• NSAIDS (Motrin®, Aleve®, Advil®, Anaprox®, Dolobid®, Feldene®, Naprosyn® and others) deplete Folic acid.
• Aspirin and Salicylates deplete Calcium, Folic acid, Vitamin C, Iron, Pantothenate (vitamin B5).

FEMALE HORMONES disrupt intestinal permeability which complicate celiac disease.

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Vitamin B2, Vitamin B3, Vitamin B6, Vitamin B12, Vitamin C, Folic Acid, Magnesium, Selenium, Zinc.
• Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others) deplete Vitamin B2, Vitamin B6, Vitamin B12, Vitamin C, Folic Acid, Magnesium, Zinc.

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• [dropcap]5[/dropcap]Nutritional Supplements That May Help:

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The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination that provides 100% once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• Specific vitamins and/or minerals depending on depletions.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion. However, because it increases blood sugar levels, it should not be used by persons with insulin resistance or diabete.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Milk Intolerance In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“A comparison between two different in vitro basophil activation tests for gluten- and cow’s milk protein sensitivity in irritable bowel syndrome (IBS)-like patients.” This study investigating the frequency of food hypersensitivity in patients with irritable bowel syndrome (IBS)-like clinical presentation demonstrated about one third of the IBS patients included in the study were suffering from food hypersensitivity and were cured on the elimination diet. This study also compared the diagnostic accuracy of two different methods of in vitro basophil activation tests.

Three hundred and five patients (235 females, age range 18-66 years) were included and underwent a diagnostic elimination diet and successive double-blind placebo-controlled challenges. Two different methods of in vitro basophil activation tests (BAT) (CD63 expression after in vitro wheat or cow’s milk proteins stimulation) were evaluated: one was performed on separated leukocytes (white blood cells) and the other on whole blood.

Ninety patients of the 305 studied (29.5%) were positive to the challenges and were diagnosed as suffering from food hypersensitivity. BAT on separate leukocytes showed a sensitivity of 86% and a specificity of 91% in food hypersensitivity diagnosis. BAT on whole blood showed a sensitivity of 15%-20% and a specificity of 73% in food hypersensitivity diagnosis (p<0.0001 compared to the other method). The BAT based on CD63 detection on whole blood samples did not work in food hypersensitivity diagnosis and showed a significantly lower sensitivity, specificity and diagnostic accuracy than the assay based on separated leukocytes.¹²

“Mucosal reactivity to cow’s milk protein in celiac disease.” This study investigating the local inflammatory reaction to gluten and cow’s milk protein in adult patients with celiac disease in remission found that a mucosal inflammatory response similar to that elicited by gluten was produced by cow’s milk protein in about 50% of the patients with celiac disease. Casein, in particular, seems to be involved in this reaction.

Rectal challenges with wheat gluten and dried cow’s milk powder were performed in 20 patients with celiac disease and 15 healthy controls. Fifteen hours after challenge the mucosal reaction was recorded by the mucosal patch technique with measurements of local release of neutrophil and eosinophil granule constituents; myeloperoxidase (MPO) and eosinophil cationic protein (ECP). The mucosal production of nitric oxide (NO) was measured simultaneously. Six of the patients who reacted to cow’s milk were also challenged with alpha-lactalbumin and casein. In 18 of 20 patients gluten challenge induced neutrophil activation defined as increased MPO release and increased NO synthesis. Ten of these 20 patients showed a similarly strong inflammatory reaction to cow’s milk challenge. Six of the cow’s milk sensitive patients were challenged with specific cow’s milk proteins: casein and alpha-lactalbumin. Casein, in contrast to alpha-lactalbumin, induced an inflammatory response similar to that produced by cow’s milk.

Five of six patients reported subjective clinical improvement of symptoms (diarrhoea, abdominal distension/pain or tiredness) after being informed about the results and excluding cow’ milk protein from their diet. The subjective improvement was reported to have begun after about 6 weeks.¹³

“Antibodies to bovine beta-casein in diabetes and other autoimmune diseases.” This study investigating the antibody response to bovine beta-casein in different immune- and non-immune-mediated diseases and to establish whether such an antibody response is specific to Type 1 diabetes found significantly increased levels of antibodies to beta-casein in patients with Type 1 diabetes, celiac disease and in latent autoimmune diabetes in adults compared to age-matched controls . No differences were observed in beta-casein antibody titres between patients with other disease conditions (MS, and ATD) and age-matched controls.

Antibodies to bovine beta-casein were measured using an enzyme-linked immunosorbent assay in a total of 519 sera from subjects as follows: 71 patients with Type 1 diabetes, 33 patients with coeliac disease, 100 patients with latent autoimmune diabetes in adults (LADA), 50 patients with autoimmune thyroid disease (ATD), 50 patients with Type 2 diabetes, 24 patients with multiple sclerosis (MS), and 3 different groups of controls numbering 191 subjects.

The highest antibody response to beta-casein in Type 1 diabetic patients and in patients with celiac disease could reflect the gut mucosal immune disorders common to Type 1 diabetes and coeliac disease. Furthermore, the elevated beta-casein antibody levels found in LADA patients suggest that the antibody response to this protein may be relevant in autoimmune diabetes.¹⁴

“Antibodies to bovine beta-casein in diabetes and other autoimmune diseases.” This study investigating the antibody response to bovine-casein in different immune- and non-immune-mediated diseases and to establish whether such an antibody response is specific to Type1 diabetes demonstrated that significantly raised antibodies to beta-casein were found in patients with Type 1 diabetes, latent autoimmune diabetes in adults (LADA), and celiac disease. Highest response to beta-casein in Type 1 diabetic patients and in patients with celiac disease could reflect the gut mucosal immune disorder common to Type 1 diabetes and Celiac Disease. Furthermore, the elevated beta-casein antibody levels found in LADA patients suggest that the antibody response to this protein may be relevant in autoimmune diabetes.¹⁵

“Malabsorption syndrome with cow’s milk intolerance.” This study investigating 54 infants with malabsorption syndrome and cow’s milk intolerance demonstrated high incidence of celiac disease 2 years after diagnosis in infants on a gluten containing diet. Celiac Disease is regarded as the primary disorder.¹⁶

Sources:

1. Kuitunen P, Visakorpi JK, Savilahti E, Pelkonen P. Malabsorption syndrome with cow’s milk intolerance. Clinical findings and course in 54 cases. Archives of Disease in Childhood. May 1975;50(50:351-6. [↩]
2. Kristjánsson G, Venge P, Hällgren R. Mucosal reactivity to cow’s milk protein in coeliac disease. Clin Exp Immunol. 2007 Mar;147(3):449-55. [↩] [↩]
3. Monetini L, Cavallo MG, Manfrini S, Stefanini L, Picarelli A, Di Tola M, Petrone A, Bianchi M, La Presa M, Di Giulio C, Baroni MG, Thorpe R, Walker BK, Pozzilli P; IMDIAB Group. Antibodies to bovine beta-casein in diabetes and other autoimmune diseases. Horm Metab Res. 2002 Aug;34(8):455-9. [↩]
4. La Villa G, Pantaleo P, Tarquini R, Cirami L, Perfetto F, Mancuso F, Laffi G. Multiple immune disorders in unrecognized celiac disease: a case report. World J Gastroenterol. 2003;9(6):1377-1380, Available at: http://www.wjgnet.com/1007-9327/9/1377.asp. Accessed Jan 3, 2005. [↩]
5. Carroccio A, Brusca , Mansueto P, D’alcamo A, Barrale M, Soresi M, Seidita A, La Chiusa SM, Iacono G, Sprini D. A comparison between two different in vitro basophil activation tests for gluten- and cow’s milk protein sensitivity in irritable bowel syndrome (IBS)-like patients. Clin Chem Lab Med. 2013 Jun;51(6):1257-63. doi: 10.1515/cclm-2012-0609. [↩]
6. Kuitunen P, Visakorpi JK, Savilahti E, Pelkonen P. Malabsorption syndrome with cow’s milk intolerance. Clinical findings and course in 54 cases. Archives of Disease in Childhood. May 1975;50(50:351-6. [↩]
7. Kristjánsson G, Venge P, Hällgren R. Mucosal reactivity to cow’s milk protein in coeliac disease. Clin Exp Immunol. 2007 Mar;147(3):449-55. [↩]
8. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
9. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
10. https://umm.edu/health/medical/altmed/depletion/antibiotic-medications-penicillin-derivatives. [↩]
11. http://umm.edu/health/medical/altmed/depletion/antibiotic-medications-macrolides [↩]
12. Carroccio A, Brusca, Mansueto P, D’alcamo A, Barrale M, Soresi M, Seidita A, La Chiusa SM, Iacono G, Sprini D. A comparison between two different in vitro basophil activation tests for gluten- and cow’s milk protein sensitivity in irritable bowel syndrome (IBS)-like patients. Clin Chem Lab Med. 2013 Jun;51(6):1257-63. doi: 10.1515/cclm-2012-0609. [↩]
13. Kristjánsson G, Venge P, Hällgren R. Mucosal reactivity to cow’s milk protein in coeliac disease. Clin Exp Immunol. 2007 Mar;147(3):449-55. [↩]
14. Monetini L, Cavallo MG, Manfrini S, Stefanini L, Picarelli A, Di Tola M, Petrone A, Bianchi M, La Presa M, Di Giulio C, Baroni MG, Thorpe R, Walker BK, Pozzilli P; IMDIAB Group. Antibodies to bovine beta-casein in diabetes and other autoimmune diseases. Horm Metab Res. 2002 Aug;34(8):455-9. [↩]
15. Monetini L, Cavallo MG, Manfrini S. Antibodies to bovine beta-casein in diabetes and other autoimmune diseases. Hormone and Metabolic Research. Aug 2002;34(8):455-9. [↩]
16. Kuitunen P, Visakorpi JK, Savilahti E, Pelkonen P. Malabsorption syndrome with cow’s milk intolerance. Clinical findings and course in 54 cases. Archives of Disease in Childhood. May 1975;50(50:351-6. [↩]