Rethinking Elimination Diets in Breastfeeding: What the Research Actually Shows with Dr. Trillitye Paullin

In this episode of Behind the Latch, Margaret Salty interviews Trillitye Paullin, CEO and co-founder of Free to Feed, who shares her groundbreaking work translating emerging research on food reactivity in breastfeeding into practical clinical guidance.

Together, they unpack one of the most misunderstood topics in lactation: how dietary proteins transfer into breast milk and what that actually means for managing elimination diets. Trillitye explains why the long-standing belief that proteins remain in breast milk for weeks is not supported by current evidence—and how confusing “transfer timing” with “healing timing” has led to unnecessary dietary restriction and early weaning.

They also explore the realities of non-IgE-mediated food allergies, why traditional allergy testing often fails these families, and how IBCLCs can more effectively assess, manage, and refer these cases.

This conversation offers a practical, evidence-based framework that has the potential to change how clinicians support breastfeeding dyads navigating food reactivity.

Key Takeaways for Clinicians

• Food proteins transfer into breast milk quickly—often within minutes—and typically clear within hours, not weeks
• The timeline we see clinically is often driven by infant healing, not ongoing exposure
• Elimination diets should be reassessed early (around 5 days) to determine effectiveness
• Not all symptoms warrant elimination—rule out more common causes first
• Most infants with food reactivity will have symptoms emerge between 2–4 months
• Cow’s milk and soy are the most common triggers, but other foods may be involved
• Reintroduction is critical to avoid unnecessary long-term restriction
• Severe symptoms or lack of improvement beyond dairy/soy elimination should prompt referral
• Non-IgE-mediated allergies cannot be diagnosed with standard allergy testing
• Supporting parental mental health is essential—elimination diets are a significant burden

Guest

Trillitye Paullin, PhD, CEO & Co-Founder, Free to Feed

Free to Feed

Supporting Families as They Navigate Infant Food Allergies

Connect with Margaret

📬 Email: hello@margaretsalty.com

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

Music by: The Magnifiers – My Time Traveling Machine