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How to tell if your baby is allergic or intolerant to milk

How to tell if your baby is allergic or intolerant to milk

An inability to digest milk properly is not an uncommon occurrence and this condition is called lactose intolerance.

Lactose is a type of sugar found in milk and milk products. Unlike cow milk protein allergy (CMPA), which involves the immune system, lactose intolerance is a digestive problem.

This means that while lactose intolerance can lead to tummy discomfort, it will not produce life-threatening reactions such as anaphylaxis.

Another difference is that milk allergies tend to appear within the first year of life, while lactose intolerance can start in childhood and gradually become more obvious in adulthood.

A study of Malaysian adults found lactose intolerance prevalence was as high as 91%. (Asmawi MZ, Seppo L, Vapaatalo H, et al [The Indian Journal of Medical Research, Dec 2006]. Hypolactasia & lactose intolerance among three ethnic groups in Malaysia.)

How does lactose intolerance develop?

Your child’s body breaks down the lactose in milk with an enzyme called lactase, which helps break down lactose into glucose and galactose.

If his body does not produce enough lactase, it will lead to lactose intolerance, as his body cannot properly break down lactose in milk.

Do note that the symptoms of lactose intolerance will also vary depending on the amount of lactose that your child consumes, i.e. drinking more milk will result in either more severe symptoms and/or increase the number of symptoms experienced.

Often, signs and symptoms will occur anywhere between 30 minutes to two hours after drinking milk (or eating dairy products).

The severity may range from mild to severe, and is largely dependent on the amount consumed and how well he can tolerate lactose.

The common signs/symptoms of lactose intolerance are: wind, pain and swelling in the tummy, failure to gain weight and diarrhoea.

​No matter what, if your child (especially in the case of infants) feels cranky or unwell, do everything you can to soothe and comfort him.

In the case of lactose-intolerant mothers, it is safe for you to breastfeed your baby as it does not increase his risk of becoming lactose intolerant.

Continue exclusive breastfeeding (unless advised not to by your doctor) for the first six months of life as studies have shown that this reduces the risk of cow’s milk protein allergy, compared to feeding using infant formula during that time.

A temporary case of lactose intolerance can also occur if your child suffers a viral infection or if he suffers from any digestive conditions that cause inflammation in his intestines (e.g. coeliac disease).

When diagnosing lactose intolerance, your child’s paediatrician will start off by taking a medical, family, and diet history.

A hydrogen breath test may be required – this is a simple test where your child breathes into a device that measures his breath’s hydrogen level before and after he drinks a sample containing a set amount of lactose.

The test should only detect a small amount of hydrogen in the breath if he is not lactose intolerant. An increase in detected hydrogen would indicate lactose intolerance.

Another test used by paediatricians is to check your child’s stools, especially if he is too young and cannot perform the hydrogen breath test correctly.

Stool acidity may indicate problems with lactose absorption, while another stool test checks for glucose in the stool, which points to undigested lactose.

Depending on the severity of his symptoms, a biopsy (tissue sample) may be required.

This is accomplished by a procedure called endoscopy, where a long, thin, flexible device is inserted via the anus to measure lactase levels in the intestines.

How you handle your child’s lactose intolerance will depend largely upon how severe his condition is.

If it is relatively mild, he may be able to tolerate small amounts of dairy or dairy products. Instead of giving him a full glass of milk, try giving him half a cup or a less each time.

If your child’s lactose intolerance is severe enough that he cannot drink any cow’s milk, he can still get enough calcium from lactose-free dairy products, dark green leafy vegetables (e.g. spinach, broccoli, kale), nuts, beans, fish (e.g. sardines, salmon) and calcium-fortified food products.

Do consult with his paediatrician before opting to give him calcium supplements as too much of it can cause constipation and may interfere with his body’s ability to absorb iron or zinc.

Alternatively, you may want to explore other milk substitutes such as soy, almond, rice and oat milk.

As a good source of calcium and protein, soy milk is a popular milk substitute, along with almond milk, which is a good source of calcium, but lower in protein when compared with cow’s milk.

Before giving your child any milk substitute, do check with his paediatrician first.

Dr Amir Hamzah Abdul Latiff is a consultant paediatrician and consultant clinical immunologist/allergist. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. For further information, please e-mail starhealth@thestar.com.my or visit www.mypositiveparenting.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Cleansing your nasal cavity as part of yoga detox

Cleansing your nasal cavity as part of yoga detox

Some may go on a veggie-juicing diet while others sing praises of detox teas, which use a concoction of herbs to cleanse and nourish the liver, an organ responsible for clearing toxins from the body.

One friend tried to sell me the wonders of colon irrigation as he lost three kilogrammes from removing all that gunk, resulting in a flatter stomach and clearer skin.

Many like him say stubborn pounds miraculously melt away after a few sessions. Sceptics like me tell him to eat healthier and accumulate less junk. It’s cheaper than flushing money down such procedures.

The truth is, your body can naturally get rid of toxins no matter what you eat, as long as you incorporate wholesome foods like fruits and vegetables, plus engage in regular physical activity.

However, there are many parts of the body that could do with some help in cleansing due to our food intake and the polluted environment we live in. The mind also needs to be purified for clarity of thought.

According to yogic science, certain cleansing processes are extremely important for a healthy body. Without regular cleansing of the bodily systems, one cannot gain maximum benefit from practising yoga.

This practice, comprising six purification techniques, is called the shatkarmas or shatkriyas, valued for healing all kinds of internal disorders. They are neti: nasal cleaning (including jala neti with salt water and sutra neti with a cotton thread); dhauti: cleansing of the digestive tract; nauli: abdominal massage; basti: colon cleaning; kapalbhati: purification and vitalisation of the frontal lobes; and trataka: blinkless gazing (which I talked about in one of my previous columns).

The shatkarma affect and activate almost all of the vital systems in the body, especially the digestive, respiratory, circulatory and nervous systems.

Every individual organ of importance, like the oesophagus, stomach, colon, lungs, eyes and ears, receive equal attention.

These purification processes are both preventive and curative.

Since sinusitis or allergic rhinitis affects about 20% of the population and up to 40% of children, one of the easiest methods to cleanse an adult’s nasal cavity is by doing jala neti.

Nasal hygiene is extremely important as it is linked to many conditions including migraine, headaches and other allergies.

Patients with sinus problems, often due to a hypersensitive immune system, suffer frequent and prolonged respiratory infections, as well as asthma, which is difficult to control.

Yoga, purification technique, jala neti, shatkarmas, shatkriyas, detox, sinusitis, allergic rhinitis, Star2.com

Sinusitis or allergic rhinitis affects about 20% of the population and up to 40% of children, — AFP

Jala neti is a simple practice that can be done along with your daily routine, such as after brushing your teeth in the morning.

All it takes is some salt, warm water and a few minutes to help relieve many of the problems related to the nasal and sinus cavities.

But first, you need to purchase a neti pot – a container made of plastic or ceramic, designed to rinse “debris” or mucus from your nasal cavity. It can be purchased from selected pharmacies, yoga studios or online.

To prepare, make sure you only use boiled water that has been left to cool until lukewarm, so that it does not irritate the tissues inside the nostrils. You don’t want it too hot as it might burn the nostrils.

Or, if you’re as finicky as me, you can filter the tap water first, then boil it. Add a teaspoon of non-iodised salt (any salt is acceptable) to half a litre of water.

The method (stand over a sink):

• Pour the salt water into the neti pot and place the cone at the end of the spout inside the left nostril.

• Tilt your head gently to the right and open your mouth (breathing should be done through the mouth during the process). Adjust the tilt of your head up to a point where water starts flowing from your left nostril to the right nostril. Continue until the water in the pot is emptied.

• Fill the pot again with salt water and do the same procedure from the right nostril.

• Repeat this process two or three times. Then blow your nose.

When you first start this practice, it may seem daunting and you may get irritations in the nose, sneezing, coughing, runny eyes etc, which will disappear after few sessions.

If you’re suffering from sinus problems, it’s recommended that you carry out the jala neti daily. If you’re normal, then once a week is sufficient.

Do not practise if you are having a severe cold or chest infection. In such scenarios, it’s better to steam your head over a pot of hot water with drops of eucalyptus oil added.

After use, clean the neti pot thoroughly to clear away contaminants, and let it air dry completely before storing it away. Like toothbrushes, your pot shouldn’t be shared with anyone else. Be stingy about it!

The Western world has caught up with this cleansing technique, but instead of doing it the traditional yogic way, medical practitioners prescribe a saline spray or drops to alleviate congestion. Often, they refer to it as nasal irrigation.

The salt water causes the blood vessels in the nose to contract and dilutes mucus, which helps reduce swelling in the sinus area.

When the different systems of the body have been purified, the overall result is that energy can flow through the body freely. One’s capacity to work, think, digest, taste, feel, experience, etc, increases and greater awareness develops.

With boosted immunity levels, the occurrence of common colds and flus are greatly reduced.

For you and me, we don’t have to do all the cleansing techniques unless you aspire to be a yogi.

So, just do the ones necessary for the body part that needs it most as you’ll still get some benefits. With jala neti, you can breathe and sleep better.

Revathi Murugappan is a certified fitness trainer who tries to battle gravity and continues to dance to express herself artistically and nourish her soul. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Curious Cook: The strange story of gluten – Part 3

Curious Cook: The strange story of gluten – Part 3

READ: Part 1 and Part 2

A curious aspect of non-coeliac gluten sensitivity (NCGS) is that this syndrome is usually acquired after childhood. It is odd because statistically, adults have a smaller percentage of allergy sufferers than children – one presumes childhood allergens are better tolerated as one grows older and develops a more rounded (or stronger) immune system.

It might be suggested that NCGS is akin to lactose intolerance, which develops after the body stops producing the enzyme lactase. The difference is the human body is innately unable to produce the enzymes to digest many complex carbohydrates at any age – it needs bacteria in the human gastrointestinal microbiota (HGM) to do this, and one supposes adults have a larger range of bacterial fauna than children.

To be clear, humans do produce enzymes to digest some common carbohydrates, especially starches (made up of amylose and amylopectin) and sugars – but most other carbohydrates need digestive help from the HGM. This is why FODMAPs may be allergens behind NCGS if the HGM is defective in some way. FODMAP stands for Fermentable, Oligo-, Di-, Mono-saccharides And Polyols, and are varieties of carbohydrates which humans cannot digest natively via enzymes – and they are often found in food where gluten is present, and also in foods where there is no gluten.

Old wheat vs new wheat?

As modern wheat is a hybrid derived from various grasses, it is worth determining if some change in wheat genes is a cause of NCGS. This was investigated by the University of Reading in 2017. Analysis of various ancient strains established differences in various compounds compared to modern wheat, in particular carotenoid lutein, a colourant mostly bred out of modern wheat (as people prefer white wheat flour). There were also minor differences in plant phytochemicals and dietary fibre content. Curiously, the profiles of FODMAPs are remarkably similar in both ancient and modern wheats. So if FODMAPs are a root cause of NCGS, then people have been suffering for thousands of years.

One mildly interesting outcome is there seems a lesser reaction to FODMAPs from a strain of khorasan wheat called kamut (also known as “mummy wheat” as it allegedly came from wheat grains found in Egyptian tombs). Symptoms of NCGS and irritable bowel syndrome (IBS) appear to be reduced with kamut wheat, and analysis of faecal samples suggested that kamut wheat has a different impact on HGM than normal bread wheat. However, the studies were on small groups and therefore not conclusive – also complicating matters is the fact that nutrition profiles of kamut grown in various countries have wide differences which may or may not be significant.

Gluten, FODMAPs and baking

Next was a look into the impact of modern processing of wheat flour, especially in commercial bakeries and food processing plants. Research in 2015 in Britain suggests that bread gluten becomes less digestible after baking (possibly due to structural changes) – in particular, baked gluten is even more indigestible in people deficient in producing the enzyme amylase (used for digesting amylose).

Furthermore, a 2014 Flinders University study researched the impact of baking on two major prebiotics in bread wheat flour: arabinoxylans (AX) and fructans – prebiotics are non-digestible food compounds which feed the HGM, and are also FODMAPs.

The study found slight variations in AX content after various stages of baking – which implies AX is not hugely affected by processing. More interesting is the impact on fructans; in particular, the use of yeast to ferment and leaven bread flour before baking can reduce fructan content in bread by 60% (though it is important to also note the baseline content and types of fructans vary widely depending on the source of the flour).

This is significant because most commercial bakeries do not proof (ferment with yeast) breads as it takes too long – instead they often use chemicals (eg. sodium bicarbonate, sodium aluminium phosphate, etc) to raise bread quickly in commercial ovens, and therefore the fructan content is significantly higher than for leavened breads.

Fructans are oligosaccharides (complex sugars consisting of polymers or chains of fructose-based molecules). There are several categories of fructans, delineated by different hydroxyl (radical –OH) bonds in their structure and the most well-known types are inulin and levan. They are interesting because a 2017 study at Oslo University claimed that fructans is a possible cause of NCGS. Although the study was small, it was a well-done double-blind exercise, though it is odd that the test fructans (inulin derived from chicory roots) are also sold as prebiotics to promote HGM health.

When test subjects did not know what they were eating, 22% reported intestinal issues with gluten while 46% reported the LEAST problems when ingesting gluten. With fructans, 41% recorded issues, almost double the number for subjects troubled by gluten. Moreover, the study suggested that issues with fructans may be dose-dependent – doubling the amount of fructans normally eaten provoked negative reactions which were absent with less consumption.

There are some considerations. The fructans used in the study were derived from chicory roots – which are different from fructans in wheat and other foods. The same fructans used are also sold commercially as prebiotic supplements to promote HGM health – presumably there are not many people reacting negatively to such supplements or else it would not be a business.

The gluten is based on the 19 most allergenic gliadins (out of around 890 types of known gliadins) – these proteins are 33-mer peptides, and as such not all the gliadins in a normal diet are covered.

It should therefore be noted that not all combinations of fructan and gluten compounds in normal diets were tested.

Durum

As an aside, durum wheat (found in good spaghetti and pasta) lacks the gene to produce 33-mer peptides so if you have a reaction to bread wheats, you might try eating some pasta instead to see if it helps.

Intestinal stories

In 1965, Bronstein’s research into the digestion of wheat gliadins indicated the resulting acidic peptides are a cause of coeliac disease (CD) as sufferers lack an enzyme to digest such peptides, which then circulate around the digestive tract. In response, the body produces antibodies to counter these peptides which are perceived as foreign pathogens. Later in 2000, Fassano showed that intestines also increase production of zonulin in such situations – this protein loosens the tight cellular linkages in the intestines, causing “leaky gut syndrome” where digestive substances permeate into the blood stream, provoking more severe reactions.

Then a 2015 US paper researched the effect of pre-digested wheat gliadins on intestinal tissues extracted from people with CD, NCGS and controls with no gluten sensitivity. The outcome was sobering – ALL tissue samples demonstrated increased permeability reactions to pre-digested gliadins. In addition, it was found that the controls produced significantly more of a protein called cytokine IL-10, which is an anti-inflammatory factor.

It should be noted that tests on tissue extracts with chemically pre-digested gliadins may not accurately reflect conditions in the body. Or it can be suggested gliadins in wheat gluten consistently provoke intestinal inflammatory issues and people who produce enough cytokine IL-10 do not feel the effects of such inflammation.

Other gunk

The probability that humans are reacting to chemical food additives used in modern processed foods also cannot be ignored. This is a long complex subject, covered in the six-part series, “How to count on food”.

If you’re not confused by now, you’re not paying attention

A summary is now in order.

Gluten (especially wheat gliadins) and FODMAPs are broad, complex groups of food substances which vary widely in quantity and types. Due to idiosyncratic differences in humans, it is difficult to pin-point exactly which compound or combinations in one or both groups cause NCGS.

FODMAPs are indigestible food compounds which need the HGM to help with digestion. As they can promote fermentation in the gut, some FODMAPs are associated with gas and distended bellies. They are not necessarily bad – but they do need a compatible, robust HGM to process them.

Ironically, a lot of commercial gluten-free food is bulked up with FODMAPs and often contain industrially-processed oils and added sugars – in short, gluten-free foods are not always inherently healthy.

Fructans are fructose-based FODMAPs which can trigger NCGS, though the reasons why are not known – maybe it is related to HGM. Fructan content varies widely by source and also by certain food processing steps, such as yeast fermentation.

Gliadins in bread wheat gluten, particularly 33-mer peptides, have been linked with intestinal permeability.

Food additives can trigger NCGS, though relevant impact analysis data is currently not available due to the wide range of additives in modern food processing.

Back to Taiwan

Based on the above, my incident in Taiwan in Part 1 of this series was likely due to over-consuming wheat flour in noodles and buns, pushing gliadin and FODMAP consumption past levels which overwhelmed the body’s anti-inflammatory response.

The same issue may apply for commercial breads using unleavened dough with high fructan content and textured with industrial additives.

Subjectively, although problems develop after consuming certain compounds (eg. gliadins, FODMAPs, additives) past a tolerance threshold, it does not mean I have NCGS – in the same way getting drunk does not mean an alcohol allergy.

So if you still consider NCGS a problem issue, you now have all the (currently known) facts before deciding to pay premium prices for gluten-free foods.

Eliminating food allergies

Eliminating food allergies

If your child has food allergies, his paediatrician may recommend that he be placed on a food elimination diet.

What it means is that you will need to temporarily eliminate specific foods from his diet, and possibly your diet as well, if you are still breastfeeding him. It should last around two to four weeks.

This method is normally combined with skin or blood tests, and its purpose is to help identify specific foods that are triggering his food allergies.

By avoiding the suspected food trigger, both you and the paediatrician can monitor his symptoms, which should disappear if the foods that trigger his allergy are excluded.

As an additional step to help determine the exact offending food, his paediatrician may ask for it to be reintroduced to his diet gradually. Any return of his symptoms would signify that he is likely allergic to the food that was reintroduced.

Allergy vs intolerance

Food allergies are a result of the immune system mistakenly identifying specific foods to be harmful, thus reacting by creating immunoglobulin E (IgE) antibodies to combat the perceived threat.

This often results in fairly immediate symptoms (within minutes) that could present as gut-related (abdominal pain, vomiting or diarrhoea), skin reactions (rashes, itching or swelling), respiratory (runny nose, sneezing or difficulty breathing), or even headaches in older children.

Food intolerance, on the other hand, is a purely gut-related problem that is caused by difficulty in digesting certain foods – the immune system is not reacting in any way.

Symptoms such as bloating, tummy aches or diarrhoea, do not normally appear immediately and can take a while before presenting.

The eight most common allergenic foods listed by the US Food and Drug Administration (FDA) are milk, eggs, fish (bass, flounder, cod), crustacean shellfish (crab, lobster, shrimp), tree nuts (almonds, walnuts, pecans), peanuts, wheat and soybeans.

Preparing fresh foods with raw ingredients may be the best solution, but this may not always be possible.

Do exercise extra care whenever you buy processed foods.

It is imperative that you read the product labels carefully before buying and serving them to your child. This will help ensure that the processed foods do not contain any of the foods that are in his food elimination diet.

As an example, if soy is part of the foods to be eliminated, buying processed foods that contain soy (commonly labelled as lecithin) would most likely skew the results, particularly if your child is allergic to it.

The eight most common allergenic foods listed by the US FDA are milk, eggs, fish (bass, flounder, cod), crustacean shellfish (crab, lobster, shrimp), tree nuts (almonds, walnuts, pecans), peanuts, wheat and soybeans.

Other common ingredients to be aware of include flour, which is often listed as wheat, and whey, which is often listed as milk.

If you are unsure about the processed food, it would be better to err on the side of caution and avoid it.

Keeping track

Keeping a food diary in conjunction with the food elimination diet is a good habit, as it could potentially be useful in identifying problem foods.

Make it a point to accurately record all symptoms (including number of times and duration) and everything that your child ate or drank.

In addition to food and drinks taken during main meals, you should also include prescribed medicines, supplements, and any sweets or snacks he takes. Yes, even taking a taste from someone else’s plate or cup counts!

Start with a fresh page every day. Remember to bring it, along with any food packaging or labels, during consultation sessions with your child’s allergist, in order to give him a complete picture to help in his analysis.

Tips for success

By this point, it should be apparent that going on a food elimination diet can be quite complex.

It is important to plan it and ensure that you take careful note throughout the course of the elimination diet. Here are things you can do to help yourself:

Preparation is key: Spend a little time doing some research prior to starting the elimination diet.

Do a search for elimination diet-friendly recipes beforehand.

You may also want to search for suitable processed foods ahead of time.

Stock up before starting: In addition to getting recipes, you should also ensure that you have all the necessary ingredients ahead of time.

Be sure to also stock up on snacks or light foods that are elimination diet-friendly. This will help increase your chances of following the elimination diet, especially on days when your child is hungry or just wants something to nibble on.

Clean out the clutter: Take some time to go through your kitchen and other parts of your house to look for foods that are not elimination diet-friendly.

Make sure that you either hide them well, discard them (if they are almost expired) or give them away. By removing non-elimination diet-friendly foods, you also remove any temptation for your child.

This will pre-empt situations where your child may see his favourite snack (that is part of the eliminated food) in plain sight and demands to have some.

Keep all caregivers in the loop: Be sure to involve all caregivers in this exercise as they will help ensure that your child adheres to his elimination diet. This includes the people who will care for him in daycare, kindergarten or school.

For school-going children, it is important that you discuss this in detail with him in order to ensure his cooperation.

You may need to prepare meals for him, unless you are 100% sure that the canteen foods can comply with his elimination diet.

It may also be necessary to inform family members and parents of friends in order to avoid accidentally sharing/giving food.

Lastly, do note that the elimination diet may not yield conclusive results, in which case your child’s allergist may recommend an oral food challenge in order to check any inconclusive results.

However, it is very important that any elimination diet be taken ONLY under the supervision of an experienced medical professional, in order to avoid possible problems such as malnutrition.


Dr Amir Hamzah Abdul Latiff is a consultant paediatrician and consultant clinical immunologist/allergist. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. For further information, please e-mail starhealth@thestar.com.my or visit www.mypositiveparenting.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
What the color of your snot can reveal about your health

What the color of your snot can reveal about your health

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Jenny Cheng/Business Insider

Open your tissue, if you dare. The color of your snot can reveal a lot about your health.

The nose is lined with mucus membranes that secrete snot to help keep tissues healthy and trap dirt, cleaning the air we breathe on its way to our lungs. The nasal discharge they produce repels infections, lubricates the skin, and keeps viruses from entering our bodies.

The color of the snot in your nasal passages is often determined by how many white blood cells are circulating in the nostrils. That’s why taking a look (as gross as it sounds) can reveal useful information about how healthy we are.

Of course, the color of your snot isn’t an absolute diagnostic test. Most of the colorful clues our noses give us are not reason enough, on their own, to call a doctor, yet the rainbow of options can serve as a first hint about what’s going on inside our bodies.

Given that we produce and swallow about 1 1/2 quarts of nasal mucus every day, we are filled with a lot of sticky data to draw from.

Take a look at what the color of your mucus may indicate:


Clear snot is generally a good thing, but too much of it can be a warning that something is brewing.

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Jenny Cheng/Business Insider

White snot signals that things are clogged up.

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Jenny Cheng/Business Insider

Yellow snot is a sign your body is fighting to keep you healthy.

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Jenny Cheng/Business Insider

Green snot is probably an indication that something isn’t right.

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Jenny Cheng/Business Insider

Red snot doesn’t mean you’re sick.

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Jenny Cheng/Business Insider

Brown snot can be a sign of irritation or pollution.

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Jenny Cheng/Business Insider

Black snot may be a reason to call the doctor. Or it could just mean you’ve been breathing in smoke.

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Jenny Cheng/Business Insider

Julia Calderone wrote an earlier version of this post.

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