April newsletter – Everything you need to know about lactose intolerance
As some of you are aware I was diagnosed as lactose intolerant about 17 years ago. It took six years to get a diagnosis in the days when I knew nothing of nutrition and health! In the last ten years I’ve seen a surge of lactose and fructose intolerance patients that are mistakingly diagnosed with IBS. Without the proper test, diagnosis, treatment or diet strategy, the symptoms wont necessarily go away. I suspect many people diagnosing themselves with “allergies to dairy” could in part be lactose intolerant. To understand what exactly is going on we need to look a bit deeper as many of you are confused! One thing is for sure try not to diagnose yourself as this area is a minefield of mis-information.
What is Lactose intolerance?
The ancient Greek physician Hippocrates (born 460 B.C.) first noted gastrointestinal upset and skin problems in some people who consumed milk. However, it has only been in the last few decades that the syndrome has been more widely described by modern medicine. Lactose intolerance is the inability to metabolize the sugar found in milk and dairy products. This is due to a lack of the enzyme lactase. Most adults in northern Europe and North America are able to absorb lactose. However, the majority of the world’s population are lactose intolerant, and as we get older our ability to digest lactose lessens. Globally a staggering 70 per cent of adults are lactose-intolerant (Gastroenterology, 1971; 61: 805-13).
Babies’ bodies make lactase so they can digest milk, including breast milk. Premature babies sometimes have lactose intolerance. Children who were born at full term usually do not show signs of lactose intolerance until they are at least 3 years old. Lactose intolerance can begin at different times in life. In Caucasians, it usually affects children older than 5 yrs old. In African Americans, lactose intolerance often occurs as early as 2 yrs old. Lactose intolerance is more common in people with Asian, African, Native American, or Mediterranean ancestry than it is among northern and western Europeans. Approximately 30 million American adults have some amount of lactose intolerance by 20 yrs old.
What are the symptoms?
Without lactase, lactose cannot pass through the gut wall into the bloodstream. This accumulation of undigested sugar causes gut bacteria to switch to lactose metabolism, resulting in abdominal symptoms such bloating, flatulence, cramps and, sometimes, diarrhoea. Symptoms often occur 30 minutes to 2 hours after you eat or drink milk products.
Infections in the small intestine from viruses or bacteria which may damage the cells lining the intestine
Intestinal disorders like coeliac disease
Children weaned in non diary consuming societies
A genetic disorder from birth – usually diagnosed in early infancy
Lactose tolerance tests
You can simply avoid eating foods that contain lactose for a couple of days and then drink two to three glasses of milk. If you get stomach ache or diarrhoea within half an hour, you might be lactose intolerant. If you would like it confirmed than the tests available are:
The lactose tolerance test.
Your doctor/consultant measures your blood sugar levels before and after you drink a liquid containing lactose. The lactose tolerance blood test looks for glucose in your blood. Your body creates glucose when lactose breaks down. For this test, several blood samples will be taken before and after you drink the lactose solution described above.
If the stool is acidic this can inidcate an infection of e. coli or lactose intolerance. This is done with children born with the condition.
The hydrogen breath test
This is the preferred method. It measures the amount of hydrogen in the air you breathe out. You will be asked to breathe into a balloon-type container, or gastrolyzer. Then, you will be asked to drink a liquid containing lactose. Samples of your breath are collected at set time periods and the hydrogen level is checked. Normally, very little hydrogen is in your breath. But if your body has trouble breaking down and absorbing lactose, breath hydrogen levels increase. There can be issues with getting this test on the NHS as it’s quite expensive and it won’t necessarily be the first test your GP will use to diagnose your symptoms.
If you’re having problems getting this test in your area, I’ve teamed up with Dr Adam Harris, Consultant Gastroenterologist who does breath tests including lactose, fructose and SIBO. For more details go to his website: www.westkentgastroenterology.com.
Where do I find lactose?
Lactose is also a commercial food additive used for its texture, flavour and adhesive qualities, and is found in foods such as processed meat, sausages, sliced meats, pates, gravy stock powder, margarines, sliced breads, breakfast cereals, processed foods, medications, pre-prepared meals, meal replacements (powders and bars), and protein supplements (powders and bars). A comprehensive list includes all these ingredients:
Skimmed milk powder
Non fat milk
Non fat milk solids
Sweet whey powder
Whey protein concentrate
Dried milk solids
Hydrolysed milk protein
Magnesium casein ate
Potassium casein ate
NB: nearly all prescription medication has lactose in from senna tablets to painkillers. If you are lactose intolerant and are needing daily medication its worth talking to your GP or pharmacist and see if there is another option.
Can I supplement with Lactase?
When lactose avoidance is not possible, or on occasions when a person chooses to consume such items, then lactase supplements may be used. Lactase enzymes similar to those produced in the small intestines of humans are produced industrially. The enzyme, β-galactosidase, is available in tablet form in a variety of doses, without a prescription. Unfortunately, too much acid can denature it, so it needs to be taken on an empty stomach. Lactase supplementation may have an advantage especially in children where the avoidance of all dairy food might be difficult. However personally for me, I’ve never found this affective in adults although this is about personal choice and what works for you.
So what’s Casein?
Casein (from Latin caseus “cheese”) is the predominant phosphoprotein in dairy food and accounts for nearly 80% of proteins in cow milk and cheese. It has been documented to break down to produce the peptide casomorphin, an opioid that appears to act primarily as a histamine releaser. One theory is that this casomorphine aggravates the symptoms of autism. Autism is complicated and is never caused simply by one problem but generally parents feel their children respond better to a casein free diet. As casein has a molecular structure that is quite similar to that of gluten, some gluten-free diets are combined with casein-free diets. Casein is often listed as sodium caseinate, calcium caseinate or milk protein. These are often found in energy bars, drinks as well as packaged goods.
What can I eat?
If you cannot eat dairy food for whatever reason you will need to look for alternatives. Twenty years ago it was difficult finding substitutes to milk products but now all supermarkets stock a good range of soya products – go to www. alprosoya.co.uk.
Soya products are low in cholesterol, trans fat and high in omega 3, 6, and 9 and help lower serum cholesterol. Rice dream and oat milk are also available in some supermarkets and health food shops if you don’t like the taste of soya. Goat, sheep and buffalo products can sometimes be tolerated better than cows milk, however please note they still contain lactose – many of you are getting confused and thinking it’s just cows milk – its not!. Lactose free milk, yoghurt and cheese are now widely available – go to www.lactofree.co.uk for more information.
Most people with low lactase levels can drink 2 – 4 ounces of milk at one time (up to one-half cup) without having symptoms. Larger (more than 8 oz.) servings may cause problems for people with lactase deficiency. However as its so individual it will differ from person to person – I can eat organic butter and feta cheese – I’ve no idea why but I can and that makes life a lot easier for me!
These milk products may be easier to digest
Fermented milk products, such as yogurt (particularly organic ” live” yogurt)
Ice cream, milkshakes, and aged or hard cheeses
Lactose-free milk and milk products
Soy formulas for infants younger than 2 years
Soy or rice milk for toddlers
If for whatever reason you are omitting dairy foods from your diet you will need other sources of calcium, so i you use soyal milk, do choose the calcium enriched soya milk. In order of greatest first here are some calcium rich foods to incorporate into your diet. You need 1,200 – 1,500 mg of calcium each day: