“Our 17-year-old son has autism and has developed diarrhea that we think is related to lactose intolerance. Would probiotics help?”
This week’s “Food for Thought” answer is by pediatric gastroenterologist Timothy Buie. Dr. Buie is the director of gastrointestinal and nutritional services at Massachusetts General Hospital’s Lurie Center for Autism, a member of the Autism Speaks Autism Treatment Network (ATN).
Thank you for your question. Probiotics may be something to consider for your son. But first let’s look at the larger issue of lactose intolerance.
Lactose intolerance involves an inability to digest lactose, or milk sugar. While some children are lactose intolerant from an early age, many of us develop this digestive issue as we get older. An estimated 25 percent of Americans become lactose intolerant by the time we reach adulthood.
So it could well be that your teenage son has become lactose intolerant – or more lactose intolerant – with age. And, yes, this could explain his bouts of diarrhea.
The most direct and effective treatment for lactose intolerance is lactose avoidance. This means eliminating dairy from his diet. If this resolves his diarrhea, great. If it doesn’t, then I recommend having your son’s doctor or a gastroenterologist evaluate him for other possible GI disorders. Chronic diarrhea can be a symptom of upper GI irritation, celiac disease or a variety of other medical issues.
Probiotics can help
Sometimes total lactose avoidance is easier said than done. Perhaps your son really loves milk, ice cream or yogurt. It’s also true that lactose intolerance is seldom all or nothing. Many of us can get away with a little dairy in our diets without a problem.
In these situations, probiotics can indeed help. In essence, probiotics are healthy digestive bacteria. They all produce digestive enzymes – chemicals that help your digestive system break down and absorb nutrients.
In fact, most probiotics on the market are lactose fermenters. That means they break down lactose into simpler sugars that the body can more easily absorb. Lactose-fermenting bacteria include acidophilus, lactobacillus and bifidus species. So when considering a probiotic supplement, check the label for these names or variations of them. It’s also important to make sure that the supplement contains viable, or “live,” bacteria.
At this point, we don’t know with certainty whether any one brand or type of probiotic is best for lactose intolerance or more-general GI issues. So I recommend getting a good quality supplement made by a reputable company, and make sure it isn’t past its expiry date.
Choosing low-lactose dairy products
Many yogurts on the market today are labeled probiotic. They contain live, lactose-digesting bacteria – but not nearly as much as you’ll find in a good probiotic supplement. As a result, yogurt and yogurt products tend to be slightly lower in lactose than comparable milk products. A cup of yogurt or yogurt ice cream, for example, contains about 70 percent of the lactose that you’ll find in the same amount of milk or ordinary ice cream.
So if your son’s lactose intolerance is relatively mild, he may be able to eat some yogurt or yogurt ice cream without triggering GI upset.
Hard cheeses tend to be even lower in lactose. So you may find that your teenager can eat, say, cheddar and Parmesan cheese without a problem, but not cream cheese. Generally, the softer the cheese, the higher the lactose content.
Okay to experiment
Fortunately, lactose intolerance doesn’t cause physical harm, just unpleasant symptoms like gas and diarrhea. So it’s okay to experiment to find your son’s threshold. I hope these suggestions are helpful. Please let us know how you and your son are doing.
Stay tuned for a new informational video series featuring Dr. Buie
Dr. Buie will discuss a variety of GI issues prevalent among individuals with autism and provide evidence-based guidance on probiotics, diet and other strategies for addressing these issues.