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Understanding Lactose Intolerance

You’ve had to give up your favourite latté now that you have been diagnosed with lactose intolerance. Unfortunately, lactose intolerance is one condition that can appear at any age with no warning. And while it is one of medicine’s most misunderstood conditions, the good news is that it is a relatively easy condition to manage in most cases.

It’s impossible to know the exact size of the lactose intolerant population, but it is estimated that about 65% of the world’s population has some degree of intolerance to dairy. In Australia, this figure is much lower since lactose intolerance has varied racial presence. According to the Victorian government’s Better Health channel, only 5% of Caucasians, but 75% of non-Caucasian’s living in Australia are lactose intolerant. In some East Asian communities, as much as 90% of the population may be affected.

Defining lactose intolerance:

Why do we develop lactose intolerance? Simply put, lactose intolerance is the body’s inability to digest sugars found in milk. It is a common digestive condition that is usually not serious. Intolerance is very different from a milk allergy, which is an immune response to milk proteins and can be very serious.

To cope with the condition, it is important to know what causes it. Dairy and its products contain sugars called lactose. An enzyme called lactase is needed to break it up into glucose and galactose. When lactase is in short supply, we get the symptoms of intolerance – bloating, diarrhoea, abdominal cramps and gas, and in some cases nausea and vomiting. The amount of lactase in our body can vary – and this is key to understanding lactose intolerance:

  • Primary, congenital lactose intolerance: this is rare, but babies can be born with lactose intolerance, having no supply of lactase. It is mostly due to genetic factors. Premature babies may also have a form of lactose intolerance called developmental intolerance.
  • Secondary lactose intolerance: usually occurs because of a surgical procedure, illness or injury related to the small intestines. According to WebMD, illnesses such as Crohn’s, celiac disease and bacterial overgrowth could cause secondary intolerance. It usually improves when the underlying condition eases. Cancer treatment is also known to increase the risk of secondary intolerance. Even a relatively minor illness like gastroenteritis can cause temporary lactose intolerance.
  • Lactose intolerance through aging: this is the most common type of intolerance. Infants usually have more lactase, which tends to fall off as they grow up and consume less dairy. It is meant to taper off, but sometimes there can be a sharp fall in lactase production – the reason why you may have to give up all those lattés.
  • Dairy insensitivity: this is a variant of being intolerant to dairy products, not to the lactase in it, but the casein protein.

Milk and Cheese

Testing for lactose intolerance:

It may be quite hard to precisely diagnose lactose intolerance because indigestion can be for several reasons. Also, there are food intolerances besides milk and so it is hard to zero in on one food group. If you have been experiencing digestive problems for a while, see your GP and avoid self-diagnosis. The two most common tests to detect lactose intolerance are:

  • Hydrogen breath test: this is usually done on an empty stomach. The person is administered 25gms of lactose and the breath is tested at 30-minute intervals for 3 hours. The level of hydrogen in the breath will reveal the degree to which the lactose has not been digested.
  • Food elimination test: this test is conducted when the GP suspects that the symptoms could be caused by another food group or more than one food groups. In this test, all foods containing lactose are removed to see if symptoms improve.

Usually these tests should quickly establish if a person is lactose intolerant. However, there are a few other tests your GP may suggest:

  • Lactose tolerance test: estimates the body’s ability to process lactose by measuring the amount of glucose in the blood after consuming a lactose intensive drink.
  • Stool acidity test: is usually administered to those who can’t take the other tests. The stool sample will reveal high levels of lactic acid, if lactose is is undigested.

For more complicated cases, intestinal biopsy or genetic testing may be required.

Lactose Intolerant
Coping with lactose intolerance:

Life is a lot easier now for those with lactose intolerance. There are a host of food alternatives available. But it does require reconfiguring your diet to get all the calcium, vitamins and minerals you need. Here are some of the measures you could take:

  • Even lactose intolerant persons can consume small quantities of lactose. Most doctors recommend not giving up calcium entirely as that could result in more complications downstream, particularly those related to calcium deficiency.
  • It’s a myth that all dairy products are high-lactose. Some hard cheeses like Cheddar and Edam have little or no lactose. Same with some types of butter and cream.
  • Yoghurt is known to break down lactose, so it can be an alternative to milk.
  • Consume dairy in small quantities with other food groups to ease absorption through the intestines.
  • Those with a very low tolerance for lactose should consume lactose-free dairy products.
  • Eat high-calcium foods like broccoli, canned salmon, soy milk etc.
  • There are OTC drugs like lactase enzymes that could help you digest dairy products. They are not always effective, so it is important that you speak to your GP before you try them.

Lactose intolerance can develop at any age. If you’ve been experiencing the symptoms of an Irritable Bowel Syndrome for some time, make an appointment to see your GP. It’s best to get tested rather than self-diagnose. And if it happens to be lactose intolerance, it is often low-risk condition that can be quite easily managed.

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