Deciphering Lactose Intolerance
Many people avoid milk and dairy products because they feel unwell after eating them. They may feel windy, bloated or even suffer from diarrhoea after eating cereal in the morning or drinking a milky drink. These symptoms could indicate possible lactose intolerance. You should not give up milk products until you have confirmed with a doctor or Dietitian that you are in fact lactose Intolerant. A Dietitian will help you learn how to include calcium rich foods in your daily diet, without aggravating your symptoms.
What is Lactose Intolerance?
Lactose, a sugar is present in milk and most milk products. It is also added to bakery products as dried milk and as an additive in some pharmaceutical products. Lactose intolerance occurs when there is a deficiency of lactase, an enzyme found in the small bowel. This enzyme breaks down lactose, the sugar in milk, to form two simple sugars called glucose and galactose. These simple sugars, glucose and galactose, are then absorbed into the blood stream and metabolised for energy. When there is insufficient lactase enzyme present, the lactose sugars are not digested properly, and the symptoms of lactose intolerance can occur.
What Causes it?
Research has discovered a probable genetic link to lactase deficiency. This is called primary lactase deficiency. They have found that people inherit a gene that will predispose them to developing lactose intolerance. Secondary lactase deficiency is a lactose intolerance that occurs due to some injury or upset to the small intestine. This may be after a bout of diarrhoea, as a side effect of IBS, or may result after the damage caused by Coeliac or Crohn’s disease or chemotherapy.
It is more common in some ethnic groups, eg Chinese and other Asian communities, Australian Aboriginals and groups from the Middle East, the Mediterranean and Africa.
What are the Symptoms?
People who suffer from lactose intolerance will each have their own tolerance level. This means they will have a particular amount of lactose they may consume with minimal side effects. Symptoms of lactose intolerance include:
• Abdominal pain
• Abdominal bloating
Diagnosing Lactose Intolerance
There are two methods of diagnosing lactose intolerance.
Hydrogen Breath Test
When lactose is not digested properly by lactase enzymes in the gut, it is fermented by the millions of bacteria in the bowel. This undigested lactose is converted into hydrogen by the bacteria. The Hydrogen breath test measures the amount of hydrogen that a person breathes out. A person with lactose intolerance will emit a larger amount of hydrogen in their breath than what is considered normal ranges.
Hydrogen breath tests are conducted in Australia, but there is currently limited access to these tests in Western Australia. The Perth Diet Clinic hopes to have this facility in the near future.
An elimination diet involves removing all foods from the diet that contain any lactose. If symptoms improve during the elimination period and then return once the foods are reintroduced, then lactose intolerance is most likely the cause. An elimination diet can be difficult, and will also eliminate most foods that are high in Calcium. Elimination diets should be trialed under the supervision of an experienced Dietitian to ensure that all lactose containing foods are eliminated, and calcium deficiency does not become an issue.
Where is Lactose Found in the Diet?
Lactose is found in all dairy products. It is also found in foods containing dairy products, except naturally maturing cheese. Lactose will also be found in cake and biscuits that contain milk products. To decipher any hidden sources of lactose, look for the following ingredients on the nutrition information panel;
• Milk solids
• Non-fat milk solids
• Milk sugar
Milk may be substituted with lactose free milk, Soya milk, rice milk and oat milk. It is important to choose sources that are still adequate in calcium and protein. Compare the calcium and protein of your milk substitute compared to regular milk by using the ‘per 100ml’ column in the nutrition panel.
Lactase Enzymes can also be used by those with lactose intolerance. They are tablets or drops that will help to digest the lactose in foods. They are available from the chemist. The drops can be added to dairy products such as milk, yoghurt and ice cream and will help to breakdown lactose. These enzymes make the milk seem much sweeter as the lactose is broken down to glucose (very sweet) and galactose. Most people adapt easily to this change of flavour.
Does A Little Bit Of Lactose Matter?
There is an individual tolerance to the amount of lactose an individual can tolerate. Often people can handle a little milk in coffee but not a full Latté. Most people can tolerate 6 to 12 grams of lactose or about 200 ml of milk spread over the day. Low fat milk has more lactose than full fat milk and skim milk products with added milk solids has even more. Yoghurt and cheese is often tolerated. Sometimes tolerance is improved by slowly increasing the amount of milk products in the diet.
The lack of lactase, the enzyme found in the small intestine, can lead to malabsorption of milk products leading to inadequate calcium uptake and a greater risk of osteoporosis. It is important to have 3 serves of dairy products or calcium-fortified substitutes each day.
Avoiding milk products due to lactose intolerance can lead to calcium deficiency. It is important to ensure that adequate calcium is obtained by other means.
Recommended daily Calcium requirements
Babies 350-500 mg
Toddlers & young children 500- 700 mg
Children 1000 –1300 mg
Adult Male 840 - 1300 mg
Adult Female 840 –1300 mg
Pregnancy and Lactation 840 –1300 mg
Osteoporosis 1500 – 2000 mg
Amenorrhoea Females 1500 mg