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LACTOSE INTOLERANCE

Nicqui Duffield

The gold standard test for lactose intolerance would be a Hydrogen Breath test. The individual would be required to fast for a number of hours prior to the test being done. They would then breathe into a specific apparatus which would measure their baseline hydrogen output in their expelled breath. They would then be given a high lactose liquid to drink and measurement for hydrogen would be done at intervals and ascertained as to whether or not they are digesting lactose efficiently or not.

Other symptoms of lactose intolerance are quite general and none specific such as noisy stomach, bloating, belching, distension, flatulence and discomfort as well as diarrhoea or vomiting.

Gabi Steenkamp

Lactose intolerance is caused by the inherent lack of the enzyme that digests lactose, the natural sugar found in milk. Thus after drinking or eating dairy containing foods that contain lactose you may get a ‘bubbly’ tummy and possibly some mild cramping as the lactose is fermented by our gut bacteria into lactic acid. A few hours after drinking or eating lactose containing dairy products the stool that is passed will have a distinct sour smell.

Nicqui Duffield

Milk allergy and lactose intolerance are two very different issues related to the same food stuff. Milk allergy is generally an immune response to the protein found in milk which results in the immune system being stimulated and a reaction results such as an itch, rash, nausea, vomiting and breathing problems depending on the severity of the sensitivity and the number of times the person has been exposed. In general, an immune reaction gets more intense and more severe the more exposures. This type of reaction can be life threatening.

On the other hand, lactose intolerance is a sensitivity and reaction to the carbohydrate found in milk, known as lactose. This reaction is not in the immune system but rather within the gut. The reaction is generally brought about as a result of too little or inefficient lactase activity – lactase is then enzyme in the gut needed to digest the lactose. If someone is born with an inability to make this enzyme, they will have what is known as primary lactose intolerance. They will either need to avoid all lactose-containing foods all their lives or alternatively should they consumer lactose foods will need to supplement a digestive enzyme supplement to assist with digestion. The gut is not a smooth tube but rather a tube with a rough or convoluted wall that looks a little like fingers sticking up – these finger like projections in the middle of the gut tube are called villi and they have a number of roles to play in the gut – one of which is to increase the surface area of the gut resulting in more chance for absorption. The other is that in their tips, they house the cells responsible for the manufacture of the enzyme lactase. This is important to know as an individual can also develop what is called transient lactose intolerance as a result of reversible damage to these tips. This happens as a result of diarrhoea, causing the finger-like projections to be “flattened” and as a result the villi are not able to make lactase resulting in lactose intolerance. Once the villi are restored back however, the lactase is manufactured again and lactose intolerance is restored.

Gabi Steenkamp

No. Lactose intolerance is merely the absence of the enzyme that digests the lactose (natural sugar in milk) and besides the discomfort and a sour smelling stool, there is no harm to the body.

Milk allergy, on the other hand, means that the body treats the protein in milk as an ‘imposter’. To fight the perceived threat of the milk protein ‘imposter’, the body calls out the ‘riot squad’ to get rid of the threat. The immune system goes on high alert and an allergic reaction develops. This can be mild in the form of itchy skin or eczema, more severe in the form of breathing difficulties, or even life threatening as in an anaphylactic shock, which is not common with milk allergies.

 

Corinna Walsch

No, it is not necessary to avoid dairy if you are lactose intolerant. International authorities such as the National Institutes of Health agree that most people who have lactose intolerance can eat small amounts of dairy foods without it causing discomfort.

Nicqui Duffield

No, not all dairy contains intact lactose – some fermented dairy products such as yoghurt, maas and some cheeses through the fermentation process, have has the lactose enzymatically digested so it no longer requires the digestive enzyme lactase and as such will not cause the same symptoms as lactose-containing foods. The other alternative is to supplement a dairy-rich meal with a digestive enzyme supplement which is able to assist with the digestion of the lactose in the meal.

Nicqui Duffield

If your lactose intolerance is a Primary intolerance due to a genetic lactase mutation then the answer is no it can’t be cured. If however it is a transient lactase deficiency due to injury to the villi of the gut whether it be as a result of gut infection, antibiotic use or other, through means of gut repair and regeneration, the lactase production can be resumed resulting in a “cured” lactose intolerance.

Corinna Walsch

Symptoms of lactose intolerance include bloating, flatulence, abdominal pain, cramps and diarrhea.

Although you may have to cut down on your intake of fresh milk, dairy foods such as cheese, yoghurt and fermented products such as buttermilk and maas contain less lactose and can be eaten without causing gastrointestinal discomfort. These foods are fermented by lactic acid bacteria, thus converting some of the lactose to lactic acid.  It is also possible to use a cup of fresh milk per day without it causing discomfort. If small amounts of dairy are used at a time, or milk is taken with a meal, it will cause less discomfort than when a large amount of milk is taken on its own. It is possible to improve your tolerance of lactose containing foods by gradually increasing your intake of lactose – in this way you can improve the ability of the bacteria in your gut to break down lactose. Although more expensive, lactose free milk is also available. This milk has many more health benefits than other beverages such as soy milk. Pills that contain lactase enzymes are also available and can be taken with milk to improve digestion.

Nicqui Duffield

If you have confirmed lactose intolerance, it would be wise to avoid non-fermented dairy products. Should this not be possible, ensure that you get sufficient good quality probiotic bacteria supplements and include digestive enzyme supplements in a high dairy meal.

Corinna Walsch

Lactose intolerance does not have to affect your health, since it is a misconception that you need to avoid milk and milk products. Dairy foods are an important food group to include in your diet, since these foods are very good sources of the nutrients calcium, magnesium, potassium and protein, and are associated with a number of health benefits. Most people are aware of the benefits of milk and other dairy foods for bone and dental health, but more recently a large body of evidence has linked dairy intake to other health benefits as well. These include a decreased risk for diabetes, hypertension and cancers of the digestive system.  Milk has also been recognized for its unique ability to prevent or treat the loss of muscle mass (sarcopaenia) that occurs commonly in the elderly.

Gabi Steenkamp

Lactose intolerance generally does not affect ones health unless in rare cases where it is severe, particularly in babies who battle to thrive.

It is also important to ensure that dairy products are not cut out of the diet completely so that adequate calcium requirements are met.

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