If you have difficulty with milk, it may mean that you have lactose intolerance. Also called lactase deficiency, the problem is that you aren’t able to fully digest the milk sugar (lactose) in dairy products. It’s usually not dangerous, but lactose intolerance can give you symptoms uncomfortable enough to keep you clear of the dairy aisles in the supermarket.
The problem behind lactose intolerance is a deficiency of lactase – an enzyme produced by the lining of your small intestine. Some people who believe they are lactose intolerant actually don’t have impaired lactose digestion. And not everyone with low levels of lactase is lactose intolerant. Only people with low lactase levels and symptoms are considered to have lactose intolerance.
You can control symptoms of lactose intolerance through a carefully chosen diet that limits lactose without cutting out calcium, and possibly by taking supplements.
SIGNS AND SYMPTOMS
If you have this condition, you will begin to have signs and symptoms 30 minutes to two hours after eating or drinking foods containing lactose. Commonly your symptoms include:
• Diarrhea, the most common symptom
• Abnormal cramps
Symptoms are usually mild but may be severe sometimes. Their severity doesn’t correlate with the degree of lactose malabsorption. Instead, symptoms relate to a range of factors like ethnicity, age, and how fast you digest food.
Symptoms alone can make it difficult to diagnose lactose intolerance. Many other conditions, including stomach flu and irritable bowel syndrome, can give similar symptoms. In young children, diarrhea along with certain other symptoms may be a sign of milk protein allergy.
Lactase from the cells lining your small intestine break down lactose into two simple sugars – glucose and galactose – which can be absorbed into your bloodstream. Without lactase, the unprocessed lactose moves on to the colon (large intestine) where bacteria there contend with it. This causes the hallmarks of lactose intolerance – gas, bloating, and diarrhea.
There are three types of lactose intolerance.
• Normal result of aging for some people (primary lactose intolerance). Normally, your body produces large amount of lactase at birth and during early childhood, when milk is the primary source of nutrition. Usually your lactase production decreases as your diet becomes more varied and less reliant on milk. This gradual decline may cause symptoms of lactose intolerance.
• Results of illness or injury (secondary lactose intolerance). This form of lactose intolerance occurs when your small intestine decreases lactase production after an illness, surgery or injury to your small intestine. Celiac disease, gastroenteritis or an inflammatory bowel disease like Chron’s are examples of small intestine problems possibly at play. This type of lactose intolerance may last only a few weeks and be completely reversible. However, if it’s caused by a long-term illness, it may be permanent.
• Condition you’re born with (congenital lactose intolerance). Babies can be born with lactose intolerance. This rare disorder is passed from generation to generation in an autosomal recessive pattern of inheritance. This means that both the mother and the father must pass on the defective form of the gene for a child to be affected. Infants with this form of lactose intolerance are intolerant of the lactose in their mothers’ breast milk and have diarrhea from birth. These babies require lactose-free infant formula.
• Age. Lactose intolerance usually starts after age 5 – the condition is uncommon in babies and young children. A child with chronic diarrhea before age 1 usually has another underlying problem.
• Ethnicity. Lactose intolerance is more common in certain ethnic and racial populations. It’s more common in black, Asian and Hispanic populations.
• Premature birth. Infants born prematurely (28 to 32 weeks of gestation) may have reduced levels of lactase, because this enzyme increases in the fetus late in the third trimester.
WHEN TO SEEK MEDICAL ADVICE
If you have signs and symptoms of lactose intolerance, talk to doctor. Don’t diagnose yourself. Your symptoms could be an indication of another illness. Your doc can help determine if you have lactose intolerance or another condition.
SCREENING AND DIAGNOSIS
Symptoms and your response to reducing the amount of dairy products you consume, may lead to the diagnosis. Confirmation may be done by doing one or more of the following tests.
• Lactose tolerance test. After given something containing lactose, the lactase in your intestine should break it down into galactose and glucose. If blood samples over a two-hour period don’t show a rising glucose level, it means you’re not properly digesting and absorbing the lactose-filled drink.
• Hydrogen breath test. You must also consume a high-lactose containing drink. Then the amount of hydrogen in your breath is measured at regular intervals. Normally, very little hydrogen is detectable. However undigested lactose reaches your colon and ferments, causing hydrogen and other gases to be released, absorbed by your intestines, and eventually exhaled. Large amounts of exhaled hydrogen indicate that you aren’t fully digesting and absorbing lactose and that you’re likely to be intolerant.
• Stool acidity test. This is mostly for infants and children. The lactose amount required for the above-mentioned tests may be dangerous for them. So the amount of acid in the stool is measured. Undigested and unabsorbed lactose ferments in the colon, producing lactic acid and other acids than can be detected in a stool sample.
Some tips for self care:
• Drink less milk more often
• Save milk for mealtime
• Experiment with an assortment of dairy products
• Buy lactose-reduced or lactose-free products
• Watch out for hidden lactose
• Seek other sources of calcium
• Use lactase enzyme tablets
• Try a calcium supplement
• Try probiotics
If you need more help with these, write me or see me.
See you next week.
Dr. Emanuel, based in the Commonwealth of Dominica, has been an educator of medical professionals, in training and the public, for over 20 years.