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  Lactose Intolerance  
 
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Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Recommendations

 

One of the most common nonallergenic food sensitivities is lactose intolerance. Except among those of Northern European descent, lactose intolerance is a condition suffered by almost 100% of the people in many areas of the world. In the United States, 95% of Asians are lactose intolerant, 75% of blacks, 60% of native Americans, and from 2 to 24% of Caucasians, depending on the group studied. Lactose is the naturally occurring sugar found in all milk (human, cow, goat, etc.). It's made up of two sugars coupled together glucose and galactose. In the scientific community it's known as a "disaccharide". An enzyme in the intestine called lactase is necessary to split the glucose and galactose apart in order to digest lactose.

Most adults lack the enzyme, lactase, to break down lactose. Instead, lactose is broken down by bacteria in the lower
intestines. The bacterial wastes combine with sugars to ferment into gas and toxins causing bloating and cramps.

Since lactose is found in mother's milk, almost all infants of nursing age are able to digest it. But past weaning and with increasing age, progressively fewer children retain this ability. One study of black children found lactose intolerance in 11% of four- to five-year-olds, 50% of six- to seven-year-olds, and 72% of eight- to nine-year-olds. Other studies have found close to 85% lactose malabsorption among black teenagers. Mexican-American children studied were 18% intolerant to lactose among two- to five-year-olds and increased to 56% among teenagers. It's usually rare among North American white children under six years of age, but increases to 30% in adolescents.

"Most formula-fed infants developed symptoms of allergic rejection to cow milk proteins before one month of age. About 50-70% experienced rashes or other skin symptoms, 50-60% gastrointestinal symptoms, and 20-30% respiratory symptoms. The recommended therapy is to avoid cow's milk." [Pediatric-Allergy-Immunology, August, 1994]

Not all individuals with proven lactose intolerance have symptoms, particularly if only small quantities of milk are drunk. When symptoms do occur, however, they can include gas, abdominal distention, diarrhea, and recurrent abdominal pain, especially among children. Infrequently, severe cases of lactose intolerance in children have been shown to cause damage to the lining of the intestine and severe diarrhea.

Although lactose intolerance, as mentioned earlier, is a good example of a nonallergenic yet food-sensitive condition, there can be an overlap of the two. People with a true milk allergy suffer both the intestinal and systemic symptoms and may have problems including nasal congesting, headache, urinary frequency, hives and protein loss in the urine. They can also have a food sensitivity. Of 24 milk-allergic individuals studied, half were found to be lactose intolerant.

Such a reaction to milk illustrates the importance of distinguishing types of food sensitivity, in this case true allergy versus intolerance due to enzyme deficiency. Not using milk is the preferred treatment option in either case. Adding sufficient acidophilus bacteria or commercial preparations of the enzyme lactose to milk-containing meals will prevent symptoms and improve nutrient absorption for individuals with lactose intolerance, but not for those allergic to milk. Conversely, milk allergy can sometimes be treated by desensitization. This is a procedure that is still somewhat mysterious; it introduces a very small dose of an allergic substance into the body and blocks the body's response to the allergy. The process doesn't cure the allergy or help lactose intolerance.

"Lactose malabsorption and lactase deficiency are chronic organic pathologic conditions characterized by abdominal pain and distention, flatulence, and the passage of loose, watery stools. Once correct diagnosis is established, introduction of a lactose-free dietary regime relieves symptoms in most patients who remain largely unaware of the relationship between food intake and symptoms." [J Clin Gastroenterol, 1999 Apr, 28:3]

There are, of course, many good reasons to avoid milk, including:-

  • "In reality, cow's milk, especially processed cow's milk, has been linked to a variety of health problems, including: mucous production, hemoglobin loss, childhood diabetes, heart disease, atherosclerosis, arthritis, kidney stones, mood swings, depression, irritability, allergies..." [Townsend Medical Letter, May, 1995]
  • Milk is linked to Crohn's disease. "Mycobacterium paratuberculosis is capable of surviving commercial pasteurization." [Applied and Environmental Microbiology: 64(3), Mar 1998] ... "Mycobacterium paratuberculosis (bacteria not killed by pasteurization) RNA was found in 100% of Crohn's disease patients, compared with 0% of controls." [D. Mishina, Proceedings National Academy of Sciences USA :93: September, 1996]
  • Diabetes. "These new studies, and more than 20 well-documented previous ones, have prompted one researcher to say the link between milk and juvenile diabetes is 'very solid'." [Diabetes Care 1994; p.17]
  • "Cow’s milk has become a point of controversy among doctors and nutritionists. There was a time when it was considered very desirable, but research has forced us to rethink this recommendation ... dairy products contribute to a surprising number of health problems (including) chronic ear problems..." [Benjamin Spock, M.D., "Child Care", 7th Edition]
  • Heart Disease. "Milk and milk products gave the highest correlation coefficient to heart disease, while sugar, animal proteins and animal fats came in second, third, and fourth, respectively." [A Survey of Mortality Rates and Food Consumption Statistics of 24 Countries, Medical Hypothesis 7: pp.907-918, 1981]
  • Osteoporosis. "Consumption of dairy products, particularly at age 20 years, was associated with an increased risk of hip fractures ... metabolism of dietary protein causes increased urinary excretion of calcium." [American Journal of Epidemiology 1994; p.139]
  • Pesticide ingestion. "A 1988 FDA survey of milk samples from grocery stores in 10 cities found that 73% of the samples contained pesticide residues." [Environmental Contamination and Toxicology, 1991; p.47]
  • "The National Dairy Board's Slogan, 'Milk. It does a body good,' sounds a little hollow these days." [Scientific American, October, 1992]
It is interesting to consider that no non-human animals naturally drink milk beyond weaning; nor do any animals naturally drink the milk of other species. "Overall, about 75 percent of the world's population, including 25 percent of those in the U.S., lose their lactase enzymes after weaning." [J. of the American Dietetic Assoc. 1996]
 

 
 

Signs, symptoms & indicators of Lactose Intolerance:
 
 
Symptoms - Allergy  Bloating caused by specific foods

Symptoms - Bowel Movements

  Having loose/having very watery stools
  (Very) frequent stools or normal stool frequency
 Loose, watery stools are signs of lactose malabsorption / lactase deficiency.

  Bowel movement changes
 Diarrhea is a symptom of lactose intolerance.


Counter-indicators:
  Having hard stools

Symptoms - Gas-Int - General

  (Severe) abdominal discomfort
 Recurrent abdominal pain is a symptom of lactose intolerance.

  Meal-related bloating
 "An estimated 50 million Americans experience intestinal discomfort after consuming dairy products. Symptoms include bloating, stomach pain, cramps, gas, or diarrhea." [Postgraduate Medicine 1994;95(1)]

  General flatulence
 "Lactose malabsorption and lactase deficiency are chronic organic pathologic conditions characterized by abdominal pain and distention, flatulence, and the passage of loose, watery stools. Once correct diagnosis is established, introduction of a lactose-free dietary regime relieves symptoms in most patients... who remain largely unaware of the relationship between food intake and symptoms." [Journal of Clinical Gastroenterology, 1999 Apr, 28:3]

  Meal-related burping
 
 

Conditions that suggest Lactose Intolerance:
 
 
Allergy  Allergy to Cow's Milk
 One study found that of 24 milk-allergic individuals studied, half were found to be lactose intolerant.

Childhood

  Colic
 Pre-incubation of infant feed with lactase reduced crying time and breath hydrogen concentrations in a double-blind, placebo-controlled study of 32 babies with symptoms of colic. [Improvement of symptoms in infant colic following reduction of lactose load with lactase. J Hum Nutr Diet 2001;14(5): pp.359-363]

Symptoms - Food - General

Counter-indicators:
  Being lactose tolerant
 
 

Risk factors for Lactose Intolerance:
 
 
Personal Background  Japanese/chinese descent
 A very significant number of Asian people suffer from lactose intolerance.
 
 

Recommendations for Lactose Intolerance:
 
 
Animal-based  Lactobacillus Acidophilus
 Adding sufficient acidophilus bacteria or commercial preparations of the enzyme lactose to milk-containing meals will prevent symptoms and improve nutrient absorption for individuals with lactose intolerance, but not for those allergic to milk.

Diet

  Dairy Products Avoidance
 However, unlike yogurt, the lactose in kefir is all digested by the time it is ingested, and some of the proteins have been broken down too. Kefir, a cultured milk product, contains several major strains of friendly bacteria not commonly found in yogurt: Lactobacillus Caucasus, Leuconostoc, Acetobacter species, and Streptococcus species. It also contains beneficial yeasts, such as Saccharomyces kefir and Torula kefir, which help control and eliminate destructive pathogenic yeasts in the body by penetrating the mucosal lining where unhealthy yeast and bacteria reside. Thus the body becomes more efficient in resisting pathogens like E. coli and intestinal parasites.
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Strongly counter-indicative
Very strongly or absolutely counter-indicative
Highly recommended







GLOSSARY

Acidophilus:  A microflora (good bacteria) that acts as a digestive aid and lives in your intestines helping your body fight disease.

Allergy:  Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.

Arthritis:  Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.

Atherosclerosis:  Common form of arteriosclerosis associated with the formation of atheromas which are deposits of yellow plaques containing cholesterol, lipids, and lipophages within the intima and inner media of arteries. This results in a narrowing of the arteries, which reduces the blood and oxygen flow to the heart and brain as well as to other parts of the body and can lead to a heart attack, stroke, or loss of function or gangrene of other tissues.

Bacteria:  Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.

Calcium:  The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. Calcium is also important to heart health, nerves, muscles and skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Crohn's Disease:  Chronic inflammatory disease of the gastrointestinal tract. The most common symptoms are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia.

Diabetes Mellitus:  A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.

Diarrhea:  Excessive discharge of contents of bowel.

Enzymes:  Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.

Epidemiology:  The study of the causes and distribution of disease in human populations.

FDA:  The (American) Food and Drug Administration. It is the official government agency that is responsible for ensuring that what we put into our bodies - particularly food and drugs - is safe and effective.

Flatulence:  Abnormal amount of gas in the stomach and intestines.

Gastrointestinal:  Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.

Glucose:  A sugar that is the simplest form of carbohydrate. It is commonly referred to as blood sugar. The body breaks down carbohydrates in foods into glucose, which serves as the primary fuel for the muscles and the brain.

Hemoglobin:  The oxygen-carrying protein of the blood found in red blood cells.

Kidney Stone:  A stone (concretion) in the kidney. If the stone is large enough to block the tube (ureter) and stop the flow of urine from the kidney, it must be removed by surgery or other methods. Also called Renal Calculus. Symptoms usually begin with intense waves of pain as a stone moves in the urinary tract. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Later, pain may spread to the groin. The pain may continue if the stone is too large to pass; blood may appear in the urine and there may be the need to urinate more often or a burning sensation during urination. If fever and chills accompany any of these symptoms, an infection may be present and a doctor should be seen immediately.

Lactase:  An enzyme that aids the body in converting lactose to glucose and galactose. It is also necessary for digestion of milk and milk products.

Lactose Intolerance:  A condition caused by a lack of an enzyme called lactase, which, in turn, causes the body to be unable to digest lactose, a sugar found in milk products. Common symptoms, which begin about 30 minutes to two hours after consuming foods or beverages containing lactose, may include: nausea, cramps, bloating, gas and/or diarrhea. The severity of symptoms varies depending on the amount of lactose consumed and the amount that an individual can tolerate.

Metabolism:  The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.

Osteoporosis:  A disease in which bone tissue becomes porous and brittle. The disease primarily affects postmenopausal women.

Protein:  Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.

RNA:  A ribonucleic acid found in plant and animal cells; a complex protein chemical. Important in the coding of genetic information with DNA carrying information from the nucleus of the cell into the cytoplasm.

Stomach:  A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.

Urticaria:  Commonly known as hives, urticaria is one of the most common dermatological conditions seen by allergists. Urticaria is not just an allergic disease, however. It can be caused by metabolic diseases, medications, infectious diseases, autoimmune disease, or physical sensitivity. Traditional allergies to foods or medications as well as viral illness are frequent causes of acute urticaria which usually lasts only a few hours but may last up to 6 weeks. Chronic urticaria (lasting more than 6 weeks) is more complex, given the vast number of potential triggers. Symptoms include sudden onset; initial itching; then swelling of the surface of the skin into red or skin-colored welts (wheals) with clearly defined edges; welts turn white on touching; new welts develop when the skin is scratched; usually disappear within minutes or hours. Welts enlarge, change shape, spread or join together to form large flat raised areas.