5 Things You Should Know About Lactose Intolerance
It’s never been so complex to order a coffee, and we Australian’s are somewhat “particular” about it especially with the rise of endless milk options to choose from! But the array of lovely milks such as almond, macadamia & coconut are serving a significant part of the population well considering 6% of Anglo Australian’s and 84% of Indigenous Australians are living with lactose intolerance and many others opting for a dairy free option for one reason or another. But what is going on with lactose exactly and could you be heading down the lactose intolerance path as well?
1. Lactose digestion – the tip of our villi (finger like projections that line the inside of our gastrointestinal tract) contain the enzyme ‘lactase’. This lactase enzyme is responsible for breaking apart the bonds of lactose leaving 1 molecule of galactose and 1 molecule of glucose. These single sugar molecules are then absorbed into the bloodstream across the intestinal wall which can then be utilised by the body. This is a normal process.
2. Lactose issues:
a. Lactose non-persistence – a normal process in which a person loses their capacity to digest lactose as they age due to a reduced production of lactase. The reduction of lactase production and at what rate depends on the individual. It is believed that as our need to consume and digest milk from our mothers is contained to the begining of our life, lactase prodcutoin naturally tapers off. Subseqently, this can lead to the following points b. and possibly c
b. Lactose malabsorption – when there is a certain amount of lactose reaching the colon due to the incomplete digestion (breaking of lactose bonds) in the small bowel. A person with lactose malabsorption may or may not experience symptoms, depending on how much undigested lactose reaches the colon. If they do experience symptoms, they can consider themselves to have lactose intolerance
c. Lactose intolerance – when the malabsorption of lactose causes symptoms such as digestive discomfort, excessive wind, diarrhoea & cramping.
d. Secondary lactose intolerance – occurs in people that have experienced an illness or significant trauma which has damaged their intestinal wall such as chemotherapy, radiotherapy, giardiasis, gastroenteritis, crohns and coeliacs.
3. The symptoms of lactose intolerance are due to the lactose bonds not been broken down. When lactose stays in tact (as opposed to being split into a galactose and a lactose molecule) it cannot be absorbed through the intestinal wall so it sits there. The bacterias in the GUT however can absorb lactose but the result is fermentation which causes methane gas (think farts!) and an osmotic effect – water is drawn into the bowel causing symtoms of bloating, gurgling and decreased transit time (think diarrhoea!)
4. Why do some people have lactose intolerance? This area is not completely understood but could be due to the health and diversity of an individuals microbiome and visceral sensitivity (pain sensation within organs). People with lactose intolerance are far more susceptible to other malabsorption issues such as fructose and gluten sensitivity.
5. Why can I eat some dairy but not all dairy? Symptoms of lactose intolerance are dose related. In other words, a low dose of lactose (under 10g) in one sitting generally causes minor or no symptoms. Some dairy is higher in lactose such as cows milk & ice cream.
My general advise around lactose is to consume small amounts of organic dairy and ensure adequate intake of other foods high in calcium on a daily basis such as unhulled tahini, mollasses, sardines & salmon, almonds, cabbage & fortified milks.
If symptoms persist or you sense there is an underlying health issue, contact me for a consultation.
Information provided by Jason Hawrelak – Gastrointestinal 2 Materclass
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