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Lactose intolerance
Milkandotherdairyproductscontainasugarorcarbohydratecalledlactose.Normally,thebody breaksdownlactoseintoitssimplercomponentswiththehelpoftheenzymelactase.Most mammalsstopproducinglactasewhentheyareweaned;humans,however,continuetoproduceit throughoutlife.Withoutenoughlactase,apersoncanhavedigestiveproblemslikeabdominalpain anddiarrhoea.Thisisknownaslactoseintoleranceorlactasedeficiency. ItisrareforCaucasianstodeveloplactoseintolerance.However,itisquitecommonamongpeople fromAsia,Africa,theMiddleEastandsomeMediterraneancountries,aswellasamongAustralian Aborigines.UptofivepercentofCaucasiansandupto75percentofnon-Caucasianslivingin Australiaarelactoseintolerant. ManyAustralianbabiesareunnecessarilyweanedbecausetheirirritabilityiswronglyassumedto belactoseintolerance.Inreality,thesevereformofthisconditionknownasprimarylactose intolerance(wheretheinfantdoesnotproducelactasefrombirth)israre.Secondarylactose intolerance(whichdevelopsafterweaning)ismorecommon.Thiscanoccurtemporarilyaftera boutofgastroenteritis,forexample,butoftenimprovesafterseveralweeksastheliningofthegut heals. Symptoms Manypeoplewithlactoseintolerancehaveaparticulartolerancelevel,whichallowsthemto consumesomelactosewithminimalsymptoms.Symptomsoflactoseintoleranceinclude: Abdominalpain Abdominalswelling Flatulence Diarrhoea.

Ima ge des crip

Symptomsoflactoseintoleranceareoftenconfusedwithsymptomsofirritablebowelsyndrome (IBS).PeoplewithIBSarenotlactoseintolerant,buttendtohavedifficultytoleratingfat.Ifyou thinkyoumaybelactoseintolerant,seeyourdoctor. Undigested milk sugars Theenzymelactasebreaksdownmilksugar(lactose).Lactaseenzymesarefoundinthemucusof thesmallintestine.Theychangethemilksugarintotheabsorbablecompoundsglucoseand galactose. Ifthereisnotenoughlactasearound,thelactoseskipstheusualdigestiveprocessandispartially brokendownbythebacteriaintheintestines.Thisfermentationprocesscausesexcessivewind, bloatingandassociatedpain.Anyundigestedlactoseissentalongtheintestinaltract.Waterisnot removedfromthefaecalmatteranddiarrhoeaistheresult. Causes of lactose intolerance Lactoseintoleranceislargelygeneticallydetermined.Somecausesinclude: Congenitalthisisthemaincausesoyoucanblameyourgenesifyouhavelesslactase thanusual. Gastroenteritisthiscanstriptheintestinesoflactaseforafewweeks. Parasitic infectionthiscantemporarilyreducelactaselevels. Iron deficiencylackofironinthedietcaninterferewithlactosedigestionand absorption.

Lactose intolerance in babies

Lactoseintolerance

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Aroundtwothirdsofbabies,eitherbreast-orbottle-fed,willexperiencesomedegreeoflactase deficiencyintheirearlymonthswithoutitcausingthemharm.Humanbreastmilkcontainsaround sevenpercentlactose.Theamountoflactoseinbreastmilkisnotaffectedbythemothersdiet. Thismeansthemothercantinfluencetheamountoflactoseinhermilkbyreducingoreliminating dairyfoods. Aboutofgastroenteritiscanstripthebabyssmallintestineoflactaseenzymes,andlactose-free formulamayneedtobeusedforanumberofweeksuntiltheirenzymelevelsrecover.Lactase dropsareanotheroption,butthesearenotalwayshelpful.Afewbabiesarebornwithoutany lactaseenzymesatall,andlactose-freeformulasmaybeanoptioninsuchcases.Lactose intolerancedoesnotcausevomitinginbabies.Thismaybesymptomaticofanallergytocows milk. Diagnosis methods Variousmethodsmaybeusedtodiagnoselactoseintolerance,including: Hydrogen breath test thisteststheamountofhydrogenthatisbreathedout.When lactoseisfermentedbybacteriainthebowel,insteadofbeingconvertedbylactase,more hydrogenisproduced. Elimination diet thisinvolvesremovingfoodsthatcontainlactosetoseeifthe symptomsimprove.Ifthesymptomsreappearoncethefoodsarereintroduced,then lactoseintoleranceismostlikelythecause.

Anothercheapandsimpletestistocomparewhetherthepersoncantoleratelactose-freemilk ratherthanordinarymilk. Managing lactose intolerance Mostpeoplewithlactoseintolerancecanhandlesmallamountsoflactose,suchasaglassofmilk. However,thefollowingtipsmayhelp: Trycheeseandyoghurt;theyaregenerallybettertoleratedthanmilk. Drinkfullfatmilkbecausethefatsslowthejourneyofthemilkthroughtheintestinesand allowthelactaseenzymesmoretimetobreakdownthesugars. Avoidlowfatornon-fatmilkstheytravelquicklythroughthegutandtendtocause symptomsinlactoseintolerantpeople.Also,manylowfatmilkproductsmaycontainskim milkpowder,whichprovidesahigherdoseoflactose. Dontgiveupmilkproductsentirely.Theyareverynutritious. Drinkmilkinmoderatequantities.Mostpeoplewiththisconditioncantolerate240mlof milkperday,butyouneedtobeworkoutyourowntolerancelevel.Youcanbuymilkthat hashadthelactosebrokendown,whichmakesitlactosefree. Havemoderateamountsofdairyfoods.Mostpeoplecantoleratetheamountoflactose foundin: -Halfacupoffullcreammilk -Three-quartersofacupoficecream -Three-quartersofacupofyoghurt -Halfacupofwhitesauce -Three-quartersofacupofunripenedcheeseslikecottageorricotta. Eatfermentedmilkproductslikesomeyoghurts,matureorripenedcheeses(likecheddar, fettaandmozzarella),andbuttertheyusuallydontcauseproblems. Eatfoodsthatcontainlactoseincombinationwithotherfoodsorspreadthemoutoverthe day,ratherthaneatingalargeamountatonce. Useheatedmilkproductslikeevaporatedmilk;theyseemtobebettertoleratedbecause theheatingprocessbreaksdownsomeofthelactosetoglucoseandgalactose. Havesoyfoods;theyarelactosefree,agoodsourceofcalciumandagoodsubstitutefor milkormilkproducts.

Hidden lactose Foodsthatmaycontainhiddenlactoseinclude: Biscuitsandcakes(ifmilkormilksolidsareadded) Processedbreakfastcereals Cheesesauce Creamsoups Custard Milkchocolate Pancakesandpikelets

Lactoseintolerance

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Scrambledeggs Quiche Mueslibars Somebreadsandmargarine(containingmilk).

Check the labels Ifyouaretryingtoavoidlactose,lookforthefollowingingredientsinlistsonfoodlabels: Milksolids Non-fatmilksolids Whey Milksugar.

Where to get help Yourdoctor Anaccreditedpractisingdietitian,contacttheDietitiansAssociationofAustralia

Things to remember

Lactoseisamilksugarthatisbrokendownbytheenzymelactase,whichisfoundinthe smallintestine. Lactoseintoleranceisthereducedabilitytodigestmilksugars,duetoinsufficientamounts ofthegutenzymecalledlactase. Symptomsincludebloating,gas,abdominalpainanddiarrhoea.

This page has been produced in consultation with, and approved by:

AustralasianSocietyofClinicalImmunologyandAllergy(ASCIA)

Copyight 1999/2009StateofVictoria.ReproducedfromtheBetterHealthChannel(www.betterhealth.vic.gov.au)at nocostwithpermissionoftheVictorianMinisterforHealth.Unauthorisedreproductionandotherusescomprisedinthe copyrightareprohibitedwithoutpermission. ThisBetterHealthChannelfactsheethaspassedthrougharigorousapprovalprocess.Forthelatestupdatesandmore informationvisitwww.betterhealth.vic.gov.au.

Lactoseintolerance

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