What is Lactose Intolerance

Lactose intolerance, or less commonly, milk-alkali syndrome, is the inability to digest lactose.

People with this condition have a problem digesting lactose, the sugar found in dairy products. Lactose intolerance is relatively common. 

This is due to a temporary lack of required lactase as an enzyme needed for digestion of dairy products such as milk and yogurt. 

Common sources include milk products made from cow’s milk; there are lesser-known sources such as goat’s and sheep’s milk. 

Lactose can also be found in larger amounts in processed foods with a longer shelf life such as canned vegetables, sausages, baked goods, and frozen dinners. 

Rarely, lactose can be found in minute amounts in certain other foods including yeast extract (marmite), certain brands of muesli bars, soy, and soybean products like soymilk ice cream (watch out for faux ice cream) vegan animal free dairy alternatives like coconut-based products including rice alternatives that use coconut extract instead of real sugar.

It can sometimes result in stomach pain or nausea, but usually these symptoms won’t be too severe and will go away after eating only small amounts of the offending foods.

The condition affects between 30 and 50 million Americans – or up to 75 percent of all adults worldwide. 

If you have a sensitivity to lactose, then it’s possible that you will have loose or even watery stool after eating foods that contain the sugar such as milk and ice cream. 

It can sometimes result in stomach pain or nausea, but usually these symptoms won’t be too severe and will go away after eating only small amounts of the offending foods. 

Causes of Lactose Intolerance

  
Lactose intolerance is caused by a shortage of lactase, an enzyme produced in the small intestine which helps to break down lactose for easy digestion.

There are two main types of lactose intolerance, and both have different causes: 

Primary Lactose Intolerance

Primary lactose intolerance is an inability of the body to digest lactose.

Lactose is broken down by an enzyme called lactase, which is produced by cells in the small intestine.

If people have primary lactose intolerance, they don’t produce enough of this enzyme to break down the amount of lactose reaching the bowel, causing symptoms such as diarrhoea and cramps.

An absence of lactase doesn’t usually cause any health problems until babies start drinking cows’ milk – a baby will stop producing its own supply by five years old.

However, some adults are born with primary lactose intolerance due to a gene mutation that can be passed from parent to child.

Alternatively it could develop as part of another digestive problem such as Crohn’s or Celiac disease or in people with irritable bowel syndrome (IBS).

Secondary Lactose Intolerance

Secondary is lactose intolerance (LI) which is caused by an underlying issue, such as surgery, illness, or a virus.

In these cases, the body loses the ability to digest lactose with normal fluid production of the enzyme that breaks down lactose.

Secondary LI can happen at any age and happens most commonly due to damage to the small intestine or following surgery.

Without enough lactase, undigested lactose is unable to pass through into the colon where it is broken down by bacteria, producing toxins and causing discomfort as a result. 

This leads to the illness known as lactose intolerance. 

These cases can result in severe cases of food allergies or symptoms that mimic other diseases like Crohn’s disease.

It should be stressed that not everyone that drinks milk will develop lactose intolerance, but there are several risk factors and causes that can leave people with the condition.

These include:

• Newborn babies produce little or no lactase and must be introduced slowly in their diets over time to avoid symptoms
• Being younger when first ingesting lactose in large quantities
• Being unable to produce the right amount of lactase
• People over 40 have lower levels of production
• Some cases can also be caused by injury or surgery on the small intestines
• Some people are simply born without adequate amounts of lactase for digestion
• Being unable to produce the right amount of lactase needed for digesting dairy products

For those who can’t tolerate the lactose in dairy products, they should completely avoid it and seek another source of nutrients. 

Symptoms of Lactose Intolerance

Symptoms of lactose intolerance can usually start from 30 minutes to two hours after eating or drinking lactose contained foods. 

In such cases, undigested lactose remains in the bowel where it draws water and ferments, leading to unpleasant symptoms such as: 

• Diarrhea
• Nausea
• Vomiting
• Stomach Cramps
• Bloating
• Gas 

The symptoms of lactose intolerance vary from person to person and can be mild or severe depending on the amount of lactose you’re able to consume in one sitting. 

Most people are unaware they have a problem with dairy products until they feel symptoms, and once they start avoiding dairy foods, it can take anywhere from four days to two weeks before they feel normal again. 

For others that have a more severe problem and process the enzyme lactase inefficiently, symptoms may occur more quickly after consuming milk or dairy products.
 

Treatment of Lactose Intolerance

Awareness of lactose intolerance is increasing at a rapid pace, but many people still don’t know about it or exactly what causes it.

There are many treatment options available for those intolerants to lactose.

The first is to cut out products which contain lactose and if you don’t like doing that, drink Lactase Enzyme Milk with your dairy products.

This reduces symptoms such as bloating and diarrhea.

Now that you know the symptoms of being lactose intolerant, let’s look at some treatment options available: 

• Limit milk and other dairy products
• Consume small servings of dairy products in your meals
• Adding lactase enzyme to milk to break down the lactose
• Probiotics or prebiotics

Lactose Intolerant Diet

Avoiding dairy products like milk, cheese and yogurt can seem difficult for lactose intolerant people.

Many people aren’t aware that there are certain foods that can help to relieve lactose intolerance, in addition to avoiding high lactose-containing foods.
 

Foods to Eat:

• Fruits: Oranges, Apples, Berries, Peaches, Plums, Grapes, Pineapples
• Nuts: Almonds, Walnuts, Pistachios, Cashews, Brazil nuts, Hazelnuts
• Vegetables: Garlic, Kale, Spinach, Arugula, Zucchini, Carrots, Onions
• Whole Grains: Barley, Buckwheat, Quinoa, Couscous, Wheat, Oats
• Meat: Beef, Lamb, Pork, Veal
• Poultry: Chicken, Turkey, Goose, Duck
• Beverages: Water, Tea, Brewed Coffee, Coconut Water
• Seafood: Tuna, Mackerel, Salmon, Anchovies, Lobster, Sardines, Clams

 Foods to Avoid:

• Milk: Cow’s Milk, Goat’s Milk
• Cheese: Soft Cheeses – Cream Cheese, Cottage Cheese, Mozzarella, Ricotta
• Butter
• Yogurt
• Whipped Cream
• Sour Cream
• Buttermilk
• Ice Cream
• Frozen Yogurt

However, you must remember to always test dairy items before ingesting them because there continues to be some debate as to whether all people lactose intolerant are sensitive to dairy items. 

Also remember not to eliminate all dairy items at once so as not cause adverse reactions or ‘rebound intolerance’.  

Summary

Being lactose intolerant can be challenging, but it does not necessarily mean that it needs to have a negative effect on your quality of life.

There are however lifestyle and dietary changes which can be implemented, along with the medicinal prescriptions from a doctor, that can alleviate most, if not all, of the suffering experienced by those with lactose intolerance.

At GiDoc JHB, we know digestive problems can affect your quality of life, but it doesn’t have to. 

Dr. Schneider is dedicated to providing compassionate, comprehensive and personalized care for all patients.

For more information contact Dr. Schneider or visit www.gidocjhb.co.za and book your consultation today.

If you’re experiencing stomach pain but are unsure whether it is serious enough to see a specialist, read here to learn how to differentiate between ordinary pain and stomach illnesses. It may be time to book an appointment with your specialist.

Most of us have experienced an upset stomach from an acute illness, this is most often something that one can self-medicate at home, or even with a visit to your GP if you feel your symptoms need medical assistance.

But what should you do if you have stomach pain that occurs frequently or lasts for long periods?

If the usual remedies don’t work and the discomfort persists long term, you might find you have an underlying condition that affects your gastrointestinal system. If you do decide to visit your GP as well, they will recommend seeing a gastroenterologist for specialist care.

There could be many reasons you should consult a gastroenterologist, also known as a digestion doctor, if you are experiencing discomfort and unusual symptoms.

It is a common misconception that a gastroenterologist is just a stomach doctor and deals exclusively with that area of the body, but in fact, these specialists help treat conditions for many different areas of your body.

A gastroenterologist can assist with symptoms ranging from the esophagus all the way down to the rectum.

This post will explore the various reasons one might need to make an appointment and get an expert opinion to get you feeling right as rain again.

What Is a Gastroenterologist?

Most of us don’t have an in-depth understanding of the specialization of a digestion doctor until we are in huge amounts of pain that does not subside the way that some acute illnesses usually would.

This is when we’re forced to seek specialized help from specialists such as a gastroenterologist. 

Where Can Stomach Pains Come From?

When we consider the gastrointestinal system, most people would naturally assume that this is limited to the stomach and intestines.

In reality, gastroenterology involves looking at the normal function and diseases of the entire gastrointestinal tract – including your esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts, and liver.

Issues with any of these parts of the body could cause what appears to be stomach pain and may warrant a visit to a gastroenterologist to confirm a diagnosis and receive treatment.

Conditions Managed by Gastroenterologists

Some of the most common ailments that one would visit a gastroenterologists for include the following:

• • • Cancer (Gastrointestinal, Liver, Pancreatic, Colorectal)
    • Irritable Bowel Syndrome (IBS)
    • Celiac Disease
    • Inflammatory Bowel Disease
    • Gallbladder Disease
    • GERD (Heartburn, Acid Reflux)
    • Hemorrhoids (Swollen Veins in the Lowest Part of the Rectum and Anus)
    • Polyps (Abnormal Tissue Growths)
    • Ulcers (Painful Sores in the Stomach Lining)
    • Pancreatitis

Some of the above conditions can become much worse and potentially cause severe long-term complications if one does not get the required medical attention as soon as possible.

Below, we will look at some of the instances where your stomach pain is no longer something that can be cured by a home remedy, but rather requires an appointment with a gastroenterologist.

Types and Sources of Stomach Pain

Stomach pain can be a difficult pain to diagnose oneself, because often the pain is not actually located in what the average person calls the stomach area but is in fact more pinpointed to a specific region of the abdominal cavity.

Many vital organs make up this general area, such as the small and large intestines, appendix, kidneys, liver, and gallbladder.

The digestive tract is also found in this general area of the body, along with all the building blocks like muscles, bones, blood vessels, and other structures.

It is clear just from listing these various areas and components that there is a lot more going on in the abdomen than just the stomach, and this is what can make it difficult for you to differentiate between and locate the issue yourself.  

There are, of course, acute ailments that most of us have experienced in the past and at least have an idea of the familiar sensation – something like indigestion, bloating and gas, or constipation.

This pain is passing, doesn’t last for long periods of time, and does not occur repeatedly. These ailments typically present as generalised pain.

Stomach Pain That Requires a Gastroenterologist

Generalised pain is something you should be able to recognise as a separate sensation to abdominal pain, which is localised to a particular region.

If you can feel, for example, that your kidneys are in pain (read here to see where they are located if you are unsure) you can then monitor it accordingly.

If it does not pass in a short amount of time but instead persists, or even worsens, it may indicate that it’s time to see your doctor.

Let’s have a look at some signs which may indicate it is necessary to seek specialised medical assistance.

1.    Intense Pain Accompanied by Bloody Diarrhea

Intense pain that comes on quickly can be a sign that you are suffering from a foodborne illness, having consumed contaminated food.

This could be a result of food poisoning, Salmonella, or E. Coli. These are generalized pains and are likely something you will have experienced before and will subside within hours.

If the pain is persistent and is accompanied by blood in diarrhoea, you could be experiencing something more serious, possibly ulcerative colitis or another inflammatory bowel disease.

2. Sudden Pain Paired with Vomiting

As with the first sign, this could be as a result of contracting a foodborne illness which would then pass within several hours or days.

Alternatively, you could be experiencing acute gastroenteritis (‘stomach flu’). Gastroenteritis is caused by a bacteria, virus, or parasite and causes inflammation of the intestine lining.

Viral gastroenteritis is very common today and is another instance where home care will suffice, and the pain will not last past a few days.

As such, it’s not essential to see a gastroenterologist but if you are struggling to keep fluids down then a visit to the doctor is needed.

3. Intense Stomach Pain in Lower Abdomen

If your pain is located in the lower abdomen, this could be something that subsides after a bowel movement, indicating you may be suffering from IBS.

Irritable bowel syndrome can sometimes seem like it’s acute pain and passes quickly but keep track of how often this happens.

It is normal to have occasional constipation, however, if you are experiencing less than three bowel movements a week coupled with intense lower abdomen pain, the issue is more serious.

4. Side or Lower Back Pain

Experiencing pain in your side or lower back could indicate kidney stones if this abdominal pain is also accompanied by discomfort and pain when urinating.

Kidney stones cause pain due to their sharp crystalline structure which irritates the urinary tract as it passes through.

Some people will find this pain almost unbearable and is uncommon in acute illnesses, making it easier to know that this is a serious instance in which a visit to your gastroenterologist is necessary.

In conclusion

It is very unlikely that you have never experienced any form of stomach pain in your life, but most of these cases will have been acute illnesses and short-lived symptoms.

These forms of stomach pain are quite mild and don’t require attention from a medical professional.

If the pain persists for long periods, intensifies over time, or is localized rather than generalised pain then you should aim to seek assistance from your doctor as soon as possible.

Learn More from the Experts

GiDoc Johannesburg is here to provide you with expert medical advice in the field of gastroenterology.

Book an appointment online or give us a call at 011 482-3010 to find out more.