Lactose Intolerance

What is lactose?

Lactose is a carbohydrate or sugar that is found in all types of milk – cow milk, goat’s milk, including human milk. Lactose is basically made up of two simple sugars galactose and glucose. Your breast milk contains around seven percent lactose and you will find the same amount in infant formulas.

Lactose is important in our diet and especially in the growth and development of your baby. It helps in better absorption of calcium and phosphorus while promoting the growth of friendly bacteria maintaining good health in our intestines.

What is lactose intolerance?

Lactose intolerance is the expression used to describe people who can’t easily digest lactose. This is due to lack of enough ‘lactase enzymes’ in the digestive system that is required to break down the lactose in milk and other dairy products.

What are the symptoms of lactose intolerance?

Symptoms of lactose intolerance in your baby can include,

  • Watery bowel movements
  • Bloating
  • Cramps
  • Excessive gas
  • Rapid weight loss
  • Red and inflamed diaper rash

What are the types of lactose intolerance?

There are different types of lactose intolerance and many people classify them differently.

Primary lactose intoleranceis rare and extreme condition where babies are born with an inability to digest the enzyme lactase. It is easy to diagnose primary lactose intolerance because your baby will not gain weight and will be often ill.

Then we have something called secondary lactose intolerance, this type of intolerance often follows a bout of illness such as diarrhea, vomiting or any bowel infection. This doesn’t last more than a few short weeks. After the balance of healthy bacteria in the gut returns, this type of intolerance disappears.

The most common type of lactose intolerance that is seen among adults is acquired lactose intolerance and as the name suggests it is inherited. This is mostly seen among ethnic backgrounds where milk is not given past infancy. Examples include,

  • Indigenous Australians – about 70 percent
  • Asians – 93 percent
  • Greeks – about 50 percent
  • Middle Eastern cultures – around 40 percent
  • People whose family history originates in Northern Europe – around 5-10 percent

Often mistaken for lactose intolerance another interesting type is lactose overload. It has the same symptoms as lactose intolerance but babies experiencing gastric symptoms attributed to lactose overload gain weight instead of losing weight.

Cow’s milk protein (CMP) intolerance VS Lactose intolerance (LI)

  • CMP is often mistaken for lactose intolerance and is not quite the same thing.
  • CMP involves the immune system, which reacts to protein molecules that have passed into the bloodstream.
  • CMP is more severe than LI, and is affected by the maternal diet, has a family factor and can interfere more with the diet.

What to do when a breastfed baby is lactose intolerant?

  • It is rare for doctors to ask a breastfeeding mum to stop feeding her baby in cases of lactose intolerance. This is because there are many compounds in breast milk that supports immune system and development and aids in lactose digestion.
  • There is a huge debate about if it is possible to reduce the level of lactose in mum’s milk while breastfeeding. There is no evidence today to suggest you can alter the levels of lactose in your milk by changing your diet or expressing before a feed.

What to do when a formula-fed baby is lactose intolerant?

  • Experts always say mum’s breast milk is best when it comes to feeding babies and no high quality formula can match that. Most formulas use cow’s milk as their base and your baby will probably experience some issues.
  • You can switch to whey- or casein-dominant formula, whey is generally better tolerated, by new born infants.
  • Another option is to use AR or anti-regurgitation formulas where the milk proteins are broken down by a high degree.
  • You can also use partially or extensively hydrolysed (HA) or amino acid (such as Neocate) formula, to reduce the risk of allergic reaction in your baby. Doctors suggest that it is the protein components in food that increase allergic reactions. These kinds of formulas have fewer milk proteins.
  • Today you also have the option of using low lactose (and in some cases lactose-free) ‘enhanced’ brands that may have a mixture of fish oils, probiotics, nucleotides and more.

Are there any tests available to detect lactose intolerance?

Hydrogen breath test:As the name suggests diagnosis of intolerance is based on the presence of hydrogen in the breath due to incomplete digestion of lactose. Most of these tests may not be reliable because normal babies under three months often test positive.

Elimination diet:Eliminate lactose in your baby’s diet for a period of time and check if symptoms of lactose intolerance persist. If symptoms disappear you can fairly sure it’s lactose intolerance, but it’s always a good idea to confirm with your doctor.

Trial lactose:Try lactose free milk and monitor if there is any change in comparison to regular milk.

Stool acidity test:Diagnosis is based on the levels of acidity in your baby’s stools.

What kinds of food have lactose in it?

If you need to eliminate lactose from foods to do the elimination diets then you have to be able to identify the foods that have lactose in it.

  • Human breast milk has around seven percent of lactose in it.
  • Unprocessed cow’s milk and goat’s milk have similar lactose content as human milk.
  • Butter has a lower percentage of lactose because it is made by separating the water content from it. Lactose is not found in the fatty layer of milk.
  • Cheese is similar to butter in lactose content because of the way it is made.
  • Check for ingredients that says milk, milk solids or modified milk ingredients on the products you buy.
  • Low lactose foods include ice-cream, cheddar cheese and naturally made yoghurt.

Useful tips when to deal with lactose intolerance

  • Lactose intolerance doesn’t mean avoiding every drop of milk; different people have different levels of tolerance to lactose. Choose low lactose products such as yoghurt.
  • Choose full cream milk and full fat diary products, skimmed milk or fat free milk usually have higher lactose content because the fatty milk layer is removed and has more of the water content that you need to avoid.
  • Having a little milk with coffee or tea is okay if you lactose intolerant.
  • Try different milk products to avoid a build up of one particular product.
  • Today you have lovely alternatives like soy, rice, oats and other plant based fluids.
  • Mix milk with other products to make it easy to digest.
  • Read labels carefully while shopping at the grocery store.
  • Some suggest adding probiotics like Yakult to milk might help digest the lactose.