A few easy steps can assist management

Lactose intolerance, a condition where the body cannot digest a milk sugar due to enzyme deficiency, is commonly considered in patients presenting with gastrointestinal symptoms including diarrhoea, abdominal pain, and bloating. It may occur in isolation or alongside other intolerances or irritable bowel syndrome.

Accredited Practicing Dietitian Joanna Baker of Everyday Nutrition is surprised by the number of patients still being referred for breath testing. She describes the most efficient and useful way of diagnosing the disorder is a simple trial of lactose exclusion for up to two weeks, although she says most patients would find resolution of symptoms much earlier. “We know that you can malabsorb lactose but not get symptoms,” Joanna says.

She explains that about 70% of Australian adults test positive on a breath test, but that CSIRO data tells us only 12% have symptoms. Joanna notes that there is large variation in terms of the way the tests are administered and reported, and that the results are often not reproducible.

Joanna Baker will be discussing lactose intolerance in detail during the 22nd November healthed webcast. Sign up for free here. 

“Lactose intolerance is not a dangerous thing,” Baker says, and hence her management goals focus on improving quality of life and protecting the patient’s relationship with food. Joanna recommends that “lactose free does not mean completely dairy free.”

Baker points out that people often forget that hard cheeses and butter do not contain lactose, and that the best milk alternative is lactose-free milk because it is nutritionally equivalent.

Baker notes that lactase is now available in tablet form to allow people to continue to eat lactose if they wish. If dairy is being completely replaced, it is important that alternatives are calcium-fortified, and in this situation, Baker would prefer soy milk.

If removing lactose does not improve all the symptoms, Baker says it is then reasonable to trial a full dairy exclusion to exclude a milk protein intolerance. The evidence for beta-casein sensitivity is mixed, but Baker has definitely seen certain patients do better on A2 milk.

Baker explains that paediatric patients are more likely to have protein intolerance than lactose intolerance, so for them she would recommend trying an A2 milk first, then going dairy free if needed. She notes that true milk protein allergy (that could cause anaphylaxis) is usually outgrown by school age.

Baker does caution that “when we start restricting diets, we risk disordered eating behaviours.” She implores GPs not to “ignore the person’s relationship with food” because food is about more than just nutrition.

“Food is about social connection. It’s about pleasure. It’s about enjoyment.”

Joanna Baker will be discussing lactose intolerance in detail during the 22nd November healthed webcast. Sign up for free here.