Trip Answers

Question answered:08/11/07 Warning! this question is over two years old.

An American guideline on lactose intolerance in infants, children and adolescents states:

 

"Treatment is relatively simple and aimed at reducing or eliminating the inciting substance, lactose, by eliminating it from the diet or by "predigesting" it with supplemental lactase-enzyme replacement.

 

“Treatment of lactose intolerance by elimination of milk and other dairy products is not usually necessary given newer approaches to lactose intolerance, including the use of partially digested products (such as yogurts, cheeses, products containing Lactobacillus acidophilus, and pretreated milks (Medow et al., 1990; Saunders & Klaenhammer, 2001). Evidence that avoidance of dairy products may lead to inadequate calcium intake and consequent suboptimal bone mineralization makes these important as alternatives to milk…” [1]

 

CORE, a gastroenterology charity, notes in its patient information leaflet:

 

“There is no cure because lactase cannot be replaced, although some cases of lactose intolerance are temporary.
Children with congenital lactase deficiency need a milk free diet and should be advised by a dietician to avoid deficiency of essential nutrients.
For affected adults, taking lactose in milk causes no harm and the worst that can happen is the development of wind or mild diarrhoea. For most adults, it is a matter of finding how much milk can be taken without causing symptoms. Most people will find, for example, that they can take milk in tea or coffee, though a glass of milk or a milk pudding causes them a mild upset.
Some people can take yoghurt without trouble because the lactose in the milk has been fermented by the bacteria used to make it. Hard cheese is naturally low in lactose and is usually well tolerated.
Lactose reduced milks are available in supermarkets. These can be used with cereals or in puddings.” [2]

 

An article published in the ‘World Journal of Gastroenterology’ in 2006 provides a review and critique of therapies for lactose intolerance. In the abstract of the article, the authors state:

 

“In patients with lactase nonpersistence, treatment is considered exclusively in the presence of intolerance symptoms [11]. In the absence of guidelines, the common therapeutic approach tends to exclude milk and dairy products from the diet. However, this strategy may have serious nutritional disadvantages, chiefly for reduced intake of substances such as calcium, phosphorus and vitamins, and may be associated with decreased bone mineral density. To overcome these limits, several studies have been carried out to find alternative approaches, such as exogenous â-galactosidase, yogurt and probiotics for their bacterial lactase activity, pharmacological and non pharmacological strategies that can prolong contact time between enzyme and substrate delaying gastrointestinal transit time, and chronic lactose ingestion to enhance colonic adaptation…”

 

The full text of this article can be accessed by following the link, given in the references section. [3]

References
1. Heyman MB, Committee on Nutrition. Lactose intolerance in infants, children, and adolescents. Pediatrics 2006 Sep;118(3):1279-86. (http://www.guideline.gov/summary/summary.aspx?doc_id=9827&nbr=5251&ss=6&xl=999)
2. CORE. Lactose intolerance. 2005. (http://www.corecharity.org.uk/content/pdfs/11_Lactose_Intolerance_2005.pdf)
3. Montalto M, Curigliano V, Santoro L et al. Management and treatment of lactose malabsorption. World J Gastroenterol. 2006 Jan 14;12(2):187-91. (http://www.wjgnet.com/1007-9327/12/187.asp)

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