Lactose Intolerance or Milk Allergy?

Shavuot is coming, bringing with it festive meals, perhaps a walk to the Kotel, interesting learning, and a whole host of gastrointestinal complications for those of us who have a complicated relationship to dairy.

Let’s take a few moments to review the various ailments we can have with lactose, how we deal with them and what our available treatment options are according to Ministry of Health guidelines.

According to recent polls, approximately 5% of the Israeli population suffer from some form of allergy to milk protein (lactose); 70% suffer some type of lactose intolerance. It’s therefore important to understand the difference between intolerance and allergy.

Lactose Intolerance – This is when the body fails to produce the enzyme lactase that breaks down the lactose, the sugar in milk, in the small intestine.  Briefly, this means that the sugar passes whole through the intestine, and cause cramping, diarrhea, gas and discomfort.  No one knows why the body has decided to not activate the gene to produce the enzyme because it can. Throughout one’s lifetime, this enzyme can be routinely be produced and then stop being produced. For example, I discovered I was lactose intolerant in my late teen years (don’t ask how), and had a dairy free diet for the next ten years, until the birth of my second child. I developed a craving for milk, and realized,  suddenly,  that I could consume milk whereas before, it wreaked havoc on my intestine.

This intolerance is technically diagnosed by having the patient drink a large quantity of milk, and then waiting to see what happens.

Milk Allergy – This response is different than intolerance, this case means that the body attacks milk like an allergen, activating autoimmune response involved in inflammation that can cause abdominal pain, headaches, or, in extreme cases, anaphylactic shock.

The test for this is similar to a regular prick allergen test, called a RAST test, like for pollen or mold.

For those who go into anaphylactic shock, they are usually diagnosed during the infant years. For those who have less acute responses, it is often diagnosed in adolescence after prolonged periods of headaches and or stomachaches.

Irritable Bowel Syndrome –  For an unknown reason, this syndrome affects mostly women. No one is quite sure of its cause, but it can wreak havoc on one’s digestion, causing diarrhea, constipation, and abdominal cramps. IBS treatments include diet and lifestyle changes, sometimes medications, and often diet changes like eliminating dairy products.

Reduced intestinal flora – The microbes that live in your gut, mostly in the lower intestine, contain between  300–500 different species of bacteria and are pretty essential to your health and well-being. They are responsible for a wide variety of functions, including digesting fiber, making certain vitamins, and preventing specific infections.

When you take antibiotics to kill off harmful bacteria during an infection, it kills ‘good’ microbes as well; sometimes lactose can also disrupt the delicate microbial balance in the intestine.

The first step in diagnosis is to see a kupah gastroenterologist, gastro in Israeli vernacular, who can begin the stages of eliminating certain issues to arrive at a diagnosis, or in many cases, a diagnosis of exclusion, which means we’ve eliminated most everything else, so it’s probably this.  That is the path of how many arrive at a lactose intolerance diagnosis.