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Saturday, January 22, 2011

Lactose Intolerance Can Be A Symptom Of Gluten Intolerance

Many people are told that they have a lactose intolerance and are never investigated further to find the cause. Usually, only a lactose-free diet is recommended. I think we (doctors, nurses) need to dig a little deeper. Gluten could be the trigger and a a gluten-free diet could be the real solution. For many, a lactose intolerance may actually disappear once an individual is consuming a gluten-free diet.

Let me explain further………

Lactose is natural sugar found in dairy products. It requires lactase, an enzyme produced within the intestines, to digest it. Usually, this enzyme is produced by the small intestinal villi. In Celiac disease (CD) (and in some with Dermatitis Herpetiformis), the intestinal villi becomes damaged (flattened) and this can impair the production of lactase. Immune reactions to ingested gluten can cause this damage. Loss of this brush border (another name for microvilli) enzyme results in a condition called lactose intolerance.

With lactose intolerance, the lactose passes undigested into the colon and then it is broken down by commensal bacteria. This process produces CO2 and hydrogen which can cause abdominal discomfort, bloating, flatulence, and possibly diarrhea. With a gluten intolerance, this may be temporary, since lactase production may resume once a gluten-free diet has commenced and the bowel has healed.

Other factors can cause villi damage and this could affect the production of lactase as well. Food allergies can also affect the villi and sometimes the reactions can lead to flattened intestinal villi. For example, flattened villi have been found in people with soy and milk allergies. Theoretically, this could lead to lactose intolerance.

As well, there is some evidence that a lectin intolerance can affect the intestinal villi. This could potentially lead to a lactose intolerance if the villi were no longer able to produce lactase to digest the lactose in diary. For people suffering with a lectin intolerance, a paleolithic diet may be helpful.

In some, the lactose intolerance may be persistent. In fact, it may appear to be a permanent condition. This could be due to ongoing accidental ingestion of the offending food that is causing villi damage, the presence of bowel infections, or perhaps a state of dysbiosis in the bowel could hinder the production of lactase as well. In this situation, further testing for infections, further diet modification to remove the offending foods or probiotics might help. Unfortunately, even with all of these interventions, the damage could be permanent. An ongoing lactose free diet may be needed along with lactase supplements when necessary. Perhaps, the persistent damage has occurred for too long in some who were undiagnosed for years.

With this in mind, I think everyone with a lactose intolerance should be tested for a gluten intolerance since it can be an underlying trigger. It is important to diagnose the cause, not just the symptoms.

Future Studies


In a study, I would like to see a large group of people with lactose intolerance investigated for gluten intolerance (celiac disease, dermatitis herpetiformis, and non-celiac gluten intolerance), a lectin intolerance, and food allergies (IgA, IgG, and IgE antibody mediated). The results may help to shed some light onto the true underlying cause of lactase deficiency.
This reminds me of how I was told that I had anemia, but further investigations were not suggested to find the cause, only iron pills were offered as a solution. 



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