lactose intolerance
and a range of small organic molecules including gases,
Symptoms of lactose intolerance
alcohols, aldehydes, ketones and diols. It is absorption of
these that cause the symptoms of lactose intolerance.
A. Gut related Abdominal pain
Gut distention
Borborygmi
The New Diagnostic Protocol
Flatulence
This discovery of the C/T13910 polymorphism led to the
Diarrhoea breakthrough in testing. All patients with the CC pattern
Constipation
were lactose sensitive, and further testing would cause un-
Nausea
necessary severe morbidity. The additional measurement
Vomiting
of methane with the hydrogen and extending the testing
B. Systemic Headache and light headedness to 6 hours, and symptom analysis for 48 hours improved
Loss of concentration and
the diagnosis in people with the C/T and T/T pattern from
poor short term memory
less than 50% to over 75%. The specificity is over 95%. Our
Chronic severe tiredness
Muscle pain
recommended diagnostic protocol is shown in fig 1.
Joint pain, and/or swelling
and stiffness
Our results
Allergy Two cases are described (see figs 4 and 5 ). The
Eczema
number of symptoms before diagnosis, during the lactose
Pruritis
challenge and on lactose exclusion is shown in fig 6.
Rhinitis with sinusitis
Asthma
Our most famous case is that of Charles Darwin (11).
Heart arrhythmia
He was ill for 50 years and we argue that this was due
Mouth ulcers to lactose sensitivity. We believe also it was the cause of
Increased frequency of mic-
death in his 10 year old daughter.
turition
Sore throat
Why has our treatment been successful?
Fig 2 Firstly, the patients were clearly defined using the proto-
col. Secondly the dietary advice was vital. Many people
is unknown (8). It does not appear to be due to any
were advised on a dairy free diet but were unaware of the
polymorphisms within the lactase gene itself, nor within its
vast amount of lactose added to foods and drinks without
promoter within a 1Kb sequence immediately upstream.
adequate labelling. Lactose is in many foods where the
However, in 2002 there was a breakthrough and a close
unsuspecting shopper will get caught out. Some foods,
correlation was shown between lactase persistence and
including fresh packaged bread and pastries and drinks
a polymorphism, C/T13910 upstream from the lactase
do not need labelling, yet these are also a minefield for
gene (9,10). CC appears always to be associated with
the lactose hunter. Lactose is the most common filler in
lactase non-persistence, and thus lactose sensitivity. This
pharmaceuticals and we had some cases where the
led to an important clinical test.
symptoms were made worse by prescribed therapy which
contained over 5g lactose a day (100 ml of milk). Table 4
The Prevalence of Lactose Sensitivity (fig3)
shows some ways that lactose is described on labelling.
The eventual level and time course of loss of lac-
tase vary considerably with ethnic group. Chinese and
Japanese lose some 80-90% within 3-4 years after wean-
Different ethnic groups with low lactase and likely lac-
ing, whereas Asians and Jews can retain some 20-30%,
tose intolerance
taking several years to reach its lowest level. The 10% of
Ethnic group (adult, unless % with low lactase and poten-
white Northern Europeans who lose large amounts of
stated) tial lactose intolerance
their lactase after weaning can take some 18-20 years to
Chinese and Japanese >90%
reach their nadir. Thus most of the world’s adult popula-
Indian and other Asian groups >80%
tion (some 6000 million people) are hypolactasic. They
Aboriginal Australian
have a threshold to lactose and thus to milk. A true
>80%
Chinese and Japanese diet contains no milk or dairy
Black African >75%
products. The problem now is that many non-white Eu- American Red Indian
>70%
ropean ethnic groups are adopting a Western style diet.
Eskimo >70%
Furthermore many are not aware that lactose is added
to many foods available in Western supermarkets, being
Spanish Greek and Italian >40%
inadequately labelled. Mid European (e.g. Hungarian
and gypsy)
>40%
What is the mechanism of the symptoms? American (total adults) 30%
The mechanism can be explained by our ‘Bacterial
White Northern European 10%
Toxin’ Hypothesis: the major cause of symptoms in food
intolerance is the production of gases and toxins by gut
Children under 2 years old (any
ethnic group)
0-20%
bacteria (12-15). The large intestine contains some 10
14

individual bacteria, 100 times the cells in the rest of our
Children under 2 years old (any
body. There are over 400 different species. The level of
ethnic group)
0-40%
oxygen in the large intestine is low, probably 1/200 of
Patients with Irritable Bowel
that in air-saturated water. Thus, >90% of the bacteria
Syndrome
>50%
there are anaerobes. In low oxygen, bacterial metabo-
Fig 3 Note: these numbers are very approximate, and intended
lism of lactose and other carbohydrates produces gases
only to give an indication of whether at risk. > means greater than.
18 NHDmag.com Aug/Sep ‘08 - issue 37
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