lactose intolerance
Case 1 Case 2
This 53 year old woman had a ten year history of asthma, eczema A 10 year old boy whose main problem was loss of school (average
and sinus problems, muscle and joint pain, and lack of concentra- 2 days a week) due to abdominal pain and headache. He had a
tion. This was so severe that she was worried that she was developing history of constipation for as long as his mother could remember and
Alzheimer’s disease. From childhood she complained of an itchy had undergone invasive investigation with no diagnosis reached. The
rash and eczema, frequent diarrhoea, nausea and sickness. She had genetic test showed he was a CC pattern at the C/T 13910 locus.
been diagnosed as having eczema, asthma and osteo-arthritis, and A lactose free diet was advised and when seen 3 months later he
was awaiting a knee replacement operation. She was on a range of had not had to take any further time off school, had improved aca-
medications, including skin creams, antihistamines, asthma inhalers, demically and had a normal bowel action. All medication had been
antibiotics, anti-diarrhoeals and strong pain relief. We carried out a stopped.
lactose tolerance test (50g oral lactose followed by an analysis of
breath hydrogen for 3h), By 3h her breath hydrogen had not risen to
Fig 5
>20ppm over the nadir, the recognised level for diagnosing lactose
Na+-dependent transporter SGLT1 at the apical surface
intolerance. However she recorded a range of gut and systemic
of the enterocytes, the protein that absorbs glucose and
symptoms following ingestion of lactose. These included abdominal
pain, nausea and vomiting, headache, light headedness, feeling
galactose from the small intestine. As a result, the sugars
drunk, heart palpitations, and joint and muscle pain. These symptoms
end up in the large intestine. Here the bacteria then gen-
after lactose lasted severely for three days. She was advised to re- erate the hydrogen and other gases and toxic metabo-
move all lactose from her diet for one month. This did not only involve
lites, exacerbating the symptoms of the lactose sensi-
avoidance of food and drinks containing ‘dairy’ products. She was
tivity. Some vegetables containing these funny sugars,
advised also to avoid foods and drinks where lactose is added with-
out being on the label. Within one month she described her skin as
eaten with lactose containing food, will have this double
‘wonderful’. Her asthma and sinusitis had gone, and her joints were
whammy effect. The dishes combining these with a high
much improved.
starch content e.g. rice, can be a particular problem.
Fig 4
Future developments
When an exclusion diet apparently fails, lactose A family of carbohydrate metabolites, including bu-
sensitivity was often ruled out inappropriately. In the USA tane 2,3 diols, acetoin and methyl glyoxal, have been
lactose production has risen six-fold since 1979 to ca300 identified as prime ‘toxins’ produced by gut bacteria
million kg/annum. Some breakfast drinks, powders and which explain the symptoms of food intolerance. How
slimming products can contain more lactose than milk. they are produced, and then act to change the bal-
One patient’s weight reducing diet involved a daily ance of microflora in the gut and affect neurones, the
intake of 100g lactose, equivalent to >2litres of milk and heart, skeletal muscle, and the immune system, is being
caused her to have symptoms. A typical meal contain- investigated using three model systems: (a) Bacteria
ing between 7-24g lactose - equivalent to 1-3 glasses of genetically engineered with bioluminescent proteins (13-
milk - is above many patients’ lactose thresholds. 15); (b) human cells in tissue culture; (c) the water flea
Daphnia (12). This mechanism has much wider implica-
An interesting part of the dietary armoury is the use of tions than food intolerance and we propose that these
soya products in those who can tolerate them. The milk toxins also play a role in diabetes, heart arrhythmias,
is an excellent alternative to cows’ milk, especially when arthritis and some cancers.
calcium has been already added. We thank the Wellcome Trust, The Waterloo Founda-
tion and Alpro Ltd for financial support.
The Double Whammy
A further problem is one with a double whammy ef- References
fect. Two of the longer chain saccharides, raffinose and
1. Waud JP, Matthews SB, Campbell AK. (2008). Measurement of breath hydrogen and methane,
together with lactase genotype, defines the current best practice for investigation of lactose sensi-
stachyose, found in chick peas, lentils, cauliflower, pars- tivity. Ann. Clin. Biochem. 45:50-58
nip, kidney beans and ‘baked’ beans, actually block the
2. Matthews SB, Waud J, Roberts A and Campbell AK (2005). Systemic lactose intolerance: a new
perspective on an old problem. Post Grad. Med. J. 81:167-183.
3. Matthews, SB and Campbell, AK (2000). When sugar is not so sweet.
Lancet 355:1330.
4. Campbell, AK and Matthews, SB (2000). Lactose intolerance and
neuromuscular symptoms. Lancet 356:510-511.
5. Matthews SB, Campbell AK. Lactose Intolerance in the Young: A New
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MATHS: syndrome: what are they and how can I cope? Pp 32. Welston
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book – the science of lactose intolerance and how to live without
lactose. The Welston Press, Pembrokeshire. ISBN 0-9540866-1-9.
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lar Basis of Lactose intolerance. Science Progress 88, 157-202.
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ated with adult-type hypolactasia. Nature Genetics 2002;30:233-237.
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13. Campbell, AK, Naseem, R, Wann, KT, Holland, IB and Matthews, SB
(2007). Fermentation product butane 2,3 diol induces Ca2+ transients
in E. coli through activation of lanthanum-sensitive Ca2+ channels. Cell
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14. Campbell, AK, Naseem, R, Wann, KT, Holland, IB, and Matthews,
SB. (2007). Methylglyoxal and other carbohydrate metabolites induce
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15. Naseem, R, Holland, I.B, Jacq, A, Wann, KT and Campbell, AK
(2008). pH and monovalent cations regulate cytosolic free Ca2+ in E.
Fig 6
coli. Biochim. Biophys. Acta Biomembranes 1778,1415-1422.
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