It’s a usual question a parent may have. "Is my child lactose intolerant?" or "Can they drink normal milk?"
If you have walked through the baby lanes in pharmacies or supermarkets, you would see lactose-free milk formulas and also a whole host of lactose-free pack milks (soy, hemp, almond, coconut..). But which baby or child really needs this? Has the thought cross your mind?
To begin understanding this, we need to realize that most milks have lactose in them. In order to utilize the energy from the lactose, it needs to be broken down by an enzyme called lactase. (Now do not get scared by the medical jargon, I will try to keep it few and far in between).
If this lactase enzyme is missing or present only in small quantities, then lactose is not broken down. This then causes the symptoms of lactose intolerance. What's the symptoms of lactose intolerance?
The main symptom is usually diarrhea within minutes to hours after drinking milk, but can also be associated with abdominal pain, cramping, bloating and excessive flatulence.
Now let's go into a little more detail.
Did you know that there are 3 types of lactose intolerance?
1. Congenital lactose intolerance.
This type is extremely rare with less than 50 cases reported in the literature. It is mostly in the Finnish population. These children are born without any lactase enzymes at all and would need to be on a lactose free diet for life to survive. It is unlikely that your child will fall in this category.
2. Primary lactose intolerance or also known as Primary adult-type hypolactasia
(big words- but just means low levels of lactose as one gets older)
This type refers to the gradual decline in lactase enzyme which can start from children 3 years old. So babies generally have enough lactase for the first 3 years of life. This is important for babies so they can drink milk when needed the most in life.
Approximately 70% of the world’s population has primary lactose intolerance but it varies depending on the country. For example, Caucasians tend to retain their lactase enzyme and generally do not have lactose intolerance.
Here are some statistics - lactase deficiency occurs in approximately 15% of white adults, 40% of adult Asians, and 85% of adult blacks in the United States. So it is likely that our adult Caribbean population will have this type of lactose intolerance and may need to drink a lactose free alternative milk as they age.
3. Secondary lactose intolerance- This type of Lactose intolerance follows injury to the small bowel lining. This can be due to infections with rotavirus (for which vaccination is now available in childhood), parasite infections or in a condition called celiac disease. Secondary lactose intolerance can be transient and usually improves once the bowel heals. In these cases, a temporary switch to lactose-free milk can be considered during the healing phase and thereafter a switch back to lactose milk.
What's the treatment?
Simple- avoid milk/lactose.
In older children and adults, a tablet with lactase activity can be ingested when eating meals that has milk.
Varying lactose free milks are also available on the market.
Live-culture yogurt can also be used as it contains bacteria that produce lactase enzyme and is tolerated by most patients with lactose intolerance. Hard cheeses have a small amount of lactose and are generally well tolerated, but lactose-free cheeses are also available though usually more expensive. Once a lactose-free diet is adopted calcium supplementation would also be required.
So the next time you see lactose free-milk, remember there are indications for it and not all children will need it. Basically, as long as you are tolerating milk continue to drink it.
Dr. Zafir Latchan
Sources:
Kliegman: Nelson Textbook of Pediatrics, 18th ed.
Melvin B. Heyman for the Committee on Nutrition. Lactose Intolerance in Infants, Children, and Adolescents. Pediatrics September 2006, VOLUME 118 / ISSUE 3.
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