Lactose-Restricted Diets And Crohn's Disease

Is there ever a time when it may be appropriate to reduce consumption or avoid a particular food group? When it comes to dairy products, the answer is yes. Delicious but dangerous is a slogan to apply to dairy products if you have IBD. While dairy products are tasty and provide important nutrients, such as protein and calcium, there are specific situations where it may be difficult to digest the primary sugar in milk.

 

Unless you have a true milk allergy (immune reaction to the protein in milk), there is no danger from eating dairy products. This type of allergy is relatively uncommon. Dairy products do not cause IBD and generally do not result in flares, but you may experience uncomfortable symptoms if you have lactose intolerance and you drink milk or eat dairy products.

 

 

Lactose is the principal carbohydrate in dairy products. It is a disaccharide, meaning that it is a larger molecule made up of two smaller sugar molecules, which are the monosaccharides glucose and galactose. An enzyme in our small intestine called lactase is responsible for breaking lactose into glucose and galactose, which are then easily absorbed.

 

If there is not enough lactase enzyme available to break down lactose into its two smaller sugars, the result is undigested lactose traveling through the small intestine to the large intestine (colon). This is why lactose intolerance can also be correctly called lactase deficiency.

 

 

The classic symptoms of lactose intolerance result from undigested lactose traveling through the small bowel and drawing water by osmosis into the bowel, which causes bloating. When the undigested lactose reaches the colon, bacteria ferment it, producing further bloating, cramping, gas, and diarrhea. Symptoms vary among individuals, but typically appear within 30 minutes to several hours after ingestion.

 

 

A hydrogen breath test, which involves drinking a test dose of lactose, can help to determine if you are lactose intolerant. If a person has lactase deficiency, the unabsorbed lactose will be fermented by colonic bacteria and hydrogen gas will be formed. Some of this hydrogen gas is absorbed into your bloodstream and breathed out through the lungs, where it can be measured in your breath.

 

If you have a hydrogen breath test, be sure to ask what dose of lactose you were tested with. Depending on the lab, doses can range anywhere from 12.5 g of lactose (equivalent to 1 cup or 250 ml of milk) to 50 g of lactose (equivalent to 4 cups or 1000 ml of milk). Many people can drink one glass of milk without difficulty, but would rarely drink a liter or quart of milk at one time, so the relevance (applicability to your daily life) of the test depends on the dose administered.

 

 

Fortunately, many individuals who develop lactose intolerance can still consume small amounts of dairy, just not as much as before. This is called a dose-dependent effect. In these cases, eliminating dairy products is not necessary, just a reduction in the amount of dairy product taken at one time. Interestingly, some people can gradually increase their tolerance to dairy. This has nothing to do with the amount of lactase enzyme they have, but rather their gastrointestinal bacteria are able to adapt to the lactose load.

 

 

There are also hidden sources of lactose in foods. If you are severely lactose intolerant, you will need to avoid all sources of lactose. Lactose can be added as a filler in some medications and some foods (for example, processed meats, gravies, breads, cereals, salad dressings, breakfast drinks, cake mixes, margarine). Lactose may also be present if the label lists added milk solids, whey, curds, butter, or cheese flavor. Casein does not contain lactose. Be sure to read food labels for hidden sources.

 

 

If you have an ileostomy and are lactose intolerant, you can still eat dairy products. The undigested lactose will reach the ileostomy pouch instead of being fermented in the colon (which may have been surgically removed). The ileostomy pouch may develop more gas (from the bacteria in the stool), but it will not give you the same symptoms of cramping, bloating, and diarrhea.