A Guide To Living With Lactose Intolerance

shutterstock_147122108What is lactose?
Lactose is the carbohydrate (or sugar) found in cow’s milk and present in most foods made from cow’s milk. Lactose is normally broken down in the small intestine by an enzyme called lactase.

lactose_intoleranceWhat is lactose intolerance?
Lactose intolerance occurs when there is not enough lactase enzyme to digest the lactose. This causes lactose to pass into the large intestine where it is fermented by the bacteria which live there. This can result in bloating, abdominal pain, excessive wind and diarrhoea.

What causes lactose intolerance?
There are several forms of lactose intolerance. Some people produce less lactase than others, and lactase production can decrease as a person ages. This is more common in people of Asian, Middle Eastern, Southern European, African or Australian Aboriginal decent. Small quantities of lactose will not cause symptoms in most people, however, some people are born with no or very few lactase enzymes. These individuals are often very sensitive to lactose in the diet and need to follow a stricter lactose free diet.

Diagnosis of lactose intolerance
Previously, accurate diagnosis of lactose intolerance required invasive procedures such as endoscopy or multiple blood tests or restrictive elimination diets. However, lactose intolerance can now be diagnosed using Hydrogen Methane Testing (HMT), a simple, non-invasive breath test.  Find more information about HMT here

The symptoms of lactose intolerance can be caused by a number of different conditions, so accurate diagnosis is important to make sure the symptoms are in fact due to lactose intolerance and not something else.

shutterstock_252532999Management of lactose intolerance
Severity of lactose intolerance varies widely, and many lactose intolerant people do not need to avoid all milk and milk products. For some people, the small amount of milk in a cup of tea or coffee will not cause them any problems, however, the amount in a milkshake will. It is important that you experiment to determine your individual level of tolerance. Follow the advice of your doctor and dietitian who will recommend a lactose-reduced or lactose-free diet.

Lactase products that you add to milk to pre-digest the lactose for you are also available. Drops containing the enzyme lactase can be added to ordinary cow’s milk to digest most of the lactose. These can be purchased at pharmacies.

Ensuring adequate calcium intake
As dairy is an excellent dietary source of calcium, appropriate high calcium alternatives need to be consumed so to ensure calcium intake remains adequate. Soy milk and other soy products are a good alternative to milk products as they contain no lactose but usually have added calcium.  Low-lactose and lactose free milks are also readily available. These have a similar calcium content to regular milk and can be used in it’s place.

Cheese and yoghurt are made from milk, however the lactose content is reduced during processing. Cheese is an excellent source of calcium, and only contains trace amounts of lactose. Yoghurt is also a rich source of calcium, and many people with lactose intolerance tolerate yoghurt because the natural bacteria in yoghurt digest some of the lactose.

Other issues
Always check the ingredients list on commercial foods. Milk solids, milk powder, non-fat or skim milk solids and whey or casein powder all contain lactose. It is likely that most people will however manage most foods with a little milk added even though they cannot tolerate a glass of milk. Lactate, lactic acid and lactalbumin do not contain lactose. Foods labelled “Milk Free” are suitable for a low lactose diet. Foods that state “may contain traces of milk” are safe.

Low lactose diet 

shutterstock_145092925Avoid or limit:
? Milk in large amounts
? Ice-cream and yoghurt in large amounts ?
?Evaporated and condensed milk
?Cottage and ricotta cheese.

?Low lactose milk (eg Liddels, Zymill)
?Low lactose yoghurt (eg Liddels, Vaalia)
?Soy yoghurt
?Soy ice-cream
?Hard cheese eg. cheddar, fetta
?Butter, margarine
?Milk as an ingredient in cakes, biscuits etc.

? Aim to include 2 to 3 low lactose dairy foods or alternatives per day.

 Please note: this advice is general and we do recommend that you seek personalised advice from a dietitian regarding appropriate management of lactose intolerance

What Exactly Is The Gut Microbiome?


You may have noticed the ‘gut microbiome’ popping up in the news a lot lately – and for good reason.

We generally don’t pay much attention to the trillions of bacteria living in our guts, but more and more evidence is emerging about just how much they influence our health.

Read more here:



What Are FODMAPS (and what do they have to do with IBS)?

Around 1 in 7 Australian adults suffer from irritable bowel syndrome and regularly experience uncomfortable and painful symptoms such as bloating, gas, abdominal pain and cramping, diarrhoea and constipation. While the causes of irritable bowel syndrome have long been a mystery, one common cause has been identified: FODMAPs, a collection of different types of sugars found in many foods. Continue reading…

Food Allergy vs Food Intolerance – What’s The Difference?

shutterstock_285849725There is a lot of confusion about the difference between a food allergy and a food intolerance, with the terms often being used interchangeably. However, there is actually a distinct and important difference between the two, with symptoms, severity and causes varying significantly.

Food Allergy
A food allergy occurs when the immune system reacts to an otherwise harmless substance present in certain foods.  Allergic reactions range from mild to severe. Reactions usually occur quickly and symptoms may include skin rashes such as eczema and hives, gastrointestinal issues such as nausea, vomiting, diarrhea, and abdominal pain or respiratory symptoms such as sneezing and asthma. Rarely, allergies can cause anaphylaxis, the most severe form of allergic reaction. The most common foods causing life-threatening anaphylaxis are peanuts, tree nuts, shellfish, milk and egg.

Food allergy is estimated to affect around 10% of children up to 1 year of age; between 4-8% of children aged up to 5 years of age and approximately 2% of adults.

Food Intolerance
Food intolerance is an adverse reaction to food in which the immune system is not involved.  Intolerance to food can result from a deficiency of certain enzymes (e.g. lactase deficiency causes lactose intolerance), sensitivity to naturally occurring chemicals in foods such as histamine or from toxins present in food. Reactions are usually delayed, occurring several hours and sometimes up to several days after eating the offending food. Food intolerance does not cause severe allergic reactions such as anaphylaxis, with the symptoms usually delayed of a more chronic nature. They may include skin rashes, e.g. dermatitis or eczema, respiratory tract issues such as nasal congestion, sinusitis, and asthma or gastrointestinal symptoms such as abdominal cramping, nausea, diarrhea, constipation, and irritable bowel syndrome. Because the immune system is not involved, food intolerances do not show on food allergy testing such as skin prick tests.


Food Intolerance and FODMAPs
One of the most common causes of food intolerances are a group of carbohydrates (sugars) know as FODMAPs. FODMAPs are a collection of different sugars which are found naturally in many of the foods we eat. These sugars are usually absorbed in the small intestine, however, they are poorly absorbed by some people. They then stay in the gut and continue to the large intestine, where they act as a food source to the bacteria that live there normally. The bacteria then digest/ferment these sugars, resulting in the symptoms of irritable bowel syndrome (IBS) such as bloating, excess gas, abdominal pain, nausea and diarrhoea and constipation.

Women IBSFODMAPs is an acronym for:
Oligosaccharides (eg. Fructans and Galacto-oligosaccharides (GOS))
Disaccharides (eg. Lactose)
Monosaccharides (eg. excess Fructose)
Polyols (eg. Sorbitol, Mannitol, Maltitol, Xylitol and Isomalt)

Some Common Sources of FODMAPs:
Excess fructose: honey, apples, mango, pear, watermelon, high fructose corn syrup
Fructans: garlic (in large amounts), leek, onion, spring onion, shallots, wheat, rye and barley (in large amounts)
Lactose: milk, ice cream, custard, yoghurt and soft unripened cheeses (eg. ricotta, cottage, cream, marscarpone).
Galacto-Oligosaccharides (GOS): Beans (eg. baked beans, kidney beans, bortolotti beans), lentils, chickpeas
Polyols: apples, apricots, avocado, cherries, nectarines, pears, plums, prunes, mushrooms, sugar alcohols such as sorbitol, mannitol and xylitol

Hydrogen Methane Testing for Food Intolerances
Hydrogen Methane Testing (HMT) is a simple and non-invasive breath test which is used to diagnose carbohydrate (sugar) intolerances. At The Breath Test Lab, we use Hydrogen & Methane Breath Tests to diagnose lactose, fructose, sorbitol, xylitol and sucrose malabsorption and intolerances. This method of diagnosis is a much simpler and easier alternative to a low FODMAP diet which requires restricting dietary intake of FODMAPs for an extended period and then gradually reintroducing them one at a time to determine which ones an individual is sensitive to.

For more information about Hydrogen Methane Testing, see our services page

Continue reading…

Could SIBO be the Cause of Your IBS?

shutterstock_328754633Small intestine bacterial overgrowth (SIBO) is a condition in which abnormally large numbers of bacteria grow in the small intestine and can result in abdominal pain, bloating, diarrhoea, excessive gas, food intolerances and vitamin and mineral deficiencies, among many other symptoms. Continue reading…