Page 57 - Retail Pharmacy Assistants September 2020

There’s nothing like lactose intolerance to make someone feel disheartened in body and soul, as so many delicious foodstuffs are bypassed for so-called health reasons.
However, for people who are – or self- diagnose as – lactose intolerant, it’s not always necessary to completely avoid dairy, with evidence pointing to certain types of yoghurt, among other dairy products, as being beneficial to health.
There’s no denying the number of people with lactose intolerance is
high. Dr Damien Belobrajdic, a Senior Research Scientist at the CSIRO, tells Retail Pharmacy Assistants that lactose intolerance affects a whopping 65 per cent-plus of Australia’s inhabitants.
Lactose intolerance is often due to the lack of or reduced function of the enzyme lactase in the small intestines to break lactose down into simple sugars that can be absorbed.
If lactose passes into the large bowel, it can cause abdominal pain, bloating, diarrhoea, gas, and nausea, Dr Belobrajdic says.
Self-diagnosis prevalent
Recent YouGov research shows that
22 per cent of surveyed Australians self-diagnose food intolerances and that more than a third of those who identify as having an intolerance have never consulted a healthcare professional to diagnose or manage their symptoms.
The research reveals that lactose intolerance is one of the most common intolerances and the most likely to be self-diagnosed, with one in 10 surveyed Australians admitting they don’t know what differentiates a lactose intolerance from a dairy allergy.
Just under half of the people who report being lactose intolerant say they have stopped eating dairy as one of the first steps to relieve symptoms.
Quitting dairy involves them, and many others, reluctantly turning away from tantalising cheeses decorating platters to an endless array of yoghurts, ice-creams, buttered-breads, condensed-milk desserts and milk-based drinks – and sometimes at the expense of their nutrition – under the belief that they will suffer the consequences of digestive unease or disease.
These concerns are very real, with a 2019 survey from the Australian Doctor Group highlighting lactose intolerance and fear of gastrointestinal disorders as
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among the biggest patient fears in terms of dairy.
However, many studies (discussed later in this article) have shown that the lactose intolerant may not need to eliminate foods and beverages that contain milk, such as milk or milk products – and risk the danger of becoming calcium and vitamin D deficient.
More importantly, some dairy products can assist with the condition.
Dr Belobrajdic says it’s extremely important that the lactose intolerant still consume the micronutrients they need, especially calcium, which come in milk, yoghurt and cheese.
This could be through optimising dairy consumption within the individual’s tolerance level, with some still being able, for example, to tolerate the equivalent of glass of milk, he says.
Milk is known to contain the highest amount of lactose, but not all dairy products contain lactose. Fermented
or cultured dairy products such as cheese and yoghurt are the least
dense in lactose because the culturing process pre-digests a lot of the lactose, and in cheesemaking (block cheeses, parmesan, cheddar) the whey and much of the lactose is separated in the process.
As butter is primarily made of fat rather than lactose-containing milk solids, it is low in lactose, while softer cheeses and conventional yoghurts are perceived as having a fair amount of lactose.
Generally speaking, though, most people are known to tolerate between 4g and 12g of lactose per serve.
According to Dr Belobrajdic, this information is of great import in Australia where “adequate nutrition, especially calcium, is a major issue”, with people suffering deficiencies on lactose-free diets.
Yoghurt may be good for the lactose intolerant
Yoghurt can be especially beneficial
for the lactose intolerant because of perceived benefits from probiotics contained in some yogurts as well as its nutritional content.
Probiotics are commonly believed to benefit people in terms of gut health, as well reducing cholesterol in the blood and boosting the immune system.
Mark Webster, the owner of Stay Well Pharmacy, advises caution in terms of all the claims made around dairy probiotics, the widespread belief that all fermented foods contain probiotics, and that
consumption of probiotics will result in good gut health.
“This is because some fermented foods have been sterilised, which could mean that there are no live microbes in the product,” Mr Webster said.
“Then there’s also confusion around strains of probiotics, some of which can cause ill health in individuals.”
To help clear the confusion, a study, ‘Lactose Intolerance: a scientific review’ (yogurtinnutrition.com/lactose_ intolerance_state_of_knowledge/) coordinated by Yoghurt In Nutrition and the World Gastroenterology Organisation was published in
August 2019.
It analysed many studies on lactose
intolerance and yoghurt, concluding that probiotics can lessen the concentration of lactose in fermented products such as yoghurt and increase the activity of the enzyme, which breaks down the lactose that enters the small intestine with the fermented products.
The study shows that the lactose contained in yoghurt is partially digested by the two active bacterial cultures,
L. delbrueckii subsp. bulgaricus and S. thermophilus, with these live bacteria producing lactase, which breaks down some of the lactose in yoghurt.
A 2003 study by Steven Hertzler, senior clinical research scientist with Abbott’s Global Scientific and Medical Affairs team in the US, found that kefir and yoghurt improved lactose digestion and intolerance by 54-71 per cent compared with milk.
Intolerance varies markedly
Dr Belobrajdic says the degree of lactose intolerance varies markedly between people and can be more pronounced as a person gets older.
He says that according to the National Institutes of Health, the prevalence of lactose intolerance is largely influenced by a person’s cultural background.
The highest intolerance to lactose is found in people of east Asian descent, whereas it is uncommon in those from northern European descent.
The lactose intolerant should discuss their diet with a relevant healthcare professional, Dr Belobrajdic emphasises, adding that this is especially important for the extremely lactose intolerant, who need to ensure that dairy-free calcium- rich food intake or supplements are considered for adequate nutrition to take place.
RETAIL PHARMACY ASSISTANTS • SEP 2020