By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

SON NOT ALLERGIC TO MILK, HAS SYMPTOMS OF LACTOSE INTOLERANCE

Question: I think my son is allergic to milk. He gets stomach- aches after drinking milk and is real gassy. He sometimes gets stomachaches from other foods like bread and cake. Is there something else he could be allergic to? Are there tests the doctor can do to tell if he is allergic to milk? I had to give him soy formula as a baby, but I thought he had outgrown this problem.

Answer: What you describe could be lactose intolerance. Many people call this a milk allergy, but technically it's not an allergy at all. People with this disorder have an inability to digest lactose -- the primary "milk sugar." This is because they do not produce a specific enzyme, lactase, in sufficient quantities to break down the lactose in the dairy products they consume into digestible sugars.

Normally the lactase enzyme is found in the small intestines. It breaks the lactose into glucose and galactose -- the digestible sugars I just mentioned. In most people the lactase enzyme levels decrease with age, so a person actually "grows into" lactose intolerance. Interestingly, many people of European descent don't seem to experience a decrease in their lactase levels as they age. This is thought to be due to a genetic mutation. On the other hand, some ethnic and racial groups have a very high incidence of lactose intolerance. Over 90 percent of Asian Americans, for instance, are lactose intolerant.

In people who do not produce enough lactase, the lack of ability to digest the lactose results in diarrhea, abdominal pain and gas. Symptoms may depend on how much lactose is consumed. Not everyone who is deficient in lactase production has symptoms of lactose intolerance. While most cases of lactose intolerance are due to the normal decrease in lactase production over time, there are some diseases of the small intestines that can cause lactose intolerance. Because of that, you should have your child evaluated by his physician, especially if his stomachaches are causing weight loss. There are some blood tests, breath tests and stool tests that can diagnose lactose intolerance.

If that is the diagnosis, treatment is relatively straightforward -- avoid lactose by steering clear of milk and related products. This simple step can "cure" most of the symptoms. Start reading labels very carefully, looking for milk, non-fat milk, milk solids, whey and butter, to name a few. Once you start reading labels, you will find that milk-based products are found in many foods, like bread, cake mixes and milk chocolate.

Be sure to discuss calcium and vitamin D supplementation with your physician since avoiding milk could deprive a growing child of these essential nutrients. Also, experiment with foods a bit. You may find that your son can't tolerate a large milk shake, but a small ice cream cone or piece of cake is okay.
Also, there are special lactase pills available without a prescription that he could take before consuming dairy products. These add the missing enzyme and thus aid digestion of lactose. Finally, some groceries now carry special milk that has had the lactose removed as well as other dairy products made out of this type of milk.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via email to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.