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Diarrhea and dairy: The Evidence on Diarrhea and Milk

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The Evidence on Diarrhea and Milk

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Diet can play an important role in the management of diarrhea, but the approach will vary on its cause. There is a common belief that dairy products should automatically be eliminated during episodes of diarrhea, but current evidence does not support avoiding dairy. In fact, some research is now suggesting that certain fermented dairy products, such as yogurt, may be helpful in alleviating acute episodes of diarrhea.

In North America, diarrhea is a common condition that is often a source of discomfort and inconvenience.1 Causes of diarrhea include gastrointestinal infections (such as the stomach flu or food poisoning), indigestion, and certain medications (such as antibiotics). 1 Certain chronic conditions may also cause persistent diarrhea if uncontrolled, such as food intolerances or digestive disorders.1 Prolonged or recurring episodes should be discussed with a healthcare practitioner.1

Diet during episodes of diarrhea

Diet plays an important role in the management of diarrhea. Hydrating appropriately is a key component in the treatment of diarrhea to prevent dehydration.2,3 In most cases, it is advised to return to a normal, solid diet as soon as possible.2-6 However, certain foods may exacerbate irritation or be more difficult to digest as the digestive tract recovers.5,6 Examples of such foods include caffeinated or sugary beverages, alcohol, fatty or spicy foods.5,6 The dietary approach to prevent or control diarrhea varies depending on its cause and on personal tolerance.


In practice

  • The dietary approach for treating diarrhea will vary based on its cause and on personal tolerance.
  • While it is generally recommended to return to a normal diet as soon as possible, certain foods such as caffeinated or sugary beverages, alcohol, and fatty or spicy foods may be irritating to the digestive tract.
  • Current evidence does not support automatically eliminating dairy during periods of acute diarrhea. Rather, favouring low-fat or fermented products is advised.
  • Some research is now suggesting that certain fermented dairy products, such as yogurt, may be helpful in avoiding or alleviating acute episodes of diarrhea.

Acute diarrhea. There is a common belief that dairy products should be eliminated during episodes of diarrhea. However, evidence does not support the need to eliminate dairy completely.4,7 Rather, it is generally advised to consume milk products as tolerated and to favour options that are low-fat or contain probiotics.5,6 In some cases, digestive irritation may trigger a temporary shortage of the enzyme needed to properly digest lactose, causing short-term secondary lactose intolerance. 8-10 The body’s ability to digest lactose will usually return to normal shortly after the irritation is resolved.10 

Some evidence suggests that fermented dairy products, such as yogurt, may also yield certain benefits for preventing or alleviating acute diarrhea.11,12 In fact, a systematic review of 31 studies that explored the health effects of probiotic foods associated certain probiotic milk products, such as yogurt, to a decrease in the duration of episodes of diarrhea that were caused by either an infection or by antibiotics.12 Moreover, a meta-analysis including over 32 000 children found that probiotic yogurt was more effective than a placebo at reducing the duration of acute diarrhea in high-income countries, such as Canada.13

Dietary intolerances. Dietary intolerances require personalized approaches to avoid symptoms, such as diarrhea.14,15 For example, lactose intolerant individuals can often tolerate varying levels of lactose without experiencing gastrointestinal discomfort. Factors include personal tolerance, the type of food consumed, and if the food is consumed alone or with other foods.14,15  

 

Interested in learning more about managing lactose intolerance?

Read more here

References



  1. National Institute of Diabetes and Digestive and Kidney Diseases. 2021. Diarrhea. https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea. Accessed July 19, 2021.
  2. UpToDate. 2021. Approach to the adult with acute diarrhea in resource-rich settings. https://www.uptodate.com/contents/approach-to-the-adult-with-acute-diarrhea-in-resource-rich-settings. Accessed July 20, 2021.
  3. Grave NS. Acute Gastroenteritis. Prim Care 2013; 40: 727–741.
  4. Lo Vecchio et al. Comparison of Recommendations in Clinical Practice Guidelines for Acute Gastroenteritis in Children. J Pediatr Gastroenterol Nutr 2016; 63:226–235.
  5. Gouvernement du Québec. 2020. Foods to eat when you have gastroenteritis. https://www.quebec.ca/en/health/health-issues/flu-cold-and-gastroenteritis/gastroenteritis/foods-to-eat-when-you-have-gastroenteritis. Accessed July 28, 2021.
  6. HealthLinkBC. 2020. Diarrhea, Age 12 and Older. https://www.healthlinkbc.ca/health-topics/diar4#hw87342. Accessed July 28, 2021.
  7. Guarino A et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. Journal of pediatric gastroenterology and nutrition 2014; 59:132-152.
  8. Di Costanzo M, Canani RB. Lactose intolerance: common misunderstandings. Annals of Nutrition and Metabolism 2018;73:30-37.
  9. National Health Service. 2019. Lactose intolerance. https://www.nhs.uk/conditions/lactose-intolerance/. Accessed July 19, 2021.
  10. American College of Gastroenterology. 2021. Lactose Intolerance in Children. https://gi.org/topics/lactose-intolerance-in-children/. Accessed July 20, 2021.
  11. Savaiano DA and Hutkins RW. Yogurt, cultured fermented milk, and health: A systematic review.  Nutrition reviews 2021;79:599-614.
  12. Scourboutakos MJ et al. Mismatch between probiotic benefits in trials versus food products. Nutrients 2017. doi 10.3390/nu9040400.
  13. Florez ID et al. Comparative effectiveness and safety of interventions for acute diarrhea and gastroenteritis in children: a systematic review and network meta-analysis. PLoS One 2018. doi.org/10.1371/journal.pone.020770.
  14. Corgneau M et al. Recent advances on lactose intolerance: Tolerance thresholds and currently available answers. Critical reviews in food science and nutrition 2017;57:3344-3356.
  15. Mattar R, de Campos Mazo DF, Carrilho FJ. Lactose intolerance: diagnosis, genetic, and clinical factors. Clinical and experimental gastroenterology 2012. doi:10.2147/CEG.S32368.

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Lactose intolerance – Symptoms & causes

Overview

People with lactose intolerance are unable to fully digest the sugar (lactose) in milk. As a result, they have diarrhea, gas and bloating after eating or drinking dairy products. The condition, which is also called lactose malabsorption, is usually harmless, but its symptoms can be uncomfortable.

Too little of an enzyme produced in your small intestine (lactase) is usually responsible for lactose intolerance. You can have low levels of lactase and still be able to digest milk products. But if your levels are too low you become lactose intolerant, leading to symptoms after you eat or drink dairy.

Colon and small intestine

The small intestine and colon are parts of your digestive tract, which processes the foods you eat. The intestines take nutrients from the foods. What isn’t absorbed by the intestines continues along the digestive tract and is passed as stool during a bowel movement.

Most people with lactose intolerance can manage the condition without having to give up all dairy foods.

Products & Services

Symptoms

The signs and symptoms of lactose intolerance usually begin from 30 minutes to two hours after eating or drinking foods that contain lactose. Common signs and symptoms include:

  • Diarrhea
  • Nausea, and sometimes, vomiting
  • Stomach cramps
  • Bloating
  • Gas

When to see a doctor

Make an appointment with your doctor if you frequently have symptoms of lactose intolerance after eating dairy foods, particularly if you’re worried about getting enough calcium.

Causes

Lactose intolerance occurs when your small intestine doesn’t produce enough of an enzyme (lactase) to digest milk sugar (lactose).

Normally, lactase turns milk sugar into two simple sugars — glucose and galactose — which are absorbed into the bloodstream through the intestinal lining.

If you’re lactase deficient, lactose in your food moves into the colon instead of being processed and absorbed. In the colon, normal bacteria interact with undigested lactose, causing the signs and symptoms of lactose intolerance.

There are three types of lactose intolerance. Different factors cause the lactase deficiency underlying each type.

Primary lactose intolerance

People who develop primary lactose intolerance — the most common type — start life producing enough lactase. Infants, who get all their nutrition from milk, need lactase.

As children replace milk with other foods, the amount of lactase they produce normally drops, but usually remains high enough to digest the amount of dairy in a typical adult diet. In primary lactose intolerance, lactase production falls off sharply by adulthood, making milk products difficult to digest.

Secondary lactose intolerance

This form of lactose intolerance occurs when your small intestine decreases lactase production after an illness, injury or surgery involving your small intestine. Diseases associated with secondary lactose intolerance include intestinal infection, celiac disease, bacterial overgrowth and Crohn’s disease.

Treatment of the underlying disorder might restore lactase levels and improve signs and symptoms, though it can take time.

Congenital or developmental lactose intolerance

It’s possible, but rare, for babies to be born with lactose intolerance caused by a lack of lactase. This disorder is passed from generation to generation in a pattern of inheritance called autosomal recessive, meaning that both the mother and the father must pass on the same gene variant for a child to be affected. Premature infants can also have lactose intolerance because of an insufficient lactase level.

Risk factors

Factors that can make you or your child more prone to lactose intolerance include:

  • Increasing age. Lactose intolerance usually appears in adulthood. The condition is uncommon in babies and young children.
  • Ethnicity. Lactose intolerance is most common in people of African, Asian, Hispanic and American Indian descent.
  • Premature birth. Infants born prematurely might have reduced levels of lactase because the small intestine doesn’t develop lactase-producing cells until late in the third trimester.
  • Diseases affecting the small intestine. Small intestine problems that can cause lactose intolerance include bacterial overgrowth, celiac disease and Crohn’s disease.
  • Certain cancer treatments. If you’ve had radiation therapy for cancer in your stomach or you have intestinal complications from chemotherapy, your risk of developing lactose intolerance increases.

Lactose intolerance – symptoms, signs

Share

Authors: doctor, candidate of medical sciences, Yudintseva M. S., [email protected]
doctor, candidate of medical sciences, Tolmacheva E. A., [email protected]
doctor, scientific director of JSC “Vidal Rus”, Zhuchkova T.V., [email protected]

Table of contents:

  • General information
  • Causes of lactose intolerance
  • Symptoms of lactose intolerance
  • What can you do
  • What a doctor can do
  • Preventive measures for lactose intolerance

General

Lactose is one of the complex sugars found in milk and all dairy products. During the digestive process, lactose is broken down by lactase (an enzyme secreted in the small intestine) into simple sugars (the monosaccharides glucose and galactose), which are absorbed into the bloodstream. “Intolerance” means an inability to digest lactose, often associated with a deficiency of the lactase enzyme. Approximately 30 minutes after drinking milk or dairy products such as ice cream or cottage cheese and homemade cheese, people with lactose intolerance may have diarrhea (diarrhea) or cramping pain (abdominal cramps) and bloating (increased gas formation in the intestines), the severity of which depends on the level of lack of enzymes. However, a person with a mild enzyme deficiency may not experience any symptoms at all.

It is widely believed that lactose intolerance is an allergy to milk. In fact, this is not so, and the difference between these two concepts is very large. People with lactose intolerance do not have to remove milk and dairy products from their diet, but they do need to control the amount of dairy products. But people suffering from an allergy to milk should not consume even the minimum amount of milk. Symptoms of a milk allergy include difficulty breathing, tightness in the throat, nasal discharge, swollen eyes and eyelids, skin rashes, and vomiting. Lactose intolerance manifests itself differently.

Causes of lactose intolerance

Congenital lactase deficiency, predominately common among persons belonging to the Asian race.

Natural decrease in lactase levels that begins in childhood (after 3 years). How significant this decrease will be depends on the characteristics of the body of a particular person. However, it is safe to say that the older a person is, the more likely they are to suffer from lactose intolerance.

Any disease that affects lactase-producing cells in the small intestine, such as inflammatory diseases and even the flu. This condition causes “secondary lactase deficiency”. This is a temporary problem that disappears as soon as the disease passes, the damaged cells are restored and begin to produce enzymes again.

Stomach and intestinal surgery that can completely destroy the body’s ability to produce lactase.

Symptoms of lactose intolerance

  • diarrhea, loose stools;
  • increased gas formation;
  • Abdominal cramps.

What you can do

Find out how lactose intolerant you are. In addition to observing how your body reacts to milk and dairy products, there are two accurate ways to test for lactose intolerance:

  • oral tolerance test;
  • breath test for hydrogen (involves measuring the level of hydrogen in exhaled air, which depends on the amount of undigested lactose).

Try lactose-reduced or lactose-free foods. You should not completely deprive yourself of dairy products containing lactose, because. this not only drastically reduces the amount of calcium in the diet, but also reduces your body’s ability to absorb calcium from non-dairy foods (as lactose helps the intestines absorb and retain calcium).

Be aware that skimmed milk is not safer due to the fact that it has less fat. The problem of intolerance is not related to fat content, but to lactose. Buttermilk and acidophilus milk also contain lactose, so you should also be careful with them.

Try yoghurt. Many people who are lactose intolerant can digest the lactose found in yogurt normally. However, yogurt is an excellent source of calcium. Use trial and error to determine which type of yogurt you tolerate best. Avoid pasteurized yoghurts as the benefits from them are much less, and the harm from lactose remains.

Drink chocolate milk. Calcium from such milk is perfectly absorbed, and the chocolate taste makes it more pleasant. What’s more, cocoa can even stimulate lactase activity.

Some cheeses, especially cheddar, parmesan, swiss cheese and mozzarella, are excellent sources of calcium. However, they are not dangerous in terms of lactose, because. whey, which contains the most lactose, is separated during the cheese making process. But cottage cheese, homemade cheese and ricotta are rich in lactose, so they should not be abused.

Drink milk with meals or cereals. Taking lactose at the same time as food makes it easier to digest and causes fewer side effects.

Drink small amounts of milk (half a cup) several times a day with meals. This will replenish the required dose of calcium and will not cause any special problems.

Be careful what you eat. Lactose can be found in bread, frozen vegetables, canned soups, salad dressings and sauces, spaghetti, etc., breakfast cereals, cakes, candies, and even pharmaceutical products.

Watch closely for signs of lactose intolerance. If you have such a problem, it is very likely that your children will also have it. In infants, congenital lactose intolerance can be life threatening. As soon as a child suffering from lactose intolerance is fed mother’s milk or artificial food containing milk, he develops colic, gas, diarrhea, and he stops gaining weight. Today, special artificial nutrition is available that does not contain lactose. Contact your pediatrician, who will select artificial nutrition for your child and a balanced diet that will allow you to replenish the required amount of calcium in his diet.

What a doctor can do

Prescribe enzyme tablets or drops. For the treatment of other diseases, prescribe drugs that do not contain lactose.

Treat severe secondary lactase deficiency.

A nutritionist can develop a balanced diet for you.

Your pediatrician can help you find the right food for your baby and give you the advice you need to feed your baby.

Preventive measures for lactose intolerance

Be careful not to get diseases of the digestive system. In addition, there are almost no ways to prevent such a genetically programmed disorder as lactose intolerance.

However, a few simple precautions can help people with mild lactase intolerance avoid symptoms without completely depriving themselves of milk and dairy products.

If you are lactose intolerant, don’t deprive yourself of dairy products. Try to eat foods rich in calcium, such as milk, but in small doses (less than a cup) and drink it with meals. In general, small amounts of cheese and yogurt are fairly well tolerated by people with lactose intolerance.

You can also try lactose-free milk, cheese and cottage cheese or other calcium sources such as soy milk, almonds, broccoli and other green vegetables, fish, etc.

E73 – Lactose intolerance

Bifiform

Caps. enteric: 15, 20, 30, 40, 60 or 100 pcs.

reg. No.: P N013677/01
from 08.06.11

GlaxoSmithKline Healthker

(Russia)

Produced by:

PFIZER CONSUMER MANUFACTURING ITALY

(Italy)

Consult a healthcare professional before using any drug
and read the instructions for use.

References

  1. Selected lectures on endocrinology. / A.S. Ametov. – M.: Medical Information Agency, 201- 544 p.
  2. Clinical endocrinology. / S.B. Shustov, I.L. Baranov, Yu.Sh. Khalimov. – M.: Medical Information Agency, 2012. – 632 p.
  3. Differential diagnosis of endocrine diseases. / M.I. Balabolkin.- M.: Medicine, 2005. – 300 p.
  4. Topical issues of endocrinology in therapeutic practice: a guide for physicians / MN Kalinkin et al. / ed. M. N. Kalinkin, L. V. Shpak. – Tver: Factor and K, 2014. – 698 c.
  5. Diseases of the endocrine system: A guide for physicians. / Ed. acad. RAMN I.I. Grandfather. – M.: Medicine, 2000. – 568 p.

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Lactose intolerance – symptoms, signs

Share

Authors: doctor, candidate of medical sciences, Yudintseva M. S., [email protected]
doctor, candidate of medical sciences, Tolmacheva E. A., [email protected]
doctor, scientific director of JSC “Vidal Rus”, Zhuchkova T.V., [email protected]

Table of contents:

  • General information
  • Causes of lactose intolerance
  • Symptoms of lactose intolerance
  • What can you do
  • What a doctor can do
  • Preventive measures for lactose intolerance

General

Lactose is one of the complex sugars found in milk and all dairy products. During the digestive process, lactose is broken down by lactase (an enzyme secreted in the small intestine) into simple sugars (the monosaccharides glucose and galactose), which are absorbed into the bloodstream. “Intolerance” means an inability to digest lactose, often associated with a deficiency of the lactase enzyme. Approximately 30 minutes after drinking milk or dairy products such as ice cream or cottage cheese and homemade cheese, people with lactose intolerance may have diarrhea (diarrhea) or cramping pain (abdominal cramps) and bloating (increased gas formation in the intestines), the severity of which depends on the level of lack of enzymes. However, a person with a mild enzyme deficiency may not experience any symptoms at all.

It is widely believed that lactose intolerance is an allergy to milk. In fact, this is not so, and the difference between these two concepts is very large. People with lactose intolerance do not have to remove milk and dairy products from their diet, but they do need to control the amount of dairy products. But people suffering from an allergy to milk should not consume even the minimum amount of milk. Symptoms of a milk allergy include difficulty breathing, tightness in the throat, nasal discharge, swollen eyes and eyelids, skin rashes, and vomiting. Lactose intolerance manifests itself differently.

Causes of lactose intolerance

Congenital lactase deficiency, predominately common among persons belonging to the Asian race.

Natural decrease in lactase levels that begins in childhood (after 3 years). How significant this decrease will be depends on the characteristics of the body of a particular person. However, it is safe to say that the older a person is, the more likely they are to suffer from lactose intolerance.

Any disease that affects lactase-producing cells in the small intestine, such as inflammatory diseases and even the flu. This condition causes “secondary lactase deficiency”. This is a temporary problem that disappears as soon as the disease passes, the damaged cells are restored and begin to produce enzymes again.

Stomach and intestinal surgery that can completely destroy the body’s ability to produce lactase.

Symptoms of lactose intolerance

  • diarrhea, loose stools;
  • increased gas formation;
  • Abdominal cramps.

What you can do

Find out how lactose intolerant you are. In addition to observing how your body reacts to milk and dairy products, there are two accurate ways to test for lactose intolerance:

  • oral tolerance test;
  • breath test for hydrogen (involves measuring the level of hydrogen in exhaled air, which depends on the amount of undigested lactose).

Try lactose-reduced or lactose-free foods. You should not completely deprive yourself of dairy products containing lactose, because. this not only drastically reduces the amount of calcium in the diet, but also reduces your body’s ability to absorb calcium from non-dairy foods (as lactose helps the intestines absorb and retain calcium).

Be aware that skimmed milk is not safer due to the fact that it has less fat. The problem of intolerance is not related to fat content, but to lactose. Buttermilk and acidophilus milk also contain lactose, so you should also be careful with them.

Try yoghurt. Many people who are lactose intolerant can digest the lactose found in yogurt normally. However, yogurt is an excellent source of calcium. Use trial and error to determine which type of yogurt you tolerate best. Avoid pasteurized yoghurts as the benefits from them are much less, and the harm from lactose remains.

Drink chocolate milk. Calcium from such milk is perfectly absorbed, and the chocolate taste makes it more pleasant. What’s more, cocoa can even stimulate lactase activity.

Some cheeses, especially cheddar, parmesan, swiss cheese and mozzarella, are excellent sources of calcium. However, they are not dangerous in terms of lactose, because. whey, which contains the most lactose, is separated during the cheese making process. But cottage cheese, homemade cheese and ricotta are rich in lactose, so they should not be abused.

Drink milk with meals or cereals. Taking lactose at the same time as food makes it easier to digest and causes fewer side effects.

Drink small amounts of milk (half a cup) several times a day with meals. This will replenish the required dose of calcium and will not cause any special problems.

Be careful what you eat. Lactose can be found in bread, frozen vegetables, canned soups, salad dressings and sauces, spaghetti, etc., breakfast cereals, cakes, candies, and even pharmaceutical products.

Watch closely for signs of lactose intolerance. If you have such a problem, it is very likely that your children will also have it. In infants, congenital lactose intolerance can be life threatening. As soon as a child suffering from lactose intolerance is fed mother’s milk or artificial food containing milk, he develops colic, gas, diarrhea, and he stops gaining weight. Today, special artificial nutrition is available that does not contain lactose. Contact your pediatrician, who will select artificial nutrition for your child and a balanced diet that will allow you to replenish the required amount of calcium in his diet.

What a doctor can do

Prescribe enzyme tablets or drops. For the treatment of other diseases, prescribe drugs that do not contain lactose.

Treat severe secondary lactase deficiency.

A nutritionist can develop a balanced diet for you.

Your pediatrician can help you find the right food for your baby and give you the advice you need to feed your baby.

Preventive measures for lactose intolerance

Be careful not to get diseases of the digestive system. In addition, there are almost no ways to prevent such a genetically programmed disorder as lactose intolerance.

However, a few simple precautions can help people with mild lactase intolerance avoid symptoms without completely depriving themselves of milk and dairy products.

If you are lactose intolerant, don’t deprive yourself of dairy products. Try to eat foods rich in calcium, such as milk, but in small doses (less than a cup) and drink it with meals. In general, small amounts of cheese and yogurt are fairly well tolerated by people with lactose intolerance.

You can also try lactose-free milk, cheese and cottage cheese or other calcium sources such as soy milk, almonds, broccoli and other green vegetables, fish, etc.

E73 – Lactose intolerance

Bifiform

Caps. enteric: 15, 20, 30, 40, 60 or 100 pcs.

reg. No.: P N013677/01
from 08.06.11

GlaxoSmithKline Healthker

(Russia)

Produced by:

PFIZER CONSUMER MANUFACTURING ITALY

(Italy)

Consult a healthcare professional before using any drug
and read the instructions for use.

References

  1. Selected lectures on endocrinology. / A.S. Ametov. – M.: Medical Information Agency, 201- 544 p.
  2. Clinical endocrinology. / S.B. Shustov, I.L. Baranov, Yu.Sh. Khalimov. – M.: Medical Information Agency, 2012. – 632 p.
  3. Differential diagnosis of endocrine diseases. / M.I. Balabolkin.- M.: Medicine, 2005. – 300 p.
  4. Topical issues of endocrinology in therapeutic practice: a guide for physicians / MN Kalinkin et al. / ed. M. N. Kalinkin, L. V. Shpak. – Tver: Factor and K, 2014. – 698 c.
  5. Diseases of the endocrine system: A guide for physicians. / Ed. acad. RAMN I.I. Grandfather. – M.: Medicine, 2000. – 568 p.

← Previous article

Next article →

Read more

You may be interested in