What is Lactose Intolerance?

lactose-intolerant

Many people realize that after they drink milk they feel awful.  They will begin to have terrible abdominal cramps, abdominal pain, diarrhea and sometimes even vomiting. However why is this happening?  People may think that they are ALLERGIC to milk.  Most often the culprit is lactose intolerance.

Is Lactose Intolerance common?

It can happen at any age from birth to adulthood.  It occurs most often after 5 years of age.  It can occur in any ethnic background.

What is Lactose Intolerance?

Lactose is a sugar found in milk.  It is broken down to glucose and galactose by the enzyme lactase, which allows lactose to be used as an energy source.  If the small intestine is missing the lactase enzyme the body can not change lactose to these smaller sugars and it leads to the symptoms of lactose intolerance.

What are the symptoms?

It is important to know about the common symptoms associated with lactose intolerance, particularly as they can manifest at any stage in life and therefore you could be experiencing these symptoms unaware of the cause. There is a direct correlation between the amount of the lactase enzyme a person is lacking in relation to the severity of symptoms.  If a person is lacking all lactase enzyme they will suffer from many symptoms and be unable to consume any milk product, this includes foods that we may not realize has dairy (such as those that have dairy fillers, like certain brands of cold cut meat and hot dogs.)  The most common symptoms include:

  • Abdominal cramps
  • Abdominal pain
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal bloating
  • Gas/Flatulence

Why do some people develop lactose intolerance?

There are many reasons that a person can develop lactose intolerance.  The National Institute of Diabetes and Digestive and Kidney Diseases have classified the 4 Types of Lactase Deficiency.

Four types of lactase deficiency may lead to lactose intolerance:

  • Primary lactase deficiency, also called lactase nonpersistence, is the most common type of lactase deficiency. In people with this condition, lactase production declines over time. This decline often begins at about age 2; however, the decline may begin later. Children who have lactase deficiency may not experience symptoms of lactose intolerance until late adolescence or adulthood. Researchers have discovered that some people inherit genes from their parents that may cause a primary lactase deficiency.
  • Secondary lactase deficiency results from injury to the small intestine. Infection, diseases, or other problems may injure the small intestine. Treating the underlying cause usually improves the lactose tolerance.
  • Developmental lactase deficiency may occur in infants born prematurely. This condition usually lasts for only a short time after they are born.
  • Congenital lactase deficiency is an extremely rare disorder in which the small intestine produces little or no lactase enzyme from birth. Genes inherited from parents cause this disorder.

How do you diagnose lactose intolerance?

A health care provider makes a diagnosis of lactose intolerance based on

  • medical, family, and diet history, including a review of symptoms
  • a physical exam
  • medical tests

Initially  an elimination diet may be recommended; eliminating all milk and milk products from a person’s diet for a short time to see if the symptoms resolve. Symptoms that go away when a person eliminates lactose from his or her diet may confirm the diagnosis of lactose intolerance.

Medical, family, and diet history. A health care provider will take a thorough medical, family, and diet history. During this discussion, the health care provider will review a patient’s symptoms. However, basing a diagnosis on symptoms alone may be misleading because digestive symptoms can occur for many reasons other than lactose intolerance. For example, other conditions such as irritable bowel syndrome, celiac disease, inflammatory bowel disease, or small bowel bacterial overgrowth can cause digestive symptoms.

Physical exam. A physical exam may help diagnose lactose intolerance or rule out other conditions that cause digestive symptoms. During a physical exam, a health care provider usually

  • checks for abdominal bloating
  • uses a stethoscope to listen to sounds within the abdomen
  • taps on the abdomen to check for tenderness or pain

Medical tests. The most commonly used tests to confirm the diagnosis are:

  • Hydrogen breath test. This test measures the amount of hydrogen in a person’s breath. Normally, only a small amount of hydrogen is detectable in the breath when a person eats or drinks and digests lactose. However, undigested lactose produces high levels of hydrogen. For this test, the patient drinks a beverage that contains a known amount of lactose. A health care provider asks the patient to breathe into a balloon-type container that measures breath hydrogen level. This test can be done at an office or hospital. Smoking and some foods and medications may affect the accuracy of the results. A health care provider will tell the patient what foods or medications to avoid before the test.
  • Stool acidity test. Undigested lactose creates lactic acid and other fatty acids that a stool acidity test can detect in a stool sample. Health care providers sometimes use this test to check acidity in the stools of infants and young children. A child may also have glucose in his or her stool as a result of undigested lactose. The health care provider will give the child’s parent or caretaker a container for collecting the stool specimen. The parent or caretaker returns the sample to the health care provider, who sends it to a lab for analysis.
  • Endoscopy. This test is performed under anesthesia or sedated.  A fiber optic tube is passed through the mouth down into the stomach and small intestine.  A tiny sample of tissue is taken or biopsied for further analysis.  This sample is sent to a lab that reviews the sample and tests to see if lactase enzyme is normally active.

How is it treated?

Many people can manage the symptoms of lactose intolerance by changing their diet. Some people may only need to limit the amount of lactose they eat or drink. Others may need to avoid lactose altogether. Using lactase products can help some people manage their symptoms  (Lactaid products)

For people with secondary lactase deficiency, treating the underlying cause improves lactose tolerance. In infants with developmental lactase deficiency, the ability to digest lactose improves as the infants mature. People with primary and congenital lactase deficiency cannot change their body’s ability to produce lactase.

Stay Healthy and Be Well.  Let me know your thought and comments.

#kidstummytroubles #lactoseintolerance #Lactaid

A Guide on Starting a Gluten Free Diet

fruit rainbow

When you realize that you need to make the change to Gluten Free it can be very overwhelming.  My patients start to search the internet and they get bombarded with info.  I always try to reassure them and say just start slowly and keep it simple.  I recommend starting by giving them a few reliable sources, such as the Gluten Free Diet Guide for Families provided by CDHNF and NASPGHAN. Look for the key words- wheat, barley or rye in the ingredient list of your packaged foods and in the beginning just stick to whole, unprocessed foods.  This means keep the diet simple initially – eat fruits, vegetables, dairy and protein.

Also a good starting point is to look for the labels on food that state Gluten Free.  There are many quality gluten free options that you can find  in most grocery stores. That being said, realize you may not like the gluten free food the first time you eat it.

More importantly, if you are changing to a gluten free diet due to an illness such as celiac disease, you may feel awful from being sick for a long time. Many people don’t have much of an appetite and have lost weight prior to their diagnosis. They may be suffering from stomach pain and no food tastes really good at this point.  Gluten free food is different. It takes time for your taste buds to change. I still remember the first time I ate gluten free pasta. My kids did not like the taste of it, it is a bit heavier than white pasta.  Start with some of the simple tested and true good gluten free unprocessed food and give yourself time to feel better and time for your taste buds to adjust.

For the first few weeks when you are learning, try some of these easy Gluten Free options.

Breakfast Ideas:

  • Yogurt, Smoothies and Parfaits – Chobani and Stonyfield yogurts are certified GF by the Gluten Intolerant Group. Top with fresh fruit for a great start to your day.
  • Eggs – scrambled, fried, or hard boiled
  • Gluten free cereal – there are several GF cereals.  General Mills and Van’s Cereals have a few Gluten free options.
  • Pocono Cream of Buckwheat – Buckwheat is good for you and naturally sweet.  Top with milk, sugar and cinnamon!
  • Certified Gluten Free Oats – only consume certified GF oats such as Bob’s Red Mill Gluten Free Oats.


Lunch and Dinner Ideas:

  • Any natural unprocessed meat
  • Baked potato
  • A sandwich on Udi Bread – you can go gluten free and still eat your favorite GF sandwich toppings on Udi bread.
  • Lunchmeat – Boar’s Head cold cuts and Hormel Natural Choice lunchmeats. For an easy lunch, roll some lunchmeat and cheese together and stick a toothpick in it.
  • Brown rice and risotto.
  • Nachos – Tostitos tortilla chips with melted cheese on top. Click on the Tostitos link to see a list of Frito Lay products that are gluten free!
  • Peanut butter on some toasted Gluten Free bread or with some Snyder’s of Hanover GF Pretzels.

Snacks:

  • Fruit and vegetables. Do not underestimate the value of fruit and veggies. We eat more of these than anything else.
  • Cheese is a great option for anyone on a gluten free diet. Gluten is not included in the standard ingredients in cheese that include milk, enzymes and sometimes salt. Most processed cheese is also likely though not guaranteed to be gluten free. You might find wheat in the seasoning  and noncaking ingredients used for some shredded cheeses, but anytime wheat is used it must be clearly labeled. I recommend shredding your own cheese if that is how you prefer to eat it.  Also blue cheese is also considered safe for those on a gluten free diet.
  • Chips are not necessarily healthy but many are gluten free. Click this link for Frito Lay Gluten Free List. Eat them with hummus, GF salsa or GF guacamole.
  • Real popcorn. Most microwave popcorn is gluten free but save yourself the worry and time and make your own popcorn.
  • Hard boiled eggs
  • Kozy Shack pudding
  • Nuts
  • Kind bars.  My kids favorite GF snack bar!
  • Make your own fresh fruit smoothies as a great snack. (and you can sneak veggies in the smoothies and your kids won’t even notice, I always try to sneak in either carrots or kale to ours at home)

Desserts:

Ice Cream itself is gluten free but may contain products which are made from gluten so avoid ice cream sandwiches, cone products, cookie and ice cream flavors such as Oreo, and flavors which contain brownie pieces, cookie dough and cheese cake etc.

 

Stay Healthy and Be Well. Please share your thoughts and comments.

#GlutenFree #KidsTummyTroubles #Celiac #Glutenfreeliving #GlutenFreeGuide

When Should I Call and When Can It Wait??

Answers to Your Questions About Your Child’s Tummy Aches

littleboybellypain

It’s been a busy week for everyone.  My Facebook feed is flooded with back to school pics of their kids holding the cute back to school signs.  So of course I posted my pic also.  My oldest daughter went back last Thursday.  Here she is holding up her sign.  She started the 2nd Grade this year. She was looking forward to seeing all her friends again.  The summer was great but after multiple trips to the pool, swim lessons, music lessons, vacations and staycations I think we were all ready to start this school year.  It is a bittersweet time.  I loved spending those lazy summer days with my girls, but they DEFINITELY need to get back to school for everyone’s sake.  The amount of fights I have broken up between these 2 sweet little girls is now in the DOZENS!!  So the school grind will do them both some good.
Back to School

This is her second year in this school, she knows the principal, all her teachers from last year, this year should be a stroll in the park for her.  Yet not even one week in and I have already had 2 phone calls from the school nurse and 5 visits to the nurse’s office. Living in the Northeast, this has been a brutal week hitting temps of 90s every day, no AC in the school (except the nurses office…..hmmmm I maybe onto something here).  The classrooms are very hot, but when should I be worried??  It is way too early in the school year to start a precedent of running to pick her up with every phone call and visit to the nurse.  But my inner mommy doesn’t want to neglect her pain and leave my baby in school if she is sick.

In my practice the start of school year is a busy time, especially for kids complaining of “tummy aches.”   As a “Kids Tummy Doc” I am going to share with you when to be alarmed with your child’s complaint and when it’s ok to wait and watch before calling your doctor. 

When should I call and when can it wait??

A Guide to your Kids Tummy Aches

  • Is it only after she eats? If so I would keep a careful eye on frequency and try to keep a record of what foods cause her to have the belly ache (fatty foods, spicy foods, dairy, etc)
  • Is it when she wakes in the morning prior to school? Make note if it only occurs weekdays, if she is symptom free on weekends this may be school related and due to stress or anxiety. I recommend talking to your child about her classmates, reach out to the teacher if this occurs excessively and always ask your child about bullying.
  • Is it after physical activity? Make note of when last meal was prior to onset of pain.  Send your child to school with water daily to avoid dehydration.
  • Does the pain wake your child from a sound sleep?  If this occurs there may be some organic etiology occurring.  Call for an appointment immediately with your child’s Pediatrician or Pediatric GI
  • Is it occurring more than 2-3 times a week?  Call for an appointment with your child’s Pediatrician or Pediatric GI
  • Where is the location of your child’s pain?  Think of the stomach as having 4 sections with the belly button at the center.  Each area helps the doctor narrow down the source of your child’s pain.  An example is that most commonly pain in the Left Lower Quadrant indicates issues with stooling or bowel movements and this patient may be suffering from constipation. Make sure to ask your child where the pain is and report this to your doctor.Quadrants
  • Does the pain radiate or spread to any other areas?  Many times it may start right around or above the belly button or in the Left Upper Quadrant and can radiate up to their chest.  This indicates gastroesophageal reflux and occasionally occurs with gastritis, and YES even kids can get stomach ulcers.  This child needs medication and a strict reflux diet to be followed.  Call for an appointment with your child’s Pediatrician or Pediatric GI.
  • Does the pain improve with eating? This may indicate gastritis or possibly a gastric ulcer, contact your child’s Pediatrician or Pediatric GI.
  • Has your child lost weight since the onset of these symptoms?  Unintentional weight loss should always indicate an immediate appointment with your child’s Pediatrician or Pediatric GI. 

Children are commonly not able to completely explain their pain to us.  I usually feel like a detective trying to get info from my patients regardless if its a 4 yo or a 16 yo (but it’s way easier to get info out of the little ones than the teenagers, believe me…. the teenagers require me to go into interrogation mode).  However, if you keep a watchful eye on their symptoms and think about these questions you will definitely know when to call for that appointment.

Now that school is back and I am trying to schedule all my kids after school activities, I think to myself that I don’t want to overload their schedules. I want them to have time to focus on school work and still have playdates with friends.   As parents we all want to offer our kids the world, but what we forget sometimes is that too many activities for children can lead to stress about their school work, their inability to keep up academically and the first way they may exhibit this, before even telling mom and dad, is by having GI complaints.  Be mindful when putting together their schedules and even with your high school kids look over how many times the teams and groups they want to join meet for practices and games each week.

Please let me know your thoughts regarding today’s post.  Did I miss any questions that your kids always complain of?  Is there something you would like me to add to this list?  Leave it below. Stay Healthy & Be Well!

#KidsTummyTroubles #bellyaches #whenshouldicall #abdominalpain