REVIEW

Systemic lactose intolerance: a new perspective on an old problem

S B Matthews¹, J P Waud¹, A G Roberts², A K Campbell³

¹ Department of Medical Biochemistry and Immunology, Llandough Hospital, Cardiff and Vale NHS Trust, Penarth, Vale of Glamorgan, UK
² Department of Medical Biochemistry and Immunology, Cardiff and Vale NHS Trust, Cardiff, UK
³ Department of Medical Biochemistry and Immunology, Wales College of Medicine, Cardiff University, Cardiff, UK

Correspondence to:
Correspondence to:
Professor A K Campbell
Department of Medical Biochemistry and Immunology, Wales College of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; campbellak{at}cf.ac.uk

Intolerance to certain foods can cause a range of gut and systemic symptoms. The possibility that these can be caused by lactose has been missed because of "hidden" lactose added to many foods and drinks inadequately labelled, confusing diagnosis based on dietary removal of dairy foods. Two polymorphisms, C/T₁₃₉₁₀ and G/A₂₂₀₁₈, linked to hypolactasia, correlate with breath hydrogen and symptoms after lactose. This, with a 48 hour record of gut and systemic symptoms and a six hour breath hydrogen test, provides a new approach to the clinical management of lactose intolerance. The key is the prolonged effect of dietary removal of lactose. Patients diagnosed as lactose intolerant must be advised of "risk" foods, inadequately labelled, including processed meats, bread, cake mixes, soft drinks, and lagers. This review highlights the wide range of systemic symptoms caused by lactose intolerance. This has important implications for the management of irritable bowel syndrome, and for doctors of many specialties.

Keywords: lactose; lactase; lactose intolerance; polymorphism; hydrogen

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