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Postgrad Med J 81:167-173 doi:10.1136/pgmj.2004.025551
  • Review

Systemic lactose intolerance: a new perspective on an old problem

  1. S B Matthews1,
  2. J P Waud1,
  3. A G Roberts2,
  4. A K Campbell3
  1. 1Department of Medical Biochemistry and Immunology, Llandough Hospital, Cardiff and Vale NHS Trust, Penarth, Vale of Glamorgan, UK
  2. 2Department of Medical Biochemistry and Immunology, Cardiff and Vale NHS Trust, Cardiff, UK
  3. 3Department of Medical Biochemistry and Immunology, Wales College of Medicine, Cardiff University, Cardiff, UK
  1. Correspondence to:
 Professor A K Campbell
 Department of Medical Biochemistry and Immunology, Wales College of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; campbellakcf.ac.uk
  • Received 15 June 2004
  • Accepted 22 September 2004

Abstract

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.

Footnotes

  • Funding: we thank the Department of Medical Biochemistry and Immunology for financial support.

  • Competing interests: none.

  • This study was approved by the appropriate ethics committee.