A blog article written to support Healthcare Professionals and their work with patients with food intolerance.
By Nicole Dynan, Accredited Practising Dietitian, Owner and Director of The Good Nutrition Co.
Confusion between food allergy and food intolerance is common and combined with high levels of self-diagnosis, this may lead to the unnecessary omission of food groups and valuable dietary nutrients. Healthcare Professionals can play a key role in educating the public on this distinction and provide advice on more suitable dietary alternatives to reduce the personal and health impacts on individuals suffering food intolerance.
Self-diagnosis and prevalence
Recent research conducted by YouGov has shown a trend in self-diagnosing food intolerance and allergies, with nearly a quarter (24%) of Australians claim to have self-diagnosed a food intolerance or allergy (1). The research findings identified that lactose intolerance is the most commonly self-diagnosed food intolerance in Australia (1). In fact, one in four (27%) Australians personally suffer from being lactose intolerant or lactose sensitive themselves or have someone in their household that is. Of these, more than 45% have self-diagnosed that they have a lactose intolerance (1).
While lactose intolerance is not life threatening, 28% of Australians do not know the difference between dairy allergy and lactose intolerance (1), which may lead to the cutting of dairy from the diet and the risk of nutrient deficiencies. Healthcare Professionals have an important role in educating Australians on the different options they have available to achieve a nutritionally balanced diet.
Australians of different ages may need to be approached in different ways, when providing education on dietary intolerance, as research shows that younger Australians are more likely to self-diagnose a dietary intolerance than older Australians (Gen Z 34%, Baby Boomers 18%). E.g. dietitians may need to spend more time providing education messages on food intolerance using social media to connect with Gen Z, whilst older Australians may benefit from food intolerance education through face-to-face or telehealth consultations. (1).
What is lactose intolerance?
Lactose is the main carbohydrate or sugar in dairy milk (including cows, goat, and sheep). It is a disaccharide, comprising one molecule of glucose and one of galactose. Those who are lactose intolerant are unable to digest lactose or have a reduced capacity to do so. This is due to them having low levels of lactase, the enzyme that breaks down the lactose sugar into glucose and galactose.
Symptoms of lactose intolerance and personal impact
Those Australians with lactose intolerance or sensitivity typically report experiencing symptoms of gas and bloating (74%), stomach pain (68%), or diarrhoea (67%) when they consume dairy products (1), agreeing that it significantly impacts their personal life and health (1).
How much lactose can most people tolerate?
Lactose intolerance tests are an unreliable indicator of the amount of lactose that an individual can consume through food. Of those who are lactase deficient, some may still produce a small amount of the lactase enzyme and tolerate up to 250ml or 1 glass of milk (12.5g lactose in 1 cup skim milk; 15.8g lactose in 1 cup full cream milk) and 30g (approximately 1 slice) of hard cheeses such as cheddar, gouda, edam, feta and swiss; and yoghurt, where the lactose is partially broken down by the bacteria.(2,3) It is worth noting that lactose sensitivity levels can vary between individuals with some reacting at lower lactose levels.
Despite this, of those people with lactose intolerance, about half cut dairy out of their diet – some swapping to nutritionally inadequate plant-based alternatives, especially when it comes to milk (1).
Increasing the awareness of clearly labelled lactose free products (i.e. products that have been tested for lactose) may provide peace of mind for those who are either newly diagnosed and learning to adjust to a new lifestyle or concerned about the gastrointestinal symptoms caused by regular dairy. These products can in provide lactose intolerant sufferers all the key nutrients from dairy as part of a healthy, well-balanced diet.
Why is dairy important?
Dairy is one of the five food groups recommended as part of the Australian Dietary Guidelines. It is easily accessible and rich in essential nutrients such as protein, carbohydrate, calcium, phosphorus, vitamin A, vitamin D, riboflavin, vitamin B 12, potassium, zinc, choline, magnesium, and selenium. These nutrients support strong bones and teeth, the growth and maintenance of cells, metabolism, and general health and wellbeing, and while obtaining them from other dietary sources is possible, dairy is an easy and convenient way for most people to regularly obtain these nutrients. Cutting dairy from the diet may leave people at risk of nutrient deficiencies which may impact bone health, muscular health, and heart health.
Awareness of Lactose-Free Alternatives The recent YouGov research found that despite two in three Australians who are lactose intolerant or who have someone in their household who is lactose intolerant being aware of lactose free products, almost half felt frustrated that they could not eat the dairy products they love, like cheese, chocolate, creamy pastas and lattes. They commented on having lower self-esteem and feeling less attractive or a burden to their family as a result (1).
Lactose-free dairy products provide a suitable alternative to dairy to assist with reducing the personal impact and symptoms induced by lactose intolerance, whilst allowing Australians to retain valuable nutrients like protein, calcium, Vitamin A, B12, zinc, phosphorus, and magnesium in their diets.
The role of Healthcare Professionals
Dairy is an important food group, that is rich in nutrients. Healthcare professionals can help reduce the personal and health impacts of dairy omission in those suffering from lactose intolerance by educating their patients to trial lactose free dairy products as a first step. A large range of lactose free dairy products are now available, including milk, cheese and yoghurt to help patients retain the nutritional benefits of dairy while avoiding the gut discomfort related to lactose-containing dairy. Encouraging the consumption of lactose-free dairy options over less nutritious plant-based alternatives or omitting dairy all together is suggested to reduce the possible health implications of dairy omission.
- YouGov – Liddells Lactose Study, 7th April 2020
- Australian Dietary Guidelines, p.60 https://www.eatforhealth.gov.au/sites/default/files/content/n55_australian_dietary_guidelines.pdf
- NUTTAB, 2010 Database, FSANZ.