As symptoms of lactose intolerance can be so similar to those of IBS, as well as a number of other conditions such as coeliac disease (an autoimmune disease triggered by eating gluten), the potential for misdiagnosis and confusion is high. Despite this, it is possible to take a patient driven approach to diagnosis, enabling you to make the right diagnosis first time and empowering your patients to manage the condition effectively, freeing up unnecessary repeat appointments. "Two appointments for a diagnosis of lactose intolerance is one appointment too many," says Dr Adam Fox , Consultant Paediatric Allergist. "With budgets getting ever tighter we need to take advantage of some quick wins on everyday diagnosis."
Lactose intolerance and your patients
Lactose intolerance occurs when a patient has a deficiency of lactase, an enzyme produced by the small intestine which is responsible for breaking down lactose, the main sugar (carbohydrate) found in milk. Undigested lactose therefore passes through the gut into the large intestine where it is fermented by colonic bacteria, resulting in uncomfortable symptoms including stomach cramps and diarrhoea. Lactose intolerance is thought to affect up to 15% of the UK population so if a GP has never made this diagnosis it should raise the question as to whether some previous cases have been missed or possibly misdiagnosed.
Two thirds of GPs also observe temporary lactose intolerance in patients, often following a disturbance to the normal function of the gut such as surgery, gastroenteritis, IBS, uncontrolled coeliac disease or cancer and its treatment.
Cutting through the confusion
The symptoms of lactose intolerance can be similar to those associated with IBS. Therefore it may come as no surprise that when presented with symptoms such as bloating, wind, nausea, diarrhoea and stomach cramps in an otherwise healthy individual, around three quarters (76%) of GPs would diagnose IBS. Dr Adam Fox highlights that for many GP’s this would feel a frustrating diagnosis, often made when at a loss for an alternative. In fact it is estimated that up to 20 per cent of those believed to be living with IBS may actually be lactose intolerant.
Dr Fox explains, "Lactose intolerant patients may typically experience IBS-type symptoms after eating dairy products and often eliminate all dairy products from their diet, when it is simply the lactose that is causing the symptoms."
He continues, "However, with guidance from you on managing their condition and by restricting dairy consumption to lactose-free products, patients can avoid missing out on the important nutrients found in dairy produce, such as calcium, an important dietary factor for children and women in particular."
Even when IBS is the correct diagnosis, lactose intolerance is so common that it will occur co-incidentally in some and may interfere with management and aggravate symptoms. As a result patients may blame dairy as a whole and cut it out of their diets unnecessarily, instead of adopting a lactose free diet (such as is offered by the Lactofree range) which could relieve their symptoms.
Diagnosing lactose intolerance
As Dr Fox has already alluded to, invasive and often expensive testing is usually not necessary in diagnosing lactose intolerance. A two phase elimination diet offers a reliable and effective way to diagnose lactose intolerance which the patient themselves can carry out. It involves eliminating foods containing lactose for two weeks from the diet to see if symptoms improve, and then gradually reintroducing lactose to determine how much lactose can be tolerated before symptoms return.
No printed materials for guidance are required as all resources can be accessed online. Refer your patients to take advantage of a quick and simple online self-diagnosis tool as provided by Lactofree under the guidance of a specialist advisory board. The Lactofree Discovery Tool will help your patient decide if they might benefit from taking a two week elimination diet test.
If this highlights to patients that they may be lactose intolerant then they will then be referred to the two week elimination, which is available from www.lactofree.co.uk.
Managing lactose intolerance
A diagnosis of lactose intolerance should not lead patients to cut essential dairy and calcium from their diet. To help patients manage their relationship with dairy and stay well, you can advise patients on products that exist that will help them manage their condition, lessening the likelihood of a repeat visit or of them not completing the elimination diet effectively.
Currently, many "milk" alternatives are on the market and claim to be lactose free however there is some confusion over what constitutes "lactose free" and the choices available to those who are lactose intolerant.
Messaging around milk derived from animals such as goat, buffalo, sheep and camel can be confusing with some consumers believing them to be lower or without lactose compared to cows milk. Plant based alternatives such as soya, nut or grain milk alternatives are lactose free however they offer nothing to the diet by way of calcium intake to your patient which is important for teenagers and women in particular.
Lactofree is a range of dairy products with all the nutritional benefits of regular dairy without the lactose*, providing a good and easily accessible sources of calcium. Patients won’t need to change their routine or get use to new products that don’t taste the same as dairy so can help aid a smooth transition from normal dairy to lactose free.
Dr Adam Fox finishes, "By making this transition as easy as possible for your patients and by advising the right route of diagnosis and management (for them and their family) you can help minimise the likelihood of patients deviating from your advised diet resulting in symptom flare up and future surgery visits."
The Lactofree range currently includes Lactofree semi-skimmed and whole (fresh and long life), hard and soft cheese, cream, fruit yogurts, spreadable and ice cream and is listed at all major supermarkets. Patients can also manage their intolerance on the go with Lactofree long life portion packs.
 Healthcare republic survey of 529 UK GPs, conducted on behalf of Lactofree.
 "Are you missing something", You Gov, 2006
 Matthews S et al. Systemic lactose intolerance: a new perspective of an old problem. Postgraduate Medical Journal 2005: 81; 167-173