Lactose Intolerance

Did you know that many people who are told that they’re lactose intolerant are not truly intolerant? So, what is it one can do to make life a lot more comfortable and enjoy a little bit of Camembert, Wensleydale or Cheddar? At Aloeride, we are particularly fond of Salade Chèvre Chaud… a mountain of fresh salad with on top, warm goat’s cheese on thinly sliced toast, oh yum! How sad if you would have to forego such a healthy delicacy, especially if this would be because of a fictitious reason of lactose intolerance. There’s lactose intolerance, there’s sensitivity, there’s digestive capacity… and there’s different milk.

From this IgG food intolerance / sensitivity test you can see that cows milk scores 2 on a scale from 0 to 4. The workable conclusion to draw from this is that the patient (old enough to have a fully developed immune system) would do fine by simply rotating dairy intake i.e. milk on Day 1, no milk on Day 2 and perhaps also not on Day 3, milk on Day 4. But what such tests omit to tell you is what I discuss below, that there are different types of milk.

Long before anyone should consider themselves allegic to cow’s milk, please understand the difference between A1 milk and A2 milk. Old breeds (smaller milk yield) of dairy cows like Guernsey, Jersey, Normande and Brown Swiss (i.e. A2A2 DNA proven) produce A2A2 milk. New breeds (bigger milk yield) cows like Holstein, Fresian, Ayrshire, Shorthorn produce A1 or A1/A2 mix milk. When supermarkets pay farmers less and less for milk (they squeezed until the pips squeaked with, at some point, them paying less than it costs to produce milk) statements like “larger, higher yielding herds were more suited to the market conditions” appeared. Farmers changed to larger yield cows (A1A1, A1A2) for economic survival and unsurprisingly sensitivity to cow’s milk increased. Sufferers being none the wiser as to how and why that happened.

The breed with the highest percentage of A2 alleles in Europe is Guernsey, with 92%, whereas A1 is the most common allele in other dairy breeds, such as Holstein (60%) or Ayrshire (60%). So try A2A2 milk from a A2A2 DNA tested Guernsey… Interesting to note that the protein structure of β-casein in human breast milk is similar to that of A2 β-casein in cows’ milk. Same goes for goats milk.

The symptoms’ trigger is, as usual, histamine… In type A2 β-casein, there is the amino acid Proline at the chain’s position 67, whereas in A1 β-casein, this Proline is replaced by Histidine. Thus, the original codon cytosine-cytosine-thymine (CCT), which forms the amino acid Proline in the A2 variant, is modified to cytosine-adenine-thymine (CAT), which encodes the formation of Histidine at position 67 of the β-casein polypeptide chain in A1 variants. L-Histidine can be converted to Histamine and CO2 by bacteria (group II decarboxylases in intestinal microbiota). As you know, in an allergic reaction, mast cells release Histamine which triggers allergy symptoms. Digestive discomfort is mainly associated with lactose malabsorption, which affects approximately 65% of the adult population worldwide. Lactose-intolerant individuals suffer diverse digestive symptoms after milk ingestion, such as abdominal pain, bloating sensation, stool frequency changes, and stool consistency changes.

Digestion of A1 milk generates the peptide β-casomorphin-7. This exogenous agonists can cross the gastrointestinal wall, enter the systemic circulation and influence systemic and cellular activities via opioid receptors. Thus influencing the digestive system and immune cells. It may also be involved in various disorders in infants, including type 1 diabetes and respiratory dysfunction, and may influence central nervous system activity. [Infant volume 9 issue 5 2013]

For most people it is true that, if their gut flora (modern term is gut microbiome) would be more diverse and robust, their sensitivity or perceived intolerance to lactose would be less or even non-existent. The simple reason for this is, that a more diverse/robust gut flora makes a greater quantity of more diverse enzymes to break down food, including lactose. Lactose is broken down by the enzyme lactase into common glucose and galactose. Lactase is produced by the epithelial cells that line the walls of the small intestine. Unless you have the rare metabolic disorder Galactosaemia, your body can metabolise i.e. tolerate galactose. Most people’s lactose problem stems from not making enough lactase. You can change this. Between 1 vegetarian capsule of Aloeride once or twice a day and a gradual increase of (and it must be) double-fermented A2 milk kefir (so all fermentation has happened outside your body) you can build a more diverse and robust gut microbiome. Also you should give the effect of your brain on your gut considerable consideration: more stress can translate in less tolerance to lactose. Your gut microbiome changes with what you eat, with your prevailing mood, with your physical activity level, and throughout seasons.

Of the four probiotics that have proven succesful in my clinic, the Probion Active is clinically proven to relief diarrhea, bloating & gas, abdominal pain & unpredictable bowel movements in clinical trials with sensitive IBS sufferers. For using daily with normal, speedy or loose (diarrhea) digestion, active lifestyle, lactose Intolerance. Probion Active is suitable for a FODMAP diet.

If you make A2 milk kefir yourself, which is what I advised to many of my patients, then, instead of just fermenting the kefir overnight, you leave it to ferment for longer (48 instead of 24hrs). This is the same approach as taken in the Specific Carbohydrate Diet with double fermented yoghurt… lactose fermentation takes place in the jar and not in your body. So you’ll get all the benefit from the wider spectrum, probiotic cultures and none of the disadvantages of lactose. Unless your lactose intolerance is an inherited genetic fault, double fermentation can be a sensible way to grow and maintain a healthy gut microbiome, and in doing so you are likely to reduce lactose sensitivity.

Of course you know of IgE-based, acute allergy (sufferers carry an EpiPen epinephrine autoinjector) but you may not be familiar with slow IgG immune responses. The danger of acute allergy is anaphylactic shock which can be triggered by food but also by biting or stinging insects or even medication. Thus ‘IgE’ presents a non-negotiable scenario but ‘IgG’ often allows for managed transgressions. Aloeride being the helpful buffer in such management.