Lactose Intolerance Can Be A Symptom Of Gluten Intolerance

January 22, 2011 · Filed Under Lactose Intolerance 

Many people are told that they have a lactose intolerance and are never investigated further to find the cause. Usually, only a lactose-free diet is recommended. I think we (doctors, nurses) need to dig a little deeper. Gluten could be the trigger and a gluten-free diet could be the real solution. For many, a lactose intolerance may actually disappear once an individual is consuming a gluten-free diet.

Let me explain further………

Lactose is natural sugar found in dairy products. It requires lactase, an enzyme produced within the intestines, to digest it. Usually, this enzyme is produced by the small intestinal villi. In Celiac disease (CD) (and in some with Dermatitis Herpetiformis), the intestinal villi becomes damaged (flattened) and this can impair the production of lactase. Immune reactions to ingested gluten can cause this damage. Loss of this brush border (another name for microvilli) enzyme results in a condition called lactose intolerance.

With lactose intolerance, the lactose passes undigested into the colon and then it is broken down by commensal bacteria. This process produces CO2 and hydrogen which can cause abdominal discomfort, bloating, flatulence, and possibly diarrhea. With a gluten intolerance, this may be temporary, since lactase production may resume once a gluten-free diet has commenced and the bowel has healed.

Other factors can cause villi damage and this could affect the production of lactase as well. Food allergies can also affect the villi and sometimes the reactions can lead to flattened intestinal villi. For example, flattened villi have been found in people with soy and milk allergies. Theoretically, this could lead to lactose intolerance.

As well, there is some evidence that a lectin intolerance can affect the intestinal villi. This could potentially lead to a lactose intolerance if the villi were no longer able to produce lactase to digest the lactose in diary. For people suffering with a lectin intolerance, a paleolithic diet may be helpful.

In some, the lactose intolerance may be persistent. In fact, it may appear to be a permanent condition. This could be due to ongoing accidental ingestion of the offending food that is causing villi damage, the presence of bowel infections, or perhaps a state of dysbiosis in the bowel could hinder the production of lactase as well. In this situation, further testing for infections, further diet modification to remove the offending foods or probiotics might help. Unfortunately, even with all of these interventions, the damage could be permanent. An ongoing lactose free diet may be needed along with lactase supplements when necessary. Perhaps, the persistent damage has occurred for too long in some who were undiagnosed for years.

With this in mind, I think everyone with a lactose intolerance should be tested for a gluten intolerance since it can be an underlying trigger. It is important to diagnose the cause, not just the symptoms.

Future Studies

In a study, I would like to see a large group of people with lactose intolerance investigated for gluten intolerance (celiac disease, dermatitis herpetiformis, and non-celiac gluten intolerance), a lectin intolerance, and food allergies (IgA, IgG, and IgE antibody mediated). The results may help to shed some light onto the true underlying cause of lactase deficiency.

This reminds me of how I was told that I had anemia, but further investigations were not suggested to find the cause, only iron pills were offered as a solution. In my case, celiac disease was the underlying cause.

References

1. Ojetti V, Nucera G, Migneco A, Gabrielli M, Lauritano C, Danese S, Zocco MA, Nista EC, Cammarota G, De Lorenzo A, Gasbarrini G, Gasbarrini A. High prevalence of celiac disease in patients with lactose intolerance. Digestion. 2005;71(2):106-10. Epub 2005 Mar 16.

2. Radlovi? N, Mladenovi? M, Lekovi? Z, Risti? D, Pavlovi? M, Stojsi? Z, Vuleti? B, Radlovi? V, Nikoli? D, Djurdjevid J, Gaji M. Lactose intolerance in infants with gluten-sensitive enteropathy: frequency and clinical characteristics. Srp Arh Celok Lek. 2009 Jan-Feb;137(1-2):33-7.

3. Jarocka-Cyrta E, Baniukiewicz A, Wasilewska J, Pawlak J, Kaczmarski M. Focal villous atrophy of the duodenum in children who have outgrown cow’s milk allergy. Chromoendoscopy and magnification endoscopy evaluation. Med Wieku Rozwoj. 2007 Apr-Jun;11(2 Pt 1):123-7.

4. Martelossi S, Ventura A, Perticarari S, Not T, Anibal J. Antibodies against milk and soy proteins in specific intolerances and celiac disease. Pediatr Med Chir. 1993 Jan-Feb;15(1):45-51.

5. K. Fälth-Magnusson, K.-E. Magnusson . Elevated levels of serum antibodies to the lectin wheat germ agglutinin in celiac children lend support to the gluten-lectin theory of celiac disease. Pediatric Allergy and Immunology. Volume 6, Issue 2, pages 98–102, May 1995.

6. Ceri H, Falkenberg-Anderson K, Fang R, Costerton JW, howard R and Barnwell JG. Bacteria-lectin interactions in phytohemagglutinin-induced bacterial overgrowth of the small intestine. Canadian Journal Of Microbiology 34, 1003-8, 1988.

7. JH Ovelgonne, JFJG Koninkxa, A Pusztaib, S bardoczb, W Koka, SWB Ewenc, HGCJM Hendriksa, JE van Dijka. Decreased levels of heat shock proteins in gut epithelial cells after exposure to plant lectins. Gut. 2000 May;46(5):679-87.

Comments

16 Responses to “Lactose Intolerance Can Be A Symptom Of Gluten Intolerance”

  1. Tweets that mention Lactose Intolerance Can Be A Symptom Of Gluten Intolerance : CeliacNurse -- Topsy.com on January 22nd, 2011 11:26 am

    [...] This post was mentioned on Twitter by Pat Yarbrough and Shelly Stuart, Shelly Stuart. Shelly Stuart said: Lactose Intolerance Can Be A Symptom Of Gluten Intolerance http://tinyurl.com/4n9y73y #celiac [...]

  2. Wendy Cohan, RN on January 22nd, 2011 11:35 am

    Hi Shelly,

    I explain this to people all the time in my work as a celiac educator, but this is the best article I’ve ever seen explaining why it is common for those who are gluten intolerant to also be lactose intolerant. It has always bothered me that so many gluten free products contain dairy. The symptoms of my lactose intolerance preceded those of gluten intolerance, at least in my experience, but I’m sure they were actually due to the underlying gluten intolerance, which I was unaware of. Great article! Keep up the good work. Do you ever post your articles on http://www.celiac.com? They get a lot of readers.

    Wendy Cohan, RN

  3. Susan on January 22nd, 2011 2:01 pm

    Someone in Ireland connected me to this website. There is lots of good information here.

    I have recently been diagnosed with Coeliac Disease and am also lactose intolerant. For the past 3 months, I have maintained a completely gluten-free diet yet continue to have diarrhea. I haven’t eliminated dairy completely from my diet. I take Lacteeze (gluten-free) lactose enzyme to help in digestion. I would really like the diarrhea to end. Should I eliminate dairy from my diet as well to see if it is the cluprit? Or could it be that it will take some time for the small intestines to heal and then the diarrhea will stop? Soy bothers me as well so I try to avoid it too.

  4. Shelly on January 22nd, 2011 2:17 pm

    Wendy,

    Thank you very much for your comment and feedback. I appreciate hearing about your professional and personal experiences. I know from my correspondence with you through e-mails, that you are a very knowledgeable celiac educator who has really contributed to increasing awareness. I have come accross your informative articles on http://www.celiac.com.

    I will give some thought to your suggestion:) Thank you for suggesting it!

    Shelly

  5. Shelly on January 22nd, 2011 2:39 pm

    Susan,

    Double check all the food you eat because there can be hidden sources of gluten, this could lead to ongoing symptoms. As well, other food allergies can lead to symptoms. Ask your doctor for a referral for allergy testing.

    My book, “Gluten Toxicity” has a whole chapter dedicated to this problem, “What If The Gluten-Free Diet Doesn’t Work”. It has many suggestions to help people who are still experiencing symptoms while on a gluten-free diet. There is also information about allergies and the elimination diet. It is available as an e-book from my blog for $9.99 and as a paperback from Amazon.com for $19.99. The e-book may be a good option since it is accessible within minutes. The payment is made through Paypal for security. People have downloaded it from Europe, Canada, USA, and from South America with no problems.

    You can find more information about the e-book at http://celiacnurse.com/products-page/
    More information about the 7×10 363page paperback can be found at http://www.amazon.com/Gluten-Toxicity-Mysterious-Herpetiformis-Intolerance/dp/1453864113

    Best Regards,
    Shelly Stuart

  6. Lactose Intolerance Can Be A Symptom Of Gluten Intolerance « CeliacFacts on January 26th, 2011 10:40 am

    [...] Read More… [...]

  7. Anonymous on May 4th, 2011 11:49 pm

    Thank you for posting this article. It helps clarify a lot of things for me. I was diagnosed with Lactose Intolerance at the age of 12. Now, 21 years later, I still continue to have stomach problems – at times it has been embarassingly severe that I had to go change my clothes because diarrhea and stomach irritation would just hit me hard. Other times, I have constipation, bloating, and abdominal pain. I’ve been diagnosed with IBS.

    The special milk I drink is lactose and gluten-free, so no worries there. But I started eating smoothies about 2 weeks ago and adding a good amount of Wheat germ in them to help keep me regular. Ever since then, my scalp is red,burning, and itchy. And sometimes if I had a larger smoothie (thus having more wheat germ) I had a little cluster rash on my neck, arms, shoulders, lower back – I thought I had fleas or something. I’m starting to think its gluten. I’m going to discontinue the wheat germ and omit gluten to see if it makes a difference in my scalp condition and my stomach conditions.

    I have struggled so badly with stomach problems for many many years when doctors have had me try different types of medications for IBS and said it was stress. Now, it is like someone just found the missing piece of a puzzle that has been missing for the last 10 years. I hope this is the it, it is worth a try – I love carbs, so trying to be gluten-free for even a week will probably make me loose weight.

  8. Shelly on May 5th, 2011 7:35 am

    Often, people with a gluten intolerance are misdiagnosed with I.B.S. Yes, gluten intolerance can cause all of those symptoms. I suggest testing right away to investigate for the presence of a gluten intolerance (i.e. celiac disease, dermatitis herpetiformis, and non-celiac gluten intolerance). My book, discusses the pros and cons of different tests. Other food allergies can cause these symptoms as well.

    Your physician may order additional tests to help rule out other causes as well. For example, an upper endoscopy and colonoscopy with biopsies can help to rule out celiac disease (although there can be false negatives) and other other underlying causes of your symptoms.

    I wish you the best,
    Shelly

  9. Narelle on December 9th, 2011 11:32 pm

    Hi my name is Narelle I am 38 and had my gall bladder out in 2007 and since then I can not have normal milk or anything with gluten in I have been tested for celiac but the doctors reckon I do not have it and I recon I do because every time I do have normal milk I feel squirmy and run to the toilet and the only way I can stop is have a drink of soy milk or a Turkish delight I also have cerebral palsy which I have had since I was 3 months old due to a reaction to a needle the doctors told mum and dad I would not walk, talk or do anything and I would be in a wheel chair and I have proved them all wrong and I live on my own and drive a modifed car I live in Perth Australia

    Would love to make some new friends From Narelle

  10. What’s So Great About Cows Anyway? | The UN-Blog on May 23rd, 2012 2:57 pm

    [...] [5].Lactose Intolerance Can Be A Symptom Of Gluten Intolerance [...]

  11. Frank Roland on July 1st, 2012 4:48 pm

    I have been lactose intolerant for 35 years. I recently started the Wheat Belly diet after reading the book in an attempt to lose some recently gained weight. Since starting the diet I can and do eat all sorts of cheeses that I have avoided for those 35 years. I have seen the connection between no more wheat, and lots more dairy and believe it.

  12. Sharon on July 9th, 2012 5:28 pm

    Agree about lactose intolerance and missed diagnoses for celiac disease. I also think some CD and GS-gluten sensitive folks continue with issues despite a strict GF such that they believe they are lactose intolerant. Many switch to soy milk to have issues with that and think they have a soy problem when in fact I think many like me have a carrageen problem – as it is in soy milk, almond milk, and boxed versions of coconut milk as well (ethnic canned varieties are usually CF-carrageenan free!). I believe the carrageenan keeps the GI inflammation up and running (who knows does it cause sprue-like enteropathy on its own) such that lactase is not produced and lactose intolerance continues. Carrageenan is a known inflammatory and for me it causes not only GI issues but joint inflammation as well – as if I had eaten gluten. Many GI docs are savvy to this and warn their patients to avoid carrageenan – many other doctors are not in the know on this.Also many folks cannot tolerate ice cream (do not drink milk),and among major ice cream producers only Breyer’s and Haagen-Dazs do not put carrageenan in their ice cream. It is in puddings (mixes and premade), heavy and whipping cream (liquid and canned spray versions), ricotta (esp.low fat), cottage cheese, even Cabot’s low fat sour cream has it.

    Carrageenan is made from red seaweed species, and when I reacted to a can of beans that had brown seaweed as if I had eaten carrageenan or gluten – I started to think is it related to gluten? I then had an issue with the ammonium version of MSG-MAG, and recall that MSG was originally derived from seaweed.

    I have helped a number of celiac people with remaining symptoms become symptom free by telling them about carrageenan’s effect on many CD and GS patients. One woman noted that the other day she had a problem with some chewy candies that she thought were safe – gluten free and they were GF. I asked if they had any sprinkles on them as I had to ditch all my Christmas cookie spinkles last year because they had carrageenan! Sure enough her candies had carrageenan-laden sprinkles! Another person had unsuccessfully tried a GF diet for fibromalagia – I now have to contact her to give it a try again – without the carrageenan.

  13. Sharon on July 9th, 2012 5:38 pm

    Forgot to post my theory that I am trying to get scientists/researchers to look at: That perhaps the inner protein core of seaweed is similar to the AA sequence of gluten’s gliadin and glutenine – and is this the reason CD and GS folks respond to it as if it were gluten?

    One CD scientist noted that he believed some big study tested thousands of natural food products to look for ones that had this gluten-like AA sequence (but he could not give me the data) – he noted that my problems and others must be one digesting the complex polysaccharide of the seaweeds. This would make sense if a) my symptoms were solely GI in origin but they are not – I have joint, bone, and sometimes muscle pain after eating something with carrageenan or pure seaweed and b)I have absolutely no other food intolerances – eating every vegetable and fruit under the sun without issue no sensitivity or allergies other than gluten, carrageenan/seaweeds and MSG and its derivatives.

  14. Jack Harrison on October 12th, 2012 5:58 am

    Shelly, I know this article is not new, but I just found it searching for gluten and lactose intolerance, while trying to find something to back up my ideas on why I can now handle dairy with no ill effect. About 3 years ago I went “Primal” (Mark Sisson), part of which includes removing gluten from the diet. I started thinking maybe gluten was the culprit.

    I developed lactose intolerance at 18. I’m now 46, and now again able to eat as much dairy as I desire. I had a bowl of cream of crab recently, not even a single gas burble in my stomach! I never thought I’d ever be able to enjoy that again. Your article helped me understand why. Yet another benefit of abandoning our modern diet!

    Thank you.

  15. Shelly on October 14th, 2012 5:49 pm

    Hi Jack,

    Glad to hear that this article was helpful:)

    Best regards,
    Celiac Nurse

  16. Amy on June 13th, 2013 6:54 pm

    Just wanted to say that this happened to me. About two years ago I started having a lot of stomach problems and mucousy stools and was diagnosed with lactose intolerance (did the breath test, the whole bit). I kept having stomach problems and my regular doctor (not the gastroenterologist I had self-referred to) finally advised me to drop gluten. When I quit eating gluten, not only did my stomach problems go away, but I quit having the intermittent red rashes that had plagued me for about ten years. I can now actually tolerate a small amount of regular dairy again, but stay lactose-free for the most part. There absolutely needs to be more awareness of this issue. I continued to suffer, with no explanation, for more than a year because I didn’t know about the lactose intolerance-gluten intolerance connection.

Leave a Reply