by Sade Oguntola
FOR Mr Tajudeen Hammed, even the smell of milk can make him throw up. Even at age 50, he does not drink tea or coffee that contains milk, neither do his two children.
“There was a festive time my aunt cooked pepper stew with plenty of meats. In it was the mammary part of the sheep. From the smell of the stew, I told my mother that the stew contained milk. My mummy laughed because she could not understand how pepper stew could contain milk,” said Mr Hammed.
His aunt later explained she had cooked the pepper stew with meat stock that contained the mammary part of the sheep. But what amazed Mr Hammed’s mother was his son’s strong smell for milk and why each time he was forced to take milk or take milk containing foods, he ended up feeling nauseous and vomiting.
In the case of Mrs Helen Azeez, she does not take milk, sugar and eggs. She also avoids fruit salads that have pineapple in them and soft drinks. A few minutes after taking these, she develops diarrhea. She only takes sweeteners.
Mrs Adesola Ugochukwu, a mother of three, stopped taking fruit juice in parties about 10 years ago after she released that consuming the drink always ended in stomach pain and diarrhea.
Intolerance to foods is a global phenomenon. Individuals’ intolerance varies in degree, depending on the severity of the symptoms. Food intolerance is reaction to foods eaten in normal quantities that do not involve the immune system.
Food intolerance is different from food allergy, which is when the body mounts an immune response to a food that is either ingested or even touches the skin. This immune response is very quick. Within 20 minutes to two hours, the released chemicals can affect the person’s breathing, gastrointestinal tract and heart.
The mechanisms behind food intolerance can vary greatly. One common mechanism is when people lack enzymes that are needed for breaking down nutrients. That is the case with milk intolerance.
Milk intolerance, for instance, is experienced throughout the world. It is one of the most common forms of food intolerance due to lactose intolerance.
“Certain people, especially adults, are not able to tolerate lactose-containing foods, especially milk. This occurs because of inadequacy of enzymes in their small intestines called lactase which is needed to digest the same sugar called lactose into two, glucose and galactose, which are the forms that the intestine can absorb,” said Dr Kolawole Akande, a consultant gastroenterologist at the University College Hospital (UCH), Ibadan.
Of all dairy products, milk contains the most lactose. Other dairy products include yoghurt, cheese and ice cream.
Common symptoms include abdominal pain and bloating, a feeling of wanting to vomit, excessive flatus, abdominal pain and watery stool following the ingestion of foods containing lactose. However, lactose intolerance sometimes does not give any symptoms.
Dr Akande said: “Sometimes, milk intolerance can cause passage of watery stool which we call diarrhoea. When lactose is not digested, it causes a lot of fluid coming into the small intestine and then disturbs absorption of nutrients from food. In its extreme form, it can lead to malnutrition later on.
“The second effect is that it gets fermented by bacteria, and they produce a whole range of fatty acids and gases, especially hydrogen, thus lots of flatulence.”
He, however, said that in people with intolerance, the symptoms usually occur a few hours after taking milk and other dairy products.
Dr Akande declared that milk intolerance is more common in adults than children because babies are fed breast milk and are able to digest it because nature has endowed them with a lot of lactase, except in those born with congenital lactase insufficiency.
“After weaning and they don’t take a lot of milk, the production of this lactase will keep going down as they grow older. This is why milk intolerance is more common in adults than in children, especially in cultures that do not have milk and other dairy products as part of their routine food.
“In Nigeria, studies found that lactose intolerance is so common in Nigeria among the Yorubas and the Igbos; it is more than 90 percent. But among the nomadic Fulanis, it is as low as 20 percent. The nomadic Fulanis take a lot of milk, even outside the childhood period, so lactose intolerance tends to be less in them,” Dr Akande said.
Interestingly, many people don’t believe that lactose intolerance is a disease to go to the hospital to complain about. They merely avoid milk or other foods their bodies find intolerable and their symptoms disappear.
Also, that the lactase in the stomach to digest that sugar in milk is either switched off or dropped down to very low levels after the weaning period, they see it as normal and therefore their body is telling them that as adults they don’t need to take milk.
The treatment of milk intolerance, he said, is to avoid taking milk as much as possible.
“Even this intolerance and its manifestation can differ from one person to another; some will still be able to tolerate a little amount of milk but will only become bloated and have diarrhoea when they drink, say, a cup of milk.
“Besides avoiding milk, they can also take the enzyme lactase in the form of medication with their meals. That can also help. The only danger is that if one avoids milk totally, one would not be able to get enough calcium and vitamin D. Milk contains a lot of calcium and it is a ready source of calcium. Vitamin D helps to absorb calcium.”
However, Dr Akande declared that lactose intolerance can occur alongside other gastrointestinal conditions like what is called irritable bowel syndrome, and as such, individuals with such persisting symptoms need to seek medical care and get tested.
A diagnosis of lactose intolerance can usually be made with a careful history supported by dietary manipulation. No single test is available for food sensitivity or intolerances.
Bloating is also very common in people with irritable bowel syndrome (IBS).It may also occur because of poor digestion and malabsorption of some carbohydrates.
Likewise, swallowing too much air, especially when eating, can also increase the amount of gas entering the gastrointestinal tract and lead to bloating.
Professor Olusegun Adekanle, a gastroenterologist at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Osun State, said most often, complaints of milk intolerance are received more by children’s doctors. He suggested that yogurt and plant-based milks like oat and soy milk may be a better option for adults with the problem.
According to him, unsweetened yogurt is better than plain milk because it is usually sour because it contains lactase, the enzyme whose production in persons with milk intolerance is either switched off or has dropped down to very low levels after the weaning period.
Even lactose-intolerant adults could have benefited from milk. Chemical evidence from ancient pots shows that these long-ago farmers learned to process the milk into cheese or yogurt, which removes some of the lactose.
Other food intolerances due to the lack of enzymes include intolerance to histamine and caffeine. Some people are unable to break down histamine, which is found in red wine, strong and blue cheeses, tuna, tomatoes and pork products.
This can lead to symptoms such as itching, red flushing on the skin, abdominal pain, nausea, dizziness, headaches and migraines. Similarly, people can also have sensitivity to caffeine that is present in coffee and cocoa.
Also, intolerance can also occur from eating fish that has not been refrigerated appropriately, causing buildup of histidine, which is metabolized by bacteria to histamine, causing flushing and a fast heart rate.
In most situations, food sensitivities may develop anywhere from 30 minutes up to four or five hours later, which is the average time it takes for food to move from the stomach. It does not cause a more immediate reaction as with food allergy.
Many people who experience gastrointestinal symptoms in reaction to wheat products assume they have celiac disease. However, they may have sensitivity to fructan, a type of carbohydrate in wheat. Fructan is a naturally fermentable carbohydrate and a “FODMAP”—which stands for Fermentable Oligo- Di- Monosaccharides and Polyols, a group of nutrients that can cause sensitivity.
Like in the case of lactose, some people are unable to absorb large amounts of fructans (also present in onions and garlic). Like lactose, this causes diarrhea, and then the bacteria in the large intestine ferment the fructan, producing gas, abdominal pain and discomfort.
A 2009 report suggests about 20 per cent of the population has one or more food intolerances, with no apparent change since 1994. A more recent survey from 2020 of self-reported intolerances in internet users indicated about 25 percent of the population.
The perceived increase may reflect many other factors. Some people may self-diagnose food intolerance from well-intended but misleading health advice from family and friends. Additionally, people may incorrectly attribute medical symptoms to foods they have eaten. (Tribune)
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