An Expert Spills the Bean on Lactose Intolerance & Your Kids

WORDS LIM TECK CHOON

FEATURED EXPERT
DR ONG SIK YONG
Consultant Paediatric Gastroenterologist and Hepatologist
Sunway Medical Centre

According to Dr Ong Sik Yong, lactose intolerance is a common gastrointestinal condition caused by the inability to digest and absorb dietary lactose.


Lactose intolerance is the result of your small intestine not producing enough of an enzyme called lactase. Lactase helps to break down lactose or milk sugars into simple sugars for absorption by your body.


BLAME IT ON DECLINING LEVELS OF LACTASE

Dr Ong shares that newborns can digest about 1 litre of breast milk every day.

However, the enzyme lactase, which digests lactose, usually declines in levels once the child stops breastfeeding, a circumstance known as lactase non-persistence.

“Approximately 70% of the world population are affected by lactase non-persistence, which causes the condition called primary lactose intolerance,” Dr Ong reveals.

He adds that generally a child shows symptoms of primary lactose intolerance after they turn 5. However, some children may exhibit symptoms as early as 2 years old.

CAN ALSO BE DUE TO OTHER GUT ISSUES

In young children, lactose intolerance may also be caused by underlying gut issues such as:

  • Gut infection.
  • Cow’s milk allergy.
  • Celiac disease.
  • Inflammatory bowel disease.

Dr Ong further shares that sometimes a child may temporarily lose the ability to digest lactose during an episode of acute gastroenteritis. Once the child recovers, however, they can continue to consume milk without further issues.

SYMPTOMS OF LACTOSE INTOLERANCE

“Usually, symptoms begin about 30 minutes to two hours after consumption,” says Dr Ong.

He adds that the common symptoms are:

  • Abdominal discomfort.
  • Bloating.
  • Farting.
  • Diarrhoea.
  • Perianal skin irritations with raw lesions surrounding the anus, due to low faecal pH in the child’s stools.
MANAGING THE DIET OF A LACTOSE INTOLERANT CHILD

Dr Ong advises parents to feed dairy products with naturally lower lactose content to children that show signs of lactose intolerance.

“After a period of limiting food with lactose, the child can consume back small amounts of foods and drinks containing lactose,” he adds.

The child’s symptoms should be observed throughout this trial period and over time, the parents or even the child would be able to tell how much of lactose the child can take.

“Besides that, parents can also consider using lactase enzyme, which can be taken by the child prior to consumption of dairy products to reduce unwanted consequences from consuming lactose,” advises Dr Ong.

NUTRITIONAL CONSIDERATION FOR THE LACTOSE-INTOLERANT CHILD

Milk and other various dairy products are a major source of calcium and vitamin D.

“Hence, it is important to make sure children who has limited dairy product intake to have other non-dairy food which are rich in these nutrients, like fish with soft edible bones, such as salmon and sardines, as well as green leafy vegetables. They may also require calcium or vitamin D supplement for their growing bones,” Dr Ong says.

Sheep’s Milk vs Goat’s Milk: Is One Better Than the Other?

WORDS GURSHARON KAUR GILL

FEATURED EXPERT
GURSHARON KAUR GILL
Dietitian
IS GOAT’S MILK THE G.O.A.T?
EASIER TO DIGEST, COMPARED TO COW’S MILK
  • The lower levels of alpha-S1-casein protein in goat’s milk explain its easier digestibility and hypoallergenic properties.
  • The casein protein in goat’s milk also results in a smaller and softer curd formation in the stomach, which can be more easily digested by stomach enzymes compared to the harder curd formed by cow’s milk.
  • Goat’s milk has more medium-chain fatty acids than cow’s milk, which has more long-chain fatty acids. Long chain fatty acids are harder to digest, because they require bile salts from the liver as well as pancreatic enzymes to break them down before they can be absorbed by the intestine. On the other hand, medium chain fatty acids in goat’s milk do not require pancreatic enzymes to be broken down; they are more readily absorbed into the blood stream.
MORE CALCIUM, VITAMIN A & PROBIOTICS THAN COW’S MILK
  • 1 cup of goat’s milk contains 327 mg of calcium, while 1 cup of cow’s milk contains 276 mg of calcium. That equates to 51 mg more calcium in goat’s milk. However, this does not mean you have to switch to goat’s milk for that extra calcium. One is still able to achieve their calcium requirement through other calcium-rich foods like yoghurt, cheese, and some vegetables like spinach, bok choy, and broccoli in addition to milk intake.
  • 1 cup of goat’s milk contains 483 IU of Vitamin A while 1 cup of cow’s milk contains 114 IU. Vitamin A is essential for good vision, growth, fetal development, and a healthy immune system.
  • Goat’s milk contains a higher amount of prebiotics (oligosaccharides) compared to cow’s milk, which encourages the growth and proliferation of beneficial bacteria in the gut.
HOWEVER, SOME CAVEATS OF NOTE
  • Goat’s milk may not be suitable for people that are lactose intolerant as it still contains lactose. Some people find goat’s milk slightly easier to digest than cow’s milk, but other people may not have the same reaction. If you are lactose intolerant or have milk allergies and want to give goat’s milk a try, do consult your doctor beforehand.
  • Children above the age of 1 year can safely drink pasteurised goat’s milk, provided they do not have any allergy issues. Raw, unpasteurized goat’s milk is not encouraged as it may contain bacteria that can cause serious illness among children.
  • Children diagnosed with cow’s milk protein allergy (CMPA) are not recommended to consume goat’s milk or goat’s milk formulas. This is because there is evidence that this milk may still cause allergy reactions in children with CMPA, due to cross reactivity with cow’s milk.
  • Goat’s milk has more calories per serving, when compared to whole cow’s milk. This is due to the higher fat content in goat’s milk (10 g per serving) compared to 8 g per serving in cow’s milk. So, if you’re watching your weight, you may want to consider low fat cow’s milk or skim milk, especially if you drink more than 2 cups of milk per day.
HOW ABOUT SHEEP’S MILK?
IT’S ALSO EASIER TO DIGEST, COMPARED TO COW’S MILK
  • Based on a recent study in New Zealand, the protein in sheep’s milk is also more readily digested as compared to cow’s milk, which may be the reason it is better tolerated by adults that are unable to tolerate cow’s milk.
MORE CALCIUM, ZINC & PROTEIN THAN COW’S MILK
  • Sheep’s milk contains as much as 35% more calcium in 1 serving (1 cup) as compared to cow’s milk. Calcium is an essential mineral for strong bones and teeth, and is one of the important minerals in the prevention of osteoporosis.
  • Sheep’s milk contains a higher amount of zinc as compared to cow’s milk. Zinc is important for cell growth and division, wound healing, and supporting a healthy immune system.
  • Sheep’s milk is a high-protein beverage, containing 7 grams more protein per serving than cow’s milk. Protein plays an important role in the building and repairing of tissues and muscles as well as for a healthy immune system.
HOWEVER, SOME CAVEATS OF NOTE
  • Pasteurized sheep’s milk is fine for children after the age of 1 year, provided that they do not have allergy issues.
  • Children diagnosed with cow’s milk protein allergy (CMPA) are not recommended to consume sheep’s milk or sheep’s milk formulas. Just like with goat’s milk, there is evidence that sheep’s milk may still cause allergy reactions in children with CMPA, due to cross reactivity with cow’s milk.
  • Sheep’s milk has more calories per serving, when compared to whole cow’s milk. This is due to the higher fat content (17 g per serving) compared to 8 g per serving in cow’s milk. So, if you’re watching your weight, you may want to consider low fat cow’s milk or skim milk, especially if you drink more than 2 cups of milk per day.
SHEEP’S MILK VS GOAT’S MILK: IS ONE BETTER THAN THE OTHER?

Looking at the data and evidence that we have, there isn’t one “best milk” out of the cow’s milk, sheep’s milk, or goat’s milk.

All three types of milk have their pros and cons, and it really depends on the specific reason you choose a particular type of milk.

Barring any intolerance or allergy issues, it is absolutely okay to choose the milk that you like the most in terms of taste as well as your health status.


References:

  1. Alberta Health Services (2022, April). Nutrition guideline: Healthy infants and young children—milk. https://www.albertahealthservices.ca/assets/info/nutrition/if-nfs-ng-healthy-infants-other-milks-fluids-milk.pdf
  2. Malaysian Paediatric Association and Malaysian Society of Allergy and Immunology. (2012). Guidelines for the management of cow’s milk children 2012 (CMPA in children). https://www.allergymsai.org/pdf/guideline-cows-milk.pdf
  3. Metzger, M. (2022, July 22). Goat milk versus cow milk: A comparison. Michigan State University Extension Sheep & Goats. https://www.canr.msu.edu/news/goat-milk-versus-cow-milk-a-comparison