Milk and dairy products play a significant role in your child’s growth and development. Lactose is the principal carbohydrate present in milk. Lactose intolerance, one of the most common food intolerances, is estimated to affect about three quarters of the world’s population. Almost 60 to 70 per cent of people in India are lactose intolerant.
What is lactose intolerance?
Lactose, the sugar present in milk, helps in the establishment of lactic acid bacteria in the intestinal tract. If lactase, an enzyme required for digestion of lactose, is not present in sufficient amounts, such individuals develop abdominal symptoms on consumption of excess milk. This is common in children after an episode of diarrhoea and is described as lactose intolerance. This intolerance calls for a huge price – ‘elimination of milk’ from your child’s diet. Since milk is the main staple in your child’s diet, substituting milk with its alternatives is a must.
The symptoms of lactose intolerance depend on the amount of lactose consumed by the child. The more lactose your child consumes, the more symptoms he might experience. Symptoms of lactose intolerance are nausea, abdominal pain, cramping, bloating and diarrhoea. Symptoms can occur within minutes to hours after consuming milk or dairy products and range from mild to severe.
The two most common methods used to test lactose intolerance are Lactose Tolerance blood Test (LTT) and Lactose Hydrogen Breath Test (LHBT). However, the diagnosis can be made easily on the basis of clinical history by physicians and dieticians. In India, diagnostic tests are rarely followed in clinical practice.
Steps to deal with lactose intolerance in children include three main elements:
i) Eliminate – systematically eliminating milk and other dairy products from your child’s diet
ii) Reintroduce – Dairy products can be reintroduced over time. The symptoms post introduction should be observed and reported to the dietician
iii) Understand – Every child differs in her tolerance levels to milk, so maintain a food dairy, recording your child’s response to dairy food consumption.
Alternatives to milk
i) Curds/yoghurts – Curd is produced by bacterial fermentation converting milk lactose into lactic acid. It prevents digestive problems, contains probiotics that improve gut health and boosts immune system. It is rich in protein, calcium, vitamin D, riboflavin, vitamin B6, and B12. On the negative side, commercially manufactured yoghurts contain more sugar, preservatives and calories.
ii) Cheese – It is rich in its nutrient profile similar to that of milk. As the separation of curd from whey is incomplete, hard and fresh cheese contains some lactose which may aggravate digestive issues.
iii) Butter and buttermilk – During the butter-making process, a majority of the water soluble components in milk are separated from the fatty matter. Lactose, being a water-soluble molecule gets expelled in the buttermilk. However, some lactose still remains in small quantities in the buttermilk. Clarified butter contains very little lactose and is safe for lactose-intolerant children.
iv) Soy milk – nutrient profile is closer to that of cow's milk. Children may dislike the taste and flavor. Flavored soy milk contains more calories, preservatives and sugar.
v) Other non-dairy milk varieties – Almond milk is loaded with magnesium and vitamin E. Rice milk is rich in vitamin B12 and has less or no saturated fats. Coconut milk tastes creamy just like cow’s milk. On the other hand, nutrient profile of these alternatives differs from that of cow's milk. These alternative milk varieties don’t work well as substitutes for milk in cooking.
vi) Lactose-free and lactose-reduced milk and milk products and whey proteins – Manufacturers treat milk with the enzyme lactase to make it almost lactose-free. This enzyme breaks down the lactose in the milk into digestible glucose and galactose. Whey protein supplements are good alternatives for bottle-fed children. Since these alternatives involve industrial processing, lack of sufficient safety information and fear of possible allergic responses prevail.
Non-dairy calcium rich sources as substitutes for milk
Cereals and legumes - Ragi, bengalgram (whole), horsegram (whole), rajmah and soya bean; green leafy vegetables; nuts and oilseeds – coconut dry, almond, mustard seeds and sunflower seeds, gingelly seeds, cumin seeds; and fish.
Foods with hidden lactose
Lactose is a common commercial food additive and hence found in processed foods such as, processed meats, gravy stock powder, margarines, breads, breakfast cereals, potato chips, ready-to-eat meals, meal replacements and protein supplements. Food labels such as lactoserum, whey, milk solids and modified milk ingredients, indicate that these products probably contain lactose. While shopping for processed foods, read the labels for terms like ‘lactose-free’ and food safety symbols indicating dairy/lactose allergen advice.
Milk is the main source of calcium and B-vitamins in children, so consumption of milk is important for your child’s bone development and growth. Increase the proportion of cheese, yoghurt and milk substitutes to meet the calcium demands.