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Ellen Eagan on Lactose Intolerance and Celiac Disease

The following is a summary of lactose intolerance which was written by Ellen Eagan eagan@pangloss.ucsf.edu. Ellen is a blood specialist at UC San Francisco Medical Center. Ellen Eagan on Lactose Intolerance:

The area in the intestines where lactase, the enzyme needed to break down lactose, is produced is called the brush border. It is at the ends of the microvilli. It is only one cell deep. As most people age, their ability to produce lactase decreases. Sometimes it decreases to the point where you are unable to deal with all of the lactose that you ingest. If you have decreased production of lactase and then something else happens to compromise the integrity of the brush border, it cases further reduction of lactase production. If you continue to take in lactose, that causes more irritation and loss of lactase production. It becomes a vicious negative feedback cycle.

When you are suffering from celiac sprue, there is damage to your intestinal villi. This can make one temporarily lactase deficient to the point where lactose becomes a problem also. This happened in my case. Once I started on the gluten-free diet and my intestines had healed, lactose was no longer a problem for me. I can eat any diary product now with no problems.

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Not everyone will be so lucky. A lot of people will remain lactase deficient. Yogurt and aged cheeses are more easily tolerated because some of the lactose has been converted to lactic acid. One rule of thumb is that the higher the fat content of the dairy product, the lower the lactose level. People who are still producing some lactase would then be able to eat a very rich ice cream but would be bothered by skim milk or ice milk.

I highly recommend the book No Milk Today: How to Live With Lactose Intolerance (Steve Carper, Simon & Schuster, Inc., 1986 ISBN0-671-60301-0). I found it at my local library. Its an excellent book for explaining the process, describing hidden sources of lactose (like whey), and tips on eating out. In regards to the fat content and lactose level I quote from page 119 of the book: Foods with high milk fat tend to be lower in lactose than other milk products. Heavy cream is lower in lactose than light cream, which in turn is lower than whole milk. Butter is higher in fat than any of these, and in turn is the lowest in lactose. It was mentioned that aged cheeses are lower in lactose than non-aged cheeses because the lactose had been broken down during the aging process.

So, even though lactase deficiency and gluten intolerance can give the same symptoms, they are not caused by the same processes. Lactase is composed of two sugars. The problems arise when you are unable to break it into its two parts and absorb them.

Gluten is a protein. It seems to cause a problem due to an immunological response, and as far as I know, symptoms are the only similarities between the two.

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Hi Could a mod please move this post: and my reply below to a new thread when they get a chance? Thanks! Matt

Hello and welcome Firstly, don't worry about it but for ease your post (and hopefully my reply) will probably be moved to its own thread. That will make it easier for others to see it and reply and also help Galaxy's own thread here on track and making sense. The antibodies that the celiac tests look for can drop very quickly, so... maybe? Celiac is difficult to test for, there are different tests and sometimes someone doesnt test on one but does on the other. If you can get a copy of the tests and post it here the community may be able to help explain the results. It may have shown damage to the villi, the little tendrils in your intestine that help you extract nutrients from your food. Celiac is one, but not the only, way in which they can get damaged leading to a vast number of potential symptoms and further making diagnosis a tricky proposition. Definitely, there's a connection. Here's a page that explains it in detail: https://stomachachefree.wordpress.com/2012/03/21/liver-disease-in-celiacs/ Fantastic It sounds as if your doctors were happy to diagnose you on the basis of the endoscopy? It may be then that you've found your answer. I hope so, you've clearly had a rotten and very scary time. I'm sure with the positive reaction to the diet you want to go on and get healthy, but I would only add that you should discuss this with your doctors, because they may want to exclude other potential causes if they've not confirmed celiac at this point. Check out the advice for newly diagnosed here: To your family I'd simply say that celiac is a disease of the autoimmune system, the part of our body that fights diseases and keeps us safe. In celiac people the autoimmune system see's the gluten protein found in wheat, barley, or rye grains as a threat to the system and it produces antibodies to attack it and in doing so attacks it's own body as well. It's genetic in component so close family members should consider a test if they have any of the many symptoms. There's roughly 1 person in 100 with celiac but most of them don't know it and are risking getting or staying sick by not finding out. There's further info for them and you here: https://www.celiac.com/gluten-free/announcement/3-frequently-asked-questions-about-celiac-disease/ I'm going to ask a mod to move your post and my reply to a new thread, but wanted to give you an answer first The good news is you've found a great site and there will be lots of support for you here. You've also got 'lucky' in that if you're going to have an autoimmune condition, celiac is a good one Most react really well to the gluten free diet and you will hopefully have much more healing to come! Best wishes Matt

Please share what was so difficult about starting your account.

I'm new here so please forgive me if I'm in the wrong forum. But I could use some clarity and input.. So I'll try to make my story brief as possible? So about 8 months ago I began itching uncontrollably and after going to the Dr for labs she found my liver enzymes were 5x what they should be and was referred to a gastro Dr. Gastrointestinal Dr ran multiple scans, blood work over the next 2 months and referred me to teaching hospital with a " tumor board" apparently I had a mass within my bile ducts that was blocking bile from liver. Was given a grim diagnosis of rare cancer and told would be dead within the year. Then had an endoscopy done to get tissue of the mass and for some reason it had partially resolved and was no longer blocking bile duct. At this point they could not find and cancerous cells. So fast forward 3 months I'm still in pain and had another endoscopy and the biopsy taken showed high possibility of celiacs. The blood work was negative for celiac but after the grim cancerous diagnosis I had been unable to eat for 2 weeks or so and so I'm not sure if that would have skewed the labs?. How could the biopsy show high possibility of celiac? And had anyone heard of celiac causing inflammation in the bile ducts? I have been gluten-free for 6 weeks and have been feeling remarkably better pain in the upper right quadrant is less, and migraines ( I have had for my whole life) have lessened. So all this to say I don't understand celiacs and how to explain it to family. Or how all of a sudden this happens. Ask if anyone can shed any insight I would appreciate it. Blessings

Thank you for taking the time for sharing that info. Don't we have the best disease ever! There's got to be a better way to cut down the scarring. Yes, I've scratched till it bleed. Can't help it. It's like having a bunch of mosquito bites. Yes, only gluten free now. Still have bursts, so probably am being exposed to gluten. Will need to stop dapsone soon. Good luck with your situation.