If you’ve recently been diagnosed with celiac disease you may be finding that there are foods other than those containing gluten that you just don’t seem to tolerate. As a result, you may be wondering if you have other food intolerances or sensitivities. While this might be the case, many of these probably are not permanent. It is a good idea to reserve judgment on which of your intolerances are permanent until your small intestine has had a chance to heal.
A common intolerance that is usually temporary among those diagnosed with celiac disease is lactose intolerance. Lactose is the sugar found in milk. If you are lactose intolerant you have difficulty digesting products containing milk. This “secondary form of lactose intolerance,” as it is commonly called, is due to the blunting of the intestinal villi that occurs in celiac disease.
Lactase is the name of the enzyme necessary for the digestion of lactose. Lactase is known as a “brush border” enzyme because it is found in the villi of the small intestine. When not enough lactase is available to break down lactose, it can not be absorbed. The unabsorbed lactose passes through the intestinal tract where it can cause a variety of symptoms, such as gas, diarrhea, and bloating. As the intestinal mucosa heals as a result of a gluten-free diet, the lactose intolerance generally resolves.
If you and your physician or dietitian suspect that you have a secondary form of lactose intolerance you will probably be advised to temporarily remove most milk-based products from your diet. After a period of time you will probably be advised to try adding small amounts back into your diet to see if you tolerate them. Milk-based products you still may be able to tolerate (depending upon your degree of intolerance) are aged hard cheeses, such as cheddar and Swiss, as well as yogurt with active live cultures. And of course there is always Lactaid brand milk. Aged hard cheese has very low lactose content and the active live cultures found in some yogurts help break down the lactose.
If you are unable to consume milk-based products, you must still make sure to take in enough calcium. The Dietary Reference Intake for both men and women aged 19 to 50 is 1,000 mg. For men and women aged 51 and older it is 1,200 mg. Calcium fortified orange juice and calcium fortified soy milk are good options, and they contain on average 300 mg of calcium per 1 cup serving. Just make sure the soy milk is gluten free–not all varieties are.
In addition to milk, there are many other types of foods that people with celiac disease report having problems with when they are first diagnosed, including fatty foods and high fiber foods. If this describes you, it is important to try to be patient and not get too frustrated. If at all possible work with a dietitian knowledgeable with celiac disease to figure out what foods you can tolerate initially. Slowly over time you should be able to incorporate most if not all of these foods back into your diet, as long as they are gluten free of course!
For more information on lactose intolerance, see the National Digestive Diseases Information Clearinghouse page on lactose intolerance at
http://digestive.niddk.nih.gov/ddiseases/pubs/lactoseintolerance/