From the Guidelines
For a patient with intermittent diarrhea, flatulence, and cramping associated with consuming fruit and milk, the correct option is B: don't give dairy products. This presentation strongly suggests lactose intolerance, which occurs when the body lacks sufficient lactase enzyme to digest lactose in dairy products 1. The temporal relationship between consuming milk and developing gastrointestinal symptoms (diarrhea, flatulence, and abdominal cramping) is characteristic of lactose intolerance. When undigested lactose reaches the colon, it's fermented by gut bacteria, producing gas and causing osmotic diarrhea.
Key Considerations
- A gluten-free diet would be appropriate for celiac disease or non-celiac gluten sensitivity, but the symptoms described here specifically correlate with dairy consumption rather than gluten-containing foods 1.
- Management should include dairy avoidance or using lactase enzyme supplements when consuming dairy.
- Patients can also try lactose-free dairy products or plant-based alternatives.
- Diagnosis can be confirmed with hydrogen breath testing or a lactose elimination diet followed by challenge if needed.
Dietary Recommendations
- First-line dietary advice should be offered to all patients with IBS, including regular exercise and soluble fibre, such as ispaghula, which is an effective treatment for global symptoms and abdominal pain in IBS 1.
- A diet low in fermentable oligosaccharides, disaccharides and monosaccharides and polyols (FODMAPs) may be considered as a second-line dietary therapy, but its implementation should be supervised by a trained dietitian 1.
From the Research
Symptoms and Diagnosis
- The patient is experiencing intermittent diarrhea, flatulence, cramps, and loose stools after consuming the same meal, including fruit milk.
- These symptoms are consistent with lactose intolerance, a common condition that can cause nonspecific gastrointestinal symptoms 2, 3, 4, 5.
Treatment Options
- A reliable diagnosis of lactose intolerance cannot be made on the basis of the patient's history alone, and a breath hydrogen test is the diagnostic method of choice 2, 3.
- Treatment options for lactose intolerance include a lactose-reduced diet, enzyme replacement, and the use of dairy products or additives that provide lactase activity 2, 3, 4.
- Avoiding dairy products is a possible solution, as lactose intolerance is caused by a reduction or loss of the activity of the intestinal enzyme lactase-phlorizin hydrolase, responsible for the digestion of lactose 3, 4, 6.
Dietary Management
- A gluten-free diet is not directly relevant to the treatment of lactose intolerance, although some patients with lactose intolerance may also have celiac disease or non-celiac gluten sensitivity 6.
- The correct option for the patient's symptoms is to avoid dairy products, as this is a common treatment approach for lactose intolerance 3, 4, 6, 5.