From the Guidelines
Breath tests are not recommended for diagnosing dairy intolerance or allergies due to their lack of accuracy and specificity, and an elimination diet is the preferred diagnostic approach. This is because breath tests, such as hydrogen breath tests, primarily detect lactose malabsorption by measuring hydrogen produced when undigested lactose ferments in the gut, but they cannot distinguish between lactose intolerance, milk protein allergies, or other dairy sensitivities 1.
Key Considerations
- Breath tests produce many false positives and negatives, which can lead to misdiagnosis and unnecessary dietary restrictions.
- They do not account for individual symptom thresholds, as some people with positive breath tests may consume dairy without symptoms.
- An elimination diet, on the other hand, involves completely removing dairy products from the diet for 2-4 weeks, then systematically reintroducing them while monitoring for symptoms, providing clearer evidence of intolerance or allergy.
Implementation of Elimination Diet
- Keep a detailed food and symptom journal during the elimination and reintroduction phases to track any changes in symptoms.
- Read food labels carefully for hidden dairy ingredients to ensure complete elimination of dairy products.
- Consider consulting a dietitian for guidance on maintaining nutritional balance while eliminating dairy, as dairy products are a significant source of calcium and other essential nutrients.
Rationale for Recommendation
The British Society of Gastroenterology guidelines for the management of irritable bowel syndrome suggest that patient reports of lactose intolerance relate poorly to objective evidence and cannot be relied upon 1. Therefore, a more reliable diagnostic approach, such as an elimination diet, is necessary to determine dairy intolerance or allergy. The guidelines for the diagnosis and management of food allergy in the United States also support this approach, emphasizing the importance of distinguishing between food allergies and intolerances 1.
From the Research
Diagnosis of Lactose Intolerance
- The breath test, specifically the hydrogen breath test (HBT), is a commonly used method for diagnosing lactose intolerance due to its non-invasive nature, low cost, and high sensitivity and specificity 2, 3, 4.
- However, the HBT may not be recommended for dairy intolerance or allergy testing in certain cases, as it only measures the body's ability to digest lactose and does not account for other potential issues with dairy products, such as milk protein allergies or sensitivities 5.
- An elimination diet, on the other hand, can be a more comprehensive approach to diagnosing dairy intolerance or allergy, as it involves removing all dairy products from the diet and monitoring for symptoms 5.
Limitations of the Breath Test
- The HBT has some limitations, including the lack of uniform criteria for administering and interpreting the test, which can lead to inconsistent results 4.
- Additionally, the HBT may not be suitable for individuals with certain gastrointestinal conditions, such as small bowel bacterial overgrowth, which can affect the accuracy of the test results 5.
- The test also requires a certain amount of lactose to be consumed, which can be problematic for individuals who are highly sensitive to lactose or have severe symptoms 6.
Elimination Diet as an Alternative
- An elimination diet can be a useful alternative to the HBT for diagnosing dairy intolerance or allergy, as it allows individuals to monitor their symptoms and reactions to dairy products in a more controlled and comprehensive way 5.
- The elimination diet involves removing all dairy products from the diet for a period of time, typically 2-4 weeks, and then reintroducing them one at a time to monitor for symptoms 6.
- This approach can help individuals identify specific dairy products or components that trigger their symptoms, and can be a more effective way to manage dairy intolerance or allergy in the long term 6, 5.