Tuesday, 5 March 2013

Lactose Intolerance!

I've been an avid exerciser my whole life. I'm fortunate to never have suffered from any serious injury and for the most part exercise has been relatively easy for me. I've spent the last 13 years working as a Physical Therapist and personal fitness trainer and I'm now a practicing Osteopath. All of this has kept me moving and therefore fit and healthy.

Over the past 5 years I've had what I can only describe as "a slight irritable bowel" when running any distance more than 5km. 3-4 years ago when I was marathon training and doing races like Ironman 70.3 UK this problem was more than a slight annoyance. Every time I ran I would get low grade intestinal pain to begin, followed by flatulence and often a need to stop for a toilet break to relieve what is commonly called "Runners Belly", know in another continent as "Dehli Belly".
I was most symptomatic on long runs and interval sessions. I was reluctant to think that I had any control over this, which meant training and racing was business as usual.

For the following 3 years my training was very limited. Myself and my wife became parents to the 2 most wonderful boys. We are both Irish and live in London which, means childcare is always a problem. When both parents run its difficult to commit to the training demands of a long distance race without alienating the other with the chore of childcare at the weekend after a busy working week. My racing was practically nil, however my training was continued albeit at a reduced rate.

Skip forward to November 2012. I signed up to the Paris marathon in early September and my training for the race had started proper. I began as I usually do with 3 weeks base work. Developing my fitness, preparing my body for the journey ahead. This entails reducing body weight; achieved by running all sessions at 65%-72% of maximum heart rate, and increasing local muscular endurance; achieved by plyometric training.

As I began to increase my weekly mileage my intestines became more and more problematic. Until one week, on a planned 22km run I basically had pain from the "Go". After 3.6km I had to stop for a toilet break due to intense intestinal cramp. This pit stop made me feel no better and I reluctantly continued until 8.6km which is when I made my second toilet pit stop. My determination drove me on and I continued with the planned 22km run. At 15km I had to stop again, at this point it I found it almost amusing that I was supposed to be racing in Paris (April 2013).
I eventually threw the towel in at 21 km cutting my run short by 1km but perhaps more disappointing was the dismal time I had accumulated on my failing effort. My (pardon the pun) gut feeling was to pull out of the Paris marathon.  But before I got too hasty I decided to try something different.

At the same time I was reading a book about inflammatory diseases and in particular a neurological condition called "Multiple Sclerosis". The author kept referring to the northern Europe and northern United States as having a pro-inflammatory diet. This phenomenon explains why Caucasians are more prone to certain inflammatory diseases like MS than an African or Asian person whose diet differs somewhat from ours. There are many inflammatory suspects in the western diet but the two obvious culprits are Lactose (a sugar found in dairy products) and gluten (a wheat protein).

Being a long distance runner and cyclist it's safe to say I love my carbs. So the thought of eliminating gluten from my diet seemed as compelling as going to the dentist. So I went with abolition of lactose first. I suppose I had an underlying thought that perhaps lactose was a key player to my symptoms.

When lactose makes its way into our gastrointestinal tract (GIT), it is broken down in the small intestine into glucose which is the sugar form we use in our bodies (see previous post on carbohydrates). The walls of our small intestines release an enzyme called lactase, thus far insulin has not part in this process. Insulin is what we use to tell our cells to burn the glucose that has been produced as a result of breaking down the lactose.
Lactose intolerant individuals do not produce lactase in their small intestine so are unable to assimilate any nutritional good from lactose products. But with an estimated 5% of Caucasians being lactose intolerant, it shouldn't be a major problem right?

With a prolonged intake of lactose such as cows milk (which has about 50% more protein than breast milk) an individual can become sensitive to lactose. This means that the cells in our small intestines can no longer manage the load of lactose that is being consumed. This maybe due to excess intake or loss of the cells that secrete lactase, either way the lactose is not digested.
We have a whole flora of bacteria in our gastrointestinal tract. These minuet microorganism have important roles but if a colony of bacterium grow out of control we will become symptomatic. This is what happens when you become sensitised to lactose.

All living things love sugar. Carbon is the fuel source of life and sugars are simple carbon chains. So when there are undigested lactose products in the GIT the bacteria multiply at rates beyond the norm. All living things produce metabolic waste as a result of metabolism. The metabolic waste produced by these bacterium is methane gas and some other compounds which promote inflammation in a human. Gas bubbles inside the intestines will cause a pressure between the walls resulting in cramps and discomfort. When this gas eventually leaves the tube which is the GIT it is commonly accompanied by a trumpeting sound, a foul odour (methane gas mixed with sour milk among other waste products) and a momentary relief from symptoms.

For the past 3 weeks I have been living off "LactoFree" products. LactoFree dairy produce are available widely across the UK. They have an ingenious way of eliminating lactose, they remove 50%. The remaining 50% is completely broken down by a synthetic lactase enzyme that they add to the milk. The result of all is is a very very slight difference in taste. The difference is so slight that my wife doesn't know if I've put LactoFree milk in her tea or regular milk.
Since using LactoFree milk and butter (that's all the dairy I eat) I have been 98% symptom free. The 2% I'm blaming on chocolate and other products that I eat that contain some lactose. Since the first day I changed to LactoFree products it has felt like somebody flicked a switch to the symptoms in my abdomen .

The plan is to stay LactoFree for a couple of months. This should be time enough to overcome an insensitivity. Then I will reintroduce some lactose products (with a careful eye on my bowels) and see how my body responds.