Lactose intolerance and celiac disease, let's study the connection.

Celiac disease is often associated with lactose intolerance. But are these two conditions related only by common symptoms, or is there a real link?

We assume that both lactose intolerance and celiac disease belong to the so-called gastrointestinal pathologies .

However, these disorders are often difficult to differentiate, because each condition shares common symptoms , which can help delay diagnosis.

But while celiac disease is an autoimmune disease (and not a gluten intolerance) known as chronic enteropathy, caused by gluten , a protein found in wheat, barley, durum wheat and many other cereals (you can consult the association's website for more information celiac disease ); lactose intolerance is caused by a lack of the enzyme lactase , responsible for the digestion of milk sugar (lactose in fact).

The symptoms of celiac disease are very varied and very often involve the gastrointestinal tract causing: diarrhea, weight loss, abdominal distension, bloating, dyspepsia and flatulence .

The pain can be located specifically in the right lower abdomen and also accompanied by a palpable mass, raising suspicions of appendicitis or Crohn's disease.

Systemic manifestations, on the other hand, include migraines, chronic fatigue, depression, irritability, dermatitis, oral aphthous ulcers, anorexia, joint pain, failure to thrive, delayed puberty, amenorrhea, premature menopause, impaired fertility.

We have already discussed extensively in this article about the symptoms of lactose intolerance , and as we can see some, related to the gastrointestinal system, are superimposable.

Interestingly , celiac disease can be associated with lactase deficiency , which leads to a consequent lactose intolerance.

Lactase deficiency or hypolactasia can be divided into three types:

• Congenital , an autosomal recessive condition, extremely rare.
• Primary , it is an autosomal recessive condition resulting from the physiological decline of the lactase activity of intestinal cells, which does not occur before the age of two.
• Secondary , also known as temporary lactase deficiency, occurs when damage to the mucosa causes atrophy of the small intestine villi. This happens as a result of rotavirus infection, celiac disease, giardiasis, Crohn's disease, and more.

It is precisely the latter form , therefore, that appears as a result of untreated celiac disease .

Lactose intolerance is therefore increased in patients with celiac disease for two reasons:

1. due to a reduced secretion of trypsin , a pancreatic enzyme that activates lactase,
2. as a result of damage to the intestinal mucosa , in which the enzyme lactase is normally present.

For the diagnosis of celiac disease it is useful to perform blood tests and evaluate the presence of specific antibodies, which belong to the class of IgA. An intestinal biopsy is then performed in adults.

In the event of a positive outcome, it is necessary to follow a diet, first of all gluten-free (the only possible therapy) and associate it with a lactose-free diet at least in the initial periods, until the intestinal mucosa is restored.

Bibliography

• Abenavoli et al. (2015). "Nutritional profile of adult patients with celiac disease". European Review for Medical and Pharmacological Sciences.
• Hurduc et al. (2017). "Lactose intolerance: new aspects of an old problem". BMJ journal Volume 102 - Suppl 2.
• Karlen E. Luthy et al. (2017). “Differentiating Between Lactose Intolerance, Celiac Disease, and Irritable Bowel Syndrome-Diarrhea” The Journal for Nurse Practitioners - JNP.