Lactose Intolerance a Somatoform Disorder? This you gotta read!

[TheMoonIsBlue]

Oh, Brother, can you believe this one! Somatoform Disorders for ALL!!

http://health.msn.com/health-topics...ance-may-sometimes-be-in-the-head-not-the-gut

(this article was on several different websites)

THURSDAY, May 12 (HealthDay News) -- Italian researchers report that some people who think they are lactose-intolerant may actually suffer from a psychological condition known as somatoform disorder.

With true lactose intolerance, a person is deficient in the enzyme lactase, which breaks down the lactose. Those who suffer it say they experience bloating, gas, gut pain and nausea when they eat or drink products containing the milk sugar lactose.

Somatoform disorder describes a group of conditions in which the physical pain and symptoms a person experiences are really related to psychological factors.

This new study shows that some people "should not blame lactose for symptoms of lactose intolerance," said Dr. Guido Basilisco, a researcher in the gastroenterology unit at IRCCS-Ca Granda, in Milan.

He presented the findings this week at Digestive Disease Week in Chicago.

In the study, Basilisco and his colleagues evaluated 102 patients, 77 of them female, who took a breath test commonly used to identify lactose intolerance. Patients also completed a questionnaire about somatization, anxiety and depression.

Those with somatoform disorder often report multiple problems in different areas of the body, such as faintness or weakness of a body part, Basilisco said, but no physical cause can be found.

Either lactose intolerance or malabsorption was identified in 29 percent and 33 percent of patients, respectively.

However, when Basilisco looked at those with what he calls "altered somatization," he found that "patients with altered somatization are four times more likely to report lactose intolerance."

It means there is strong link between the two conditions, he said.

Those who reported they were intolerant were also more likely to be anxious, but that link was not as strong.

The findings didn't surprise Dr. Mary Maish, surgical director of the Center for Esophageal Disorders at the University of California, Los Angeles.

She has seen the same connections in her patients.

"It's a real thing, they really do have these symptoms," she said. Most experts in the field, she said, do think many of the symptoms linked with what is called lactose intolerance are probably more related to other kinds of psychological issues that have not been addressed.

"It's good to see some science behind it," she said.

Basilisco plans to look at why some patients focus on food as the cause of their symptoms.

Maish said it may help for doctors to refer to the study when talking to some patients. With that as an introduction, she said, doctors could then investigate other avenues to helping reduce psychological symptoms.

Patients can then focus on the real root of the problem and get back to eating dairy, she added.

That's important because not eating dairy products raises the risk of calcium deficiency and osteoporosis, the researchers noted.

More information

To learn more about lactose intolerance, visit the U.S. National Institutes of Health.

SOURCES: Guido Basilisco, M.D., researcher, IRCCS-Ca Granda, Milan, Italy; Mary Maish, M.D., associate clinical professor, surgery, David Geffen School of Medicine, University of California, Los Angeles, and surgical director, UCLA Center for Esophageal Disorders; May 8, 2011, presentation, Digestive Disease Week, Chicago

 

[maddietod]

I wonder if this was funded by the dairy industry......

 

[ahimsa]

Ignoring the somatoform issues for a moment, here's my first reaction:

Patients can then focus on the real root of the problem and get back to eating dairy, she added. That's important because not eating dairy products raises the risk of calcium deficiency and osteoporosis, the researchers noted.

Sheesh, was this study sponsored by the National Dairy Council?

It's certainly up to each individual whether they want to eat dairy products or not. Just to show where I'm coming from, I eat dairy products. I don't have any lactose intolerance and no problem with digesting milk/cheese/butter/etc. However, that statement above, that patients can "go back to eating dairy" (as if not eating dairy is some horrible fate) sounds a bit strange in the context of the article.

If a patient misses dairy products, and wants to solve their digestion problems so they can resume eating them, then that's one situation. But making a statement that all people must consume dairy products or else risk health problems seems a bit much. People can be perfectly healthy without dairy. And since dairy is higher on the food chain it may more pesticides, antibiotics, and so on. Again, I have no ax to grind here, but it's strange that the article frames avoiding dairy as a health risk without weighing the pros/cons of both sides, eating dairy vs. not eating dairy.

I think there are studies that show that drinking more milk does not necessarily protect someone against osteoporosis. Here's a link from the Physicians Committee for Responsible Medicine web site - http://www.pcrm.org/health/veginfo/dairy.html

 

[caledonia]

Nobody ever died from not eating dairy...in fact entire Asian cultures do not eat dairy and their bones are just fine.

Notice how women are singled out - 102 patients "77 of them female", as if the females are expected to be the ones more susceptible to "somatoform lactose intolerance", because as we all know, females are crazy <sarcasm>

It never occurred to them that their test might only work 1/3 of the time.

 

[Dainty]

I really hope they tested for a dairy allergy.

I'm allergic to dairy, have been since I was a baby, with obvious symptoms. Yes, it is possible to live without dairy.

And have these people never heard of food sensitivities? Nope, those must just be anxiety too...

 

[Snow Leopard]

Sounds like a Non Sequitur doesn't it?

Hydrogen breath testing methods are somewhat prone to error:
http://www.ncbi.nlm.nih.gov/pubmed/3343009
http://www.biomedcentral.com/1471-230X/9/82

I've tested positive on the hydrogen breath test to lactose (negative to fructose), but I don't get the abdominal symptoms of lactose intolerance.

 

[Tulip]

Can a somatoform disorder make run off to the loo? I think not.

I swear there is a special place in hell for all these *mental health professionals*.

 

[In Vitro Infidelium]

http://health.msn.com/health-topics...ance-may-sometimes-be-in-the-head-not-the-gut



With true lactose intolerance, a person is deficient in the enzyme lactase, which breaks down the lactose. Those who suffer it say they experience bloating, gas, gut pain and nausea when they eat or drink products containing the milk sugar lactose.

Somatoform disorder describes a group of conditions in which the physical pain and symptoms a person experiences are really related to psychological factors.

This new study shows that some people "should not blame lactose for symptoms of lactose intolerance," said Dr. Guido Basilisco, a researcher in the gastroenterology unit at IRCCS-Ca Granda, in Milan.

This is rather a peculiar presentation of the science of what more reasonably could be identified as "adult human lactose tolerance" - that being the more notable phenomenon. Most adult humans lack the enzymes to digest lactose - it's an evolutionary supported condition that would have promoted weaning. It is only very recently in evolutionary terms that retention of the lactose digesting enzymes into adulthood has occurred in some European populations - the change appears coincident with cattle domestication within the last 20,000 years and the limited winter sunlight in northern Europe would have made the ability to utilise a dietry source of Vitamin D a strong evolutionary advantage.

There is an issue of Vitamin D deficiency for some darker skinned people living in Northern latitudes, whose lifestyles involve limited sun exposure - rickets, a disease formerly seen only in conditions of childhood deprivation has been noted in girls of Asian heritage living in the UK. In these girls, where for cultural reasons dairy products form only a very limited part of the diet, the combination of their 'protective skin', limited outdoor exposure and culturally mediated covering of the body, seriously reduces the opportunity to produce skin cell generated vitamin D.

There have been studies on the balance of healthy sun exposure for different skin types and for adults who are otherwise healthy, appropriate levels of daily skin exposure is considered sufficient to maintain adequate Vitamin D availability without any dietry source.

Presumably doctors are enountering people who are complaining about the effects of lactose intollerance and are then 'medicalising' this natural state of affairs, and instead of simply saying - if it makes you ill don't eat it, just make sure you get fifteen minutes of sun a day (the walk will do you good !!) there's a medically mediated response which says a) we have to cure this person of their 'intollerance', or b) cure them of their false belief they have an intollerance. Obviously there are social implications to 'not being able to eat dairy' - but should doctors be medicalising this socialising problem for people who are simply facing either some inconvenience or having to deal with occasional discomfort, after all billions of humans regular suffer the consequences of not being able to tollerate a large intake of alcohol, perhaps we should have the same attitude to post cheese cake bloating that we have to a booze induced hangover. Or maybe we have to look forward to post cocktail headaches being defined as somataformic maladaption.

IVI

 

[taniaaust1]

And have these people never heard of food sensitivities? Nope, those must just be anxiety too...

The General Medical community dont recognise food sensitivities at all (at least that is how it is in Australia where it isnt really a recognised illness). Many do react to not the lactose in the milk but other things.

The also probably didnt consider endocrine issue such as insulin problems (lactose being a kind of carb/sugar triggers insulin.. so one can have lactose issues but it not be lactose intollerance as such, those need insulin testing).

 

[Esther12]

I've recently had a problem with a post-nasal drip, which can lead to me gagging up phlegm in the morning. This seems to be worsened by dairy, and some other foods. I don't think I'm lactose intolerant, but surely there will be lots of people with various medical problems that mean they will react badly to dairy anyway. It does seem unreasonable to assume anyone who claims to react badly to dairy and does not satisfy the criteria for lactose intolerance should be viewed as somatizing, and it's not at all surprising that those with less well understood medical problems tend to be more anxious that others either.

Saying all that... presumably it is possible for some people to suffer from a somatization disorder which manifests in various dietary restrictions. Maybe not though... and these ideas are just the result of the prejudices of certain clinicians.

 

[Angela Kennedy]

I've recently had a problem with a post-nasal drip, which can lead to me gagging up phlegm in the morning. This seems to be worsened by dairy, and some other foods. I don't think I'm lactose intolerant, but surely there will be lots of people with various medical problems that mean they will react badly to dairy anyway. It does seem unreasonable to assume anyone who claims to react badly to dairy and does not satisfy the criteria for lactose intolerance should be viewed as somatizing, and it's not at all surprising that those with less well understood medical problems tend to be more anxious that others either.

Saying all that... presumably it is possible for some people to suffer from a somatization disorder which manifests in various dietary restrictions. Maybe not though... and these ideas are just the result of the prejudices of certain clinicians.

Well, bearing in mind a somatization diagnosis is based on the not being able to find a clear biomedical explanation for a problem coupled with some circumstantial distress (bearing in mind episodes of varying distress is ubiquitous to humans), and is therefore something of a 'god of the gaps' theory, and cannot differentiate between explanations of malingering, hypochondria or beliefs in 'mind over body' processes that cannot currently be substantiated in medical science, 'somatization' is an unsafe diagnosis.

 

[In Vitro Infidelium]

Well, bearing in mind a somatization diagnosis is based on the not being able to find a clear biomedical explanation for a problem coupled with some circumstantial distress (bearing in mind episodes of varying distress is ubiquitous to humans), and is therefore something of a 'god of the gaps' theory, and cannot differentiate between explanations of malingering, hypochondria or beliefs in 'mind over body' processes that cannot currently be substantiated in medical science, 'somatization' is an unsafe diagnosis.

Unsafe it may be but what economic model of health provision do you propose to manage a demand led system where the worried well can require endless investigations of minor discomforts without the clinician being able to raise the possibility that an emotional cause is driving the patients health anxiety ? It may be obvious to those affected by M.E/CFS why somatisation is a problematic diagnosis, but how is it any more problematic than any other psychiatric diagnosis ?

Health provision driven by the worried well and the minorly discomforted of itself raises problems for M.E/CFS affected people not only does it institutionalise trivialisation approaches by practitioners but it takes up huge areas of resource allocation that could otherwise be directed to serious chronic conditions such as CFS. If somatisation is to be challenged as a diagnosis (and the DSM -5 proposals ought to raise the concern that such a challenge is needed) then there has to be articulation of arguments that deal with real world delivery of health services, not merely academic critiques of disease theory.

IVI

 

[Esther12]

Unsafe it may be but what economic model of health provision do you propose to manage a demand led system where the worried well can require endless investigations of minor discomforts without the clinician being able to raise the possibility that an emotional cause is driving the patients health anxiety ?

I don't think there's any problem with doctors 'raising the possibility'. The problem is when they raise it as a conclusion, without having any positive evidence to support their case.

There are difficult moral and financial questions to be answered surrounding the rights of those with health problems, but I don't think we do need to have answers for these in order to make the more basic moral point about the dangers of presuming psychological illness in cases where doctors have not yet found a physical cause for a patient's illness.

 

[Angela Kennedy]

I don't think there's any problem with doctors 'raising the possibility'. The problem is when they raise it as a conclusion, without having any positive evidence to support their case.

There are difficult moral and financial questions to be answered surrounding the rights of those with health problems, but I don't think we do need to have answers for these in order to make the more basic moral point about the dangers of presuming psychological illness in cases where doctors have not yet found a physical cause for a patient's illness.

Thank you Esther for answering that. Why should patients have to put up with unsafe practice (logically, scientifically, ethically and in terms of effect on physical health to the point of death- as some inquests have found for example- even some case studies reported), for unsafe health economic ideologies?

But, would IVI feel the same, I wonder also, if doctors started invoking bad karma, astrology or demon possession to explain difficult to diagnose illnesses? I suspect not- because he doesn't believe in these, but he does believe in psychogenic explanations, I suspect- although the flaws in reasoning in these as explanations are many.

That's even before we question the concept of 'the worried well' - a construct particularly associated with the writings of Simon Wessely. At what point does a doctor decide someone is a 'worried well'? Is there even such a thing? We actually can't say for sure. Other doctors in the literature remind us people go to the doctors whenever they are concerned about their health, a ubiquitous phenomenon! How many cancer patients find out about their cancer by firstly, going to the doctor! If these concerns turn out to be unfounded- in ethical medicine you would need to be SURE they are unfounded, not dismiss the patient as hypochondriac, malingering, or somehow using the power of the mind through some occult process to THINK their bodies to dysfunction- based on the fact the doctor doesn't know what is wrong and can't be arsed/is too fiscally loyal to the state to order other investigations and is therefore placing responsibility to this onto the patient.

But, if doctors are working under fiscal loyalty to the state, and a belief in an unsafe and confused, often incoherent construct (psychogenic illness), it's an ultimate cop-out to blame the patient for being 'worried well'. BUT THEN - the doctor may also decide the worried well is insane- so doles out anti-depressants, CBT, sends them off to the local 'chronic fatigue unit', sections people like Sophia Mirza or Eon Proctor (sorry to bring up those, IVI, I know theses examples discomfit you but people like them are part of this scenario, unfortunately), ending up costing the country thousands, if not millions in misdiagnosis. That's before we have legal cases of neglect having to be defended, and sometimes lost. That's not fiscally sound, as it turns out.

In summary IVI, psychogenic explanations to save money, while being the favoured choice of Simon Wessely and Michael Sharpe (who have both advanced these arguments) don't, in the long run, make fiscal sense, and can (and do) cause iatrogenic damage to patients (some to the point of death), which doesn't make ethical sense.

 

[Enid]

Very much appreciated your phrase "god of the gaps" Angela - I wonder whether my A&E "diagnosis" following many collapses and basic tests, was "we have a new theory - it's all in the mind". Let me guess somatisation and psychiatric. This seems overly represented in their medical textbooks (very young Docs) with a conviction that if their (limited) tests reveal nothing they must be correct. I think there is a breakdown of trust - Docs not believing patients and sadly now we don't believe them either. "God of the gaps" infiltrating and trying to take over real medicine. Who knows the answer ?

 

[Desdinova]

Yes just Picture it you think that you are lactose intolerance so you go to the doctor. Your doctor says he doesn't think that you are and tells you to give it a while. You push for a test and he promptly assigns you with DSM-5 listing in your medical records. This morning on CNN etc. they were talking about how a study showed that a shocking high percentage of the population was afraid to go to the doctor. One local radio station had a local talk show on wonder why or what people were afraid of. For those who have never had an issue or major disagreement with a Dr. it's next to impossible for them to understand.

 

[SilverbladeTE]

Can a somatoform disorder make run off to the loo? I think not.

I swear there is a special place in hell for all these *mental health professionals*.

Nah, Satan has specifically banned lawyers and psychiatrists from Hell, as they were making the place look bad and thus, we're being infested by those Human cockroaches instead