I've been thinking about the terms "primary, secondary lactose intolerance"
and find that they can lead to confusion (in me anyway). Thus I've found
what the AAP defines as lactose intolerance and for anyone, who like me was
beginning to mix things up, here is their definition (which has unmixed
things for me!

"Lactose intolerance is defined[1] as a clinical syndrome of abdominal pain,
diarrhea, flatulence, and bloating after the ingestion of a standard lactose
tolerance test dose (2 gm of lactose per kilogram of body weight or 50 gm/sq
m of body surface area, maximum 50 gm in a 20% water solution). If a maximum
increase in blood glucose level of less than 26 mg/dl is observed after a
lactose tolerance test dose, lactose malabsorption is diagnosed.[1] Lactose
intolerance is classified as primary, secondary, or congenital. Lactose
intolerance is classified as primary when it is observed with no history or
signs of underlying intestinal disease. If there is gastrointestinal
disease, it is usually classified as secondary. Primary and secondary
lactose intolerance are not uncommon; however, congenital lactose
intolerance is rare. This form is present at birth, the histologic features
of the gastrointestinal mucosa are normal, and brush-border lactase activity
is low or completely absent.[6,7] The three forms of lactose intolerance
must be considered separately to avoid confusion."

"CONGENITAL LACTOSE INTOLERANCE
The extremely low or absent activity of brush-border lactase[6,7] in
congenital lactose intolerance can be life-threatening because of the
accompanying severe diarrhea and dehydration when lactose is fed. The
condition is rare, but it is not unusual for secondary lactose intolerance
to be misdiagnosed during the newborn period as congenital lactose
intolerance. A definite diagnosis requires intestinal biopsy for histology
and enzyme assay. Nonetheless, it is imperative that a lactose-free formula
be provided as soon as the diagnosis is suspected because of the seriousness
of the condition."


It has helped me read this article, now I can see galactosemia as a
completely different condition. In galactosemia it's a lack in an enzyme to
handle galactose NOT lactose. Of course they are related, as galactose comes
from lactose!! Maybe this clears the situation up in the two articles and
the fact that galactosemia was not mentioned.

I'm going to shut up now, as I'm going around in circles and more than
likely stating the obvious.

Sara Bernard
THe Netherlands
(just switched the TV on and wishing everyone involved strength and peace)

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