Can you get lactose intolerant later in life: Can You Get It as You Get Older?
Can You Become Lactose Intolerant Later In Life? It’s Actually More Common Than You Think
If dipping Oreos in a tall, ice-cold glass of milk is one of your fondest childhood memories, I’m right there with you. And if, besides the cream filling, the best part of the entire experience was letting each chocolate disk soak in the pool of white to enhance the subtle cocoa flavor you’d drink down after savoring the last crumb, same. But maybe indulging in a glass of milk with dessert is more problematic for you now than it is pleasurable, and if that’s the case, you should know you can become lactose intolerant later in life. So if drinking milk, or eating a few slices of extra cheese pizza causes a ruckus in your stomach, it’s possible you could have developed a sensitivity over the years.
Notice how, above, I described lactose intolerance as a sensitivity, not an allergy. That’s because, according to Mayo Clinic, lactose intolerance “isn’t a true allergy;” it’s a direct result of your body lacking or completely missing an enzyme called lactase, whose function is to break down the lactose, aka a type of sugar, found in dairy products.
What’s really fascinating, though, is that, according to the Physicians Committee for Responsible Medicine, humans are born with this enzyme in order to drink the milk from their mothers, but after weaning, “75 percent of the world’s population” lose their lactase enzymes. Which, the organization adds, isn’t a huge loss (except, of course, if you love the taste of dairy), because milk products don’t actually offer any exclusive nutrients you can’t get from other foods.
Being born with a lactose intolerance is rare, but it’s actually common to develop a lactose intolerance as you get older.
Trust me, friends, I sympathize with just how hard it is to internalize this information, especially when, like me, you just cannot imagine a life without cheese or scoops of ice cream piled high on a waffle cone on summer nights. If nothing else, we can at least take comfort in the fact that the majority of us share the same intolerance, right? As for those of you eating spoonful after spoonful of yogurt reading this, we’re not friends. Just kidding! Kind of.
In terms of how the human body can just sort of lose its ability to break down lactose, nothing freaky has to happen to the body, your insides won’t go through anything traumatic. According to Grace Derocha, registered dietitian, certified diabetes educator and certified health coach at Blue Cross Blue Shield of Michigan, lactose intolerance can occur if your small intestine stops producing enough lactase enzymes over time, or your LCT gene, which gives your body the go-ahead to produce lactase slows down. It’s really just as simple as that. Plus, Derocha tells Elite Daily, “poor gut health and diet can also impact the body’s efficiency of producing lactase,” so you might want to take care of that if there’s any shred of hope that dairy can still do it for you.
So there’s a good chance you’ll become lactose intolerant later in life, but now the question is, how can you tell?
You might not even realize you have a dairy intolerance, but you’re definitely going to be feeling the effects of dairy regardless if you can identify the issue yourself or need a doctor to do the honors. For me, anytime I overload on cheese (sometimes you eat pizza for dinner three days in a row, OK?), I know for a fact the food baby expanding my abdomen is all thanks to lactose (and, sure, my lack of self control, whatever). This, Derocha says, is one of many signs of a lactose intolerance, while other symptoms like gassiness, stomach pain, diarrhea or constipation, and cramping are also common. Worst case scenario, she tells Elite Daily, you might experience nausea or vomiting. Which, in that case, put the pint of Ben & Jerry’s down; not even Cherry Garcia is worth that mess.
Even though it’s not considered a true allergy, your doctor can still diagnose your lactose intolerance. The first step is going to be to make an appointment as soon as you start noticing any of these symptoms after consuming dairy. I cannot stress enough how important it is to consult your doctor ASAP, because even though lactose intolerance can’t be cured it can be treated.
Once your appointment’s in the books, and you make your way to the office, Mayo Clinic reports your doctor will either perform one or more of three tests to diagnose you with lactose intolerance. For example, a lactose intolerance test might be issued in which you’ll have to drink liquid high in lactose to see whether or not you glucose levels rise and if your body is breaking down the sugars in dairy. A hydrogen breath test is also possible, and will require you to drink a similar liquid high in lactose so your doctor can measure the amount of hydrogen in your breath. If hydrogen levels are high, that means your body is unable to breakdown lactose properly. Stool tests are generally more for children and infants who can’t undergo any of the aforementioned tests, but your doctor could require you to submit a sample of your business to check its acidity.
Right now, dairy might not be an issue for you, but if you do develop a lactose intolerance later in life, it’s not the end of the world.
OK, so you have to lighten up on the dairy products, or, if worse comes to worst, eliminate lactose from your diet altogether. At first, it’s going to suck, and take some adjusting. Your body is probably going to taunt you with relentless cravings, and it’s going to be really hard not to give in, but let me tell you about all the benefits of nixing dairy from your diet, because there’s a bunch.
For starters, the food industry has really stepped up their game in order to cater to all kinds of sensitivities, which means dairy alternatives are plentiful. If you’re an ice cream connoisseur, for example, Ben & Jerry’s released non-dairy pints that are just as delicious as their milky offerings, and So Delicious’s cashew milk ice cream is amazing. You won’t even miss the milk. Cheese lovers can get their fix from brands like Field Roast’s Chao, Follow Your Heart, and if you’re a pizza fanatic you have to give Daiya’s pies a taste. As for those ice-cold glasses of milk, skip traditional gallons for plant-based alternatives like oat milk, almond milk, and, my personal fave, Elmhurst hazelnut milk.
Plus, on top of exploring all of these delicious dairy alternatives, saying buh-bye to lactose means saying hello to gorgeous, clear skin. And, without all that excessive fat weighing you down, chances are you’ll have a ton of energy throughout the day because instead of milk, you might start your day off with hot water and lemon, instead. So don’t think of lactose intolerance as yet another downside to adulthood. It’s a struggle for sure, but rest assured the pros outweigh the cons.
Can You Become Lactose Intolerant As An Adult?
- Lactose intolerance usually happens with younger people, but you can develop it as an adult.
- Sometimes it’s genetics, but other triggers include food poisoning, extreme stress, and cutting dairy out of your diet for long periods of time.
- It’s important to work with a doctor or R.D. to determine if you’re truly intolerant or have another dietary issue.
- Some people can redevelop tolerance slowly, while others will have to avoid lactose for life.
It’s every dairy-lover’s worst nightmare: One day you’re eating cheese by the hunk and ice cream by the pint, and the next you can’t stomach a sip of milk without becoming as gassy as a football player on an all-broccoli diet.
What fresh hell is this? Can you become lactose intolerant as an adult?
I’m sorry to break it to you, but…yes.
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Remind me…what is lactose intolerance?
Lactose intolerance, of course, is when your small intestine doesn’t make enough of the enzyme lactase to break down the sugar in dairy, a.k.a. lactose.
Because your body can’t digest and absorb those sugars, it has to eliminate them somehow, and that can bring on the fun symptoms of nausea, bloating, cramps, diarrhea, and gas.
When can you become lactose intolerant?
Lactose intolerance usually begins in kids around age 5; and about 30 million American adults are lactose intolerant by age 20, according to the National Institutes of Health (NIH).
For most, lactose intolerance is genetic. “All babies can digest and absorb lactose as their first food. As we get older, for many of us that potential diminishes and parts of the intestine that secrete lactase stop working,” says Robin Foroutan, R.D., a spokesperson for the Academy of Nutrition and Dietetics and a health coach at The Morrison Center who specializes in food sensitivities.
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Though lactose intolerance most often starts by your teens or early twenties, “it’s pretty common for people to become lactose intolerant as adults,” says Foroutan. In fact, some research suggests as many as 75 percent of the world’s population loses the ability to digest milk at some point.
What causes lactose intolerance in adults?
Foroutan says there are a lot of triggers that can mess up your body’s ability to digest lactose, such as:
- Food poisoning
- Stomach bug
- Small-intestine diseases (like Crohn’s)
- Extreme stress
“Lactase enzymes live on the brush border, or the tippy-top of edge of the small intestine. If there’s irritation to the digestive tract, that section of the brush border is the first to be affected, so those enzymes are often the first to go,” explains Foroutan.
Other people find they simply “age out” of their ability to digest lactose. “No one really knows exactly why, but it’s common enough,” says Foroutan. “If you think about it from an evolutionary perspective, for an infant, milk is the only food source. But as you get older, your evolutionary requirement to absorb nutrients from milk is not as important.” (Your tastebuds may not agree.)
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It could also very well be that you were always lactose intolerant, you just never realized it. “Adults tend to be better at making connections between what they eat and how they feel,” says Foroutan.
How do I know I’m lactose intolerant?
Foroutan says that when lactose doesn’t break down and those sugars hang out in digestive tract, your body tries to flush out that sugar by bringing water into the colon—leading to gas, loose stools, and cramping. Most symptoms pop up within two hours of eating…so, your body lets you know pretty quickly that it’s not happy.
However, Foroutan says that people sometimes assume they’re lactose intolerant when they’re actually sensitive to casein or to whey—the protein in milk and the watery substance that remains after milk is turned into curds. For example, if you can’t stomach hard cheeses, which don’t contain lactose, it may point to a casein sensitivity. You might also be sensitive to any combination of lactose, casein, and whey.
The best way to figure out your sensitivities and limits is to work with a nutritionist to eliminate dairy, then slowly reintroduce it to your diet. After avoiding all dairy for two to three weeks, you’ll begin eating certain products one at a time—usually butter, then hard cheeses, then yogurt or kefir. “That way you can really note what foods your digestive tract is comfortable with and your body tolerates well,” says Foroutan.
If you find that you are still intolerant to a certain dairy product, Foroutan says you can eliminate it for a few months until your digestive tract calms down enough, then try it again. If you still have symptoms when you re-introduce the food, try eliminating and re-introducing it one more time. “After three times of eliminating and reintroducing, if you still have symptoms, you’re better off avoiding it,” she says.
Can I prevent lactose intolerance?
As long as you’re not genetically predisposed to lactose intolerance, you should be able to digest lactose your whole life (barring illness or injury to your digestive tract), says Foroutan. And it’s an important part of your diet: The USDA and Academy of Nutrition and Dietetics recommend aiming for three servings of dairy per day.
Cut dairy from your diet for an extended period of time, however, and you might wind up with sensitivities when you do eat it again. “If you don’t use it, you lose it,” says Foroutan. Even then, you can teach your body to tolerate dairy again. “You just have to go little by little,” she adds—following the same kind of re-introduction plan that you would for an elimination diet.
If, however, you are genetically intolerant to lactose, you probably won’t ever be 100 percent okay eating dairy products. “When you eat or drink anything that your body doesn’t digest well, it creates a lot of inflammation in the digestive tract, which in turn increases inflammation in your body. This is why it’s important to avoid the foods that you know trigger any kind of unpleasant reaction,” says Foroutan.
There’s no reliable test to tell whether you’re genetically intolerant to lactose, although lactose intolerance in close family members is a relatively reliable signal.
What should I do if I’m diagnosed with lactose intolerance?
Most people who are diagnosed with lactose intolerance can still enjoy up to eight ounces of dairy per day without symptoms, according to AND. Foroutan says most people do better with fermented dairy products, like yogurt and kefir, than liquid milk. Foroutan suggests experimenting with different types of milk: You may find that cow’s milk roils your tummy but not sheep’s or goat’s milk, or vice versa. Otherwise, popping a lactase pill may help keep symptoms under control.
If all dairy is off limits, never fear: Lactose-free milk and yogurt are required by the FDA to contain zero lactose. You can usually get all the calcium you need from other calcium-rich foods, like dark leafy greens, tahini, tofu, and sardines. And most of us—unless we live in a sunny southern state—need to take a vitamin D supplement to meet our needs whether or not we eat dairy, says Foroutan.
Colleen de Bellefonds
Colleen de Bellefonds is an American freelance journalist living in Paris, France, with her husband and dog, Mochi.
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Lactose Intolerance in Adults | Gastro Specialists Southwest Fl
What is Lactose Intolerance in Adults?
If you have bloating, gas, and stomach pain after drinking milk or eating a bowl of ice cream, you may be lactose intolerant. The condition is caused when your body rejects lactose, a certain type of sugar, in milk.
Lactose intolerance stems from your small intestine. When it doesn’t produce enough lactase, which is an enzyme that helps you digest lactose, you’ll experience physical symptoms after consuming milk. Lactase works to turn the sugar in cow’s milk into glucose and galactose, which are sugars that your body can absorb.
When you lack lactase, the sugar from milk or other dairy products can’t be absorbed into the walls of the intestinal lining. So, when the milk moves into the colon, or large intestine, the lactose interacts badly with the normal bacteria and causes discomfort in the body. Basically, instead of digesting the dairy product, your body starts to ferment it.
What are the Symptoms of Lactose Intolerance?
Lactose intolerance in adults isn’t harmful but it can be an uncomfortable and sometimes embarrassing condition. If you suffer from this illness, about 30-minutes to two-hours after eating or drinking a milk product, you may feel varying levels of:
- Stomach cramps
These are all signs that you may have lactose intolerance. The disorder isn’t the same as a milk allergy, which can be life-threatening. People with food allergies must avoid those foods altogether. If you have lactose intolerance, you’ll likely feel worse if you consume dairy products, but you will be unlikely to end up calling 911.
Is Lactose Intolerance Common in Adults?
Infants need milk, it’s where they gather their nutrition. But even babies can occasionally be born with congenital lactase deficiency, a condition called congenital alactasia. This can cause the infant to be unable to break down the lactose found in breast milk or formula.
But even infants that consume and digest milk sugar with no problems can develop lactose intolerance later on in life. It’s common for lactose intolerance in adults to develop when the production of lactase naturally drops after infancy and even on into adulthood.
Research shows that approximately 65% of adults have a reduced ability to digest lactose after infancy. There seems to be a genetic component to the disorder, with people of East Asian descent experiencing the highest levels of lactose intolerance. The research also shows the disorder is common in people of Arab, Greek, Italian, Jewish, and West African descent. But only about 5% of people descended from Northern European countries experience the problem.
What are the Causes of Lactose Intolerance?
Most people stop producing lactase as they mature. The Food and Drug Administration (FDA) says approximately 30 to 50 million Americans suffer from lactose intolerance. They also suggest up to 75% of adult African Americans and Native Americans suffer from the disorder. Another 90% of Asian Americans are lactose intolerant.
As people age, they naturally produce less of the enzymes needed to break down milk products. That’s why adults more commonly acquire the symptoms.
While there is a genetic component to lactose intolerance, there are three types of lactose intolerance with different factors causing each:
- Primary lactose intolerance is the most common type of the illness. Most adults begin their lives with all the lactase they need to digest milk. But as they age, lactase production drops, leading to discomfort when ingesting dairy products.
- Secondary lactose intolerance often stems from illness or injury that affects your small intestine. This could include Celiac disease, Crohn’s disease, an intestinal infection, or other problems. Treating the underlying condition may help with the symptoms of lactose intolerance.
- Congenital lactose intolerance in babies is rare but possible. It can occur in infants whose parents have the disorder, or in premature infants due to a lower or insufficient level of lactase.
Am I at Risk for Lactose Intolerance?
Lactose intolerance is very common. However, adults may be more at risk for lactose intolerance if they:
- Are older, since lactose intolerance appears typically later in life
- Are of African, American Indian, Asian, or Hispanic
- Were born prematurely
- Have been treated for cancer with radiation therapy or chemotherapy
When Should I See a Doctor?
While experiencing occasional pain or discomfort from gas, heartburn, or stomach ache is common, if these problems occur regularly it’s time to see a gastroenterologist.
Your doctor may suspect you are lactose intolerant given your symptoms and your response to dietary changes. There are two possible tests used to confirm the diagnosis:
- A hydrogen breath test requires you to drink a liquid with high amounts of lactose. Then your doctor will measure the volume of hydrogen in your breath, which is an indicator that you aren’t fully digesting the lactose.
- A lactose tolerance test requires you to drink the lactose liquid. Two hours after drinking it your doctor will conduct blood tests to measure the glucose in your blood. If your glucose (sugar) level doesn’t rise after drinking the lactose beverage, you are lactose intolerant.
What is the Treatment for Lactose Intolerance in Adults?
Determining the cause of lactose intolerance is the first step toward treating it. If you have the secondary form of the disease caused by an underlying medical condition, treating that illness may help. Other causes of lactose intolerance can be managed potentially by lowering the amount of lactose in your diet.
Here are four things you can do now to manage the condition:
- Limit consumption of milk or other dairy products like cheese and ice cream
- Consume only small amounts of milk products in your daily meals
- Only eat lactose-reduced or lactose-free dairy products
- Add a powder or liquid lactase enzyme to break down the lactose in the dairy products that you do consume
If you’re worried about receiving enough calcium, maintaining good nutrition will help you gather the nutrients you need from other foods such as:
- Broccoli and leafy green vegetables
- Calcium-fortified foods like juices and cereals
- Milk substitutes such as almond, soy, or rice milk
- Nuts and grains
The good news is that most supermarkets offer lactose-free products, including ice cream, milk, and even yogurt. These substitutes can help you manage the disease.
However, if the symptoms don’t go away, it’s important that you schedule an appointment with the team at Gastroenterology Associates of Southwest Florida, PA. We’ve been a trusted resource for patients for more than a decade and can help you with a host of digestive health disorders. Click here to schedule an appointment.
Lactose Intolerance – Jackson Siegelbaum Gastroenterology
Lactose intolerance develops when the body has difficulty digesting whole and skim milk and other dairy products. Lactose is a milk sugar and like most sugars, it is broken down by enzymes in the intestinal tract so it can be absorbed as an energy source. The enzyme that breaks down lactose is called lactase. When the intestine does not contain lactase, then lactose intolerance can occur. It is a troublesome and annoying problem, but it is never a serious one.
Who Has Lactose Intolerance?
As commonly expected, infants and small children have the enzyme lactase so they can digest mothers’ milk. However, as time passes, lactase can begin to disappear in some people. Some ethnic groups are more likely to develop lactose intolerance. By adolescence, it is gone in about 75% of African-Americans, Jews, Native Americans, Hispanic persons, and in 90% of Asians. So the condition is very common.
What Are The Symptoms?
When undigested lactose reaches the colon (large intestine), it is broken apart by bacteria. Intestinal gas along with lactic acid and other acidic chemicals result. It is these products that create the symptoms of lactose intolerance. These symptoms include nausea, abdominal cramps and rumbling, bloating, rectal gas (flatus), and diarrhea. They usually occur 30 minutes to two hours after ingesting lactose-containing foods. The severity of symptoms usually depends on the amount of lactose ingested and how much of the enzyme, lactase, remains in the intestinal tract.
First, the physician reviews the patient’s medical history. Sometimes that is enough to determine the problem. However, to make a definitive diagnosis, one of several tests may be needed:
Lactose Tolerance Test
A test dose of lactose is ingested and blood sugar determinations are made over several hours. If lactase is present to break down the lactose load, then the blood sugar level rises. If no lactase is present, the blood sugar level does not change.
Hydrogen Breath Test
When lactose is broken down by the colon’s bacteria, hydrogen is released, which then passes out through the lungs. An increase in the amount of hydrogen released after a lactose meal can indicate lactose deficiency.
Stool Acidity Test
When lactose breaks down to lactic and other acids in the colon, the resulting acidity can be detected by a simple measurement of stool acidity. This test is more commonly reserved for infants or small children who cannot do the other tests.
he Home Do-It-Yourself Test – Since lactose intolerance is not a serious disorder, some people may want to test themselves at home. First, avoid milk and lactose-containing foods for several days. Then on a free morning, such as a Saturday, drink two large glasses of skim or low-fat milk (14-16 oz). If symptoms develop within four hours, the diagnosis of lactose intolerance is fairly certain.
Therapy depends on whether a patient is willing to tolerate the symptoms. If the symptoms are mild, then avoiding large amounts of milk and milk products may be enough. For those who are very sensitive to small amounts of lactose, there are two options. First, all foods should be carefully checked for lactose. Grocery items such as bread, baked goods, cereals, instant potatoes, soups, margarine, lunch meat, salad dressings, pancakes, biscuits, cookies, and candy can contain hidden lactose. Even prescription and over-the-counter drugs may contain lactose. The patient must become a label reader looking for and avoiding “milk” and “lactose”.
The second option is buying milk substitutes or milk to which lactase, the enzyme, has been added. Lactase drops or tablets are also available which can be placed in milk. A pharmacist or food store manager can provide advice. There are over-the-counter lactase tablets that can be taken with meals to replace the enzyme the body no longer has. Finally, a variety of lactose-free milk alternatives are now available in the dairy section of most food stores these days.
Calcium and Lactose
Milk is a major source of calcium and calcium is necessary for good health and strong bones. Most adults need 1,000 mg of calcium a day, except for young (less than 18 years of age), pregnant and nursing females (1,300 mg per day) and post-menopausal females (1,200 mg per day).
For the lactose-intolerant individual, ingesting enough calcium may be difficult. Calcium supplements, such as calcium carbonate, are often recommended. The decision to take calcium supplements should be discussed with the physician.
Can You Eat Dairy If You Are Lactose Intolerant?
If eating a cup of ice cream or drinking a glass of milk sends you scurrying to the bathroom or starts your gut gurgling, you might have lactose intolerance.
And you’re not alone. About 65 percent of the world’s population has some issues digesting milk products. And the effects don’t need to be as severe as full-blown diarrhea—even symptoms like slight bloating or mild cramping can indicate a problem.
But the question is, what’s your move if you do have a sensitivity to things like milk, cheese, and ice cream? Are you destined to a life sans dairy? And if you choose to eat the good stuff anyway—symptoms be damned—are you putting your body at risk? We break it down below. (Plus, find out if dairy really causes acne, here.)
What Exactly Is Lactose Intolerance?
When you eat foods containing lactose—a sugar found in milk products—an enzyme called lactase works to break down the sugar into smaller particles, explains Jennifer Inra, M.D., a gastroenterologist at Brigham and Women’s Hospital in Boston, MA.
These smaller particles are easier for your GI tract to absorb and digest. A problem arises, though, if your body doesn’t produce enough lactase to break the milk sugars down.
And that’s a common side effect of growing older, says Dana Hunnes, R. D., a senior dietitian at Ronald Reagan UCLA Medical Center.
“As infants, we require milk [preferably breastmilk or a similar alternative] to properly access healthful nutrition,” she says.
But after that, we can get our nutrients form solid food, so we no longer need to drink milk. As a result, many of lose the lactase enzyme that allows us to break those milk sugars down into smaller parts, says Hunnes.
That’s what causes lactose intolerance. Without enough of the lactase enzyme, your body can’t metabolize dairy, leading to digestive problems like diarrhea, abdominal cramping or pain, bloating, gas, nausea, and sometimes even vomiting about 30 minutes to two hours after eating it. (Here’s what to do if you get diarrhea on a run.)
“The severity of symptoms typically increases with the amount of lactose you eat,” says Dr. Inra.
Usually, lactose intolerance is something that develops as you age—you’ll usually notice some symptoms start to begin in adolescence.
It’s also possible to pick up symptoms later in life, says Dr. Inra. An injury to your small intestine—from infection or inflammation, such as from celiac disease or inflammatory bowel disorders—can also lead to lactose intolerance. The good news, though, is in these cases, your lactase levels will return to normal after you treat the underlying disease.
Otherwise, lactose intolerance doesn’t get better over time—even if you try to reintroduce yourself to dairy little by little, she says.
So How Bad Is It to Eat Dairy If You’re Lactose Intolerant?
Lactose intolerance isn’t dangerous, Dr. Inra notes, and if you splurge on the cheesy nachos, there will likely be no long-term consequences.
But, that’s not the case 100 percent of the time: “There are some individuals who actually do have permanent damage done to the microvilli [finger projections lining the intestine] of their intestine when they drink or consume foods with lactose in it,” says Hunnes.
And that’s a problem, since the microvilli absorb nutrients into your bloodstream. So if they are damaged, you won’t be able to absorb and utilize your nutrients properly. The result? Malnutrition, says Hunnes, which can leave you lacking the nutrients you need.
But don’t freak out—it’s a very rare condition, affecting less than one percent of the population, she says.
Most of us, instead, pay for eating dairy with the nasty—albeit temporary—symptoms listed above. In most cases, you’ll start to feel better once everything is through your system, about 12 to 24 hours later, says Hunnes. (Here are 12 reasons your stomach hurts.)
Still, even if you’re lactose intolerant, you don’t have to swear off cheese. You just need a better game plan, and that can include some OTC meds that can help you digest dairy.
“Lactaid pills and other similar products such as Dairy-Ease contain the enzyme lactase, and help some people tolerate dairy,” says Dr. Inra.
Just make sure to take the pills before eating dairy. “If they are taken later, they may not work as well. ”
One important note: The OTC pills aren’t foolproof, either. Many people have mild symptoms even with a lactase enzyme supplement, because these meds may not be able to break down all the lactose present in your food—say, especially if you’re eating foods with lots of lactose, says Dr. Inra.
That’s where choosing your dairy wisely comes into play, too. The aging process reduces lactose, so aged cheeses like cheddar, Parmesan, and Swiss may be safer, says Dr. Inra.
“Younger, fresher cheeses, such as American, feta, and mozzarella have higher lactose content,” she says.
Plus, fermented foods such as yogurt and kefir are also naturally lower in lactose, too, says Hunnes. On the other hand, reduced-fat and fat-free dairy products also tend to have a higher lactose contents, Dr. Inra says.
Fortunately, we also live in an age of dairy-free and lactose-free foods and drinks. “Almond milk, soy milk, or Lactaid milk are good options instead of regular milk,” says Dr. Inra.
Even better: Even Ben & Jerry’s and Breyer’s sell ice cream made with real milk, sans the lactose.
Dairy without the diarrhea. A win-win.
Cassie Shortsleeve is a skilled freelance writer and editor with almost a decade of experience reporting on all things health, fitness, and travel.
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How to Tell if Your Child is Lactose Intolerant
Lactose is a sugar found in dairy products, like milk and cheese. To help digest it, our small intestine contains an enzyme called lactase. Lactase turns lactose into glucose, which our bodies use for energy. However, for children and adults with lactose intolerance, this digestive process doesn’t occur properly, which can result in uncomfortable gastrointestinal (GI) symptoms.
“Lactose intolerance is when your intestine is lacking lactase,” explains Charina Ramirez, M.D., a pediatric gastroenterologist at Children’s Health℠ and Associate Professor at UT Southwestern. “If you don’t have lactase, you can’t break lactose down properly.”
What are lactose intolerance symptoms in kids?
When a child cannot properly digest lactose, it can cause many symptoms. Signs your child may be lactose intolerant include:
- Stomach pain and cramping
Babies with lactose intolerance may be very fussy and may not gain weight or grow well. Lactose intolerance symptoms can range from mild to severe, depending on the amount of lactose a child consumes and how much lactase a child’s body makes.
Is there a difference between lactose intolerance and milk allergy?
Lactose intolerance is not the same as a milk protein allergy, the most common food allergy in babies. Infants who have milk protein allergy are allergic to the protein in cow’s milk. Children who are lactose intolerant cannot properly digest lactose, which is a sugar. While both groups of children may experience similar symptoms, the two conditions are very different. Learn more about symptoms of a food allergy in children.
What causes lactose intolerance in kids?
Lactose intolerance can occur in children for different reasons depending on their age. Reasons can include prematurity, congenital lactase deficiency, primary lactase deficiency and secondary lactase deficiency.
Prematurity and lactase deficiency
Though lactose intolerance is not common in babies, some babies who are born before 34 weeks don’t have a fully functional gastrointestinal tract. They may lack lactase and other enzymes they need to digest food, though these can develop later as the child grows. Interestingly, these premature infants may still tolerate intact milk protein based formulas.
Congenital lactase deficiency
In rare cases, babies are born with lactose intolerance, which is known as congenital lactase deficiency.
“Infants with congenital lactase deficiency are born without any lactase enzyme,” explains Dr. Ramirez. “These babies are diagnosed early in life because they have severe diarrhea and do not gain weight. You’ll know right away if your child has it.”
Primary lactase deficiency
The most common cause of lactose intolerance in kids is primary lactase deficiency. These children don’t have enough lactase enzyme, and the amount of lactase they have may decline as they get older. While it may seem like lactose intolerance starts suddenly, it gradually worsens over time and the symptoms become more obvious.
About 65-70% of the world’s population is affected by primary lactase deficiency, which is a genetic condition. It is extremely common among people of Asian and African descent, as well as Native Americans. While primary lactase deficiency can start as early as age 2, symptoms may not be noticeable until the adolescent and young adult years.
Secondary lactase deficiency
Other children may develop secondary lactase deficiency, which can occur suddenly after an illness.
“Any illness that injures the small intestine, such as gastroenteritis, can result in temporary or long-term lactase deficiency,” says Dr. Ramirez. “Infants younger than 3 months are more at risk of being adversely affected by this. They may experience severe diarrhea and poor growth.”
Chronic conditions such as Crohn’s disease or celiac disease can also result in lactase deficiency.
How is lactose intolerance diagnosed in children?
One simple way to determine if your child is lactose intolerant is to stop giving them dairy products (such as milk, cheese, ice cream, pizza) and see if their symptoms go away. To ensure your child still eats a well-rounded diet, you can offer your child dairy replacements such as vitamin D and calcium supplements. Your child’s pediatrician can also offer additional recommendations and provide a referral to a specialist for further help.
A pediatric gastroenterologist can diagnose lactose intolerance in children by performing a hydrogen breath test. “We can perform a hydrogen breath test in the GI lab,” says Dr. Ramirez. “Increased amounts of hydrogen on the test after drinking a lactose-containing product indicates lactose intolerance.”
Your child may also be diagnosed after an endoscopy, a minimally invasive procedure to take samples of the tissues in the esophagus, stomach and small intestine. The tissue sample from the small intestine can be tested for lactase and other sugar enzymes.
What to do if your child is lactose intolerant
If your child is lactose intolerant, there are many solutions that allow your child to have a healthy, well-rounded diet. With the right foods and treatments, you can help stop your child’s symptoms.
For true lactose intolerant babies, it is recommended that parents seek the help of a pediatric gastroenterologist to manage this condition. Because these infants are often “failure to thrive” and have diarrhea, they may need a special formula and should be closely monitored for adequate weight gain.
Older children have multiple options, such as choosing dairy-free milk and dairy-free cheese products or using Lactaid tablets, which contain lactase enzymes. Lactaid tablets come in a chewable form for children ages 4 years and up.
“You can take Lactaid tablets with the first sip or bite of dairy,” says Dr. Ramirez. “It gives you the enzyme needed to break down the lactose for 45 minutes of eating or drinking. Taking a Lactaid tablet should help prevent symptoms such as bloating, stomach pain and diarrhea.”
If children have temporary secondary lactase deficiency, you can help them avoid dairy for about two weeks, then reintroduce dairy products. Transient lactose intolerance can sometimes occur after a viral or bacterial gastroenteritis.
If your child has unexplained gastrointestinal symptoms like diarrhea, a Children’s Health pediatric gastroenterologist can help you find answers. Learn more about our pediatric gastroenterology program and services.
Stay current on the health insights that make a difference to your children. Sign up for the Children’s Health newsletter and have more tips sent directly to your inbox.
Lactose Intolerance: Common Misunderstandings – FullText – Annals of Nutrition and Metabolism 2018, Vol. 73, Suppl. 4
Lactose intolerance primarily refers to a syndrome having different symptoms upon the consumption of foods containing lactose. It is one of the most common form of food intolerance and occurs when lactase activity is reduced in the brush border of the small bowel mucosa. Individuals may be lactose intolerant to varying degrees, depending on the severity of these symptoms. When lactose is not digested, it can be fermented by gut microbiota leading to symptoms of lactose intolerance that include abdominal pain, bloating, flatulence, and diarrhea with a considerable intraindividual and interindividual variability in the severity of clinical manifestations. These gastrointestinal symptoms could be similar to cow’s milk allergy and could be wrongly labeled as symptoms of “milk allergy.” There are important differences between lactose intolerance and cow’s milk allergy; therefore, a better knowledge of these differences could limit misunderstandings in the diagnostic approach and in the management of these conditions.
© 2019 S. Karger AG, Basel
• Lactose intolerance is often confused with cow’s milk allergy by patients and parents.
• A better knowledge of the differences between these clinical conditions could limit misunderstandings in the diagnostic approach and management.
The signs and symptoms of adverse food reactions (AFRs) in children derive from several mechanisms (see Fig. 1) . These mechanisms can be triggered by different components of the same food. Immune-mediated reactions (i.e., food allergy, celiac disease) are elicited by food proteins, whereas the vast majority of non-immune-mediated AFRs derive from carbohydrate intolerances (see Fig. 2). The most common carbohydrate intolerance in the pediatric age is lactose intolerance. During infancy, lactose accounts for most of the dietary carbohydrates. Lactose is a disaccharide, which is present in many dairy products, composed by galactose linked to glucose via a β-1→4 glucosidic bond. Lactose is hydrolyzed by β-galactosidase (lactase) bound to the small intestine brush border membrane, then the monosaccharides glucose and galactose are both actively absorbed in the small intestine. Lactose intolerance primarily refers to a syndrome having different intestinal or extraintestinal symptoms upon the consumption of foods containing lactose that derives from an insufficient level of lactase activity in the brush border of the small bowel mucosa .
Classification of adverse food reactions.
Classification of carbohydrate intolerances.
Three Types of Lactose Intolerance
Different factors cause the lactase deficiency underlying each type:
Congenital lactase deficiency (CLD): an extremely rare autosomal recessive disease characterized by absent or reduced enzymatic activity from birth.
Primary lactose intolerance or adult-type lactase deficiency: a common autosomal recessive condition resulting from a developmentally regulated change of the lactase gene expression.
Secondary lactase deficiency: a transient condition deriving from intestinal damage secondary to several diseases such as infections, food allergy, celiac disease, small bowel bacterial overgrowth, Crohn’s disease, or radiation/chemotherapy-induced enteritis.
CLD is a rare (only a few cases have been described) and severe intestinal autosomal recessive disease, within the group of congenital diarrheal disorders, caused by the absence of lactase activity from birth (OMIM 223000) [3, 4]. This condition must be distinguished from the developmental lactose intolerance that could be observed in premature infants. These subjects may have reduced levels of lactase because small intestinal lactase-expressing enterocytes develop later in the third trimester. The main symptoms of CLD are watery diarrhea, intestinal meteorism, and malnutrition, beginning on the first days after birth with the onset of lactation with breast milk or lactose-containing formula. Symptoms disappear when patients change to a lactose-free diet. The typical feature of CLD is the absence or very low levels of lactase expression deriving from a mutation in lactase phlorizin hydrolase gene (LPH) located on 2q21.3 [5, 6]. Most CLD cases have been described in Finland, where the disorder is enriched due to a founder effect and genetic drift [5, 7]. Premature stop codons and a truncated protein as a result of frame shifts, missense mutations in the coding region of LPH, or exon duplication are the most common genotypes identified in these patients [7-10]. Some other cases include mutations leading to single amino acid substitutions that can interfere with the proper maturation and function of LPH [7, 11]. More recently, severe forms of CLD elicited by mutations in the LPH gene that occur in either a compound heterozygous or homozygous pattern of inheritance have been described .
In primary lactose intolerance, intestinal lactase expression falls off sharply, making dairy products difficult to digest later in childhood or adolescence. It is the most common type of lactose intolerance and it is genetically determined. Approximately 70% of the global adult population are lactase non-persistent (hypolactasia). The global distribution and the age at which lactase expression declines vary with ethnicity. In South America, Africa, and Asia, more than 50% are lactase non-persistent. The condition is also common in Mediterranean or Southern European populations. In some Asian countries, up to 100% are lactase non-persistent. In the United States, the percentage of lactase non-persistence varies with ethnic origin with the lowest percentage in the population of European origin and the highest percentage in Hispanics and in the Afro-American population. People who develop primary lactose intolerance start life producing plenty of lactase, a necessity for infants, who get all their nutrition from milk. As children replace milk with other foods, their lactase production decreases. Children of African, Asian, or Hispanic descent may experience symptoms beginning between the age of 2 and 3 years, whereas subjects of European and American descent typically do not develop symptoms of lactose intolerance until later in childhood (5–6 years of age) or adolescence [12-14]. Lactase persistence is inherited as a dominant Mendelian trait . The genetic trait of persistence of intestinal lactase expression can be caused by five or more independent single nucleotide variants in a regulatory region (a transcriptional enhancer) upstream of the lactase gene. One of these, −13910*T (rs4988235) is responsible for most cases of lactase persistence in Caucasian individuals, others such as −13907*G (rs41525747), −13915*G (rs41380347), −14009*G (rs869051967), and −14010*C (rs145946881) are found at variable frequencies in the Middle East and Africa [16, 17]. Several individual variables can influence the development of symptoms in non-persistence lactase subjects: dose of lactose in diet, intestinal transit time, lactase expression, distribution and fermentation ability of gut microbiota, sensitivity towards chemical and mechanical stimulation of the gut, and psychological factors [18-20]. Adaptation of gut microbiota, assuming a growing dose of lactose, with increase of bacteri- al β-galactosidase activity is recognized as a cause of symptom reduction in lactose intolerance [21, 22].
Lastly, virtually all pathological conditions that cause small intestine damage can induce a reduction in lactase expression determining a secondary and transient lactase deficiency. Among the diseases associated with secondary lactose intolerance there are celiac disease, small bacterial overgrowth, and Crohn’s disease. Treatment of the underlying disorder may restore lactase levels and improve signs and symptoms, though it can take time. Abdomen radiation therapy or chemotherapy could also lead to lactose intolerance. Cow’s milk allergy (CMA) can cause severe enteropathy with secondary lactase deficiency. In these patients, there may be an overlap of gastrointestinal symptoms due to CMA and lactose intolerance. Therefore, the same food, such as cow’s milk, can lead to an adverse reaction through different mechanisms.
Differences between Lactose Intolerance and CMA
Frequently, among both patients and physicians, there is confusion between lactose intolerance and CMA, which could result in unnecessary dietary restriction or avoidable reactions. “Milk allergy,” “milk intolerance,” and “lactose intolerance” are often used by patients and their parents without a clear sense of the different meanings, understanding of the different mechanisms that underlie them, or the dietary implications of the diagnosis. The management of these conditions is distinctly different, and inappropriate recognition or management may have significant implications for the patient .
Lactose intolerance results from a reduced ability to digest lactose, a sugar. As explained above, lactose intolerance is a “non-immune-mediated AFR,” while CMA is one of the most common forms of food allergy (“immune-mediated AFR”) in particular in the first years of life. CMA may be due to immunoglobulin E (IgE), non-IgE mediated, or mixed reactions. After food intake, IgE-mediated reactions typically occur within 2 h, whereas non-IgE-mediated reactions develop after 2–48 h or some days after the food ingestion . In particular, the symptoms of non-IgE-mediated CMA are frequently wrongly labeled as symptoms of intolerance. The main differences between CMA and lactose intolerance are summarized in Table 1.
Main differences between (adult-type) lactose intolerance and cow’s milk allergy
Clinical Symptoms of Lactose Intolerance
Non-digested lactose in the intestinal tract drives fluids into the gut lumen through an osmotic force, causing osmotic diarrhea. Moreover, gut microbiota fermented lactose, producing volatile fatty acids and gases (hydrogen, methane, and carbon dioxide). All these events are responsible for the clinical symptoms, such as distension of the small bowel, non-focal abdominal pain associated with bloating and flatulence, nausea, increased gut motility, and diarrhea . These symptoms usually develop from 30 min to 2 h after the ingestion of lactose-containing foods. Food intolerances have long been reported by patients with functional gastrointestinal disorders; however, randomized controlled trials are lacking in this area . Extraintestinal symptoms, such as headache, vertigo, memory impairment, and lethargy, have been described in up to 20% of subjects with carbohydrate intolerance . These systemic symptoms could be the result of toxic metabolites, produced by sugar fermentation of colonic bacteria that can alter cell-signaling mechanisms . However, it is unclear whether these atypical symptoms are directly due to lactose ingestion or related to the presence of the so-called “functional disease,” frequently accompanied by multiple somatic complaints .
Diagnostic Approach to a Pediatric Patient with Suspected Lactose Intolerance
Genetic testing for mutations of the LPH gene should be performed whenever CLD is suspected in infants with typical symptoms and a positive response to dietary elimination of lactose . In secondary lactase deficiency, a good clinical history often reveals the relationship between lactose ingestion and symptoms. The mainstays of adult-type lactose intolerance diagnosis are anamnesis and the lactose breath test (LBT) . The LBT is a rapid, non-invasive test that allows measuring the content of hydrogen in the expired air. The dose of lactose administered is 1 g/kg in children. Although high doses of lactose (≥50 g) have been used for LBT, 25 g (equivalent of 500 mL of milk) is within the normal range of consumption and is the recommended dose after 8–12 h of fasting . All breath testing should incorporate measurement of CO2 (or O2) to adjust the breath sample for non-alveolar dilution of exhaled air . Concomitant measurement of CH4 is also required because the detection rate of an early rise in H2 production significantly decreases in excess methane producers . A cutoff increase of H2 of 20 parts per million (ppm) above the baseline level is considered as positive (CH4 ≥10 ppm) (see Fig. 3).
Lactose breath test procedure in children with suspected lactose intolerance.
Factors that may produce false-negative or false-positive results include conditions affecting the gut microbiota (e.g., recent use of antimicrobial agents), lack of hydrogen-producing bacteria (10–15% of the population), ingestion of high-fiber diets before the test, small intestinal bacterial overgrowth, or intestinal motility disorders [17, 32].
Another diagnostic test, quite popular in the past, is the lactose tolerance test. In this test, the patient suspected to have lactose intolerance assumes 50 g of lactose dissolved in water. Samples of capillary blood are taken to test the plasma glucose concentration at −5, 0, 15, 30, 45, and 60 min. A maximal plasma-glucose increase of 1.4 mmol/L or higher indicates lactose tolerance . The lactose tolerance test is not sensitive enough; it is also often falsely positive because of lack of an increase of blood glucose concentration attributable to a normal insulin response to the carbohydrate load. Given the high rate of false-negative and false-positive results, this test should not be used and has been replaced by the LBT .
The genetic test, identifying single nucleotide polymorphism associated with lactase persistence/non-persistence, is also available. It should be noted that the presence of the lactase non-persistent gene does not imply the simultaneous presence of lactose intolerance that may appear later in life.
Management of Lactose Intolerance and Nutritional Issues
The mainstay of treatment for AFRs is to eliminate the causative food from the diet. In the AFRs induced by CMA, also small protein doses can cause symptoms, so the management is based on the strict avoidance of the cow’s milk-derived allergenic peptides in the diet. On the contrary, a reduction of lactose intake rather than full exclusion is recommended in lactose intolerance, because available data suggest that adolescents and adults can usually ingest up to 12 g of lactose in a single dose (equivalent to 1 cup of milk, corresponding to 240 mL) with no or minimal symptoms . So, in these patients dietary treatment consists only in a low-lactose diet (Tables 2, 3) [2, 35]. There is no scientific evidence to identify the tolerable dose of lactose for children with lactose intolerance. Determining the amounts of lactose that can be tolerated is necessary to develop evidence-based dietary recommendations that meet the needs of the individual. In primary lactose intolerance, lactose-containing dairy products are generally avoided for 2–4 weeks, the time required to induce symptom remission. Then, a gradual reintroduction of dairy products low in lactose up to a threshold dose of individual tolerance should be recommended.
Lactose content in common dairy foods
In secondary hypolactasia, a restricted diet is necessary only for a limited time . Concern about lactose intolerance and osmotic diarrhea in the treatment of undernourished children has led to a restricted use of lactose in these patients. Even in well-nourished children, low-lactose formulas are frequently used in children with persistent diarrhea. It is useful to find a balance where the amount of lactose in food does not induce osmotic diarrhea, but can help to achieve the beneficial effects of lactose. Clinical trials are needed to better define the safe and appropriate lactose dietary levels for moderately and severely undernourished children . In the rare form of CLD, a complete lactose-free diet is required for life.
Enzyme replacement is another therapeutic approach in patients with lactose intolerance that wish to enjoy dairy products. Preliminary data showed an improvement of gastrointestinal symptoms and a decrease of H2 levels at breath test with the administration of 1,500 U/day of β-galactosidase. However, more data regarding the efficacy of this microbial exogenous enzyme are needed . Other evidence suggested that efficacy of exogenous lactase was obtained from Kluyveromyces lactis, Aspergillus oryzae, or Kluyveromyces lactis [38, 39]. Another strategy involves probiotics that could shape gut microbiota composition. Four-week consumption of a mix probiotic combination (Lactobacillus casei Shirota and Bifidobacterium breve) improved symptoms and decreased H2 production in lactose-intolerant patients. These effects appeared to be persistent for at least 3 months after suspension of probiotic consumption , and strain-specific because in a similar study a milk containing L. acidophilus resulted ineffective . A randomized, double-blind, placebo-controlled trial conducted in adult lactose-intolerant patients demonstrated that a 36-day treatment with a highly purified (> 95%) short-chain galactooligosaccharide (GOS), designated “RP-G28” (escalating doses from 1. 5 to 15 g/day) plus subsequent dairy consumption significantly improved clinical outcomes for lactose digestion and tolerance. These clinical outcomes correlated with a significant modification in gut microbiota composition consisting of an increase in lactose-fermenting Bifidobacterium, Faecalibacterium, Lactobacillus, and Roseburia . Further studies are required to provide high-quality evidence to support or compare the efficacy of all these strategies.
In the management of lactose-intolerant patients, it is important to consider that lactose intolerance can be part of a wider intolerance to variably absorbed, fermentable oligo-, di-, monosaccharides and polyols (FODMAPs). This is present in a high percentage of patients with irritable bowel syndrome and this group requires not only restriction of lactose intake but also a low-FODMAP diet to improve gastrointestinal symptoms .
“Free” diets are in fashion. In supermarkets tons of products labeled lactose-free can be easily found; there are more and more cafes, ice-cream shops, bakeries, and restaurants offering special menus, where lactose has been banished. Milk consumption is decreasing in the USA and is the lowest in countries with a high prevalence of lactase non-persistence . Indeed, the National Health and Nutrition Examination Survey (NHANES) reported approximately 5% of infants received lactose-reduced formulas in the USA alone between 2003 and 2010, and this trend is increasing . A common rationale for the use of lactose-free infant formulas is that infants are presumed to be lactose intolerant; although there is little or no evidence that lactose-reduced formulas are beneficial . Preliminary evidence shows that elimination of lactose from the infants’ diet is disadvantageous for the development of healthy gut microbiome  and a different plasma metabolic profile in lactose-free formula-fed children . A lactose-free diet should be prescribed only when a true diagnosis of lactose tolerance is achieved. A full dairy exclusion diet may also affect other health outcomes. It is important to underline that if dairy products are eliminated, other dietary sources of calcium or calcium supplements need to be provided. The current recommendations for calcium intake are 700 mg/day for children aged 4–9 years, and 1,300 mg/day over 10 years, according to the EFSA guidelines . Educational and commercial efforts to improve calcium and vitamin D intake are now focusing on stimulating the consumption of tolerable amounts of milk, use of lowered lactose-containing foods including hard cheeses, yogurt, and lactose-hydrolyzed milk products.
M. Di Costanzo has no interest to declare.
R. Berni Canani has the following relevant financial relationships with the following manufacturers of commercial products: Ch.Hansen (research grant, speaker), Danone (research grant, speaker), Humana (research grant), Kraft-Heinz (research grant, speaker), Mead Johnson Nutrition (research grant, speaker), Nestlè (research grant), Novalac (research grant), Sanofi (research grant, speaker) as part of publically funded research projects with the support of the Italian Ministry of Health.
The writing of this article was supported by Nestlé Nutrition Institute.
Lomer MC. Review article: the aetiology, diagnosis, mechanisms and clinical evidence for food intolerance. Aliment Pharmacol Ther. 2015 Feb;41(3):262–75.
Berni Canani R, Pezzella V, Amoroso A, Cozzolino T, Di Scala C, Passariello A. Diagnosing and treating intolerance to carbohydrates in children. Nutrients. 2016 Mar;8(3):157.
Diekmann L, Pfeiffer K, Naim HY. Congenital lactose intolerance is triggered by severe mutations on both alleles of the lactase gene. BMC Gastroenterol. 2015 Mar;15(1):36.
Berni Canani R, Castaldo G, Bacchetta R, Martín MG, Goulet O. Congenital diarrhoeal disorders: advances in this evolving web of inherited enteropathies. Nat Rev Gastroenterol Hepatol. 2015 May;12(5):293–302.
Järvelä I, Enattah NS, Kokkonen J, Varilo T, Savilahti E, Peltonen L. Assignment of the locus for congenital lactase deficiency to 2q21, in the vicinity of but separate from the lactase-phlorizin hydrolase gene. Am J Hum Genet. 1998 Oct;63(4):1078–85.
Järvelä I, Torniainen S, Kolho KL. Molecular genetics of human lactase deficiencies. Ann Med. 2009;41(8):568–75.
Torniainen S, Freddara R, Routi T, Gijsbers C, Catassi C, Höglund P, et al. Four novel mutations in the lactase gene (LCT) underlying congenital lactase deficiency (CLD). BMC Gastroenterol. 2009 Jan;9(1):8.
Kuokkanen M, Kokkonen J, Enattah NS, Ylisaukko-Oja T, Komu H, Varilo T, et al. Mutations in the translated region of the lactase gene (LCT) underlie congenital lactase deficiency. Am J Hum Genet. 2006 Feb;78(2):339–44.
Sala Coromina J, Vinaixa Vergés A, Garcia Puig R. [Congenital lactase deficiency: identification of a new mutation]. An Pediatr (Barc). 2015 May;82(5):365–6.
Uchida N, Sakamoto O, Irie M, Abukawa D, Takeyama J, Kure S, et al. Two novel mutations in the lactase gene in a Japanese infant with congenital lactase deficiency. Tohoku J Exp Med. 2012 May;227(1):69–72.
Behrendt M, Keiser M, Hoch M, Naim HY. Impaired trafficking and subcellular localization of a mutant lactase associated with congenital lactase deficiency. Gastroenterology. 2009 Jun;136(7):2295–303.
Born P, Sekatcheva M, Rösch T, Classen M. Carbohydrate malabsorption in clinical routine: a prospective observational study. Hepatogastroenterology. 2006 Sep-Oct;53(71):673–7.
Lomer MC, Parkes GC, Sanderson JD. Review article: lactose intolerance in clinical practice—myths and realities. Aliment Pharmacol Ther. 2008 Jan;27(2):93–103.
Bayless TM, Brown E, Paige DM. Lactase Non-persistence and lactose intolerance. Curr Gastroenterol Rep. 2017 May;19(5):23.
Enattah NS, Sahi T, Savilahti E, Terwilliger JD, Peltonen L, Järvelä I. Identification of a variant associated with adult-type hypolactasia. Nat Genet. 2002 Feb;30(2):233–7.
Liebert A, López S, Jones BL, Montalva N, Gerbault P, Lau W, et al. World-wide distributions of lactase persistence alleles and the complex effects of recombination and selection. Hum Genet. 2017 Nov;136(11-12):1445–53.
Deng Y, Misselwitz B, Dai N, Fox M. Lactose Intolerance in Adults: Biological Mechanism and Dietary Management. Nutrients. 2015 Sep;7(9):8020–35.
Zhao J, Fox M, Cong Y, Chu H, Shang Y, Fried M, et al. Lactose intolerance in patients with chronic functional diarrhoea: the role of small intestinal bacterial overgrowth. Aliment Pharmacol Ther. 2010 Apr;31(8):892–900.
Tomba C, Baldassarri A, Coletta M, Cesana BM, Basilisco G. Is the subjective perception of lactose intolerance influenced by the psychological profile? Aliment Pharmacol Ther. 2012 Oct;36(7):660–9.
Suchy FJ, Brannon PM, Carpenter TO, Fernandez JR, Gilsanz V, Gould JB, et al. NIH consensus development conference statement: lactose intolerance and health. NIH Consens State Sci Statements. 2010 Feb;27(2):1–27.
Johnson AO, Semenya JG, Buchowski MS, Enwonwu CO, Scrimshaw NS. Adaptation of lactose maldigesters to continued milk intakes. Am J Clin Nutr. 1993 Dec;58(6):879–81.
Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC. Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect? Gut. 1997 Nov;41(5):632–5.
Walsh J, Meyer R, Shah N, Quekett J, Fox AT. Differentiating milk allergy (IgE and non-IgE mediated) from lactose intolerance: understanding the underlying mechanisms and presentations. Br J Gen Pract. 2016 Aug;66(649):e609–11.
Turnbull JL, Adams HN, Gorard DA. Review article: the diagnosis and management of food allergy and food intolerances. Aliment Pharmacol Ther. 2015 Jan;41(1):3–25.
Vandenplas Y. Lactose intolerance. Asia Pac J Clin Nutr. 2015;24 Suppl 1:S9–13.
Wilson K, Hill RJ. The role of food intolerance in functional gastrointestinal disorders in children. Aust Fam Physician. 2014 Oct;43(10):686–9.
Matthews SB, Waud JP, Roberts AG, Campbell AK. Systemic lactose intolerance: a new perspective on an old problem. Postgrad Med J. 2005 Mar;81(953):167–73.
Campbell AK, Matthews SB, Vassel N, Cox CD, Naseem R, Chaichi J, et al. Bacterial metabolic ‘toxins’: a new mechanism for lactose and food intolerance, and irritable bowel syndrome. Toxicology. 2010 Dec;278(3):268–76.
Fazeli W, Kaczmarek S, Kirschstein M, Santer R. A novel mutation within the lactase gene (LCT): the first report of congenital lactase deficiency diagnosed in Central Europe. BMC Gastroenterol. 2015 Jul;15(1):90.
Rezaie A, Buresi M, Lembo A, Lin H, McCallum R, Rao S, et al. Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: the North American Consensus. Am J Gastroenterol. 2017 May;112(5):775–84.
Goldoni M, Corradi M, Mozzoni P, Folesani G, Alinovi R, Pinelli S, et al. Concentration of exhaled breath condensate biomarkers after fractionated collection based on exhaled CO2 signal. J Breath Res. 2013 Mar;7(1):017101.
Däbritz J, Mühlbauer M, Domagk D, Voos N, Henneböhl G, Siemer ML, et al. Significance of hydrogen breath tests in children with suspected carbohydrate malabsorption. BMC Pediatr. 2014 Feb;14(1):59.
Di Rienzo T, D’Angelo G, D’Aversa F, Campanale MC, Cesario V, Montalto M, et al. Lactose intolerance: from diagnosis to correct management. Eur Rev Med Pharmacol Sci. 2013;17 Suppl 2:18–25.
Heyman MB; Committee on Nutrition. Lactose intolerance in infants, children, and adolescents. Pediatrics. 2006 Sep;118(3):1279–86.
Usai-Satta P, Scarpa M, Oppia F, Cabras F. Lactose malabsorption and intolerance: what should be the best clinical management? World J Gastrointest Pharmacol Ther. 2012 Jun;3(3):29–33.
Grenov B, Briend A, Sangild PT, Thymann T, Rytter MH, Hother AL, et al. Undernourished Children and Milk Lactose. Food Nutr Bull. 2016 Mar;37(1):85–99.
Ibba I, Gilli A, Boi MF, Usai P. Effects of exogenous lactase administration on hydrogen breath excretion and intestinal symptoms in patients presenting lactose malabsorption and intolerance. BioMed Res Int. 2014;2014:680196.
Montalto M, Nucera G, Santoro L, Curigliano V, Vastola M, Covino M, et al. Effect of exogenous beta-galactosidase in patients with lactose malabsorption and intolerance: a crossover double-blind placebo-controlled study. Eur J Clin Nutr. 2005 Apr;59(4):489–93.
Ojetti V, Gigante G, Gabrielli M, Ainora ME, Mannocci A, Lauritano EC, et al. The effect of oral supplementation with Lactobacillus reuteri or tilactase in lactose intolerant patients: randomized trial. Eur Rev Med Pharmacol Sci. 2010 Mar;14(3):163–70.
Almeida CC, Lorena SL, Pavan CR, Akasaka HM, Mesquita MA. Beneficial effects of long-term consumption of a probiotic combination of Lactobacillus casei Shirota and Bifidobacterium breve Yakult may persist after suspension of therapy in lactose-intolerant patients. Nutr Clin Pract. 2012 Apr;27(2):247–51.
Shaukat A, Levitt MD, Taylor BC, MacDonald R, Shamliyan TA, Kane RL, et al. Systematic review: effective management strategies for lactose intolerance. Ann Intern Med. 2010 Jun;152(12):797–803.
Azcarate-Peril MA, Ritter AJ, Savaiano D, Monteagudo-Mera A, Anderson C, Magness ST, et al. Impact of short-chain galactooligosaccharides on the gut microbiome of lactose-intolerant individuals. Proc Natl Acad Sci USA. 2017 Jan;114(3):E367–75.
Rossen LM, Simon AE, Herrick KA. Types of Infant Formulas Consumed in the United States. Clin Pediatr (Phila). 2016 Mar;55(3):278–85.
Sherman AL, Anderson J, Rudolph CD, Walker LS. Lactose-Free Milk or Soy-Based Formulas Do Not Improve Caregivers’ Distress or Perceptions of Difficult Infant Behavior. J Pediatr Gastroenterol Nutr. 2015 Jul;61(1):119–24.
Uy N, Graf L, Lemley KV, Kaskel F. Effects of gluten-free, dairy-free diet on childhood nephrotic syndrome and gut microbiota. Pediatr Res. 2015 Jan;77(1-2):252–5.
Slupsky CM, He X, Hernell O, Andersson Y, Rudolph C, Lönnerdal B, et al. Postprandial metabolic response of breast-fed infants and infants fed lactose-free vs regular infant formula: A randomized controlled trial. Sci Rep. 2017 Jun;7(1):3640.
Agostoni C, Berni Canani R, Fairweather-Tait S, Heinonen M, Korhonen H, La Vieille S, et al. Scientific opinion on dietary reference values for calcium. EFSA J. 2015;13(5):4101.
Roberto Berni Canani, MD, PhD
Department of Translational Medical Science
European Laboratory for the Investigation of Food Induced Diseases
ImmunoNutritionLab at CEINGE-Advanced Biotechnologies
University of Naples “Federico II,” Via S. Pansini 5, IT–80131 Naples (Italy)
E-Mail [email protected]
Article / Publication Details
Published online: February 19, 2019
Issue release date: February 2019
Number of Print Pages: 8
Number of Figures: 3
Number of Tables: 3
ISSN: 0250-6807 (Print)
eISSN: 1421-9697 (Online)
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90,000 what is it and what are the reasons?
This is the first article in a series on lactose intolerance. In it we will tell you what it is, what this problem is associated with and what types it can be divided into.
If you have experienced intestinal discomfort after dairy products or have heard that milk is bad for adults – this series of articles is for you. In three articles, we will talk about what lactose intolerance is, what types it is divided into, we will analyze the most common misconceptions, and also clarify how to live with it.
What is lactose intolerance
This is a condition in which milk and dairy products are difficult for the body to digest. Lactose (milk sugar) intolerance can cause diarrhea, pain, cramping and bloating, flatulence and vomiting. Symptoms appear within hours of eating or drinking lactose-rich foods such as milk, yogurt, or cheese.
Usually in humans, the body produces lactase in the small intestine, an enzyme that breaks down lactose into other sugars (glucose and galactose).If there is not enough lactase, lactose moves to the large intestine, where bacteria begin to process it. But here, not sugars, but fatty acids, carbon dioxide, hydrogen and methane appear from lactose. This is what causes all the symptoms.
Genes are a common cause of lactose intolerance
Lactose intolerance comes in many forms. The most common in the world is primary lactose intolerance. In this case, in childhood, the body produces a sufficient amount of lactase, but with age it loses this ability due to a gradual decrease in the activity (expression) of the LCT gene.
Moreover, more often the population of Africa and Asia is faced with primary lactose intolerance, but Europeans in adulthood have such a problem less often. This is attributed to a special mutation that appeared in the ancestors who first domesticated cows (and other milk-producing animals) and constantly consumed dairy products.
There is also congenital lactose intolerance. The body of such people does not produce lactase from birth. It is a rare disease that is inherited in an autosomal recessive manner.
What else leads to lactose intolerance
Another type is secondary lactose intolerance or lactase deficiency, which occurs due to problems in the intestines. It can happen at any age after an injury, surgery, or medication, such as chemotherapy or long courses of antibiotics.
It can also happen with diseases like gastroenteritis, Crohn’s disease, ulcerative colitis and celiac disease. Treating the underlying condition over time can restore lactase levels and improve symptoms of lactose intolerance.
They also isolate lactose intolerance associated with preterm labor. Some babies born before the 37th week of pregnancy have temporary lactose intolerance. This is due to the fact that their small intestine has not fully developed by the time of birth, but as the child grows up, this condition usually improves or goes away.
- Lactose intolerance is a condition in which milk and dairy products are difficult for the body to digest due to a lack of the enzyme lactase.
- The most common in the world is primary lactose intolerance, with it, with age, the activity of the LCT gene, which is responsible for the production of the enzyme, decreases.
- Secondary lactose intolerance is caused by illness or injury in the intestines.
- Still intolerance is congenital, and sometimes develops due to premature birth.
- You can use the Atlas Genetic Test to find out about your metabolic characteristics and check if you have any breakdowns in genes associated with lactose.
In the following articles, we will talk about what misconceptions exist about lactose intolerance, for example, why it has nothing to do with allergies, and how you can live with this condition.
- Mayo Foundation for Medical Education and Research, Lactose intolerance, 2021
- National Health Service, Lactose intolerance, 2021
- MedlinePlus, Lactose intolerance, 2021
- UpToDate, Lactose intolerance: Clinical manifestations, diagnosis, and management, 2021
- UpToDate, Patient education: Lactose intolerance (The Basics), 2021
Lactose intolerance – symptoms, treatment, prevention, causes, first signs
Lactose is one of the complex sugars found in milk and all dairy products.During the digestive process, lactose is broken down by lactase (an enzyme secreted in the small intestine) into simple sugars (monosaccharides glucose and galactose), which are absorbed into the bloodstream. “ Intolerance ” means an inability to digest lactose, often associated with deficiency of the enzyme lactase . About 30 minutes after consuming milk or dairy products such as ice cream or cottage cheese and homemade cheese, people with lactose intolerance may have diarrhea (diarrhea) or cramping pains (stomach cramps) and bloating (increased gas in the intestines). the severity of which depends on the level of enzyme deficiency.However, a person with mild enzyme deficiencies may not experience any symptoms at all.
It is widely believed that lactose intolerance is a milk allergy. In fact, this is not the case, and the difference between the two is very great. People with lactose intolerance do not need to remove milk and dairy products from their diet, but they do need to control the amount of dairy products. But people suffering from milk allergies should not consume even the smallest amount of milk.Symptoms of milk allergy include shortness of breath, tightness in the throat, nasal discharge, puffy eyes and eyelids, skin rashes, and vomiting. Lactose intolerance manifests itself differently.
Causes of lactose intolerance
Congenital deficiency of the enzyme lactase , prevalent mainly among people of Asian race.
Natural decrease in lactase levels, which begins in childhood (after 3 years).How significant this decrease will be depends on the characteristics of the organism of a particular person. However, it is safe to say that the older a person is, the more likely they are to suffer from lactose intolerance .
Any disease that affects lactase-producing cells in the small intestine, such as inflammatory diseases and even influenza. This condition causes “ Secondary Lactase Deficiency”. This is a temporary problem that disappears as soon as the disease passes, the damaged cells regenerate and begin to produce enzymes again.
Surgery on the stomach and intestines, which can completely destroy the body’s ability to produce lactase.
Symptoms of lactose intolerance
- diarrhea, loose stools;
- increased gassing;
- abdominal cramps.
What you can do
Find out your degree of lactose intolerance . In addition to monitoring your body’s response to milk and dairy products, there are two accurate ways to test for lactose intolerance:
- oral tolerance test;
- hydrogen breath test (includes measuring the level of hydrogen in exhaled air, which depends on the amount of undigested lactose).
Try lactose-reduced or lactose-free foods. You should not completely deprive yourself of lactose-containing dairy products. not only does this drastically reduce the amount of calcium in your diet, but it also reduces your body’s ability to absorb calcium from non-dairy foods (as lactose helps the intestines absorb and retain calcium).
Please note that skim milk is not safer because it is less fat.The problem of intolerance is not associated with fat content, but with lactose. Buttermilk and acidophilus milk also contain lactose, so you should also be careful with them.
Try yogurt. Many people suffering from lactose intolerance can normally digest the lactose in yogurt. At the same time, yogurt is an excellent source of calcium. Use trial and error to determine which type of yogurt you tolerate best. Avoid pasteurized yoghurts asbecause the benefits from them are much less, and the harm from lactose remains.
Drink chocolate milk. Calcium from such milk is perfectly absorbed, and the chocolate taste makes it more pleasant. What’s more, cocoa can even stimulate lactase activity.
Certain cheeses, especially cheddar, parmesan, Swiss cheese and mozzarella, are excellent sources of calcium. Moreover, they are not dangerous from the point of view of lactose, because The whey, which contains the most lactose, is separated during the cheese making process.But cottage cheese, cottage cheese and ricotta are rich in lactose, so they should not be overused.
Drink milk with food or cereals. Taking lactose with food makes it easier to digest and has fewer consequences.
Drink milk in small portions (half a cup) several times a day with meals. This will replenish the required dose of calcium and will not cause any particular problems.
Be attentive and watch what you eat. Lactose can be found in breads, frozen vegetables, canned soups, salad dressings and sauces, spaghetti, and more.in breakfast cereals, cakes, candy, and even pharmaceuticals.
Watch closely for signs lactose intolerance . If you have such a problem, it is very likely that your children will also have it. In infants, congenital lactose intolerance can be life threatening. As soon as a baby with lactose intolerance is fed with breast milk or formula containing milk, he develops colic, gas, diarrhea, and stops gaining weight.A special lactose-free formulation is available today. Talk to a pediatrician who can provide artificial nutrition and a balanced diet for your child that will replenish the necessary amount of calcium in his diet.
What a doctor can do
Prescribe enzymes as tablets or drops. For other conditions, prescribe lactose-free drugs.
Prescribe treatment for severe secondary lactase deficiency .
A nutritionist can work out a balanced diet for you.
A pediatrician will help you choose the right food for your baby and give you the necessary recommendations for feeding your baby.
Preventive measures for lactose intolerance
Be careful not to get sick with diseases of the digestive system. In addition, there are almost no ways to prevent a genetically programmed disorder such as lactose intolerance.
However, some simple precautions can help people with mild lactase intolerance to avoid unpleasant symptoms without completely depriving themselves of milk and dairy products.
If you are lactose intolerant, do not deprive yourself of all dairy products. Try to eat calcium-rich foods, such as milk, but in small doses (less than a cup) and drink it with meals. Usually cheese and yoghurt in small quantities are quite easily tolerated by people with lactose intolerance.
Alternatively, try lactose-free milk, cheese and cottage cheese or other sources of calcium such as soy milk, almonds, broccoli and other green vegetables, fish, etc.
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Outlook – Newborn Screening – Future Health Biobank Russia
Bitter taste in the mouth
Deafness due to taking medication
The newborn screening test is an easy, affordable way to find out if your baby is at an increased or high risk of developing any of the conditions listed above and to prepare you for possible medical and / or dietary needs in the future.
How do I make an Outlook test?
OUTLOOK newborn screening test is available in two different formats; as a saliva collection kit or as part of a cord blood collection and storage package.
Choose your service package
Cord blood samples will be collected after birth and sent to our laboratory
We will test Outlook on a small amount of cord blood and send you
Order an Outlook on the web test or use our
customer service team
Collect saliva samples at home
Return the sample container to us for test results
More about OUTLOOK
Learn more about how the Outlook test works if you ordered it as a separate service.As a reminder, you can also add an Outlook test to your cord blood storage bag!
Diseases that can be detected by the test
This is a common problem that can develop at any age, including the indigestion of lactose from animal milk and dairy products. People with lactose intolerance are unable to break down two sugars – glucose and galactose, due to a decrease in the production of the enzyme – lactase.This leads to an overgrowth of bacteria in the digestive system.
Also known as gluten intolerance, celiac disease is common and can develop and be diagnosed at any age. It occurs when the small intestine becomes hypersensitive to gluten, causing inflammation and an inability to digest important nutrients. This leads to digestive problems and a host of other symptoms.Trigger foods include wheat, barley, and rye, as well as pasta, cakes, cereals, bread, and some sauces.
Bitter taste in the mouth
Bitter taste in the mouth is caused by sensitivity to compounds called glucosinolates, which are found in foods such as cabbage, broccoli and other cruciferous vegetables. People who have this genetic trait and are more sensitive to bitter foods are called “tasters”, and people who do not have this sensitivity and are less able to detect bitterness are called “non-tasters”.
Deafness caused by taking medications
A certain type of antibiotic called aminoglycosides is known to damage the inner ear. Some children have a mitochondrial mutation that can lead to complete hearing loss even after a single dose of these drugs. Screening for a genetic predisposition to these four conditions is important because even if such symptoms develop, the disease will be diagnosed and compensated for more quickly.
90,000 Signs of lactose intolerance in newborns
Home »Blog» Signs of lactose intolerance in newborns
Symptoms and main signs of lactose intolerance in infants
Lactose intolerance is one of those cases where breast milk or formula causes health problems in infants.
Features of lactose
Lactose is one of the main components of breast milk.In addition, artificial formula for children also contains it as a main component. She herself is a combination of glucose and galactose.
The role of these substances in the development of the baby is enormous. After all, it is glucose that is the source of energy that is so necessary for every cell for almost any vital chemical reaction. Galactose is directly involved in the formation of a healthy nervous system.
The importance of lactase
Specially for the breakdown of lactose by intestinal cells, the enzyme lactase is produced.With a low amount of the produced enzyme, lactose is not properly broken down, so it cannot be absorbed and remains in the intestine.
So the lactose of milk or artificial infant formula for nutrition from necessary for a growing organism turns into harmful to it. All its valuable components begin to use opportunistic microorganisms for their nutrition. They multiply, causing symptoms of dysbiosis. Their vital activity leads to an increase in gas production in the intestines.
Intolerance and allergic reaction
Thus, with a lack of lactase or an excess of lactose, the diagnosis is made: lactose intolerance. Some say it is lactose allergy. However, this definition is incorrect. With lactase deficiency, only lactose intolerance occurs, as a pathology of the digestive system due to its inability to process and assimilate this substance.
Allergy is a perverse reaction of the immune system to the consumption of certain foods.Allergy is manifested by a rash, swelling, and in severe cases, respiratory failure. Allergies may also have symptoms of gastrointestinal disorders, but they will not be the main ones. The rash will come first. However, allergies can trigger lactose intolerance. For example, an allergy to whole milk can trigger this mechanism.
Varieties of pathology
Lactase deficiency can be of three types:
- Primary. It is diagnosed if the intestinal cells do not synthesize lactase at all or produce little of it.This lactose intolerance is more common in premature babies due to the immaturity of their digestive tract. The condition returns to normal in the 3-4th month of life. When the intestines mature, the synthesis of lactase is normalized, the symptoms of pathology disappear. The so-called “adult” type of functioning of the digestive system is also possible. At the same time, after birth, the level of lactase is sufficient, meets the needs of children. But by the end of one year of age or a little earlier, its amount decreases, and signs of lactase deficiency appear.The tendency towards a decrease in the enzyme continues in the future.
- Secondary lactose intolerance. This type of insufficiency is the result of various diseases and infections of the gastrointestinal tract in children, which lead to damage to the intestinal wall.
- Relative lactose intolerance, which manifests itself in the presence of too much milk sugar. At the same time, the intestinal cells function well, and there should be enough lactase to process the normal amount of lactose. However, excess milk sugar is retained in the intestines and causes symptoms similar to those of enzymatic lactase deficiency.Such lactose deficiency can be the result of feeding children primarily with the first breast milk, which contains a lot of lactose.
Manifestations of lactase deficiency
For children in the first year of life, lactose intolerance is a big problem, given that milk or artificial milk formulas are at first their only food, and then – the main food. This pathology leads to disruptions not only in the digestive tract, but throughout the body. So, an excessive amount of lactose and its constant presence in the intestine leads to the fact that its walls are damaged.Then the absorption of any nutrients is disturbed. This leads to malnutrition and a delay in the physical development of the baby.
Symptoms of lactase deficiency can be easily missed in infants during their first days of life. But already in the first weeks, it manifests itself, and the characteristic symptoms become obvious.
- Increased gas production causes abdominal pain. The child is naughty, crying, eats badly.
- The baby’s tummy is slightly swollen, tense.
- The stool becomes liquid and foamy. Its smell is sour. Either it becomes green, there is an admixture of mucus.
- The number of bowel movements is increasing. However, for babies who are bottle-fed, constipation is more common.
- The child often spits up after eating.
- As a result of the fact that most of the substances are not absorbed, the necessary weight gain is not observed in infants.
- However, these children tend to have good appetite.But, as soon as they start to eat (mother’s milk or mixtures), after a couple of minutes they stop, get naughty, twist their legs, categorically refuse to eat, bend over.
In the CIS countries, lactose intolerance is usually diagnosed based on clinical symptoms, analysis for carbohydrates and coprograms.
Analysis for carbohydrates of feces. This method is the simplest. Unfortunately, its information content is also relative. It does not show exactly which carbohydrates are in the stool in greater quantities.In addition, the units of their norm in feces are also not precisely defined.
Coprogram. It determines the acidity level of the stool and the volume of fatty acids. Their high content suggests lactose intolerance (deficiency).
Biopsy. The method of intestinal biopsy and histological examination is considered reliable. This method was not widely used due to its traumatic nature, as well as the fact that anesthesia is required for sampling.
Hydrogen test and lactose curve formation.With these methods, the patient is injected with lactose through the mouth. Then, at regular intervals, the blood or exhaled air is examined for the level of lactose. The curve is analyzed.
These methods have not become widespread either, since the administration of lactose causes negative sensations in sick children. The study of hydrogen is also only relatively informative, since today there are no exact data on its proper level in the blood of newborn babies.
If the tests give reason to believe the presence of pathology, and clinical signs do not appear, treatment is not carried out.
Basics of treatment
- For treatment, it is necessary to organize feeding the baby so that he receives all the milk, and not only the first (you need to express the first milk, give one breast at one meal).
- It is also necessary to exclude whole milk from the diet. It is the allergy to it that contributes to the formation of lactose intolerance.
- The mother’s diet also excludes foods that are most often allergic to (chocolate, oranges, honey …).
- In the absence of improvement in response to the adoption of such measures, the use of medications is necessary (taking lactase by mouth with food).
- Treatment of pathologies that could provoke insufficiency is necessary, including any allergy should be stopped.
The transition to lactose-free mixtures is carried out in the absence of effect from the use of the above measures. Lactose-free formulas are made by almost all manufacturers of formulas for baby food.
Sometimes they switch to lactose-free mixtures for a while.
Lactose intolerance is common today. Fortunately, the primary form is rarely found. Therefore, it is usually possible to eliminate the signs of lactose intolerance, as a rule, without switching to lactose-free mixtures, observing the correct nutritional conditions.
Lactose intolerance in a baby – how to determine and how to treat it
Your baby often spits up, after feeding often there are bouts of vomiting, have you noticed that he quickly spits out his breast? Most likely, your child has lactose intolerance, this problem is not as common as it is said, but it gives mothers a lot of trouble.How is an allergy to milk sugar manifested, what to do, whether this disease is curable – we will talk about all this with you today.
We understand the terms: what is lactose and lactase
Lactose is milk sugar, in breast milk it contains more than 80%, in the intestine it breaks down into galactose and glucose. This substance is important for a growing body – it provides the baby with energy, improves the absorption of microelements, and helps to form the intestinal microflora. Lactose is essential for strong immunity and normal functioning of the nervous system.
Lactase is an enzyme that promotes the breakdown of milk sugar in the intestine into galactose and glucose, it is because of lactase deficiency that milk is not absorbed in the child’s body.
Alactasia – complete absence of the lactase enzyme in the body, hypolactasia – deficiency of an enzyme for the breakdown of milk sugar.
Many mothers confuse lactose intolerance and lactase deficiency. The disease is one and the terms are similar, but mean different.
- Lactose sugar enters the body with dairy and other products, with medicines.There can be no lack of it.
- And the amount of breaking lactase can be produced by the body in a miniscule amount. And then – yes – its lack is very noticeable. Unbroken lactose causes negative side effects.
Why lactose intolerance occurs
Milk sugar allergy can occur in breastfed or artificially fed babies, since most quality formulas are almost similar in composition to breast milk.
Why milk sugar is not digested
- Genetic factor – lactase deficiency is inherited, this form of pathology is called primary lactase deficiency;
- enterocolitis, other types of diseases of the digestive system;
- some infectious diseases;
- allergy due to parasite infestation;
- Lactose intolerance often occurs in premature or very weak babies.
Dr. Komarovsky believes that the prevalence of lactose intolerance is greatly exaggerated, most often milk is not absorbed due to the banal overfeeding of the child.But in order to accurately determine the cause of the unpleasant symptoms, it is necessary to visit a pediatric gastroenterologist and undergo a comprehensive examination.
How lactose intolerance manifests itself in newborns
The primary form of lactase deficiency manifests itself already in the first day of a child’s life, an attentive mother will not be difficult to notice signs of pathology. But you should not make a diagnosis yourself – the symptoms of an allergy to milk sugar in many ways resemble dysbiosis, intestinal, rotavirus infectious diseases.
Lactose intolerance in babies – symptoms
- The baby willingly picks up the breast, but quickly spits it out, at the same time begins to cry, becomes restless.
- During feeding or immediately after feeding, there are signs of abdominal pain, colic – the baby cries, knocks his legs, pushes, his stomach swells, you can hear a loud rumbling.
- Profuse regurgitation, which often turns into an attack of vomiting.
- Diarrhea is constantly alternating with constipation.
- With an upset stomach, feces have a greenish tint and an unpleasant sour odor, the feces foam, has a heterogeneous consistency, while defecation occurs more than 10 times a day.
- Atopic dermatitis.
- The child is poorly or does not gain weight at all, begins to lose weight.
It is impossible to ignore the dangerous symptoms of the disease, it does not always go away on its own, in advanced cases, consequences dangerous for the child develop.
To confirm or deny the presence of an allergy to milk sugar, you need to visit a specialist, the doctor examines the behavior of the baby during the examination, studies the order and nature of feedings, and measures weight.
- coprogram – in healthy children, the amount of carbohydrates in the feces is not more than 0.25%, with lactose intolerance, the pH level rises to 5.5 units;
- Genetic analysis is done for children whose parents suffer from lactase deficiency;
- blood test for worms;
- Ultrasound of the abdominal organs;
- In some cases, an examination of the small intestine is prescribed, which will establish the degree of lactase activity.
Until the test results are obtained, doctors recommend limiting or completely eliminating dairy products from the child’s diet, babies are transferred to a lactose-free formula.
What to do
With secondary lactase deficiency, treatment is aimed at eliminating the underlying disease, which caused a decrease in the level of the enzyme in the intestine. With a hereditary form, the child will have to take medications and follow a diet all his life.
What to do if you are allergic to milk sugar:
- the doctor prescribes drugs that contain lactase – Lactrase, Maxilac, Lactase Enzyme, they must be given to the baby before each feeding;
- lactose-free diet;
- children from breastfeeding should be transferred to mixed – breastfeeding should be alternated with lactose-free formula feeding;
- When breastfeeding, the first milk should be expressed as it contains the maximum amount of lactose.
Lactose-free mixtures are designated by the letters BL or LF, contain whey proteins and albumin, but such products contain a small amount of lactose – 0.1 g / l. There is no lactose at all in blends that contain calcium caseinate.
The best mixtures are Bellakt, Nan, Nutrilak, Similak, but only a doctor can choose the optimal food for a child with lactose intolerance.
The nutrition of the mother is of great importance for the well-being of the baby with lactose intolerance.
| all vegetables, berries, green fruits in any form;
wheat, buckwheat, corn, oatmeal on the water;
dried apricot and prune compote;
natural marshmallow, jelly.
| all dairy and fermented milk products;
products that increase gas production – rye bread, grapes, legumes;
canned food, pickles, spicy, spicy dishes;
vegetables, berries, fruits of red and yellow color;
any sweets with dyes.
Remember that many medicines contain lactose as an additional ingredient – this substance improves the solubility of the main active ingredient. Therefore, if your baby is allergic to milk sugar, carefully read the composition of all drugs that you are going to take or give to your child.
Predictions and prevention
It is impossible to prevent the hereditary form of pathology, parents should be prepared for a child’s lactose intolerance, first consult with a specialist about all the difficulties and nuances of feeding.
Prevention of secondary lactase deficiency consists in strict observance of the rules of hygiene, careful boiling of the nipples, baby bottles, the mother needs to carefully approach the issue of the quality of the products, and avoid contact of sick people with the baby.
The prognosis for recovery depends on the form of pathology – hereditary primary lactase deficiency cannot be treated.
In case of a secondary form of the disease that arose against the background of past diseases, it is possible to fully or partially restore the production of lactase within 1-2 months.The transient form, which occurs in premature babies, will disappear on its own when the baby is six months old.
Why is sugar allergy dangerous?
Against the background of frequent vomiting, weight deficiency, rickets, dysbiosis can develop, children often have a lag in physical and mental development, muscle weakness, and convulsions.
With lactase deficiency, dehydration may occur, which is fraught with retraction of the fontanelle for infants, severe neurological disorders.
Now you know what to do if your baby is lactose intolerant. Tell us in the comments if you have ever encountered an allergy to milk sugar, how you were treated, how successful the therapy was.
And do not forget to share the article with your friends on social networks – different types of food allergies in children are being diagnosed more and more often.
Symptoms and signs of lactose intolerance in infants
Many parents have probably heard of such a pathology as lactose intolerance.
This ailment involves special nutrition for the baby.
But how to recognize it and determine that it is in her?
Correct diagnosis is the lot of physicians, but the parent should notice the first symptoms, as well as respond to them in a timely and competent manner. We will talk about the symptoms of lactose intolerance in infants in the article.
How does pylorospasm manifest in newborns? Find out about it from our article.
Description and characteristics
Lactose is considered the main carbohydrate found in milk and dairy products.
Consists of lactose from glucose and galactose.
When lactose is broken down, it releases a special enzyme called lactase.
And if this very lactase is not enough, then this will be the root cause of lactose intolerance.
This condition may be due to a genetic factor. Quite often, this disorder is diagnosed in babies born prematurely. Low birth weight newborns are also more susceptible to the disease.
But even older children may develop secondary lactose intolerance, which appears in connection with another disease.
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There are a number of clearly identified provoking factors that can lead to this diagnosis. As already mentioned, this is a genetic predisposition – the disease tends to be inherited.
Reasons for IP:
- ethnicity; 90,035 90,034 premature delivery;
- pathologies associated with the small intestine, where the breakdown of lactose and its synthesis takes place.
The causes of secondary lactose intolerance are intestinal infections, inflammation in the intestines, and allergy to cow protein, and celiac disease.
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How to recognize?
How is lactose intolerance manifested in infants?
In babies, the nature of the stool can signal the disease. It is distinguished by a pronounced sourish unpleasant odor and a watery state.
Also, the ailment is indicated by frequent and severe regurgitation, flatulence, diarrhea, whims during feeding, refusal to eat, be it breast milk or formula.
Older children lag behind in weight gain, grow poorly, have a decrease in muscle tone and even convulsive seizures.Flatulence and rumbling of the abdomen in older children can also speak of an illness. Sometimes the child has peri-umbilical pain.
Recommendations for the treatment of intestinal malabsorption syndrome in children can be found on our website.
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Symptoms and signs
How to understand if a newborn baby is lactose intolerant?
A complex of signs that appear from the gastrointestinal tract system will let the parent know that something is wrong. And if these signs are systemic, then it is most likely that the case is in lactose intolerance.
Symptoms of the disease:
- Baby’s stool – often, a lot, stool is watery with a sour odor, when tested for acidity, this indicator will be increased.
- Flatulence – increased bloating and gas formation leads to colic, which make the baby anxious, but this often speaks of other physiological processes in the body.
- Regurgitation – almost immediately after feeding, the baby regurgitates breast milk or formula, if regurgitation is infrequent and insignificant, this is the norm, but constant ones should be studied.
- The behavior of the child – he refuses to eat, almost immediately after feeding the baby begins to cry.
Remember that one way or another similar phenomena can occur in all healthy babies. But if the phenomena are constant, this should alarm the parents – show the baby to the pediatrician.
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Diagnostics and analyzes
It is possible to diagnose lactose intolerance on the basis of clinical manifestations.
But if the doctor has doubts, additional tests will be ordered.
Diet diagnostics is very often used – foods that contain lactose are excluded from the child’s diet.
Then they look at the clinical manifestations, do the analysis of feces. If the symptoms diminish, the pH is normal or higher, therefore, the baby is lactose intolerant.
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What is the danger of pathology?
If the pathology is primary, then it will remain forever. But the fact is that absolute lactose intolerance is very rare, children can still consume a certain amount of milk.
And the signs of this ailment will begin to appear if you have increased the norms of dairy products for the child.
Secondary intolerance has no consequences. Time will pass, and the baby’s body will begin to respond normally to milk again. It is believed that six months or a little longer is enough for the disease to go away completely.
What does the presence of Klebsiella in a baby mean in feces? Find out the answer right now.
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Methods of treatment
If the pathology is secondary, the doctor will focus on treating the underlying disease.
The child will be assigned a special diet. When remission occurs, the list of foods gradually expands. The clinical picture of the disease is constantly monitored, all the necessary tests are carried out.
If the intolerance is primary, children are prescribed a diet that requires constant adherence. But do not worry, this diet does not cause serious inconvenience.
Children who are already one year old are advised to replace milk with products with a low lactose content, or simply fermented milk products.
Dairy confectionery is also excluded.
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How to feed your baby?
A child who has reached the age of transition to a common table can eat yoghurts with live bacteria, as well as soy milk and cheese instead of dairy products. Since milk contains a lot of calcium, which is so important for a growing child’s body, it is necessary to replace the product with something alternative.
These can be:
- tuna (canned), salmon and sardines;
- collard greens, broccoli;
- soy products;
- walnut almonds.
At the insistence of the doctor, special medications can be prescribed for the child.
It can be “Laktaza-baby”, “Linex”, as well as “Hilak-forte”.
Pancreatin can be prescribed additionally as an enzyme that improves digestion.
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Special diet for a nursing mother
The amount of lactose in breast milk will not depend on the diet of a nursing mother. Therefore, the woman herself does not need to reduce foods with lactose in her diet.
And in order to prevent the occurrence of secondary lactose intolerance, the mother needs to limit the intake of products with a large amount of whole cow’s milk.
What does Komarovsky say?
The famous pediatrician Yevgeny Komarovsky notes that true lactose intolerance does not appear as often as it is detected.
And it is simply impossible to completely abandon products with lactose, the doctor assures, in the first months of a baby’s life. He notes that giving up breast milk is unacceptable, and it is definitely more harmful than consuming it.
The doctor also says that the consequences of improper feeding are often mistaken for the disease. For example, a child receives only so-called foremilk, which is less nutritious, but rich in carbohydrates and lactose.
But back milk contains all the components for saturation and digestion of front milk.
Therefore, proper feeding, which can be helped by a lactation specialist, can relieve symptoms that are similar to those of lactose intolerance.
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Subject to all medical recommendations, if you adhere to the prescribed diet therapy, any complications are excluded.
If you do not follow the prescriptions of doctors, then gastroenterological pathologies can develop, since an intolerable substance will affect the body.
You can learn about what is lactose intolerance in a child from the video:
We earnestly ask you not to self-medicate. Make an appointment with a doctor!
Lactase deficiency in infants: symptoms and diagnosis | Signs of lactase intolerance in newborns
Signs of lactase deficiency in infants should be known to parents, because this will promptly suspect this condition, identify its cause and improve the condition of the baby.
Signs of lactose intolerance
Signs of lactase deficiency in a child are manifold. This is a stool with a large watery spot and a sour odor, bloating, rumbling, abdominal pain (colic). One of the most common symptoms that worries parents is frequent loose stools in a baby. It is watery, foamy and has a sour smell. It should be remembered that the younger the child, the more frequent his bowel movements, and this is completely normal. So if the baby is developing well and is feeling well, and his feces are normal, do not think that these are signs of lactose intolerance in newborns.
Sometimes lactase deficiency in newborns is accompanied by poor weight gain and growth. This is due to the fact that the carbohydrates necessary for the child do not enter the body, and the baby may lack nutrients.
If the crumb rather quickly grew out of recently purchased sliders and slips, and its cheeks and arms are round and plump, you should not suspect the child has lactase deficiency.
Intestinal colic may be present in children with lactose intolerance.After eating, the child will have bloating, anxiety, and screaming. These signs usually appear in the 3rd to 6th weeks of a baby’s life. This is probably due to an increase in milk consumption by an older baby.
The mechanism of such manifestations of lactose intolerance as intestinal colic, bloating and rumbling is as follows. The carbohydrates not split due to the absence or lack of the lactase enzyme continue their movement through the intestines. In the colon, they are exposed to the intestinal microflora, resulting in an excess of gases (hydrogen, methane, carbon dioxide).The gases stretch the intestinal walls, causing bloating, pain, and increased bowel movements. Violation of the normal chemical composition of intestinal contents can lead to disturbances in the composition of the intestinal microflora.
When should you not think about lactase deficiency?
Quite often in recent years, children have been diagnosed with lactose intolerance if they have problems with digestion. However, this does not always correspond to reality. As mentioned above, the frequency of stool in infants is individual.Frequent or infrequent bowel movements are not in themselves a sign of lactase deficiency in a child. Symptoms for this pathology are multiple.
Occasionally, spitting up is mistaken by parents for signs of lactose intolerance. But even if regurgitation is frequent and profuse, it is unlikely that this is lactase deficiency – the symptoms in children with this pathology are associated with the work of the intestines, and not the esophagus or stomach.
How to determine lactase deficiency
Usually, the diagnosis of lactose intolerance begins with an organoleptic assessment of feces.This pathology is supported by unformed, watery, frothy yellow or green feces with a sour odor. In a chemical study, the reaction of feces is acidic (pH less than 5.5).
Another research method is to determine the content of carbohydrates in feces. Exceeding their value by 0.25% is characteristic of lactase deficiency. Despite its widespread use, this method is not the most accurate, since it does not allow determining which carbohydrates are present in the feces.
Whenever you suspect lactose intolerance, you should consult a specialist. He will prescribe tests that will tell you if the child has lactose intolerance, or if the symptoms are not related to this condition.
In difficult cases, other methods are used. For example, a specific breath test based on determining the concentration of hydrogen in exhaled air after loading with lactose. The advantage of this method is its simplicity, the disadvantage is the possibility of false positive results and the impossibility of determining the degree of lactase deficiency.
Lactose Curve – Another test for lactose intolerance. Normally, lactose is broken down by the enzyme lactase into simpler sugars, in particular glucose. Subsequently, glucose is absorbed through the intestinal wall and enters the bloodstream. Accordingly, the determination of the level of glucose in the blood on an empty stomach and after taking lactose makes it possible to judge the breakdown of the latter under the influence of the enzyme lactase. If the rise in blood glucose after loading with lactose is less than 20%, you should think about the lack of this enzyme.
Intestinal biopsy and genetic testing are reliable but rarely used methods for detecting lactose intolerance.
A biopsy is a study of cells in the mucous membrane of the small intestine. The collection of intestinal tissue is carried out during endoscopic examination. In the obtained tissues, the activity of intestinal digestion and absorption is determined using enzymes. This test for lactase deficiency is the reference.