Lactose intolerance – Illnesses & conditions

There’s no cure for lactose intolerance, but most people are able to control their symptoms by making changes to their diet.

Some cases of lactose intolerance, such as those caused by gastroenteritis, are only temporary and will improve within a few days or weeks. Other cases, such as those caused by an inherited genetic fault or a long-term underlying condition, are likely to be lifelong.

Changing your diet

In most cases, cutting down on or avoiding sources of lactose and replacing them with lactose-free alternatives is enough to control the symptoms of lactose intolerance.

The exact changes you need to make to your diet depend on how sensitive you are to lactose. Some people are able to tolerate some lactose in their diet without any problems, whereas others experience symptoms after consuming food containing only a tiny amount of lactose.

If you decide to experiment with what you can and can’t eat, make sure to introduce new foods gradually, rather than all at once. This will help you to get used to any foods you might be sensitive to and identify any that cause problems.

Eating fewer products containing lactose, or avoiding them completely, can mean you miss out on certain vitamins and minerals in your diet and increase your risk of complications. You’ll also need to make sure you’re getting enough nutrition from either lacto-free foods or dietary supplements.

If you or your child are extremely sensitive to lactose, talk to your GP about your diet.

Milk products are rich in calcium needed for healthy bones so you may need to have regular bone density checks.

You may be referred to a dietitian (an expert in diet and nutrition) who can advise about what foods should be included in your, or your child’s, diet.

Sources of lactose

Some of the main sources of lactose you may need to cut down on or avoid if you’re lactose intolerant are described below.

Milk

A major source of lactose is milk, including cow’s milk, goat’s milk and sheep’s milk. Depending on how mild or severe your lactose intolerance is, you may need to change the amount of milk in your diet.

For example:

• you may be able to have milk in your tea or coffee, but not on your cereal
• some products containing milk, such as milk chocolate, may still be acceptable in small quantities
• you may find that drinking milk as part of a meal, rather than on its own, improves how the lactose is absorbed

If even a small amount of milk triggers your symptoms, there are some alternatives you can try, such as soya or rice milk (see below).

Dairy products

Other dairy products made from milk, such as butter, ice cream and cheese, can also contain high levels of lactose and may need to be avoided if you’re lactose intolerant.

Some dairy products however, such as hard cheese and yoghurt, contain lower levels of lactose than milk and other products, so you may still be able to have them.

It’s worth experimenting with different foods to find out if there are any dairy products you can eat because they’re a good source of essential nutrients such as calcium.

Other foods and drinks

As well as milk and dairy products, there are other foods and drinks that can sometimes contain lactose.

These include:

• salad cream, salad dressing and mayonnaise
• biscuits
• chocolate
• boiled sweets
• cakes
• some types of bread and other baked goods
• some breakfast cereals
• packets of mixes to make pancakes and biscuits
• packets of instant potatoes and instant soup
• some processed meats, such as sliced ham

Check the ingredients of all food and drink products carefully, because milk or lactose are often hidden ingredients.

The lactose found in some foods won’t necessarily be listed separately on the food label, so you need to check the ingredients list for milk, whey, curds and milk products such as cheese, butter and cream.

Some ingredients may sound like they contain lactose when they don’t, such as lactic acid, sodium lactate and cocoa butter. These ingredients don’t need to be avoided if you’re lactose intolerant.

Medication

Some prescription medicines, over-the-counter medicines and complementary medicines may contain a small amount of lactose. While this isn’t usually enough to trigger the symptoms of lactose intolerance in most people, it may cause problems if your intolerance is severe or you’re taking several different medicines.

If you need to start taking a new medication, check with your GP or pharmacist in case it contains lactose.

Lactose-free foods and drinks

There are a number of alternative foods and drinks available in supermarkets to replace the milk and dairy products you need to avoid.

Food and drinks that don’t usually contain lactose include:

• soya milks, yoghurts and some cheeses
• milks made from rice, oats, almonds, hazelnuts, coconut, quinoa, and potato
• foods which carry the ‘dairy-free’ or ‘suitable for vegans’ signs
• carob bars

You can also buy cow’s milk containing additional lactase (the enzyme used to digest lactose). This means you still get the nutritional benefits of the milk, but you’re less likely to experience any symptoms after consuming it.

Getting enough calcium

If you’re unable to eat most dairy products, you may not be getting enough calcium in your daily diet. Calcium has several important functions, including:

• helping build strong bones and teeth
• regulating muscle contractions (including heartbeat)
• ensuring blood clots normally

Therefore, it’s a good idea to choose lactose-free products with added calcium and ensure your diet contains alternative sources of calcium, such as:

• green leafy vegetables, such as spinach, kale, broccoli, cabbage and okra
• soya beans
• tofu
• nuts
• bread and anything made with fortified flour
• fish containing edible bones (for example, sardines, salmon, and pilchards)

You can also buy combined calcium and vitamin D supplements from most pharmacists to help maintain good bone health.

It’s important to check with your GP or dietitian whether you should be taking supplements, however, as taking excessively high levels of calcium can cause side effects.

Lactase substitutes

In addition to dietary changes, you may also find it useful to take liquid drops, tablets or capsules that contain lactase substitutes. These are available from most health foods shops.

Lactase substitutes replace the lactase your small intestine isn’t producing, which can reduce your symptoms by helping your body break down any lactose in your diet more easily.

Lactase substitutes can either be added to milk or taken just before eating a meal containing lactose.

Lactose intolerance in children

If your child is lactose intolerant, they may be able to consume small amounts of lactose without experiencing symptoms. This is quite safe, but you may need to experiment to find out how much they can comfortably eat or drink.

If your child is unable to tolerate any lactose, your doctor may refer you to a dietitian for nutritional advice because it’s important for young children to have certain nutrients in their diet to ensure healthy growth and development.

In general, the same rules about foods to try or to avoid are similar for children and adults (see above).

For babies with lactose intolerance, lactose-free formula milk is available to buy from pharmacies and supermarkets. However, soya formula isn’t recommended for children under six months because it contains hormones that may interfere with your baby’s future physical and sexual development.

Breastfed babies may benefit from lactase substitute drops to help their bodies digest the lactose in breast milk.

For many children, lactose intolerance is only temporary and will improve after a few weeks. After this point it’s safe to gradually reintroduce milk and dairy products into their diet.

5 symptoms that you might be lactose intolerance & need to look into it ASAP

For the uninitiated, lactose is a type of sugar found naturally in the milk of mammals and also happens to be the main source of calories in milk. Ideally, this complex sugar is supposed to be broken down into a pair of simpler sugars—namely, glucose and galactose—for easy absorption into the bloodstream through the small intestine.

In the case of lactose intolerance though, this ideal scenario doesn’t quite exist and thus, the milk which is otherwise a great source of calcium, several vitamins, and fats, might not go down too well with the body, doing you more harm than good and well, placing you in the category of lactose-intolerant people. 

What exactly does it mean?
The U.S. National Library of Medicine defines it as “an impaired ability to digest lactose, a sugar found in milk and other dairy products.” You may be able to digest lactose partially or not at all—depending on your lactase production. 

Basically, when you’re an infant, you need more of the lactase enzyme to digest mom’s breast milk. With age, your lactase production tends to decrease, making it exceptionally difficult for you to digest lactose. As per a study published in the journal Nutrients, we undergo “a genetically programmed decrease in lactase synthesis after weaning (primary lactase deficiency during infancy). ” This is what is known as primary lactose intolerance.

Milk is definitely not your cuppa. Image courtesy: Shutterstock

In case you’re lucky enough to still have enough lactase in your body while you’re all grown up, don’t celebrate just yet. There’s a rare but fair chance of all of us developing secondary lactose intolerance due to a temporary decrease in lactase production because of inflammation in the gut wall post an illness such as a stomach bug or a celiac disease. 

Why take it seriously?
The result of any type of lactose intolerance is sheer discomfort in the stomach after the consumption of milk or dairy products. But, that’s not it.

The study quoted above warns that the unabsorbed lactose that stays in the intestinal tract can lead to gastrointestinal infection, bowel bacterial overgrowth, inflammatory bowel disease, and other health issues.

Now, according to a study published in the British Medical Journal, almost all Asians and Native Americans are likely to be lactose intolerant. Sadly, this also means that there’s a high probability of us not being aware of whether we are lactose intolerant. 

So, here’s how you can find out
These 5 common symptoms of lactose intolerance can help you identify whether you’re suffering from it:

(P.S. If you happen to find the mentioned symptoms relatable, you must see your doctor for help and cut out milk from your diet while banking on other food sources to fulfil your nutritional requirements.)

Diarrhoea: A study published in the journal Mayo Clinic Proceedings defines diarrhoea as a condition wherein a person passes more than 200 grams of stool, usually high in liquid volume, within 24 hours. And you’re highly likely to face this problem—especially after the consumption of milk and other dairy products such as cottage cheese, butter, ghee, etc.

Ghee is not meant for everyone especially if you are lactose intolerant. Image courtesy: Shutterstock.

Research published in the Alimentary Pharmacology & Therapeutics points out the reason behind this rather uncomfortable symptom of lactose intolerance and explains that the leftover acids from the partially digested lactose along with the completely undigested lactose can increase the amount of water in your colon (a tube-like organ in the large intestines which is responsible for removing water from digested food and passing on the solid waste to the rectum for excretion). This is exactly why you get those loosies over and over again. 

Stomach pain: Thanks to the inability of your intestines to absorb lactose, it is likely to be fermented instead in the colon, or so says the same study quoted above. This, in turn, leads to the release of short-chain fatty acids and gases such as hydrogen, methane and carbon dioxide. As a result, you could experience stomach ache and cramps—especially around the navel area. 

Don’t underestimate the power of recurring stomach pain. Image courtesy: Shutterstock

Bloating: The increased water content in the colon along with these gases can stretch out the walls of your gut, leading to bloating. In some cases, this bloating can even lead to nausea and vomiting as per a study published in the Postgraduate Medical Journal.

Gas problem: The fermentation of undigested lactose into acids and gases can obviously lead to gas accumulation in your intestines—so much so, that you may feel uneasy despite the numerous burps and farts.  

Gross right? But, there’s nothing stopping your body from becoming habituated and efficient at fermenting undigested lactose over time. However, note that the gas due to lactose fermentation is odourless. So, if those burps and farts stink, they could be a result of the undigested protein in the gut—not lactose.

Constipation: A rare symptom of lactose intolerance, constipation is the exact opposite of diarrhoea, and involves passing harder, infrequent stools, lack of bowel movement, and excessive straining during defecation, according to a study published in the journal Clinics in Geriatric Medicine. 

If pooping is becoming problematic then you must go and see a doctor. Image courtesy: Shutterstock

Do you remember how we explained the fermentation of undigested lactose leads to the production of gases like hydrogen, methane and carbon dioxide? Well, in this case, methane acts as a villain and slows down the movement of food through your gut, making you constipated and uneasy.  

All said and done, don’t get confused about your condition
Many people may be allergic to cow’s milk and may take their food allergy for lactose intolerance. However, they’re different and the milk allergy can be characterized by skin rashes, asthma, and nausea. 

Another similar digestion problem that is likely to be confused with lactose intolerance is Crohn’s disease, which is a chronic inflammatory bowel disease (IBD) and has symptoms similar to that of lactose intolerance.

While clarifying with your doctor can be the safest bet to identify and thus, treat your condition, symptoms such as loss of appetite, blood in the stool, and fever are unique to Crohn’s disease and can help you distinguish between these strikingly similar health issues.

Lactose intolerance | Symptoms, complications, diagnosis and treatment

People with lactose intolerance are unable to fully digest the lactose in milk. As a result, they develop diarrhea, gas, and bloating after eating or consuming dairy products. The condition, also called lactose malabsorption, is usually harmless, but its symptoms can be uncomfortable. Most people with lactose intolerance can manage the condition without giving up all dairy products.

Lactase deficiency, an enzyme produced in the small intestine, is usually responsible for lactose intolerance. Many people have low lactase levels but can digest dairy products without problems. If you are actually lactose intolerant, lactase deficiency leads to symptoms after you eat dairy products.

Signs and symptoms of lactose intolerance usually begin 30 minutes to two hours after eating or drinking foods containing lactose. General signs and symptoms include:

• Diarrhea
• Nausea and sometimes vomiting
• Abdominal cramps
• Inflate
• Gases

Make an appointment with your doctor if you often experience symptoms of lactose intolerance after eating dairy products, especially if you are worried about getting enough calcium.

Reasons

Lactose intolerance occurs when the small intestine does not produce enough enzyme (lactase) to digest milk sugar (lactose).

Normally, lactase converts milk sugar into two simple sugars, glucose and galactose, which are absorbed into the bloodstream through the intestinal lining.

If you are lactase deficient, the lactose in food moves to the large intestine instead of being processed and absorbed. In the colon, normal bacteria interact with undigested lactose, causing the signs and symptoms of lactose intolerance.

There are three types of lactose intolerance. Various factors cause lactase deficiency underlying each type.

Primary lactose intolerance

This is the most common type of lactose intolerance. People with primary lactose intolerance begin their lives by producing large amounts of lactase, a must for babies who get all their nutrients from milk. As children replace milk with other foods, their lactase production usually decreases but remains high enough to digest the amount of dairy in a normal adult diet.

In primary lactose intolerance, lactase production drops dramatically, making it difficult for adults to digest dairy products. Primary lactose intolerance is genetically determined, which occurs in a significant proportion of people of African, Asian, or Hispanic ancestry. This condition is also common among Mediterranean or South European ancestry.

Secondary lactose intolerance

This form of lactose intolerance occurs when the small intestine reduces its production of lactase after illness, injury, or surgery involving the small intestine. Diseases associated with secondary lactose intolerance include celiac disease, bacterial overgrowth, and Crohn’s disease. Treating the underlying disorder can restore lactase levels and improve symptoms and signs, although this may take some time.

Congenital or developing lactose intolerance

This disorder is passed from generation to generation in a form of inheritance called autosomal recessive. Premature babies may also be lactose intolerant due to insufficient lactase levels.

Factors that may make you or your child more likely to become lactose intolerant, include:

• Growing up. Lactose intolerance usually appears in adulthood. This disease is rare in children and young children.
• Ethnos. Lactose intolerance is most common in African, Asian, Hispanic, and American Indian people.
• Premature birth. Babies born prematurely may have low lactase levels because the small intestine does not develop lactase-producing cells until late in the third trimester.
• Diseases affecting the small intestine. Small intestinal problems that can cause lactose intolerance include bacterial overgrowth, celiac disease, and Crohn’s disease.
• Some treatments for cancer. If you’ve had radiation therapy for abdominal cancer or intestinal complications from chemotherapy, you’re at increased risk of lactose intolerance.

Lactose intolerance: causes, symptoms, analysis

Do you suffer from cramps and bloating? Do you hear a rumbling in your stomach? Periodically worried about loose stools? If these signs appear some time after taking milk and milk-containing products, lactose intolerance (hypolactasia) can be assumed.

Why does this pathology occur and can it be avoided? Let’s figure it out.

Lactose (milk sugar) is a substance found in the milk of mammals and humans. The role of lactose in the body is great: it helps the absorption of certain minerals, including calcium, in the intestines, and also promotes the reproduction of lactobacilli necessary for the body.

Normally, in all babies, lactose is broken down in the small intestine by a special enzyme – lactase. With age, the amount of lactase in the body of some people decreases.

The diet of a modern person is difficult to imagine without dairy products, and the presence of this enzyme in the body is extremely important for the normal process of digestion.

The mechanism of development of hypolactasia

Lactose intolerance occurs when there is a complete absence or insufficient amount of lactase. The task of this enzyme is to participate in the conversion of lactose in the small intestine into glucose and galactose. These carbohydrates are able to pass through the intestinal wall into the bloodstream.

With a lack or absence of lactase, milk sugar in an unsplit form enters the large intestine, where it becomes “food” for the bacteria living here. The result of the processing of lactose by bacteria is carbon dioxide, methane, hydrogen and water. The gases formed in the lumen of the large intestine stretch its walls, causing bloating (flatulence) and pain in it, and water causes the development of diarrhea (loose stools).

Lactose intolerance is much less common in children than in adults. It is congenital and acquired. Alactasia, or the complete absence of the enzyme, is associated with a structural disorder of the lactase gene. In this case, the baby should receive lactose-free food from birth. Fortunately, this disease is quite rare. More often one can observe the functional immaturity of the enzyme system of infants, which causes insufficient milk tolerance; some time after birth, the amount of the enzyme increases and the breakdown of lactose improves.

Acute and chronic intestinal infections, immune, inflammatory, atrophic processes in the intestine can lead to secondary (acquired) intolerance to milk sugar.

Factors such as age, ethnicity increase the risk of developing this pathology (in the countries of North America, Africa, Southeast Asia, the percentage of those suffering from hypolactasia is higher), and premature birth.

How does lactose intolerance manifest itself?

Rumbling in the abdomen and its distension, diarrhea, nausea, vomiting, abdominal pain, headaches – these symptoms of lactose intolerance occur in some people an hour after taking whole milk or dairy products (cheese, cottage cheese, kefir, ice cream).

The higher the degree of hypolactasia, the more intense the clinical manifestations. However, it should be remembered that such a reaction of the body may also be due to the use of stale products with an expired shelf life or their incompatibility. In both cases, if you have the symptoms mentioned above, you should consult a doctor.

Diagnosis of lactose intolerance

A biopsy of the small intestine mucosa is a direct way to measure the activity of the lactase enzyme it contains. Due to the trauma and complexity of this study, it is used during operations or other vital interventions.

Genetic tests can identify genes that block lactase production.

One common indirect test for lactose intolerance, among others, is the lactose load test. It is based on a comparison of blood glucose levels in an adult before the study and after ingestion of 50 grams of lactose dissolved in 0.5 liters of water. If lactose is broken down and the resulting glucose is absorbed into the blood, the meter will show an increase in blood glucose.