Intermittent lactose intolerance: All about lactose intolerance | One Medical

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All about lactose intolerance | One Medical

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Oct 25, 2017

By Michelle Konstantinovsky

Dairy-free milk alternatives are flying off the shelves in record numbers, and for good reason: About 30 million adults develop some degree of lactose intolerance by age 20. While the condition isn’t dangerous, it can cause some discomfort.

What is lactose intolerance?

While the symptoms are similar, lactose intolerance isn’t the same as a dairy allergy. A dairy allergy is an immune response to milk protein, while lactose intolerance occurs when you have a deficiency in an enzyme called lactase. The small intestine produces lactase to break down milk sugar (lactose) into simple sugars which are then absorbed in the bloodstream. Insufficient lactase levels can cause symptoms of lactose intolerance.

What are the symptoms of lactose intolerance?

Signs and symptoms of lactose intolerance usually begin within 30 minutes to two hours after eating or drinking foods containing lactose (milk, yogurt, cheese, etc.). Symptoms include:

Nausea
Vomiting
Abdominal cramps
Bloating
Gas
Diarrhea

Symptoms are usually mild, but can sometimes be severe. Consistently experiencing symptoms after eating or drinking dairy products may be a sign that you are lactose intolerant. But if you experience occasional bouts of discomfort following dairy consumption, it doesn’t necessarily mean that you’re lactose intolerant.

What causes lactose intolerance?

When there is a low level of lactase in the small intestine, the lactose in food moves into the colon unprocessed and interacts with intestinal bacteria, leading to symptoms of lactose intolerance.

Lactase production can decline over time due to normal aging. The body typically produces large amounts of lactase at birth and during early childhood when milk is the main source of nutrition. But as our diets become more varied over time, lactase production usually decreases. Rarely, some people are born with an insufficient level of lactase. It’s also possible, but uncommon, to develop lactose intolerance as a result of illness or injury.

Is there a test for confirming lactose intolerance?

An elimination diet is the preferred method for confirming lactose intolerance. An elimination diet involves removing dairy from your diet for three weeks, and then reintroducing it for up to 72 hours. If you begin having symptoms within that three-day reintroduction period, you may be lactose intolerant.

There is also a hydrogen breath test that can confirm diagnosis. If your provider orders this test, you will be asked to drink a liquid containing high levels of lactose, while he or she measures hydrogen levels in your breath. If your body doesn’t process lactose normally, it will ferment in your colon and release higher-than-normal hydrogen levels, which may indicate lactose intolerance.

What can I do to ease symptoms and stay healthy?

While there is no cure for lactose intolerance, reducing or eliminating the amount of dairy products in your diet can cut down on symptoms. But because dairy is a major dietary source of calcium, if you choose to eliminate it altogether, consider adding other calcium-rich foods like broccoli, spinach, or canned salmon to your diet.

If you eliminate dairy, it’s also important to get adequate amounts of vitamin D from foods like eggs or liver. Sun exposure also triggers vitamin D production, but this this doesn’t occur in the presence of sunscreen. Many non-dairy alternative milks are fortified with calcium and vitamin D. Talk to your health care provider if you’d like suggestions regarding meal planning or calcium or vitamin D supplements.

Some people with lactose intolerance can actually tolerate low-fat milk products, and can gradually increase their tolerance to dairy by slowly introducing new foods. Additionally, hard cheeses like cheddar or Swiss contain smaller amounts of lactose, and may not cause symptoms in people with lactose intolerance. However, many processed foods– including cereals, instant soups, and salad dressings–contain milk and lactose, so if you’re experiencing symptoms of lactose intolerance, be sure to read nutrition labels carefully before purchasing these products.

Are there any over-the-counter remedies?

Some people with lactose intolerance are able to relieve symptoms by taking tablets or drops containing lactase, like Dairy Ease or Lactaid, just before meals and snacks, but these products aren’t guaranteed to be effective. Some studies suggest that specific strains of probiotics (organisms that reduce the amount of harmful bacteria in the digestive system) may also help alleviate symptoms, but further research is necessary.

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Is It IBS or Lactose Intolerance? Symptoms, Differences, and Treatments

Written by WebMD Editorial Contributors

What Are the Symptoms?
What Are the Differences?
What Is the Treatment?

Irritable bowel syndrome (IBS) and lactose intolerance can seem similar. The symptoms they cause are nearly identical. But there are distinct differences in why they happen and how you handle them.

If you have lactose intolerance, it’s because your body doesn’t digest one specific type of food: the sugar in milk. If you have IBS, on the other hand, many things can be behind your symptoms. You can have both conditions at the same time, but they are two separate problems.

IBS and lactose intolerance can both cause:

Bloating or swelling in your belly
Pain
Diarrhea
Gas

IBS can also cause constipation. You might have mucus in your stool or feel like you can’t completely empty your colon. Symptoms can change over time and flare up, get better, or disappear.

Along with the other symptoms, lactose intolerance can cause nausea. You usually start to feel bad between 30 minutes and 2 hours after you eat milk or other dairy products.

It’s not clear what causes IBS. Some doctors think it happens when the muscles around the colon don’t work properly to move waste along. A problem with the signals between the brain and the nerves in the gut may also play a role. It might also happen when someone is very sensitive to triggers like some foods or stress.

Although the cause is still a mystery, doctors do know some things that can raise your risk for IBS, including:

Your genes
Infections in your intestines
Long-term stress or emotional trauma

Lactose intolerance is better understood: The body can’t digest the sugar in milk, called lactose. It happens when your body doesn’t make enough of the enzyme lactase, which the gut uses to break down lactose. It’s not a harmful condition, but it can keep you from getting the right amount of important nutrients like calcium and vitamin D, which most people get from dairy products.

The problem can run in families. You’re also more likely to have it if you have another digestive disease, like:

Ulcerative colitis
Crohn’s disease
Celiac disease

Only a doctor can tell if your symptoms come from IBS or lactose intolerance. They usually diagnose IBS based on the symptoms you describe. For lactose intolerance, you’ll need to give a little more information, such as:

Your family history
A physical exam
A hydrogen breath test. Undigested lactose in your body gives off high levels of hydrogen. During the test, you drink a beverage that has lactose, then blow air into a special bag. A lab tests your breath to look for the gas.

IBS symptoms can come and go, but it’s a condition you’ll have for the rest of your life. There is no cure for it. But you can use a few different strategies to manage how you feel. Changes to your diet and tools to handle stress may help ease your symptoms. Medications like anti-diarrhea drugs or laxatives can make you feel better, too. It’s important to work with a doctor to find the approach that works for you.

There is also no cure for lactose intolerance, but it usually helps to avoid milk, cheese, and other dairy foods. Some people with the condition can handle small amounts of them, and others have to cut them out completely. Your doctor or dietitian can help you figure out the right diet and suggest supplements that may help. There are lactase enzyme replacements available which can be taken with food, but they have varying degrees of benefit.

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Lactase deficiency or lactose intolerance

Lactase deficiency is a congenital or acquired pathology of the small intestine, in which the lactase enzyme is absent or its activity is reduced.

Another name for the same condition is lactose intolerance.

This disease is accompanied by a syndrome of impaired absorption and digestion of lactose – the so-called milk sugar. All dairy products contain lactose. The concentration of this sugar in cow’s milk is approximately 5 g per 100 ml, and in breast milk – 7 g per 100 ml.

Depending on the severity of , two types of lactase deficiency are distinguished:

partial (hypolactasia)
complete (alactasia).

Depending on the origin, lactase deficiency can be:

primary (caused by congenital reduced lactase activity with a healthy enterocyte structure)
secondary (associated with a decrease in lactase activity when the enterocyte is damaged).

Primary lactase deficiency can be:

congenital (hereditary)
constitutional (adult type)
transient (occurs in preterm infants and children who are underdeveloped at the time of birth).

Secondary lactase deficiency may develop:

against the background of an inflammatory process in the small intestine with an infectious genesis (viral or bacterial inflammation)
for gastrointestinal food allergy (allergy to cow’s milk protein)
for atrophic anomalies.

Lactase deficiency in adults may be accompanied by the following conditions:

osmotic (foamy, liquid) diarrhea after consumption of dairy products
stomach pain
flatulence
weight loss (ed. co).

Lactose intolerance is characterized by a wide range of symptoms, and there was no dependence of symptoms on the degree of lactase activity in adult patients. At the same level of enzyme activity, signs of the disease may manifest themselves to a greater or lesser extent. However, in all patients, an increase in lactose intake causes an increase in the severity of symptoms.

The severity of this pathology is affected by the severity of malnutrition, dehydration, dyspeptic symptoms (diarrhea, stomach pain), as well as the duration of the disease.

In our clinic, the diagnosis of “lactase deficiency” is made by a doctor after a thorough examination of the patient’s symptoms and the results of additional diagnostics, which includes special laboratory tests.

Examination of a patient with lactase deficiency includes the following methods:

breath tests
analysis of lactase activity in a biopsy sample of the small intestine mucosa (an invasive technique, the use of which is limited due to the complexity and high cost of the procedure)
genetic analysis of the biopsy during EGD.

The treatment of this pathology requires a differentiated approach. The doctor plans the necessary therapy, based on the reasons for the development of enzyme deficiency and the severity of the disease.

Treatment of lactose intolerance begins with diet therapy, which involves reducing the intake of lactose or completely eliminating products that contain it.

Treatment of secondary lactase deficiency should be aimed at elimination of the disease that caused this pathology. However, the reduction of lactose in the diet is a temporary measure that can restore the normal state of the small intestinal mucosa.

Avoiding dairy products is entirely possible for adults with lactase deficiency. Detailed recommendations regarding nutrition will be given by the attending physician.

Secondary lactase deficiency is cured as the underlying pathology that caused this condition is eliminated. At the same time, lactase activity is restored. The effectiveness of therapy for lactase deficiency can be judged by the disappearance of flatulence, normalization of weight and a decrease in the content of carbohydrates in the analysis of feces.

It is not possible to prevent the development of primary lactase deficiency.

Timely diagnosis and treatment of diseases of the gastrointestinal tract will help prevent secondary lactase deficiency.

Doctors treating the disease

Zinovieva Evgenia Nikolaevna

Chief Physician, Gastroenterologist, Hepatologist, Candidate of Medical Sciences, Associate Professor

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Andrey Kharitonov 9010 4 Gastroenterologist, Ph.

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Maria Prashnova

Gastroenterologist, hepatologist, Ph.D.

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Sokolova Ksenia Sergeevna

Doctor gastroenterologist, hepatologist, therapist ologist of the highest category, PhD, associate professor

Marina Vladimirovna

Therapist of the highest category, gastroenterologist, hepatologist

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Clinical cases

Prolonged diarrhea after drinking milk

pathological center EXPERT with complaints of long-term loosening of the stool. Before that, she had not been examined, in general, her state of health was satisfactory. Adapted to habitual diarrhea. In connection with admission to the university, a change in the rhythm of life, I decided to be examined.

Lactose and gluten intolerance

Patient B, 26 years old, applied to the EXPRET gastro-hepatocenter with complaints of diarrhea, general weakness. Prior to this, he repeatedly turned to gastroenterologists at the place of residence and received treatment for irritable bowel syndrome without a significant effect.

When taking a detailed history, the gastroenterologist revealed that since childhood, the patient had experienced periodic occurrence of intestinal disorders, but he had never undergone an in-depth examination. Recently noted that the most pronounced symptoms are noted after the use of dairy products.

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Doctors demystified lactose intolerance0001

10/06/2019 at 18:29

The science

13465

In recent years, studies proving both the benefits and harms of milk for adults have been multiplying like mushrooms after rain. Regarding children, scientists seem to have decided: yes, children need it, because it helps to form the skeletal system and provides the growing body with much-needed protein. But there is no consensus with adults: the camps of supporters and opponents are approximately the same. In addition, the problem of lactase deficiency is well known: some people, having lived to a certain age, stop absorbing dairy products. What should the average consumer do, drink or not drink? Let’s try to figure it out.

Photo: Natalia Muschinkina

We live in the age of information technologies, and therefore we constantly cook in the information field that is being formed around us. It is difficult for an ordinary person to separate the wheat from the chaff and understand which facts are true and which are just idle speculation.

A recent report by experts from the National Dairy Council shared the latest data on the role of milk in human life. For example, they noted the important role of dairy products in bone formation. Of course, in youth, few people are interested in bone health, but with age, osteopenia and osteoporosis (diseases associated with the fragility of the skeletal system) become a real problem. meanwhile 90% bone mass is reached at age 18 in women and 20 in men. And to build strong bones, the American Academy of Pediatrics recommends 2-3 servings of dairy products (milk, cheese, and yogurt) for children four to eight years old, and four servings for teens to meet calcium and vitamin D needs.

New research shows that the consumption of dairy products (regardless of fat content) is not associated with an increased risk of cardiovascular disease, on the contrary, it can serve as a preventive measure. What’s more, a 2018 study found that consumption of dairy products, including milk, cheese, and yogurt, is associated with a lower risk of high blood pressure in adults. The study analyzed data from over 150,000 women and over 30,000 men. It turned out that those who ate at least 3 dairy products (including milk, cheese, yogurt, ice cream and sorbet) a day had a lower risk of high blood pressure. Those who followed a diet of five servings of yogurt per week, for example, had a 30% lower risk of high blood pressure compared to those who did not consume yogurt or diet.

Eating dairy products is also beneficial for type 2 diabetes. For example, the 2015 Dietary Guidelines for Americans contain a clause on the inclusion of low-fat dairy products to provide the nutrients a healthy person needs, just to prevent diabetes.

Data on the connection between the consumption of dairy products and skin rashes have been refuted. A balanced eating plan that contains all food groups may help keep skin healthy, researchers from the American Academy of Dermatology say.

Yet the problem of lactose intolerance to the milk protein is not far-fetched. Lactase deficiency (lactose intolerance) is a condition in which the body of a child or adult is not able to digest (absorb) milk sugar (lactose). For in his intestines, not enough of a special enzyme is produced – lactase. Among the adult population of Europe, lactose intolerance occurs in 1-7% of cases, and in Russia this figure ranges from 6 to 15%, according to various sources. As a rule, lactase deficiency is rare among those peoples (populations) where there is a traditionally high consumption of milk and dairy products during life, as, for example, in Russia, where animal husbandry has more than one century. But the peoples of Southeast Asia are much more likely to have lactase deficiency. Lactose intolerance is a genetically determined feature of the body, and among the representatives of different nations, the percentage of people who are lactose intolerant is different.

Russians like to engage not only in self-treatment, but also in self-diagnosis – that is why many more people find themselves in the statistics with lactase deficiency. Its symptoms are not specific and can be with a variety of diseases. Main manifestations: increased gas formation, diarrhea and feeling of nausea.

Well-known nutritionist, candidate of medical sciences of the Department of Dietetics and Nutrition of the State Educational Institution DPO RMAPE Lyudmila Volkova explained that there are several methods for diagnosing this condition: “For example, determination of total carbohydrates in feces, determination of acidity (pH) of feces, determination of the content of hydrogen, methane or CO2 in exhaled air, glycemic stress test with lactose. There are also genetic tests that help diagnose this condition.”

Only a doctor can decide whether or not a person with lactase deficiency should refuse milk. With the use of small amounts of milk and sour-milk products, the symptoms of lactase deficiency may not appear or be moderate. In addition, such patients are recommended fermented milk products as a complete replacement: yogurt, kefir, fermented baked milk, acidophilus. In their production, sourdough from microorganisms is used, under the influence of which lactose is partially broken down. In this form, it is absorbed 3-8 times better than milk lactose.

As for the assertion that adults, regardless of the presence of lactase deficiency, by definition do not need milk, it is, of course, debatable. And this is true only for people aged 60 and older – at this age it is recommended to replace whole milk with fermented milk products.

Well, no one has yet disputed the fact that milk is a valuable source of well-digestible protein, complete in amino acid composition, calcium and phosphorus. It contains vitamin A, which helps maintain vision, healthy skin and a healthy immune system; vitamin B12, which supports the functioning of the central nervous system; riboflavin, whose task is to convert food into energy, niacin, which ensures the normal functioning of many enzymes in the body, and potassium, which maintains healthy blood pressure. According to Russian recommendations, the daily norm of milk per day for an adult is 900 grams.

Authors:

org/Person”>
Arina Petrova

Russia
Children
Science

Published in the Moskovsky Komsomolets newspaper No. 28094 dated October 7, 2019

Newspaper headline:
Why is milk useful?

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