Can lactose intolerance develop later in life. How does aging affect lactose digestion. What are the common symptoms of lactose intolerance. Which foods and medications contain lactose. How can lactose intolerance be managed effectively.

Understanding Lactose Intolerance: A Common Digestive Issue

Lactose intolerance is a digestive condition that affects millions of people worldwide. It occurs when the body cannot properly digest lactose, the primary sugar found in dairy products. While many associate this condition with childhood, it’s important to note that lactose intolerance can develop at any age, including adulthood.

The primary cause of lactose intolerance is a deficiency in lactase, an enzyme produced in the small intestine that breaks down lactose into simpler sugars for absorption. When lactase levels are insufficient, undigested lactose moves through the digestive system, leading to various uncomfortable symptoms.

Common Symptoms of Lactose Intolerance

• Bloating
• Gas
• Abdominal cramps
• Diarrhea
• Nausea

These symptoms typically occur within 30 minutes to 2 hours after consuming dairy products. The severity of symptoms can vary from person to person, depending on the amount of lactose consumed and individual tolerance levels.

The Age Factor: Can Lactose Intolerance Develop Later in Life?

Many people wonder if lactose intolerance can emerge as they get older. The answer is yes, it’s entirely possible to develop lactose intolerance later in life. This phenomenon is known as adult-onset lactose intolerance or secondary lactose intolerance.

As we age, our bodies may produce less lactase, the enzyme responsible for breaking down lactose. This gradual decline in lactase production can lead to the onset of lactose intolerance symptoms in adulthood, even if an individual had no previous issues with dairy consumption.

Factors Contributing to Adult-Onset Lactose Intolerance

1. Genetic predisposition
2. Ethnicity (more common in certain populations)
3. Age-related decline in lactase production
4. Gastrointestinal diseases or conditions
5. Medications affecting intestinal function

Dr. Vijaya Surampudi, assistant professor of medicine at the University of California, Los Angeles, notes that approximately 65% of people may experience lactose intolerance at some point in their lives. This statistic highlights the prevalence of this condition and its potential to develop over time.

Genetic and Ethnic Factors in Lactose Intolerance

Lactose intolerance has a strong genetic component, with certain ethnic groups being more predisposed to developing the condition. Research has shown that lactose intolerance is more common among individuals of Southeast Asian, East Asian, West African, Native American, Hispanic, or Italian ancestry.

This increased prevalence in specific populations is due to a higher likelihood of carrying gene mutations that affect lactase production. Understanding these genetic factors can help individuals assess their risk and make informed decisions about their diet and lifestyle.

Prevalence of Lactose Intolerance in Different Ethnic Groups

• East Asians: 90-100%
• Native Americans: 80-100%
• Africans: 60-80%
• Hispanics: 50-80%
• Southern Europeans: 40-70%
• Northern Europeans: 5-17%

These figures demonstrate the significant variation in lactose intolerance rates across different ethnic groups, emphasizing the importance of considering genetic factors when assessing an individual’s risk for developing the condition.

Medical Conditions and Medications Influencing Lactose Intolerance

While age and genetics play a significant role in the development of lactose intolerance, certain medical conditions and medications can also contribute to its onset or exacerbation. Understanding these factors is crucial for proper diagnosis and management of the condition.

Medical Conditions Associated with Lactose Intolerance

• Crohn’s disease
• Ulcerative colitis (UC)
• Celiac disease
• Small intestine injuries or trauma
• Gastrointestinal infections

These conditions can damage the lining of the small intestine or affect the production of lactase, leading to lactose intolerance. In some cases, treating the underlying condition may help improve lactose tolerance.

Medications That May Contain Lactose

• Birth control pills
• Antacid tablets
• Some prescription medications
• Certain over-the-counter drugs

It’s important to note that while some medications contain lactose, they typically only cause symptoms in individuals with severe lactose intolerance. Always consult with your healthcare provider or pharmacist about the lactose content of your medications if you have concerns.

Identifying Lactose-Containing Foods and Hidden Sources

Managing lactose intolerance requires a thorough understanding of which foods contain lactose and where it might be hidden. While dairy products are the primary source of lactose, this sugar can be found in a variety of unexpected places.

Common Dairy Products Containing Lactose

• Milk (all types)
• Cheese
• Yogurt
• Ice cream
• Butter
• Cream
• Cottage cheese

Hidden Sources of Lactose

• Baked goods
• Chocolate candies
• Sauces and dressings
• Instant mashed potatoes
• Pancake mixes
• Protein shakes
• Non-dairy coffee creamers
• Whipped toppings

Always check ingredient labels for terms such as “milk by-products,” “whey,” “dry milk,” and “curds,” as these indicate the presence of lactose. Being vigilant about hidden sources can help prevent unexpected symptoms and discomfort.

Strategies for Managing Lactose Intolerance

Developing lactose intolerance doesn’t necessarily mean you have to completely eliminate dairy from your diet. There are several strategies and options available to help manage the condition and minimize symptoms while still enjoying some of your favorite foods.

Dietary Adjustments

1. Gradually reduce dairy intake to determine your personal tolerance level
2. Opt for lactose-free or lactose-reduced dairy products
3. Try hard cheeses, which typically contain less lactose
4. Experiment with yogurt, as its live cultures may aid in lactose digestion
5. Consume dairy products with meals to slow digestion and reduce symptoms

Lactase Enzyme Supplements

Over-the-counter lactase enzyme supplements, available in tablet or liquid form, can be taken before consuming dairy products to help break down lactose. These supplements can be an effective way to enjoy dairy occasionally without experiencing symptoms.

Non-Dairy Calcium Sources

For those who need to significantly limit or eliminate dairy, it’s crucial to ensure adequate calcium intake through other sources:

• Leafy green vegetables (kale, spinach, collard greens)
• Fortified plant-based milk alternatives
• Canned fish with soft bones (sardines, salmon)
• Nuts and seeds (almonds, sesame seeds)
• Calcium-fortified juices and cereals

Consulting with a registered dietitian can help ensure you’re meeting your nutritional needs while managing lactose intolerance.

When to Seek Medical Advice for Lactose Intolerance

While lactose intolerance is generally not a serious health condition, it’s important to know when to consult a healthcare professional. Certain symptoms or circumstances may warrant medical attention to rule out more serious conditions or to develop an appropriate management plan.

Signs That Require Medical Evaluation

• Unexplained weight loss
• Blood in stool
• Anemia
• Persistent nausea or vomiting
• Severe abdominal pain
• Symptoms that persist despite dietary changes

Dr. Christine Lee, a gastroenterologist at Cleveland Clinic, emphasizes the importance of discussing symptoms with a physician to ensure proper diagnosis and treatment. Some symptoms of lactose intolerance can mimic those of more serious gastrointestinal disorders, making professional evaluation crucial.

Diagnostic Tests for Lactose Intolerance

1. Hydrogen breath test
2. Lactose tolerance test
3. Stool acidity test
4. Genetic testing

These tests can help confirm a diagnosis of lactose intolerance and rule out other potential causes of symptoms. Your healthcare provider can determine which test is most appropriate based on your individual circumstances.

The Future of Lactose Intolerance Research and Treatment

As our understanding of lactose intolerance continues to evolve, researchers are exploring new avenues for diagnosis, management, and potential treatments. These advancements may offer hope for individuals struggling with the condition and provide more options for maintaining a balanced diet.

Emerging Research Areas

• Microbiome studies and probiotics for lactose digestion
• Gene therapy to enhance lactase production
• Development of more effective lactase supplements
• Personalized nutrition approaches based on genetic profiles

While these areas of research are promising, it’s important to note that many are still in early stages and may not lead to immediate practical applications. However, they highlight the ongoing efforts to improve the lives of those affected by lactose intolerance.

Importance of Ongoing Research

Continued research into lactose intolerance is crucial for several reasons:

1. Improving diagnostic accuracy and efficiency
2. Developing more targeted and effective treatments
3. Enhancing our understanding of the condition’s genetic and environmental factors
4. Exploring potential links between lactose intolerance and other health conditions
5. Addressing the nutritional challenges associated with dairy avoidance

As research progresses, individuals with lactose intolerance may have access to more options for managing their condition and maintaining optimal health.

In conclusion, lactose intolerance is a common digestive issue that can develop at any age, including adulthood. Understanding its causes, symptoms, and management strategies is crucial for those affected by the condition. By working closely with healthcare providers, making informed dietary choices, and staying abreast of new developments in research and treatment, individuals with lactose intolerance can effectively manage their symptoms and maintain a healthy, balanced diet.

Can You Get It as You Get Older?

Written by Susan Bernstein

Do you get gas, bloating, or even diarrhea after you eat dairy foods? You may be lactose intolerant. This is when you can’t digest lactose, the type of sugar found in dairy products.

Lactose intolerance isn’t a serious health condition, but symptoms can be uncomfortable. You may have stomach upset or gas about 30 minutes to 2 hours after you eat or drink any dairy food.

Lactose intolerance is caused by low levels of lactase, an enzyme that helps you digest lactose in dairy foods, says Laura Acosta, a registered dietitian at the University of Florida in Gainesville.

“Some people are able to tolerate lactose throughout their lives, but others become more lactose intolerant as they age,” usually caused by your genes, she says. “Some people stop producing lactase, or produce less of it, as they reach adulthood and beyond.”

Lactose intolerance is more common among people of Southeast Asian, East Asian, West African, Native American, Hispanic, or Italian ancestry because they’re more likely to carry the gene mutation that causes the condition, says Vijaya Surampudi, MD, assistant professor of medicine at the University of California, Los Angeles.

“We have the highest amounts of lactase when we are young because as babies, we feed on milk. But we often make less and less lactase as we age,” she says. “About 65% of people may experience lactose intolerance at some point in their lives.”

There’s a wide range of lactose intolerance, with some people having no tolerance for dairy, while others can manage to digest foods like hard cheeses or yogurt, she says.

It’s fairly common to notice the signs of lactose intolerance appear as you get older, says Christine Lee, MD, a gastroenterologist at Cleveland Clinic in Ohio.

“This enzyme production can decrease over time in some people, so most people can experience some degree of lactose intolerance as they get older,” Lee says. You can also become lactose intolerant if you have an illness, infection, or take a medication that affects the bowels or intestines.

These conditions can also cause you to develop lactose intolerance later in life:

• Crohn’s disease
• Ulcerative colitis (UC)
• Celiac disease
• Injury or trauma to your small intestines

Foods. Any dairy foods or drinks can have lactose, so read food labels carefully. These foods or ingredients may trigger symptoms:

• Cheese
• Whey
• Milk by-products
• Dry milk
• Butter
• Curds
• Ice cream
• Heavy cream
• Cottage cheese
• Cheese spreads
• Yogurt

Look for milk in ingredients lists in baked goods, chocolate candies, sauces, instant mashed potatoes, pancakes, or milk-based meal replacement or protein shakes. Even non-dairy coffee creamer or whipped toppings may contain some lactose.

Medications. Some medications like birth control pills or antacid tablets also contain lactose, but these may only cause symptoms in people with severe lactose intolerance. Check the labels of your prescription or OTC medications to see if they contain lactose. Ask your doctor or pharmacist if it’s OK for you to take them.

You may not have to give up all the dairy foods you enjoy if you develop lactose intolerance.

Some people with lactose intolerance may be able to eat or drink small amounts of dairy or switch to skim milk and have fewer symptoms. Some people can eat yogurt because it contains live bacteria cultures that help you produce the lactase enzyme to break down lactose.

“Cheese actually has very little lactose. In general, the harder the cheese, the less lactose it has. So many people with lactose intolerance can still tolerate cheese like Parmesan and Swiss in small amounts. This depends on an individual’s sensitivity,” Acosta says.

Talk to your doctor to identify what’s causing your lactose intolerance so you can make the right changes to your diet, Lee says.

“If it’s due to decreased production of lactase, then you can choose to take lactase tablets or drops, enzymes sold in most grocery stores without a prescription, or buy lactose-free milk products,” she says. Supplements are taken before a meal with dairy to help you digest the lactose.

If your lactose intolerance is due to a bowel disease or other health conditions, treat that illness first, she adds. “Always play it safe and discuss your symptoms with your physician.” Unexplained weight loss, bleeding, anemia, nausea, or vomiting may be signs of a more serious medical condition, not just lactose intolerance, she says.

As you age, you still need to get enough calcium even if you develop lactose intolerance. Calcium helps you maintain strong bones and teeth, and healthy muscles and nerves.

“There are many calcium-rich foods people can eat if they’re avoiding lactose,” says Allie Wergin, a registered dietitian/nutritionist with Mayo Clinic Health System. “These include lactose-free dairy products like Lactaid or Dairy Ease milks, where the lactose is predigested or hydrolyzed. This means the milk protein has already been broken down and is easier to digest.”

Other foods that are good sources of calcium, according to Wergin:

• Calcium-fortified cereals and fruit juices
• Tofu prepared using calcium sulfate
• Canned salmon or sardines with bones
• Plant-based soy, almond, oat, or rice milks
• Leafy green vegetables like spinach, kale, bok choy, or collard greens
• Broccoli
• Almonds
• Beans like garbanzo, kidney, or navy

“We recommend that you get calcium through your diet. There are different calcium supplements, including calcium carbonate, which is best absorbed if you take it with food, and calcium citrate, which you can take with or without food,” Surampudi says. Only take a calcium supplement if your doctor says you need one, she says.

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Can You Suddenly Develop Lactose Intolerance?

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If enjoying ice cream, mac and cheese, or coffee creamer leads to excessive burping, abdominal pain, and diarrhea—you may be lactose intolerant.

Even if you’ve never had an issue digesting dairy in the past, this uncomfortable and sometimes embarrassing condition can develop as you age. It’s not as rare as you might think. In fact, approximately 68% of adults around the world experience some degree of difficulty digesting dairy foods.

“Many factors can trigger lactose intolerance or lactase deficiency, or it can develop over time,” says Elizabeth Ferrer, R.D., LD/N, CNSC, a registered dietitian with the University of Miami Health System.

“As we age, we tend to replace milk with other foods. This leads to a decreased amount of lactase (the enzyme responsible for breaking down lactose sugar) activity and production. Some adults produce enough lactase enzyme to digest the amount of dairy in a typical adult diet. But, lactase production can fall off sharply by the time you reach adulthood (called primary lactose intolerance), making milk products difficult to digest. ”

What causes lactose intolerance?

– genetics: lactose intolerance can run in families
– gastrointestinal surgery
– injury or damage to the small intestine
– cancer treatments
– conditions such as Cohn’s Disease, Celiac Disease, Irritable Bowel Syndrome/Disease, and Small Intestinal Bacterial Overgrowth

How do I know if I am lactose intolerant?

It may be difficult for you and your doctor to tell if an inability to digest lactose is causing your symptoms because other conditions create similar gastrointestinal distress.

Keeping a food diary is one way to start narrowing down potential causes.

“It’s helpful to keep a food diary for one to five days, recording what you eat, including the amounts of all food and beverages, and how you feel hours later,” Ferrer says. “This information will be useful when you visit a registered dietitian or gastroenterologist for a full evaluation. During your visit (in office or via telehealth), your health care provider will ask for at least one day of a diet recall or a food frequency questionnaire. ”

Therefore, doing this before your visit will save time and offer insight into which foods or ingredients cause your digestive problems.

In addition, your physician may order a lactose tolerance blood test or a hydrogen breath test.

Are there non-dairy foods with calcium?

With a proper diagnosis, you can make dietary changes to avoid the uncomfortable gas, cramping, and trips to the bathroom associated with this condition. If your lactose intolerance began with a related gastrointestinal condition or disease, effectively managing the underlying illness may help resolve it.

The best advice is to stop eating and drinking food containing lactose. However, they are a primary source of calcium, a mineral that’s important to good health.

“When you avoid milk and dairy,” Ferrer says, “you need to get calcium from other foods.”

Non-dairy sources of calcium include:
– sardines
– canned salmon
– tofu (calcium-fortified)
– shellfish
– turnip greens
– collard greens
– kale
– dried beans
– broccoli
– calcium-fortified orange juice
– calcium-fortified soy milk
– blackstrap molasses
– almonds

“By following appropriate advice by a registered dietitian, most people with lactose intolerance can enjoy some lactose-containing foods without symptoms,” Ferrer says.

It may take time for your body to re-adjust to lactose consumption, or you may be able to find certain dairy products that don’t lead to your worst symptoms. First, try eating solid food with a small amount of dairy, which will help slow digestion and may reduce the symptoms.

Do some foods have less lactose?

These dairy items may be okay for you to consume in moderation because they have lower levels of lactose:
– butter
– aged/hard cheeses
– natural cheeses
– yogurt low in sugar, high in probiotic cultures
– kefir (a fermented drink similar to yogurt)
– heavy cream
– whey protein powders

“Some people with this condition can tolerate up to 10 to 12 grams of lactose per day,” Ferrer says.
Pay attention to dairy portion sizes, and keep track of which foods and amounts leave you regretting your choices.

Other options include lactose-free milk, ice cream, and cottage cheese, which are available at most grocery stores. Similarly, you can try an over-the-counter lactase enzyme supplement pill or chewable tablet. If you take it just before consuming lactose-containing food, it can provide your body with the enzyme it needs to break down lactose sugar effectively.

Dana Kantrowitz is a contributing writer for UMiami Health News.

Originally published on: February 03, 2021

Tags: diarrhea, food allergies, lactose intolerance, stomach cramps, symptoms of lactose intolerance

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at the following URL: https://news.umiamihealth.org/en/cancer-patients-should-you-juice/

Copyright © 2023 University of Miami Health System

Probiotics in patients with secondary lactase deficiency » Medvestnik

Lactase deficiency (LN) is associated with a decrease in the activity of the lactase enzyme of the brush border of enterocytes of the small intestine, which breaks down milk sugar – lactose ¹ . According to the etiology, LN is divided into primary (PLN) and secondary (VLN). PLN is caused by congenital lactase deficiency and is of great importance for pediatric practice. VLN develops as a result of a decrease in lactase activity in the small intestine due to damage to enterocytes during intestinal infections, diseases of the small intestine (Crohn’s disease, celiac disease, etc.), extensive resections of the small intestine. In the elderly and senile age, VLN can be a manifestation of the involutive extinction of the enzymatic activity of lactase. An increase in the prevalence of VLN is observed in people aged 25 to 45 years. On average, VLN occurs in 30–40% of adults ² .

In VLN, the main focus should be on treating the underlying disease. Reducing the amount of lactose in the diet is a temporary recommendation, which is carried out until the intestinal mucosa is restored ¹ .

It should be remembered that a significant proportion of lactase (approximately 80%) is produced by bacteria of the normal intestinal microflora (mainly bifidobacteria and lactobacilli). The severity of the clinical manifestations of LN often does not correlate with the degree of decrease in lactase activity, since it is associated not only with the activity of the enzyme, but also with the number of lactose-fermenting bacteria. Therefore, changes in the composition of the microflora of the small intestine can also disrupt the metabolism of lactose in the body. A high prevalence of VLN is observed in patients with postinfectious irritable bowel syndrome (pIBS). It is explained by the influence of pathogenic microflora on the enzymatic activity of enterocytes. Undigested lactose accumulates in the intestinal lumen and retains fluid there, contributing to the development of diarrhea, the formation of a large amount of gas, the appearance of crampy pain in the abdomen ³ .

Thus, in patients with LN, the use of probiotics is a clinically justified therapeutic option.

Probiotics are live microorganisms that improve the health of the host when used in adequate amounts ⁴ .

Probiotics promote lactose absorption in people with lactose intolerance by increasing the overall hydrolytic capacity of the small intestine and increasing lactose fermentation in the colon ⁵ .

The drug Bifiform has a balanced composition, contains two strains of bacteria – Enterococcus faecium ENCfa-68 at a dose of at least 1 × 10 ⁷ CFU and Bifidobacterium longum BB-46 at a dose of at least 1 × 10 90 003 7 CFU ⁶ . Double-layer enteric capsule protects beneficial bacteria from the aggressive environment of the stomach ⁷ .

In the study of I.N. Ruchkina et al. (2013) evaluated the efficacy of Bifiform in patients with iBSC and VLN. The study included 138 patients with iBS. 59.4% of patients were diagnosed with VLN. In all cases, it was accompanied by bacterial overgrowth syndrome (SIBO) in the lumen of the small intestine, which was confirmed by the results of a respiratory hydrogen test (101±37 ppm at a rate of 3.

According to the instructions for medical use, when taking Bifiform in the recommended doses according to the established no adverse reactions have been identified according to indications.The drug is approved for use in adults and children from the age of 2 years ⁷ .

With the beginning of the use of drugs such as Bifiform in the practice of a gastroenterologist, the “Renaissance” of the human microbiota begins.

Learn more

References:

1. Belmer S.V. Lactase deficiency: origin and ways of correction. Attending doctor. 2018;2.

2. Ruchkina I.N., Lychkova A.E., Fadeeva N.A. Secondary lactase deficiency and the influence of small intestine microflora on the electromotor activity of intestinal smooth muscles. Doctor.Ru. Gastroenterology. 2015;2(103):44-8.
3. Ruchkina I.N. The role of the microflora of the small intestine in the development of secondary lactase deficiency and the possibility of its treatment with probiotics. Therapeutic archive. 2013;2:21-6.
4. FAO/WHO. Working group on drafting guidelines for the evaluation of probiotics in food. Guidelines for the evaluation of probiotics in food. 2002. URL: ftp://ftp.fao.org/es/esn/food/wgreport2.pdf.
5. Oak SJ, Jha R. The effects of probiotics in lactose intolerance: A systematic review. Crit Rev Food Sci Nutr. 2019;59(11):1675-83.
6. Kornienko E.A., Mazankova L.N., Gorelov A.V. The use of probiotics in pediatrics: analysis of therapeutic and prophylactic effects from the standpoint of evidence-based medicine. Attending doctor. 2015;9.
7. Instructions for the medical use of the drug Bifiform RU P N013677/01 dated 06/08/2011.

This material is intended for healthcare professionals.

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Tel. +7 (495) 777-98-50.
Trademark owned or used by the GlaxoSmithKline Group of Companies.
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Milk intolerance: causes, symptoms, treatment

Lactose intolerance is a group of pathological conditions caused by a decrease in lactase levels (an enzyme needed for the digestion lactose found in milk and dairy products). The disorder may be hereditary or acquired. With age, the percentage of people with milk intolerance increases. The first symptoms can occur both in childhood and in adulthood.

Causes of milk intolerance

Etiological factors in the development of lactase deficiency are:

• genetic predisposition;
• celiac disease;
• allergy to gluten and milk proteins;
• lactose overload;
• acute intestinal infections;
• Crohn’s disease;
• pancreatitis;
• resection of the small intestine.

Congenital milk intolerance occurs in 5-6% of people. In this case, there is a deficiency of lactase in the normal intact mucosa of the small intestine. The cause is believed to be a mutation in the LCT (locus 2q21) and MCM6 (locus 2q21.3) genes. Marker C139 allows to determine this genetic anomaly10T.

Symptoms of milk intolerance

Lactase deficiency manifests itself as dyspeptic disorders and general malaise that occurs 1. 5-2 hours after taking a dairy product.

Milk intolerance causes:

• nausea;
• intestinal colic;
• reflex vomiting;
• increased flatulence;
• osmotic diarrhea.

Symptoms of general malaise in milk intolerance include headache, dizziness, general weakness, chills, excessive sweating, muscle weakness, tachycardia and pain in the heart.

Signs of lactase deficiency in infants of breast return are:

• painful abdominal distension;
• loose stools;
• anxiety;
• poor weight gain or loss.

Diagnosis of milk intolerance

Diagnosis is based on the results of laboratory and instrumental studies. Among them:

• genetic testing;
• analysis of feces for carbohydrates;
• scatological analysis;
• lactose breath test;
• elimination diet;
• lactose curve;
• biopsy of the small intestine.

Treatment of milk intolerance

Drug therapy as such is not used. The basis of treatment is a properly selected diet. In case of disorders of the gastrointestinal tract, antiemetics, myotropic antispasmodics, drugs to improve intestinal motility and stabilize the stool can be prescribed.

There are several dietary options for people with milk intolerance. Some can use lactic fermentation products – kefir, yogurt, cottage cheese, cheese. With a significant deficiency of lactase, preference should be given to special products – for example, lactose-free milk. You can also take the enzyme lactase in the form of tablets directly with the use of dairy dishes.

The norm of lactose, which can be consumed without harm to health, is individual. In case of severe milk intolerance, no more than 1 g of milk sugar per day is allowed. In case of violation of moderate severity – no more than 10 g.

You need to make a diet taking into account the composition.