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Lactose Intolerance | HealthLink BC
What is lactose intolerance?
Lactose intolerance means the body cannot easily digest lactose, a type of natural sugar found in milk and dairy products. This is not the same thing as a food allergy to milk.
When lactose moves through the large intestine (colon) without being properly digested, it can cause uncomfortable symptoms such as gas, belly pain, and bloating. Some people who have lactose intolerance cannot digest any milk products. Others can eat or drink small amounts of milk products or certain types of milk products without problems.
Lactose intolerance is common in adults. It occurs more often in Indigenous peoples and people of Asian, African, and South American descent than among people of European descent.
A big challenge for people who are lactose-intolerant is learning how to eat to avoid discomfort and to get enough calcium for healthy bones.
What causes lactose intolerance?
Lactose intolerance occurs when the small intestine does not make enough of an enzyme called lactase. Your body needs lactase to break down, or digest, lactose.
Lactose intolerance most commonly runs in families, and symptoms usually develop during the teen or adult years. Most people with this type of lactose intolerance can eat some milk or dairy products without problems.
Sometimes the small intestine stops making lactase after a short-term illness such as the stomach flu or as part of a lifelong disease such as cystic fibrosis. Or the small intestine sometimes stops making lactase after surgery to remove a part of the small intestine. In these cases, the problem can be either permanent or temporary.
In rare cases, newborns are lactose-intolerant. A person born with lactose intolerance cannot eat or drink anything with lactose.
Some premature babies have temporary lactose intolerance because they are not yet able to make lactase. After a baby begins to make lactase, the condition typically goes away.
What are the symptoms?
Symptoms of lactose intolerance can be mild to severe, depending on how much lactase your body makes. Symptoms usually begin 30 minutes to 2 hours after you eat or drink milk products. If you have lactose intolerance, your symptoms may include:
- Pain or cramps.
- Gurgling or rumbling sounds in your belly.
- Loose stools or diarrhea.
- Throwing up.
Many people who have gas, belly pain, bloating, and diarrhea suspect they may be lactose-intolerant. The best way to check this is to avoid eating all milk and dairy products to see if your symptoms go away. If they do, then you can try adding small amounts of milk products to see if your symptoms come back.
If you feel sick after drinking a glass of milk one time, you probably do not have lactose intolerance. But if you feel sick every time you have milk, ice cream, or another dairy product, you may have lactose intolerance.
Sometimes people who have never had problems with milk or dairy products suddenly have lactose intolerance. This is more common as you get older.
If you think you might have lactose intolerance, talk with your doctor. He or she can make sure that your symptoms are caused by lactose intolerance and not by another problem.
How is lactose intolerance diagnosed?
A doctor can usually tell whether you have lactose intolerance by asking questions about your symptoms. He or she may also ask that you avoid dairy products for a short time to see if your symptoms improve.
Sometimes doctors order a hydrogen breath test or a blood sugar test to confirm the diagnosis. These simple tests check to see if you are digesting lactose normally.
How is it treated?
There is no cure for lactose intolerance. But you can treat your symptoms by limiting or avoiding milk products. Some people use milk with reduced lactose, or they substitute soy beverage and soy cheese for milk and milk products. Some people who are lactose-intolerant can eat yogurt without problems, especially yogurt with live cultures. You can also take dietary supplements called lactase products that help digest lactose. In time, most people who have lactose intolerance get to know their bodies well enough to avoid symptoms.
One of the biggest concerns for people who are lactose-intolerant is making sure they get enough of the nutrients found in milk products, especially calcium. Calcium is most important for children, teens, pregnant women, and women after menopause. There are many non-dairy foods that contain calcium, including:
- Broccoli, okra, kale, collards, and turnip greens.
- Fish canned with bones (examples: sardines and salmon).
- Calcium-fortified juices and cereals.
- Calcium-fortified soy products such as soy beverage and tofu.
Symptoms of lactose intolerance can be mild or severe, depending on how much lactase your body makes. Symptoms usually begin 30 minutes to 2 hours after eating or drinking milk or milk products. If you have lactose intolerance, your symptoms may include:
- Pain or cramps in the lower belly.
- Gurgling or rumbling sounds in the lower belly.
- Loose stools or diarrhea. Sometimes the stools are foamy.
- Throwing up.
Many people think they are lactose-intolerant, because the symptoms of lactose intolerance are very common symptoms. If you feel sick after drinking a glass of milk one time, you probably do not have lactose intolerance. But if you feel sick every time you have milk, ice cream, or another dairy product, you may have lactose intolerance.
Sometimes people who have never had problems with milk or dairy products suddenly have lactose intolerance. This is more common as you get older.
Symptoms of the most common type of lactose intolerance—adult lactose intolerance—often start during the teen or adult years and continue for life. Symptoms of acquired lactose intolerance last as long as the small intestine does not make lactase.
In rare cases, newborns are lactose-intolerant. Symptoms in newborns include severe foamy diarrhea, diaper rash, vomiting, dehydration, weakness and irritability, and slow weight gain.
Lactose intolerance is not the same thing as a food allergy to milk. Symptoms of a milk allergy are usually more severe than those from lactose intolerance. People who have a milk allergy cannot eat or drink any milk products. For more information, see the topic Food Allergies.
If you think you might have lactose intolerance, talk it over with your doctor. Your doctor can make sure that your symptoms are caused by lactose intolerance and not by another problem. Other conditions can cause symptoms similar to those of lactose intolerance, including irritable bowel syndrome, inflammatory bowel disease, overuse of laxatives, and problems digesting foods that contain fructose and sorbitol.
Examinations and Tests
If your doctor thinks you have lactose intolerance, he or she will ask questions about your medical history and do a physical examination. Before making a diagnosis, your doctor may ask that you avoid dairy products for a short time to see if your symptoms improve. You may also be asked to bring in a sample of your stool. The stool of a person who has lactose intolerance is usually loose or watery. It also can be foamy.
To confirm a diagnosis, your doctor may order a:
- Hydrogen breath test. This is the most accurate lactose intolerance test. Before the test, you need to avoid certain foods and medicines and cigarettes. On the day of the test, you will drink a liquid that contains lactose and then breathe into a machine several times over a couple of hours. If the hydrogen levels in your breath are high, you may have lactose intolerance. This test is not usually done on babies and very young children, because it can cause severe diarrhea.
- Lactose tolerance test. This test measures your blood sugar after you eat or drink lactose. After midnight on the night before the test, you should not eat or drink anything. On the day of your test, you will drink a liquid that contains lactose, which may cause gas or pain in your belly. Then your blood will be tested every 30 minutes for 2 hours. If your blood sugar levels do not rise, you may be lactose-intolerant. This test is not done on people who have diabetes. And it is usually not done on babies and very young children.
If you think you have lactose intolerance, it is a good idea to talk it over with your doctor. Your doctor can make sure that your symptoms are caused by lactose intolerance and not by another problem such as irritable bowel syndrome, inflammatory bowel disease, overuse of laxatives, or problems digesting foods that contain fructose or sorbitol. Your doctor can also make sure that your lactose intolerance is not related to another health problem.
After being diagnosed with lactose intolerance, you may feel relieved to find out what has been causing your symptoms. You may also feel frustrated by having to deal with this condition for the rest of your life. You may find it reassuring to know that there are many people who have lactose intolerance. Most can avoid discomfort and still eat or drink some milk products throughout the day.
There are different ways to live with lactose intolerance. What works for one person may not work for another. Because there is no cure for lactose intolerance, controlling your symptoms is mostly up to you. The following tips can help you prevent symptoms of lactose intolerance.
Limit the amount of milk and milk products in your diet. Most people can have about 10 g of lactose each day. This can be a glass of whole, low-fat, or skim milk, for example. All milk contains the same amount of lactose. Other milk products contain different amounts of lactose:
1 cup (250 mL)
1 oz (30 g)
Cottage cheese, 2% milk fat
0.5 cup (125 mL)
1 oz (30 g)
Foods with less lactose, such as Swiss or cheddar cheese, may not cause problems. If you are not sure whether a milk product causes symptoms, try a small amount and wait to see how you feel before you eat or drink more.
Eat or drink milk and milk products along with other foods. For some people, combining a solid food (like cereal) with a dairy product (like milk) may reduce or eliminate symptoms.
Spread milk or milk products throughout the day. Many people who are lactose-intolerant find it helpful to eat small amounts of lactose-containing products throughout the day instead of larger amounts all at one time.
Eat or drink milk and milk products that have reduced lactose. In most grocery stores, you can buy milk with reduced lactose. Some people like buying this kind of milk and find that it helps control their symptoms. Others find that it tastes too sweet or is too expensive. People who have diabetes may find that lactose-reduced milk raises their blood sugar levels higher than normal.
Eat or drink other foods instead of milk and milk products. You can substitute soy beverage and soy cheese for milk and milk products. You can also use non-dairy creamers in your coffee. But keep in mind that non-dairy creamers do not contain the same vitamins and minerals as milk, and they may contain more fat than milk contains.
Use lactase products. Lactase products are dietary supplements that help you digest lactose. There are many different brands of lactase products. Some are pills that you chew (such as Lactaid) before you eat or drink milk products. Others are liquids that you can add to milk 24 hours before you drink it. Some foods have extra lactase added to them. Because products and brands are different, you may want to try a few to see which ones work best for you.
Eat yogurt with live bacterial cultures. Some people who are lactose-intolerant can eat yogurt without having problems, especially yogurt that contains live cultures. This type of yogurt can help people digest lactose. All yogurts are made with live cultures, but many yogurts go through a process called “heat treatment” that kills the bacteria. If you want to be sure you are buying yogurt that still contains live cultures, check the label. It will say that it contains live and active cultures. It’s best to try a small amount of different brands of yogurt to see which ones work best for you.
If you have severe lactose intolerance, you may need to avoid lactose completely. Some medicines and many prepared foods contain lactose. Examples of prepared foods with lactose include breads and baked goods; breakfast cereals and instant breakfast drinks; instant potatoes and instant soups; pancake, cookie, and biscuit mixes; margarine and salad dressings; candies, milk chocolate, and other snacks. Be sure to read labels for lactose and for lactose’s “hidden” names, such as:
- Dry milk solids.
- Milk by-products.
- Non-fat dry milk powder.
One of the biggest concerns for people who are lactose-intolerant is making sure they get enough of the nutrients found in milk products, especially calcium. Calcium is especially important for women, because it keeps bones strong and reduces the risk of osteoporosis. There are many non-dairy foods that contain calcium, including:
- Broccoli, okra, kale, collards, and turnip greens.
- Fish canned with bones (examples: sardines and salmon).
- Calcium-fortified juices and cereals.
- Calcium-fortified soy products such as soy beverage and tofu.
To absorb calcium, your body needs vitamin D. Vitamin D is also found in fortified orange juice, fortified soy beverage, oily fish (such as salmon), egg yolks, and liver.
If you don’t know whether you are getting enough calcium, vitamin D, and other important nutrients found in milk products, such as magnesium, potassium, protein, and riboflavin, talk to your doctor. He or she may recommend that you take a calcium supplement or meet with a registered dietitian to make sure you are getting enough of certain vitamins and minerals.
You should also talk with your doctor if your symptoms do not go away with treatment, if they get worse, or if you have other symptoms, such as a fever, chills, or severe belly pain or vomiting.
What to think about
Lactose intolerance in newborns of normal birth weight and in babies is rare. But if your child has symptoms of lactose intolerance, see your doctor right away. Diarrhea is very dangerous because it can lead to dehydration, a serious problem that requires immediate attention.
Babies who are only fed breast milk do not develop lactose intolerance, because breast milk contains lactase, the enzyme that helps digest milk sugar. If your baby is formula-fed and develops lactose intolerance, you can switch to a formula made without lactose. In rare cases, a baby may have a reaction to the proteins in milk, which is a different condition called sensitivity to milk protein.
- U.S. Department of Agriculture, Agricultural Research Service (2012). Nutrient data laboratory. USDA National Nutrient Database for Standard Reference, Release 25. Available online: http://ndb.nal.usda.gov.
Other Works Consulted
- American Academy of Pediatrics (2014). Carbohydrate and dietary fiber. In Pediatric Nutrition, 7th ed., pp. 387–406. Elk Grove Village, IL: American Academy of Pediatrics.
- Hogenauer C, Hammer HF (2010). Maldigestion and malabsorption. In M Feldman et al., eds., Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 1735–1767. Philadelphia: Saunders.
- Whitney E, Rolfes SR (2011). Digestion and absorption of carbohydrates section of The carbohydrates: Sugars, starches, and fibers. In Understanding Nutrition, 12th ed., pp. 105–107. Belmont, CA: Wadsworth.
Adaptation Date: 3/1/2021
Adapted By: HealthLink BC
Adaptation Reviewed By: HealthLink BC
Lactose intolerance – Better Health Channel
Milk and other dairy products contain a sugar or carbohydrate called lactose. Normally, the body breaks down lactose into its simpler components with the help of the enzyme lactase. Most mammals stop producing lactase when they are weaned. Most people of Western European descent, however, continue to produce it throughout life.
Without enough lactase, a person can have digestive problems like abdominal pain and diarrhoea when they consume foods containing lactose. This is known as lactose intolerance or lactase deficiency.
It is rare for Caucasians to develop lactose intolerance. However, a form of lactose intolerance that develops after about five years of age is quite common (and normal) among people from Asia, Africa, the Middle East and some Mediterranean countries, as well as among Aboriginal Australians. Up to five per cent of Caucasians and up to 75 per cent of non-Caucasians living in Australia are lactose intolerant.
Babies of all populations can tolerate lactose. Many Australian babies are unnecessarily weaned because their irritability is wrongly assumed to be lactose intolerance. In reality, the severe form of this condition – known as primary or congenital lactose intolerance (where the infant does not produce lactase from birth) – is very rare.
Secondary lactose intolerance is more common. This can occur temporarily after a bout of gastroenteritis, for example, but often improves after several weeks as the lining of the gut heals.
Symptoms of lactose intolerance
Symptoms of lactose intolerance include:
- abdominal pain
- abdominal swelling (bloating)
- flatulence (excessive wind)
If you are experiencing these symptoms and you are concerned, talk to your doctor.
It is important not to eliminate dairy foods completely from your diet if lactose intolerance is suspected, as dairy foods are rich sources of nutrients. Some dairy products (such as hard and mature cheeses) contain no lactose, and others (such as cream, butter, cottage cheese and ricotta) contain very little. Many people with lactose intolerance can tolerate small amounts of lactose with minimal symptoms.
Undigested milk sugars
The enzyme lactase breaks down milk sugar (lactose). Lactase enzymes are found in the lining of the small intestine. They change the milk sugar into absorbable compounds – glucose and galactose.
If your body does not produce enough lactase, lactose is not digested and absorbed in the small intestine in the usual way. Instead, it continues to travel along the digestive tract to the large intestine, where bacteria partially break it down into acids and gases. This fermentation process causes excessive wind, bloating and associated pain.
Any undigested lactose continues along the intestinal tract. This lactose attracts water molecules. So rather than being absorbed into the bloodstream, water remains in the faecal matter (poo) and watery poo (diarrhoea) is the result.
Causes of lactose intolerance
Lactose intolerance is largely genetically determined – where your genetic make-up causes you to have less lactase than usual. Some other causes include:
- gastroenteritis – this can strip the intestines of lactase for a few weeks
- parasitic infection – this can temporarily reduce lactase levels
- coeliac disease – this also damages the gut lining.
Lactose intolerance in babies
There are two types of lactose intolerance in babies: primary and secondary lactose intolerance.
Primary lactose intolerance (or congenital lactose intolerance) is a very rare genetic condition. Babies with this condition are born without any lactase enzymes at all. They cannot process or absorb lactose. They fail to thrive from birth, and have severe diarrhoea from the day they are born. They are diagnosed straight after birth. Babies with this condition must be fed feeds free of lactose.
Secondary lactose intolerance occurs when the gut lining (where lactase is produced) is damaged. This can occur due to a bout of gastroenteritis or due to chronic irritation (such as that due to food allergy or food intolerance), among other reasons.
Breastfed babies experiencing symptoms of lactose intolerance but who do not have primary lactose intolerance should continue to breastfeed. Once the source of the damage is removed, their gut will heal and produce lactase again.
There is no need for women who are breastfeeding to reduce or cut out dairy foods if their baby is showing signs of lactose intolerance. This is because the amount of lactose in breastmilk is not affected by the mother’s diet. Regardless of what they eat or drink, the level of lactose in breastmilk stays at around seven per cent. An exception may be if secondary lactose intolerance is being caused by allergy or intolerance to cows’ milk protein, where cutting out dairy foods will prevent ongoing damage to the gut lining.
For formula-fed babies, there is no benefit in using lactose-free formula unless the baby is losing weight. Lactase drops are available from pharmacies, but are not always helpful.
If your baby is showing signs of lactose intolerance, such as excessive bowel motions, wind in the bowel, and pain, have your baby checked by your GP for any medical problems such as infection. Check that your baby is gaining weight and growing normally.
If all this is okay, speak to an Australian Breastfeeding Association counsellor, lactation consultant or child health nurse, to check if your baby has a lactose overload. This is common in the early weeks and can happen when a baby is taking in more milk than they can digest easily. Breastfeeding advice is helpful in this situation.
If the situation is more complex, such as if your baby has poor weight gain or blood in their bowel motions, then this needs further investigation. See your GP.
Vomiting is not a symptom of lactose intolerance in babies. Note that vomiting in the early weeks of life is quite normal, as long as the baby is not distressed by it and they are keeping down sufficient milk to gain weight and grow normally. If weight gains are normal and there are normal amounts of urine and bowel motions in the baby’s nappies, then the vomiting is not a medical problem.
If your baby is vomiting excessively and unsettled, this could be due to an allergy to cows’ milk protein or another food in your diet if you are breastfeeding, or another health condition, and should be assessed by a doctor.
Diagnosis of lactose intolerance
Various methods may be used to diagnose lactose intolerance, including:
- hydrogen breath test – this tests the amount of hydrogen that is breathed out. When lactose is fermented by bacteria in the bowel, instead of being converted by lactase, more hydrogen is produced
- elimination diet – this involves removing foods that contain lactose to see if the symptoms improve. If the symptoms reappear once the foods are reintroduced, then lactose intolerance is most likely the cause.
Another cheap and simple ‘test’ is to compare whether the person can tolerate lactose-free milk rather than ordinary milk.
Management of lactose intolerance
Most people with lactose intolerance can handle small amounts of lactose, such as a glass of milk, which contains 8–10 grams of lactose.
Some helpful tips include:
- Don’t give up milk products entirely. They are an important source of nutrients, especially calcium.
- Hard and matured cheeses such as cheddar, Edam, Swiss, mozzarella, brie and fetta contain no lactose and are tolerated by people with lactose intolerance.
- Similarly, butter and cream contain very low levels of lactose and are well tolerated.
- Yoghurt is usually well tolerated because the lactose content decreases each day as the bacteria use lactose for energy.
- Fresh cheeses such as cottage cheese and ricotta have very low levels of lactose and are usually well tolerated in small amounts.
- Drink milk in moderate quantities. Most people with this condition can tolerate 240 ml of milk per day, but you need to work out your own tolerance level. You can buy milk that has had the lactose broken down, which makes it lactose free.
- Drink full-fat milk because the fats slow the journey of the milk through the intestines and allow the lactase enzymes more time to break down the sugars.
- Avoid low-fat or non-fat milks – they travel quickly through the gut and tend to cause symptoms in lactose intolerant people. Also, many low-fat milk products may contain skim milk powder, which provides a higher dose of lactose.
- Eat foods that contain lactose in combination with other foods or spread them out over the day, rather than eating a large amount at once.
- Soy foods such as soy milk and yoghurt are lactose free, a good source of calcium and a good substitute for milk or milk products.
Foods that may contain hidden lactose include:
- biscuits and cakes (if milk or milk solids are added)
- processed breakfast cereals
- cheese sauce
- cream soups
- milk chocolate
- pancakes and pikelets
- scrambled eggs
- muesli bars
- some breads and margarine (containing milk).
Checking food labels for lactose
If you are trying to avoid lactose, ingredients to look for in lists on food labels include:
- milk solids
- non-fat milk solids
- milk sugar.
Where to get help
Lactose intolerance – NHS
Lactose intolerance is a common digestive problem where the body is unable to digest lactose, a type of sugar mainly found in milk and dairy products.
Symptoms of lactose intolerance
Symptoms of lactose intolerance usually develop within a few hours of consuming food or drink that contains lactose.
They may include:
- a bloated stomach
- stomach cramps and pains
- stomach rumbling
- feeling sick
The severity of your symptoms and when they appear depends on the amount of lactose you have consumed.
Some people may still be able to drink a small glass of milk without triggering any symptoms, while others may not even be able to have milk in their tea or coffee.
When to seek medical advice
The symptoms of lactose intolerance can be similar to several other conditions, so it’s important to see your GP for a diagnosis before removing milk and dairy products from your diet.
For example, the symptoms above can also be caused by:
- irritable bowel syndrome (IBS) – a long-term disorder that affects the digestive system
- milk protein intolerance – an adverse reaction to the protein in milk from cows (not the same as a milk allergy)
If your GP thinks you have lactose intolerance, they may suggest avoiding foods and drinks containing lactose for 2 weeks to see if your symptoms improve.
What causes lactose intolerance?
The body digests lactose using a substance called lactase. This breaks down lactose into 2 sugars called glucose and galactose, which can be easily absorbed into the bloodstream.
People with lactose intolerance do not produce enough lactase, so lactose stays in the digestive system, where it’s fermented by bacteria.
This leads to the production of various gases, which cause the symptoms associated with lactose intolerance.
Depending on the underlying reason why the body’s not producing enough lactase, lactose intolerance may be temporary or permanent.
Most cases that develop in adults are inherited and tend to be lifelong, but cases in young children are often caused by an infection in the digestive system and may only last for a few weeks.
In the UK, lactose intolerance is more common in people of Asian or African-Caribbean descent.
Lactose intolerance can develop at any age. Many cases first develop in people aged 20 to 40, although babies and young children can also be affected.
Is it an allergy?
Lactose intolerance is not the same as a milk or dairy allergy. Food allergies are caused by your immune system reacting to a certain type of food. This causes symptoms such as a rash, wheezing and itching.
If you’re allergic to something, even a tiny particle can be enough to trigger a reaction, while most people with lactose intolerance can still consume small amounts of lactose without experiencing any problems, although this varies from person to person.
Treating lactose intolerance
There’s no cure for lactose intolerance, but cutting down on food and drink containing lactose usually helps to control the symptoms.
Lactose-free products include:
- lactose-free cows’ milk
- soya milks, yoghurts and some cheeses
- rice, oat, almond, hazelnut, coconut, quinoa and potato milks
Your GP may also recommend calcium and vitamin D supplements.
You may be advised to take lactase substitutes, which are drops or tablets you can take with your meals or drinks to improve your digestion of lactose.
Complications of lactose intolerance
Milk and other dairy products contain calcium, protein and vitamins, such as A, B12 and D.
Lactose also helps your body absorb a number of other minerals, such as magnesium and zinc.
These vitamins and minerals are important for the development of strong, healthy bones.
If you’re lactose intolerant, getting the right amount of important vitamins and minerals can prove difficult.
This may lead to unhealthy weight loss and put you at increased risk of developing the following conditions:
- osteopenia – where you have a very low bone-mineral density; left untreated, it can develop into osteoporosis
- osteoporosis – where your bones become thin and weak, and your risk of breaking a bone is increased
- malnutrition – when the food you eat does not give you the nutrients essential for a healthy functioning body; this means wounds can take longer to heal and you may start to feel tired or depressed
If you’re concerned that dietary restrictions are putting you at risk of complications, you may find it helpful to consult a dietitian.
They can advise you on your diet and whether you require food supplements.
Your GP should be able to refer you to an NHS dietitian free of charge. Or you can contact a private dietitian.
The British Dietetic Association has information on how to find a private dietitian.
Page last reviewed: 25 February 2019
Next review due: 25 February 2022
Symptoms & Causes of Lactose Intolerance
What are the symptoms of lactose intolerance?
If you have lactose intolerance, you may have symptoms within a few hours after you have milk or milk products, or other foods that contain lactose. Your symptoms may include
Your symptoms may be mild or severe, depending on how much lactose you have.
If you have lactose intolerance, you may have symptoms within a few hours after you have foods or drinks
that contain lactose.
What causes lactose intolerance?
Lactose intolerance is caused by lactose malabsorption. If you have lactose malabsorption, your small intestine makes low levels of lactase—the enzyme that breaks down lactose—and can’t digest all the lactose you eat or drink.
The undigested lactose passes into your colon. Bacteria in your colon break down the lactose and create fluid and gas. In some people, this extra fluid and gas causes lactose intolerance symptoms.
In some cases, your genes are the reason for lactose intolerance. Genes play a role in the following conditions, and these conditions can lead to low levels of lactase in your small intestine and lactose malabsorption:
- Lactase nonpersistence. In people with lactase nonpersistence, the small intestine makes less lactase after infancy. Lactase levels get lower with age. Symptoms of lactose intolerance may not begin until later childhood, the teen years, or early adulthood. Lactase nonpersistence, also called primary lactase deficiency, is the most common cause of low lactase levels.
- Congenital lactase deficiency. In this rare condition, the small intestine makes little or no lactase, starting at birth.
Not all causes of lactose intolerance are genetic. The following can also lead to lactose intolerance:
- Injury to the small intestine. Infections, diseases, or other conditions that injure your small intestine, like Crohn’s disease or celiac disease, may cause it to make less lactase. Treatments—such as medicines, surgery, or radiation therapy—for other conditions may also injure your small intestine. Lactose intolerance caused by injury to the small intestine is called secondary lactose intolerance. If the cause of the injury is treated, you may be able to tolerate lactose again.
- Premature birth. In premature babies, or babies born too soon, the small intestine may not make enough lactase for a short time after birth. The small intestine usually makes more lactase as the baby gets older.
What is the difference between lactose intolerance and milk allergies?
Lactose intolerance and milk allergies are different conditions with different causes. Lactose intolerance is caused by problems digesting lactose, the natural sugar in milk. In contrast, milk allergies are caused by your immune system’s response to one or more proteins in milk and milk products.
A milk allergy most often appears in the first year of life, while lactose intolerance typically appears later.3,4 Lactose intolerance can cause uncomfortable symptoms, while a serious allergic reaction to milk can be life threatening.
 Luyt D, Ball H, Makwana N, et al; Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). BSACI guideline for the diagnosis and management of cow’s milk allergy. Clinical and Experimental Allergy. 2014;44(5):642–672.
 Bayless TM, Brown E, Paige DM. Lactase non-persistence and lactose intolerance. Current Gastroenterology Reports. 2017;19(5):23.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:
Rachel Fisher, M.S., M.P.H., R.D., NIDDK Office of Nutrition Research
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.
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.
- 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).
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.
- salad cream, salad dressing and mayonnaise
- boiled sweets
- 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.
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
- 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.
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.
Lactose intolerance: Symptoms, diagnosis, and treatment
Lactose intolerance happens when a person’s body cannot break down lactose properly. Symptoms include bloating, flatulence, and diarrhea.
Lactose is a sugar found only in milk. It is also present in dairy products and products made from milk, including cheese and ice cream.
If a person has lactose intolerance, their digestive system produces too little of an enzyme known as lactase. Lactase is needed to break down lactose.
Lactose intolerance is different from a milk allergy. In a milk allergy, the body reacts to milk proteins, not milk sugar. A milk allergy can result in severe symptoms, including anaphylaxis.
Worldwide, an estimated 68% of people have trouble digesting lactose. The figure is lower in the U.S., affecting 36% of individuals.
This article looks at the symptoms, diagnosis, causes, and treatments for lactose intolerance. It also discusses foods to avoid and alternatives to dairy products.
People with lactose intolerance experience symptoms after eating or drinking milk or dairy products that contain lactose.
Symptoms can range from mild discomfort to a severe reaction. This depends on how much lactase a person’s body produces and how much lactose they consumed.
Most people with lactose intolerance can eat some amount of lactose without experiencing symptoms. Each person has a different tolerance level.
Symptoms of lactose intolerance can include:
The person may have a sudden urge to use the bathroom 30 minutes to 2 hours after consuming lactose.
Chronic diarrhea can lead to dehydration, so it is important for a person to drink plenty of water if they have diarrhea.
If a person suspects that they are lactose intolerant, they can keep a food diary that lists the foods they eat and any symptoms that arise. This can help them and their physician work out which foods are causing the symptoms.
Most healthcare providers recommend that people try a lactose free diet for a period to see if symptoms improve.
Some tests can detect a lactose intolerance. They are:
- Hydrogen breath test: The person fasts overnight and then takes a lactose solution the following morning. A physician then measures the levels of hydrogen in exhaled air. High levels of hydrogen indicate lactose intolerance.
- Lactose tolerance test: The person consumes a lactose solution, and a physician takes blood samples to measure their glucose levels. If blood glucose levels remain the same, the body has not broken down the lactose properly.
- Stool sample test: Lactose tolerance tests and hydrogen breath tests are not suitable for infants, so a physician may perform a stool test. High levels of acetate and other fatty acids in the stool can be a sign of lactose intolerance.
Physicians will also want to rule out other conditions that can cause similar symptoms. These include inflammatory bowel disease, irritable bowel syndrome, and celiac disease.
For more science-backed resources on nutrition, visit our dedicated hub.
To avoid symptoms, a person with a severe lactose intolerance may need to avoid milk, milk products such as ice cream, and other processed foods that contain milk powder and whey.
Avoiding lactose may require some trial and error, but food labeling can help, as a product that contains lactose must have a label stating that it contains “milk.”
Many people with lactose intolerance can tolerate up to 10 grams of lactose, or around a glass of milk, without significant symptoms. Spreading consumption throughout the day, and consuming lactose-containing products with meals, can increase tolerance.
People can use lactase enzyme supplements, which contain lactase, to break down the lactose in milk and milk products. This lowers the chances of lactose intolerance symptoms.
Lactase is an enzyme produced in the small intestine. The body uses lactase to break down lactose into components called galactose and glucose. The glucose is then absorbed into the bloodstream.
If a person’s lactase levels are low, the lactose does not break down and it does not absorb into the bloodstream. Instead, it moves into the large intestine, or colon. Bacteria in the colon react to any product that contains lactose by creating more gas. That can lead to discomfort and other unpleasant symptoms for the individual.
In some regions, more people carry a gene that allows them to digest lactose. Lactose intolerance is less common in people who are from Europe, or whose families are from Europe.
In the U.S., the following ethnic and racial groups are more likely to have trouble digesting lactose:
- African Americans
- American Indians
- Asian Americans
Some people believe that it is not natural for people to drink milk, as humans are the only mammals that continue to consume milk products after weaning. Lactose intolerance, they argue, is not a medical condition but a natural occurrence.
Lactose intolerance is often inherited. The types include:
- Primary lactase deficiency, which is the most common type of lactose intolerance. It is genetic and symptoms often appear when an infant is weaned from milk to solids. Lactase production drops, and symptoms of intolerance appear.
- Congenital lactase deficiency, which is when a person is born with a genetic mutation results in them producing very little or no lactase.
- Familial lactase deficiency, which is when a person produces enough lactase, but the person does not break down the lactose for absorption into the bloodstream.
In some people, lactase levels drop from an early age, but the symptoms of lactose intolerance may not appear until they are an older child or adult.
There is also a condition called secondary lactase deficiency, in which a problem with the small intestine results in too little lactase production. Possible causes are:
If the underlying condition is chronic, such as Crohn’s disease, the resultant intolerance is often long-term too. An intolerance that starts with a short-term condition, such as gastroenteritis, normally passes within a few days or weeks.
Most milk and milk products have lactose in them, and many processed foods have milk and dairy products added to them.
Lactose is a sugar found in the milk of most mammals in similar amounts, except for some sea mammals. Different dairy products can, however, contain different amounts of lactose depending on how they are processed.
Any product with milk, lactose, whey, curds, milk byproducts, dry milk solids or non-fat dry milk powder listed in its ingredients will have lactose in it.
Foods that commonly contain lactose include:
- cakes and biscuits
- cheese sauce
- cream soups
- milk chocolate
- scrambled eggs
To avoid symptoms, a person with a lactose intolerance should check food labels carefully, as some foods may contain hidden lactose.
- muesli bars
- breakfast cereals
- some instant soups
- boiled candies
- chocolate candies and bars
- some processed meats, such as sliced ham
- salad dressing and mayonnaise
Around 20% of drugs contain lactose as a filler. These might include birth control pills, over-the-counter drugs, and treatments for stomach acid.
In many societies, dairy products are an important source of nutrients, including calcium, protein, and vitamins A, B12, and D. When eliminating dairy, it is important to get these nutrients from elsewhere.
Many alternative dairy products, including soy milk, almond milk, and alternative cheeses, are reinforced with vitamins.
Sources for these vitamins other than dairy include:
- Calcium: Seaweeds, nuts and seeds, blackstrap molasses, beans, oranges, figs, quinoa, amaranth, collard greens, okra, rutabaga, broccoli, dandelion leaves, kale, and fortified products such as orange juice and plant milks. Read more here.
- Vitamin A: Carrots, broccoli, sweet potatoes, cod liver oil, liver, spinach, pumpkin, cantaloupe melon, egg, apricot, papaya, mango, and peas.
- Vitamin D: Levels can be enhanced by exposure to natural sunlight, consuming fatty fish, egg yolk, fish liver oils, and some fortified plant milks, as well as other fortified products, including many breakfast cereals.
- Lactose-free milk: A person with severe symptoms should check the label to ensure that lactose levels are zero, and not just reduced. Vegetable-based milks also contain less protein than cow’s milk.
It is best to talk to a doctor or dietician before making significant dietary changes.
Read about alternatives to milk, cheese, cream, and more here.
Lactose intolerance happens when a person’s body is unable to break down proteins in milk. It is very common, and can cause mild to severe symptoms.
While there is no cure for lactose intolerance, people can prevent symptoms by avoiding milk and products that contain milk, or by taking lactase enzymes.
Alternatives to milk and other dairy products are becoming increasingly popular in the West, and more of those products are becoming available all the time.
9 Signs of Lactose Intolerance You Shouldn’t Ignore
While a food allergy will cause obvious (often severe) symptoms, food intolerances often fly under the radar. When you have an intolerance, your body doesn’t know how to digest something—often a protein or enzyme—found in the food you’re eating. As a result, your body can only partially break it down. But instead of life-threatening symptoms, as would be the case with an allergy, an intolerance — like lactose intolerance — typically gives you mild to moderate ones, meaning you may not even realize you have a problem.
Lactose intolerance is probably the most common of all the food intolerances, affecting around 36 percent of Americans. If you have lactose intolerance, your intestines don’t produce enough of an enzyme called lactase that breaks down the sugar, or lactose, found in milk. This also applies to other dairy products like cheese, yogurt, and ice cream (Related: Lactose-Free Milk Solved My Bloating—It Could Work For You, Too)
Your symptoms can vary based on how much lactase you produce. If your levels are moderately low, you might have a dairy “threshold,” or a maximum amount of lactose you can consume before feeling sick. If your lactase levels are very low, however, you may not be able to tolerate much lactose at all.
It’s usually not dangerous or harmful to your health to eat a food you’re intolerant of, but it can definitely be uncomfortable. And consuming more lactose than you can digest will cause all kinds of unpleasant symptoms. If your daily serving of yogurt is accompanied by a daily bout of gastrointestinal distress, you may be lactose intolerant; here are nine key symptoms to look for. Read on, and for more on how to eat for better health, you won’t want to miss The Best Ways to Lose Belly Fat for Good, Say Doctors.
Having trouble zipping up your jeans after eating dairy may not be because you overindulged; it could be that any amount of dairy would make you feel bloated and uncomfortable.
“If you have lactose intolerance, you may experience symptoms such as bloating or gas within 30 minutes to two hours after consuming a lactose-containing food or drink,” says Amy Gorin, MS, RDN, a registered dietitian in the New York City area and owner of Plant-Based Eats.
The timing is key for most people: if you feel bloated soon after eating dairy products, it could be an important clue. But if it happens even after eating non-dairy products, your intolerance is probably related to another type of food (like gluten) or simply the way you eat (too fast, maybe?).
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One of the most common signs that you have a lactose intolerance is abdominal pain or cramping that follows consumption of dairy products. If you’re always complaining of a stomach ache after enjoying a bowl of ice cream or noshing on a cheese board, it could be because your stomach is not digesting lactose properly.
“The [undigested] lactose sits in the gut, where it is broken down by bacteria that can produce gas and cause uncomfortable bloating and cramping,” explains New Jersey-based registered dietitian Erin Palinski-Wade, RD, CDE, LDN author of Belly Fat Diet For Dummies.
If you’re predisposed to symptoms of acid reflux like heartburn and indigestion, having a lactose intolerance can make things worse. This isn’t the most common symptom of lactose intolerance, but it is an indicator that cutting back on dairy could help your symptoms. since dairy is high in fat and also known to relax the sphincter muscle of the esophagus (allowing more acid to travel upward), your reaction to dairy can really start to add up here if you’re sensitive to lactose at all.
So far, no studies have looked directly at the connection between lactose intolerance and indigestion, but several have studied the relationship between cow’s milk allergy and acid reflux. Caused by the protein found in cow’s milk, this allergy is common in young children and frequently goes hand-in-hand with symptoms of acid reflux; in a small 2012 study from The Journal of Pediatrics, parents who eliminated cow’s milk from their child’s diet reported a decrease in episodes of reflux.
Do you find yourself running to the bathroom whenever you eat yogurt or drink a glass of milk? Do you need to carry anti-diarrheal tablets around with you “just in case” your fancy Italian restaurant dinner comes with a side of *ahem* unpleasantness?
If so, you could have lactose intolerance. Diarrhea is a warning sign that your stomach is not tolerating your dairy consumption, says Palinski-Wade, who adds that the amount of dairy you consume can play a role in the severity of your symptoms: “Generally, the more lactose consumed, the worse the symptoms, so a small amount of lactose may trigger gas or bloating whereas eating a large amount may lead to diarrhea.”
While gas can be the cause for some other symptoms on this list, like bloating and cramps, it can be bad enough to be a symptom in itself. Eating dairy when you have lactose intolerance can cause severe flatulence (which is not only uncomfortable but obviously fairly embarrassing, too).
“When you’re deficient in [lactase], the lactose in the foods you eat moves into the colon rather than being processed and absorbed within the body,” explains Gorin. “In the colon, the undigested lactose commingles with the normal bacteria and causes unpleasant symptoms such as gas.”
There’s no specific reason for why eating dairy with a lactose intolerance causes nausea, but it’s a widely recognized symptom. Some experts speculate that it’s possibly because of the overgrowth of bacteria that occurs when your colon struggles to digest the lactase you’ve consumed.
A 2015 study published in Nutrients found a relationship between bacterial overgrowth in the small intestine and the prevalence of lactose intolerance in patients with irritable bowel syndrome (IBS). The authors note that this overgrowth is often to blame for the uncomfortable abdominal symptoms many people with a lactose intolerance experience.
Another less-common but still possible symptom of lactose intolerance is constipation. While diarrhea is more likely, there are people who experience the total opposite problem with their bowel movements.
In an older study on lactose intolerance published in Alimentary Pharmacology and Therapeutics, researchers noted that improper digestion of lactose can disrupt something called gut motility, a.k.a. your colon’s ability to move food waste through your digestive system. Too fast and you end up with diarrhea…but too slow and you could end up with constipation, most likely because of the increased amounts of gas in your colon caused by the buildup of lactose.
Maybe you don’t check the toilet bowl before flushing when you have a bowel movement, but you probably should: how your stool looks can tell you a lot about your overall health. And if you see greasy, orange-colored, or fatty deposits floating around in your stool after you go, that’s a sign that all is not well in your colon.
“When you see a greasy or fatty stool, this can be a sign of malabsorption within the body,” says Gorin. With a lactose intolerance, your body doesn’t digest the milk sugar; instead, it sits around in your colon (and blocks its absorption of other key nutrients).
Any time your stool doesn’t look the way it should (i.e. soft, smooth, and brownish in color) it’s good practice to give your doctor a call and see what they think might be the cause.
Finally, there is a chance that some other common allergic symptoms can be caused by lactose intolerance. Again, the research is older (and not thorough enough to be definitive), but some studies suggest a connection between a person’s inability to digest lactose and recurring allergy symptoms like eczema and sinus congestion.
For example, a Postgraduate Medical Journal review studied small groups of patients reporting itching, skin rashes, nasal allergy symptoms, and asthma and found that many of the patients ultimately diagnosed as lactose intolerant during the testing period reported symptoms like eczema, rhinitis, and sinusitis. If it isn’t dairy, your skin problems may also be linked to these 6 Worst-Ever Foods for Your Skin.
90,000 Lactose intolerance: causes, symptoms, analysis
Are you suffering from cramps and bloating? Can you hear the rumbling in your stomach? Are you periodically worried about loose stools? If these signs appear some time after the intake of milk and milk-containing products, one can assume the presence of lactose intolerance (hypolactasia).
Why does such a pathology arise 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.
Mechanism of development of hypolactasia
Lactose intolerance occurs when lactase is completely absent or insufficient. 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 penetrate the intestinal wall into the bloodstream.
In case of a lack or absence of lactase, milk sugar in an unbroken 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 in children is much less common than in adults. It can be congenital and acquired. Alactasia, or complete absence of an 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 condition is quite rare. More often, you can observe the functional immaturity of the enzyme system of infants, which leads to 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.
The risk of developing this pathology is increased by such factors as age, ethnicity (in the countries of North America, Africa, Southeast Asia, the percentage of those suffering from hypolactasis is higher), premature birth.
How is lactose intolerance manifested?
Rumbling and bloating in the stomach, 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 that have expired or are incompatible.In both cases, if you have the symptoms mentioned above, you should consult a doctor.
Diagnosis of lactose intolerance
A biopsy of the mucous membrane of the small intestine is a direct way of measuring the activity of the enzyme lactase it contains. Due to the trauma and complexity of this study, it is used during operations or other vital interventions.
Genetic tests identify genes that block the production of lactase.
One of the most common indirect tests for lactose intolerance, among others, is the lactose load test. It is based on a comparison of blood glucose values 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. Otherwise, it can be concluded that lactase does not work.
How to treat lactose intolerance?
Primary hypolactasia is a kind of norm, not a disease, therefore there is no specific treatment for this form of lactose intolerance, but a lactose-free diet must be followed.Secondary hypolactasia is corrected in the treatment of the underlying disease that led to its development. Taking the missing enzyme in the form of tablets and drops must be combined with a balanced diet developed by a nutritionist.
Do not forget that with a mild degree of lactose intolerance, you can avoid the occurrence of unpleasant symptoms if you reduce the amount of whole milk you drink and include lactose-free cheese, cottage cheese, kefir, yogurt in the diet. Eating milk porridge will cause much less consequences than a glass of milk, since lactose will enter the intestines in portions, and its processing will be more efficient.
90,000 Lactose Intolerance | Symptoms, complications, diagnosis and treatment
People with lactose intolerance are unable to completely 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 this 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 any 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 lactose-containing foods. Common signs and symptoms include:
- Nausea and sometimes vomiting
- Abdominal cramps
Make an appointment with your doctor if you frequently experience symptoms of lactose intolerance after consuming dairy products, especially if you are concerned about getting enough calcium.
Lactose intolerance occurs when the small intestine does not produce enough enzyme (lactase) to digest milk sugar (lactose).
Typically, 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 your food travels to the colon instead of being processed and absorbed. In the colon, normal bacteria interact with undigested lactose, causing signs and symptoms of lactose intolerance.
There are three types of lactose intolerance. Various factors cause a lactase deficiency underlying each type.
Primary lactose intolerance
This is the most common type of lactose intolerance. People with primary lactose intolerance start their lives by producing large amounts of lactase – a necessity 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.
With primary lactose intolerance, lactase production drops sharply, which makes it difficult to digest dairy products in adulthood. Primary lactose intolerance is genetically determined, which occurs in a significant proportion of people of African, Asian or Latino ancestry. This condition is also common among Mediterranean or southern European descent.
Secondary lactose intolerance
This form of lactose intolerance occurs when the small intestine decreases lactase production after illness, injury, or surgery using the small intestine.Among the diseases associated with secondary lactose intolerance are celiac disease, bacterial growth and Crohn’s disease. Treating the underlying disorder can restore lactase levels and improve symptoms and symptoms, although this may take a while.
Congenital or developing lactose intolerance
This disorder is passed down from generation to generation through an inheritance called autosomal recessive. Premature babies can also be lactose intolerant due to insufficient lactase levels.
Factors that may make you or your child more prone to lactose intolerance include:
- Growing up. Lactose intolerance usually appears in adulthood. This condition is rare in children and young children.
- Ethnicity. Lactose intolerance is most common in African, Asian, Hispanic and American Indians.
- Premature birth. Babies born prematurely may have decreased lactase levels because the small intestine does not develop lactase-producing cells until the late third trimester.
- Diseases affecting the small intestine. Small bowel problems that can cause lactose intolerance include bacterial growth, celiac disease, and Crohn’s disease.
- Certain cancer treatments. If you have had radiation therapy for abdominal cancer or intestinal complications from chemotherapy, you have an increased risk of lactose intolerance.
Lactase deficiency in adults
Lactase deficiency is a violation of the breakdown of lactose due to a deficiency of the enzyme lactase of the mucous membrane of the small intestine, accompanied by clinical symptoms.
Lactose is milk sugar. The enzyme that breaks down lactose is called lactase.
Adult-type lactase deficiency develops after a period of breastfeeding. This is due to the gradual decrease in lactase activity with age.After ingestion of dairy products or whole milk, as a rule, intestinal disorders (diarrhea, flatulence) appear. Prevention and treatment consists of adhering to a diet low in lactose or completely eliminating it.
Congenital lactase deficiency in adults (type with delayed onset), primary lactase deficiency of the adult type, hypolactasia, lactose intolerance, lactose malabsorption.
#OMIM 223100, Lactose intolerance, adult type, Hypolactasia, adult type, Disaccharide intolerance III.
Lactase deficiency is characterized by the development of intestinal symptoms after ingestion of milk and dairy products: flatulence, pain and rumbling in the abdomen, diarrhea, bloating. Nausea is possible. The stool is liquid or mushy, light yellow in color, with a sour odor.
General information about the disease
Lactase deficiency, or primary lactase deficiency, is a violation of lactose breakdown due to a deficiency of the lactase enzyme of the mucous membrane of the small intestine, accompanied by clinical symptoms.It is caused by a genetically determined decrease in its production, which manifests itself in the inability to absorb milk sugar (lactose).
The activity of lactase is manifested from the 12-14th week of intrauterine development and reaches its maximum values by the time of birth (at a period of 39-40 weeks). After birth, lactase is produced in large quantities, but by the end of the first year of life, its production decreases. This is the primary, or congenital, late-onset lactase deficiency, which is inherited in an autosomal recessive manner.
Nonspecific abdominal symptoms (bloating, upset stools, nausea) develop after eating foods containing lactose, mainly whole milk and dairy products. But today lactose is added to other food products (for example, meat, confectionery). The pharmaceutical industry also uses it as an excipient.
The severity of symptoms of hypolactasia depends on the individual physiological characteristics of a person, intestinal microflora, diet, psychological factors.Deliberate avoidance of milk, which is an important source of calcium, can lead to a deficiency of this element and, as a result, to osteoporosis. Keep this in mind and cover your daily requirement with other calcium-rich foods. This is especially important for postmenopausal women.
Primary lactase deficiency should be distinguished from secondary (acquired), which occurs when the mucous membrane of the small intestine is damaged against the background of any acute or chronic disease.Such damage is possible with infectious (intestinal infection), immune (intolerance to cow’s milk protein), inflammatory processes in the intestines, atrophic changes (with celiac disease, after a long period of complete parenteral nutrition, etc.).
Also, this disorder should not be confused with congenital lactase deficiency, a rare genetic disorder, the symptoms of which appear immediately after birth and are associated with the initiation of breastfeeding.
There is a genetic diagnosis of late-onset primary lactase deficiency.The region of the MCM6 gene is one of the important regulatory elements of the lactase gene. The genetic marker MCM6 (C (-13910) T) is associated with lactose intolerance.
Who is at risk?
- Persons with relatives with intolerance to milk and dairy products.
- Specified ethnic groups. Lactose intolerance is most common in North America, Africa, Southeast Asia (the incidence of lactase deficiency is 70-100%). In the Russian population, lactase deficiency is observed in about 16%.
- The condition is rare in the first year of life, the development of lactose intolerance is associated with adulthood.
The diagnosis can be assumed on the basis of genealogical data, the results of coprology (an increase in starch, fiber, iodophilic microflora, a decrease in fecal pH less than 5.5), determination of carbohydrates in feces. The diagnosis uses a hydrogen breath test. The concentration of hydrogen in exhaled air is determined before and after loading with lactose.In patients with lactase deficiency, an increase in hydrogen content is recorded, which is associated with increased bacterial breakdown of lactose in the colon. That is, lactose, which is not completely absorbed in the small intestine, reaches the large intestine, where it is broken down by anaerobic microflora.
Molecular genetic research for susceptibility to lactase deficiency is important in diagnostics. The analysis will help in the differential diagnosis of the causes of lactose malabsorption and in the selection of an appropriate diet.
In case of severe clinical manifestations, refusal of milk, it is also important to determine the calcium content in blood serum and in urine.
Diet therapy: restriction of foods containing lactose.
Prescription of enzyme preparations that break down lactose is possible.
It is allowed to use fermented milk products with a reduced amount of lactose (yoghurts, curdled milk), cottage cheese, butter, hard cheeses, as well as lactose-free.
It is important to take into account the possible lack of calcium intake on a dairy-free diet, which is recommended to be compensated for with other foods rich in it, or with medications.
In young children, lactase deficiency is often combined with intolerance to cow’s milk proteins. In this case, special mixtures are prescribed based on a complete milk protein hydrolyzate.
According to indications – antidiarrheal drugs, enzyme preparations, vitamin D preparations and other vitamin complexes, preparations for the restoration of intestinal biocenosis.
Prevention consists in preventing the symptoms of hypolactasia by following a diet low in lactose or none at all. Therefore, if symptoms of indigestion are detected after consuming unfermented dairy products, it is advisable to carry out a genetic test for lactase activity in order to avoid attempts at pointless treatment and choose an appropriate diet. The test also helps predict lactose intolerance in children in order to prevent unexpected bowel disorders.
90,000 dysbiosis, lactase deficiency and sowing milk for sterility
Once I received an assignment from my management to answer a question from our American colleague, a breastfeeding consultant from La Lache League: “At parenting conferences on the Internet, Russian mothers very often discuss three issues: lactase deficiency, dysbiosis and sowing milk for sterility . What is meant?”
The first two conditions resemble what they, in LLL, are called fore and hind milk imbalances and dysbiosis.But these conditions are not a terrible pathology, and on the sites they are discussed from this point of view. About sowing milk for sterility – the American asked at all, why do they do it ??
I’ll start in order.
Lactase deficiency (or lactose intolerance)
According to special literature, diseases of carbohydrate metabolism associated with changes in the activity of enzymes that break down sugars, including lactose, are extremely rare in the population. Data varies from country to country.The incidence of these diseases ranges from 1 in 20,000 to 1 in 200,000 children. Why do pediatricians talk about lactose intolerance in almost every second child?
How could humanity survive if this disease, leading, for example, to malnutrition in the absence of treatment and death, occurs in most babies? Humanity was able to survive to the present time because true lactose intolerance, caused genetically and associated with a complete absence or serious deficiency of necessary enzymes, is very rare.And what happens very often? What do modern doctors constantly face? With lactose intolerance resulting from improperly organized breastfeeding.
If a mother feeds her baby 6-7 times a day, “saves” milk for feeding, decant after feeding, transfers the baby to one breast or the other during feeding, the likelihood of developing lactose intolerance is very high. This is the same lactose intolerance, the cause of which is the imbalance between the “front” and “back” portions of milk.It turns out that the child feeds mainly on the “front” portion of milk, which is more liquid and contains a large amount of lactose. Between feedings, the breast also collects mainly “front” milk, “back” milk, thick, more fatty, is formed mainly during the sucking of the baby. If the mother transfers the baby 5-10 minutes after the start of feeding to the other breast, he will suck the fore milk out of it too. Mom will express the back milk. The baby will not gain weight very well, sometimes just a little.He may have loose, green, foamy stools. Mom will think that she has bad milk, although there is a lot of it.
The same situation can be if the mother restricts the baby in sucking, for example, strictly for 15-20 minutes. The baby often does not have time to get to the rear milk. And, in addition, he does not sufficiently stimulate the breast to produce milk, if he sucks for 15-20 minutes 6-7 times a day. Therefore, in parallel, in the situations described above, a lack of milk will develop. When a child begins to be fed a lactose-free formula, he will begin to get fat, everyone will breathe a sigh of relief, and the myth that milk can be bad and there is little of it in modern women will strengthen in the mind.There is also a transient, temporary lactase deficiency. A child on properly organized breastfeeding, with good weight gain, generally with good health, in the first 2-3 months of life (and sometimes longer), the stool is foamy. If mom tells the doctor about this, an examination will be scheduled, and sugars will be found in the analysis. The child will be transferred to a lactose-free mixture. However, incomplete absorption of lactose is common for a breastfed baby !!! (66% of children at 6 weeks and 60% of children at 3 months).
One mother, for example, was told in such a situation: “Your child is in great pain! Look at how much gas it has! And you continue to feed him with your milk! It is poison for him !!! ” I am not suggesting that all doctors do this. I know pediatricians who, seeing that the child is quite well, do not begin to treat him, relying only on the laboratory results obtained, and do not even prescribe unnecessary examinations! Let’s remember that for the last 50 years, doctors have dealt mainly with children who were fed formula.Accordingly, much of the knowledge and laboratory tests are applicable only to this group of children. The presence of sugar in the stool of a bottle-fed child is a pathology. Sugar in the stool of a breastfed baby is normal!
A significant amount of sugar can be the result of incorrect recommendations for feeding the baby (frequent breast changes during feeding, limiting the duration of sucking, pumping after feeding), because the baby gets a lot of lactose-rich foremilk.Lactose intolerance and a newborn baby is an unheard-of combination !!!
Dysbacteriosis of the newborn
This condition is extremely popular. The baby is known to be born with sterile intestines. If from the moment of birth nothing but the mother’s nipple gets into his mouth (which, by the way, is only designed by nature), then quite quickly the child’s gastrointestinal tract is seeded with normal microflora. Colostrum and breast milk contain factors that promote the growth of normal microflora and suppress pathogenic ones.In the event that breastfeeding was organized incorrectly (and this case, unfortunately, is the most common), if already in the first day after giving birth, before becoming acquainted with the maternal microflora, the baby began to receive a variety of fluids through the mouth, the colonization of the intestine is far from ideal.
But even so, breast milk will help to cope with the problems. The most interesting thing happens when the child appears at home. The normal stool of a breastfed baby is liquid, yellow, with white lumps, maybe 7-10 times a day, a little bit or 1 time in several days, but in a large volume.Most often, stool occurs 3-5 times a day, in babies in the first months of life. Local pediatricians call these normal children’s poop diarrhea and send their mother to have a feces test for dysbiosis.
This does not take into account the fact that the baby for the first six months of life has the right to dysbiosis in his intestines and any stool, especially if at the same time he grows and develops well. Then treatment begins, one of the main points of which is the transfer of the child, for example, to a fermented milk mixture.Pediatricians are not to blame. They are used to bottle-fed stools, which are thicker and more uniform. An even more interesting situation occurs later, when, despite drinking, for example, various biological products, microorganisms that are not suitable for his intestines continue to be sown in the child. In this case, the mother is told that it is all about her milk, and insists on stopping breastfeeding.
The following case is indicative in this respect. The breastfed baby was constantly sown with Candida fungi and hemolyzing Escherichia coli, in large quantities.No treatment had any effect on these microorganisms. Mom was told all the time that the milk was to blame. After feeding the baby to one year old, the mother took him away from the breast. The child began to get sick often, but mushrooms and sticks remained in the same quantities.
Milk culture for sterility
When sowing milk for sterility in 50-70% of cases, various microorganisms are sown, most often Staphylococcus aureus and epidermal. Very often, when these organisms are found, the mother is prescribed a course of antibiotic treatment, at which time the child is fed with a mixture for a week, after which he usually refuses to breast.This is the worst option, but a common one. Either mother and child begin to be treated using biological products, or mother and child drink chlorophyllipt. Meanwhile, the presence of staphylococci in milk means nothing! Both Staphylococcus aureus and Staphylococcus aureus live on human skin, and are also found on most of the surrounding objects. For example, staphylococcus aureus has a tropism for cotton fabric. When you move a stack of diapers, the number of staphylococci in the air increases dramatically! Together with breast milk, the child receives specific antibodies that help him cope with staphylococcus if necessary.
It turns out that staphylococcus aureus of mother’s milk enters the baby along with protection from it. It is not dangerous for the child! Moreover, the child needs, in the first hours after childbirth, to settle in with his mother’s staphylococcus. He will be protected from this staphylococcus by his mother’s antibodies, which he will receive with colostrum and milk, and which he has already received transplacentally! The entire microflora of the mother’s body is already “familiar” to the child’s immune system, thanks to antibodies penetrating transplacentally.For a child, it is dangerous to colonize the maternity hospital with microflora, including hospital strains of antibiotic-resistant staphylococcus! He is not familiar with these microorganisms and their colonization of his skin and gastrointestinal tract is dangerous for the baby. If the child does not have the opportunity to “settle” with the mother’s microflora, he is populated with what is around. As they say, a holy place is never empty. If it is not possible for the “home” strain of Staphyloccocus aureus to settle on the baby, a hospital strain will take its place.But this is not scary for a breastfed baby, the mother’s body, by developing appropriate antibodies, will help the baby. If, of course, there is a place for breastfeeding in a child’s life.
The presence of staphylococcus in milk does not affect its quality in any way. Staphylococcal enterocolitis, with which mothers are often frightened, convincing them to stop feeding with their “poisonous” milk, is an extremely rare condition that occurs in diseases of the immune system, and the occurrence of which is facilitated by artificial feeding! Presumably because even if the baby’s immune system is weakened for some internal reason, he will still receive significant support with breast milk.When transferred to artificial feeding, he loses this support.
Dear colleagues! If you are observing a somatically healthy baby who is breastfeeding, is gaining weight poorly, has green, unstable stools, skin problems, before transferring him to artificial feeding, prescribing examination and treatment, try to find out if breastfeeding is organized correctly. baby? Breastfeeding is a very simple process, if not elementary.But! Only if the breastfeeding mother follows a few simple rules and actions.
These rules and practices related to the culture of motherhood have been widely known and used for millennia. And now they are almost lost. Without knowledge of these rules, full breastfeeding cannot take place.
If the mother feeds the baby 6-7 times a day, uses a pacifier, gives the baby tea or water, decant, does not feed at night – she performs actions for which neither the child nor she herself was designed by nature.It is impossible to establish a natural process by acting unnaturally! If a child has an incorrect attachment to the breast, and no one notices it, this is very sad, because nature did not expect that a woman starting to feed would not gain experience in observing other nursing women during her life and would not have an experienced mother by her side who could correct her.
Without proper attachment, there will not be sufficient breast stimulation to produce the required amounts of milk, even with frequent feedings and it is difficult for a baby with improper attachment to extract “back”, fatty, thick milk from the breast! In such a situation, it is necessary to teach the mother and child how to properly attach to the breast, establish frequent feedings at the request of the child, exclude the use of other oral objects and supplementation, establish full-fledged night feedings, and nullify pumping, if any.Look at the baby again after 2-4 weeks. In 99% of cases, the child will not need artificial nutrition, examination or treatment.
Author: Lilia Kazakova, pediatrician,
Head of the “Breastfeeding and Child Care Consultants Service”
90,000 Lactase deficiency – Aleksandrovskaya Family Clinic
Lactase deficiency is a problem of modern children.
Recommendations of a pediatrician of the highest category Mikhaleva Irina Igorevna.
On the agenda is the next “culprit of all problems” arising in a child in the first months of life with a digestive tract – lactase deficiency. Particularly enlightened parents, and there are more and more of them in our age of universal computer literacy, independently try to “tie” this diagnosis to their baby, and what is most paradoxical, find many supporters among medical workers. More and more often, coming to the first patronage of a newborn child who has just left the door of the maternity hospital with her mother, I hear the question: “When can I get tested for lactase deficiency?” And less and less often, there are doctors who explain to their mother that the treatment of tests is a thankless, costly and most often, ending with a deterioration in the child’s condition.
Let’s deal with this at the same time incomprehensible, but at the same time well-known disease, lactase deficiency. To begin with, let’s define the terms: lactose is milk sugar, the main disaccharide of the milk of all mammals, and therefore of a nursing woman, which provides about half of all energy costs of a child. Consists of two molecules: glucose and galactose, into which it breaks down in the baby’s intestines under the influence of the enzyme lactase.It is not a secret for everyone that it is glucose that is the main source of energy for the body, as for galactose, it plays an important role in the development of the central nervous system. If, for some reason, the lactase enzyme was not enough to digest all the incoming lactose, then the milk sugar passes unchanged into the large intestine, where it is processed by bacteria, but already with the formation of fatty acids, the release of an increased amount of gases. Bottom line: the child’s feces acquire a foamy, liquid character, have a sour smell, the digestion process is accompanied by increased gas production.The child loses weight, since the main source of energy, glucose, is not absorbed, as well as due to the fact that under the influence of the decomposition products of lactose, damage to the intestinal mucosa occurs, and other, necessary elements of milk cannot pass through the intestinal mucosa.
Thus, under lactase deficiency is understood either a reduced activity of the enzyme lactase, or the complete absence of this enzyme in a child. Moreover, we can immediately say that primary lactase deficiency (congenital absence of this enzyme) is a serious disease, but extremely rare in the world.
In most cases, we are talking about:
- or about secondary lactase deficiency, that is, arising under the influence of any reason (most often intestinal infections, or allergy to cow’s milk proteins),
- or about the discrepancy between the incoming volumes of milk and lactase, the existing functional capabilities of the baby’s digestive tract. Transient, that is, passing, lactase deficiency is characteristic to some extent of almost all newborns, since in the first weeks of a baby’s life, the activity of the lactase enzyme is low, but as the child grows up, the enzyme activity increases and the body assimilates lactose in sufficient volume.
- exists, and the so-called adult type of lactase deficiency, it is also genetically determined, that is, as a person grows up, lactase activity decreases (as the proportion of milk in the daily diet decreases). This process is characteristic of almost everyone, starting from the age of 2 years, therefore a very large percentage of the adult population of the country experiences difficulties in consuming whole milk or food based on it.
What symptoms are most often associated with the presence of lactase deficiency in a child:
- Frequent, loose, frothy stools with a sourish odor
- Presence of mucus and undigested lumps in the child’s feces
- Feeding anxiety, baby screaming, throwing breast while feeding, pulling legs in 9080
- bloating, rumbling
- weight loss! The most significant sign to which you need to pay attention to the parents and the pediatrician watching the child’s development
Diagnosis of lactase deficiency is based on an assessment of all the symptoms in the complex, including the condition of the child, the nature of feeding, past diseases, and laboratory methods. I draw your attention to the fact that the test results cannot indicate the presence or absence of lactase deficiency, if they are evaluated separately from clinical manifestations.
There are a number of laboratory and instrumental research methods that allow the doctor to suspect the presence of a disease:
- coprogram – a mandatory research method, lactase deficiency is characterized by a decrease in the pH of the child’s feces below 5.5 and the presence of fatty acids in it.
- analysis of feces for carbohydrates – assessed depending on the age of the child and the nature of his feeding. So, for a child under the age of 1 month who is completely breastfed or artificially fed with a milk formula based on cow’s milk – a variant of the norm would be a carbohydrate content of up to 1%. As the child grows up and is transferred to complementary foods, which means a decrease in the amount of milk in the daily diet, the rate of carbohydrate content also decreases to 0.5 – 0.25% by 6 – 8 months.At the age of 1 year and older – up to 0.9080
- Other research methods (lactose curve, hydrogen test) are based on the fact that the patient is given a load of lactose and the result is assessed by either the lactose breakdown curve in the blood or the amount of hydrogen in the exhaled air. Both methods are of little use in children’s practice, since they cause a lot of unpleasant emotions in the child and parents, ranging from clinical manifestations (pain, bloating, crying of the child), to the need for repeated blood sampling from a vein in the baby for accurate interpretation of the results.
- the most accurate and reliable method, it is also extremely rarely used – a biopsy of the small intestine. An invasive method that requires significant moral costs from the child and the parents.
By clicking on the button you can make an appointment with a specialist!
Thus, having assessed the child’s condition, the data of laboratory research methods and the possible reasons for the development of lactase deficiency in the baby, we turn to possible methods for correcting this condition.
1. To exclude overfeeding of the child with milk, and, consequently, the excess intake of lactose into the intestines of the child. It has long been known that the composition of the front and rear breast milk differs precisely in the greater amount of carbohydrates in the front milk, and relatively more fat in the rear. From this follows a number of tips for organizing breastfeeding, namely:
- Do not express breast after feeding as the baby will receive more lactose-rich front milk during feeding
- to achieve emptying of the breast while feeding the baby, even if you have to apply it to the same breast several times in a row, with a breast change once every 3 hours.
- it is necessary to ensure correct attachment of the baby to the breast
- Night feeds are encouraged as more hind milk is produced at night
2. If there are signs of the development of secondary lactase deficiency, then it is necessary to eliminate the original cause that caused it. The pediatrician is responsible for determining the cause and prescribing treatment!
- with the development of lactase deficiency against the background of an intestinal infection, it will be necessary to cure the infection.
- If signs of allergy to cow’s milk proteins are detected, then whole cow’s milk will need to be excluded from the diet of a nursing mother. If the child is bottle-fed, then it is necessary to choose the right medicinal mixture
3. If all the moments of organizing the regimen could not normalize the baby’s condition, then the pediatrician may prescribe the enzyme lactase. The drug is prescribed in a certain dose, almost before each feeding.The need for prescription, the dose of the drug and the duration of administration (course of treatment) are determined only by the pediatrician. Most often, the need to use lactase passes as the child’s enzyme systems mature, and this happens at the age of 3-4 months of the baby’s life.
4. When artificially feeding a child, it may be necessary to switch to a lactose-free formula. It should be remembered that this type of mixture belongs to medicinal, and, like any drug, can only be prescribed by a pediatrician for a certain period of time.
5. It is also worth paying attention to the composition of some drugs prescribed to a child, in which lactose is also present (plantex, bifidum bacterin and others). The use of such drugs can aggravate the baby’s condition, so be careful.
Summing up our conversation, I would like to note the fact that in the vast majority of babies lactase deficiency is a transient phenomenon that passes with age, as the child’s own enzyme systems mature.The excessive zeal of many mothers and some doctors in terms of prescribing various drugs, or even stopping breastfeeding, is completely unreasonable and can lead to unfavorable outcomes for the child.
Remember that only a competent pediatrician will be able to assess the condition of the child and, if necessary, prescribe methods for correcting deviations in the state of the baby’s health.
Contact Aleksandrovskaya Family Clinic and we will help you cope with all the questions that arise as your child grows and matures!
Good to know about MILK ALLERGY (melk)
Useful Information on Milk Allergy – Norwegian Asthmatics and Allergy Association Fact Sheet
What is milk allergy?
If you are allergic to cow’s milk protein, the body’s immune system may react strongly by producing antibodies (IgE), or by activating inflammatory cells.With every meal containing milk proteins, an allergic reaction of the immune system is observed in the form of the production of mediators such as histamine, or a T-cell inflammatory response. Histamine is produced in several places in the body and leads to symptoms such as diarrhea, nausea, abdominal pain, or skin lesions (hives, eczema).
Cow’s milk contains over 25 different proteins that can cause a reaction in “dairy” allergy sufferers. For most people, the allergic reaction can be caused by several types of protein.The milk of other artiodactyls such as goat, horse and buffalo contains many of the same proteins. Therefore, allergy sufferers should not consume the milk of cloven-hoofed animals at all.
If a nursing mother herself consumes cow’s milk, some proteins can be transferred with the mother’s milk into the baby’s body and lead to negative consequences. Therefore, a breastfeeding mother should follow a dairy-free diet.
Cow’s milk allergy is not the same as lactose intolerance.The latter is due to the reduced ability of the body to digest milk sugar (lactose). Lactose intolerance leads to stomach pain and diarrhea as a result of consuming large amounts of dairy products with high levels of lactose (sweet milk, brown (goat’s) cheese, ice cream and cream).
The symptoms of milk allergy are very individual. For some, they are insignificant and safe, while others may have a severe allergic reaction, even with a small amount of milk.Gastrointestinal upset is common. It is less common to experience itching in the mouth and throat, swelling of the mucous membranes, and trouble breathing, which is especially common in young children. It is also common for them to develop eczema and hives on the skin.
Who is affected?
Milk allergy is the most common type of allergy in young children, which is explained by the early inclusion of cow’s milk in the diet of infants (for example, in cereals or in breast milk substitute).About 2-5% of Norwegian babies (0-3 years old) suffer from this type of allergy.
In order to determine the presence of milk allergy, the doctor must familiarize himself with the patient’s medical history, as well as take a blood test for the presence of allergic antibodies and a Pirquet test. Not all milk allergy sufferers will show positive results on these tests. This is especially true for infants with symptoms such as vomiting, diarrhea, or blood in the stool. The only reliable way to find out if milk is causing these symptoms is to eliminate milk from the diet for a period of time.When in doubt, it should be injected back into the diet and checked to see if symptoms return. For children who have not received milk for some time due to allergies, a control test using cow’s milk should be performed to ensure that there is no allergic reaction.
Usually, cow’s milk allergy has a fairly good prognosis. Most of the children get rid of it before they reach school age. Breastfeeding babies who have had negative test results are often allowed to resume milk intake after half a year or a year.It is not known how many adults suffer from milk allergy, but it is estimated that this number does not exceed one percent of the population.
Where is milk protein found?
Milk is found in many semi-finished and industrial food products. Therefore, when buying a product, it is important to familiarize yourself with the list of substances it contains. All ingredients containing milk must be declared on the goods declaration. A specific group of words used in such lists indicates the content of milk protein in the product:
Cream fresh, cream, ice cream, casein, caseinate, feta cheese, lactalbumin, margarine, whey, whey powder, cheese, cheese powder, sour cream, butter, yogurt, yoghurt powder.
Cocoa butter, lactic acids and group E substances do not contain milk protein.
Milk is an important source of nutrients in the Norwegian diet. 25% of the protein that children get, 70% of the iodine and about 70% of the calcium come from dairy products. That is why, in cases where dairy products are excluded from the diet, these products should be replaced with others that will ensure the intake of the above nutrients.Alternatively, specially formulated additives can be used.
How to replace milk?
– Drinks: A hypoallergenic milk replacer is recommended for young children, which can be purchased at the pharmacy. These products can be bought at a pharmacy or with a “blue prescription” (concessional prescription). Because of their taste, it can be difficult for older children to get used to these milk replacers, it is recommended to start using the milk replacers as early as possible, for example while breastfeeding.Young people and adults can consume milk substitutes such as rice milk, oat milk, etc. The amount of calcium in these products is similar to that in cow’s milk, but these drinks are often lower in protein and nutrients.
– Cooking: Over-the-counter milk substitutes can be used in most meals. Soy milk, rice milk, or coconut milk can be used depending on what you are cooking.
– Other Substitutes: The following products are available in a dairy-free version – margarine, sour cream, yogurt, ice cream and cream substitutes based on soy, rice or oats.
Lactase deficiency / Diseases / Clinic EXPERT
It is known that lactose is contained in any dairy products. It is actually the only sugar in cow’s milk (98%), its concentration is 4.5-5.0 g / 100 ml (in breast milk – 6.0-7.0 g / 100 ml).About 80–85% of the carbohydrates in breast milk are lactose. Lactose – the main sugar in the diet of newborns, provides about 40% of its energy costs.
Types of lactase deficiency
According to the severity, partial lactase deficiency is distinguished (hypolactasia) and complete (alactasia) .
By origin, they are divided into primary or secondary lactase deficiency.
Primary lactase deficiency is associated with a congenital decrease in lactase activity in a structurally intact enterocyte (intestinal epithelial cell).
The following variants of primary lactase deficiency are distinguished:
- congenital (genetically determined, familial)
- adult type (constitutional)
- transient, which is observed in premature and immature children at the time of birth.
Secondary lactase deficiency is caused by a decrease in lactase activity associated with damage to the enterocyte. This can be observed with an inflammatory process in the small intestine of infectious origin (intestinal infection of viral or bacterial etiology), gastrointestinal food allergy (intolerance to cow’s milk protein), atrophic changes (with celiac disease, after a long period of complete parenteral nutrition), with a lack of trophic factors.
Symptoms of lactase deficiency
The main clinical signs of lactase deficiency are:
- osmotic (“fermentative”) diarrhea after ingestion of milk or lactose-containing dairy products (frequent, liquid, frothy, sour-smelling stools, abdominal pain)
- increased flatulence in the intestine (flatulence, bloating, abdominal pain)
- in some cases – weight loss.
The severity of clinical symptoms in lactase deficiency varies widely.At the same time, in adults, no connection was found between the level of lactase activity and the severity of clinical symptoms. With the same degree of enzyme deficiency, there is a large variability of symptoms (severity of diarrhea, flatulence and pain). However, each patient has a dose-dependent effect on the amount of lactose in the diet: an increase in lactose load leads to more vivid clinical manifestations.
The severity of the disease depends on the severity of nutritional status disorders (malnutrition), dehydration, dyspeptic symptoms (diarrhea, abdominal pain) and the duration of the disease.
The diagnosis can be established on the basis of the characteristic clinical picture of the disease and patient interview and is confirmed by additional methods of examination. In addition, there are special tests to diagnose this condition.
For the diagnosis of lactase deficiency, determination of the content of hydrogen, methane or 14C-labeled carbon dioxide in exhaled air has become widespread. “Gold Standard” is the method for determining the activity of lactase in biopsies of the mucous membrane of the small intestine. However, due to the invasiveness, complexity and high cost of the method, its use in everyday practice is limited. Also, a test for lactase deficiency is performed during EGD. Another modern research method is genetic research.
Treatment and recommendations
The main principle of the treatment of lactase deficiency is a differentiated approach to therapy. Therapy depends on the degree and cause of the enzyme deficiency (primary or secondary).
The main treatment for lactase deficiency is diet therapy , aimed at reducing or completely eliminating lactose from the diet.
In case of secondary lactase deficiency , the main attention should be paid to the treatment of the underlying disease, and reducing the amount of lactose in the diet is a temporary measure that is carried out until the mucous membrane of the small intestine is restored.