Lactose Intolerance - Symptoms and Treatments
Did you know that more than half of the
world population has lactose intolerance? A 2017 review article
published in The Lancet states that 68% of all people are lactose
intolerant. Even more astonishing is the fact that many people don’t
realize that they have lactose intolerance, and simply accept the
constant bloating, pain, and nausea as a part of life.
Although it’s not life-threatening, lactose intolerance can be quite a
bothersome health condition and one that can take the fun out of any
family meal or restaurant outing. Get to understand this health
condition better and learn how to reduce or even fully eliminate
symptoms here.
What is Lactose Intolerance?
Lactose intolerance and milk allergy - many
use these terms interchangeably although they refer to different
conditions. So let’s begin by differentiating between these diagnoses.
Lactose intolerance is not an allergy. Instead, it’s a digestive
condition where the body is unable to effectively break down a type of
sugar called lactose. Naturally found in dairy products, lactose is a
disaccharide, or a molecule consisting of two sugars - glucose and
galactose. Disaccharides cannot be readily absorbed by the body and must
be broken down into their basic components. When the body is lacking
lactase, the enzyme that dissolves lactose, consuming dairy irritates
the GI tract and triggers unpleasant symptoms.
Lactose intolerance should be distinguished from a milk allergy, which
is an immune condition that can result in a life-threatening allergic
reaction. Milk allergies are typically triggered by the proteins in
dairy. Compared to lactose intolerance which typically develops later in
life, milk allergy is a lifelong condition.
Causes and Symptoms of Lactose Intolerance
One can develop this condition for a
variety of reasons. The most common cause lies in one’s genetics.
Although most infants can digest lactose, the genes responsible for
making lactase can “turn off” with age. This is why lactose intolerance
is more likely to be diagnosed in adulthood - the older we get, the less
lactase the body produces.
This type of lactose intolerance is called primary lactase deficiency,
or lactase non-persistence, and it disproportionately affects certain
ethnic groups. Scientists believe that the ability to digest lactose is a
genetic mutation acquired by some groups of humans in response to dairy
farming. In the US, Asian Americans, Hispanics, African Americans, and
Native Americans are all more likely to suffer from lactose intolerance.
Another cause of lactose intolerance is an injury to the small
intestine. GI infections, celiac disease, and Crohn’s disease damage the
intestines and diminish the ability to break down lactose.
So what happens when undigested lactose ends up in the small intestine?
Fluid and gas start to build up, producing many uncomfortable symptoms,
namely:
Bloating and flatulence
Abdominal pain
Nausea and vomiting
Diarrhea and watery stools
Which Foods Trigger Lactose Intolerance?
Many people don’t realize that they are
lactose intolerant because this condition varies in a case-by-case
scenario. Some people can safely consume certain dairy products. For
others, the dose makes the poison, and they can tolerate a moderate
amount of any dairy. Generally speaking, milk products with higher sugar
content, such as milk, heavy cream, ice cream, cream cheese, cottage
cheese, and soft cheeses like mozzarella are more likely to trigger
symptoms.
Fermented dairy products, on the other hand, such as yogurt, butter, and
hard cheeses have lower amounts of lactose and some even contain
bacteria that break down lactose, so they may be better tolerated.
In addition, please remember that lactose isn’t only present in dairy.
It’s also a common additive in packaged foods, instant soup, salad
dressings, pancake mix, chocolate, desserts, baked foods, and infant
formula. If you notice that a specific food hurts your stomach, check
the ingredients list for names like whey, curds, lactose, milk, cheese,
cream, and butter.
How Lactose Intolerance is Diagnosed
If you notice unpleasant symptoms after eating milk and dairy, you may
have lactose intolerance. Your doctor may help you diagnose lactose
intolerance and rule out other, more serious conditions, like Irritable
Bowel Syndrome (IBS), celiac disease, or Small Intestinal Bacterial
Overgrowth (SIBO).
During the doctor’s visit, your physician
will ask about your symptoms, examine your medical history, inquire
about eating habits, and finally conduct a physical exam. A few weeks
prior to the doctor’s visit, it would be great to keep track of the food
you eat, especially dairy, and how it affects your well-being. You may
also want to try excluding dairy from your diet for a few days and write
down if you notice an improvement in your symptoms.
Your doctor may also conduct one of the following tests to confirm the
diagnosis:
Hydrogen breath test - lactose intolerance creates higher levels of
hydrogen in the breath. During this test, you’ll be asked to drink milk.
After a few hours, you’ll need to breathe into a container a few times.
Higher concentrations of hydrogen in your breath indicate that you have
lactose intolerance.
Lactose tolerance test - a blood test can also help diagnose lactose
intolerance. During this test, you’ll be asked to drink milk. After 2
hours, you'll undergo a blood glucose test. If your glucose levels don't
rise after consuming the milk, your body isn't properly breaking down
and absorbing lactose.
Stool acidity test - those who have trouble digesting lactose have
higher levels of lactic acid and glucose in the stool. A stool acidity
test can help diagnose the condition, although it is mostly used in
infants and small children.
Treatments of Lactose Intolerance
Unfortunately, there is no cure for lactose intolerance. However,
lactose intolerance is quite easy to manage with simple dietary changes
and supplements. In fact, many lactose intolerance sufferers may not
have to eliminate dairy completely.
1. Lactose elimination diet
Dietary adjustments are the first step to
combatting lactose intolerance. Start by eating different dairy products
one at a time and observing your symptoms. Begin with small amounts,
and if you don’t see any response, add a little more. Once you know
which products trigger your symptoms the most, it would be wise to
eliminate them completely or replace them with something else. For
example, milk is generally the strongest irritant, so replacing it with
lactose-reduced milk or plant milk alternative alone may improve your
symptoms.
Some people also find that mixing dairy with other foods - such as
yogurt and granola or cheese and bread - makes these foods more
tolerable.
If you’re eliminating dairy products from your diet, it’s also advised
to be mindful of your calcium intake. Dairy contains a lot of calcium,
but you can also get it from green leafy vegetables, squash, almonds,
pumpkin seeds, onions, sardines, and asparagus. Avoid taking a calcium
supplement without your doctor’s advice, as these can be harmful to the
kidneys.
2. Lactase supplements
So what do you do if you’re really craving
ice cream but can’t have any due to your lactose intolerance? You don’t
have to suffer the consequences. There is a magic pill, and it’s called a
lactase supplement. These are pills or drops that contain synthetic
lactase enzymes. If you take them right before you consume dairy, they
will help break down the lactose for you and either reduce or completely
eliminate the unpleasant symptoms.
However, these supplements are not advised for children or pregnant and
breastfeeding individuals, according to the National Institute of
Diabetes and Digestive and Kidney Diseases. And there might be other
restrictions too, so make sure to check with your doctor before you
start taking these supplements.
3. Probiotic supplements
You’re surely familiar with probiotics. If
not, we have a whole article on the subject available here, but here’s a
brief explanation too. Probiotics are live microorganisms that, when
consumed, work to improve our gut microbiome.
An increasing body of research suggests that consuming certain strains
of probiotics found in fermented and non-fermented dairy can improve the
symptoms of lactose intolerance. However, it’s not yet known if these
probiotics work for everyone, so take this last suggestion with a grain
of salt. Of course, we’ll keep you posted if any new developments emerge
on that front.
All in all, lactose intolerance is certainly an unpleasant condition. It
can mess with your day-to-day life, as eliminating dairy can get
tricky, especially if you don’t cook or can’t prepare your own food at
work, school, or when traveling. However, with a little trial and error,
you will be able to find a diet that works for you and stop the
uncomfortable gut symptoms once and for all.