Lactose Intolerance

Lactose Intolerance is the inability to digest significant quantities of lactose. Lactose is a sugar found in milk and other dairy products.

Causes

Lactose Intolerance is caused by an inadequate amount of the digestive enzyme lactase. Lactase breaks down the sugar lactose into more easily absorbed sugars. Without enough lactase to digest the lactose eaten, lactose ferments in the colon and causes symptoms.
Some people are born with the inability to make the enzyme lactase. Others develop the intolerance over time.
Causes of Lactose Intolerance include:
  • Aging (lactase decreases as people age)
  • Gastroenteritis
  • Nontropical and tropical sprue
  • Cystic fibrosis
  • Ulcerative colitis
  • Immunoglobulin deficiencies

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Race: Black, Asian, or Native American
  • Ethnicity: Mediterranean or Jewish

Symptoms

Symptoms of Lactose Intolerance generally begin within two hours of consuming too much milk or other dairy products. The severity of symptoms depends on how much lactase your body produces and how much lactose you eat.
Symptoms include:
  • Nausea
  • Cramping
  • Bloating
  • Abdominal rumbling sounds
  • Gas
  • Diarrhea
  • Loose stools

Diagnosis

The doctor will ask about your symptoms and medical history and perform a physical exam. Often the doctor will recommend a two-week trial period of eating no milk or milk products. If symptoms subside, you will be asked to consume milk products again. If milk causes symptoms to recur, you will be diagnosed with Lactose Intolerance.
Tests may include:
Lactose Tolerance Test – measures the amount of glucose absorbed two hours after drinking a high-lactose liquid
Hydrogen Breath Test – measures how much hydrogen is exhaled after drinking a high-lactose liquid
Stool Acidity Test (for infants and small children) – measures lactic acid in the stool
Biopsy of the Small Intestine – removing and testing a sample of tissue to confirm lactase deficiency (only in rare cases)

Treatment

Currently there is no way to increase production of lactase, so treatment focuses on managing symptoms.
Treatments include:
Dietary Changes
Dietary changes include:
  • Keep a food diary of what you eat and what the reaction is. Discuss the findings with your doctor or a dietitian.
  • Make gradual changes to your diet and record the results.
  • Try eating a smaller portion before giving up on a dairy product. Dairy products made from milk include:
    • Ice cream
    • Sherbet
    • Cream
    • Butter
    • Cheese
    • Yogurt
  • Aged cheese and yogurt may be easier to tolerate than other dairy products.
  • Try milk that is modified so it contains less lactose.
  • Ask a dietitian for help choosing substitutes for dairy products or recommending supplements to ensure that you eat enough calcium.
  • Non-dairy foods rich in calcium include:
    • Salmon
    • Sardines
    • Oysters
    • Collard greens
    • Broccoli
  • Read product labels because other foods containing lactose include:
    • Breads
    • Baked goods
    • Processed cereals
    • Instant potatoes and soups
    • Margarine
    • Non-kosher lunchmeats
    • Salad dressings
    • Candies
    • Pancake mixes
    • Frozen dinners
  • Other words that indicate lactose are:
    • Whey
    • Curds
    • Dry milk solids
    • Nonfat dry milk
    • Milk by-products
  • Be aware that some medications may contain small amounts of lactose.
Medications
The doctor may recommend lactase enzymes if you can tolerate only small quantities of lactose. The enzyme supplements come in liquid and chewable form. A few drops of the liquid added to milk and allowed to sit overnight can decrease the amount of lactose in the milk by 70-90%. Tablets are chewed or swallowed prior to eating foods that contain lactose.

Prevention

There are no guidelines for preventing lactose intolerance.