Lactose Intolerance: The Mystery Revealed

There are many people these days that suffer from a condition known as lactose intolerance, but not many people fully understand it.

Lactose intolerance is a medical condition that is characterized by digestive symptoms of gas, bloating, and diarrhea after consuming milk-based products.

There are two things that could result in lactose intolerance:

• Lactase deficiency: in this condition, the small intestine cannot digest much lactose because it produces very low amounts of lactase
• Lactose malabsorption: a lactase deficiency can result in lactose malabsorption. This is a condition in which lactose will pass to the colon undigested. In the colon, bacteria will break down the undigested lactose and gas/fluid will result. Not everyone with a lactase deficiency or lactose malabsorption will have the digestive symptoms.

Lactose intolerance occurs when a lactase deficiency and/or lactose malabsorption result in the digestive symptoms.

Most of the time, individuals with this condition can still have some lactose without experiencing the symptoms- but it varies from one person the next on the amount of lactose they can handle.

Often, individuals confuse a milk allergy with lactose intolerance. A milk allergy is the body’s immune system reaction to one or more of the milk proteins. Lactose intolerance is a digestive problem.

If an individual is allergic to milk, the reaction can be life-threatening even if they have a very small amount.

Milk allergies are common in the first year of life. Lactose intolerance occurs most often during adolescence or adulthood.

Lactase Deficiency: 4 Types

There are four types of lactase deficiency that might result in lactose intolerance:

Primary lactase deficiency: this is also referred to as lactase nonpersistence and is the most common form of this condition.

With the condition, the body’s lactase production gradually declines over time. In most cases, the decline begins around age 2 but it may begin later in life.

Children with this condition might not experience symptoms of lactose intolerance until they are older teens or even adults.

Research has pointed out that some individuals inherit genes from their parents that could cause this condition.

Secondary lactase deficiency: this condition results from an injury to the small intestine. Getting treatment for the underlying cause could result in an improvement of lactose intolerance.

Developmental lactase deficiency: this condition occurs most often in infants that are premature and usually lasts for only a short time.

Congenital lactase deficiency: this is a very rare disorder where the small intestine produces little to no lactase from birth and is a result of genes inherited from both parents.

Who is at Risk?

In the USA, there are some ethnic/racial populations that seem to be at a greater risk for developing this condition such as:

• African Americans
• Hispanics/Latinos
• Asian Americans
• American Indians.

This condition is least common among those Americans of European descent.

Symptoms of Lactose Intolerance

Some of the most common symptoms of this condition include the following:

• Abdominal pain
• Abdominal bloating
• Gas
• Nausea
• Diarrhea

These symptoms will typically occur thirty minutes to two hours after consuming milk related products and can range from mild to severe, depending upon the amount of lactose ingested and how much the individual can tolerate.

Effect of Lactose Intolerance on Overall Health

Lactose intolerance does much more than just causing unpleasant symptoms. It can have an effect on an individual’s health if they are not able to get the nutrients such as vitamin D and calcium that are provided by milk products.

Individuals with lactose intolerance are not getting enough calcium if they are not either taking a supplement or getting their calcium from other foods.

Calcium is critical for all ages, as it has an effect on the growth and maintenance of your bones. A shortage of calcium can result in less dense bones that are more prone to fracture- and can lead to osteoporosis later in life.

Diagnosing Lactose Intolerance

Your physician can diagnose you with lactose intolerance based upon the following:

• Medical history, family history, and diet history
• Physical exam
• Medical testing

Medical History, Family History, and Diet History

In order to diagnose your lactose intolerance, your physician will start by collecting a thorough medical history, family history, and diet history.

He/she will take the time to review all of your symptoms. However, since digestive symptoms can occur for many reasons besides this condition, this will not be enough information to get a proper diagnosis.

Physical Examination

When checking for lactose intolerance, your physician will perform a physical exam to rule out any other conditions that could be causing your condition. During this exam, he/she will:

• Check for bloating
• Listen to abdomen with a stethoscope
• Tap abdomen to check for pain/tenderness

He/she will likely recommend eliminating all milk-related products from your diet for a short time to see if your symptoms resolve. If the symptoms do go away, the diagnosis of lactose intolerance may be confirmed.

Medical Tests

Your physician is likely to order some special testing in order to provide more information on your signs/symptoms. There are two tests that are commonly used for measuring how well an individual is able to digest lactose:

Hydrogen Breath Test

This is a test that will measure the amount of hydrogen present in your breath. In most cases, there is only a very small amount of hydrogen detectable when an individual eats/drinks and then digests lactose.

However, if there is undigested lactose in an individual’s system, there will be a high level of hydrogen. For this test, the individual will drink a beverage with a specific amount of lactose.

Then they will breathe into a balloon-type container/device that will measure the amount of hydrogen in their breath. This test is typically performed on an outpatient basis.

Be aware that there are some foods, medications, and smoking that can have an effect on the accuracy of your results. Your physician will tell you what foods and medications that should be avoided before the test.

Stool Acidity Test

Lactic acid and other fatty acids are produced in the body by undigested lactose. These acids can be detected with a stool acidity test.

Physicians usually use this test for checking stool acidity in infants and young children. In addition, children may have glucose in their stool as a result of undigested lactose in their system.

The physician will give the parent/caretaker a container to collect the specimen, which will then need to be brought to the physician and sent to a lab to be analyzed.

How Much Lactose is Too Much?

Most of the time, individuals with this condition can tolerate some lactose in their diet and will not need to avoid these products completely.

Be aware that avoiding milk products completely can result in consuming less vitamin D and calcium than they need.

Everyone is different and will therefore, vary in the amount of lactose that their body can tolerate. There is a variety of factors that can affect how much an individual can have.

Research does show that adults/adolescents who have lactose malabsorption can eat/drink at least 12 grams of lactose symptom-free or only minor symptoms.

This is approximately one cup of milk. Individuals with lactose malabsorption may be able to eat/drink more if they can eat/drink with meals or in smaller amounts during the day.

Managing Lactose Intolerance

In most cases, the symptoms of lactose intolerance can be managed by simply making some dietary changes. Some individuals should only limit the amount of lactose they ingest, while others will need to avoid it completely. Consider using lactase products to manage symptoms.

For those who have secondary lactase deficiency, it can often be helpful to treat the underlying cause. Infants who have developmental lactase deficiency will have an improvement in their ability to digest lactose as they grow.

Individuals who have primary or congenital lactase deficiency will not be able to change their body’s ability to produce lactase.

In many cases, it can be helpful to discuss a dietary plan with your physician or a registered dietician. A dietary plan will help manage your symptoms and also ensure that you are getting the necessary nutrients.

Individuals working with children with the condition should follow the dietary plan that has been recommended by a physician or dietician.

Milk/Milk Products

Slowly integrating small amounts of milk-related products into an individual’s diet may be helpful for adapting to few symptoms. In most cases, individuals can tolerate milk related products by having them with meals.

Individuals who have lactose intolerance can often tolerate hard cheeses than they can a glass of milk. Additionally, they can often tolerate yogurt better than milk, even though they have very similar amounts of lactose.

Lactose-free/Lactose-reduced Products

Both lactose-free and lactose-reduced products are available at most grocery stores and are identical to the nutrition found in regular milk products.

The difference is that the lactose-free and lactose-reduced products have been treated with a lactase enzyme, which breaks down the lactose in milk.

Lactose-free milk is likely to have a slightly sweet taste as compared to regular milk and will typically remain fresh as long as, if not longer than, regular milk.

Lactase Products

If you have lactose intolerance, you can get lactase tablets and drops to use when you’re eating/drinking milk related products. This will digest the lactose for you and will reduce your risk of developing digestive symptoms.

You will need to check with your physician before trying these products because there are some groups such as pregnant/breastfeeding women and young children that might not be able to use them.

Calcium & Vitamin D

It is vital to make sure that individuals with this condition are able to get enough calcium and vitamin D in their diet- especially if they consume little to no milk related products. The amount of these nutrients needed varies by age.

Most of the time, you can get all of the necessary nutrients from other foods. Some of the non-milk related products that are high in calcium include:

• Soft-boned fish
• Dark green veggies

In addition, calcium is often added to fruit juices, soy beverages, and fortified breakfast cereals. The fortified foods are also a great source of vitamin D and other vital nutrients.

Vitamin D is necessary to help your body to properly absorb and use calcium. Some individuals with this condition are not getting enough of this essential nutrient. Following are some foods that are great natural sources of vitamin D.

• Tuna
• Liver
• Salmon
• Eggs

Additionally, most milk and milk products in the United States have been fortified with vitamin D. This is also found in breakfast cereals, yogurt, and even non-milk beverages. Your body will naturally produce vitamin D when you are exposed to sunlight.

If you are having difficulty regulating your diet, you may wish to speak with your physician or a registered dietician to make sure you’re getting the proper nutrients including both vitamin D and calcium.

To help facilitate safe and coordinated care, you should discuss whether or not you are using alternative and complementary practices with your physician or dietician.

Which Products Contain Lactose?

You can find lactose present in some medications and many different food products.

Medications Containing Lactose

There are some medications that contain lactose such as birth control pills, and OTC medications that treat gas and stomach acid.

These medications do often result in the symptoms of intolerance in those with severe lactose intolerance.

Individuals with this condition who use these and other medications should speak with their physician about some other alternatives.

Foods Products Containing Lactose

Lactose can be found in all milk and other milk related products. In addition, milk and milk related products are often added to frozen, prepared, canned, and packaged foods.

Individuals who experience symptoms after a very small quantity of lactose should know that many foods they enjoy may contain trace amounts of lactose including the following:

• Bread/Baked goods
• Waffles and mixes
• Cookies and mixes
• Pancakes and mixes
• Biscuits and mixes
• Toaster pastries
• Doughnuts
• Frozen waffles/pancakes
• Breakfast cereals
• Instant Soups
• Breakfast drinks
• Instant potatoes
• Chips/other processed snacks
• Processed Meats
• Margarine
• Liquid/powered milk-related meal replacements
• Protein powders/bars
• Candies
• Nondairy liquid/powdered creamers
• Nondairy whipped topping

You can check the ingredient labels on foods to find the potential sources of lactose in your foods. If the following words are present on the label, you will know that the products contain lactose:

• Milk
• Whey
• Milk by-products
• Lactose
• Curds
• Nonfat dry milk powder
• Milk dry solids

Tips to Keep in Mind

If you suspect that you or someone you know has lactose intolerance, here are some tips that you should always keep in mind:

• Lactose is a sugar that is found in milk and milk related products
• Lactose intolerance is a condition characterized by digestive symptoms such as diarrhea, gas, and bloating after consuming milk or milk related products
• Your physician will make a diagnosis based on your medical, family, and diet history; a physical examination, and medical testing.
• The diagnosis will not be based upon your symptoms alone because these same digestive symptoms can occur for other reasons.
• In most cases, an individual with this condition will be able to tolerate some lactose in their diet and will not need to avoid these products completely. However, everyone is different and will vary in the amount of lactose they can tolerate.
• Research has shown that adults/adolescents who have a lactose malabsorption can consume at least 12 grams of lactose in one sitting and experience minor to no symptoms. This is approximately one cup of milk.
• In most cases, the symptoms of lactose intolerance can be managed simply by making a few dietary changes. Some individuals will only need to limit the amount of lactose they consume while others will need to avoid it completely and find something else to replace the lost nutrients.
• You might find it helpful to speak with your physician or a registered dietician in order to determine if your diet is offering the necessary nutrients that your body needs. In order to ensure a safe and coordinated care, you should discuss any other treatments you’re using, including alternative and complementary.
• Lactose can be found in all milk and milk related products. In addition, it is often added to prepared, boxed, frozen, or canned foods. You will need to check the ingredient list on the labels to find all sources of lactose in the foods you’re consuming.

Lactose intolerance is not a curable condition, but it is a manageable one. If you are experiencing the signs/symptoms of this condition, you should speak with your physician about a diagnosis and treatment.

As mentioned, the digestive symptoms could also be indicative of other medical conditions- so it is best to find a diagnosis as soon as possible.