Lactose Intolerance

1 What is Lactose Intolerance?

People who are unable to digest lactose are likely to suffer from lactose intolerance. Lactose is a type of sugar present in milk and milk products. This may result into symptoms like diarrhea, gas and bloating after eating or drinking dairy products. Lactose malabsorption is usually harmless, but its symptoms can be uncomfortable.

The main cause of lactose intolerance is deficiency of lactase, which is an enzyme produced in the small intestine. Most of the people with lactose intolerance can manage the condition without having to give up all dairy foods.

2 Symptoms

The signs and symptoms of lactose intolerance usually begin after 30 minutes to 2 hours of eating or drinking foods that contain lactose.

Common signs and symptoms include:

See your doctor if you experience frequent symptoms of lactose intolerance after eating dairy foods.

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3 Causes

Lactose intolerance is caused when the small intestine doesn't produce enough of the enzyme lactase, which causes indigestion of lactose. Lactase works by turning milk sugar lactose into two simple sugars, glucose and galactose, which are then easily absorbed into the bloodstream through the intestinal lining. In the cases of lactase deficiency, the lactose moves into the colon instead of being processed and absorbed. The local bacteria population interacts with the undigested lactose and causes the symptoms of lactose intolerance. There are three types of lactose intolerance:

  1. Primary lactose intolerance is the most common type of lactose intolerance. In this case, lactase production sharply falls as the child grows. This can be acquired genetically, occurring in a large proportion of people with African, Asian or Hispanic ancestry. The condition is also prevalent among those of Mediterranean or Southern European descent. 
  2. Secondary lactose intolerance is a form of lactose intolerance which occurs when the small intestine decreases lactase production after an illness, injury or surgery. Secondary lactose intolerance is usually associated with diseases like celiac disease, bacterial overgrowth and Crohn's disease. Treatment of the underlying disorder may lead to restoration of lactase levels and may improve signs and symptoms. 
  3. Congenital or developmental lactose intolerance is a possible but rare condition observed in babies. It is caused by a complete absence of lactase activity. It is a genetic disorder inherited as an autosomal recessive disease; this means that both the mother and the father must pass on the same gene variant for a child to be affected. Premature babies may also have lactose intolerance because of an insufficient level of lactase.

4 Making a Diagnosis

Firstly one can consult his/her family doctor or general practitioner if he/she feels the signs and symptoms of lactose intolerance to receive a diagnosis. Before consulting a doctor one should pen down the following things on a notepad:

  • The signs and symptoms one encounters.
  • Any kind of medication, if taken.
  • Any vitamins or supplements, if you are taking them regularly.

You may also ask your doctor about:

  • Cause of your problem.
  • Medical examination required, if any.
  • Any kind of pre-preparation required before tests.
  • Is it a lifelong condition?
  • Treatment options.
  • Whether to stop eating dairy products.
  • How can I be certain that I'm getting enough calcium in my diet?
  • Should I see a dietitian?
  • Other health conditions?

While diagnosing the cause of your problem your doctor may suggest the following tests:

  • Lactose tolerance test: Wherein the reaction of liquid that consists of high level of lactose with the body is examined. After consuming this liquid one will undergo blood test after 2 hours and it will give the amount of glucose in the blood stream. 
  • Hydrogen breath test: This test also requires you to drink a liquid that contains high levels of lactose. The doctor then measures the amount of hydrogen in your breath at regular intervals. Normally, very little hydrogen is detectable. However, if the body doesn't digest the lactose, it ferments in the colon, to produce hydrogen and other gases, which are absorbed by the intestines and is eventually exhaled. 
  • Stool acidity test: This test used for infants and children. The fermention of undigested lactose produces lactic acid and other acids that can be detected in a stool sample.

5 Treatment

Though there is no cure for lactose intolerance, various treatments may help you safely consume milk products.

Symptoms can be managed by: 

  1. Avoiding large servings of milk and other dairy products.
  2. Including small servings of dairy products in your regular meals.
  3. Eating and drinking lactose-reduced ice cream and milk.
  4. Drinking regular milk after you add a liquid or powder to it to break down the lactose.
  5. Consumption of probiotics.

Probiotics are living microorganisms present naturally in your intestines that help in maintaining a healthy digestive system. Probiotics are also available as active or "live" cultures in some yogurts and as supplements in capsule form. They are also used for gastrointestinal conditions, such as diarrhea and irritable bowel syndrome. Probiotics are generally considered safe and may be worth a try.

6 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with lactose intolerance.

Following measures can be taken to avoid symptoms of lactose intolerance:

  1. Cut out all milk products and avoid non-dairy foods or medications that contain lactose. 
  2. Maintain a good diet to fulfill your daily calcium and vitamin D needs.
  3. Take low lactose diets if you are tolerant to low doses of milk or milk products.
  4. Use over-the-counter tablets or drops containing the lactase enzyme (Dairy Ease, Lactaid, others) which may help you digest dairy products.
  5. Increase the intake of probiotics. 

7 Risks and Complications

Factors that increase your risks of lactose intolerance include: 

  1. Aging: Lactose intolerance usually affects adults. 
  2. Nativity:  Lactose intolerance is frequent in people of African, Asian, Hispanic and American Indian descent. 
  3. Premature babies may have reduced levels of lactase due to an under-developed small intestine.
  4. Other small intestine related problems that can cause lactose intolerance include bacterial overgrowth, celiac disease and Crohn's disease.
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