Lactose Intolerance

Lactose Intolerance

Lactose intolerance is a digestive condition that occurs due to the body’s inability to properly break down lactose, which is the natural sugar found in milk. This can lead to uncomfortable symptoms after consuming dairy products. While most people have trouble digesting lactose, not everyone develops visible symptoms. When symptoms do occur, the condition is known as lactose intolerance.

The body relies on an enzyme referred to as lactase, produced in the small intestine, to break down lactose so it can be absorbed. However, individuals with lactose intolerance have insufficient levels of lactase.

Despite low lactase levels, some people can still digest dairy products without any issues. For those who are lactose intolerant, reduced lactase levels often result in symptoms after consuming dairy.

What Is Lactose Malabsorption?

Lactose malabsorption occurs when the small intestine cannot absorb lactose properly. Instead of being absorbed, the lactose travels through your digestive system unprocessed. When it reaches the large intestine, it can trigger symptoms, and this is what defines lactose intolerance.

However, lactose malabsorption doesn’t always result in lactose intolerance. You can have malabsorption without experiencing noticeable symptoms, meaning not all cases of malabsorption lead to intolerance.

Signs and Symptoms

Common symptoms of lactose intolerance are:

  • Intestinal gas
  • Bloating
  • Nausea and vomiting
  • Stomach discomfort and cramping
  • Diarrhea
  • Stomach rumbling or gurgling

Usually, the symptoms result from undigested lactose reaching the large intestine. It typically takes 6–10 hours for food to travel to the large intestine after consumption and another 24–36 hours to pass through. As a result, symptoms may appear up to one or two days after eating foods containing lactose.

Foods That Trigger Lactose Intolerance Symptoms

Lactose is found in most dairy products unless specifically removed. This comprises products made from cow or goat milk.

The amount of lactose varies between products. For instance, hard cheese contains less lactose than cream and fresh milk. However, a sprinkle of parmesan on the salad can be just fine.

If you are highly sensitive to lactose, even trace amounts can cause reaction symptoms. It’s also important to read food ingredient lists and nutrition labels, as lactose can be present in processed foods such as salad dressings, soup, and snacks. Sometimes, it is included in the prescription drugs you take.

Causes

Lactose intolerance is influenced by two key factors: lactose malabsorption and gut sensitivity. The most significant factor is lactose malabsorption, which occurs when the small intestine cannot effectively break down and absorb lactose. As a result, it enters the large intestine, which triggers symptoms.

  • Lactase deficiency

The small intestine relies on lactase to break down lactose into small molecules, allowing it to be absorbed into the bloodstream. Many individuals produce lactase during infancy to assist in the digestion of breast milk, but the body naturally begins producing less lactase as they age.

Those with lactase deficiency are unable to properly digest lactose. While some may release more or less lactase, most people worldwide experience some level of lactose malabsorption. Only a small percentage of the population continues producing lactase even during adulthood.

  • Gut sensitivity

Gut sensitivity refers to how an individual’s digestive system reacts to substances that are not fully digested, such as certain sugars or dietary fibers. These substances pass through the digestive system and feed the gut bacteria.

While most people can tolerate small amounts of undigested substances without severe symptoms, everyone’s body is unique. Intestinal health, genes, diet, and sensitives are factors that determine the levels of sensitivity to lactose.

Your symptoms will indicate how much lactose your body can tolerate, as your gut microbiome (various types of bacteria in the colon) plays a significant role in processing it.

Types of Lactose Intolerance

The 4 primary types of lactose intolerance include:

  • Primary: Result from diminishing production of lactase in the small intestine.
  • Secondary: Result from injury or illness damaging the small intestine.
  • Congenital: Triggered by lack of lactase from birth.
  • Developmental: Occurs due to premature birth, when the small intestine is immature.

Risk Factors

The following factors are likely to make you or your child susceptible to lactose intolerance:

  • Age: Lactose intolerance generally develops in adulthood and is rare in babies and small children.
  • Ethnicity: The condition is more common among people of Asian, African, American Indian, and Hispanic lineage.
  • Premature birth: Premature birth results in lower lactose levels since the small intestine doesn’t form lactase-producing cells till later during the third trimester.
  • Disorders of the small intestine: Conditions like celiac disease, bacterial overgrowth, and Crohn’s disease can lead to lactose intolerance.
  • Certain cancer treatments: Radiation therapy in the stomach or intestinal complications caused by chemotherapy can increase the risk of lactose intolerance.

Diagnosis

Lactose intolerance may be suspected depending on your symptoms and how they improve when you reduce dairy in your diet. To confirm the diagnosis, your doctor can perform one or more of these tests:

  • Hydrogen breath test: This measures the level of hydrogen and methane gases present in your breath after exhaling. These gases are produced by bacteria in the colon when they ferment lactose. If high levels of these gases are detected after lactose ingestion, it indicates that your gut bacteria are fermenting the lactose, releasing gas in the large intestine that can be detected in your breath.
  • Blood sugar test: When breath test results are inconclusive, a blood sugar test may be conducted. This test checks the sugar levels in the bloodstream before and after consuming lactose. If blood sugar fails to rise, it indicates that your body isn’t absorbing the lactose.
  • Stool acidity test: For infants and young children, a stool acidity test may be used. A stool sample is collected after the child ingests lactose for analysis. The levels of lactic acid and other by-products in the stool can reveal whether the body is absorbing the lactose or not.

Treatment and Management

Treatment for lactose intolerance depends on the underlying cause. If the condition is triggered by another health issue, addressing that condition may help restore the body’s capacity to digest lactose, though this can take several months. In cases of other causes, discomfort caused by lactose intolerance can be avoided with a low-lactose diet.

To reduce lactose intake, you should consider:

  • Restricting milk as well as other dairy products.
  • Including small portions of dairy in your meals.
  • Consuming lactose-reduced milk ice and cream.
  • Adding a liquefied or powdered lactase enzyme to milk to facilitate the breakdown of lactose.

Living With

Foods containing lactose

Many foods contain lactose, so it’s important to always check labels. Foods such as snack foods, dried vegetables, candy, bakery items, dry mixes, and infant formulas may contain lactose. Additionally, many medicines, especially white tablets like birth control pills or drugs for stomach acid and gas, use lactose as a filler. Your GP or pharmacist can help you identify if any of your prescription medications contain lactose.

The high-lactose foods to be aware of include:

  • Milk and heavy cream
  • Ice cream
  • Condensed and evaporated milk
  • Cottage cheese
  • Sour cream
  • Ricotta cheese
  • Cheese spreads

Lactose-free substitutes you can try include:

  • Rice beverages
  • Soymilk, which is rich in potassium, protein, and antioxidants
  • Almond milk
  • Lactose-free milk; which is full of calcium, protein, and various vitamins, including A, B, and K, as well as potassium, zinc, and magnesium
  • Coconut milk

Takeaways

Lactose intolerance is usually not considered an illness; rather, it’s a natural dissimilarity in the manner in which our digestive systems function. In fact, the capacity to digest lactose beyond infancy is a somewhat new genetic adaptation, and not everyone has it. This is completely fine because it is possible to live healthily with lactose intolerance.

If you’re experiencing digestive symptoms and suspect they may be linked to dairy products, seek medical assistance. Your doctor can check for lactose intolerance and other potential reasons for your symptoms. If you are diagnosed with lactose intolerance, your provider will help you in modifying your lifestyle to manage the condition and avoid discomfort.

Book Your Appointment