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In the Know - All about...Lactose Intolerance

In the Know

All about… Lactose intolerance


You may have heard of lactose intolerance. Perhaps a close relative—a spouse, a child, a parent—has it. Perhaps you do.


That’s because lactose intolerance, or the reduced ability to digest lactose, is a condition that strikes approximately 65 of the human population to some degree. Among adults, it is most prevalent in people of East Asian descent, but is also very common in people of West African, Jewish, Greek, and Italian descent—making it quite the common diagnosis.


Lactose intolerance is caused by the digestive system being unable to fully digest lactose, the sugar that is found naturally in milk. People with lactose intolerance typically get such symptoms as diarrhea, gas and bloating after eating or drinking dairy products.


Other than those uncomfortable symptoms, lactose intolerance is usually harmless. What’s more, most people with lactose intolerance can manage the condition without having to give up all dairy foods. And contrary to popular misconception, lactose intolerance is not an allergy. Do read on!



There are three types of lactose intolerance. Different factors cause the lactase deficiency underlying each type.


Primary lactose intolerance

This is the most common type. People who develop primary lactose intolerance start life producing plenty of lactase—a necessity for infants, who get all their nutrition from milk. As children replace milk with other foods, their lactase production normally decreases, but remains high enough to digest the amount of dairy in a typical adult diet.


What happens in primary lactose intolerance is that the body’s natural production of lactase drops sharply, making milk products difficult to digest by the time the person reaches adulthood. Primary lactose intolerance is genetically determined, occurring in a large proportion of people with Asian ancestry. The condition is also common among those of Mediterranean or Southern European descent.


Secondary lactose intolerance

In secondary lactose intolerance, lactase production drops sharply not due to natural reasons (as in primary lactose intolerance) but as a result of an illness, injury or surgery involving the small intestine (which produces lactase). Among the diseases associated with secondary lactose intolerance are celiac, bacterial overgrowth and Crohn’s. Treatment of the underlying disorder may restore lactase levels and improve signs and symptoms, though it can take time.


Congenital or developmental lactose intolerance

It’s possible (although rare) for babies to be born with lactose intolerance caused by a complete absence of lactase activity. Such a disorder is passed from generation to generation in a pattern of inheritance called autosomal recessive. That means that both mother and father must pass on the same gene variant for a child to be affected.



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

·   Diarrhea

·   Nausea, and sometimes, vomiting

·   Abdominal cramps

·   Bloating

·   Gas


When to see a doctor

Make an appointment with your doctor if you frequently have symptoms of lactose intolerance after eating dairy foods, particularly if you’re worried about getting enough calcium.



Normally, the small intestine produces an enzyme called lactase. Lactose intolerance is usually caused when the small intestine doesn’t produce enough lactase. Without enough lactase, the digestive system will have difficulty digesting milk products.


Normally, lactase turns milk sugar (lactose) into two simple sugars—glucose and galactose—which are absorbed into the bloodstream through the intestinal lining.


But if someone is lactase deficient, lactose in the food moves into the colon instead of getting processed and absorbed. Once in the colon, the undigested lactose interacts with the normal bacteria that are already there, causing the signs and symptoms of lactose intolerance.


In lactose intolerance, the general rule is this: the less lactase, the more the milk-based indigestion.


Therefore, many people have low levels of lactase but are able to digest milk products without problems (because they still have enough).


Risk factors

Factors that can make one more prone to lactose intolerance include:

·   Increasing age. Lactose intolerance usually appears in adulthood. The condition is uncommon in babies and young children

·   Diseases affecting the small intestine. Small intestine problems that can cause lactose intolerance include bacterial overgrowth, celiac disease and Crohn’s disease

·   Certain cancer treatments. If someone has received radiation therapy for cancer of the abdomen, or has intestinal complications from chemotherapy, they have an increased risk of lactose intolerance



A doctor may suspect lactose intolerance based on symptoms and the patient’s response to reducing the amount of dairy foods in the diet. The doctor can confirm the diagnosis by conducting one or more of the following tests:

·   Lactose tolerance test. The lactose tolerance test gauges the body’s reaction to a liquid that contains high levels of lactose. Two hours after drinking the liquid, the patient will undergo blood tests to measure the amount of glucose in the bloodstream. If the glucose level doesn’t rise, it means the body isn’t properly digesting and absorbing the lactose-filled drink

·   Hydrogen breath test. This test also requires the patient to drink a liquid containing high levels of lactose. The doctor then measures the amount of hydrogen in the breath at regular intervals. Normally, very little hydrogen is detectable. But if the body doesn’t digest the lactose, it will ferment in the colon, releasing hydrogen and other gases, which are absorbed by the intestines and eventually exhaled. Larger-than-normal amounts of exhaled hydrogen measured during a breath test indicate that the patient isn’t fully digesting and absorbing lactose.



One would think that if lactose intolerance is caused by lack of lactase, then lactose intolerance should simply be treated by increasing lactase. But there’s currently no way to boost the body’s natural production of lactase. However, people with lactose intolerance can usually avoid its discomfort by:

·   Avoiding large servings of milk and other dairy products

·   Including small servings of dairy products in their regular meals

·   Eating and drinking lactose-reduced ice cream and milk

·   Drinking regular milk after adding lactase enzyme tablets or drops like Lactaids; these break down lactose and make it more digestible

·   Saving milk for mealtimes. Drink milk with other foods. This slows the digestive process and may lessen symptoms of lactose intolerance


Lifestyle and home remedies

Most people with lactose intolerance can enjoy some milk products without symptoms. It may be possible to increase tolerance to dairy products by gradually introducing them into the diet. Some people actually find that they can tolerate full-fat dairy products, such as whole milk and cheese, more easily than dairy products with no or reduced fat.


Maintaining good nutrition

Reducing dairy products in the diet doesn’t mean that the person won’t get enough calcium. Calcium is found in many other non-dairy foods, including:

·   Broccoli

·   Calcium-fortified products like breads and juices

·   Canned salmon

·   Milk substitutes like soy or rice milk

·   Oranges

·   Pinto beans

·   Rhubarb

·   Spinach


People who have lactose intolerance should also make sure they are getting enough vitamin D, which people typically get from fortified milk. But vitamin D can also be gotten from eggs, liver, yogurt, or even direct skin exposure to natural sunlight. To be sure, to your doctor about taking vitamin D and calcium supplements.



Probiotics are living organisms present in the intestines that help maintain a healthy digestive system. Probiotics are also available as active or “live” cultures in some yogurts and as supplements in capsule form. Probiotics may also help the body digest lactose; they are generally considered safe and may be worth a try if other methods don’t help.



Avoiding and living with lactose intolerance is largely a matter of experience—knowing what foods, and how much of those foods, to avoid so as to avoid the unpleasant symptoms.


With some trial and error, a person who has lactose intolerance may be able to predict his or her body’s response to different foods that have lactose—and eventually know how much foods with lactose that he or she can eat or drink and still live a symptom-free life.