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Lactose Intolerance

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

Lactose intolerance is caused by an inadequate amount of the digestive enzyme lactase. Lactase breaks down the sugar lactose into sugars the bloodstream can more easily absorb. Without enough lactase to digest the lactose eaten, lactose ferments in the colon (large intestine) 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 (or infection in the intestinal tract)
  • 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.

Risk factors include:

  • Race: Black, Asian, or Native American
  • Ethnicity: Mediterranean or Jewish
Symptoms of lactose intolerance generally begin within two hours of consuming 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
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.

Your doctor may also order some tests, which may include:

Lactose Tolerance Test–measures the amount of glucose (simple sugar that is created from lactose) absorbed two hours after drinking a high-lactose liquid. This tells how well the body is digesting lactose.

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 performed in rare cases)

Currently there is no way to increase the body’s production of lactase (though gene therapy has been suggested as a future treatment), so treatment today focuses on managing symptoms. Experts counsel against complete elimination of dietary lactose, especially in children and adolescents, because milk and milk products provide sources of calcium and other food elements that are otherwise hard to replace. If complete elimination is chosen, then careful replacement of calcium is essential for good health.

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. Many people can tolerate 4-8 ounces of milk at a time, and may have better tolerance for some of the following dairy products made from milk:
    • 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.
  • Nondairy 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.
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 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.

There are no guidelines for preventing lactose intolerance.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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