What is lactose intolerance

Lactose intolerance is a digestive disorder caused by the inability to digest lactose, the main carbohydrate in dairy products. People with lactose intolerance are unable to fully digest the sugar (lactose) in milk. As a result, they have diarrhea, gas and bloating after eating or drinking dairy products. The condition, which is also called lactose malabsorption, is usually harmless, but its symptoms can be uncomfortable. Too little of an enzyme produced in your small intestine (lactase) is usually responsible for lactose intolerance. You can have low levels of lactase and still be able to digest milk products. But if your levels are too low you become lactose intolerant, leading to symptoms after you eat or drink dairy.

Most people with lactose intolerance can manage the condition without having to give up all dairy foods.

Symptoms

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

• Diarrhea

• Nausea, and sometimes, vomiting

• Stomach cramps

• Bloating

• Gas

• Some people also experience urgency to go to the toilet, nausea, vomiting, pain in the lower belly and occasionally constipation.

• Diarrhea occurs due to undigested lactose in your small intestine, which causes water to move into your digestive tract.

• Once it reaches your colon, the lactose is fermented by the bacteria in your gut, forming short-chain fatty acids and gas. This causes the bloating, flatulence and pain.

• The severity of symptoms can vary, depending on how much lactose you can tolerate and how much you have eaten

Causes

Lactose intolerance occurs when your small intestine doesn't produce enough of an enzyme (lactase) to digest milk sugar (lactose).

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

If you're lactase deficient, lactose in your food moves into the colon instead of being processed and absorbed. In the colon, normal bacteria interact with undigested lactose, causing the signs and symptoms of lactose intolerance. Lactose is also found in breast milk, and almost everyone is born with the ability to digest it. It is very rare to see lactose intolerance in children under the age of five.

Currently, about 75% of the world’s population is lactose intolerant. The risk varies greatly between countries, as shown on this map:

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Types

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

Primary lactose intolerance

People who develop primary lactose intolerance — the most common type — start life producing enough lactase. Infants, who get all their nutrition from milk, need lactase.

As children replace milk with other foods, the amount of lactase they produce normally drops, but usually remains high enough to digest the amount of dairy in a typical adult diet. In primary lactose intolerance, lactase production falls off sharply by adulthood, making milk products difficult to digest.

Secondary lactose intolerance

This form of lactose intolerance occurs when your small intestine decreases lactase production after an illness, injury or surgery involving your small intestine. Diseases associated with secondary lactose intolerance include intestinal infection, celiac disease, bacterial overgrowth and Crohn's disease.

Treatment of the underlying disorder might restore lactase levels and improve signs and symptoms, though it can take time.

Congenital or developmental lactose intolerance

It's possible, but rare, for babies to be born with lactose intolerance caused by a lack of lactase. This disorder is passed from generation to generation in a pattern of inheritance called autosomal recessive, meaning that both the mother and the father must pass on the same gene variant for a child to be affected. Premature infants can also have lactose intolerance because of an insufficient lactase level.

4 Risk factors

Factors that can make you or your child more prone to lactose intolerance include:

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

• Ethnicity. Lactose intolerance is most common in people of African, Asian, Hispanic and American Indian descent.

• Premature birth. Infants born prematurely might have reduced levels of lactase because the small intestine doesn't develop lactase-producing cells until late in the third trimester.

• 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 you've had radiation therapy for cancer in your stomach or you have intestinal complications from chemotherapy, your risk of developing lactose intolerance increases.

Which Foods Contain Lactose?

Lactose is found in dairy foods and products that contain dairy.

Dairy Foods That Contain Lactose

The following dairy products contain lactose:

• Cow’s milk (all types)

• Goat’s milk

• Cheese (including hard and soft cheeses)

• Ice cream

• Yogurt

• Butter

Foods That Sometimes Contain Lactose

Foods that have some form of dairy as an ingredient may also contain lactose, including:

• Foods made with a milky sauce, like quiche

• Biscuits and cookies

• Chocolate and confectionary, like boiled sweets and candies

• Breads and baked goods

• Cakes

• Breakfast cereals

• Instant soups and sauces

• Processed meats, such as pre-sliced ham or sausages

• Ready meals

• Sauces and gravies

• Potato chips, nuts and flavored tortillas

• Desserts and custards

People With Lactose Intolerance May Be Able to Eat Some Dairy

All dairy foods contain lactose, but this doesn’t mean they are totally off limits for people with lactose intolerance.

Most people with lactose intolerance can tolerate small amounts of lactose. For example, some people can tolerate the small amount of milk in tea but not the amount you would get from a bowl of cereal.

It’s thought that people with lactose intolerance can tolerate up to 18 grams of lactose, spread throughout the day. Some types of dairy are also naturally low in lactose when eaten in their usual portions. Butter, for example only contains 0.1 grams of lactose per 20-gram portion.Certain types of cheese also have less than 1 gram of lactose per serving. This includes cheddar, Swiss, Colby, Monterey Jack and mozzarella.Interestingly, yogurt tends to causes fewer symptoms in people with lactose intolerance than other types of dairy

Treatments for Lactose Intolerance

If you don’t want to give up dairy, then there are a few natural treatments that can help.

Enzyme Supplements

It’s possible to buy enzymes to help digest lactose. These are tablets you swallow or drops you add to foods and drinks.However, the effectiveness of these products seems to vary from person to person. Nevertheless, lactase enzyme supplements may be very effective for some people.

One study examined the effects of three different types of lactase supplements in lactose-intolerant people who took 20 or 50 grams of lactose.Compared to placebo, all three lactase supplements improved overall symptoms when taken with 20 grams of lactose.However, they weren’t effective at the higher dose of 50 grams of lactose.

Lactose Exposure

If you are lactose intolerant, regularly including lactose in your diet could help your body adapt to it.So far, studies on this are few and far between, but initial studies have shown some positive results. In one small study, nine lactose-intolerant people experienced a threefold increase in their lactase production after 16 days of eating lactose.

Probiotics and Prebiotics

Probiotics are microorganisms that provide health benefits when consumed. Prebiotics are types of fiber that function as food for these bacteria. They feed the beneficial bacteria you already have in your gut, so that they thrive.Both probiotics and prebiotics have been shown to reduce symptoms of lactose intolerance, although most studies so far have been small.

Some types of probiotics and prebiotics may be more effective than others for people with lactose intolerance. One of the most beneficial probiotics is thought to be Bifidobacteria, often found in probiotic yogurts and supplements.

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