Lactose Intolerance


lactose intolerance

WHAT IS LACTOSE INTOLERANCE?

Lactose intolerance is defined as the inability to fully digest lactose, the sugar in milk. This difficulty digesting occurs when the small intestine produces too little of the enzyme lactase. 

This GI condition often results in diarrhea, gas, and bloating – symptoms that affect sufferers after consuming dairy products. While symptoms are unpleasant, lactose intolerance, also known as lacrosse malabsorption, is typically harmless and can often be managed without completely eliminating dairy for your diet.

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CAUSE

Lactose intolerance occurs in patients whose small intestine fails to produce adequate levels of the enzyme lactase, responsible for digesting lactose, the sugar found in milk. Lactase typically turns lactose into two simple sugars, glucose, and galactose, which get absorbed through the intestinal lining into the body’s bloodstream. 

For those with a lactase deficiency, the lactose in food moves along the digestive tract into the colon, instead of being properly processed and then absorbed. Once in the colon, the lactose interacts with the bacteria naturally found there, ultimately causing the symptoms associated with a dairy intolerance.

Note that there are three types of lactose intolerance, with different factors causing the body’s lactase deficiency. 

FOODS TO AVOID WITH LACTOSE INTOLERANCE

Here at Charleston GI, our board-certified gastroenterologists recommend limiting foods that contain the following, or in more severe cases, avoiding them altogether: 

  • Milk
  • Milk solids
  • Butter
  • Buttermilk
  • Cream
  • Whey

These symptom-triggering ingredients can be found in foods like these:

  • Margarine
  • Non-dairy creamers
  • Baked goods and desserts
  • Creamy sauces and salad dressings 
  • Instant soup 
  • Mashed potatoes
  • Beverage mixes
  • Pancake or cake mixes

FOODS TO EAT TO RELIEVE LACTOSE INTOLERANCE 

To relieve symptoms, replace dairy products with the following calcium- and vitamin D-rich foods – many of which are readily available at most grocery stores and are just as nutritious as milk and milk products!

  • Certain types of fish (ex. canned salmon or sardines)
  • Leafy greens (ex. broccoli, kale, spinach etc.)
  • Tofu
  • Oranges
  • Almonds
  • Dried beans
  • Products fortified with added calcium, like cereals, fruit juices, and soy milk.

RISK FACTORS 

Studies show that these risk factors may increase your – or your child’s – odds of developing lactose intolerance:

  • Older Age
    Lactose intolerance most often does not occur until adulthood and is uncommon in infants 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.
  • Conditions involving the small intestine
    Bacterial overgrowth, celiac disease and Crohn's disease all boost your risk of lactose intolerance.
  • Certain cancer treatments
    Research has shown a link between radiation therapy for stomach cancer and lactose intolerance. Those with intestinal complications due to chemotherapy also face an increased risk.

SYMPTOMS

While symptoms vary from patient to patient, they often become evident between 30 minutes and two hours of consuming dairy products. Some common symptoms include:

WHEN TO SEE A DOCTOR

If painful symptoms and digestive discomfort frequently plague you after eating dairy, consult your local GI specialist – especially if you are concerned that you are not getting enough calcium. There's no referral needed, so contact Charleston Gi today!

DIAGNOSTIC TEST 

If your GI doctor believes that lactose intolerance may be to blame for your symptoms, their diagnosis may be confirmed using one of these tests:

  • Hydrogen breath test
    After drinking a high-lactose beverage, the amount of hydrogen in your breath will be measured at several intervals. Breathing out too much hydrogen is a strong indication that you aren't fully digesting and absorbing lactose.
  • Lactose tolerance test
    Two hours after drinking a high-lactose beverage, you'll undergo blood tests to measure the amount of glucose in your bloodstream. If glucose level remains steady, it means that your body isn't digesting and absorbing lactose as it should.

TREATMENT

There is no treatment that can stimulate lactase production. But diet changes can go a long way toward alleviating symptoms. To ease discomfort, our GI physicians recommend the following lifestyle modifications: 

LIMIT DAIRY

Incorporate small servings of dairy into meals as needed, mostly choose products with reduced lactose content. Add a liquid or powder lactase enzyme to your milk to help break down the lactose before drinking it.

CHOOSE NUTRIENT-RICH FOODS

It’s important to ensure that you consume enough calcium on your reduced dairy diet. These foods are not only great for you but boast high levels of calcium too! 

  • Broccoli and leafy green vegetables.
  • Calcium-fortified products, such as cereals and juices.
  • Canned salmon or sardines.
  • Milk substitutes, such as soy milk and rice milk.
  • Oranges
  • Almonds, Brazil nuts and dried beans.
  • Probiotics

PREVENTION

Eating smaller portions of foods that contain lactose – or avoiding them completely – is one way to manage symptoms. Try these tips as well:

  • Start small.
    Try adding small amounts of milk or milk products and see how your body reacts.
  • Consume dairy along with other foods.
    You may find you have fewer or milder symptoms if you consume dairy as part of a meal or snack instead of alone, such as cheese and crackers or yogurt and granola.
  • Choose dairy with naturally lower lactose levels.
    Hard cheeses and yogurt belong on the top of the list!
  • Try lactose-free and lactose-reduced milk and dairy products.
    Found at many food stores, these products are much the same as regular dairy products, with the addition of lactase.
  • Ask About lactase products.
    Consult your GI specialist about taking a lactase pill or lactase drops when you eat or drink milk products.

If you have trouble finding dairy products that don’t cause symptoms, talk to your Charleston GI physician. Why suffer in silence? We’re happy to help! 

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FREQUENTLY ASKED QUESTIONS 

What question should I ask a doctor concerning lactose intolerance?

Ask your GI doctor the following:

  • Are there other possible causes for my symptoms?
  • What tests are needed to confirm a lactose intolerance diagnosis?
  • What are my treatment options?
  • Do I need to stop eating all dairy products to alleviate my symptoms?
  • How can I be certain that I'm getting enough calcium in my diet?
  • Should I visit a dietitian or nutritionist?
  • How can I best manage lactose intolerance alongside my other health conditions?
  • What websites do you recommend so I can learn more?

How do I know if I am lactose intolerant?

Common symptoms include: 

  • Abdominal cramps or discomfort
  • Nausea
  • Bloating
  • Gas
  • Diarrhea

What foods to avoid if you are lactose intolerant?

Limit or avoid foods that contain milk, milk solids, butter, buttermilk, cream, and whey. Even foods like margarine, non dairy creamer, baked goods, and salad dressings may contain some lactose. Instant soup or potatoes, beverage mixes, and pancake or cake mixes may also contain some lactose. 

Can lactose intolerance go away?

In most cases, the lactose intolerance goes away when the underlying cause is treated, but some people become permanently lactose intolerant. It seems possible, even probable, that such trauma to the digestive tract can trigger the same epigenetic change that normally turns off the lactase gene in childhood.

How do you fix lactose intolerance?

Some treatment options for individuals who suffer lactose intolerance include: 

  • Limit milk and other dairy products.
  • Include small servings of dairy products in your regular meals.
  • Eat and drink lactose-reduced ice cream and milk.
  • Add a liquid or powder lactase enzyme to milk to break down the lactose.

What happens if you ignore lactose intolerance?

If left untreated, lactose intolerance can cause severe digestive discomfort, often in the form of bloating and gas pain in the stomach and chest.

Can taking probiotics help fight lactose intolerance?

Yes, research continues to show that probiotic bacteria can help manage symptoms of lactose intolerance.

How long does it take dairy products to get out of your system?

It can take up to three weeks after consumption for dairy to fully exit your system. 

Are eggs high in lactose?

No, eggs do not contain dairy. While they are found in the grocery store’s dairy section, eggs are a completely safe choice for those with lactose intolerance. 

Why can I eat ice cream but not drink milk?

Ice cream and milk have the highest lactose content. But because ice cream also has a high fat content, you may be able to eat it with fewer symptoms than drinking plain milk. Cultured milk products, like yogurt, may also be consumed symptom-free in some patients because the bacteria used to culture them produces lactase.

Which food is highest in lactose?

Milk contains the most lactose out of all the dairy products. Whole milk contains about 13 grams of lactose per 1-cup serving, while skim milk can contain between 12 and 13 grams. 

Why can't I drink milk but can eat cheese?

Because the process milk undergoes to become cheese converts the lactose into lactic acid, many people with lactose intolerance are able to eat it. Hard cheeses, such as cheddar, Swiss, mozzarella and other aged cheese are considered essentially lactose-free.


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If you are experiencing GI tract symptoms or pains, schedule your appointment today! No referral needed.

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