Lactose Intolerance

What is Lactose Intolerance?

Dairy milk contains a sufficient amount of lactose (milk sugar). Lactose is digested with the help of an enzyme names Lactase. Some people are unable to digest milk lactose due to the lack of lactase enzyme. Lactose intolerance is a digestive disorder that occurs when the body is unable to fully digest lactose, a type of sugar found in milk and dairy products. Lactose intolerance is caused by a deficiency of the enzyme lactase, which is produced by the cells lining the small intestine. Without sufficient lactase, the body is unable to break down and absorb lactose, leading to symptoms such as abdominal pain, bloating, gas, diarrhea, and nausea after consuming dairy products.

Lactose intolerance is not a food allergy, and it is not the same as a milk allergy, which is an immune system reaction to proteins in milk. Lactose intolerance is more common in people of African, Asian, Hispanic, and American Indian descent, and it is also more common in adults than in children.

There is no cure for lactose intolerance, but the symptoms can be managed by limiting or avoiding lactose-containing foods and drinks, or by taking lactase supplements. Some people with lactose intolerance may be able to tolerate small amounts of lactose, while others may need to completely avoid it. It is important to speak with a healthcare provider or a registered dietitian to develop a dietary plan that meets your nutritional needs.

Symptoms of Lactose Intolerance

There are several symptoms of lactose intolerance, including:

1. Bloating: This is a common symptom of lactose intolerance. The body is unable to digest lactose properly, causing gas and bloating.
2. Diarrhea: Lactose intolerance can cause diarrhea due to the inability to digest lactose.
3. Abdominal pain: Lactose intolerance can cause stomach cramps, discomfort, and pain.
4. Nausea: Some people with lactose intolerance may experience nausea after consuming dairy products.
5. Flatulence: Excess gas and flatulence can be a sign of lactose intolerance.
6. Constipation: Lactose intolerance can cause constipation due to the inability to absorb lactose.
7. Headaches: Some people with lactose intolerance may experience headaches after consuming dairy products.
8. Skin rash or hives: Some people with lactose intolerance may experience an allergic reaction, which can cause a rash or hives.

It is important to note that these symptoms can vary in severity and may not always be present. It is also possible to have lactose intolerance and not experience any symptoms at all. If you suspect that you may have lactose intolerance, it is important to speak with a healthcare provider for proper diagnosis and treatment.

Causes of Lactose Intolerance

Lactose intolerance is caused by a deficiency or deficiency of the enzyme lactase, which is responsible for breaking down lactose (a sugar found in milk and dairy products) into simpler sugars (glucose and galactose) that can be absorbed by the body.

There are several causes of lactose intolerance:

1. Congenital lactose intolerance: This is a rare genetic disorder that is present at birth. People with this condition do not produce any lactase enzyme and therefore cannot digest lactose.
2. Primary lactose intolerance: This is the most common form of lactose intolerance and is usually caused by a decline in lactase production as we age.
3. Secondary lactose intolerance: This is a temporary form of lactose intolerance that can be caused by certain medical conditions such as inflammatory bowel disease (Crohn’s disease or ulcerative colitis), coeliac disease, or infections of the small intestine (e.g. bacterial gastroenteritis).
4. Developmental lactose intolerance: This type of lactose intolerance can occur in very premature infants who are born before their lactase enzyme production has fully developed. This condition usually resolves on its own as the baby grows and develops.

Types of Lactose intolerance

There are five types of lactose intolerance

1. Primary lactose intolerance: Primary lactose intolerance is the most common type and occurs when the body naturally produces less lactase, the enzyme that breaks down lactose, as it gets older. This type usually develops in adulthood and is more prevalent in certain ethnicities, such as African, Asian, and Latino populations.
2. Secondary lactose intolerance: This type of lactose intolerance is caused by an underlying condition that damages the small intestine, such as celiac disease, intestinal infection, 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. It can also be caused by certain medications that damage the small intestine or cause inflammation.
3. Congenital lactose intolerance: Congenital lactose intolerance is a rare genetic disorder that affects newborns and is characterized by an absence of lactase from birth. This type of lactose intolerance is typically diagnosed within the first few weeks of life. 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. Developmental lactase deficiency:  Developmental lactose intolerance is a type of lactose intolerance that occurs in infants and young children. Developmental lactose intolerance is typically temporary and resolves as the child grows and produces more lactase enzymes. However, in some cases, it may persist into adulthood.
5. Lactose intolerance due to surgery:  It is possible that lactose intolerance can develop after surgery, although it is not a common occurrence. Some surgeries, such as gastric bypass surgery or intestinal surgery, can damage the small intestine where lactase is produced, leading to a deficiency of the enzyme and lactose intolerance. It is important to note that lactose intolerance can also be genetic or develop gradually over time due to age or other factors. If you suspect that you have developed lactose intolerance after surgery, it is important to speak with a healthcare professional for proper diagnosis and treatment.

Risk Factors of Lactose Intolerance

There are several factors that may increase the risk of lactase deficiency;

1. Age: Lactose intolerance is more common in people over the age of 20, with the highest prevalence in people of African, Asian, and Hispanic descent.
2. Ethnicity: People of African, Asian, Hispanic, and Native American descent are more likely to develop lactose intolerance.
3. Genetics: Lactose intolerance can be inherited and is more common in people with certain genetic backgrounds.
4. Medical conditions: Some medical conditions, such as inflammatory bowel disease and celiac disease, bacterial overgrowth, and Crohn’s disease can increase the risk of lactose intolerance.
5. Medications: Some medications, such as antibiotics, can disrupt the balance of bacteria in the gut and lead to lactose intolerance.
6. 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.
7. Surgery: Some types of surgery, such as weight loss surgery, can disrupt the digestive system and increase the risk of lactose intolerance.
8. 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.

Diagnosis of Lactose Intolerance

This is a medical condition, which can be diagnosed simply by observing its symptoms, like bloating, nausea, abdominal pain, diarrhea, constipation, etc. Your doctor can confirm the suspected condition by your response to reduce the milk in your diet. If the condition gets better after reducing drinking milk, then the conditions would be confirmed. Apart from the above method, there are some tests, which may further help diagnose the condition. These tests are;

Hydrogen Breath Test

The hydrogen breath test is a diagnostic tool used to detect lactose intolerance in individuals. The hydrogen breath test involves the person drinking a solution containing lactose and then breathing into a special machine that measures the amount of hydrogen gas in their breath. The presence of hydrogen in the breath is an indicator of lactose intolerance because the body produces hydrogen when it is unable to digest lactose.

The test is typically administered in a medical office or clinic, and the person may be asked to fast for several hours before the test. The test typically takes about two hours to complete, and the person will be asked to breathe into the machine at various intervals to measure the amount of hydrogen in their breath.

If the results of the hydrogen breath test show high levels of hydrogen in the breath, it is likely that the person is lactose intolerant. In this case, the person may need to make dietary changes to avoid lactose-containing foods or take lactase supplements to help digest lactose. If the results show low levels of hydrogen, it is likely that the person is able to digest lactose without any problems.

Lactose Tolerance Test

The lactose tolerance test is a diagnostic test used to determine if an individual has lactose intolerance. This test involves drinking a liquid containing a high amount of lactose and then measuring the amount of glucose in the blood over a period of time.

To begin the test, the individual will be asked to fast (not eat or drink anything except water) for several hours before the test. Next, a healthcare provider will take a blood sample to measure the baseline level of glucose in the blood. The individual will then be asked to drink a liquid containing lactose. Another blood sample will be taken at set intervals (usually 30 minutes, 1 hour, 2 hours, and 3 hours) after consuming the lactose to measure the amount of glucose in the blood.

If the body is able to properly digest lactose, the blood glucose levels will increase over the course of the test. However, if the body is unable to digest lactose, the blood glucose levels will not increase significantly. This indicates that the individual may have lactose intolerance.

The lactose tolerance test is a simple and reliable way to diagnose lactose intolerance. It is usually performed in a healthcare setting, but some at-home kits are also available. It is important to note that this test is not recommended for people with certain medical conditions, such as pregnancy or diabetes, and should only be performed under the guidance of a healthcare provider.

Genetic Testing

Genetic testing can be used to diagnose lactose intolerance by examining an individual’s DNA to determine whether they have a genetic mutation that affects their ability to produce the enzyme lactase, which is needed to break down lactose.

To undergo genetic testing for lactose intolerance, a person would typically need to provide a sample of their DNA, which can be collected through a simple saliva or blood test. The sample is then analyzed in a laboratory to look for specific genetic mutations that are associated with lactose intolerance.

If the genetic test shows that a person has the genetic mutation that causes lactose intolerance, it can be used to diagnose the condition. However, it is important to note that genetic testing is not the only method of diagnosing lactose intolerance, and other tests, such as lactose tolerance tests, may also be necessary to confirm the diagnosis.

Stool Acidity Tests

The stool acidity test is a diagnostic test used to determine if a person has lactose intolerance. During the test, a small sample of stool is collected and sent to a laboratory for analysis. The lab will measure the pH of the stool, which is a measure of acidity. If the pH of the stool is high, it indicates that the person is not digesting lactose properly. This can be a sign of lactose intolerance.

The stool acidity test is a quick and easy way to diagnose lactose intolerance, and it is often used in conjunction with other tests, such as the lactose tolerance test or hydrogen breath test, to confirm the diagnosis.

Intestinal Biopsy

An intestinal biopsy is a diagnostic procedure in which a small sample of tissue is taken from the lining of the intestine for laboratory analysis. This procedure is typically performed to diagnose lactose intolerance, a condition in which the body is unable to properly digest lactose, a sugar found in milk and dairy products.

To perform an intestinal biopsy, a healthcare provider will typically use a thin, flexible tube called an endoscope, which is inserted through the mouth and down the throat into the intestine. The endoscope has a tiny camera on the end that allows the healthcare provider to view the inside of the intestine. The provider will then use specialized instruments to take a small sample of tissue from the intestine.

The sample is then sent to a laboratory for analysis, where it is examined under a microscope to determine if the cells in the tissue are able to produce lactase, the enzyme needed to digest lactose. If the cells are not producing enough lactase, it may be a sign of lactose intolerance.

Intestinal biopsy is a relatively safe and non-invasive procedure, but it may cause some discomfort and may require sedation. It is typically performed in a hospital or outpatient clinic setting.

Treatment of Lactose Intolerance

If the lactose intolerance is caused by some underlying condition, treating the condition might restore lactose tolerance. On the other hand, if the condition is caused by the lack of production of lactase in the small intestine, then intolerance is to simply avoid consuming lactose-containing foods or taking lactase supplements to help digest lactose.

Other treatment options may include:

1. Consuming lactose-free or lactose-reduced products: These products are made with lactase enzymes to help digest lactose.
2. Gradually increasing lactose intake: Some people may be able to tolerate small amounts of lactose over time by gradually increasing their intake.
3. Using lactase drops or tablets: These supplements contain the enzyme needed to break down lactose and can be taken before consuming lactose-containing foods.
4. Consuming probiotics: Probiotics are those health-friendly bacteria, which keep you healthier and help digest foods. Certain probiotic strains have been shown to help improve lactose digestion.
5. Enzyme replacement therapy: The enzyme which digests the lactose is known as lactase. This treatment involves injecting the enzyme (lactase) needed to digest lactose into the body.
6. Experiment with an assortment of dairy products. Not all dairy products have the same amount of lactose. For example, hard cheeses, such as Swiss or cheddar, have small amounts of lactose and generally cause no symptoms.

   Ice cream and milk contain the most lactose, but the high-fat content in ice cream might allow you to eat it without symptoms. You might tolerate cultured milk products such as yogurt because the bacteria used in the culturing process naturally produce the enzyme that breaks down lactose.

7. Taking milk at mealtime: Saving milk for mealtime is a good way to get it digested. Drinking milk with other foods will slows the digestive process and may lessen symptoms of lactose intolerance.

It is important to speak with a healthcare professional to determine the best treatment plan for lactose intolerance.

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