Lactose intolerance is a common condition, and it is one that a lot of people suffer from without really realizing that they have it. Only those with quite serious versions of the condition tend to get diagnosed. The good news is that for all it can be quite frustrating and embarrassing, it is also quite easy to manage.
Highlighted below is an overview of lactose intolerance as well as tips for managing and preventing symptoms.
What Is Lactose Intolerance?
Lactose intolerance is a digestive condition where the body cannot digest lactose, a form of sugar that is present in milk and dairy produce.1 When most people eat or drink something that contains lactose, an enzyme called lactase will help to break the lactose down into glucose and galactose, which can be absorbed by the body and used as fuel.2
Those who suffer from lactose intolerance do not produce enough lactase to do that, so the undigested lactose goes through the digestive system as it is, resulting in some unpleasant side effects for the individual.
Symptoms of Lactose Intolerance
Lactose intolerance can cause a number of symptoms, including flatulence, bloating, stomach cramps, nausea, diarrhea.3
These symptoms will usually appear a couple of hours after the individual eats or drinks something that contains significant amounts of lactose. Because there is a delay between eating the food and the symptoms appearing, it is easy for people to fail to make the connection between what they are eating and their symptoms.
In fact, because some people who are lactose intolerant can actually tolerate small amounts of dairy products, it is easy for people to go undiagnosed for quite some time.
Who Develops Lactose Intolerance?
Lactose intolerance can affect people of all ages and seems to affect the genders equally. There is some evidence to suggest that there is a genetic element to lactose intolerance.4 Some ethnicities are more likely to be lactose intolerant than others, with more than 90 percent of east Asians being lactose intolerant, while fewer than 15 percent of British people are diagnosed as lactose intolerant.5
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Most humans are born with the ability to digest lactose, but, in general, some people lose that ability as they get older. It is thought that Europeans are less likely to be lactose intolerant than Asians because, in Europe, it was common for farmers to keep cattle and to give the milk from the cattle to children.
Any children who had the mutation that allowed lactase production to continue into adulthood had an advantage over those without the gene, and over time, the mutation became more commonplace and tribes that were able to keep large herds and live on milk, cheese, and other dairy products became dominant.
Some people develop what is known as secondary lactose intolerance where they become unable to digest lactose for a while after an infection or because they are having a flare-up of celiac disease or inflammatory bowel disease (IBS). In those cases, once whatever it is that was damaging the intestines has been resolved, the intestinal wall will repair itself and the intolerance will resolve. It usually takes about a month for the intestines to recover after an illness like this.6
Managing Lactose Intolerance
Lactose intolerance can be managed in a number of ways. A lot of people simply choose to manage their lactose intolerance by changing their diets to avoid dairy products. This is not always practical, however, and some people opt to use lactase instead. Lactase tablets are tablets that contain the enzyme of the same name. You can either take a tablet before consuming products that contain lactose or add a few drops of lactase to your milk before you drink it.7
Some people keep lactase on hand so that they can take it if they are going to be out in a social situation where they feel like they should indulge in a food that would otherwise make them sick. Adults who developed lactase intolerance later in life may opt to use lactase so that they can still enjoy their favorite foods.
If you are pregnant or breastfeeding, then you may not be able to take lactase. It is also not always a good idea for young children to take it, so talk to a doctor before using lactase tablets.
Can Lactose Intolerant People Consume Any Dairy Products?
Some people who are lactose intolerant are still able to tolerate cheese and yogurt because of the slightly different chemical composition of these products. They may even be able to cope with consuming a small amount of milk if they consume it in with food.
The problem comes if they drink milk, consume large quantities of ice cream or cheese, or have something like breakfast cereal with milk so that there is nothing else in the stomach to aid with the flow of the food through the intestines.
The list of foods that people with lactose intolerance should avoid begins with the most obvious things like milk, cream, yogurt, butter, and cheese.8
However, the list also contains a number of processed foods that might otherwise be unexpected. For example, anything that contains whey or casein on the ingredients list will probably also contain lactose.
Other products that often contain milk so could be inadvisable for those with lactose intolerance include cakes, cereals, biscuits, creams and dressings, sweet snacks, and chocolate.
Healthy Diets for Lactose Intolerant Individuals
If you suffer from lactose intolerance and you miss a lot of the foods that are known to contain lactose, then you may want to look at lactose-free products. Many supermarkets now sell lactose-free cow’s milk and there are a number of vegan products suitable for people with lactose intolerance.
For example, soy milk (and soy yogurts and cheeses) are available and margarine can be used in most areas where people would traditionally use butter. Additionally, with more individuals moving away from dairy, there are many other alternatives to soy products, including products made from almond, coconut, and even oat mix.
One challenge that a lot of people with lactose intolerance face is getting enough calcium. Most people get the calcium that they require in their diet through consuming dairy products, and if dairy products are no longer an option, then it’s important to find other ways of boosting your calcium intake.9
Luckily, there are some good plant sources of calcium including leafy green vegetables, fish, nuts and beans, oranges, and seaweed.
To ensure that your body is able to absorb non-dairy calcium, you should also make sure that you eat it with a source of Vitamin D. The body can produce Vitamin D by itself if you are exposed to sunlight on a regular basis, but some people are deficient in it and may need to take supplements.10 Dietary sources of vitamin D include fish and mushrooms. Additionally, some processed foods are fortified with both Vitamin D and calcium.
Children and Lactose Intolerance
It is not uncommon for children to show symptoms of lactose intolerance, but a lot of the time, they are not really intolerant to lactose itself. It is rare for a child under the age of six to have the condition. It is more likely that they either have a temporary intolerance because of a stomach infection or that they are allergic to a protein found in cow’s milk.
If the symptoms are new, and the child insists that they want to continue drinking milk, then there is usually no harm in allowing them to do so for a few days. However, if the symptoms persist, then you should have them see a doctor.
Can You Grow Out of Lactose Intolerance?
Children can sometimes be sensitive to milk products in childhood but be able to tolerate them later. Adults who develop lactose intolerance, however, are not likely to outgrow it. If your body is not producing enough of the enzyme, then that is unlikely to change over time.11 The best that most people can hope for is that they will be able to find alternatives to the foods that they enjoyed, or find that they can eat small quantities of them.
Condition Linked to Lactose Intolerance
Some people who have lactose intolerance also suffer from other conditions, including celiac disease and irritable bowel syndrome. It can be challenging to manage all of these conditions because of the dietary restrictions they impose.
For instance, someone who has both celiac and lactose intolerance is going to be at increased risk of developing osteoporosis, a condition where the bones become weaker because of a lack of calcium. Because of this, it’s particularly important that people who have multiple diet-related conditions pay close attention to their micronutrient intake.12,13
When Should You See a Doctor?
If you are an adult who has suddenly started experiencing unpleasant digestive issues, then it is a good idea to see a doctor before you start cutting out dairy products from your diet. Keeping a food diary is also useful and could help your doctor to diagnose the issue, but you should still speak to them before making changes to your diet.
The symptoms of lactose intolerance are quite similar to the symptoms of IBS and milk protein intolerance and your doctor may want to rule those out first. If they think that you are lactose intolerant then they may recommend avoiding lactose-containing foods for a week or two in order to see if your symptoms improve.
If you do respond to cutting lactose out in the short term then they may suggest you have some further tests completed.14 Additional tests are not always necessary, but they can be useful to confirm the diagnosis and they might also help you figure out how much lactase your body is still producing, telling you whether you might be able to tolerate small amounts of dairy products. The tests might also help you figure out what has caused the sudden onset of your symptoms and will rule out other potentially serious conditions.
The most common test that doctors do is the hydrogen breath test. This test involves fasting overnight then breathing into a bag so that they can tell how much hydrogen your breath usually has. They will then ask you to drink a lactose solution and will measure your breath every 15 minutes over a period of a few hours to monitor changes in the level of hydrogen. If your breath contains a lot more hydrogen after you drink the lactose solution, this is likely because you are lactose intolerant and the lactose in the solution is causing your gut bacteria to produce hydrogen.15
In rare cases, your doctor may suggest other tests, but they usually do not do this unless they suspect that your symptoms are being caused by another condition such as celiac disease.
Lactose intolerance does not have to be a limiting condition. You can still enjoy most of the foods that you have always eaten, although you may need to either buy alternative versions that are dairy-free or take lactase tablets to enable you to digest them.
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