Lactose intolerance is one of the most common afflictions, affecting around 65% of the population worldwide. Unlike conditions that cause severe health complications, lactose intolerance does not cause harm, but it can severely impair the quality of life. 

Understanding the basics of lactose intolerance is important to help manage its symptoms and get the proper nutrition. The following guide will discuss the causes, symptoms, diagnosis, and treatment of lactose intolerance.

What is Lactose Intolerance?

Lactose is a sugar found in milk and dairy products; lactose intolerance refers to the inability to digest this sugar. This happens when there is insufficient lactase, the enzyme that breaks down lactose into its easily absorbed sugars, glucose and galactose, in the small intestine. 

When there is insufficient lactase, lactose cannot be digested and enters the large intestine, where it is fermented by bacteria, causing painful symptoms. Lactose intolerance is different from a milk allergy, which is an immune system response to milk proteins. Biologic and synthetic agents differ enough for their different diagnoses and management. 

A milk allergy usually features symptoms like hives, itching, swelling, stomach cramps, diarrhoea, and trouble breathing, and it can be life-threatening if not treated quickly. Lactose intolerance, on the other hand, mainly results in gastrointestinal distress but no allergic response.

This is much more common among certain populations. The coconut, or cabbage form, is more prevalent in African, Asian, and Hispanic people who are not acquainted with dairy products in their dietary staple. The condition can occur in people of all ages, but it is usually more common after childhood.

Lactose Intolerance and Nutrition

Balancing diets is crucial for people with lactose intolerance. Dairy is full of calcium and vitamin D, which are the keys to bone health. Hence, it is suggested to consume other sources of these nutrients to avoid deficiencies. Lactose-free or low-lactose products and supplements can aid in getting enough of these important nutrients.

Types of Lactose Intolerance

There are 3 different types of lactose intolerance that includes:

1. Primary Lactose Intolerance

This is the most common type of lactose intolerance. It happens when the body slowly stops producing lactase as it ages, usually following weaning. The type is widespread among populations that do not consume dairy as a staple adult diet, such as many Asian, African, and Hispanic people.

In these populations, the genetic adaptation not to produce lactase after childhood is common because adults did not traditionally consume a substantial amount of dairy. Hence, they are more than likely to develop lactose intolerance.

2. Secondary Lactose Intolerance

This type occurs when a small intestine injury or condition occurs, including Crohn’s disease, celiac disease, or a bacterial infection. It can also occur after surgery on the small intestine. Lactase production may return to normal when the underlying condition is treated.

Anyone can develop secondary lactose intolerance, regardless of genetics, and this type is often transient. However, when the underlying condition is managed, normal lactase production needs to be restored.

3. Congenital Lactose Intolerance

Lactose needs enzymes called lactase to be broken down, and some babies are born with an inability to produce lactase due to a genetic condition. This type is severe and requires immediate dietary changes to prevent severe dehydration and malnutrition.

Congenital lactose intolerance is identified early in life, usually when infants display intolerance to lactose-containing formulas. Urgent action is required to correct poor nutrition and save lives.

Causes of Lactose Intolerance 

There are multiple causes that contribute to developing lactose intolerance in adulthood:

• Ethnicity: Those of Asian, African, and Hispanic background are more susceptible to developing lactose intolerance, owing to genetic tendencies.
• Genetics: Lactose intolerance is often hereditary, meaning it can be passed down in families.
• Age: The risk increases as you grow older since ageing naturally produces less lactase.
• Dietary Practices: Regular intake of lactose-containing foods may sustain some degree of lactase production, although this varies from person to person.

Symptoms of Lactose Intolerance 

Symptoms of lactose intolerance usually emerge within half an hour to two hours after consuming lactose-containing products, and their severity can vary:

• Common Symptoms: Bloating, gas, diarrhoea, abdominal cramps, and nausea.
• Less Common Symptoms: Vomiting, abdominal borborygmi.

Diagnosis of Lactose Intolerance

Diagnosis is usually based on symptoms and dietary responses. A healthcare provider may suggest cutting back on dairy to see whether symptoms improve. 

Formal diagnostic tests include hydrogen breath tests, which measure the amount of hydrogen in the breath (a byproduct of lactose fermentation), and stool tests to look for acidity, which can be a sign of undigested lactose.

• Symptom Examination: Maintaining a food diary to make a note of symptoms after consuming dairy products.
• Dairy-elimination Diet: One helpful intervention is to remove dairy from the diet for a time and see if symptoms resolve.
• Hydrogen Breath Test: A test measuring hydrogen levels in the breath after lactose consumption
• Stool Acidity: This test checks for more than normal stool acidity, which usually indicates lactose malabsorption.

Correct diagnosis is important to rule out other conditions that could be linked to similar symptoms, like irritable bowel syndrome (IBS) or small intestine bacterial overgrowth (SIBO). Misdiagnosis can also result in ineffective treatment and continuation of discomfort.

Treatment Options for Lactose Intolerance

Although there is no cure for lactose intolerance, symptoms can be managed effectively with dietary changes and supplements:

• Dietary Changes: Avoidance or decreased intake of lactose-containing foods or simple intake of lactose in small quantities with food to minimise symptoms.
• Lactose-Free or Low-Lactose Products: Eating lactose-free milk, cheese, and yoghurt, or lactose-reduced ice cream.
• Lactase Supplements: Lactase enzyme drops or tablets are dissolved in milk before consumption to break down lactose.
• Calcium and Vitamin D: These nutrients, often found in dairy products, help keep bones strong.

In such cases, treating the underlying condition may restore lactase production over time. Adhering to a lactose-free diet is critical for individuals with congenital lactose intolerance to avert life-threatening health consequences.

Managing Lactose Intolerance in Daily Life

Managing lactose intolerance means some adjustments in your life. However, that doesn’t have to severely influence daily life. Here are some tips to keep the condition under control:

• Scan Food Item Labels: Lactose can be found in foods such as bread, cereals, and processed meats.
• Consider Alternatives: Many lactose-free or low-lactose products are available, or choose non-dairy alternatives (such as almond or soy milk).
• Cooking and Recipes: Adjust recipes so that you cook them with lactose-free products or simply reduce the lactose present through cooking techniques such as boiling or fermenting.

FAQs about Lactose Intolerance

1. How do I know if I’m lactose intolerant?

Lactose intolerance symptoms include bloating, gas, diarrhoea, nausea, and stomach cramps after consuming dairy. If you suspect intolerance, eliminate dairy for a few days and observe if symptoms improve. A hydrogen breath test or stool acidity test can help confirm the diagnosis.

2. Can lactose intolerance be harmful?

Lactose intolerance is not harmful but can cause discomfort and digestive issues. Long-term dairy avoidance without proper nutrition can lead to calcium and vitamin D deficiencies, increasing the risk of bone problems. Managing the condition with dietary changes and supplements can help prevent these deficiencies.

3. Why am I suddenly lactose intolerant?

Lactose intolerance can develop later in life as lactase production naturally decreases with age. It is also possible due to gut infections, digestive disorders, or surgery affecting the small intestine. If symptoms appear suddenly, identifying any underlying health conditions can help manage intolerance.

4. Can lactose intolerance come and go?

If you are genetically predisposed, lactose intolerance does not completely go away. However, symptoms can vary depending on diet, gut health, and the amount of lactose consumed. Some people tolerate small amounts of dairy, while others need to avoid it completely.

5. Is lactose intolerance an allergy?

No, lactose intolerance is different from a milk allergy. A milk allergy is an immune reaction to proteins in milk, which can cause rashes, swelling, or even life-threatening anaphylaxis. Lactose intolerance results from a lack of lactase enzyme and only causes digestive discomfort.

6. Can you suddenly become lactose intolerant?

Yes, many people develop lactose intolerance over time. Lactase production starts declining after infancy, and by adulthood, many individuals—especially those of non-European descent—no longer produce enough to digest dairy properly. This can cause symptoms to appear seemingly out of nowhere.

Conclusion

The severity of lactose intolerance ranges from mild discomfort to major diet limitations. Diagnosis may include assessing symptoms, elimination diets, and tests such as the hydrogen breath test. Early recognition and appropriate management are critical to benefitting quality of life.DocTutorials offers detailed coverage of all important topics for medical aspirants. Check out our NEET PG course, which includes video explanations, question banks, quick revision, and more.