Lactose Intolerance

Lactose intolerance is a prevalent digestive issue that affects millions of people worldwide. Lactose intolerance is the inability of the body to digest lactose, the sugar found in milk and various dairy products. It happens due to a deficiency in the lactase enzyme, produced in the small intestine. This inability leads to a range of uncomfortable symptoms, such as bloating, diarrhoea, gas, and nausea.

These symptoms typically occur after consuming lactose-containing foods or drinks and can include abdominal pain. Understanding the causes and symptoms of lactose intolerance is crucial for those affected by this condition. This knowledge helps individuals manage their condition effectively and maintain a healthy, comfortable lifestyle.

What is Lactose Intolerance?

Lactose intolerance is a digestive disorder that should not be confused with a milk allergy, which is an immune system reaction to milk proteins. It specifically refers to the digestive issues that arise when the small intestine does not produce enough lactase enzyme. This condition can affect individuals of all ages, from infants to adults. It is more common in certain ethnic groups, such as African Americans, Asian Americans, Hispanics/Latinos, and Native Americans.

The severity of lactose intolerance can vary from person to person. Some individuals may tolerate small amounts of lactose without experiencing significant symptoms. In contrast, others may need to avoid lactose-containing products entirely to prevent discomfort.

There are four main types of lactose intolerance, each with distinct causes.

• Primary Lactose Intolerance: Primary lactose intolerance is the most prevalent form of lactose intolerance. It typically starts in late childhood or early adulthood. The body naturally reduces lactase enzyme production in the small intestine. This condition is more prevalent among people of African, Asian, Hispanic, and American Indian descent.

• Secondary Lactose Intolerance: In secondary lactose intolerance, the small intestine reduces its production of lactase. The decrease can occur due to an illness, injury, or surgery affecting the small intestine. Additionally, bacterial overgrowth and Crohn's disease are linked to secondary lactose intolerance.

• Congenital Lactose Intolerance: Congenital lactose intolerance is a rare form of lactose intolerance. Babies are born with a complete deficiency of the lactase enzyme due to a genetic disorder. This condition can be life-threatening if not promptly recognized and treated.

• Developmental Lactose Intolerance: Developmental lactose intolerance affects premature babies specifically. This condition usually improves as the baby's small intestine matures. Most infants outgrow this type of lactose intolerance with time.

Early signs of lactose intolerance can manifest in various ways but typically involve gastrointestinal discomfort after consuming dairy products. Some key early signs include:

• Flatulence: Excessive gas production can be an early indicator of lactose intolerance, especially if it occurs consistently after consuming milk or dairy products.

• Abdominal Discomfort: Mild abdominal pain, bloating, or a feeling of fullness after consuming lactose-containing foods may be an early sign of intolerance.

• Loose Stools: While not as severe as full-blown diarrhoea, having looser or more frequent stools after consuming dairy can be an early indication of lactose intolerance.

• Nausea: Some individuals may experience mild nausea after consuming lactose, even before other symptoms appear.

Lactose intolerance is the inability to digest lactose due to insufficient lactase enzyme production in the small intestine. Common symptoms of lactose intolerance include:

• Diarrhoea: This is one of the most common symptoms of lactose intolerance and usually occurs within 2 hours of consuming lactose-containing foods.

• Bloating and Gas: Undigested lactose can lead to bloating and excessive gas production in the intestines.

• Abdominal Cramps: Pain and discomfort in the abdomen can occur due to the fermentation of lactose by bacteria in the colon.

• Nausea and Vomiting: Some people with lactose intolerance may feel nauseous and vomit after consuming dairy products.

Lactose intolerance happens when the body can't digest lactose, the sugar in dairy products. The main causes include:

• Lactase Deficiency: The body produces insufficient lactase, which prevents proper digestion of lactose in the small intestine.

• Genetic Factors: Lactase non-persistence, common in African, Asian, Hispanic, Mediterranean, and Native American populations, is caused by genetic factors.

• Intestinal Damage: Secondary lactose intolerance results from damage to the small intestine caused by infections, diseases, or surgeries.

• Congenital Disorder: Congenital lactose intolerance is a rare genetic disorder where lactase is absent from birth.

• Premature Birth: Premature infants may experience temporary lactose intolerance due to their underdeveloped small intestines.

Several factors can increase the risk of developing lactose intolerance, including genetic, developmental, and medical conditions.

• Ethnic Background: Individuals from African, Asian, Hispanic, Mediterranean, and Southern European backgrounds have a higher genetic risk of developing lactose intolerance.

• Genetic Predisposition: These ethnic groups have a genetic predisposition due to the absence of an ancestral need to maintain high lactase levels into adulthood.

• Premature Birth: Premature birth increases the risk of developmental lactose intolerance, as the small intestines may be underdeveloped.

• Intestinal Diseases: Conditions like celiac disease or Crohn's disease can raise the risk of secondary lactose intolerance by damaging the intestines.

• Bowel Damage: Bowel infections or surgeries can cause damage to the small intestine, leading to lactose intolerance.

Diagnosing lactose intolerance involves assessing symptoms and conducting specific tests to confirm the condition. The first step is a thorough medical history and physical examination, where the healthcare provider will ask about symptoms, dietary habits, and family history. If lactose intolerance is suspected, several tests can be performed:

• Lactose Breath Test: This test measures the amount of hydrogen in the breath after consuming a lactose liquid. If the body is unable to digest lactose, it will ferment in the colon, producing hydrogen that can be detected in the breath.

• Lactose Tolerance Test: This test involves consuming a liquid containing lactose, followed by measuring blood glucose levels over a few hours. If blood glucose levels do not rise significantly, it may indicate that the body is not properly digesting and absorbing lactose.

• Stool Acidity Test: This test is particularly useful for diagnosing lactose intolerance in infants and young children. It measures the acidity of a stool sample, as undigested lactose can cause the stool to be more acidic than normal.

• Small Intestine Biopsy: In rare cases, a biopsy of the small intestine may be performed to measure lactase activity directly. This is usually done if other tests are inconclusive or if there is suspicion of other digestive disorders.

The treatment and management of lactose intolerance primarily involve dietary changes to reduce or eliminate lactose consumption. For individuals with lactose intolerance, the following strategies can help alleviate symptoms:

• Limit Lactose Intake: Reduce the amount of lactose-containing foods in your diet, such as milk, cheese, and ice cream. Instead, opt for lactose-free alternatives or products with reduced lactose content.

• Choose Lactose-Free Foods: Many supermarkets now offer a wide range of lactose-free products, including milk, yoghurt, and cheese. These products are suitable for those with lactose intolerance and can help maintain a balanced diet.

• Use Lactase Enzyme Supplements: Lactase enzyme supplements that are available over the counter can be ingested before consuming foods that contain lactose. This can aid in breaking down lactose and alleviating symptoms. These supplements come in tablet or liquid form.

• Gradually Introduce Lactose: Some individuals with lactose intolerance may be able to tolerate small amounts of lactose. Gradually introducing lactose-containing foods into your diet and monitoring your symptoms can help determine your tolerance level.

• Read Food Labels Carefully: When shopping for groceries, read food labels carefully to identify lactose-containing ingredients. Look for terms such as milk, whey, curds, or milk by-products.

In some cases, medication may be prescribed to manage severe symptoms of lactose intolerance. However, dietary changes and lactase enzyme supplements are usually sufficient for most individuals. If you suspect lactose intolerance, consult a healthcare professional for a proper diagnosis and personalised treatment plan.

While lactose intolerance is generally not a serious condition, there are certain situations in which it is important to seek medical attention. If you experience severe or persistent symptoms of lactose intolerance, such as abdominal pain, bloating, diarrhoea, or nausea, it is advisable to consult a doctor. These symptoms may indicate a more serious underlying condition, such as celiac disease or inflammatory bowel disease.

In addition, if you suspect that an infant or newborn may have lactose intolerance, it is crucial to seek medical advice. Lactose intolerance in newborns and infants is rare. Symptoms such as diarrhoea, vomiting, and failure to thrive may indicate other health issues requiring prompt medical attention.

Your doctor can help diagnose lactose intolerance through various tests, such as the hydrogen breath or lactose tolerance tests. Once diagnosed, your doctor can provide guidance on managing your condition effectively. This includes dietary recommendations and medication options to help you maintain a healthy, symptom-free lifestyle.