Last updated on July 19, 2021.
Dairy products are an indispensable part of the contemporary diet, but not everyone has the privilege to enjoy them indulgently. Many people experience nausea, abdominal discomfort, stomach pain or even diarrhea whenever they eat or drink milk and dairy products — and lactose intolerance may be to blame. Feeling bad for people with lactose intolerance as they have to avoid dairy products? In fact, it is not always the case. Read about the causes, symptoms, diagnosis and treatment of lactose intolerance on Healthy Matters.
What is lactose intolerance?
Lactose is the form of sugar present in milk and dairy products; whereas lactase is an enzyme responsible for breaking down lactose into simpler sugar, such as glucose and galactose, to be circulated in the blood and utilized by the body.
In essence, Lactose intolerance is defined as a condition when people cannot properly digest lactose due to insufficient lactase production, leading to symptoms like diarrhea, bloating and abdominal pain.This condition is not harmful to health but may cause discomfort and limit your food choice. Some people who are lactose intolerant can manage the condition without completely avoiding dairy products.
What is the difference between lactose intolerance and milk allergy?
People sometimes confuse lactose intolerance with milk allergy. Although the two share similar symptoms, they have different pathogenesis. Milk allergy is when the body’s immune system defends against the protein in milk and misinterprets it as a pathogenic substance. Mast cells (responsible for homeostasis) in the immune system then release histamine and other chemicals to attack the foreign “enemies”, causing allergic reactions like diarrhea, runny nose or rashes. Here we have compiled a list of the differences between lactose intolerance and milk allergy for your reference:
Onset of symptoms
Within 30 minutes to 2 hours after intake of dairy products
After a few hours or a day after intake of dairy products
Occurrence of symptoms & Dosage that triggers symptoms
- Occurs every time after intake
- May not occur every time after intake
Severity of symptoms
Severe, can lead to vomiting, bronchoconstriction, anaphylaxis or even death
Less severe, mainly gastrointestinal problems, e.g. bloating and diarrhea
Food prick test or blood test
Hydrogen breath test, Lactose tolerance test (blood test) or stool sample test
What are the causes of lactose intolerance?
According to a study, close to 75% of the world’s population is affected by lactose intolerance. A research on the update on lactose malabsorption and intolerance suggests, there are 3 main types of lactose intolerance:
Congenital Lactose Intolerance
Lactose intolerance can be caused by genes as some people are born with a poorer ability to produce lactase. Preterm infants have a high tendency to develop lactose intolerance because their digestive system may not be fully developed when they are born.
Primary Lactose Intolerance
Lactose intolerance rarely occurs during infancy because full-term infants are usually born with sufficient lactase to prepare for digestion of lactose in breastmilk. In most cases, lactose intolerance develops over time as lactase production decreases with age. Symptoms of lactose intolerance usually appear after childhood (after 5 years old).
Secondary Lactose Intolerance
Lactose intolerance may also be caused by a virus or infection, which inflicts temporary damage to the small intestine due to inflammation in the intestinal wall, consequently reducing lactase production. Once the virus is cleared from the body, the symptoms of lactose intolerance will be lifted as well.
Occasionally, lactose intolerance occurs in parallel with other diseases, in particular gastroenteritis and celiac disease.
What are the risk factors of lactose intolerance?
According to a study by Purdue University, risk factors of lactose intolerance include:
- Age: lactose intolerance is more common in adults but less in children or infants.
- Ethnicity: lactose intolerance is very common amongst Asian and African populations, and within specific races such as Spaniards, Mediterranean, Southern Europeans, and American Indians.
- Premature birth: preterm infants have less lactase because the lactase-producing cells in the small intestine only begin to develop in the third trimester of pregnancy.
What are the symptoms of lactose intolerance?
Symptoms usually appear 30 minutes to 2 hours after eating or drinking foods that contain lactose, i.e. milk and dairy products. The severity of the symptoms usually depends on the amount of lactose intake and the effectiveness of enzymatic action in the body.
Under lactose intolerance, lactose in milk and dairy products cannot be completely digested and absorbed in the digestive tract. As a result, most water is retained in the digestive tract to form watery stool which passes out as diarrhea. The undigested lactose then enters the large intestine, in which gut bacteria ferment the unabsorbed lactose and produce gases like carbon dioxide and hydrogen, as well as other byproducts that act as laxatives. Eventually, it brings about digestive signs and symptoms such as nausea, bloating, abnormal bowel movement, abdominal pain and farting.
How to treat people with lactose intolerance?
While severe consequences like dehydration, electrolyte imbalance and malnutrition are rarely caused by lactose intolerance, there is no cure for lactose intolerance. No known treatment to date can increase the production of lactase in the body. Most people with lactose intolerance usually avoid the digestive symptoms by cutting down on milk and dairy products. Also, certain medications and supplements can mediate the symptoms of lactose intolerance.
However, milk and dairy products are important sources of protein, calcium and vitamin D, which are essential for growth and development. In fact, according to research, many people with lactose intolerance can tolerate small amounts of lactose, up to 18g to be exact, if the intake is distributed throughout the whole day. So even for people with lactose intolerance, they may be able to enjoy some milk and dairy products. Some people may be more adapted to a certain dairy product and can tolerate a certain level of lactose intake. A clinical trial study even found that people with lactose intolerance can be trained gradually to adapt to dairy products, but it is important to keep the intake low in the beginning, then increase progressively.
Lactase enzyme supplements can be added into milk and dairy products to ease lactose digestion in people with lactose intolerance, so that they can still eat or drink dairy products with minimal symptoms of lactose intolerance.
Food to be aware of
People with lactose intolerance are suggested to be cautious of foods that contain lactose, particularly dairy products. For example, milk, ice cream, cheese, yogurt and butter.
Certain foods may contain some lactose even though they are not dairy products by definition. For example, breakfast cereals, breads and baked goods, chocolate and confectionery, biscuits and cookies, desserts, etc.
Check the ingredients before consuming food items to see if it contains milk or other sources of lactose.
Alternatives for people with lactose intolerance
Dairy products contain many essential nutrients, including calcium and vitamin D, which is important for growth and development. Alternatively, people with lactose intolerance may choose foods with non-dairy sources of calcium and/or vitamin D. For example, lactose-free milk, yoghurt and cheese, as well as tofu, boned fish and many vegetables etc. These foods contain either natural or fortified calcium and/or vitamin D.
What are some complications linked to lactose intolerance?
People with lactose intolerance often avoid most dairy products and milk which in fact contain a lot of essential nutrients, such as protein, calcium and vitamins. Deficiency of these essential nutrients may lead to the following complications:
- Osteopenia/Osteoporosis: a condition where low bone-density may bring a high risk of bone fracture due to insufficient intake of calcium and vitamin D (kids and elderly are more susceptible).
- Malnutrition: a condition in which food intake is insufficient to support normal body function due to absence of intake of essential nutrients like protein.
Any adverse effects of eating or drinking dairy products if one is lactose intolerant?
Generally no. But as people with lactose intolerance cannot digest lactose well, they may experience gastric discomfort, such as abdominal pain, bloating, abnormal bowel movement, gas and nausea. Some people can get used to the feeling of discomfort and gradually adapt to it, and still manage to eat or drink a certain amount of dairy products.
How do I know if I am lactose intolerant?
Check to see if you experience above-mentioned symptoms almost every time after intake of dairy products or milk. If in doubt, you may consult the doctor for further diagnosis by taking a hydrogen breath test, lactose tolerance test (blood test) or stool sample test.