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Lactose intolerance is a condition that makes it hard for a person’s body to digest sugar that is in dairy products, i.e. milk, cheese, curd, and all milk by- products. People with lactose intolerance may experience the following symptoms, usually within 30 minutes to about 2 hours after ingesting dairy products:
Stomach cramps (usually around or below the belly button)
Bloating
Flatulence, i.e. feel ‘gassy’
Constantly passing gas
Nausea
Diarrhea (often it is bulky, foamy, and watery)
The severity of your symptoms and when they appear depends on the amount of lactose you have consumed. Some people may still be able to drink a small glass of milk without triggering any symptoms, while others may not even be able to have milk in their tea or coffee.
In people who do not have lactose intolerance, the body makes an enzyme called lactase that breaks down lactose, the main form of sugar found in milk. In people who do have lactose intolerance, the body either does not make enough of the enzyme (lactase deficiency), or the enzyme does not work as well as it should. As a result, the lactose is not broken down properly and stays in the digestive system, where it's fermented by bacteria. This leads to the production of various gases, which cause the symptoms associated with lactose intolerance.
Lactose intolerance is closely linked to genetics, prematurity in babies, or underlying intestinal diseases. Depending on the underlying reason on why the body is not producing enough lactase, lactose intolerance may be temporary or permanent. Most cases that develop in adults are inherited and tend to be lifelong, but cases in young children are often caused by an infection in the digestive system and may only last for a few weeks.
Indeed, there is such a thing as dairy allergy, but the symptoms of a dairy allergy are often different from those of lactose intolerance. In the case of an allergy, the body reacts to the protein in milk, rather than to the sugar. Food allergies like dairy allergy involve the body's immune system, whereas lactose intolerance does not. As a result, food allergies like dairy allergy can trigger symptoms such as rash, wheezing and itching; and even a tiny bit of dairy can trigger a reaction.
If you suspect yourself having lactose intolerance, see a doctor for a test. There are two ways to test for lactose intolerance:
Lactose hydrogen breath test – For this test, you drink a liquid that has high levels of lactose in it. Then you breathe into a special machine every 30 minutes. The machine measures how much hydrogen you breathe out. People who have lactose intolerance breathe out more hydrogen than normal which indicates that you are not fully digesting and absorbing lactose as you should.
Lactose tolerance test – For this test, you will drink a liquid that has high levels of lactose in it. The doctor will then take your blood samples 2 hours after the test to measure the amount of glucose circulating in your bloodstream. If your blood has low levels of sugar after that drink means you probably are not fully digesting and absorbing the lactose and you have lactose intolerance.
Your doctor will tell you how to prepare for your test. You will not be able to eat or drink anything for several hours before the test. Plus, you might have to change your medicines or stop smoking for a while before the test.
The lack of lactase not only triggers uncomfortable and embarrassing symptoms when you eat dairy, it can also lead to certain nutritional deficiencies. This is because milk and other dairy products contain calcium, protein and vitamins, such as A, B12 and D. The lactose in dairy foods also helps your body absorb a number of other minerals, such as magnesium and zinc. Collectively, these nutrients are important for bone health as well as your general well-being. If you're lactose intolerant, getting the right amount of important vitamins and minerals can be tricky, and you’re at risk for osteoporosis and malnutrition.
Addressing the underlying issue in those with lactose intolerance may reinstate the body's capacity to digest lactose, although it might take a while to achieve this. The objective of managing this condition is to manage the symptoms by dietary adjustments.
Lactose intolerance sufferers may generally be able to discover a certain level of lactose-containing meal that does not cause them symptoms by trial and error. Alternatively, you can choose to adopt lactose free-diet and then re-introduce small amounts of lactose gradually to discover the degree of tolerance you have towards lactose.
Avoiding dairy foods & finding alternatives which are rich in Vitamin D and calcium - this is perhaps the most straightforward approach to treat lactose intolerance, although it’s a bummer that one may not be able to enjoy the goodness of dairy products as freely. You can work with a nutritionist to devise a diet plan that is suitable for you, learn which food contains dairy and still make sure you have adequate intake of calcium and vitamin D in your diet. Also, when buying food, check the ingredients and watch out for these labels:
Milk, "milk byproducts," "dry milk powder," and "dry milk solids"
Lactose
Whey (whey is milk that has gone sour)
You can consult a community pharmacist on which enzyme supplements you can take to help break down dairy. Of course, they’re no magic bullet – none of them can break down every last bit of lactose you ingest, and so some people still have symptoms even with the help of an enzyme supplement. But taking enzyme supplements may help you cope with the after effects of dairy products better.
If you avoid dairy products completely, you may need to take vitamin D and calcium dietary supplements. Talk to a healthcare professional to check whether you really need such supplementation.
Medically reviewed by Ashwini Nair, MB BCh BAO.
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References:
1. Patient education: Lactose intolerance (The Basics) - UpToDate. Accessed May 28, 2022. https://www.uptodate.com/contents/lactose-intolerance-the-basics?search=lactose%20intolerance&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2
2. Lactose intolerance and malabsorption: Clinical manifestations, diagnosis, and management - UpToDate. Accessed May 28, 2022. https://www.uptodate.com/contents/lactose-intolerance-and-malabsorption-clinical-manifestations-diagnosis-and-management?search=lactose%20intolerance&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
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