How to Manage Lactose Intolerance

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Information on lactose intolerance

Lactose intolerance is the inability or inadequate ability to process lactose, a sugar found in milk and milk products and is caused by a deficiency of the enzyme lactase, which is produced by the cells lining the small intestine. Through this enzyme, lactose is broken down into two simpler forms of sugar called glucose and galactose, which are then absorbed into the bloodstream.

Not all people with lactase deficiency have digestive symptoms, but those who do may have lactose intolerance. Most people with lactose intolerance can tolerate some amount of lactose in their diet.

People sometimes confuse lactose intolerance with cow milk allergy which can be life threatening with small amounts.  Milk allergy most commonly appears in the first year of life, while lactose intolerance occurs more often in adulthood.


Primary lactase deficiency develops over time and begins after about age 2, although most children do not experience symptoms until late adolescence or adulthood.

Secondary lactase deficiency results from injury to the small intestine that occurs with an illness involving severe diarrhea, celiac disease, Crohn’s disease, or chemotherapy. This type of lactase deficiency can occur at any age but is more common in infancy.

Who is at risk for lactose intolerance?

Lactose intolerance is likely to occur in adulthood, particularly with older adults. Some ethnic and racial populations are more affected with the least common occurrence being among adults of northern European descent.

What are the symptoms of lactose intolerance?

People with lactose intolerance may feel uncomfortable 30 minutes to 2 hours after consuming milk and milk products. Common symptoms include abdominal pain, abdominal bloating, gas, diarrhea, nausea

How is lactose intolerance diagnosed?

Although people may think they suffer from lactose intolerance because they have digestive symptoms, other conditions such as irritable bowel syndrome can cause similar symptoms. After taking a medical history and performing a physical examination, the doctor may first recommend eliminating all milk and milk products from the person’s diet for a short time to see if the symptoms resolve. Tests (such as a hydrogen breath test for adults or a stool acidity test for children under 2) may be necessary to provide more information.

Hydrogen Breath Test. After the consumption of a lactose-loaded beverage, the breath is analyzed at regular intervals to measure the amount of hydrogen. Undigested lactose produces high levels of hydrogen. Since smoking and some foods and medications may affect the accuracy of the results, it is important to check with a doctor about ones that may interfere with the test results.

Stool Acidity Test. The stool acidity test is used for infants and young children to measure the amount of acid in the stool since undigested lactose creates lactic acid (sometimes glucose) and other fatty acids can be detected in a stool sample.

How is lactose intolerance managed?

Although the body’s ability to produce lactase cannot be changed, the symptoms of lactose intolerance can be managed with dietary changes. Small amounts of lactose in their diet can generally be tolerated. Often, people can better tolerate milk or milk products by taking them with meals. The amount depends on how much lactose a person can consume without symptoms.

Lactose-free and lactose-reduced milk and milk products, available at most supermarkets, are identical to regular milk except that the lactase enzyme has been added and may have a slightly sweeter taste than regular milk. Soy milk and other products may be recommended by a health professional.

People who still experience symptoms after dietary changes can take over-the-counter lactase enzyme drops or tablets. Taking the tablets or a few drops of the liquid enzyme when consuming milk or milk products may make these foods more tolerable for people with lactose intolerance.

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