Understanding the meaning of lactose intolerance

Are you lactose intolerant? Do you suffer from digestion problems like flatulence, bloating, cramps etc following milk and dairy product intake? This article helps in getting a complete understanding about lactose intolerance, its symptoms, diagnosis, its types and management. It explains the terms like low-lactose or lactose-free and lactase products with simple explanations about what is lactose and functions of enzyme lactase.

Lactose Intolerance

Lactose intolerance is a condition, in which some individuals are unable to digest lactose sugar causing digestive problems like flatulence, bloating, cramps, and diarrhea.It results from deficiency of lactase enzyme or hypolactasia. Such individuals may have digestive problems after eating or drinking milk or milk products.

Understanding lactose, a sugar.

Lactose is a simple disaccharide sugar containing glucose and galactose units. It is found in milk and milk products and is a major component of whey, a by-product of dairy products. It aids in absorption and retention of minerals like calcium, magnesium, zinc and manganese. It also helps to promote intestinal health by contributing to the maintenance on healthy intestinal flora and act as nutrient source of energy for the body. Use of lactose as an ingredient in infant nutrition in the form of infant formula has markedly increased over time among food industry to match the composition of human milk.

Understanding lactose in the intestine

During food digestion in the small intestine, lactose is broken down by enzyme lactase into glucose and galactose, which are then absorbed into the bloodstream. Lactase is an enzyme found on the small intestinal villi (small brush like structure present on intestinal lining). This is a lactose tolerance state

In lactase intolerance state, lactose remains undigested and passes to the colon in large intestine, where it is broken down by bacteria into organic acids, gas and water in turn causing digestive problems. Thus lactase deficiency causes lactose malabsorption leading to lactose intolerance.

Understanding causes and types of lactase deficiency

Most lactose intolerant people can tolerate some amount of lactose in diet and do not need to completely avoid them, while a very few may need to avoid it altogether. This depends upon the type of lactase deficiency.

There are 4 types of lactose deficiency/ intolerance

  • Primary lactase deficiency:
  • This is the most common type of lactase deficiency and is primarily result of aging. Milk drinking mammals including humans are generally born with functional lactase enzyme for digesting lactose. However, with time in adulthood in some individuals the ability of lactase production declines. This is controlled by genetic makeup that is often inherited, aging and diet patterns of an individual. Various ethnic and racial groups like African Americans, Asian Americans, and Hispanic are more prone to lactose intolerance because of their genetic makeup. It is the most common type.
  • Secondary lactase deficiency:
  • An infection, underlying diseases, surgery or an injury to the small intestine or the villi producing lactase enzyme may cause lactase enzyme dysfunction leading to lactose intolerance state.
  • Developmental lactase deficiency:
  • It develops in infants those are born prematurely. The condition may last for short period.
  • Congenital lactase deficiency:
  • Mutation or a defective gene may result in little or no lactase enzyme in an individual from birth. This extremely rare case of deficiency is often inherited and may be life-threatening for babies intolerant to breast milk.

Understanding Lactose Intolerance symptoms

Symptoms of lactose intolerance vary among individuals depending upon the amount of lactose they can tolerate. And usually appear 2 minutes to 2 hours after consuming milk or milk products. Common symptoms are

  • Flatulence or gas

  • Bloating or feeling of fullness

  • Abdominal cramps, pain

  • Diarrhea, nausea

Other health problem like bone problems may be encountered by lactose intolerant individuals from deficiency of essential nutrients like vitamins and minerals. Avoiding or restricting lactose in diet may interfere with absorption and retention of essential nutrients, and keep people from consuming nutrient rich foods.

Understanding Lactose Intolerance and milk allergy

Lactose Intolerance is not a milk allergy. It is important to understand that lactose intolerance is a digestive problem due to an enzyme deficiency, while milk allergy is an immunological reaction in the body against milk protein. Lactose intolerance develops in adulthood and can be managed by reducing lactose in the diet. However, allergy to milk develops exclusively in infants, babies and continues lifelong and needs to be managed by replacement of milk with special nutritional formula. It can be life threatening with symptoms like eczema, nausea, diarrhea, colic, respiratory dysfunction, anaphylaxis etc.

Understanding Lactose Intolerance diagnosis

Digestive symptoms in lactose Intolerance resemble symptoms in other medical conditions like irritable bowel syndrome, celiac disease, inflammatory bowel disease etc. Hence it is important to make proper diagnosis of lactose intolerance under a doctor's guidance.

Diagnosis is based on family and diet history, medical examinations and tests. In general, a doctor may ask to avoid or exclude milk and milk products containing lactose for time being. Symptoms that resolve back on consuming milk and milk products again help in the diagnosis.

More accurate diagnostic tests to confirm lactose intolerance are as follow:

  • Lactose tolerance test.

  • It is a blood test following an intake of lactose rich drink that determines the level of glucose in the bloodstream. A reduced or unchanged glucose level confirms lactose intolerance.
  • Hydrogen breath test.

  • Detection of specific amount of hydrogen in the breath following lactose intake confirms lactose intolerance. In lactose intolerant person, undigested lactose is acted upon by the bacteria in the colon producing large amount of hydrogen and other gases than in normal person, and this large amount of hydrogen gets detected in the Hydrogen breath test. Possibility for false negative results does exist in some cases.
  • Stool acidity test.

  • Detection of lactic acid and other fatty acids in the stool sample because of lactose indigestion confirms lactose intolerance. It is commonly used among infants and children.
  • Gene test.

  • It confirms hereditary lactose intolerance using blood or saliva.

Understanding Lactose Intolerance Management

Lactose Intolerance cannot be treated but can be managed. Lactose Intolerance can be managed through diet control or changing diet options. Depending upon the type of lactase deficiency, people may need to limit or completely avoid lactose containing products or replace Low-lactose or lactose-free or lactase products in their diet to mange lactose Intolerance symptoms.

Secondary lactase deficiency can be corrected by treating the underlying cause leading to the lactase deficiency. Developmental lactase deficiency in infant improves with time, as infant grows up. However, people with primary lactase deficiency and congenital lactase deficiency need to managed lactose Intolerance through diet control or changing diet options as there is no treatment to produce lactase. Following a low lactose or lactose free dietary plan under the guidance of a physician is helpful in the management of lactose intolerance and also in fulfilling other nutritional requirement.

Products containing lactose

Milk is the major source of lactose. Beside milk, all other milk products like curd, cheese, yogurt, creams, butter, whey and milk powder contain lactose. Lactose is also present in products added with milk and milk products like cakes, puddings, ice creams, pastries, breads, biscuits etc. Frozen, packaged, canned or processed food may also contain lactose. People may have digestive problem on consuming such products. Hence it is important to check the food labels for sources of lactose. Some medications may also contain lactose as filler.

Low-lactose or lactose-free products

Most milk products readily available in the market as low lactose or lactose free have identical nutritional composition to the original one. In Low lactose or lactase free products, the lactose is hydrolyzed by using immobilized enzymes in to glucose and galactose. Lactose-free products are devoid of lactose to a great extend. Lactose content may vary from 0.00 –0.1%. These products are sweet in taste with some lactose left behind. Lactose-free milk, yogurt, cheese, creams are readily available in market.

Lactase products

Lactase preparations are available in tablets and drops form which can be added or consumed along with the diet. They help in digesting the lactose in the body. They are sweet in taste, expensive and may not be effective in all patients. Lactase products must be taken under physicians' guidance.

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Author: Venkiteswaran10 Feb 2017 Member Level: Diamond   Points : 7

I hit upon this article by chance. But I am happy that I got a very good source of knowledge on Lactose intolerance.

I came to know about Lactose intolerance very recently. I know what our doctor has told us and though I wanted to know more, did not bother about it later. So now I find this article a relevant one for me and many others.

My wife was suffering from flatulence for months. She tried home remedies, adjusted diet, avoided many items of pulses and roots, avoided sour things etc. She consulted a few doctors. All gave some symptomatic medicines. She would get some superficial relief only. Even Ayurvedic medicines did not help.

It was then that I took her to my usual doctor. He is an elderly person and had worked in European countries also. When we narrated the problem to him, he did not take much time to tell us that my wife is suffering from lactose intolerance.(Reading this article I infer that it is primary lactose intolerance )
He told us to stop taking all milk and milk based products. To our happiness and surprise, she got relief within one week. Now she is not taking milk or milk products.

It was as if by coincidence that I found Lactose-free milk from Amul in one departmental store. I consulted the doctor and with his permission she used it as far as it was available. But as the turnover is less, shops do not keep it regularly.

Now, whenever we go on travel and tour, if she has to take coffee or tea or curd, she gets the problem again. So wherever possible we avoid that.

I think this article and this response post may be of help to many.

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