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DESCRIPTION
Lactose intolerance is the inability to digest (metabolize) lactose (milk sugar). It is caused by a lack or deficiency of lactase, an enzyme manufactured in the small intestine that splits lactose into glucose and galactose. When a person with lactose intolerance consumes milk or other dairy products, some or all of the lactose they contain remains undigested, resulting in digestive upsets. Some people also mention pasteurized dairy products as cause (raw milk contains small amounts of lactase).
The most common cause of lactase deficiency is a decrease in the amount of lactase that occurs after childhood and persists into adulthood, referred to as adult-type hypolactasia. This decrease is genetically programmed, and the prevalence of this type of lactase deficiency among different ethnic groups is highly variable. Thus, among Asian populations it is almost 100 percent, among American Indians it is 80 percent, and among blacks it is 70 percent; however, among American Caucasians the prevalence of lactase deficiency is only 20 percent. In addition to variability in the prevalence of lactase deficiency, there also is variability in the age at which symptoms of lactose intolerance appear. Thus, among Asian populations, the symptoms of deficiency (intolerance) occur around the age of 5, among Blacks and Mexican-Americans by the age of 10, and among the Finnish by age 20.
It is important to emphasize that lactase deficiency is not the same as lactose intolerance. Persons with milder deficiencies of lactase often have no symptoms after the ingestion of milk. For unclear reasons, even persons with moderate deficiencies of lactase may not have symptoms. A diagnosis of lactase deficiency is made when the amount of lactase in the intestine is reduced, but a diagnosis of lactose intolerance is made only when the reduced amount of lactase causes symptoms.
Lactose intolerance is not the same as milk allergy. Lactose intolerance specifically refers to a syndrome caused by the failure to digest milk sugar. A person with a milk allergy may be able to digest milk normally, but his or her immune system then has an allergic response to one or more of the milk's components.
MoonDragon's Health & Wellness: Allergies
SIGNS & SYMPTOMS
The symptoms of lactose intolerance in adults usually begin between 30 minutes and 2 hours after the consumption of dairy products. Symptoms include:
Fluid retention. Fermentation in the colon. Gurgling or rumbling sounds in the abdomen. Abdominal cramps or pain. Abdominal bloating or distention. Diarrhea or loose stools. Flatulence (passing of gas) caused by hydrogen gas buildup. Nausea and vomiting.
Although far less common, lactose intolerance can occur in children as well as adults. In infants, lactose intolerance can occur after a severe bout of gastroenteritis, which damages the intestinal lining. Symptoms of lactose intolerance in an infants can include:
Foamy diarrhea with diaper rash. Slow weight gain and development. Vomiting.
Many people who have gas, belly pain, bloating, and diarrhea suspect they may be lactose-intolerant. The best way to check this is to avoid eating all milk and dairy products to see if your symptoms go away. If they do, then you can try adding small amounts of milk products to see if your symptoms come back.
If you feel sick after drinking a glass of milk one time, you probably do not have lactose intolerance. But if you feel sick every time you have milk, ice cream, or another dairy product, you may have lactose intolerance.
Sometimes people who have never had problems with milk or dairy products suddenly have lactose intolerance. This is more common as you get older.
CAUSES
Lactose intolerance is the inability to metabolize lactose, a sugar found in milk and other dairy products because the required enzyme lactase is absent in the intestinal system or its availability is lowered.
Disaccharides cannot be absorbed through the wall of the small intestine into the bloodstream, so in the absence of lactase, lactose present in ingested dairy products remains uncleaved and passes intact into the colon. The operons of enteric bacteria quickly switch over to lactose metabolism, and the resultant in vivo fermentation produces copious amounts of gas (a mixture of hydrogen, carbon dioxide, and methane). This, in turn, may cause a range of abdominal symptoms, including stomach cramps, bloating, and flatulence. In addition, as with other unabsorbed sugars (such as sorbitol, mannitol, and xylitol), the presence of lactose and its fermentation products raises the osmotic pressure of the colon contents, thereby preventing the colon from reabsorbing water, and causing osmotic diarrhea.
The degree of lactose intolerance varies from individual to individual. For most of the world's adults, lactose intolerance is actually a normal condition. Only Caucasians of northern European origin generally retain the ability to digest lactase after childhood.
In the United States, an estimated 30 to 50 million people are lactose intolerant. About 75% of adults show some decrease in lactase activity during adulthood worldwide. The frequency of decreased lactase activity ranges from 5 percent in northern Europe to more than 90 percent in some Asian and African countries.
Lactase deficiency can occur as a result of a gastrointestinal disorder that damages the intestinal tract, such as celiac disease, irritable bowel syndrome, regional enteritis, or ulcerative colitis. It can develop on its own.
TYPES OF LACTASE DEFICIENCY
There are three major types of lactose intolerance:
- Primary lactose intolerance. Environmentally induced when weaning a child in non-dairy consuming societies. This is found in many Asian and African cultures, where industrialized and commercial dairy products are uncommon. Populations where primary lactose intolerance is the norm have demonstrated similar health levels to westerners (outside of malnutrition issues) or better health (Japan).
- Secondary lactose intolerance. Environmentally induced, resulting from certain gastrointestinal diseases, including exposure to intestinal parasites such as giardia. In such cases the production of lactase may be permanently disrupted. A very common cause of temporary lactose intolerance is gastroenteritis, particularly when the gastroenteritis is caused by rotavirus. Another form of temporary lactose intolerance is lactose overload in infants.
While secondary lactose intolerance does not inherently affect an individual's nutritional needs, according to mainstream media and "accepted" doctrines in western European and North American countries, dairy is an essential part of a healthy diet. Dairy products are relatively good and accessible sources of calcium and potassium and many countries mandate that milk be fortified with vitamin A and vitamin D. Consequently, in dairy consuming societies, dairy is often a main source of these nutrients; and, for lacto-vegetarians, a main source of vitamin B-12. Individuals who reduce or eliminate consumption of dairy must obtain these nutrients elsewhere. Asian populations for whom dairy is not part of their food culture do not present decreased health and sometimes present above average health, like Japan.
Plant based milk substitutes are not naturally rich in calcium, potassium, or vitamins A or D (and, like all non-animal products, contain no vitamin B-12). However, prominent brands are often voluntarily fortified with many of these nutrients, although one should read the label to be certain. An increasing number of calcium-fortified breakfast foods, such as orange juice, bread, and dry cereal, have been appearing on supermarket shelves. Many fruits and vegetables are rich in potassium and vitamin A; animal products like meat and eggs are rich in vitamin B-12, and the human body itself produces some vitamin D from exposure to direct sunlight. Finally, a dietitian or health care provider may recommend a vitamin or mineral supplement to make up for any remaining nutritional shortfall.
Lactose-reduced dairy products have the same nutritional content as their full-lactose counterparts, but their taste and appearance may differ slightly.
Most infants with gastroenteritis due to rotavirus do not develop lactose intolerance, so these infants do not benefit from being put on a lactose-free diet unless symptoms of lactose intolerance are severe and persistent.
- Congenital lactase deficiency. A genetic disorder which prevents enzymatic production of lactase. Present at birth, and diagnosed in early infancy. Congenital lactase deficiency, or CLD, is an autosomal recessive disorder which prevents the expression of lactase. Before the 20th century, infants with this disease rarely survived. As substitute and lactose-free infant formulas later became available, nursing infants affected with CLD could now have their normal nutritional needs met. Beyond infancy, individuals with CLD usually have the same nutritional concerns as those affected by secondary lactose intolerance.
LACTASE BIOLOGY
The normal mammalian condition is for the young of a species to experience reduced lactase production at the end of the weaning period (a species-specific length of time). In non-dairy consuming societies, lactase production usually drops about 90 percent during the first four years of life, although the exact drop over time varies widely. The majority of the world's human population follows this trend, with the lactase producing genes largely inactivated in adulthood.
However, certain human populations have a mutation on chromosome 2 which eliminates the shutdown in lactase production, making it possible for members of these populations to continue consumption of fresh milk and other dairy products throughout their lives without difficulty. This appears to be an evolutionarily recent adaptation to dairy consumption, and has occurred independently in both northern Europe and east Africa in populations with a historically pastoral lifestyle. Lactase persistence, allowing lactose digestion to continue into adulthood, is a dominant allele, making lactose intolerance a recessive genetic trait.
Some cultures, such as that of Japan, where dairy consumption has been on the increase, demonstrate a lower prevalence of lactose intolerance in spite of a genetic predisposition.
Pathological lactose intolerance can be caused by Celiac disease, which damages the villi in the small intestine that produce lactase. This lactose intolerance is temporary. Lactose intolerance associated with celiac disease ceases after the patient has been on a gluten-free diet long enough for the villi to recover.
Sometimes the small intestine stops making lactase after a short-term illness such as the stomach flu, or as a part of a lifelong disease such as cystic fibrosis, or after surgery to remove a part of the small intestine. In these cases, the problem can be either permanent or temporary.
In rare cases, newborns are lactose-intolerant. A person born with lactose intolerance cannot eat or drink anything with lactose. Some premature babies have temporary lactose intolerance because they are not yet able to make lactase. After a baby begins to make lactase, the condition generally goes away.
Certain people who report problems with consuming lactose are not actually lactose intolerant. In a study of 323 Sicilian adults, Carroccio et al. (1998) found only 4 percent were both lactose intolerant and lactose maldigesters, while 32.2 percent were lactose maldigesters but did not test as lactose intolerant. However, Burgio et al. (1984) found that 72 percent of 100 Sicilians were lactose intolerant in their study and 106 of 208 northern Italians (i.e., 51 percent) were lactose intolerant.
LACTOSE INTOLERANCE BY GROUP
Human Groups Individuals Examined Percent Intolerant Allele Frequency Dutch N/A 1% N/A Swedes N/A 2% 0.14 Europeans in Australia 160 4% 0.20 Northern Europeans & Scandinavians N/A 5% N/A Danes N/A 5% N/A Basques 85 Less Than 10% N/A British N/A 5-15% N/A Swiss N/A 10% 0.316 European Americans 245 12% 0.346 Tuareg N/A 13% N/A Germans N/A 15% N/A Austrians N/A 15-20% N/A Eastern Slavs
(Russians, Belarusians, Ukrainians)N/A 15% N/A Northern French N/A 17% N/A Finns 134 18% 0.424 Central Italians 65 19% N/A Indian Children N/A 20% N/A African Tutsi N/A 20% 0.447 African Fulani N/A 23% 0.48 Bedouins N/A 27% N/A Portuguese Adults 102 Less Than 35% N/A African American Children N/A 45% N/A Indian Adults 150 50% N/A Southern Italians 51 41% N/A North American Hispanics N/A 53% N/A Balkans N/A 55% N/A Mexican American Males N/A 55% N/A Cretans N/A 56% N/A African Maasai 21 62% N/A Southern French N/A 65% N/A Greek Cypriots N/A 66% N/A North American Jews N/A 68.8% N/A Southern Indians N/A 70% N/A Sicilians 100 71% N/A South Americans N/A 65-75% N/A Rural Mexicans N/A 73.8% N/A African Americans 20 75% 0.87 Kazakhs from Northwest Xinjiang 195 76.4% - Lebanese 75 78% N/A Central Asians N/A 80% N/A Alaskan Eskimo N/A 80% N/A Australian Aborigines 44 85% 0.922 Inner Mongolians 198 87.9% - African Bantu 59 89% 0.943 Asian Americans N/A 90% N/A Northeastern Han Chinese 248 92.3% - Chinese 71 93% 0.964 Southeast Asians N/A 98% N/A Thais 134 98% 0.99 Native Americans 24 100% 1.00
Lactose intolerance levels also increase with age. At ages 2 - 3 yrs., 6 yrs., and 9 - 10 yrs., the amount of lactose intolerance is, respectively:
- 6% to 15% in white Americans and northern Europeans
- 18%, 30%, and 47% in Mexican Americans
- 25%, 45%, and 60% in black South Africans
- Approximately 30%, 80%, and 85% in Chinese and Japanese
- 30-55%, 90%, and more than 90% in Mestizos of Peru
Chinese and Japanese populations typically lose between 80 and 90 percent of their ability to digest lactose within three to four years of weaning. Some studies have found that most Japanese can consume 200 ml (8 fl oz) of milk without severe symptoms.
Ashkenazi Jews can keep 20 to 30 percent of their ability to digest lactose for many years. Of the 10 percent of the Northern European population that develops lactose intolerance, the development of lactose intolerance is a gradual process spread out over as many as 20 years.
Information & references as well as more information about the history behind lactose intolerances in various ethnic groups is available from Wikipedia.org: Lactose Intolerance.
PREVENTION
There is no known way to prevent lactose intolerance from occurring. However, watching your diet and your intake of lactose can help to prevent lactose-related digestive upsets.
TREATMENT
DIAGNOSTIC EXAMS & TESTS
Your health care provider can usually tell whether you have lactose intolerance by asking questions about your symptoms. You may be asked to avoid dairy products for a short time to see if your symptoms improve.
Sometimes a health care provider will order a diagnostic test to confirm diagnosis. There are several tests used to measure the absorption of lactose into the digestive system and if you are digesting lactose normally.
ELIMINATION DIET
Probably the most common way that people self-diagnose lactose intolerance is by an elimination diet, a diet that eliminates obvious milk and milk products. There are several problems with this type of "testing."
- Milk products are so common in prepared foods from the supermarket or restaurant that it is likely that an elimination diet that is not rigorous (i.e., does not eliminate all milk) will still include substantial amounts of milk. Thus, persons with severe lactase deficiency attempting an elimination diet may be ingesting enough lactose to have symptoms and erroneously conclude that lactose intolerance is not responsible for the symptoms.
- People often make the assumption that they are lactose intolerant based on a short trial of elimination. A short trial may be adequate if symptoms are severe and occurring daily, but not if the symptoms are subtle and/or variable. In the latter case, an elimination diet may need to be continued for weeks.
- Because symptoms of lactose intolerance are subjective and variable, there always is the possibility of a "placebo effect" in which people think they feel better eliminating milk when, in fact, they are no better. With subjective symptoms such as those of lactose intolerance, a placebo effect can be expected to occur 20-40 percent of the time.
If an elimination diet is to be used for diagnosing lactose intolerance, it should be a rigorous diet. A rigorous diet requires counseling by a dietician or reading a guide to a lactose-elimination diet. The diet also needs to be continued long enough to clearly evaluate whether or not symptoms are better. If there is doubt about improvement on the diet, particularly if symptoms normally fluctuate in intensity over weeks or months, repeated periods of lactose elimination should be tried until a firm conclusion can be drawn. Elimination of all milk products should eliminate symptoms completely if lactose intolerance alone is the cause of the symptoms.
MILK CHALLENGE TEST
A milk challenge is a simpler way of diagnosing lactose intolerance than an elimination diet. A person fasts overnight and then drinks a glass of milk in the morning. Nothing further is eaten or drunk for 3-5 hours. If a person is lactose intolerant, the milk should produce symptoms within several hours of ingestion. If there are no symptoms, it is unlikely that lactose intolerance is the cause of the symptoms. It is important for the milk that is used to be non-fat milk to eliminate the possibility that fat in the milk is the cause of symptoms. It is not possible to eliminate the possibility that symptoms are due to milk allergy, a very different condition than lactose intolerance; however, this is not usually confusing since allergy to milk is rare and usually occurs in infants and young children. (If milk allergy is a consideration, pure lactose can be used instead of milk.)
An important issue in the milk challenge is the amount of milk to use.
- If a person drinks glasses of milk or ingests larger amounts of milk-containing products in their normal diet, then a larger amount of milk should be used in the challenge, 8-16 ounces in an adult, equivalent to one or two large glasses of milk.
- If the person being tested usually does not drink glasses of milk or ingest larger quantities of milk-containing products, there may be a problem with using 8-16 ounces of milk for testing. These larger quantities of milk used for testing may cause symptoms, but the smaller amounts of milk or milk products that these persons ingest in their normal diet may not be enough to cause symptoms. Technically, they may be lactose intolerant when they are tested with larger amounts of milk, but lactose in their normal diet cannot be responsible for their usual symptoms.
Recognition of this issue is important in interpreting the results of a milk challenge.
THE LACTOSE TOLERANCE TEST
The first test usually used is the lactose tolerance test, in which a person drinks a liquid containing lactose after fasting overnight. Approximately 1/2 hour later, the amount of glucose (sugar in the blood) is measured and the presence of symptoms assessed. Measuring the blood glucose level every 10 to 15 minutes after ingestion will show a "flat curve" in individuals with lactose malabsorption, while the lactase persistent will have a significant "top", with an elevation of typically 50 to 100% within 1 to 2 hours. If the blood glucose does not rise by at least 20 points, and especially if there are symptoms such as bloating and discomfort, a diagnosis of lactose intolerance is confirmed. This method requires frequent blood draws for testing and has largely been replaced by breath testing.
BLOOD GLUCOSE TEST
The blood glucose test is an older test for lactase deficiency and lactose intolerance. For the blood glucose test, lactose is ingested (usually 0.75 to 1.5 grams of lactose per kg of body weight) after an overnight fast, and serial blood samples are drawn and analyzed for glucose. If the level of blood glucose rises more than 25 mg / 100 ml, it means that the lactose has been split in the intestine and the resulting glucose has been absorbed into the blood. This implies that lactase levels are normal. Unfortunately, the blood glucose test, though simple in principle, requires the collection of multiple samples of blood. Moreover, the test has many real and potential problems, the most common of which is false positive tests, that is, an abnormal test in people who have normal lactase levels and no lactose intolerance. For these reasons, the blood glucose test is not often used.
THE HYDROGEN BREATH TEST
The hydrogen breath test measures the amount of hydrogen in the breath. After an overnight fast, a person is given a drink containing a high level (25 to 50 grams, 25 grams is the equivalent of 16 ounces of milk) of lactose in a solution with water. If and when lactose cannot be or is improperly digested in the colon, enteric bacteria metabolize it and gases form and produce hydrogen and are carried through the bloodstream to the lungs and are exhaled. Samples of breath are collected every 10 to 15 minutes for 3-5 hours after ingestion of lactose. Along with hydrogen, methane can be detected in the patient's breath by a clinical gas chromatograph or a compact solid state detector. A higher level of hydrogen in the breath indicates faulty digestion of lactose. The amount of hydrogen and/or methane in the breath, however, is not proportional to the severity of the symptoms. In other words, a person who produces little hydrogen and/or methane may have more severe symptoms than a person who produces a large amount hydrogen and/or methane. This test is given to adults and children, but it not recommended for infants and very young children. The breath test is the best test for determining lactase deficiency and lactose intolerance, but it has several weaknesses. The first is that it is a long, boring test. The second is that it suffers from the same issue as the milk challenge test with respect to the quantity of lactose that should be used. Lastly, the breath test can be falsely abnormal when there is spread of bacteria from the colon into the small intestine, a condition called bacterial overgrowth of the small bowel. When overgrowth occurs, the bacteria that have moved up into the small intestine get to the lactose in the intestine before it has time to be digested and absorbed normally, and these bacteria produce hydrogen and/or methane. This may lead erroneously to a diagnosis of lactose intolerance. Other conditions also interfere with the breath test. Thus, diseases that markedly speed up transit of lactose through the small intestine prevent lactose from being fully digested and absorbed, leading to a misdiagnosis of lactose intolerance. Recent treatment with antibiotics can suppress colonic bacteria and their production of hydrogen or methane and lead to a misdiagnosis of lactose tolerance. Fortunately, these latter conditions are uncommon and usually can be anticipated on the basis of a person's history or symptoms. A medical condition with similar symptoms is fructose malabsorption.
THE STOOL ACIDITY TEST
Young children and infants, as well as those for whom other forms of testing are risky or impractical, are tested by the stool acidity test, which measures the amount of acid in the stool. This test also assesses the levels of glucose and lactic acid present in the stool. For the stool acidity test, the infant or child is given a small amount of lactose orally. Several consecutive stool samples then are tested for acidity. With a deficiency of lactase, unabsorbed lactose enters the colon and is split into glucose and galactose. Some of the glucose and galactose is broken down by the bacteria into acids, for example, lactic acid. Lactic acid turns the stool acidic. Therefore, a lactase deficient infant or child will develop an acidic stool following the test dose of lactose. Despite the availability of the stool acidity test, the superiority of breath testing has led to modifications in equipment for collecting breath samples that makes it easier to do breath testing in young children and even infants. As a result, the stool acidity test is not done frequently.
DIAGNOSTIC PROCEDURES
An intestinal biopsy can confirm lactose intolerance following discovery of elevated hydrogen in the hydrogen breath test. The most direct test for lactase deficiency is biopsy of the intestinal lining with measurement of lactase levels in the lining. The biopsy can be obtained by endoscopy or by special capsules that are passed through the mouth or nose and into the small intestine. The analysis of lactase levels in the biopsy requires specialized procedures that are not often available, and given the invasive nature of this procedure and the need for a highly specialized laboratory to measure lactase enzymes or mRNA in the biopsy tissue, this approach is used almost exclusively in clinical research.
TREATMENT PROGNOSIS
Lactose intolerance can cause discomfort and digestive disruption, but it is not a serious threat to health and it can easily be managed through dietary modification.
MANAGING LACTOSE INTOLERANCE
For people living in societies where their normal diet contains relatively little or no dairy products, lactose intolerance is not considered a condition that requires any treatment or management. However, the people living societies that are largely lactose-tolerant may find lactose intolerance a problem. Some people have reported their intolerance to dairy products will vary over time depending on health status and pregnancy. Lactose intolerance is not usually an all-or-nothing condition. The reduction in lactase production and the amount of lactose that can be tolerated varies from individual to individual. Since lactose intolerance poses no further threat to a person's health, managing the condition consists of minimizing the occurrence and severity of symptoms. There are four general principles for management of lactose intolerance:1. Avoidance of dietary lactose.
2. Substitution to maintain nutrient intake.
3. Regulation of calcium intake.
4. Use of a lactase enzyme substitute.
AVOIDANCE OF LACTOSE-CONTAINING PRODUCTS
Since each person's tolerance to lactose varies, dietary control of lactose intolerance depends on learning through trial and error how much a person can handle in their diet. Label reading is essential and understanding commercial terminology varies according to an individual's education, language and region. Lactose is found in two large food categories: Conventional dairy products and as a food additive in dairy and non-dairy processed food products.
Lactose in dairy products is a water soluble molecule. The fat percentage and the curdling process have an impact on which foods will be tolerated. In the curdling process lactose is found in the water portion along with the whey and casein, but is not found in the fat portion. Dairy products which are "fat free" or "fat reduced" generally have a slightly higher lactose percentage. In addition, low fat dairy foods often have various dairy derivatives such as milk solids added to them to enhance sweetness, thereby increasing the lactose content.
MILK: Human milk has the highest lactose percentage at around 9 percent. Unprocessed cow milk has 4.7 percent lactose. Unprocessed milk from other mammals contains similar lactose percentages: goat milk has 4.1 percent, sheep milk has 4.6 percent, buffalo milk has 4.86 percent and yak milk has 4.93 percent.
BUTTER: The butter making process separates the majority of milk's water components from the fat components. Lactose, being a water soluble molecule, will be present is small quantities in the butter unless it is also fermented to produce cultured butter.
YOGURT & KEFIR: People with lactose intolerance can be more tolerant of traditionally made yogurt than milk because it contains lactase enzyme produced by the bacterial cultures used to make the yogurt. However, many commercial brands contain added milk solids, increasing the lactose content. Homemade Yogurt is preferred over commercially manufactured yogurts since homemade yogurts do not contain additives and also contains an active bacterial culture used to make the yogurt. Homemade yogurt has a pleasant flavor and is easy to make.
CHEESES: Traditionally made hard cheese (such as Swiss or Cheddar Cheese) and soft ripened cheeses may create less reaction than the equivalent amount of milk because of the processes involved. Fermentation and higher fat content contribute to lesser amounts of lactose. Swiss or Cheddar cheese might contain 10 percent of the lactose found in whole milk. In addition, the aging methods of cheese (over 2 years) reduces the lactose content to practically nothing. Commercial cheese brands, however, are generally manufactured by modern processes that do not have the same lactose-reducing properties. Since there are no regulations that mandate what qualifies as an "aged" cheese, this description does not provide any indication of whether the process used significantly reduced the lactose content of the cheese.
SOUR CREAM & ICE CREAM: Like yogurt, if made the traditional way, may be tolerable for persons with lactose intolerance, but most modern commercially manufactured brands add milk solids. Become a label reader and look for added ingredients.
The following chart shows examples of lactose levels in foods which commonly cause symptoms. These quantities are to be considered and treated as a guideline only.
DAIRY PRODUCT LACTOSE CONTENT Swiss Cheese, 28 g 1 g Cottage Cheese, 120 mL 2-3 g Yogurt, Plain, Low-Fat, 240 mL 5 g Ice Cream, 120 mL 6 g Milk, Reduced Fat, 240 mL 11 g
LACTOSE IN NON-DAIRY PRODUCTS
Lactose, also seen on labels listed as lactoserum, whey, milk solids, modified milk ingredients, and others, is a commercial food additive used for its texture, flavor and adhesive qualities, and is found in foods such as processed meats (sausages, hot dogs, sliced meats except for kosher meats), gravy stock powder, margarines, sliced breads and other baked goods, processed breakfast cereals, dried fruit, processed foods such as instant potatoes, soups and breakfast drinks, medications, pre-prepared meals, meal replacement (powders and bars), protein supplements (powders and bars), salad dressings, candies and other snacks, mixes for pancakes, biscuits and cookies. Some products labeled non-dairy, such as powdered coffee creamer and whipped toppings, also may include ingredients that are derived from milk and, therefore, contain lactose. Smart shoppers learn to read food labels with care, looking not only for milk and lactose among the contents but also for such words as whey, curds, milk by-products, dry milk solids, and nonfat dry milk powder. If any of these are listed on a label, the item contains lactose. In addition to food sources, lactose can be "hidden" in medicines. Lactose is used as the base for more than 20 percent of prescription drugs and about 6 percent of over-the-counter drugs. Many types of birth control pills, for example, contain lactose, as do some tablets for stomach acid and gas. However, these products typically affect only people with severe lactose intolerance.
Kosher products labeled pareve are free of milk. However, if a "D" (for "Dairy) is present next to the circled "K," "U," or other hechsher, the food likely contains milk solids (although it may also simply indicate that the product was produced on equipment shared with other products containing milk derivatives).
ALTERNATIVE PRODUCTS
The dairy industry has created quality low-lactose or lactose-free products to replace regular dairy. Lactose-free milk can be produced by passing milk over lactase enzyme bound to an inert carrier: once the molecule is cleaved, there are no lactose ill-effects. A form is available with reduced amounts of lactose (typically 30 percent of normal), and alternatively with nearly 0 percent. Finland has had "HYLA" (acronym for hydrolyzed lactose) products available for many years, even though the number of lactose intolerant people there is relatively small. These low-lactose level cow's milk products, ranging from ice cream to cheese, use a Valio patented chromatographic separation method to remove lactose. The ultra-pasteurization process, combined with aseptic packaging, ensures a long shelf-life. Recently, the range of low-lactose products available in Finland has been augmented with milk and other dairy products (such as ice cream, butter, and buttermilk) that contain no lactose at all. The remaining about 20 percent of lactose in HYLA products is taken care of enzymatically. These typically cost 2 - 4 times more than equivalent products containing lactose. Valio also markets these products in Sweden. Alternatively, a bacterium such as L. acidophilus may be added, which affects the lactose in milk the same way it affects the lactose in yogurt.
Plant based milks and derivatives are the only ones to be 100 percent lactose free (soy milk, almond milk, oat milk, rice milk, peanut milk).
LACTASE SUPPLEMENTS
When lactose avoidance is not possible, or on occasions when a person chooses to consume such items, then enzymatic lactase supplements may be used. Lactase enzymes similar to those produced in the small intestines of humans are produced industrially by fungi of the genus aspergillus. The enzyme, B-galactosidase, is available in tablet form in a variety of doses, in many countries without a prescription. It functions well only in high-acid environments, such as that found in the human gut due to the addition of gastric juices from the stomach. Unfortunately, too much acid can denature it, and it therefore should not be taken on an empty stomach. Also, the enzyme is ineffective if it does not reach the small intestine by the time the problematic food does. Lactose-sensitive individuals should experiment with both timing and dosage to fit their particular need. But supplements such as these may not be able to provide the accurate amount of lactase needed to adequately digest the lactose contained in dairy products, which may lead to symptoms similar to the existing lactose intolerance.
While essentially the same process as normal intestinal lactose digestion, direct treatment of milk employs a different variety of industrially produced lactase. This enzyme, produced by yeast from the genus kluyveromyces, takes much longer to act, must be thoroughly mixed throughout the product, and is destroyed by even mildly acidic environments. It therefore has been much less popular as a consumer product (sold as a liquid) than the aspergillus-produced tablets, despite its predictable effectiveness. Its main use is in producing the lactose-free or lactose-reduced dairy products sold in supermarkets.
Enzymatic lactase supplementation may have an advantage over avoiding dairy products, in that alternative provision does not need to be made to provide sufficient calcium intake, especially in children.
DAIRY PRODUCT REHABITUATION
For healthy individuals with Secondary lactose intolerance, it may be possible to train bacteria in the large intestine to break down lactose more effectively by consuming small quantities of dairy products several times a day over a couple of weeks. Re-introducing dairy in this way to people who have an underlying or chronic illness, however, is not recommended, as certain illnesses damage the intestinal tract in a way which prevents the lactase enzyme from being expressed.
Some studies indicate that environmental factors (more specifically, the consumption of lactose) may "play a more important role than genetic factors in the etio-pathogenesis of milk intolerance", but some other publications suggest that lactase production does not seem to be induced by dairy/lactose consumption.
LONG TERM CONSEQUENCES OF LACTOSE INTOLERANCE
The important long-term health consequence of lactose intolerance is calcium deficiency that leads to osteoporosis. Less commonly, vitamin D deficiency may occur and compound the bone disease. Both of these health issues can be prevented easily by calcium and vitamin D supplements. The real problem is that many lactose intolerant people who consciously or unconsciously avoid milk do not realize that they need supplements.
GENE THERAPY RESEARCH
It is now possible to test the DNA of individuals to make a diagnosis of lactose intolerance. This is likely to be an important research tool for studying lactase deficiency and lactose intolerance. It is still too early to know how helpful this sophisticated testing will be in the clinical evaluation and treatment of patients. It is an expensive test.
In 1998, scientists were able to make lactose intolerant rats tolerant of lactose by transferring the gene for lactase to their intestinal lining cells. It is unlikely that this type of gene therapy will find much of an application in people. Nevertheless, it is a fascinating example of what science can accomplish.
HOLISTIC & NUTRITIONAL RECOMMENDATIONS
RECOMMENDATIONS
Avoid milk and all dairy products except yogurt. This is the most important dietary measure for everyone who is intolerant to lactose. Use soymilk or rice milk in place of milk and soy cheese instead of dairy cheese. Especially avoid consuming lactose-containing foods on an empty stomach. Acidophilus containing milk is not that beneficial since it contains as much lactase as regular milk, and acidophilus bacteria does not break down (split) the lactose.
Include yogurt in your diet. Yogurt is one dairy product that can be good for a person with lactose intolerance. Yogurt has been shown to empty more slowly from the stomach than an equivalent amount of milk. This allows more time for intestinal bacteria to break down the lactose in yogurt and, at least theoretically, would result in less lactose reaching the colon. The cultures present in yogurt digest the lactose it contains, so it is no longer a problem. They also aid in overall digestion. Be sure to eat only yogurt that contains active live yogurt cultures. Homemade yogurt is best.
One of the biggest concerns for people with lactose intolerance is making sure they get enough of the nutrients found in milk products, especially calcium. Calcium is most important for children, teens pregnant women and women after menopause. Be sure to eat plenty of foods that are high in calcium. Good choices include apricots, blackstrap molasses, broccoli, okra, kale, turnip greens, collard greens, spinach, dried figs, almonds, calcium-fortified orange juice, rhubarb, canned salmon, sardines, and tuna, calcium-fortified soy products such as soy milk, tofu, and soybeans and yogurt. Calcium supplements may be beneficial.
Milk and milk-containing products are the best sources of dietary calcium, so it is no wonder that calcium deficiency is common among lactose intolerant persons. This increases the risk and severity of osteoporosis and the resulting bone fractures. It is important, therefore, for lactose intolerant persons to supplement their diets with calcium. A deficiency of vitamin D also causes disease of the bones and fractures. Milk is fortified with vitamin D and is a major source of vitamin D for many people. Although other sources of vitamin D can substitute for milk, it is a good idea for lactose-intolerant persons to take supplemental vitamin D to prevent vitamin D deficiency.
Check with your pharmacist before taking any medications. Many pills are formulated using lactose as a filler. Some birth control pills and stomach medications contain lactose. If you use homeopathic remedies, many of these also contain milk sugar (lactose) as a base for their tablets and other preparations.
During an acute attack, do not eat any solid food, but do drink plenty of quality water and replace lost minerals lost with diarrhea. See link below for dietary suggestions.
Read food product labels carefully, and avoid any that contain lactose or "milk solids" on the label. Lactose is added to many different types of processed food, including breads, canned and powdered soups, cookies, pancake mixes, powdered drink mixes such as flavored coffees, processed breakfast cereals, processed meats, and salad dressings.
If you are pregnant and have a family history of lactose intolerance, give serious consideration to breast-feeding your baby. If that is not possible, choose a non-dairy baby formula, such as a soy-based product. However, breastfed is the best choice.
Hard, aged cheeses, such as Parmesan cheese, are relatively low in lactose, and may be easier to tolerate than other dairy products.
Ice cream is particularly difficult for a person with lactose intolerance to digest. Not only is ice cream made from milk, but many brands add extra lactose to achieve the desired texture, and the cold temperature can be shocking to the digestive system as well.
Consuming small amounts of dairy products with meals may help improve the lactose tolerance level. Meals (particularly meals containing fat) reduce the rate at which the stomach empties into the small intestine. This reduces the rate at which lactose enters the small intestine and allows more time for the limited amount of lactase to break down the lactose without being overwhelmed by the full load of lactose at once. Studies have shown that the absorption of lactose from whole milk, which contains fat, is greater than from non-fat milk, perhaps for this very reason. Nevertheless, the substitution of whole milk or yogurt for non-fat milk or yogurt does not seem to reduce the symptoms of lactose intolerance. The large intestine becomes more accustomed to digesting the lactose when it is introduced in small quantities on a regular basis.
The symptoms of lactose intolerance are similar to those of celiac disease, and the two disorders may occur together.
Lactose-free and lactose-reduced products are available in most supermarkets.
NUTRITIONAL SUPPLEMENTS
Unless otherwise specified, the following recommended doses are for adults over the age of 18. For a child between 12 and 17 years, reduce the dose to 3/4 the recommended dose. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended dose.
LACTOSE INTOLERANCE SUPPLEMENTAL PRODUCTS
Supplements and products for lactose intolerance, the inability to digest milk sugar (lactose) because of a lack or a lactase enzyme in the small intestine.
Activated Charcoal Supplement, Nature's Way, 260 mg, 100 Caps
Nature's Way Activated charcoal supplement captures unwanted material of gas and carries it safely through the digestive system.Body Alkalizer Liquid, Alkaline Booster, 1 fl. oz.
The Body Alkalizer is essentially a form of liquid that when added to water will change the value thereof to an alkaline. The basis behind this is to reverse the aging that occurs in one's body because of the accumulation of non-disposed cellular waste in the system.Calcium Complex Bone Formula, Nature's Way, 100 Caps
Nature's Way Calcium Complex Bone Formula provides the key minerals and trace elements necessary for the dynamic process that maintains bone mass.Colostrum Chewables, Natural Vanilla Flavor, 480 mg, 90 Chewables
Colostrum known for its powerful healing factors offers optimal health. Colostrum research proves a wide spectrum of immunoglobulins, antibodies, and accessory immune factors.Dry Vitamin D, 400 IU, Nature's Way, 100% Natural, 100 Caps
Vitamin D helps the body to regulate the transport of calcium from the digestive system through the bloodstream to bone. It also assists in the retention of calcium and phosphorus.Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz.
Just An Ounce, Calcium and Magnesium Liquid can help with the development of strong bones and teeth, also prevents muscle cramping, risk of colon cancer, maintain regular heart beat, protects against osteoporosis and helps relax the central nervous system.Lactase Enzyme, Lactase Formula, EnzymeActive, Nature's Way, 230 mg, 100 Caps
Lactase Enzymes are a dietary supplement which supports the digestion of lactose rich foods. Lactase Enzymes are especially useful for those with lactose intolerance, but is also helpful for any lover of dairy products.Lactobacillus Acidophilus Supplement, Non-Dairy, 100 Caps
Lactobacillus Acidophilus Supplement taken as a dietary supplement may help to detoxify and to rebuild a balanced intestinal flora.Multi-Vitamin Without Iron, Nature's Way, 100 Caps
The vitamins and minerals in this Multi Vitamin without Iron play many important roles in the body: antioxidants to protect fats, cells and DNA, coenzyme precursors for energy production and metabolism, and cofactors for hormones and enzymes which regulate body processes.Super Strength FarmFresh Colostrum Chewables, Natural Vanilla Flavor, 480 mg, 60 Chews
Colostrum known for its powerful healing factors offers optimal health. Colostrum research proves a wide spectrum of immunoglobulins, antibodies, and accessory immune factors.Vitamin E, Natural D-Alpha-Tocopherol, 400 IU, 100 Softgels
Vitamin E has potent antioxidant activity, supplies oxygen to the blood, aids in strengthening capillary walls, and plays a beneficial role in cancer and cardiovascular disease prevention, anti-aging benefits, circulation, wound-healing, immune function, nervous system function, PMS, hot flushes, diabetes, vascular disease, eye health, tissue repair, athletic performance, leg cramps, skin and hair health, and alleviating fatigue.
HerbalRemedies: Lactose Intolerance Information
HerbalRemedies: Lactose Intolerance Supplements & Products
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
If you think you might have lactose intolerance, talk with your midwife or health care provider. He or she can make sure that your symptoms are caused by lactose intolerance and not by another problem.
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HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
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