Many people realize that after they drink milk they feel awful.  They will begin to have terrible abdominal cramps, abdominal pain, diarrhea and sometimes even vomiting. However why is this happening?  People may think that they are ALLERGIC to milk.  Most often the culprit is lactose intolerance.

Is Lactose Intolerance common?

It can happen at any age from birth to adulthood.  It occurs most often after 5 years of age.  It can occur in any ethnic background.

What is Lactose Intolerance?

Lactose is a sugar found in milk.  It is broken down to glucose and galactose by the enzyme lactase, which allows lactose to be used as an energy source.  If the small intestine is missing the lactase enzyme the body can not change lactose to these smaller sugars and it leads to the symptoms of lactose intolerance.

What are the symptoms?

It is important to know about the common symptoms associated with lactose intolerance, particularly as they can manifest at any stage in life and therefore you could be experiencing these symptoms unaware of the cause. There is a direct correlation between the amount of the lactase enzyme a person is lacking in relation to the severity of symptoms.  If a person is lacking all lactase enzyme they will suffer from many symptoms and be unable to consume any milk product, this includes foods that we may not realize has dairy (such as those that have dairy fillers, like certain brands of cold cut meat and hot dogs.)  The most common symptoms include:

• Abdominal cramps
• Abdominal pain
• Nausea
• Vomiting
• Diarrhea
• Abdominal bloating
• Gas/Flatulence

Why do some people develop lactose intolerance?

There are many reasons that a person can develop lactose intolerance.  The National Institute of Diabetes and Digestive and Kidney Diseases have classified the 4 Types of Lactase Deficiency.

Four types of lactase deficiency may lead to lactose intolerance:

• Primary lactase deficiency, also called lactase nonpersistence, is the most common type of lactase deficiency. In people with this condition, lactase production declines over time. This decline often begins at about age 2; however, the decline may begin later. Children who have lactase deficiency may not experience symptoms of lactose intolerance until late adolescence or adulthood. Researchers have discovered that some people inherit genes from their parents that may cause a primary lactase deficiency.
• Secondary lactase deficiency results from injury to the small intestine. Infection, diseases, or other problems may injure the small intestine. Treating the underlying cause usually improves the lactose tolerance.
• Developmental lactase deficiency may occur in infants born prematurely. This condition usually lasts for only a short time after they are born.
• Congenital lactase deficiency is an extremely rare disorder in which the small intestine produces little or no lactase enzyme from birth. Genes inherited from parents cause this disorder.

How do you diagnose lactose intolerance?

A health care provider makes a diagnosis of lactose intolerance based on

• medical, family, and diet history, including a review of symptoms
• a physical exam
• medical tests

Initially  an elimination diet may be recommended; eliminating all milk and milk products from a person’s diet for a short time to see if the symptoms resolve. Symptoms that go away when a person eliminates lactose from his or her diet may confirm the diagnosis of lactose intolerance.

Medical, family, and diet history. A health care provider will take a thorough medical, family, and diet history. During this discussion, the health care provider will review a patient’s symptoms. However, basing a diagnosis on symptoms alone may be misleading because digestive symptoms can occur for many reasons other than lactose intolerance. For example, other conditions such as irritable bowel syndrome, celiac disease, inflammatory bowel disease, or small bowel bacterial overgrowth can cause digestive symptoms.

Physical exam. A physical exam may help diagnose lactose intolerance or rule out other conditions that cause digestive symptoms. During a physical exam, a health care provider usually

• checks for abdominal bloating
• uses a stethoscope to listen to sounds within the abdomen
• taps on the abdomen to check for tenderness or pain

Medical tests. The most commonly used tests to confirm the diagnosis are:

• Hydrogen breath test. This test measures the amount of hydrogen in a person’s breath. Normally, only a small amount of hydrogen is detectable in the breath when a person eats or drinks and digests lactose. However, undigested lactose produces high levels of hydrogen. For this test, the patient drinks a beverage that contains a known amount of lactose. A health care provider asks the patient to breathe into a balloon-type container that measures breath hydrogen level. This test can be done at an office or hospital. Smoking and some foods and medications may affect the accuracy of the results. A health care provider will tell the patient what foods or medications to avoid before the test.
• Stool acidity test. Undigested lactose creates lactic acid and other fatty acids that a stool acidity test can detect in a stool sample. Health care providers sometimes use this test to check acidity in the stools of infants and young children. A child may also have glucose in his or her stool as a result of undigested lactose. The health care provider will give the child’s parent or caretaker a container for collecting the stool specimen. The parent or caretaker returns the sample to the health care provider, who sends it to a lab for analysis.
• Endoscopy. This test is performed under anesthesia or sedated.  A fiber optic tube is passed through the mouth down into the stomach and small intestine.  A tiny sample of tissue is taken or biopsied for further analysis.  This sample is sent to a lab that reviews the sample and tests to see if lactase enzyme is normally active.

How is it treated?

Many people can manage the symptoms of lactose intolerance by changing their diet. Some people may only need to limit the amount of lactose they eat or drink. Others may need to avoid lactose altogether. Using lactase products can help some people manage their symptoms  (Lactaid products)

For people with secondary lactase deficiency, treating the underlying cause improves lactose tolerance. In infants with developmental lactase deficiency, the ability to digest lactose improves as the infants mature. People with primary and congenital lactase deficiency cannot change their body’s ability to produce lactase.

Stay Healthy and Be Well.  Let me know your thought and comments.

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