People can manage lactose intolerance by not drinking as much milk and eating fewer dairy products. Most can eat a small amount of dairy. But they need to eat it with other foods that don't contain lactose and not eat too much dairy at once.
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You may find that other dairy products, such as yogurt and cheeses, are easier to digest than milk. Lactose-free milk is also a great way to get calcium in the diet without the problems. It can also help to keep a food diary to learn which foods you can or can't tolerate.
Lactose intolerance is a common condition caused by a decreased ability to digest lactose, a sugar found in dairy products.[1] Those affected vary in the amount of lactose they can tolerate before symptoms develop.[1] Symptoms may include abdominal pain, bloating, diarrhea, flatulence, and nausea.[1] These symptoms typically start thirty minutes to two hours after eating or drinking milk-based food.[1] Their severity typically depends on the amount a person eats or drinks.[1] Lactose intolerance does not cause damage to the gastrointestinal tract.[2]
Diagnosis may be confirmed if symptoms resolve following eliminating lactose from the diet.[1] Other supporting tests include a hydrogen breath test and a stool acidity test.[1] Other conditions that may produce similar symptoms include irritable bowel syndrome, celiac disease, and inflammatory bowel disease.[1] Lactose intolerance is different from a milk allergy.[1] Management is typically by decreasing the amount of lactose in the diet, taking lactase supplements, or treating the underlying disease.[1][6] People are able to drink at least one cup of milk without developing symptoms, with greater amounts tolerated if drunk with a meal or throughout the day.[1][7]
Worldwide, around 65% of adults are affected by lactose malabsorption.[5][8] Other mammals usually lose the ability to digest lactose after weaning and this was the ancestral state of all humans before the recent evolution of lactase persistence, which extends lactose tolerance into adulthood.[9] Lactase persistence evolved in several populations independently, probably as an adaptation to the domestication of dairy animals around 10,000 years ago.[10][11] Today the prevalence of lactose tolerance varies widely between regions and ethnic groups.[5] The ability to digest lactose is most common in people of European descent, and to a lesser extent in some parts of the Middle East and Africa.[5][8] Lactose intolerance is common among people of Jewish descent, as well as in many African countries and Arab countries. Traditional food cultures reflect local variations in tolerance[5] and historically many societies have adapted to low levels of tolerance by making dairy products that contain less lactose than fresh milk.[12] The medicalization of lactose intolerance as a disorder has been attributed to biases in research history, since most early studies were conducted amongst populations which are normally tolerant,[9] as well as the cultural and economic importance of milk in countries such as the United States.[13]
Lactose intolerance is not an allergy, because it is not an immune response, but rather a sensitivity to dairy caused by a deficiency of lactase enzyme. Milk allergy, occurring in about 2% of the population, is a separate condition, with distinct symptoms that occur when the presence of milk proteins trigger an immune reaction.[15]
The principal manifestation of lactose intolerance is an adverse reaction to products containing lactose (primarily milk), including abdominal bloating and cramps, flatulence, diarrhea, nausea, borborygmi, and vomiting (particularly in adolescents). These appear one-half to two hours after consumption.[1] The severity of these signs and symptoms typically increases with the amount of lactose consumed; most lactose-intolerant people can tolerate a certain level of lactose in their diets without ill effects.[16][17]
Lactose intolerance is a consequence of lactase deficiency, which may be genetic (primary hypolactasia and primary congenital alactasia) or environmentally induced (secondary or acquired hypolactasia). In either case, symptoms are caused by insufficient levels of lactase in the lining of the duodenum. Lactose, a disaccharide molecule found in milk and dairy products, cannot be directly absorbed through the wall of the small intestine into the bloodstream, so, in the absence of lactase, passes intact into the colon.[citation needed] Bacteria in the colon can metabolise lactose, and the resulting fermentation produces copious amounts of gas (a mixture of hydrogen, carbon dioxide, and methane) that causes the various abdominal symptoms. The unabsorbed sugars and fermentation products also raise the osmotic pressure of the colon, causing an increased flow of water into the bowels (diarrhea).[18][9]
Some human populations have developed lactase persistence, in which lactase production continues into adulthood probably as a response to the benefits of being able to digest milk from farm animals. Some have argued that this links intolerance to natural selection favoring lactase-persistent individuals, but it is also consistent with a physiological response to decrease lactase production when it is not needed in cultures in which dairy products are not an available food source.[24] Although populations in Europe, India, Arabia, and Africa were first thought to have high rates of lactase persistence because of a single mutation, lactase persistence has been traced to a number of mutations that occurred independently.[11] Different alleles for lactase persistence have developed at least three times in East African populations, with persistence extending from 26% in Tanzania to 88% in the Beja pastoralist population in Sudan.[25]
Primary congenital alactasia, also called congenital lactase deficiency, is an extremely rare, autosomal recessive enzyme defect that prevents lactase expression from birth.[2] People with congenital lactase deficiency cannot digest lactose from birth, so cannot digest breast milk. This genetic defect is characterized by a complete lack of lactase (alactasia). About 40 cases have been reported worldwide, mainly limited to Finland. Before the 20th century, babies born with congenital lactase deficiency often did not survive,[2] but death rates decreased with soybean-derived infant formulas and manufactured lactose-free dairy products.[34]
Lactose intolerance is distinct from milk allergy, an immune response to cow's milk proteins. They may be distinguished in diagnosis by giving lactose-free milk, producing no symptoms in the case of lactose intolerance, but the same reaction as to normal milk in the presence of a milk allergy. A person can have both conditions. If positive confirmation is necessary, four tests are available.[36]
In a hydrogen breath test, the most accurate lactose intolerance test, after an overnight fast, 25 grams of lactose (in a solution with water) are swallowed. If the lactose cannot be digested, enteric bacteria metabolize it and produce hydrogen, which, along with methane, if produced, can be detected on the patient's breath by a clinical gas chromatograph or compact solid-state detector. The test takes about 2.5 hours to complete. If the hydrogen levels in the patient's breath are high, they may have lactose intolerance. This test is not usually done on babies and very young children, because it can cause severe diarrhea.[37]
There is no standardized method for measuring the lactose content of food.[59] The stated dairy content of a product also varies according to manufacturing processes and labelling practices, and commercial terminology varies between languages and regions.[42] As a result, absolute figures for the amount of lactose consumed (by weight) may not be very reliable. Kosher products labeled pareve or fleishig are free of milk. However, if a "D" (for "dairy") is present next to the circled "K", "U", or other hechsher, the food product likely contains milk solids,[60] although it may also simply indicate the product was produced on equipment shared with other products containing milk derivatives.
Lactose is also a commercial food additive used for its texture, flavor, and adhesive qualities. It is found in additives labelled as casein, caseinate, whey, lactoserum, milk solids, modified milk ingredients, etc.[citation needed] As such lactose is found in foods such as processed meats (sausages/hot dogs, sliced meats, pâtés),[60] gravy stock powder, margarines,[61] sliced breads,[62][63] breakfast cereals, potato chips,[64] processed foods, medications, prepared meals, meal replacements (powders and bars), protein supplements (powders and bars), and even beers in the milk stout style. Some barbecue sauces and liquid cheeses used in fast-food restaurants may also contain lactose. Lactose is often used as the primary filler (main ingredient) in most prescription and non-prescription solid pill form medications, though product labeling seldom mentions the presence of 'lactose' or 'milk', and neither do product monograms provided to pharmacists, and most pharmacists are unaware of the very wide scale yet common use of lactose in such medications until they contact the supplier or manufacturer for verification.[citation needed]
Plant-based milks and derivatives such as soy milk, rice milk, almond milk, coconut milk, hazelnut milk, oat milk, hemp milk, macadamia nut milk, and peanut milk are inherently lactose-free. Low-lactose and lactose-free versions of foods are often available to replace dairy-based foods for those with lactose intolerance.[65]
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. Its main use is in producing the lactose-free or lactose-reduced dairy products sold in supermarkets.[69] 2ff7e9595c
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