Symptoms of lactose intolerance

Symptoms of lactose intolerance

It is important not to eliminate dairy foods completely from your diet if lactose intolerance is suspected, as dairy foods are rich sources of nutrients.

Some dairy products (such as hard and mature cheeses) contain no lactose, and others (such as cream, butter, cottage cheese and ricotta) contain very little. Many people with lactose intolerance can tolerate small amounts of lactose with minimal symptoms.

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Causes of lactose intolerance

Lactose intolerance is largely genetically determined – where your genetic make-up causes you to have less lactase than usual. Some other causes include:

  • gastroenteritis – this can strip the intestines of lactase for a few weeks
  • parasitic infection – this can temporarily reduce lactase levels
  • coeliac disease – this also damages the gut lining.

Checking food labels for lactose

If you are trying to avoid lactose, ingredients to look for in lists on food labels include:

  • milk solids
  • non-fat milk solids
  • whey
  • milk sugar.

Lactose intolerance

Milk and other dairy products contain a sugar or carbohydrate called lactose. Normally, the body breaks down lactose into its simpler components with the help of the enzyme lactase. Most mammals stop producing lactase when they are weaned. Most people of Western European descent, however, continue to produce it throughout life.

Without enough lactase, a person can have digestive problems like abdominal pain and diarrhoea when they consume foods containing lactose. This is known as lactose intolerance or lactase deficiency.

It is rare for Caucasians to develop lactose intolerance. However, a form of lactose intolerance that develops after about five years of age is quite common (and normal) among people from Asia, Africa, the Middle East and some Mediterranean countries, as well as among Aboriginal Australians. Up to five per cent of Caucasians and up to 75 per cent of non-Caucasians living in Australia are lactose intolerant.

Babies of all populations can tolerate lactose. Many Australian babies are unnecessarily weaned because their irritability is wrongly assumed to be lactose intolerance. In reality, the severe form of this condition – known as primary or congenital lactose intolerance (where the infant does not produce lactase from birth) – is very rare.

Secondary lactose intolerance is more common. This can occur temporarily after a bout of gastroenteritis, for example, but often improves after several weeks as the lining of the gut heals.

Management of lactose intolerance

Most people with lactose intolerance can handle small amounts of lactose, such as a glass of milk, which contains 8–10 grams of lactose.

Some helpful tips include:

  • Don’t give up milk products entirely. They are an important source of nutrients, especially calcium.
  • Hard and matured cheeses such as cheddar, Edam, Swiss, mozzarella, brie and fetta contain no lactose and are tolerated by people with lactose intolerance.
  • Similarly, butter and cream contain very low levels of lactose and are well tolerated.
  • Yoghurt is usually well tolerated because the lactose content decreases each day as the bacteria use lactose for energy.
  • Fresh cheeses such as cottage cheese and ricotta have very low levels of lactose and are usually well tolerated in small amounts.
  • Drink milk in moderate quantities. Most people with this condition can tolerate 240 ml of milk per day, but you need to work out your own tolerance level. You can buy milk that has had the lactose broken down, which makes it lactose free.
  • Drink full-fat milk because the fats slow the journey of the milk through the intestines and allow the lactase enzymes more time to break down the sugars.
  • Avoid low-fat or non-fat milks – they travel quickly through the gut and tend to cause symptoms in lactose intolerant people. Also, many low-fat milk products may contain skim milk powder, which provides a higher dose of lactose.
  • Eat foods that contain lactose in combination with other foods or spread them out over the day, rather than eating a large amount at once.
  • Soy foods such as soy milk and yoghurt are lactose free, a good source of calcium and a good substitute for milk or milk products.

Diagnosis of lactose intolerance

Various methods may be used to diagnose lactose intolerance, including:

  • hydrogen breath test – this tests the amount of hydrogen that is breathed out. When lactose is fermented by bacteria in the bowel, instead of being converted by lactase, more hydrogen is produced
  • elimination diet – this involves removing foods that contain lactose to see if the symptoms improve. If the symptoms reappear once the foods are reintroduced, then lactose intolerance is most likely the cause.

Another cheap and simple ‘test’ is to compare whether the person can tolerate lactose-free milk rather than ordinary milk.