Lactase deficiency; Milk intolerance; Lactose intolerance; Dairy product intolerance
Lactose intolerance is the inability to digest lactose, a type of sugar found in milk and other dairy products. It is caused by a deficiency of the enzyme lactase.
Causes, incidence, and risk factors
Lactose intolerance occurs when the small intestine does not produce enough of the enzyme lactase. Babies’ bodies produce this enzyme so they can digest milk, including breast milk. Before humans became dairy farmers, most people did not continue to drink milk, so their bodies did not produce lactase after early childhood.
People from cultures in which adult consumption of milk and milk products occurred earliest are less likely to suffer from lactose intolerance than those from areas where dairy farming began more recently. As a result, lactose intolerance is more common in Asian, African, African-American, Native American, and Mediterranean populations than it is among northern and western Europeans.
Lactose intolerance can begin at various times in life. In Caucasians, it usually starts to affect children older than five years of age. In African-Americans, lactose intolerance often occurs as early as two to three years of age.
When people with lactose intolerance consume milk products, they may have symptoms such as abdominal bloating, excessive intestinal gas, nausea, diarrhea, and abdominal cramping.
Lactose intolerance is very common in adults and is not dangerous. Many adults have some degree of lactose intolerance by age 20 (approximately 30 million Americans).
Lactose intolerance is sometimes seen in premature babies. Full-term babies generally do not show signs of lactose intolerance until they are at least three years old.
Eliminating milk from the diet can result in a deficiency of calcium, vitamin D, riboflavin, and protein. Therefore, a milk substitute is a necessity. For infants younger than two years old, soy formulas are adequate substitutes. Good alternatives for toddlers are soy or rice milk. Older children may also use lactase-treated cow’s milk.
Lactase deficiency may also occur as a result of intestinal diseases such as celiac sprue and gastroenteritis, or it may follow gastroduodenal surgery. Temporary lactase deficiency can result from viral and bacterial enteritis, especially in children, when the mucosal cells of the intestine are injured.
- Abdominal cramps
- Weight loss
- Slow growth
- Abdominal distention
- Abdominal fullness, gaseous
- Floating stools
- Foul-smelling stools
Symptoms often follow ingestion of milk products and are often relieved by withdrawal of milk products. Large doses of milk products may cause worse symptoms.
Signs and tests
- Test for stool-reducing substances
- Lactose tolerance test
- Lactose-hydrogen breath test
- Small bowel biopsy (shows a negative mucosal lactase assay)
Removing milk products from the diet usually improves the symptoms. Other sources of calcium should be added to the diet if milk products are eliminated.
Fermented milk products such as yogurt can usually be tolerated. Buttermilk and cheeses have less lactose than milk. Goat’s milk can sometimes be tolerated but should be consumed with meals, not alone.
Choosing lactose-free milk and milk products may be helpful. Lactase enzymes can be added to regular milk or may be taken in capsule or chewable tablet form.
Symptoms usually go away when milk products are eliminated from the diet.
Weight loss and malnutrition are Complications.
Calling your health care provider
If you or your child has symptoms of lactose intolerance, consult with your physician regarding dietary substitutions.
Also call if symptoms worsen or do not improve with treatment, or if new symptoms develop.
There is no known way to prevent the development of lactose intolerance.
If you have the condition, avoiding or restricting the amount of milk products in your diet can reduce or prevent symptoms.
by Arthur A. Poghosian, M.D.