How to detect lactose intolerance and live with it?

If the intestine does not contain enough lactase enzyme, the unbroken lactose passes into the large intestine, fermented by intestinal bacteria. This causes distension or bloating of the abdomen, colic (pain in the form of abdominal spasms and tension), meteorism or gas and flatulence, and also nausea. If the patient is highly intolerant, diarrhea is also common.

Lactase is a type of enzyme produced by the small intestine that separates lactose into its two components or basic sugars (galactose and glucose), so that it can be digested by the intestine.

But what is lactose?

Lactose is a type of sugar found in mammalian milk, as well as in dairy products such as custards, puddings, creams, yogurts, creams or ice creams, and even in some prepared foods.

As mentioned above, lactose is made up of two types of sugars, galactose and glucose. In order to be absorbed by the intestine, it is important that these molecules are separated.

Who is affected by lactose intolerance?

Lactose intolerance can occur:

  • In premature infants, due to the immaturity of the digestive tract, or in children under 3 years of age.
  • In a transitory way, by digestive infections or an alteration in the intestinal flora due to the intake of antibiotics, for example.
  • In diseases that produce lesions in the small intestine, such as Crohn’s disease or celiac disease.
  • In adults it is quite common, with different degrees of permanence. It is more common in Asians, Africans and American Indians. On the other hand, it is less common in northern Europe, due to the introduction of milk in the diet more than 11,000 years ago, when cattle farming and milking of animals began.

How is lactose intolerance diagnosed?

A clinical diagnosis is possible by withdrawing milk for two weeks and observing the results, and if symptoms improve. In such a case, it will be upon reintroduction of milk that symptoms occur again.

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In addition, other methods exist, although they cannot always confirm the diagnosis:

  • Hydrogen breath test. It is used to measure the amount of hydrogen in the exhaled air. During the test the patient breathes into a balloon which measures the hydrogen expelled, as there is usually little nitrogen in the breath. Subsequently, the patient should ingest a liquid containing lactose and perform exhalation tests, in order to see the exhaled hydrogen. When the intestine is not able to break down lactose, hydrogen levels in the breath increase. It will be considered positive when there is an increase of hydrogen by 12 parts per million over the initial level.
  • Lactose intolerance blood test. Measures the amount of glucose after ingestion of lactose. If it increases to more than 30mg/dL (1.6mmol/L) within 2 hours after ingestion, it is considered normal, as the lactose will have been separated into galactose and glucose and, therefore, the glucose will rise in the blood. On the other hand, if there is an increase below 20mg/dL it will be considered lactose intolerance.

Is eliminating lactose from the diet the solution?

Reducing dairy products alleviates the symptoms. However, from a nutritional point of view, it is not advisable to eliminate lactose because they contain the most calcium. It is necessary to ingest about 1,000-1,200mg of calcium to maintain good bone health. The ideal is to eliminate dairy foods that cause bothersome symptoms and find other tolerable products.

On the other hand, it is important for lactose intolerant patients to read the labeling carefully, as there are foods that may contain lactose, milk, milk powder, whey, cream, etc.

Which dairy products have less lactose?

There are some dairy products that have less lactose and therefore may be more tolerable:

  • Ice cream and cured or hard cheeses.
  • Milk butter.
  • Yogurts without powdered milk.
  • Lactase-treated cow’s milk.
  • Milk and milk derivatives lactose-free (lactose removed).
  • Soy products for infants under 2 years of age.
  • Rice or soy milk for children.