Thursday, May 30, 2024
Nutrition

How to Deal With Lactose Intolerance

In this article:

  • Ways to Manage Lactose Intolerance
  • Precautions to Consider
  • Most-Asked Questions About Lactose Intolerance
  • Final Word

Lactose is a type of sugar present in milk and some milk products. The human body has an enzyme called lactase, which helps in the digestion of lactose.

The lack of this enzyme because of an illness, genetics, or digestive diseases such as Crohn’s disease, celiac disease, ulcerative colitis, and gastroenteritis causes clinical symptoms when food containing lactose is consumed.

The common symptoms of lactose intolerance (LI) include bloating, abdominal pain, loose stools, and flatulence. (1)

Treatment of LI includes dietary changes, supplements containing lactase, and treating the condition that is causing the intolerance, if it is treatable. (1)

It is important to note that intolerance is not the same as an allergy. In people with lactose or milk allergy, the immune system flares up as a response to the consumption of lactose, whereas in the case of LI, the person can have some amount of lactose. This amount varies from person to person.

A large part of the treatment plan for LI includes making dietary changes and managing the condition.

Ways to Manage Lactose Intolerance

Here are some ways that can help you deal with lactose intolerance.

1. Finding your intolerance threshold

The LI threshold is the maximum amount of lactose a person can tolerate in a day. This amount varies from person to person and is dependent on several factors.

Research has found that almost all people with LI can tolerate up to 12 g of lactose (present in about 250 ml of milk) at once or up to 24 g (present in about 500 ml of milk) spread throughout the day. (2)

The threshold can be increased if the lactose-rich food is consumed along with other nutrients. This is important as the elimination of dairy can lead to certain micronutrient deficiencies.

The LI threshold can be determined by tests that your physician will conduct. Finding out individual thresholds is very crucial as not everyone tolerates the same amount of lactose.

2. Opting for lactose-free dairy products

Restricting, rather than avoiding, is the way to go with LI management. Some lactose-free dairy a person with LI can consume include:

  • Aged cheese: Hard aged cheese contains about 0.1–0.9 g of lactose in 30 g. This amount is well within the tolerance limit of most people. (3) It is rich in protein and good fats and makes for a delicious inclusion in meals.
  • Yogurt: Since the production of yogurt involves fermentation, most of the lactose has been digested by bacteria and turned into lactic acid. Hence, most people with LI can tolerate eating yogurt. (3)

3. Consuming probiotic-rich foods

Probiotic-rich foods contain strains of bacteria that are beneficial for the gut. Most bacteria produce lactic acid and are therefore good for people with LI.

Yogurt, kefir, and laban (a type of fermented buttermilk commonly consumed in Arab countries) are common probiotic-rich foods. (3)

Kefir is fermented milk produced from grains. Not only does it contain useful strains of bacteria, but regular consumption has also been associated with improved digestion and tolerance to lactose. (4)

4. Choosing lactose-free milks

Soymilk, almond milk, coconut milk, and oat milk, among others, have become increasingly popular and widely available.

As the taste of these milk options is vastly different from animal milk, inclusion of these can begin in the form of smoothies or milkshakes. These are a great substitution amongst infants and children suffering from LI.

It is advisable to choose lactose-free milk options that contain little to no additives or make these at home.

5. Taking lactase supplements

Supplementing the diet with lactase supplements compensates for the insufficiency or lack of the enzyme within the body.

In a study with 47 patients with LI, lactase supplementation for a week resulted in a significant reduction in the clinical symptoms of LI. (5)

Dosing with 25–50 g of lactase in the form of chewable tablets or pills has been found to be most effective according to many studies. (5) This supplement is ideally taken before the consumption of a lactose-rich drink or food.

6. Managing symptoms

Accidental consumption of lactose or taking more than the threshold can result in clinical symptoms that can cause severe discomfort. Here are some things you can do to ease the symptoms associated with LI.

  • Ginger: Ginger is an effective remedy to treat nausea, indigestion, bloating, abdominal discomfort, and vomiting. (6) Simply chewing 2–3 slices of ginger, consuming ginger tea, or taking ginger candy can be helpful in relieving the symptoms of LI.
  • Peppermint: Studies have found peppermint to reduce abdominal pain and discomfort associated with irritable bowel syndrome (IBS). If the LI is resulting from digestive diseases, drinking peppermint tea or chewing peppermint leaves can bring relief. (7) It is also important to note that people with gastroesophageal reflux disease (GERD) need to avoid the use of peppermint.
  • Chamomile: The use of chamomile has been known to manage abdominal pain and gas and reduce inflammation in the digestive tract. (8) Drinking chamomile tea is the most effective way to reap its benefits.

7. Reading nutrition labels

Living with LI can seem difficult. You become restricted in what you can choose and consume.

Fortunately, lactose-free products are now available, which many people are turning to as part of managing LI. This has created a need for lactose-free products that many companies are readily catering to.

Do note that many products use lactose additives for various reasons. Therefore, knowing how to read nutritional labels can help you pick out lactose-free products easily. Always check the label for ingredients such as milk, milk derivatives, milk powders, milk solids, and low-fat milk solids.

The European Regulation (EU) has made provisions for mentioning the use of milk and lactose on food labels. (9) However, the limit to declare a product lactose-free has not been determined except for infant formula, and many companies declare their product to be lactose-free even when it is not completely free of lactose.

Precautions to Consider

Though consuming some amount of milk is okay for people with LI, it is important to note that each person’s threshold for lactose tolerance is going to be very different. Therefore, even though safe values are mentioned in this article, it is critical to find your own threshold level.

The remedies to deal with LI symptoms are home remedies. If the symptoms don’t ease after a few hours, it is better to consult a doctor.

Most-Asked Questions About Lactose Intolerance

What do I do if I accidentally ingest large amounts of lactose?

Take a prescription for lactase supplements from your doctor. It is recommended to consume a single dose following accidental lactose consumption.

If the symptoms are mild, management can be achieved by using remedies for easing abdominal pain or distress.

How do I ensure the right nutrition in a lactose-free diet?

Consult a dietitian to help you with a plan that provides all major nutrients. Consume foods that will provide adequate vitamin D and calcium that are otherwise obtained from milk. Your doctor may also prescribe supplements for the same.

How do I find out whether I am lactose intolerant and what tests need to be done?

The general symptoms of LI are gas, bloating, and stomach cramps after the consumption of lactose-rich food. If you or someone you know experiences these symptoms, get it checked by a healthcare provider.

Doctors may conduct allergy and intolerance tests to determine if you are indeed allergic or intolerant to lactose.

Final Word

Lactose intolerance may seem difficult to deal with but it is very manageable. The first thing to do is to establish your LI threshold. If some amount of milk is tolerated, it can help evade possible nutritional deficiencies.

Other alternatives such as lactose-free milk, lactose-free dairy products including cheese and yogurt, and fermented probiotic-rich foods can form a part of the treatment plan for LI.

Ensuring nutritional deficiencies are addressed is also critical. The lack of milk in the diet can lead to a loss of nutrients, which can be overcome by consuming other foods rich in those nutrients. Reading nutritional labels is very helpful when choosing products.

As most products declare allergies on their packs, it is vital to read the ingredient label to identify potential ingredients that may cause LI symptoms to flare up.

References

  1. Malik TF, Panuganti KK. Lactose Intolerance. [Updated 2022 May 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532285/.
  2. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Living with lactose intolerance. 2010 Sep 15 [Updated 2018 Nov 29]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534631/.
  3. Szilagyi A, Ishayek N. Lactose Intolerance, Dairy Avoidance, and Treatment Options. Nutrients. 2018;10(12):1994. Published 2018 Dec 15. doi:10.3390/nu10121994.
  4. Rosa DD, Dias MMS, Grześkowiak ŁM, Reis SA, Conceição LL, Peluzio MDCG. Milk kefir: nutritional, microbiological and health benefits. Nutr Res Rev. 2017;30(1):82-96. doi:10.1017/S0954422416000275.
  5. Baijal R, Tandon RK. Effect of lactase on symptoms and hydrogen breath levels in lactose intolerance: A crossover placebo-controlled study. JGH Open. 2020;5(1):143-148. Published 2020 Dec 1. doi:10.1002/jgh3.12463.
  6. Nikkhah Bodagh M, Maleki I, Hekmatdoost A. Ginger in gastrointestinal disorders: A systematic review of clinical trials. Food Sci Nutr. 2018;7(1):96-108. Published 2018 Nov 5. doi:10.1002/fsn3.807.
  7. Fifi AC, Axelrod CH, Chakraborty P, Saps M. Herbs and Spices in the Treatment of Functional Gastrointestinal Disorders: A Review of Clinical Trials. Nutrients. 2018;10(11):1715. Published 2018 Nov 9. doi:10.3390/nu10111715.
  8. Agah S, Taleb AM, Moeini R, Gorji N. (PDF) Chamomile efficacy in patients of the irritable bowel syndrome. ResearchGate. Der Pharma Chemica 7(4):41-45. https://www.researchgate.net/publication/281859945/.
  9. Facioni MS, Raspini B, Pivari F, Dogliotti E, Cena H. Nutritional management of lactose intolerance: the importance of diet and food labelling. J Transl Med. 2020;18(1):260. Published 2020 Jun 26. doi:10.1186/s12967-020-02429-2.