Lactose and lactose intolerance- an overview
Lactose is a sugar that occurs naturally in milk and other dairy products. It’s digested by an enzyme in your gut called lactase. If you haven’t got enough of this enzyme, you can’t digest lactose properly, and you get lactose intolerance – with symptoms such as bloating, burping, diarrhoea, abdominal pain and irritation of the skin around the anus. In babies, it can cause poor weight gain. It’s important to realise that lactose intolerance is NOT an allergy. It’s simply the inability to digest lactose.
Types of Lactose Intolerance
Lactose intolerance can be inherited from your parents. Some people are born without any lactase enzyme whatsoever. This is called congenital lactase deficiency. This tends to cause symptoms from birth, as both breast milk and formula contain lactose.
Primary lactase deficiency is a little less severe- in this condition, there is some lactase, but levels are low-it can become symptomatic at any age, though it’s rare before the age of 6.
It’s also possible to develop lactose intolerance if your gut becomes temporarily inflamed for some reason- for example, after a bout of gastroenteritis. This type of lactose intolerance tends to settle whenever the inflammation gets better.
Developmental lactase deficiency may occur in premature babies because their gut has not yet matured. It settles as they get older.
Some people DO have an allergy to cow’s milk protein. This is an entirely different condition to lactose intolerance, though there are similar symptoms. Some babies have this problem, but it tends to get better as they get older- they often grow out of it entirely.
Diagnosis of Lactose Intolerance
Lactose Intolerance can be diagnosed based on the history- particularly if lactose is then withdrawn from the diet and symptoms settle. It’s also possible to perform a test on a stool (poo) sample, or a breath test, to confirm the diagnosis.
Treatment of lactose intolerance
The treatment for lactose intolerance is to reduce the amount of lactose in your diet, or eliminate it entirely if necessary. Some people who are lactose intolerant will be able to tolerate small amounts of lactose- though it may take a while to figure out personal limitations. Some dairy products are less problematic- such as hard cheeses like Cheddar, Parmesan and Emmenthal, which are naturally lower in lactose. Also, dairy products with thicker consistency, such as natural yoghurt, may be better tolerated than milk, as they are digested more slowly. It’s wise to check food labels for hidden lactose. In the case of temporary lactose intolerance after an episode of gastro, often no changes are recommended, as the symptoms will quickly settle anyway. And some people report benefit from taking lactase (enzyme) tablets when they are eating lactose.
If you have been diagnosed as lactose intolerant, and are therefore avoiding dairy products, it’s important to source adequate amounts of calcium from other foods to protect bone health. If you have been told you might have lactose intolerance but you are not feeling 100% sure of the diagnosis, it’s best to speak to a doctor and consider proper testing, as avoiding dairy products can be tricky, and may lead to low calcium intake and thinning of the bones.