Answer

Lactose intolerance is a common digestive problem where the body is unable to fully digest lactose, a type of sugar primarily found in milk and dairy products. This inability to digest lactose results from a shortage of lactase, an enzyme produced by the small intestine. Lactase breaks down lactose into simpler sugars, glucose and galactose, which are then absorbed into the bloodstream.

When lactose isn’t properly digested, it passes into the colon. In the colon, bacteria ferment the undigested lactose, producing gases and acids. This fermentation process can cause a variety of uncomfortable symptoms.

Causes of Lactose Intolerance:

• Primary Lactose Intolerance: This is the most common type and is genetically determined. It develops gradually over time, often starting in adulthood, as the body naturally produces less lactase. The amount of lactase produced decreases with age.
• Secondary Lactose Intolerance: This occurs when the small intestine is damaged or diseased, impairing lactase production. Conditions like Crohn’s disease, celiac disease, ulcerative colitis, gastroenteritis (stomach flu), and certain medications (e.g., some antibiotics) can cause secondary lactose intolerance. Treating the underlying condition may improve lactose digestion.
• Congenital Lactose Intolerance: This is a rare genetic disorder where infants are born with little or no lactase. It is inherited and requires special lactose-free infant formulas.
• Developmental Lactose Intolerance: This can occur in premature babies because their small intestines are not fully developed and may not produce enough lactase. It usually improves as the baby matures.

Symptoms of Lactose Intolerance:

The severity of symptoms varies from person to person and depends on the amount of lactose consumed and the amount of lactase the body produces. Symptoms typically begin 30 minutes to two hours after consuming lactose-containing foods or drinks. Common symptoms include:

• Diarrhea: Undigested lactose draws water into the colon, leading to watery stools.
• Gas: Fermentation of lactose in the colon produces excess gas.
• Bloating: Gas and increased water content in the colon can cause a feeling of fullness and distension.
• Abdominal Cramps and Pain: Gas and irritation in the colon can lead to cramping and discomfort.
• Nausea: Some individuals may experience nausea, and in rare cases, vomiting.
• Borborigmi: Audible rumbling or gurgling sounds from the intestines, caused by gas and fluid movement.

Diagnosis of Lactose Intolerance:

Several tests can help diagnose lactose intolerance:

• Lactose Tolerance Test: The individual drinks a liquid containing lactose. Blood samples are taken over a two-hour period to measure blood glucose levels. If glucose levels do not rise sufficiently, it indicates that the lactose was not properly digested.
• Hydrogen Breath Test: The individual drinks a liquid containing lactose. The amount of hydrogen in the breath is measured at regular intervals. Undigested lactose in the colon produces hydrogen, which is absorbed into the bloodstream and exhaled through the lungs. High levels of hydrogen in the breath suggest lactose intolerance.
• Stool Acidity Test: This test is primarily used for infants and young children who cannot undergo other tests. It measures the acidity of the stool. Undigested lactose in the stool produces acids that can be detected.
• Intestinal Biopsy: In rare cases, a biopsy of the small intestine may be performed to measure lactase levels directly. This is typically done to rule out other conditions.

Management of Lactose Intolerance:

There is no cure for lactose intolerance, but it can be effectively managed through dietary modifications and, in some cases, lactase supplements.

• Dietary Modifications:
  • Limit Lactose Intake: Identifying and limiting foods and drinks containing lactose is the cornerstone of management. Common sources of lactose include milk, cheese, yogurt, ice cream, butter, and cream. Processed foods may also contain lactose as an ingredient. Reading food labels carefully is essential.
  • Choose Lactose-Free Alternatives: Many lactose-free alternatives are available, such as lactose-free milk, cheese, yogurt, and ice cream. These products contain lactase added during processing, which breaks down the lactose.
  • Consume Smaller Portions: Smaller amounts of lactose may be better tolerated than larger amounts.
  • Eat Lactose-Containing Foods with Other Foods: Combining lactose-containing foods with other foods can slow down digestion and reduce symptoms.
  • Hard Cheeses and Yogurt: Hard cheeses (e.g., cheddar, Parmesan) and yogurt often contain less lactose than other dairy products due to the fermentation process.
• Lactase Supplements: Lactase enzyme supplements are available in tablet or liquid form. These supplements can be taken before consuming lactose-containing foods or drinks to help digest the lactose.
• Calcium and Vitamin D: Since dairy products are a significant source of calcium and vitamin D, individuals with lactose intolerance may need to obtain these nutrients from other sources, such as fortified foods, supplements, leafy green vegetables, and oily fish.
• Probiotics: Some studies suggest that probiotics may help improve lactose digestion and reduce symptoms. However, more research is needed.