How does one deal with lactose intolerance?

Milk is one of the first foods for most people. Surprisingly there are a few who cannot cope with milk or milk-based items. The frustration of having to forego one of the simplest and most nutritious foods adds to their woes. A proper understanding of lactose intolerance, however, can help one live normally.

Dr. Ajay Bhalla — Principal Consultant and Head of the Department of Gastroenterology and Hepatology, Fortis Hospital, Noida — defines lactose intolerance “as the body’s inability to digest lactose, which is the natural sugar present in milk and dairy products. The enzyme lactase, which digests lactose, is found on the intestinal lining. The maximum concentration is seen in infants and it reaches very low levels by age five.”

Dr. Raj Vigna Venugopal — Consultant Gastroenterologist and Head of the Department of Gastroenterology Manipal Hospital, Bangalore — adds, “Lactose is normally digested in the small intestine. But when lactase levels are low, it is transported into the colon where intestinal bacteria cause fermentation and thereby symptoms of intolerance.”

The classic symptoms of lactose intolerance include abdominal pain, bloating, excessive burping, excess gas and diarrhoea half an hour to two hours following ingestion. This is a result of the colonic bacteria converting the undigested lactose into carbon dioxide, hydrogen and water.

Dr. Venugopal offers an explanation of the three types of lactose intolerance.

Primary Lactase Deficiency, which is a very rare condition and occurs when babies are born with a deficiency or absence of the enzyme lactase.

Secondary Lactase Deficiency is the most common cause of lactose intolerance in infants, children and adults. It is due to infections — like viral, bacterial or parasitical diarrhoea, gluten intolerance and certain inflammatory conditions — that affect the gastro-intestinal tract and damage the lining of the small intestine. Once the causative conditions are treated, the lactase deficiency resolves.

Acquired lactase deficiency is due to a normal decline in the amount of lactase present in the small intestine as we age.

Lactose intolerance can also be a by-product of certain other situations.

According to Dr. Bhalla “Premature babies are lactose intolerant, but this is temporary. Surgery involving small bowel resection also leads to lactose intolerance.”

If the condition is temporary or due to intestinal diseases it can be resolved with appropriate treatment. In other cases, lactose intolerance cannot be cured but can be managed effectively.

Dr. Ajay Bhalla offers advice: “Treatment involves avoiding milk and dairy products, although most people can tolerate curd and cheese. Soya milk and soya cheese can be used as substitutes. Lactase substitute drops or pills taken with meals that contain dairy products help.”

Dr. Venugopal adds, “Dietary lactose restriction, reduction in the daily lactose consumption and gradual adaptation. Avoid high-lactose foods like condensed milk, cottage cheese and ice cream. Enzyme supplements — commercially available lactase preparation — can be added to food lactose containing or taken with meals containing lactose. While they help reduce symptoms, the results differ among various people. Ingestion of lactose containing probiotics can help. Vitamin D and calcium supplements are recommended as are alternate food sources for calcium such as broccoli, spinach, salmon, beans, fortified juices and soy milk, which should form part of the diet.”

Quick tips

Have smaller servings of milk, say, 120ml at a time

Drink milk with other foods. This slows the digestive process and may reduce symptoms

Hard cheeses and yoghurt might be better tolerated as the bacteria in the culturing process produce the enzyme that breaks down lactose naturally

Try soy milk or goat’s milk, which contain less lactose.

Avoid stress, as it increases bowel movement and lowers the enzyme in the intestines

Take lactase substitutes in capsule form when required

Take calcium supplements.