You’re not alone if you suffer bouts of diarrhea, stomach pain, gas, and bloating after consuming even the slightest amount of dairy foods. According to the National Institute of Diabetes, Digestive, and Kidney Diseases, approximately 36% of American adults have lactose malabsorption and develop intolerance by age 20.
Before we find out what lactose intolerance is, let’s look at lactose. Lactose is a type of naturally occurring sugar found in the milk of most animals. An enzyme called lactase is synthesized by the body to help with breaking down lactose for digestion.
By adulthood, most people can’t produce adequate amounts of lactase in the small intestines. This, in turn, leads to lactose intolerance when they eat or drink dairy products. Their digestive system can’t digest the lactose (sugar) in milk.
You most likely have intolerance if you become excessively gassy and your stomach cramps up after consuming some ice cream, cheese, or milk with your bowl of cereal. Lactose intolerance is simply having lactase deficiency. To most sufferers, symptoms such as diarrhea, gas, and bloating start presenting immediately or 30 minutes after consuming foods that contain lactose.
Note that people who are lactose intolerant develop the condition from a shortage of the lactase enzyme produced by cells that line the small intestine. However, it’s not uncommon for patients to develop lactose malabsorption after surgery. It can also be due to bacterial infections or viral gastrointestinal conditions.
When the body cannot break down carbohydrates (sugars) like lactose, which in this case can’t be absorbed by the colon lining. It’s fermented by gut microflora bacteria. The result is an increased release of short-chain fatty acids, methane, carbon dioxide, and hydrogen.
The build-up of gases and acids leads to bloating and stomach discomfort – two common symptoms of lactose intolerance. While rare, the stomach distension and pain may also cause severe nausea and vomiting in some cases.
Bear in mind that stomach aches and bloating are also signs of overeating or other gut infections. A lactose intolerance test is required if the gastrointestinal symptoms don’t remedy over time. Most lactose intolerance symptoms are stomach-related. Some people report experiencing fatigue, lack of concentration, mouth ulcers, eczema, headaches, muscle pulls, joint pain, etc.
If symptoms such as gas, bloating, abdominal pain, and diarrhea persist, it is crucial to get tested before eliminating milk and milk products from your diet. To diagnose lactose intolerance accurately, your doctor will use the hydrogen breath test.
During the test, you will drink 50 grams (1.8 ounces) of a lactose solution and then breathe it into a plastic bag every 15 minutes. The samples check for the amount of hydrogen in your breath. It is to determine if you have bacterial overgrowth or intolerances to lactose (including fructose, sorbitol, and sucrose).
High levels of hydrogen in the breath mean that the type of naturally occurring sugar found in the milk wasn’t digested, and your gut bacteria is fermenting lactose in the colon. In the weeks, days, and hours leading up to the test, your doctor will take you off certain foods and medication that may alter the final results. For example, some antibiotics and probiotics may change the normal balance of gut bacteria. On the other hand, smoking, taking fiber supplements or laxatives may affect bacterial motility.
Diet, medicine, and lifestyle recommendations will vary. Nonetheless, your diet will mainly consist of easily-digestible, low-fiber foods a day before the test. You’ll also be required to fast for 12 hours on the day of the lactose tolerance test. Ingesting the given amount of lactose solution may cause some abdominal discomfort. However, the hydrogen breath test is the ideal noninvasive procedure to help identify the underlying cause of your symptoms and consequent digestive issues.
While lactose intolerance is not a life-threatening disease, there is nothing fun with constantly having distressing stomach discomforts of gas and indigestion. When left untreated, these symptoms may have many causes that require more than a simple hydrogen breath to diagnose and treat.
Viral or bacterial infections can cause gastrointestinal symptoms that often present as lactose malabsorption. E.coli and Salmonella are examples of bacterial gastroenteritis. It can result in symptoms like abdominal cramping, stomach pain, nausea, diarrhea, and vomiting.
These symptoms can also present in viral gastroenteritis (stomach flu). It causes an inflammation of the digestive tract from consuming contaminated food or water. A rapid stool test or blood sample can help diagnose and treat bacterial as well as viral gastroenteritis.
Unfortunately, there’s no known cure for lactose intolerance. If ingesting milk products containing lactose, for instance, cheese, butter, curds, milk powder, and whey exacerbates your symptoms, limiting or altogether avoiding their consumption is best. Additionally, watch for high-lactose food items such as ice cream, heavy and sour cream, condensed milk, cottage and ricotta cheese, and cheese spreads.
Soy, almond, and coconut milk, including lactose-free milk, and fortified sources of calcium like orange juice, are healthy milk substitutes. Also, always read food labels because most if not all baked goods and some medications contain lactose. It’s equally important to seek treatment for underlying conditions that cause lactose malabsorption to restore ‘normal’ lactose digestion.
Note: Some individuals are genetically predisposed to primary lactose intolerance. In addition, aging and injury to the small intestines, including health conditions like chemotherapy, Crohn’s, and Celiac diseases, are factors associated with malabsorption. Genetic tests and invasive procedures such as endoscopy to rule out lactose intolerance are also available.
If you have recurring symptoms, there are successful ways to help manage the condition and alleviate bouts of discomfort. The first step is to book a hydrogen breath test with a gastroenterologist in our clinic. We can provide the best possible cause of action, for example, starting a lactose-reduced or lactose-free diet regimen and supplementing with lactase products comprising enzymes, prebiotics, or probiotics. We have thus far answered the question; is lactose intolerance treatable?
Contact us today for help improving your symptoms and overall quality of health.
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Dr. Anu Sampat: (718) 227-1282