Trouble Digesting Sugar in Milk
Lactose, a natural sugar found in milk and products made from milk, is digested in the body by an enzyme known as lactase. If a person does not produce sufficient lactase, lactose can be difficult to digest. In some people, this problem results in a condition known as lactose intolerance. A deficiency in lactase is usually hereditary and develops slowly from early childhood. Although lactase levels may be low, the symptoms of lactose intolerance may not appear until adolescence or adulthood. In other cases, lactase deficiency can be due to other conditions, such as an intestinal disease or chemotherapy.
Avoiding Dairy Is the Primary Treatment
Lactose intolerance is a fairly common condition that is estimated to affect between 30 million and 50 million people in the United States. People with this condition have trouble digesting milk sugar (lactose) due to a relative lack of the enzyme lactase. Lactase, found in the lining of the small intestine, is needed to break down lactose sugar into two simple sugars—glucose and galactose—for absorption.
The most common symptoms usually appear within 1 to 2 hours after ingestion of lactose-containing foods. These include nausea, abdominal cramping, bloating, gas pains, and diarrhea. These symptoms are similar to those for many other conditions, so the correct diagnosis is needed to determine the appropriate treatment.
The diagnostic process begins with the elimination of all milk and milk-related products from the diet to determine if the symptoms improve. After several weeks, these foods are reintroduced to see if symptoms return. In adults, a confirmation test for lactose intolerance known as the hydrogen breath test can be performed. During this test, the amount of hydrogen in the breath is measured after the patient ingests a lactose-containing drink. Since lactose that is not broken down by digestion gives off hydrogen gas, this test can help confirm the relative lack of lactose digestion by lactase. Some foods, drugs, and cigarette smoke can interfere with this test.
Treatment is aimed at reducing symptoms by decreasing or eliminating the amount of lactose in the diet. This includes avoiding the wide variety of processed foods that contain milk and milk products as stabilizers. Even OTC and prescription medications may contain lactose as an inactive ingredient. If foods that contain lactose are eliminated and symptoms continue, a doctor may recommend supplementing the diet with nonprescription lactase enzyme tablets or drops. Avoiding milk and dairy products may mean that people who are lactose-intolerant require calcium and vitamin D supplementation.
Not a True Milk Allergy
Unlike people with a true milk allergy, who must avoid milk or dairy products altogether, those with lactose intolerance can often ingest small amounts without experiencing serious symptoms. In fact, after the diagnosis is confirmed, the doctor may recommend eliminating the offending products from the diet for a period, then slowly reintroducing small amounts of food with lactose to see which foods cause symptoms. Some people with lactose intolerance are able to eat certain dairy products without symptoms, especially milk products with lower lactose levels, such as certain cheeses and yogurt. Others are so sensitive that they react after eating even the smallest amount of milk-containing products.
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Identifying Offending Foods
Unfortunately, there is no treatment that will increase the amount of lactase manufactured in the body. The key to treatment in patients with lactose intolerance is to identify the foods that cause symptoms. Once these foods are eliminated from the diet, the symptoms become manageable. Sometimes foods, especially processed foods, contain hidden milk products. Product labels should be read carefully to detect ingredients such as milk solids or whey. Even nondairy products such as creamers or whipped toppings can contain milk derivatives or caseinate ingredients that contain small amounts of lactose. Many foods are now labeled lactose-free or lactose-reduced, which may be good choices for people with little or no lactase production. Although the cornerstone of treatment is avoidance of lactose-containing foods, some doctors recommend a trial of nonprescription lactase enzyme supplements. For other people, the gradual introduction of small amounts of low-lactose foods, especially if eaten with regular meals, can help the body adjust to the lactose and lessen annoying symptoms.
