Lactose intolerance (patient information): Difference between revisions

	Lactose intolerance
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Lactose intolerance?
What to expect (Outlook/Prognosis)?
Lactose intolerance On the Web
Ongoing Trials at Clinical Trials.gov
Images of Lactose intolerance
Videos on Lactose intolerance
FDA on Lactose intolerance
CDC on Lactose intolerance
Lactose intolerance in the news
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Directions to Hospitals Treating Lactose intolerance
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Latest revision as of 22:28, 29 July 2020

For the WikiDoc page for this topic, click here.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2]

Overview

Lactose is a type of sugar found in milk and other dairy products. An enzyme called lactase is needed by the body to digest lactose. Lactose intolerance develops when the small intestine does not make enough of this enzyme. People sometimes confuse lactose intolerance with cow’s milk intolerance because the symptoms are often the same. However, lactose intolerance and cow’s milk intolerance are not related. Being intolerant to cow’s milk is an allergic reaction triggered by the immune system. Lactose intolerance is a problem caused by the digestive system.

What are the symptoms of Lactose intolerance?

Symptoms often occur 30 minutes to 2 hours after having milk products. Symptoms may be worse when you consume large amounts.

Symptoms include:

Abdominal bloating
Abdominal cramps
Diarrhea
Gas (flatulence)
Nausea

What causes Lactose intolerance?

.Babies' bodies make the lactase enzyme so they can digest milk, including breast milk.

Babies born too early (premature) sometimes have lactose intolerance.
Children who were born at full term often do not show signs of the problem before they are 3 years old.

Lactose intolerance is very common in adults. It is rarely dangerous. About 30 million American adults have some degree of lactose intolerance by age 20.

In white people, lactose intolerance often develops in children older than age 5. This is the age when our bodies may stop making lactase.
In African Americans, the problem can occur as early as age 2.
The condition is very common among adults with Asian, African, or Native American heritage.
It is less common in people of northern or western European background, but still may occur.

An illness that involves or injures your small intestine may cause less of the lactase enzyme to be made. Treatment of these illnesses may improve the symptoms of lactose intolerance. These may include:

Surgery of the small intestine
Infections in the small intestine (this is most often seen in children)
Diseases that damage the small intestines, such as celiac sprue or crohn disease

Babies may be born with a genetic defect and are not able to make any of the lactase enzyme.

Who is at highest risk?

Between 30 and 50 million Americans are lactose intolerant and certain ethnic and racial populations are more affected than others. Up to 80 percent of African Americans, 80 to 100 percent of American Indians, and 90 to 100 percent of Asian Americans are lactose intolerant. The condition is least common among people of northern European descent.

Babies that are born prematurely are also more likely to be lactose intolerant, because lactase levels do not increase until the third trimester of a woman’s pregnancy.

Diagnosis

Finding the cause of a food intolerance is not easy. There are various ways to diagnose lactose intolerance.

Elimination diet: This involves avoiding anything that contains lactose. If your symptoms improve, it is taken as an initial sign that you have lactose intolerance. You also keep a log of what you ate and any symptoms you had. Then a tolerance test is done. This test checks whether the symptoms return after you drink a lactose solution.
Hydrogen breath test: If the tolerance test results are inconclusive, the amount of hydrogen in your breath is measured before and after drinking a lactose solution. When lactose is broken down by bacteria in the large intestine, hydrogen is produced as a byproduct. The hydrogen is released into the bloodstream through the walls of the intestine and ends up being breathed out once it reaches the lungs. So people with lactose intolerance generally have more hydrogen in their breath. The test solution for adults contains 50 mg of lactose in 0.4 liters of fluid and is taken on an empty stomach. The breath test is repeated every 15 to 30 minutes for at least two or three hours. But smoking, chewing gum, poor oral hygiene and other factors can influence the results of the test. That is why it is important to check whether the lactose solution also causes typical lactose intolerance symptoms like bloating and diarrhea. If not, then higher hydrogen levels are likely to be caused by something else.
Lactose intolerance test: This test measures blood sugar levels after drinking a lactose solution. If blood sugar does not rise significantly it is a sign that you have lactose intolerance. This is because the body cannot absorb the sugar molecules when there is not enough lactase in the large intestine to break down lactose. The test solution for adults contains about 50 grams of lactose and is also taken on an empty stomach. Blood sugar levels are measured regularly over the next two hours. It is important to watch out for symptoms like diarrhea or cramps during this test as well.

When to seek urgent medical care?

Lactose intolerance is not serious.

Call your provider if:

You have an infant younger than 2 or 3 years old who has symptoms of lactose intolerance.
Your child is growing slowly or not gaining weight.
You or your child has symptoms of lactose intolerance and you need information about food substitutes.
Your symptoms get worse or do not improve with treatment.
You develop new symptoms.

Treatment options

Cutting down your intake of milk products that contain lactose from your diet most often eases symptoms. Also look at food labels for hidden sources of lactose in nonmilk products (including some beers) and avoid these.

Most people with low lactase level can drink up to one-half cup of milk at one time (2 to 4 ounces or 60 to 120 milliliters) without having symptoms. Larger servings (more than 8 ounces or 240 mL) may cause problems for people with the deficiency.

Milk products that may be easier to digest include:

Buttermilk and cheeses (these foods contain less lactose than milk)
Fermented milk products, such as yogurt
Goat's milk
Ice cream, milkshakes, and aged or hard cheeses
Lactose-free milk and milk products
Lactase-treated cow's milk for older children and adults
Soy formulas for infants younger than 2 years
Soy or rice milk for toddlers

You can add lactase enzymes to regular milk. You can also take these enzymes as capsules or chewable tablets. There are also many lactose-free dairy products available.

Not having milk and other dairy products in your diet can lead to a shortage of calcium, vitamin D, riboflavin, and protein. You need 1,000 to 1,500 mg of calcium each day depending on your age and gender. Some things you can do to get more calcium in your diet are:

Take calcium supplements with Vitamin D. Talk to your healthcare provider about which ones to choose.
Eat foods that have more calcium (such as leafy greens, oysters, sardines, canned salmon, shrimp, and broccoli).
Drink orange juice with added calcium.

Where to find medical care for Lactose intolerance?

Directions to Hospitals Treating Lactose intolerance

Prevention

There is no known way to prevent lactose intolerance. You can prevent symptoms by avoiding foods with lactose.

What to expect (Outlook/Prognosis)?

Symptoms most often go away when you remove milk, other dairy products, and other sources of lactose from your diet. Without dietary changes, infants or children may have growth problems.

Possible Complications

Common complications of lactose intolerance if they do not intake adequate quantities of dairy products and calcium include:

Sources

NLM

Template:WH Template:WS

@@ Line 1: / Line 1: @@
 __NOTOC__
 '''For the WikiDoc page for this topic, click [[Lactose intolerance|here]].'''
 {{Lactose intolerance (patient information)}}
-{{CMG}}; '''Assistant Editor(s)-In-Chief:''' Meagan E. Doherty
+{{CMG}}; {{AE}} {{MA}}
 ==Overview==
-Lactose intolerance is the inability to digest significant amounts of lactose, the major sugar found in milk. Lactose intolerance is caused by a shortage of the enzyme [[lactase]], which is produced by the cells that line the [[small intestine]]. Lactase breaks down milk sugar into two simpler forms of sugar called [[glucose]] and [[galactose]], which are then absorbed into the bloodstream. Not all people deficient in lactase have the symptoms commonly associated with lactose intolerance, but those who do are said to have lactose intolerance.
+[[Lactose]] is a type of [[sugar]] found in milk and other dairy products. An enzyme called [[lactase]] is needed by the body to digest [[lactose]]. Lactose intolerance develops when the [[small intestine]] does not make enough of this enzyme. People sometimes confuse lactose intolerance with cow’s milk intolerance because the symptoms are often the same. However, lactose intolerance and cow’s milk intolerance are not related. Being intolerant to cow’s milk is an [[allergic reaction]] triggered by the [[immune system]]. Lactose intolerance is a problem caused by the [[digestive system]].
-People sometimes confuse lactose intolerance with cow’s milk intolerance because the symptoms are often the same. However, lactose intolerance and cow’s milk intolerance are not related. Being intolerant to cow’s milk is an allergic reaction triggered by the immune system. Lactose intolerance is a problem caused by the [[digestive system]].
 ==What are the symptoms of Lactose intolerance?==
-Symptoms of lactose intolerance can include:
+Symptoms often occur 30 minutes to 2 hours after having milk products. Symptoms may be worse when you consume large amounts.
-:* [[Abdominal pain]]
-:* [[Diarrhea]]
-:* [[Flatulence]]
-:* [[Bloating]]
-Symptoms can be mild or severe, usually depending on how much [[lactose]] a person has eaten or drank, and how much [[lactase]] is in their body.
+Symptoms include:
+* Abdominal [[bloating]]
+* Abdominal [[Cramp|cramps]]
+* [[Diarrhea]]
+* [[Gas]] ([[flatulence]])
+* [[Nausea]]
 ==What causes Lactose intolerance?==
-Some causes of lactose intolerance are well known. Primary [[lactase]] deficiency is a condition that develops over time. After about age 2 the body begins to produce less lactase, though most people will not notice symptoms until they are much older.
+.Babies' bodies make the [[lactase]] enzyme so they can digest milk, including breast milk.
+* Babies born too early ([[premature]]) sometimes have lactose intolerance.
-Secondary lactase deficiency occurs when injury to the small intestine or certain digestive diseases reduce the amount of lactase a person produces. These diseases include [[celiac disease]], [[inflammatory bowel disease]], and [[Crohn’s disease]].
+* Children who were born at [[full term]] often do not show signs of the problem before they are 3 years old.
+Lactose intolerance is very common in adults. It is rarely dangerous. About 30 million American adults have some degree of lactose intolerance by age 20.
-Researchers have identified a genetic link for lactose intolerance. Some people are born with a likelihood of developing primary lactase deficiency because it has been passed to them genetically (inherited from their parents). This discovery may be useful in developing a diagnostic test to identify people with the condition.
+* In white people, lactose intolerance often develops in children older than age 5. This is the age when our bodies may stop making [[lactase]].
+* In African Americans, the problem can occur as early as age 2.
+* The condition is very common among adults with Asian, African, or Native American heritage.
+* It is less common in people of northern or western European background, but still may occur.
+An illness that involves or injures your [[small intestine]] may cause less of the [[lactase]] enzyme to be made. Treatment of these illnesses may improve the symptoms of lactose intolerance. These may include:
+* Surgery of the [[small intestine]]
+* [[Infection|Infections]] in the [[small intestine]] (this is most often seen in children)
+* Diseases that damage the [[Small intestine|small intestines]], such as [[Celiac disease|celiac sprue]] or [[Crohn's disease|crohn disease]]
+Babies may be born with a genetic defect and are not able to make any of the [[lactase]] enzyme.
 ==Who is at highest risk?==
-Between 30 and 50 million [[Americans]] are [[lactose]] intolerant and certain [[ethnic]] and [[race|racial]] populations are more affected than others. Up to 80 percent of African Americans, 80 to 100 percent of American Indians, and 90 to 100 percent of Asian Americans are lactose intolerant. The condition is least common among people of northern European descent.
+Between 30 and 50 million Americans are [[lactose]] intolerant and certain [[Ethnic group|ethnic]] and [[race|racial]] populations are more affected than others. Up to 80 percent of African Americans, 80 to 100 percent of American Indians, and 90 to 100 percent of Asian Americans are lactose intolerant. The condition is least common among people of northern European descent.
 Babies that are born [[prematurity|prematurely]] are also more likely to be lactose intolerant, because [[lactase]] levels do not increase until the [[third trimester]] of a woman’s [[pregnancy]].
 ==Diagnosis==
+Finding the cause of a food intolerance is not easy. There are various ways to diagnose lactose intolerance.
+* '''Elimination diet:''' This involves avoiding anything that contains lactose. If your symptoms improve, it is taken as an initial sign that you have lactose intolerance. You also keep a log of what you ate and any symptoms you had. Then a tolerance test is done. This test checks whether the symptoms return after you drink a lactose solution.
+* '''Hydrogen breath test:''' If the tolerance test results are inconclusive, the amount of hydrogen in your breath is measured before and after drinking a lactose solution. When lactose is broken down by bacteria in the large intestine, hydrogen is produced as a byproduct. The hydrogen is released into the bloodstream through the walls of the intestine and ends up being breathed out once it reaches the lungs. So people with lactose intolerance generally have more hydrogen in their breath. The test solution for adults contains 50 mg of lactose in 0.4 liters of fluid and is taken on an empty stomach. The breath test is repeated every 15 to 30 minutes for at least two or three hours. But smoking, chewing gum, poor oral hygiene and other factors can influence the results of the test. That is why it is important to check whether the lactose solution also causes typical lactose intolerance symptoms like bloating and diarrhea. If not, then higher hydrogen levels are likely to be caused by something else.
+* '''Lactose intolerance test:''' This test measures blood sugar levels after drinking a lactose solution. If blood sugar does not rise significantly it is a sign that you have lactose intolerance. This is because the body cannot absorb the sugar molecules when there is not enough lactase in the large intestine to break down lactose. The test solution for adults contains about 50 grams of lactose and is also taken on an empty stomach. Blood sugar levels are measured regularly over the next two hours. It is important to watch out for symptoms like diarrhea or cramps during this test as well.
-Lactose intolerance can be hard to diagnose based on symptoms alone. People sometimes think they suffer from lactose intolerance because they have the symptoms associated with the disorder, not knowing other conditions such as irritable bowel syndrome can cause similar symptoms. A doctor can use tests to diagnose lactose intolerance but may first recommend eliminating cow’s milk from the diet to see if the symptoms go away.
+==When to seek urgent medical care?==
+Lactose intolerance is not serious.
-The most common tests used to measure the absorption of lactose in the digestive system are the lactose tolerance, hydrogen breath, and stool acidity tests.
-*The Lactose Tolerance Test: This test requires fasting (not eating) before the test and then drinking a liquid that contains lactose. Several blood samples are then taken over a 2-hour period to measure the person’s blood glucose (blood sugar) level. These measures indicate how well the body is able to digest lactose.
-Normally, when lactose reaches the digestive system, the lactase enzyme breaks it down into glucose and galactose. The liver then changes the galactose into glucose, which enters the bloodstream and raises the person’s blood glucose level. If, however, lactose is incompletely broken down, the blood glucose level does not rise and a diagnosis of lactose intolerance is confirmed.
-*The Hydrogen Breath Test: This test measures the amount of hydrogen in a person’s breath. Very little hydrogen is normally detectable. However, undigested lactose in the colon is fermented by bacteria and produces various gases, including hydrogen. The hydrogen is absorbed from the intestines, carried through the bloodstream to the lungs, and exhaled. In this test, the person drinks a lactose-loaded beverage and the breath is analyzed at regular intervals. Raised levels of hydrogen in the breath indicate improper digestion of lactose. Certain foods, medications, and cigarettes can affect the accuracy of the test and should be avoided before taking the test. People should check with their doctor to make sure they are not taking medications that may interfere with test results.
-The lactose tolerance and hydrogen breath tests are not given to infants younger than 6 months of age. A large lactose load can be dangerous prior to this age, as infants are more likely to become dehydrated from diarrhea that can be caused by lactose intolerance.
-*Stool Acidity Test: This test may be used for infants and young children to measure the amount of acid in their stool. Undigested lactose fermented by bacteria in the colon creates lactic acid and other fatty acids that can be detected in a stool sample. Glucose may also be present in the sample as a result of unabsorbed lactose in the colon.
-===Diseases With Similar Symptoms===
-*[[Irritable bowel syndrome]]
-*[[Inflammatory bowel disease]]
-*Overuse of laxatives
-*Problems digesting foods that contain fructose and sorbitol.
-==When to seek urgent medical care?==
+Call your provider if:
-Lactose intolerance is not serious. But it is important to talk to your doctor if you suspect you may have some of the mentioned symptoms.
+* You have an infant younger than 2 or 3 years old who has symptoms of lactose intolerance.
+* Your child is growing slowly or not gaining weight.
+* You or your child has symptoms of lactose intolerance and you need information about food substitutes.
+* Your symptoms get worse or do not improve with treatment.
+* You develop new symptoms.
 ==Treatment options==
-Lactose intolerance is easy to treat. No treatment can improve the body’s ability to produce lactase, but symptoms can be controlled through diet.
+Cutting down your intake of milk products that contain lactose from your diet most often eases symptoms. Also look at food labels for hidden sources of lactose in nonmilk products (including some beers) and avoid these.
-Young children and infants with lactase deficiency should not consume lactose-containing formulas or foods until they are able to tolerate lactose digestion. Most older children and adults do not have to avoid lactose completely, but people differ in the amounts and types of foods they can handle. For example, one person may have symptoms after drinking a small glass of milk, while another can drink one glass but not two. Others may be able to manage ice cream and aged cheeses, such as cheddar and Swiss, but not other dairy products. People can also tolerate more lactose by having smaller amounts of it at one time. The level of dietary control needed with lactose intolerance depends on how much lactose a person’s body can handle.
+Most people with low lactase level can drink up to one-half cup of milk at one time (2 to 4 ounces or 60 to 120 milliliters) without having symptoms. Larger servings (more than 8 ounces or 240 mL) may cause problems for people with the deficiency.
-For those who react to very small amounts of lactose or have trouble limiting their intake of foods that contain it, the lactase enzyme is available without a prescription to help people digest foods that contain lactose. The tablets are taken with the first bite of dairy food. Lactase enzyme is also available as a liquid. Adding a few drops of the enzyme makes lactose more digestible for people with lactose intolerance.
+Milk products that may be easier to digest include:
+* Buttermilk and cheeses (these foods contain less lactose than milk)
+* Fermented milk products, such as yogurt
+* Goat's milk
+* Ice cream, milkshakes, and aged or hard cheeses
+* Lactose-free milk and milk products
+* Lactase-treated cow's milk for older children and adults
+* Soy formulas for infants younger than 2 years
+* Soy or rice milk for toddlers
+You can add lactase enzymes to regular milk. You can also take these enzymes as capsules or chewable tablets. There are also many lactose-free dairy products available.
-Lactose-reduced milk and other products are available at most supermarkets. The milk contains all of the nutrients found in regular milk and remains fresh for about the same length of time, or longer if it is super-pasteurized.
+Not having milk and other dairy products in your diet can lead to a shortage of calcium, vitamin D, riboflavin, and protein. You need 1,000 to 1,500 mg of calcium each day depending on your age and gender. Some things you can do to get more calcium in your diet are:
+* Take calcium supplements with Vitamin D. Talk to your healthcare provider about which ones to choose.
+* Eat foods that have more calcium (such as leafy greens, oysters, sardines, canned salmon, shrimp, and broccoli).
+* Drink orange juice with added calcium.
 ==Where to find medical care for Lactose intolerance?==
 [http://maps.google.com/maps?f=q&amp;hl=en&amp;geocode=&amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|Lactose Intolerance}}}}&amp;sll=37.0625,-95.677068&amp;sspn=65.008093,112.148438&amp;ie=UTF8&amp;ll=37.0625,-95.677068&amp;spn=91.690419,149.414063&amp;z=2&amp;source=embed Directions to Hospitals Treating Lactose intolerance]
+==Prevention==
+There is no known way to prevent lactose intolerance. You can prevent symptoms by avoiding foods with lactose.
-==What to expect (Outook/Prognosis)?==
+==What to expect (Outlook/Prognosis)?==
-Even though lactose intolerance is common, it is not a threat to good health. People who have trouble digesting lactose can learn which dairy products and other foods they can eat without discomfort and which ones they should avoid. Many people can enjoy milk, ice cream, and other such products if they eat them in small amounts or eat other food at the same time. Others can use lactase liquid or tablets to help digest the lactose. Even older women at risk for osteoporosis and growing children who must avoid milk and foods made with milk can meet most of their dietary needs by eating greens, fish, and other calcium-rich foods that are free of lactose. A carefully chosen diet, with calcium supplements if the doctor or dietitian recommends them, is the key to reducing symptoms.
+Symptoms most often go away when you remove milk, other dairy products, and other sources of lactose from your diet. Without dietary changes, infants or children may have growth problems.
+==Possible Complications==
+Common complications of lactose intolerance if they do not intake adequate quantities of dairy products and [[calcium]] include:
+* [[Osteopenia]]
+* [[Osteoporosis]]
+* [[Malnutrition]]
+* [[Rickets]]
+* [[Osteomalacia]]
 ==Sources==
-* [http://digestive.niddk.nih.gov/ddiseases/pubs/lactoseintolerance/#risk NIDDK]
-* [http://www.healthfinder.gov/scripts/SearchContext.asp?topic=481 Health Finder]
 * [http://www.nlm.nih.gov/medlineplus/lactoseintolerance.html NLM]
 {{WH}} {{WS}}
 [[Category:Patient information]]
-[[Category:Disease]]
-[[Category:Metabolic disorders]]
-[[Category:Conditions diagnosed by stool test]]
 [[Category:Gastroenterology]]
-[[Category:Inborn errors of metabolism]]
+[[Category:Medicine]]
+[[Category:Up-To-Date]]