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What Is Lactose Intolerance and What Causes It?

Lactose intolerance is the inability to digest a sugar called lactosethat is found in milk and dairy products. Normally when a person eats something containing lactose, an enzyme in the small intestine called lactase breaks down lactose into simpler sugar forms called glucose and galactose. These simple sugars are then easily absorbed into the bloodstream and turned into energy fuel for our bodies. People with lactose intolerance do not produce enough of the lactase enzyme to break down lactose. Instead, undigested lactose sits in the gut and gets broken down by bacteria, causing gas, bloating, stomach cramps, and diarrhea. Lactose intolerance is fairly common. It seems to affect guys and girls equally. Some ethnic groups are more likely to be affected than others because their diets traditionally include fewer dairy products: Almost all Asians and Native Americans are lactose intolerant, and up to 80% of African Americans and Hispanic Americans also have symptoms of lactose intolerance. Their ancestors did not eat dairy foods, so their bodies were not prepared to digest dairy, and they passed these genes on from generation to generation. Little kids are less likely to have lactose intolerance. But many people eventually become lactose intolerant in adulthood some while they are still teens. Some health care providers view lactose intolerance as a normal human condition and therefore don't really consider it a disease. Who Gets Lactose Intolerance? A person may be or may become lactose intolerant for different reasons: Ethnic background. People of Asian, African, Native American, and Hispanic backgrounds are more likely to develop lactose intolerance at a young age. Other problems with the digestive tract. People who have inflammation of their upper small intestine, such as celiac or Crohn's disease, have a reduced level of the lactase enzyme. Medications. Certain antibiotics can trigger temporary lactose intolerance by interfering with the intestine's ability to produce the lactase enzyme. Infection. After a bout of infectious diarrhea, some kids can develop a temporary lactose intolerance that usually improves after a few days or weeks. Age. As people get older, their bodies usually stop producing the lactase enzyme, and most people will naturally become lactose intolerant over time. What Happens When Someone Has Lactose Intolerance? People with lactose intolerance may have a variety of symptoms. It all depends on how much dairy or how many milkcontaining foods the person eats and how little lactase the body produces. Usually within 30 minutes to 2 hours after eating, someone with lactose intolerance will experience nausea, stomach cramps, bloating, gas, and diarrhea. This can be unpleasant, not to mention embarrassing if you're at school or out with friends.

Because many people may think they're lactose intolerant when they really aren't, it helps to see a doctor who can diagnose the condition correctly and advise you on ways to manage it. How Do Doctors Diagnose It? If your doctor suspects you might be lactose intolerant, he or she will take your medical history by asking about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. Your doctor will also perform a physical examination. Doctors can test for lactose intolerance by using the hydrogen breath test. Normally very little hydrogen gas is detectable in the breath. However, undigested lactose in the colon ferments (breaks down) and produces various gases, including hydrogen. If your doctor decides to give you a hydrogen breath test, you'll be asked to blow into a tube for a beginning sample. You'll then swallow a drink with lactose in it, wait a while, and breathe into the tube again. You'll be asked to blow into the tube every half hour for 2 hours in order to measure hydrogen levels in your breath. The levels should go up over time if you have lactose intolerance. Doctors also can find out if you're able to digest lactose by testing for the presence of lactase with an endoscopy. During this procedure, doctors view the inside of the intestines by inserting a long tube with a light and a tiny camera on the end into the mouth. A doctor can then take tissue samples and pictures of the inside of your gut and look for clues to why you've been having problems with what you're eating. The amount of lactase enzyme can be measured in one of these tissue samples. Living With Lactose Intolerance Lactose intolerance is a very individual condition and it's often easy to manage if you're in tune with your body. Everyone's different, but most people with lactose intolerance are able to eat a small amount of dairy. The trick is to eat dairy products in combination with other foods that don't contain lactose and not eat too much dairy at once. It can also help to keep a food diary to learn which foods your body can or can't tolerate. Dairy foods are the best source of calcium, a mineral that's important for bone growth. Because growing teens need about 1,300 milligrams (mg) of calcium each day, the American Academy of Pediatrics (AAP) recommends that even teens who have lactose intolerance continue to include some dairy in their diet. Foods like cheese or yogurt may be easier to digest than milk, so try a cup of yogurt for dessert or add a piece of cheese to your sandwich. Lactose-free milk is also a great way to get calcium in your diet without the problems that can come with lactose. Taking a lactase enzyme supplement might help, too. Taking this before eating foods that contain dairy will help the body digest the lactose sugar in dairy so you don't develop the symptoms of lactose intolerance, like pain, cramping, bloating, gas, and diarrhea. Teens with the most severe symptoms of lactose intolerance might have to avoid all dairy products. It's extra important that these teens find other good calcium sources, so talking to a registered dietitian is a good idea. Dietitians are trained in

nutrition and they can help people who are lactose intolerant come up with eating alternatives and develop a well-balanced diet that provides lots of calcium for developing strong bones.

Here are some tips for dealing with lactose intolerance: Choose lactose-reduced or lactose-free milk. Take a lactase enzyme supplement (such as Lactaid) just before you eat dairy products. These can be taken in drops or tablets and even added directly to milk. When you do drink milk or eat lactose-containing foods, eat other non-lactose foods at the same meal to slow digestion and avoid problems. (For example, if you are going to have a milkshake, don't drink it by itself. Have something else with it, like a healthy sandwich.) Drink juices that are fortified with calcium. Eat a variety of dairy-free foods that are rich in calcium, such as broccoli, beans, tofu, or soy milk. Consider hard cheeses such as cheddar, which are lower in lactose. Yogurts that contain active cultures are easier to digest and much less likely to cause lactose problems. Learn to read food labels. Lactose is added to some boxed, canned, frozen, and prepared foods like bread, cereal, lunchmeats, salad dressings, mixes for cakes and cookies, and coffee creamers. Be aware of certain words that may mean the food has lactose in it: butter, cheese, cream, dried milk, milk solids, powdered milk, and whey, for example. Causes Lactose intolerance occurs when the small intestine does not produce enough of an enzyme called lactase. Your body needs lactase to break down, or digest, lactose (the sugar found in dairy products). Lactose intolerance generally develops in individuals as they age. People tend to become lactose intolerant around their teenage years, or during adulthood (ages 30 to 40). Generally, lactose intolerance most commonly runs in families and is related to ones familys genes. Lactose intolerance can also be brought on by infections, chemotherapy, penicillin reactions, surgery, pregnancy, or from the avoidance of dairy products for a prolonged period of time. Additionally, specific ethnicities are more likely to suffer from lactose intolerance than others. On rare occasions, newborns are lactose-intolerant. Usually newborns outgrow the condition as they get older.

Genetics Ones genes can play a key role in being able to consume dairy product without symptoms. Ones genetic make-up dictates if his or her body can produce enough lactase enzyme, an enzyme the body needs to break down dairy products. Many ethnic cultures are in fact more likely to be lactose intolerant because their diets call for low lactose intake. Over generations, these ethnic groups dont pass on the enzyme to break down dairy because they arent consuming dairy. Causes By Mayo Clinic staff

Small intestine

Lactose intolerance is usually caused by low levels of the enzyme lactase in your small intestine that lead to signs and symptoms. Normally, the cells that line your small intestine produce an enzyme called lactase. The lactase enzyme attaches to lactose molecules in the food you eat and breaks them into two simple sugars glucose and galactose which can be absorbed into your bloodstream. Without enough of the lactase enzyme, most of the lactose in your food moves unprocessed into the colon, where the normal intestinal bacteria interact with it. This causes the hallmarks of lactose intolerance gas, bloating and diarrhea. There are three types of lactose intolerance. Normal result of aging for some people (primary lactose intolerance) Normally, your body produces large amounts of lactase at birth and during early childhood, when milk is the primary source of nutrition. Usually your lactase production decreases as your diet becomes more varied and less reliant on milk. This gradual decline may lead to symptoms of lactose intolerance. Result of illness or injury (secondary lactose intolerance) This form of lactose intolerance occurs when your small intestine decreases lactase production after an illness, surgery or injury to your small intestine. It can occur as a result of intestinal diseases, such as celiac disease, gastroenteritis and an inflammatory bowel disease like Crohn's disease. Treatment of the underlying disorder may restore lactase levels and improve signs and symptoms, though it can take time. Condition you're born with (congenital lactose intolerance) It's possible, but rare, for babies to be born with lactose intolerance caused by a complete absence of lactase activity. This disorder is passed from generation to generation in a pattern of inheritance called autosomal recessive. This means that both the mother and the father must pass on the defective form of the gene for a child to be affected. Infants with congenital lactose intolerance are intolerant of the lactose in their mothers' breast milk and have diarrhea from birth. These babies require lactose-free infant formulas. Premature infants may also have lactose intolerance because of an insufficient lactase level. In babies who are otherwise healthy, this doesn't lead to malnutrition.

How is lactose intolerance diagnosed? To find out if you have lactose intolerance, your doctor will ask about your symptoms. The doctor may ask you to stop eating or drinking milk and milk products to see if your symptoms improve. Your doctor might perform other tests to confirm your diagnosis: Breath tests. You will drink a sweet drink with lactose in it. Then your breath is tested to see if you were able to digest the lactose. Stool test. Your stool can be tested to see if you digest lactose. Stool is the waste that passes through the rectum as bowel movements. The stool test is often used to check babies for lactose intolerance.

What should I do if I think my child is lactose intolerant? Talk with your doctor before making any changes in your childs diet. While lactose intolerance is more common in adults, children may be lactose intolerant. How is lactose intolerance managed? You can change your diet to manage your symptoms. Most people with lactose intolerance do not have to give up milk or milk products. You may be able to tolerate milk and milk products if you drink small amounts of milk4 ounces or lessat a time drink small amounts of milk with meals gradually add small amounts of milk and milk products to your diet and see how you feel eat milk products that are easier for people with lactose intolerance to digest, such as yogurt and hard cheeses like cheddar and Swiss You can also use over-the-counter products that may help you digest milk and milk products. You can take a tablet that contains the lactase enzyme when you eat foods that contain lactose add liquid lactase drops to liquid milk products You can also find lactose-free and lactose-reduced milk and milk products at the grocery store. These products have the same nutrients and benefits as regular milk. How will I know if a food has lactose? Lactose is found in milk and all foods made with milk, such as ice cream cream butter cheese cottage cheese yogurt Rarely, people with lactose intolerance are bothered by small amounts of lactose. Some boxed, canned, frozen, packaged, and prepared foods contain small amounts of lactose. These foods include bread and other baked goods waffles, pancakes, biscuits, cookies, and mixes to make them prepared or frozen breakfast foods such as doughnuts, frozen waffles and pancakes, toaster pastries, and sweet rolls boxed breakfast cereals instant potatoes, soups, and breakfast drinks potato chips, corn chips, and other packaged snacks prepared meats, such as bacon, sausage, hot dogs, and lunch meats

margarine salad dressings liquid and powdered milk-based meal replacements protein powders and bars candies nondairy liquid and powdered coffee creamers nondairy whipped toppings

Look for certain words on food labels. These words mean the food has lactose in it: milk lactose whey curds milk by-products dry milk solids nonfat dry milk powder How will I get the calcium I need? Milk and milk products are the most common sources of calcium. Calcium is a mineral the body needs for strong bones and teeth. If you are lactose intolerant, make sure you get enough calcium each day. Other foods contain calcium, such as canned salmon or sardines with bones broccoli and other leafy green vegetables oranges almonds, Brazil nuts, and dried beans soy milk and tofu products with added calcium, such as orange juice To absorb calcium, your body needs vitamin D. Be sure to eat foods that contain vitamin D, such as eggs, liver, and certain kinds of fish like salmon and tuna. Also, getting enough sun helps your body make vitamin D. Vitamin D is added to some milk and milk products. If youre able to drink small amounts of milk or eat yogurt, choose varieties that have vitamin D added. Its hard to get enough calcium and vitamin D even if you eat and drink milk and milk products. Talk with your doctor about how to get calcium and vitamin D in your diet. Ask if you should also take a supplement to get enough calcium, vitamin D, or other nutrients. Points to Remember Lactose intolerance means you have trouble digesting lactose. If you have lactose intolerance, you may not feel well after you eat or drink milk and milk products. Many people with lactose intolerance can tolerate small amounts of milk4 ounces or lessat a time, especially with meals. You may be able to gradually add small amounts of milk and milk products to your diet. You can use over-the-counter products that may help you digest milk and milk products. If you are lactose intolerant, make sure you get enough calcium each day. Talk with your doctor about how to get enough calcium in your diet. Ask if you should take a calcium supplement. If you're lactose intolerant, you are unable to digest lactose, which is the sugar that occurs naturally in milk. As a result, you experience uncomfortable digestive symptoms, including cramping and gas, when you drink milk or

consume most dairy products. While you do have options -- like lactose-free milk and dairy -- available to you, there are a number of foods you shouldn't eat if you are lactose intolerant. Conventional Milk If you are lactose intolerant, the most basic of foods you need to avoid is milk. Milk, whether it's from a cow, a goat, or any other mammal, contains lactose. To absorb the nutritional compounds in lactose, you need to digest the sugar first, explain Dr. Reginald Garrett and Dr. Charles Grisham in their book "Biochemistry." This requires lactase, an intestinal enzyme. Lactose intolerant individuals don't produce lactase, meaning that lactose in your diet passes through to your lower intestine where it is digested by bacteria, resulting in uncomfortable gastrointestinal symptoms. Caseinate Supplier JLS Foods is a leading supplier of Caseinates and dairy ingredients. Sponsored Links Some Alternative Milks There are several reasons that some people seek out alternatives to milk, such as soy milk or almond milk. These include lactose intolerance, milk allergy and following a vegan diet. Because not all those who consume alternative milks are lactose intolerant, however, some manufacturers add lactose as a milk sweetening agent to soy and other milks. Read the ingredients carefully before using any milk substitute. Cheese Some individuals with various milk sensitivities can consume cheese, because the cheese-manufacturing process separates out some of the proteins in milk, leaving others behind. Unfortunately for the lactose intolerant individual, however, most cheeses still contain sufficient lactose to cause digestive problems. If you're only mildly lactose intolerant, you can try different cheeses to see whether there are some to which you don't react. The very sensitive, however, should avoid all cheeses. Some Yogurts Unlike most other dairy products, yogurt contains very little lactose. This is because the process of making yogurt involves culturing milk with a number of bacterial species, including Lactobacillus acidophilus. The Lactobacillus bacteria digest lactose, explain Dr. Mary Campbell and Dr. Shawn Farrell in their book "Biochemistry." In many yogurts, sufficient bacterial activity will have removed most -- if not all -- lactose by the time you consume the yogurt, so you may find that you can eat some brands of yogurt even if you are lactose intolerant. The most sensitive digestive tracts, however, will be unable to eat any yogurt. If you find that yogurt causes you digestive distress, avoid it.

If youre lactose intolerant, you probably avoid dairy products like the plague. But you dont need to! There are still some nutrient-rich dairy products that can enjoy, without suffering any unpleasant consequences. Before we go any further, lets review what it means to be lactose intolerant. Lactose is a naturally occurring sugar found in milk and many dairy products. Most people can easily digest lactose because they have an enzyme called lactase in their gut. But people with lactose intolerance dont have enough lactase to digest lactose, so when they eat dairy, their bodies dont know what to do with the lactose and they get stomach aches, bloating, gas, or diarrhea. With those unpleasant symptoms, why would anyone whose even remotely lactose intolerant want to try eating dairy? Because dairy is an excellent source of naturally-occurring calcium and protein. Its also delicious, and many foods are made with dairy products, which can make eating out inconvenient for those who have lactose intolerance. What Can You Eat If Youre Lactose Intolerant? 1. Yogurt. The good bacteria (live, active cultures) found in yogurt will digest the lactose for you. Choose a high quality yogurt (heres a guide to help) with very few ingredients, or Greek yogurt, which has less lactose to begin with. 2. Aged cheeses. The harder a cheese is, the less lactose it has. Thats because the lactose is found in the watery part of milk, and harder cheeses have less liquid, so less lactose. Extra sharp cheddar, Parmesan, Pecorino, aged gouda, and other very hard cheeses have essentially no lactose. 3. Lactase-fortified dairy products. Lactaid is the most well-known example in this category, but there now quite a few other cheeses, yogurts, and ice creams that are fortified with the lactase enzyme, so people with lactose intolerance can digest them.



Low-fat dairy products in small amounts. Low-fat dairy like low-fat milk and cheese, are easier on the system, and can be consumed in small amounts, especially when combined with other foods at a meal (these foods are also higher in protein and calcium than their high-fat counterparts). Finding the foods that work for you may just be a matter of trial and error, so start slow. Dairy products eaten with a lactase pill. Some people find lactase enzyme pills more effective than others, but theyre worth a try. Pop a lactase pill 30-60 minutes before consuming dairy to see if this method works for you. (Note: it probably wont work if you take lactase and then down a huge banana split, but it may be effective for eating a small serving of cereal with milk).

What Foods Should Be Avoided? Very high fat dairy products, like ice cream, soft creamy cheeses, and cream (including foods made with cream). These are harder to digest than low-fat dairy products, and will likely cause unpleasant symptoms. The one exception here is aged cheese, which is high-fat but low-lactose. 2. Whey protein concentrate. This is a doozy, because its added to a lot of foods to make them seem richer and creamier. But it can wreak havoc on a lactose intolerant persons system (and on a normal persons system), because it often contains concentrated lactose. 3. Soft-serve ice cream/frozen yogurt. This is mostly because of reason #2. Many soft-serve desserts, smoothies, and protein shakes have significant amounts of whey protein concentrate, and will cause major digestive distress. If you love ice cream-style desserts, buy real frozen yogurt from the grocery store (Stonyfield, Julies Organic, and Straus Family Creamery all contain live active cultures that will help you digest). 1.