LACTOSE INTOLERANCE

WHAT IS LACTOSE INTOLERANCE

SIGNS/SYMPTOMS Lactose a sugar made of galactose and glucose that is found in milk
Stomach pain Lactose intolerance is an absence of the enzyme lactase, which is vital for
the digestion of lactose
Cramps
Bloating, gas, stomach discomfort, and diarrhea can occur
Bloating
Bacteria produces gases which causes the intestine to swell
Gas
Lactose intolerance differs from a milk allergy, which is cause by an
Diarrhea
immune reaction to the protein in milk
Nausea
About 30 to 50 million people in the United States are lactose intolerant
Vomiting

CAUSES
Absence of lactase, which is the enzyme that digests sugar in milk
After age 3, making of lactase starts to decrease and by teen years we are left with about 5 to 10 percent of lactase
activity.
o Only a small number of people in the world retain enough lactase to digest and absorb lactose well
Large intakes of lactose for people who have little lasting lactase enzyme or with GI problems can cause loose stools or
diarrhea

METABOLIC PATHWAY
Lactose normally gets broken down into glucose and galactose
in the small intestine
o Lactose is not absorbed reaches large intestine
Not enough of the lactase enzyme
o Lactose is not broken down, therefore lactose collects in
the gut
Some people may be more sensitive to lactose in large
quantities, varies person to person

TESTS
Lactose hydrogen breath test
o Given standard dose of lactose after fasting
o Breath hydrogen is measured
o If lactose is not digested in the small intestine, it passes into colon and converted to hydrogen
o Hydrogen is absorbed into blood stream and exhaled through lungs
o Shows increased levels 60 to 90 minutes after lactose ingestion
[Click here to add a caption]
Lactose intolerance test
o Lactose is given, if someone has enough lactase enzyme, blood sugar will rise, showing the breakdown of
lactose to galactose and glucose
o If lactose intolerant, blood sugar will not raise because lactose is not absorbed
Passes into the colon and GI symptoms can appear

MEDICAL NUTRITION THERAPY

Dietary change
o Eat less foods with lactose in them
 o Consume Lactaid which has been treated with an enzyme that breaks down the lactose
Take enzyme tablets with meals or add enzyme drops to their milk
o Enzymes breaks the lactose to galactose and glucose
Tolerable intake of foods must generally be individualized with each patient
o Most lactose maldigesters can consume some lactose without major symptoms when taken with meals or in
the form of cultured dairy products
Each patient is different; therefore, some may be more sensitive than others (stricter diet)
o People on a strict lactose-free diet should be aware of other foods that could contain lactose
Breads, cereals, breakfast drinks, salad dressing and cake mixes
Be aware of medications that have lactose as a filler
People who avoid dairy products may need a calcium and Vitamin D supplementation if not getting enough nondairy
sources of these nutrients

DIET

HIGH LACTOSE / POORLY LOW LACTOSE / WELL

TOLERATED TOLERATED
Milk (nonfat, 1%, 2% whole) Cheese (cheddar, sharp, American,
Buttermilk swiss, parmesan and bleu cheese)
Evaporated Milk Cultured dairy products
Nonfat dry milk powder Butter
Sweetened condensed milk, undiluted Whole-wheat bread
Yogurt Cream cheese
Ice cream Sherbet
Sour cream Non-dairy milks
Lactaid

SOURCES

Boyle, M. A., & Holben, D. H. (2013). Community Nutrition in Action: An Entreprenurial Approach ( 6th ed.) Belmont. CA:Wadsworth

Byrd-Brednenner, C., Moe, G., Beshgetoor, D., Berning, J. (2013). Wardlaws Perspectives In Nutrition (9th ed.) New York, NY:
McGraw-Hill.

Rolfes, S. R., & Whitney, E. (2011). Understanding Nutrition (12th ed.) Belmont. CA: Wadsworth.

Vandenplas, Y. (2015). Lactose intolerance. Asia Pacific Journal of Clinical Nutrition, 24 Suppl 1S9-S13.
doi:10.6133/apjcn.2015.24.s1.02