Lactose Intolerance – Causes, Symptoms, Diagnosis, Treatment
Lactose intolerance is a condition generally caused by lactase deficiency, where the small intestine produces low levels of lactase, or lactase malabsorption and leads to digestive problems such as bloating, diarrhoea, and gas after consuming milk or milk products.
Lactose intolerance is not the same as milk allergy, the latter being a reaction to one or more milk proteins by the body’s immune system and can even be life threatening.
People manage this condition or disorder of lactose intolerance by changing their diet and being under the supervision of a specialist.
What is lactose?
Lactose is basically a sugar found in milk and milk products. In the body it is the small intestine that produces an enzyme called lactase. This enzyme helps in the break down of lactose into two simpler forms of sugar, namely glucose and galactose. The body will then absorb these simpler sugars into the bloodstream.
Four Types of Lactase Deficiency
- Primary lactase deficiency is also called lactase non-persistence and is the most common type of lactase deficiency and can even be due to the inheritance of the genes from their parents
- Secondary lactase deficiency is caused due to the infection, diseases, or other problems that result in the injury of the small intestine.
- Developmental lactase deficiency is a condition in infants who are born prematurely. Although this typically lasts only for a short time after birth.
- Congenital lactase deficiency is an extremely rare genetic disorder where the small intestine does not produce lactase enzyme or produces very less amount of lactase enzyme from birth.
Causes of lactose intolerance
Lactose malabsorption is the prime reason to cause lactose intolerance. The basic problem with lactose malabsorption is that the small intestine will make less amount of an enzyme called lactase which helps in the break down of lactose. This results in the indigestion of all the lactose which is consumed.
All the undigested lactose then passes into the colon. In the colon there is bacteria present that breaks down the lactose. This process create fluid and gas that causes lactose intolerance symptoms ion some people.
Genes can also be a cause for lactose intolerance. Genes can have a role to play in certain following conditions thus affecting the levels of lactase made in the small intestine keeping it low and leading to lactose malabsorption:
Primary lactase deficiency is also called as lactase nonpersistence. This is the most common cause of low levels of lactase. The small intestine typically makes lesser amounts of lactase after infancy for some people having lactase nonpersistence. The level of lactase subsequently gets lower with increasing age. Also sometimes the symptoms of lactose intolerance may not even start until later childhood, teen age, or early adulthood.
Congenital lactase deficiency:
This is a rare condition. In this since the birth itself the small intestine makes little or no lactase thus leading to lactose intolerance altogether.
It should be noted that all causes of lactose intolerance are not genetic. There are certain other factors too that can lead to lactose intolerance:
Injury to the small intestine:
An injury to the small intestine may also cause the person to develop lactose intolerance. There are infections, diseases, or other medical conditions like Crohn’s disease or celiac disease that may affect the small intestine and may cause it to make less lactase. Also, sometimes the treatments such as medicines, surgery, or radiation therapy for any other health or medical conditions may also injure the small intestine.
In some cases when the babies are born before their maturity time, the premature babies, then the small intestine may not make enough amounts of lactase for a short time after birth. But then as the baby gets older the small intestine usually starts to make more lactase.
Symptoms of lactose intolerance
The symptoms of lactose intolerance ranges from mild to severe based on the quantity of milk or milk product consumed and generally develop 30 minutes to 2 hours after the consumption. the symptoms are
- Bloating or pain in the abdomen
- Medical history
- Diet history
- Physical exam such as checking for bloating or swelling in the abdomen, or checking for tenderness or pain by tapping on the abdomen
- Medical tests such as stool acidity test
What products contain lactose?
Lactose is present in many food products and in some medications.
Food products having even small quantities of lactose are
- Milk and milk products
- Some baked goods
- Waffles, pancakes, biscuits, cookies, and their batter
- Packaged food items such as chips, soups, or breakfast cereals
- Processed meats such as bacon, sausage
- Salad dressings
- Protein powders and bars
Ingredients which can be sources of lactose in food products are
- Milk and it’s by products
- Dry milk powder or milk solids
Typically the treatment for lactose intolerance will mainly depend on the cause of lactose intolerance. If it is caused by lactase non-persistence or congenital lactase deficiency, then no treatment would be of much help. The amount of lactase that your small intestine makes cannot be increased. So, the doctor will help you in planning a diet to better suited to your particular symptoms.
Although, another cause of lactose intolerance can be an injury to the small intestine. The doctor then plans and advices the course of treatment. This helps to treat the cause of the injury. And post treatment the person may be able to tolerate lactose.
Also, sometimes there are premature babies who are lactose intolerant. But the condition would generally improve as the baby gets older and not require any treatment.
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