Lactose Intolerance Guide

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Lactose Intolerance is a symptom where people show allergic reactions to dairy products. However before you press the blame game trigger on dairy, there is much more you need to know. This includes the fact that dairy may not always be the cause of your woes.

Chandan Singh, a 35 year old chemical factory owner in New Delhi has for the last three years been on antibiotics for his recurrent sinusitis. During this period he also noticed a change in his gut behaviour often manifested by nausea, bloating, stomach aches, excessive burping, gastric feeling and diarrhea. These are typical symptoms of lactose intolerance and a diet rich in sugar, high fructose corn syrups and junk food can also lead to decreased intestinal immunity. “Endoscopy showed no changes but hydrogen breath test revealed unfermented sugars. Symptoms were improved upon, gut microbiota correction and abstinence from dairy products. The treatment of the gut microbiome is what we extensively practice at the Smart Metabolic Anti-Aging Centre because a weak or leaky gut can result in various, sometimes deadly autoimmune disorders,” says Dr. Sandeep Datta, Consultant, Smart Metabolic Anti-Aging Centre, Saket.

Identify the problem
In a country like India where dairy is such an important part of daily diet, lactose intolerance is largely undetected. Incidentally pain, bloating, urge to pass stools and diarrhea with or without vomiting are typical in classic lactose intolerance. Previously labelled as Irritable Bowel Syndrome (IBS) or Gastroenteritis, there are varying degrees of lactose intolerance too. Lactose is a type of sugar which is normally found in dairy products. Dr. Dheeraj Karanth C, Consultant Medical Gastroenterologist, Vikram Hospital, Bengaluru says, “mild intolerance following an acute infection usually sees recovery in a few weeks. Just dyspepsia discomfort and mild pain which is difficult to distinguish from other food poisoning but there is classic relationship with milk intake.” Dr. Abhishek C Kanade, Medical Consultant,, a herbal nutrition supplement platform explains, “the problem of Lactose intolerance grows with repeated exposure to large quantities of lactose in people having it in the first place. It is caused by the deficiency of enzyme lactase in their intestinal lining. Increasing exposure to milk and dairy products is the main reason behind this and is most common in Asians because of their genetic makeup.” Lactose intolerance occurs when your small intestine doesn’t produce enough of an enzyme called lactase to digest milk sugar or Lactose. “Usually, lactase turns milk sugar into two simple sugars, glucose and galactose which are absorbed through the intestinal lining. When someone is deficient in lactase, the lactose in the food moves to large intestine instead of being processed and absorbed. Normal bacteria interact with lactose causing symptoms of lactose intolerance,” says Dr. Anukalp Prakash, Senior Consultant, Gastroenterology Paras Hospitals Gurgaon. Dr. Rishi Bolia, Consultant, Gastroenterology & Hepatology – Paediatric, Narayana Health – SRCC Children’s Hospital says, “the easiest way to see if one is lactose intolerant is to run one’s own test. One can consume dairy in different amounts and see how they feel 30-90 minutes after consumption. If a person develops any of the symptoms that are described above, then it would suggest that he or she is lactose intolerant. Even with lactose intolerance most people can digest small amounts of cow’s milk without having any severe symptoms. Anything more than a cup of milk is a good test threshold.”

Increased Awareness
Your body makes an enzyme called lactase that breaks down lactose into smaller sugars that the body can then digest and use as energy. There are more number of cases diagnosed every year due to increased awareness among physicians and patients. Primary lactose intolerance is the most common form. “Our bodies typically stop making lactase by about age 5. As lactase levels decrease, dairy products become harder to digest. Secondary lactose intolerance happens because of an injury, illness like diarrhea. Any of these can affect your small intestine and cause you to make less lactase. Lactose intolerance after diarrhea is most commonly seen in infants and is self-limiting and does not need any specific treatment. Common intestinal diseases linked to low lactase are Celiac disease and Crohn’s disease. Developmental lactose intolerance happens in babies who are born prematurely. It usually goes away on its own, lasting for only a short time after birth. Congenital lactose intolerance is quite rare and occurs when no lactase or a very small amount of it is produced by the small intestine from birth. It’s a genetic disorder, and both parents have to pass the gene on to their child,” says Dr. Somashekara HR, Consultant Paediatric Gastroenterologist & Hepatologist, Mazumdar Shaw Medical Centre, Narayana Health City, Bengaluru. Again, there is no data to suggest a rising incidence. The incidence increases with age, about 70 % of the population by the age of 40 years. Dr. Yogesh Batra, BLK Super Speciality Hospital explains, “there are different terms used in lactose intolerance including lactase deficiency which is low concentrations of lactase in the small intestinal brush border relative to the concentrations observed in infants. Lactose malabsorption happens when the small bowel fails to absorb the bulk of an ingested load of lactose and lactose intolerance is a symptomatic response to malabsorption of lactose.” The majority of individuals diagnosed with lactose intolerance can likely to tolerate up to 12 grams (equivalent to 1 cup of milk) at a given sitting with minimal to no symptoms, especially if consumed with other foods.

Changing Vistas
According to, studies have indicated that by adulthood, up to 70% of people no longer produce enough lactase to properly digest the lactose in milk, leading to symptoms when they consume dairy. One’s diet plays a significant role nevertheless, some people may also develop lactose intolerance after surgery or due to gastrointestinal diseases such as viral or bacterial infections. Unfortunately, the world’s milk supply is not 100% authentic. “By this I mean that similar to wheat, cows (A1) have been cloned and reproduced to support the demand and growing population. This type of milk using the A1 protein has been shown to cause intolerance symptoms from an early age. As babies are born and continue to grow, their anatomy and genetic predisposition determines their tolerances, therefore, without realizing it, many adults have naturally “handed down” these traits,” explains Anita Mirchandani, Consulting Registered Dietitian, Epigamia. Dr. Siddhant Bhargava, co-founder of Mumbai-based food start up, FoodDarzee adds, “research at Sanjay Gandhi Post Graduate Institute of Medical Sciences shows that every 3 out of 4 Indians are lactose intolerant. With age, the expression of the enzyme lactase in the enterocytes decreases which explains the why people gradually become intolerant to milk and certain milk products. Kids are not at risk unless they have a congenital defect which is extremely rare.”

Take Care
Study published by Prof. R.K. Tandon in 1981 showed a higher prevalence in southern parts of India, compared with the northern region. Other studies have estimated that about three quarters of the world’s population to be already harbouring lactose intolerance in varying degrees. “The symptoms of this condition are easily manageable by changing dietary habits and by addition of commercially available medicine. It does not need to be feared. People need to be more aware of this condition. And this awareness leads to lesser anxiety and early diagnosis,” says Dr. Saswata Chatterjee, Consultant Gastroenterologist, CK Birla Hospitals. Dr. Gowri Kulkarni, Head of Operations, DocsApp, a Doctor consultation app advices, “avoid eating milk or milk products for a few days. If your symptoms disappear, introduce dairy products back into your diet slowly and note down how you feel. If your symptoms continue after avoiding dairy, or if they return, it’s advised to visit a doctor.” Lactose intolerance is usually treated by withdrawing ingestion of dairy products when the first sign starts developing. “It takes about 2 – 3 weeks for lactose to be completely flushed out of the system. You can also try lactose substitutes such as soya milk, almond milk, rice milk, coconut milk and lactose-free milk,” says Dr. Manoj Kutteri, Wellness Director at Atmantan Wellness Centre. So the key really is to be aware and ensure that you take the right steps to be able to consume dairy products without being worried.

Check Point
• Lactose tolerance test – Blood tests checking the levels of lactose after consuming a lactose dose.
• Breath test to measure hydrogen levels in breath after a dose of lactose.
• Intestinal biopsy – Sample of intestinal lining is obtained and checked.
• Stool test chromatography – Mostly done for children. It checks the acid levels in stools.
• Flat curve on serial blood glucose analysis upon ingestion of dairy products.

• Know what foods and drinks contain lactose.
• Pay attention to food labels.
• Start with small portions of dairy foods.
• Combine dairy foods with nondairy foods.
• Eat smaller portions of milk or dairy products more frequently.
• Eat dairy foods like cheese and yogurt that are naturally lower in lactose.

Dairy Substitutes
• Tofu
• Soy Milk
• Almond milk
• Beans
• Orange juice, fortified with calcium
• Fatty fish

This story appeared in the July 2018 issue of Smartlife Magazine here:

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