Lactose intolerance is a common digestive problem where the body is unable to digest

lactose, a type of sugar mainly found in milk and dairy products.

Symptoms of lactose intolerance include:
flatulence (wind)
diarrhoea
bloated stomach
stomach cramps
These symptoms usually develop within a few hours of consuming food or drink that contains
lactose.
Read more about the symptoms of lactose intolerance.
When to seek medical advice
The symptoms of lactose intolerance can be similar to several other conditions, such as
irritable bowel syndrome (IBS), so it's important to see your GP for a diagnosis before removing
milk and dairy products from your diet.
If your GP thinks you are likely to have lactose intolerance, they may then suggest avoiding
foods and drinks containing lactose for two weeks to see if your symptoms improve.
Read more about diagnosing lactose intolerance.
What causes lactose intolerance?
The body digests lactose using a substance called lactase to break down lactose into two sugars
called glucose and galactose, which can then be easily absorbed into the bloodstream.
People with lactose intolerance don't produce enough lactase, so lactose stays in the digestive
system where it is fermented by bacteria, leading to the production of various gases, which cause
the symptoms associated with lactose intolerance.
Depending on the underlying reason why the body does not produce enough lactase, lactose
intolerance may be temporary or permanent. Most cases that develop in adults are inherited and
tend to be lifelong, but cases in young children are often caused by an infection in the digestive
system and may only last for a few weeks.
Read more about the causes of lactose intolerance.
Is it an allergy?
Lactose intolerance is not the same as a milk or dairy allergy. Food allergies are caused by a
reaction to a food by your immune system, causing symptoms such as a rash, wheezing and
itching.
If youre allergic to something, even a tiny particle can be enough to trigger a reaction, while
most people with lactose intolerance can still consume small amounts of lactose without
experiencing any problems (although this varies from person to person).
Treating lactose intolerance
There is no cure for lactose intolerance, but limiting your intake of food and drink containing
lactose will usually help control the symptoms.
Depending on what dairy products you are able to eat, you may also require additional calcium
and vitamin D supplements to keep your bones strong and healthy. In some cases, your GP may
refer you to a dietitian for further advice.
In addition to dietary changes, lactase substitutes may also be helpful. These are drops or tablets
you can take with your meals or drinks to improve your digestion of lactose.
Read more about treating lactose intolerance.
Who is affected
Rates of lactose intolerance can differ significantly between different ethnic groups. For
example, it is thought that only one in 50 people of northern European descent have some degree
of lactose intolerance, whereas most people of Chinese descent have the condition.
This may be because people from places where there has historically been no ready access to
milk, such as Africa or east Asia, may not have evolved the ability to digest lactose as there was
no significant benefit in being able to do so.
In the UK, lactose intolerance is more common in people of Asian or African-Caribbean descent.
Lactose intolerance can develop at any age. Many cases first develop in people aged 20 to 40,
although babies and young children can also be affected.





Lactose Intolerance - Topic Overview
Lactose intolerance means the body cannot easily digest lactose, a type of
natural sugar found in milk and dairy products. This is not the same thing as
a food allergy to milk.
When lactose moves through the large intestine (colon) without being
properly digested, it can cause uncomfortable symptoms such as gas, belly
pain, and bloating. Some people who have lactose intolerance cannot digest
any milk products. Others can eat or drink small amounts of milk products or certain types of
milk products without problems.
Lactose intolerance is common in adults. It occurs more often in Native Americans and people of
Asian, African, and South American descent than among people of European descent.
A big challenge for people who are lactose-intolerant is learning how to eat to avoid discomfort
and to get enough calcium for healthy bones.
Lactose intolerance occurs when the small intestine does not make enough of an enzyme
called lactase. Your body needs lactase to break down, or digest, lactose.
Lactose intolerance most commonly runs in families, and symptoms usually develop during the
teen or adult years. Most people with this type of lactose intolerance can eat some milk or dairy
products without problems.
Sometimes the small intestine stops making lactase after a short-term illness such as the stomach
flu or as part of a lifelong disease such as cystic fibrosis. Or the small intestine sometimes stops
making lactase after surgery to remove a part of the small intestine. In these cases, the problem
can be either permanent or temporary.
In rare cases, newborns are lactose-intolerant. A person born with lactose intolerance cannot eat
or drink anything with lactose.
Some premature babies have temporary lactose intolerance because they are not yet able to make
lactase. After a baby begins to make lactase, the condition typically goes away.







Milk and other dairy products contain a sugar or carbohydrate called lactose. Normally, the body
breaks down lactose into its simpler components with the help of the enzyme lactase. Most
mammals stop producing lactase when they are weaned; humans, however, continue to produce
it throughout life. Without enough lactase, a person can have digestive problems like abdominal
pain and diarrhoea. This is known as lactose intolerance or lactase deficiency.

It is rare for Caucasians to develop lactose intolerance. However, it is quite common among
people from Asia, Africa, the Middle East and some Mediterranean countries, as well as among
Aboriginal Australians. Up to five per cent of Caucasians and up to 75 per cent of non-
Caucasians living in Australia are lactose intolerant.

Many Australian babies are unnecessarily weaned because their irritability is wrongly assumed
to be lactose intolerance. In reality, the severe form of this condition known as primary lactose
intolerance (where the infant does not produce lactase from birth) is rare.

Secondary lactose intolerance (which develops after weaning) is more common. This can occur
temporarily after a bout of gastroenteritis, for example, but often improves after several weeks as
the lining of the gut heals.
Symptoms of lactose intolerance

Many people with lactose intolerance have a particular tolerance level, which allows them to consume
some lactose with minimal symptoms. Symptoms of lactose intolerance include:
Abdominal pain
Abdominal swelling
Flatulence
Diarrhoea.
Symptoms of lactose intolerance are often confused with symptoms of irritable bowel syndrome (IBS).
People with IBS are not lactose intolerant, but tend to have difficulty tolerating fat. If you think you may
be lactose intolerant, see your doctor.
Undigested milk sugars

The enzyme lactase breaks down milk sugar (lactose). Lactase enzymes are found in the mucus of the
small intestine. They change the milk sugar into the absorbable compounds glucose and galactose.

If there is not enough lactase, it skips the usual digestive process and is partially broken down by the
bacteria in the intestines. This fermentation process causes excessive wind, bloating and associated
pain. Any undigested lactose is sent along the intestinal tract. Water is not removed from the faecal
matter and diarrhoea is the result.
Causes of lactose intolerance

Lactose intolerance is largely genetically determined. Some causes include:
Congenital this is the main cause, where your genetic make up causes you to have less lactase
than usual.
Gastroenteritis this can strip the intestines of lactase for a few weeks.
Parasitic infection this can temporarily reduce lactase levels.
Iron deficiency lack of iron in the diet can interfere with lactose digestion and absorption.
Lactose intolerance in babies

Around two thirds of babies, either breast- or bottle-fed, will experience some degree of lactase
deficiency in their early months without it causing them harm. Human breast milk contains around
seven per cent lactose. The amount of lactose in breast milk is not affected by the mothers diet. This
means the mother cant influence the amount of lactose in her milk by reducing or eliminating dairy
foods.

A bout of gastroenteritis can strip the babys small intestine of lactase enzymes, and lactose-free
formula may need to be used for a number of weeks until their enzyme levels recover. Lactase drops are
another option, but these are not always helpful. A few babies are born without any lactase enzymes at
all, and lactose-free formulas may be an option in such cases. Lactose intolerance does not cause
vomiting in babies. This may be symptomatic of an allergy to cows milk.
Diagnosis methods

Various methods may be used to diagnose lactose intolerance, including:
Hydrogen breath test this tests the amount of hydrogen that is breathed out. When lactose is
fermented by bacteria in the bowel, instead of being converted by lactase, more hydrogen is
produced.
Elimination diet this involves removing foods that contain lactose to see if the symptoms
improve. If the symptoms reappear once the foods are reintroduced, then lactose intolerance is
most likely the cause.
Another cheap and simple test is to compare whether the person can tolerate lactose-free milk rather
than ordinary milk.
Managing lactose intolerance

Most people with lactose intolerance can handle small amounts of lactose, such as a glass of milk.
However, the following tips may help:
Try cheese and yoghurt; they are generally better tolerated than milk.
Drink full-fat milk because the fats slow the journey of the milk through the intestines and allow
the lactase enzymes more time to break down the sugars.
Avoid low-fat or non-fat milks they travel quickly through the gut and tend to cause symptoms
in lactose intolerant people. Also, many low-fat milk products may contain skim milk powder,
which provides a higher dose of lactose.
Dont give up milk products entirely. They are very nutritious.
Drink milk in moderate quantities. Most people with this condition can tolerate 240ml of milk
per day, but you need to work out your own tolerance level. You can buy milk that has had the
lactose broken down, which makes it lactose free.
Eat fermented milk products like some yoghurts, mature or ripened cheeses (like cheddar, fetta
and mozzarella), and butter they usually dont cause problems.
Eat foods that contain lactose in combination with other foods or spread them out over the day,
rather than eating a large amount at once.
Use heated milk products like evaporated milk; they seem to be better tolerated because the
heating process breaks down some of the lactose to glucose and galactose.
Have soy foods; they are lactose free, a good source of calcium and a good substitute for milk or
milk products.
Hidden lactose

Foods that may contain hidden lactose include:
Biscuits and cakes (if milk or milk solids are added)
Processed breakfast cereals
Cheese sauce
Cream soups
Custard
Milk chocolate
Pancakes and pikelets
Scrambled eggs
Quiche
Muesli bars
Some breads and margarine (containing milk).
Check the labels

If you are trying to avoid lactose, look for the following ingredients in lists on food labels:
Milk solids
Non-fat milk solids
Whey
Milk sugar.
Where to get help
Your doctor
Dietitians Association of Australia Tel. 1800 812 942
Things to remember
Lactose is a milk sugar that is broken down by the enzyme lactase, which is found in the small
intestine.
Lactose intolerance is the reduced ability to digest milk sugars, due to insufficient amounts of
the gut enzyme called lactase.
Symptoms include bloating, gas, abdominal pain and diarrhoea.
You might also be interested in:
Allergies.
Flatulence.
Food allergy and intolerance.
Hay fever.
Irritable bowel syndrome (IBS).
Milk - facts and fallacies.





Lactose intolerance
From Wikipedia, the free encyclopedia
Lactose Intolerance
Classification and external resources

lactose (disaccharide of -D-galactose & -D-glucose) is
normally split by lactase.
ICD-10 E73
ICD-9 271.3
OMIM 223100 150220
DiseasesDB 7238
MedlinePlus 000276
MeSH D007787
Lactose intolerance, also called lactase deficiency and hypolactasia, is the inability to digest
lactose, a sugar found in milk and to a lesser extent dairy products. As a genetic disorder, it
prevents babies from drinking human milk.
[citation needed]

Lactose intolerant individuals have insufficient levels of lactase, an enzyme that catalyzes
hydrolysis of lactose into glucose and galactose, in their digestive system. In most cases this
causes symptoms which may include abdominal bloating and cramps, flatulence, diarrhea,
nausea, borborygmi (rumbling stomach), or vomiting
[1]
after consuming significant amounts of
lactose. Some studies have produced evidence that milk consumption by lactose intolerant
individuals may be a significant cause of inflammatory bowel disease.
[2][3]

Most mammals normally cease to produce lactase, becoming lactose intolerant, after weaning,
[4]

but some human populations have developed lactase persistence, in which lactase production
continues into adulthood. It is estimated that 75% of adults worldwide show some decrease in
lactase activity during adulthood.
[5]
The frequency of lactose intolerance ranges from 5% in
Northern European countries (England, Scotland, Ireland, Scandinavia, and Iceland) to 71% in
Italy (Sicily) to more than 90% in most African and Asian countries.
[6]
This distribution is now
thought to have been caused by recent natural selection favoring lactase-persistent individuals in
cultures in which dairy products are available as a food source.
[7]
While it was first thought that
this would mean that populations in Europe, India, Arabia, and Africa had high frequencies of
lactase persistence because of a particular mutation, it was later shown that lactase persistence is
caused by several independently occurring mutations.
[8]






Jessie was so embarrassed! About an hour after chowing down on pizza and ice cream with a
group of friends, her stomach suddenly started rumbling, and she started farting. Then Jessie's
stomach began to ache and she had to run to the restroom every few minutes. In the excitement
of an afternoon hanging out at the mall, Jessie had forgotten to watch her dairy intake.
Jessie has lactose intolerance and her symptoms flare up when she eats more dairy than her body
can handle.
What Is Lactose Intolerance and What Causes It?
Lactose intolerance is the inability to digest a sugar called lactose that 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.

What is lactose?
Lactose is a sugar found in milk and milk products. The small intestinethe organ where most
food digestion and nutrient absorption take placeproduces an enzyme called lactase. Lactase
breaks down lactose into two simpler forms of sugar: glucose and galactose. The body then
absorbs these simpler sugars into the bloodstream.
[Top]
What is lactose intolerance?
Lactose intolerance is a condition in which people have digestive symptomssuch as bloating,
diarrhea, and gasafter eating or drinking milk or milk products.
Lactase deficiency and lactose malabsorption may lead to lactose intolerance:
Lactase deficiency. In people who have a lactase deficiency, the small intestine produces low
levels of lactase and cannot digest much lactose.
Lactose malabsorption. Lactase deficiency may cause lactose malabsorption. In lactose
malabsorption, undigested lactose passes to the colon. The colon, part of the large intestine,
absorbs water from stool and changes it from a liquid to a solid form. In the colon, bacteria
break down undigested lactose and create fluid and gas. Not all people with lactase deficiency
and lactose malabsorption have digestive symptoms.

The digestive tract
People have lactose intolerance when lactase deficiency and lactose malabsorption cause
digestive symptoms. Most people with lactose intolerance can eat or drink some amount of
lactose without having digestive symptoms. Individuals vary in the amount of lactose they can
tolerate.
People sometimes confuse lactose intolerance with a milk allergy. While lactose intolerance is a
digestive system disorder, a milk allergy is a reaction by the bodys immune system to one or
more milk proteins. An allergic reaction to milk can be life threatening even if the person eats or
drinks only a small amount of milk or milk product. A milk allergy most commonly occurs in the
first year of life, while lactose intolerance occurs more often during adolescence or adulthood.
1,2

1
Boyce JA, Assaad A, Burks AW, et al. Guidelines for the diagnosis and management of food
allergy in the United States: report of the NIAID-sponsored expert panel. Journal of Allergy and
Clinical Immunology. 2010;126(6 suppl.):S1S58.
2
Suchy FJ, Brannon PM, Carpenter TO, et al. National Institutes of Health Consensus
Development Conference: lactose intolerance and health. Annals of Internal Medicine.
2010;152(12):792796.
[Top]
Four Types of Lactase Deficiency
Four types of lactase deficiency may lead to lactose intolerance:
Primary lactase deficiency, also called lactase nonpersistence, is the most common type of
lactase deficiency. In people with this condition, lactase production declines over time. This
decline often begins at about age 2; however, the decline may begin later. Children who have
lactase deficiency may not experience symptoms of lactose intolerance until late adolescence or
adulthood. Researchers have discovered that some people inherit genes from their parents that
may cause a primary lactase deficiency.
Secondary lactase deficiency results from injury to the small intestine. Infection, diseases, or
other problems may injure the small intestine. Treating the underlying cause usually improves
the lactose tolerance.
Developmental lactase deficiency may occur in infants born prematurely. This condition usually
lasts for only a short time after they are born.
Congenital lactase deficiency is an extremely rare disorder in which the small intestine produces
little or no lactase enzyme from birth. Genes inherited from parents cause this disorder.
[Top]
Who is more likely to have lactose intolerance?
In the United States, some ethnic and racial populations are more likely to have lactose
intolerance than others, including African Americans, Hispanics/Latinos, American Indians, and
Asian Americans. The condition is least common among Americans of European descent.
2

[Top]
What are the symptoms of lactose intolerance?
Common symptoms of lactose intolerance include
abdominal bloating, a feeling of fullness or swelling in the abdomen
abdominal pain
diarrhea
gas
nausea
Symptoms occur 30 minutes to 2 hours after consuming milk or milk products. Symptoms range
from mild to severe based on the amount of lactose the person ate or drank and the amount a
person can tolerate.
[Top]
How does lactose intolerance affect health?
In addition to causing unpleasant symptoms, lactose intolerance may affect peoples health if it
keeps them from consuming enough essential nutrients, such as calcium and vitamin D. People
with lactose intolerance may not get enough calcium if they do not eat calcium-rich foods or do
not take a dietary supplement that contains calcium. Milk and milk products are major sources of
calcium and other nutrients in the diet. Calcium is essential at all ages for the growth and
maintenance of bones. A shortage of calcium intake in children and adults may lead to bones that
are less dense and can easily fracture later in life, a condition called osteoporosis.
[Top]
How is lactose intolerance diagnosed?
A health care provider makes a diagnosis of lactose intolerance based on
medical, family, and diet history, including a review of symptoms
a physical exam
medical tests
Medical, family, and diet history. A health care provider will take a medical, family, and diet
history to help diagnose lactose intolerance. During this discussion, the health care provider will
review a patients symptoms. However, basing a diagnosis on symptoms alone may be
misleading because digestive symptoms can occur for many reasons other than lactose
intolerance. For example, other conditions such as irritable bowel syndrome, celiac disease,
inflammatory bowel disease, or small bowel bacterial overgrowth can cause digestive symptoms.
Physical exam. A physical exam may help diagnose lactose intolerance or rule out other
conditions that cause digestive symptoms. During a physical exam, a health care provider usually
checks for abdominal bloating
uses a stethoscope to listen to sounds within the abdomen
taps on the abdomen to check for tenderness or pain
A health care provider may recommend eliminating all milk and milk products from a persons
diet for a short time to see if the symptoms resolve. Symptoms that go away when a person
eliminates lactose from his or her diet may confirm the diagnosis of lactose intolerance.
Medical tests. A health care provider may order special tests to provide more information.
Health care providers commonly use two tests to measure how well a person digests lactose:
Hydrogen breath test. This test measures the amount of hydrogen in a persons breath.
Normally, only a small amount of hydrogen is detectable in the breath when a person eats or
drinks and digests lactose. However, undigested lactose produces high levels of hydrogen. For
this test, the patient drinks a beverage that contains a known amount of lactose. A health care
provider asks the patient to breathe into a balloon-type container that measures breath
hydrogen level. In most cases, a health care provider performs this test at a hospital, on an
outpatient basis. Smoking and some foods and medications may affect the accuracy of the
results. A health care provider will tell the patient what foods or medications to avoid before the
test.
Stool acidity test. Undigested lactose creates lactic acid and other fatty acids that a stool acidity
test can detect in a stool sample. Health care providers sometimes use this test to check acidity
in the stools of infants and young children. A child may also have glucose in his or her stool as a
result of undigested lactose. The health care provider will give the childs parent or caretaker a
container for collecting the stool specimen. The parent or caretaker returns the sample to the
health care provider, who sends it to a lab for analysis.
[Top]
How much lactose can a person with lactose intolerance have?
Most people with lactose intolerance can tolerate some amount of lactose in their diet and do not
need to avoid milk or milk products completely. Avoiding milk and milk products altogether
may cause people to take in less calcium and vitamin D than they need. See the Calcium and
Vitamin D section.
Individuals vary in the amount of lactose they can tolerate. A variety of factorsincluding how
much lactase the small intestine producescan affect how much lactose an individual can
tolerate. For example, one person may have severe symptoms after drinking a small amount of
milk, while another person can drink a large amount without having symptoms. Other people can
easily eat yogurt and hard cheeses such as cheddar and Swiss, while they are not able to eat or
drink other milk products without having digestive symptoms.
Research suggests that adults and adolescents with lactose malabsorption could eat or drink at
least 12 grams of lactose in one sitting without symptoms or with only minor symptoms. This
amount is the amount of lactose in 1 cup of milk. People with lactose malabsorption may be able
to eat or drink more lactose if they eat it or drink it with meals or in small amounts throughout
the day.
2

[Top]
How is lactose intolerance managed?
Many people can manage the symptoms of lactose intolerance by changing their diet. Some
people may only need to limit the amount of lactose they eat or drink. Others may need to avoid
lactose altogether. Using lactase products can help some people manage their symptoms.
For people with secondary lactase deficiency, treating the underlying cause improves lactose
tolerance. In infants with developmental lactase deficiency, the ability to digest lactose improves
as the infants mature. People with primary and congenital lactase deficiency cannot change their
bodys ability to produce lactase.
[Top]
Eating, Diet, and Nutrition
People may find it helpful to talk with a health care provider or a registered dietitian about a
dietary plan. A dietary plan can help people manage the symptoms of lactose intolerance and
make sure they get enough nutrients. Parents, caretakers, childcare providers, and others who
serve food to children with lactose intolerance should follow the dietary plan recommended by
the childs health care provider or registered dietitian.
Milk and milk products. Gradually introducing small amounts of milk or milk products may
help some people adapt to them with fewer symptoms. Often, people can better tolerate milk or
milk products by having them with meals, such as having milk with cereal or having cheese with
crackers. People with lactose intolerance are generally more likely to tolerate hard cheeses, such
as cheddar or Swiss, than a glass of milk. A 1.5-ounce serving of low-fat hard cheese has less
than 1 gram of lactose, while a 1-cup serving of low-fat milk has about 11 to 13 grams of
lactose.
2

However, people with lactose intolerance are also more likely to tolerate yogurt than milk, even
though yogurt and milk have similar amounts of lactose.
2

Lactose-free and lactose-reduced milk and milk products. Lactose-free and lactose-reduced
milk and milk products are available at most supermarkets and are identical nutritionally to
regular milk and milk products. Manufacturers treat lactose-free milk with the lactase enzyme.
This enzyme breaks down the lactose in the milk. Lactose-free milk remains fresh for about the
same length of time or, if it is ultra-pasteurized, longer than regular milk. Lactose-free milk may
have a slightly sweeter taste than regular milk.
Lactase products. People can use lactase tablets and drops when they eat or drink milk
products. The lactase enzyme digests the lactose in the food and therefore reduces the chances of
developing digestive symptoms. People should check with a health care provider before using
these products because some groups, such as young children and pregnant and breastfeeding
women, may not be able to use them.
[Top]
Calcium and Vitamin D
Ensuring that children and adults with lactose intolerance get enough calcium is important,
especially if their intake of milk and milk products is limited. The amount of calcium a person
needs to maintain good health varies by age. Table 1 illustrates recommendations for calcium
intake.
Table 1. Recommended Dietary Allowance of calcium by age group
Age Group
Recommended Dietary
Allowance (mg/day)
13 years 700 mg
48 years 1,000 mg
918 years 1,300 mg
1950 years 1,000 mg
5170 years, males 1,000 mg
5170 years, females 1,200 mg
70+ years 1,200 mg
1418 years, pregnant/breastfeeding 1,300 mg
1950 years, pregnant/breastfeeding 1,000 mg
Source: Adapted from Dietary Reference Intakes for Calcium and Vitamin D, Institute of
Medicine, National Academy of Sciences, November 2010.
A U.S. Recommended Dietary Allowance for calcium has not been determined for infants.
However, researchers suggest 200 mg of calcium per day for infants age 0 to 6 months and 260
mg for infants age 6 to 12 months.
3

Many foods can provide calcium and other nutrients the body needs. Nonmilk products high in
calcium include fish with soft bones, such as canned salmon and sardines, and dark green
vegetables, such as spinach. Manufacturers may also add calcium to fortified breakfast cereals,
fruit juices, and soy beveragealso called soy milk. Many fortified foods are also excellent
sources of vitamin D and other essential nutrients, in addition to calcium.
Table 2 lists foods that are good sources of dietary calcium.
Table 2. Calcium content in common foods
Nonmilk Products Calcium Content
sardines, with bone, 3.75 oz. 351 mg
rhubarb, frozen, cooked, 1 cup 348 mg
soy milk, original and vanilla, with added calcium and vitamins A and D 299 mg
spinach, frozen, cooked, 1 cup 291 mg
salmon, canned, with bone, 3 oz. 181 mg
pinto beans, cooked, 1 cup 79 mg
broccoli, cooked, 1 cup 62 mg
soy milk, original and vanilla, unfortified, 1 cup 61 mg
orange, 1 medium 52 mg
lettuce, green leaf, 1 cup 13 mg
tuna, white, canned, 3 oz. 12 mg
Milk and Milk Products

yogurt, plain, skim milk, 8 oz. 452 mg
milk, reduced fat, with added vitamins A and D, 1 cup 293 mg
Swiss cheese, 1 oz. 224 mg
cottage cheese, low fat, 1 cup 206 mg
ice cream, vanilla, 1/2 cup 84 mg
Source: Adapted from U.S. Department of Agriculture, Agricultural Research Service. 2013.
USDA national nutrient database for standard reference, release 26.
Vitamin D helps the body absorb and use calcium. Some people with lactose intolerance may not
get enough vitamin D. Foods such as salmon, tuna, eggs, and liver naturally contain vitamin D.
Most milk sold in the United States is fortified with vitamin D, and vitamin D is added to some
nonmilk beverages, yogurts, and breakfast cereals. Peoples bodies also make vitamin D when
the skin is exposed to sunlight.
People may find it helpful to talk with a health care provider or a registered dietitian to determine
if their diet provides adequate nutrientsincluding calcium and vitamin D. To help ensure
coordinated and safe care, people should discuss their use of complementary and alternative
medical practices, including their use of dietary supplements, with their health care provider.
Read more at www.ods.od.nih.gov and www.nccam.nih.gov.
3
Institute of Medicine, National Academy of Sciences. Dietary Reference Intakes for Calcium
and Vitamin D. 2010. Report.
[Top]
What products contain lactose?
Lactose is present in many food products and in some medications.
Food Products
Lactose is in all milk and milk products. Manufacturers also often add milk and milk products to
boxed, canned, frozen, packaged, and prepared foods. People who have digestive symptoms after
consuming a small quantity of lactose should be aware of the many food products that may
contain even small amounts of lactose, such as
bread and other baked goods
waffles, pancakes, biscuits, cookies, and the mixes to make them
processed breakfast foods such as doughnuts, frozen waffles and pancakes, toaster pastries, and
sweet rolls
processed breakfast cereals
instant potatoes, soups, and breakfast drinks
potato chips, corn chips, and other processed snacks
processed 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
People can check the ingredients on food labels to find possible sources of lactose in food
products. If a food label includes any of the following words, the product contains lactose:
milk
lactose
whey
curds
milk by-products
dry milk solids
nonfat dry milk powder
Medications
Some medications also contain lactose, including prescription medications such as birth control
pills and over-the-counter medications such as products to treat stomach acid and gas. These
medications most often cause symptoms in people with severe lactose intolerance. People with
lactose intolerance who take medications that contain lactose should speak with their health care
provider about other options.
[Top]
Points to Remember
Lactose is a sugar found in milk and milk products.
Lactose intolerance is a condition in which people have digestive symptomssuch as bloating,
diarrhea, and gasafter eating or drinking milk or milk products.
A health care provider makes a diagnosis of lactose intolerance based on medical, family, and
diet history, including a review of symptoms; a physical exam; and medical tests.
Basing a diagnosis on symptoms alone may be misleading because digestive symptoms can
occur for many reasons other than lactose intolerance.
Most people with lactose intolerance can tolerate some amount of lactose in their diet and do
not need to avoid milk or milk products completely. However, individuals vary in the amount of
lactose they can tolerate.
Research suggests that adults and adolescents with lactose malabsorption could eat or drink at
least 12 grams of lactose in one sitting without symptoms or with only minor symptoms. This
amount is the amount of lactose in 1 cup of milk.
Many people can manage the symptoms of lactose intolerance by changing their diet. Some
people may only need to limit the amount of lactose they eat or drink. Others may need to
avoid lactose altogether.
People may find it helpful to talk with a health care provider or a registered dietitian to
determine if their diet provides adequate nutrients including calcium and vitamin D. To help
ensure coordinated and safe care, people should discuss their use of complementary and
alternative medical practices, including their use of dietary supplements, with their health care
provider.
Lactose is in all milk and milk products. Manufacturers also often add milk and milk products to
boxed, canned, frozen, packaged, and prepared foods. People can check the ingredients on food
labels to find possible sources of lactose in food products.
Lactose intolerance facts
Lactose intolerance is an inability to digest lactose, the main sugar in milk, that gives rise to
gastrointestinal symptoms.
Lactose intolerance is caused by a deficiency of the intestinal enzyme lactase that splits lactose
into two smaller sugars, glucose and galactose, and allows lactose to be absorbed from the
intestine.
The primary symptoms of lactose intolerance are diarrhea, flatulence (passing gas), and
abdominal pain. Abdominal bloating, abdominal distention, and nausea also may occur.
Lactose intolerance can be diagnosed by eliminating lactose from the diet, milk challenge,
breath test, blood glucose test, stool acidity test, and intestinal biopsy.
Lactose intolerance is treated with dietary changes, supplements of lactase enzyme, and
adaptation to increasing amounts of milk.
Avoidance of milk and milk-containing products can lead to a dietary deficiency of calcium and
vitamin D that, in turn, can lead to bone disease (osteoporosis).
What is lactose intolerance?
Lactose intolerance is the inability to digest and absorb lactose (the sugar in milk) that results in
gastrointestinal symptoms when milk or food products containing milk are consumed.
What causes lactose intolerance?
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Lactose is a large sugar molecule that is made up of two smaller sugars, glucose and galactose.
In order for lactose to be absorbed from the intestine and into the body, it must first be split into
glucose and galactose. The glucose and galactose are then absorbed by the cells lining the small
intestine. The enzyme that splits lactose into glucose and galactose is called lactase, and it is
located on the surface of the cells lining the small intestine.
Lactose intolerance is caused by reduced or absent activity of lactase that prevents the splitting
of lactose (lactase deficiency). Lactase deficiency may occur for one of three reasons, congenital,
secondary or developmental.
Congenital causes of lactose intolerance
Lactase deficiency may occur because of a congenital absence (absent from birth) of lactase due
to a mutation in the gene that is responsible for producing lactase. This is a very rare cause of
lactase deficiency, and the symptoms of this type of lactase deficiency begin shortly after birth.
Secondary causes of lactose intolerance
Another cause of lactase deficiency is secondary lactase deficiency. This type of deficiency is
due to diseases that destroy the lining of the small intestine along with the lactase. An example of
such a disease is celiac sprue.
Developmental causes of lactose intolerance
The most common cause of lactase deficiency is a decrease in the amount of lactase that occurs
after childhood and persists into adulthood, referred to as adult-type hypolactasia. This decrease
in lactase is genetically programmed, and the prevalence of this type of lactase deficiency in
different ethnic groups is highly variable. Lactose intolerance is most common among Asians,
affecting more than 90 % of adults in some communities. People with ancestry from Northern
Europe, on the other hand, have a 5% rate of lactose intolerance. In addition to variability in the
prevalence of lactase deficiency, there also is variability in the age at which symptoms of lactose
intolerance appear.
It is important to emphasize that lactase deficiency is not the same as lactose intolerance. Persons
with milder deficiencies of lactase often have no symptoms after the ingestion of milk. For
unclear reasons, even persons with moderate deficiencies of lactase may not have symptoms. A
diagnosis of lactase deficiency is made when the amount of lactase in the intestine is reduced,
but a diagnosis of lactose intolerance is made only when the reduced amount of lactase causes
symptoms.

People with lactose intolerance or lactase deficiency cannot metabolize lactose properly;
they lack lactase, an enzyme required in the digestive system to break down lactose.
Patients typically experience bloating, flatulence, and diarrhea after drinking milk. Lactose is a
sugar that is found most notably in milk.
Lactose intolerance is characterized by abdominal cramps and diarrhea after consumption of
food that contains lactose (milk, ice cream). Patients typically experience bloating, flatulence,
and diarrhea after drinking milk. Lactose is a sugar that is found most notably in milk
Symptoms can range from some mild discomfort to severe, depending on how much lactase they
produce and the extent of their consumption of milk and other dairy products.
This in-depth and easy-to-read Medical News Today information article provides details on what
lactose is, the signs and symptoms of lactose intolerance, its causes, the four main types of
lactose deficiency, risk factors of lactose intolerance, how it is diagnosed, some treatment
options, products that contain lactose, and the complications of lactose intolerance.
What is lactose?
Lactose, which has a formula C
12
H
22
O
11
, is a sugar that is found in the milk of mammals; it
makes up around 2% to 8% of milk. It was discovered by Fabriccio Bartoletti in 1619, and later
identified as a sugar by Carl Wilhelm Scheele in 1780.
The human body uses the enzyme lactase to break down lactose into galactose and glucose -
which is then absorbed into the bloodstream.
What are the signs and symptoms of lactose intolerance?
A symptom is something the patient feels and reports, while a sign is something other people,
such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.
Typically, a person with lactose intolerance will experience symptoms after consuming milk
or some dairy product that contains lactose. Symptoms may include:
1


Stomach ache and abdominal pains can be a symptom of lactose intolerance
Flatulence - a buildup of excessive gas in the intestinal tract; this can lead to farting and burping.
Diarrhea - an hour or two after consuming lactose the individual can suddenly become
desperate to go to the toilet.
Bloated feeling
Stomach ache and abdominal pains
Tummy rumbles
Nausea
Dehydration - if symptoms are severe
What are the causes of lactose intolerance?
Lactose is a type of sugar found in milk. Lactase is a protein, an enzyme that is produced in the
small intestine - it breaks down lactose. Individuals with lactose intolerance do not produce
enough lactase.
People with adequate amounts of lactase can break down lactose into glucose and galactose (a
type of sugar) which are then absorbed into the bloodstream.
In people with low levels of lactase, the lactose is not broken down and does not absorb into the
bloodstream, instead it moves into the large intestine (colon). Bacteria in the colon react to the
lactose, triggering symptoms.
Four main types of lactose deficiency
Primary lactase deficiency - genetically inherited. It is the most common type and usually
develops when the patient is under 20 years of age. As soon as the individual's diet includes less
milk, lactase production drops.
In most cases, this occurs when the baby is weaned from milk to solids. Although lactase levels
may drop at such an early age, it may be a few years before lactose intolerance symptoms
develop.
Secondary lactase deficiency - there is a problem with the small intestine that results in
inadequate amounts of lactase production. Possible causes are intestinal surgery, Crohn's disease,
ulcerative colitis, chemotherapy, celiac disease and gastroenteritis.
If the underlying condition is chronic (long-term), the resultant lactose intolerance tends to be
long-term too.
Congenital lactase deficiency - the person is born with a genetic mutation which means they
produce very little lactase (or none at all). The condition is inherited from the patient's parents.
Familial lactase deficiency - lactase production is fine, but it does not do the job. It does not
break down the lactase into glucose and galactose so that it can be absorbed into the
bloodstream. This condition is also inherited from the parents.

Northern Europe has the lowest rates of lactose intolerance
What are the risk factors of lactose intolerance?
A risk factor is something which increases the likelihood of developing a condition or disease.
For example, obesity significantly raises the risk of developing diabetes type 2. Therefore,
obesity is a risk factor for diabetes type 2.
Age- older people are more likely to have lactose intolerance than babies or young children.
Ancestry - northern Europeans are less likely to suffer from lactose intolerance than southern
Europeans. People from all non-European (non-Caucasian) ancestries are more likely to develop
lactose intolerance compared to people from southern Europe.
Radiation therapy (radiotherapy) - people who have received radiotherapy in their abdomen
have a higher risk of subsequently developing lactose intolerance.
Being born prematurely - children who were born at full term will never have lactose
intolerance symptoms until they are 3 years of age or more. Premature babies may have
symptoms earlier.
How is lactose intolerance diagnosed?
Most people will visit their GP (general practitioner, primary care physician first) if they have
lactose intolerance type symptoms. Ideally, before the visit, keeping a food diary and writing
down when symptoms appear and how severe they are may help the doctor reach a diagnosis.
The doctor may advise the patient to try a lactose free diet for a couple of weeks, to see if
symptoms improve. If they do, the individual most likely suffers from lactose intolerance.
Hydrogen breath test - the patient fasts overnight and then has a lactose solution the following
morning. Hydrogen concentrations in exhaled air are measured. If levels are very high, the
patient probably has lactose intolerance.
Lactose tolerance test - the patient consumes a lactose solution before a blood sample is taken
to measure glucose levels. If glucose levels have not risen, it means the lactose has not been
broken down into glucose and galactose, which in normal cases would have gone into the
bloodstream. A milk tolerance test is the same, just that the patient's drink is milk instead of a
lactose solution.
Stool sample - lactose tolerance tests and hydrogen breathe tests are not suitable for babies and
very young children. So the doctor may have a stool sample tested. If levels of acetate and other
fatty acids are high, the child is probably lactose intolerant.
Underlying disease/condition - if the doctor suspects there may be an underlying cause, such as
celiac disease, a small bowel biopsy may be ordered; a tissue sample of the small intestinal lining
is taken. This is a surgical procedure.
What are the treatment options for lactose intolerance?
There are many people who insist that lactose intolerance in people who are no longer being
bottle fed or breast fed is not an undesirable condition, but a natural state of a human being. We
are the only mammals that carry on drinking milk after babyhood.
For people who live in countries where the non-baby human diet contains very little lactose,
lactose intolerance does not require treatment - in fact, many lactose-intolerant people in these
countries will be unaware of it.
If the patient has an underlying condition/disease, it is important that he/she has it under control -
this means adhering/complying to their treatment plan.
The simplest way to avoid having the symptoms if you are lactose intolerant is to avoid lactose.
If symptoms are mild, it might be a question of trial an error until you find your lactose
threshold.
Any product that contains lactose will have the ingredient listed on its label.
According to Cleveland Clinic
2
, "dietary control of lactose intolerance depends on people
learning through trial and error how much lactose they can handle."
Products containing lactose
Most milk and milk products have lactose in them. Many processed foods have milk and milk
products added to them.
If you are lactose intolerant, check the labels carefully in the following types of foods, as they
may have "hidden lactose", according to the Australian State Government of Victoria.
3

Cakes and biscuits
Processed breakfast cereals
Cheese sauce
Cream soups
Custard
Milk chocolate
Pancakes
Scrambled eggs
Quiche
Muesli bars
Breads
Margarine
Any product with milk, lactose, whey, curds, milk by-products, dry milk solids or non-fat dry
milk powder listed in their labeling (ingredients) will have lactose in them.
Some medications, such as birth control pills and stomach acid medications have lactose in them.
Patients with severe lactose intolerance should tell their doctor or pharmacist.
The complications of lactose intolerance

Almond milk contains high levels of vitamin E, iron, zinc and calcium and, although it contains less
protein, is a good non-dairy alternative to milk
If a person comes from a dairy-friendly society and tries to avoid lactose-containing products,
he/she will have to make sure their move does not result in malnutrition. Milk contains calcium,
proteins, vitamins A, B12 and D - all important nutrients for good health.
If you are embarking on a change of diet, make sure you ask your doctor or a qualified
dietician/nutritionist what you should do.
Calcium is found in seaweeds, nuts and seeds, blackstrap molasses, beans, oranges, figs, quinoa,
amaranth, collard greens, okra, rutabaga, broccoli, dandelion leaves, kale, and fortified products
such as orange juice and soy milk
Vitamin A can be found in carrots, broccoli, sweet potatoes, cod liver oil, liver, spinach,
pumkin, cantaloupe melon, egg, apricot, papaya, mango, and peas.
Vitamin D levels can be enhanced by exposure to natural sunlight, consuming fatty fish, eggs,
fish liver oils, and some fortified soy milks and other fortified products.
Lactose free milk - this does exist. If you suffer from severe symptoms, make sure the lactose
levels are zero, and not just reduced.


Lactose intolerance is a condition in which the body has difficulty handling lactose. People with
this condition may get diarrhoea, stomach pains and bloating if they drink milk or eat dairy
products. Some people are born with a tendency to develop lactose intolerance; others get it as a
result of gastroenteritis or chemotherapy. The treatment is mainly to avoid lactose.
What is lactose intolerance?

Lactose is a sugar found in milk. It cannot become absorbed by the body unless is gets changed
into more simple sugars called glucose and galactose. This change happens when the lactose
passes through the stomach into the upper part of the gut (small intestine) and comes into contact
with a chemical called lactase.
Lactase is made by cells that line the upper part of the small intestine.
If there is not enough lactase in the small intestine, lactose cannot be broken down and cannot
get absorbed. This leads to lactose intolerance.
Some people confuse lactose intolerance with allergy to cow's milk. With milk allergy, your
immune system reacts to proteins found in milk which can cause symptoms.
Lactose intolerance is not an allergy. Symptoms are caused by the undigested lactose in the gut.
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What causes lactose intolerance?
There can be a number of causes:
Inherited forms
These are passed on through families:
Primary lactase deficiency: this causes low levels of lactase. Symptoms can develop at any age
but rarely before the age of 6.
Congenital lactase deficiency: this causes a complete lack of lactase from birth. Symptoms
develop as soon as the baby is given milk or lactose formula.
Secondary lactase deficiency
This happens when something damages the cells in the lining of the upper gut (small intestine)
which produce lactase. It is common in children and often occurs after a stomach infection (such
as viral or bacterial gastroenteritis). It can also be a complication of other bowel diseases or
chemotherapy.
Developmental lactase deficiency
When a baby is born, it takes time for a reasonable amount of lactase to build up in the digestive
system. Babies more than six weeks premature may be born with very low levels of lactase,
leading to temporary lactose intolerance. The condition disappears as the baby gets older.
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How common is lactose intolerance?
It varies according to ethnic group and how much dairy produce is eaten within the country. In
communities where a lot of dairy food is eaten, lactose intolerance is less common. Two in 100
people in Northern Europe have the inherited form, whereas this figure can be up to 80 in 100
people in Hispanic communities.
Lactose intolerance is very common in adults worldwide.


6 Lactose Intolerance
What are the symptoms of lactose intolerance?
You may get bloating, or stomach pains. Excessive burping or passing a lot of wind can occur.
You may also get watery diarrhoea, and itching around your bottom (anus). These symptoms
tend to develop from one to several hours after milk, dairy products or any food containing
lactose.
How bad the symptoms are depends on how much lactose you take into the bowel. Many people
who have lactose intolerance can eat some lactose without developing symptoms. In general, the
more lactose you eat, the more likely that symptoms will develop. The inherited condition tends
to cause less severe symptoms than the intolerance which develops after gastroenteritis or
chemotherapy.
Babies and toddlers may have signs of malnutrition and poor growth (failure to thrive) but this is
unusual.
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How is lactose intolerance diagnosed?
If you get symptoms after drinking milk or eating dairy products or other lactose-containing
foods, it is fairly clear that you have lactose intolerance. Tests are not usually needed.
If there is any doubt, special tests can be performed on your breath or blood. The breath test
involves measuring the amount of a gas called hydrogen in your breath after taking a test dose of
lactose. Rarely, you may need an intestinal biopsy (a procedure which takes a sample of lining of
the gut (small intestine)) to make the diagnosis.
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Are there any complications from lactose intolerance?
Most people do not have any long-term problems. Babies with severe deficiency of lactase may
develop lack of fluid in the body (dehydration) and malnutrition if the condition is not diagnosed
early enough.
Avoiding all dairy products can mean you don't get enough calcium. Calcium is a mineral
needed for bones to grow normally and be strong. Lack of it could mean children don't grow as
well as they should, or adults could have weak bones that break easily.
What is the treatment of lactose intolerance?
People with primary lactose intolerance (the inherited form) should be tested to find out how
much lactose they can handle. People do have varying levels of intolerance. Sometimes the
amount they can tolerate can be increased by giving milk or dairy products little and often.
Having milk with meals may help. Full-fat or chocolate milk may be better than skimmed milk.
Thicker foods such as yoghurts and curds are likely to be better tolerated because they move
through the bowel at a slower rate. Live yoghurts and hard cheese (such as Cheddar, Edam,
Emmental or Parmesan) may not cause problems. Lactose-free milks are available but may be
less nutritious than cow's milk. Check they are calcium-enriched. It is possible to buy lactase
supplements at health food shops, to be taken with dairy products. However, these may be
expensive and cannot be prescribed.
Secondary lactose intolerance, due to damage to the lining of the gut (small intestine), may need
treatment by fluid through a drip if the diarrhoea is very severe. Most doctors advise parents of
babies and children with gastroenteritis to carry on with breast milk, formula milk or cow's milk.
In some cases if the diarrhoea is very prolonged, or in very young babies, some doctors
recommend withdrawing lactose for three weeks after the infection.
The chance of premature babies getting lactose intolerance due to developmental lactase
deficiency can be reduced by feeding them half-strength lactose formula or breast milk.
What can I do to help with symptoms?
If you have lactose intolerance you should read the labels of foods and drinks very carefully. Not
all foods with milk in them will cause problems. For example, lactose is broken down by
fermentation processes and is not found in hard cheese such as Cheddar or Emmenthal. Foods
that may cause problems include milk, cream, cottage cheese, yoghurts, ice cream and milk
chocolate. Lactose is not present in dark chocolate.
Foods containing 'hidden' lactose may include some types of the following:
Bread
Cakes
Cereals
Margarine
Dressings
Sweets
Snacks
To access the best possible advice, ask your GP about seeing a dietician. Also remember that
many tablets contain lactose so you should check the leaflet that comes with any medication you
are taking.