Lactose Intolerance (Milk Sugar Intolerance): Causes, Symptoms & Treatment

About 90 percent of the world’s population suffers from lactose intolerance or milk sugar intolerance. In the countries of Central Europe, there are fewer people who suffer from lactose intolerance. Here, only about 10 to 20 percent of the population is found to be lactose intolerant.

What is lactose intolerance (milk sugar intolerance)?

Infants and young children usually tolerate dairy products one hundred percent without problems. Milk contains the component lactose, which is also called milk sugar. The lactose is broken down by the enzyme lactase. In adulthood, the ability to optimally digest lactose slowly decreases. This is how lactose intolerance develops. Lactose intolerance should not be confused with an allergy to milk protein. This is because lactose intolerance is merely a digestive weakness.

Causes

Lactose is broken down in the intestine into its components glucose and galactose with the help of lactase. This digestive enzyme is produced in the small intestine. If it is produced insufficiently or not at all in the human body, this is called lactose intolerance. The lactose can no longer be digested properly. The undigested lactose then migrates to other parts of the intestine that are colonized with a different type of intestinal bacteria. These intestinal bacteria feed on the undigested lactose. This creates larger amounts of gases and organic acids in the intestine. They also cause water retention in the intestine. This results in violent intestinal movements. In primary lactase deficiency, patients suffer from neonatal lactase deficiency as a result of a metabolic disease. This form of the disease is very rare. Physiological lactase deficiency begins in infancy after weaning. Very slowly, the ability to produce lactase then declines. Secondary lactase deficiency is triggered by a disease such as Crohn’s disease or celiac disease. When the disease is cured, the lactose intolerance goes back.

Symptoms, complaints and signs

The most common symptoms of lactose intolerance (milk sugar intolerance) include unexplained abdominal pain, bloating, and diarrhea. These occur after consuming foods and beverages containing lactose. Symptoms may occur immediately after consuming lactose, but may also occur with a delay. How sensitive individuals are depends on the enzyme lactase, which is used to metabolize lactose. The problem is that the symptoms may initially remain unexplained and diffuse. The organism must of necessity get used to the lactose intake. As a result, the symptoms may be more inconspicuous. They can be “masked” for years and be overshadowed by other complaints. In this case, the symptoms that occur may include a tendency to [[gastrointestinal diseases|gastrointestinal complaints, noticeable immune problems, sleep disorders or urinary urgency after eating foods containing lactose. Complaints caused by lactose intolerance can vary from person to person. Some people react to even the smallest doses of lactose with severe digestive complaints. Other people tolerate foods with a low lactose content well, but not those with a higher lactose content. It is difficult to always attribute the symptoms that occur to lactose, as this is often hidden under the ingredient “spices” in industrially produced foods. If the lactose intolerance along with the accompanying complaints occurs in childhood, the causes may be easier to identify than if the intolerance becomes apparent only in adulthood due to an increasing lactase deficiency.

Disease progression

What makes lactose intolerance noticeable? After a meal that contains lactose, patients first get a feeling of fullness. This is followed by bloating and belching. Abdominal pain can develop up to colic, but this does not necessarily have to occur so drastically. Nausea and diarrhea can also result from lactose intolerance. There are numerous gradations in this condition. Some patients can consume small amounts of lactose-containing foods. For example, although this group cannot tolerate whole milk, cream or sweet cream butter. Natural yogurt, buttermilk and sour cream butter, on the other hand, are often well digested. The same applies to cheese. Matured cheeses are better tolerated than fresh cheese, for example.Provided that too large quantities of these foods are not consumed. The lactic acid contained in slightly acidified milk products ensures that they are well tolerated. It takes over part of the digestive work. As a rule of thumb, one group can consume up to one gram of lactose without experiencing symptoms. Another group can tolerate up to 10 grams of lactose. Only a very small percentage of patients cannot tolerate lactose at all. These patients must make sure that all foods and beverages, as well as medications, do not contain lactose.

Complications

Usually, no special or life-threatening complications occur with lactose intolerance. The life expectancy of the affected person is not affected or reduced due to lactose intolerance. However, lactose intolerance has a negative effect on the quality of life, so the patient has to avoid dairy products. When dairy products are consumed, the patient experiences pain in the abdomen and stomach and, furthermore, flatulence. Not infrequently, this pain can also lead to depressive moods in the long term. Especially at night, the pain can lead to sleep problems and thus to irritability of the patient. However, a causal treatment of lactose intolerance is not possible. Those affected must avoid dairy products in their daily lives or resort to lactose-free products. This can limit most of the symptoms. Taking supportive medication can also alleviate and limit the symptoms. As a rule, no particular complications or other complaints occur. Furthermore, in some cases, patients rely on supplements to obtain the missing nutrients from dairy products. However, life expectancy is not negatively affected by lactose intolerance.

When should you see a doctor?

Persistent digestive problems must always be examined by a doctor. Chronic intestinal problems reduce well-being and can cause secondary diseases associated with further discomfort. Therefore, a doctor must be consulted if the symptoms described keep recurring or even persist permanently. If malnutrition and weight problems occur in connection with intolerance, a doctor’s office or clinic should be consulted immediately. If risk factors such as regular use of medications (especially painkillers and antibiotics), illnesses or surgical procedures, and an unhealthy diet are present, a visit to the doctor is also recommended. Lack of exercise and stress are also typical triggers of intolerance. People to whom the above factors apply must seek medical advice. In addition, a nutritionist or therapist should be consulted, depending on the cause. Additional contacts are the gastroenterologist, internist or allergist. The physician can diagnose the lactose intolerance and suggest a suitable therapy to the patient. If this is done early, chronic gastrointestinal complaints can usually be avoided.

Treatment and therapy

The treatment of lactose intolerance varies from individual to individual. There is once the possibility to supply the missing enzyme by suitable preparations from the pharmacy. Tablets containing the enzyme lactase, however, are not reimbursed by health insurance companies. The most sensible thing to do is to change your diet and adapt it to your lactose intolerance. It is not advisable to avoid dairy products in general. Dairy products are important components of the diet because they provide calcium, which is important for bone formation. It therefore remains to be clarified to what extent lactose actually has to be avoided or whether smaller amounts can be tolerated. If patients can only consume very small amounts of the milk sugar and therefore have to restrict dairy products very much, taking a preparation with the enzyme lactase is recommended.

Outlook and prognosis

Lactose intolerance is not a life-threatening condition. Affected individuals need not expect any limitations in life expectancy or quality of life. However, lactose-containing products must be permanently avoided. In addition, those affected should regularly consult their gastroenterologist or family doctor. The physician can monitor the course of the disease and advise on suitable antidotes in the event of complaints.This is particularly useful in the case of chronic complaints that cannot be alleviated by avoiding the corresponding foods alone. If the symptoms persist despite all measures, there may be another underlying cause. In this case, a thorough medical examination is recommended. The physician can give an exact prognosis and provide further tips on how to manage everyday life with the disease. Mild secondary lactose intolerance can often be cured by slowly increasing the consumption of products containing lactose. Congenital lactose intolerance persists throughout life. The enzyme disorder must be treated permanently by avoiding the corresponding foods. Otherwise, major complications can occur that significantly affect well-being. In children, lactose intolerance can cause life-threatening symptoms. The course of the disease depends on whether the enzyme disorder is detected early and what measures are taken. If treated early by a specialist, the prognosis is generally positive.

Prevention

To prevent symptoms from developing, patients can choose dairy-free foods as a preventive measure. The ingredient lists of the products declare whether a food that does not contain milk really has not been supplied with lactose. Unfortunately, there is no other prevention, for example against the actual digestive weakness.

Aftercare

Follow-up care often takes place in the case of serious diseases that may recur after a successful procedure. Cancers represent a classic example. In contrast, lactose intolerance is permanent. It does not disappear. Moreover, it is not life-threatening. In the case of lactose intolerance, aftercare has a different focus: the patient should lead a symptom-free life in his or her everyday life. This is best achieved by avoiding foods with a high lactose content. Follow-up care actually represents medical monitoring. Mandatory six-monthly appointments are often arranged in which the progress of a disease is documented. During these, sometimes complex examinations take place, which allow statements about internal organs. In the case of lactose intolerance, on the other hand, the involvement of doctors and therapists is limited to a pure transfer of knowledge. The doctor informs his patient of his diagnosis and may recommend nutritional counseling. The implementation of the advice given is then the responsibility of the patient. In addition, taking certain medications prevents the typical signs. Patients can ask their doctor for a prescription for any symptoms. Especially when unclear about the sugar content in food and beverages can be useful to use.

What you can do yourself

Those who suffer from lactose intolerance should change their diet. In doing so, it is important to find out whether lactose must be completely avoided or whether a low-lactose diet is sufficient. This is because affected people can often consume small amounts of lactose without complaints. In order to maintain a balanced diet despite abstaining from dairy products, it makes sense to contact a nutritionist. In addition to the family doctor, this person can answer questions and rule out malnutrition. Because by the general renouncement of milk-containing meals, it can come to a lack of calcium, which is important for the bone structure. To counteract this, it helps to eat green vegetables rich in calcium, such as broccoli or fennel. However, it is not necessary to completely avoid dairy products. Supermarkets offer a variety of labeled lactose-free products. Here, the enzyme lactase is added to the milk, which ensures that the milk sugar is broken down and thus becomes easier to digest. It is also possible to switch to plant-based substitutes, such as soy or oat milk. It is also possible to take lactase supplements with foods containing milk. These enable lactose-containing foods to be digested without any problems. The preparations are available in the form of tablets or powders, over-the-counter in pharmacies, drugstores or supermarkets. It is important to observe the correct dosage and not to take too little of the enzyme, otherwise the effect will not be felt.