Lactose Intolerance
Lactose intolerance is a condition in which one cannot tolerate milk products due to an inability to break down the sugar in milk, lactose. Adequate levels of the enzyme lactase (produced in the small intestine) must be produced in order to breakdown lactose into simpler, more digestible sugars. If this enzyme is lacking, the result is malabsorption of the lactose sugar. When lactose is not broken down in the small intestine, it passes to the colon where it is then fermented by bacteria, causing symptoms such as bloating, gas, abdominal cramping, nausea, and diarrhea. These symptoms usually arise thirty minutes to two hours after consuming product containing lactose. If symptoms are severe or prolonged, malnutrition and/or dehydration may develop, especially in very young children.
Lactose intolerance arises from a deficiency of the enzyme lactase. There are four types of lactase deficiency. In primary lactase deficiency, lactose tolerance declines over time, and is inherited genetically. This is the most common form of lactose intolerance and usually develops in early childhood, though symptoms may appear later in life. Secondary lactase deficiency occurs after injury to the small intestine (which produces the lactase enzyme) due to causes such as infection, injury, or sometimes medication. This type may resolve when the original insult is resolved or corrected. Congenital lactase deficiency is seen in newborns, and is the result of a genetic mutation. Developmental lactase deficiency occurs in premature infants when the small intestine is not mature enough to produce lactase. A physician may diagnose lactose intolerance after completing a health history, physical exam, and completing diagnostic tests such as blood tests, a hydrogen breath test, and/or stool acidity test.
If You’ve Been Diagnosed with Lactose Intolerance
If you’ve been diagnosed with lactose intolerance, your doctor may recommend limiting or eliminating products containing lactose. Learning to read product labels for dairy containing ingredients, as well as educating oneself on what medications may contain lactose, is important for strict avoidance of lactose. Other than eliminating lactose containing products, other treatments include taking lactase supplements, consuming milk fortified with lactase, and perhaps slowly re-introducing lactose to build lactose tolerance in the large intestine. If lactase deficiency is determined to be due to a secondary cause such as infection or injury, correcting these problems may decrease or resolve symptoms.
A Whole Health Perspective:
Looking at Lactose Intolerance through a Whole Health model, we explore the individual’s unique presentation from the 5 Aspects of Whole Health™ perspective.
1. Physical: Lactose intolerance and the symptoms it produces directly affect the gastrointestinal tract, the primary site for digesting and absorbing nutrients. Regardless of the type of lactase deficiency, the symptoms and their underlying cause can disturb the normal function of the GI tract. Dysfunction in the GI tract can affect overall health by changing the way nutrients are assimilated into the body. Further, the GI tract communicates with the central nervous system via the enteric nervous system, sometimes referred to as the “the second brain.” The nerve cells within and around the GI tract produce many of the same chemicals (neurotransmitters) that are produced within the brain. Additionally, the GI tract houses immune tissue that assists the body in monitoring and removing harmful substances, while allowing for beneficial gut bacteria to remain. Thus the health of the GI tract also affects multiple other body systems, and can impact overall health. Consuming products, such as lactose, which can affect the health of the gastrointestinal system can therefore affect the nervous system, the endocrine (hormonal) system, immune system, and the body as whole.
Many who are lactose intolerant also have intolerance to other foods, such as fermentable saccharides and polyols. Monitoring the diet for foods beyond lactose which cause symptoms, and reducing or removing these foods, may alleviate discomfort. Further, keeping the gut bacteria/microbiome in a healthy balance can affect symptoms and promote overall health, especially for those whose lactase deficiency is due to an underlying condition such as Crohn’s disease, ulcerative colitis, or food allergies. Chronic stress, such as difficult job, relationships, or illness, can also negatively affect the GI tract. Those with lactose intolerance may already have a compromised GI tract, so choosing options to reduce stress could reduce symptoms. For those with severe symptoms, monitoring for dehydration and malnutrition can be guided by a physician, as well as correcting nutrition and stress disorders.
2. Environmental: Environmental pollutants can contribute to dysfunction within the gastrointestinal tract. For those with lactose intolerance, whose GI systems already may be dysfunctional, limiting exposure to pollutants in the soil, air, and water is important (such as heavy metals, household cleaners, etc.). Direct or passive exposure to cigarette smoke is known to negatively affect the gastrointestinal tract and its function. Increased exposure to stress in the environment, whether through difficult relationships, loud noises, bright lights or abrupt changes in weather, can affect the GI tract in general. Exposure to nature, even visual or auditory, can decrease stress and have a positive effect on health. Moderate weight bearing exercise, such as walking or weight lifting, will assist in bone strength and integrity, especially for those who may have limited calcium intake due to lactose intolerance.
3. Nutritional: Dietary recommendations to reduce lactose intolerance symptoms include the exclusion or reduction of food and medicine containing lactose. Other foods which may affect lactose intolerant individuals include FODMAP (Fermentable Oligo-Di-Monosaccharides and Polyols) foods. These are certain carbohydrate foods that are poorly absorbed in the intestine and may be fermented by intestinal bacteria, leading to increased gastrointestinal symptoms. Monitoring for food allergies and/or sensitivities and decreasing consumption of alcohol, sugar, refined carbohydrates, saturated fats, and caffeine can assist in gastrointestinal health.
Decreasing and/or eliminating lactose products can have other health outcomes such as osteoporosis or bone fractures, since milk products contain calcium and vitamin D. These two mineral/vitamins necessary for bone stability, especially for children, pregnant, lactating, and post-menopausal women. Replacement of calcium and vitamin D can be accomplished through the many dairy alternatives, alternative food sources, and/or supplements. Other supplements which may assist in proper nutrition and gastrointestinal function include probiotics. Lactase enzymatic tablets are also available and may help reduce symptoms.
Symptom relief may be augmented with other dietary interventions including small but frequent meals, eating slowly and mindfully, and avoiding highly stimulatory foods such as caffeine and sugar. Keeping a food diary to track intake, stressors, and symptoms may be helpful.
4. Emotional: The gastrointestinal tract and the brain and nervous system communicate closely. The function of the GI tract may be altered by emotions such as anger, fear, and frustration, as well as by what is consumed. Similarly, what is consumed may affect neurochemical/emotional responses within the brain and beyond. Being aware of emotional eating patterns helps bring awareness to food choices and reinforces decisions to limit foods which produce gastrointestinal symptoms. Because stress and emotions affect gastrointestinal health, engaging in activities which assist in stress reduction and emotional awareness (such as choosing supportive relationships, yoga, meditation, relaxation techniques, cognitive behavioral therapy, etc.) can be beneficial in symptom reduction.
5. Beliefs, Values and Worldview – also identified as Spirituality: Cultural or religious traditions regarding food and dietary choices may be involved in gastrointestinal function. Spiritual expression and development, whether through prayer, meditation, yoga, etc., has been shown to be an important factor in health. Possible feelings of isolation, living in discordance with one’s values, or inability to connect with support and the natural surroundings due to illness or other factors could increase stress and exacerbate symptoms.