Lactose Intolerance: Foods to Avoid

Living with lactose intolerance can be a daily struggle for many individuals, impacting their dietary choices and overall well-being. This condition hinders the ability to digest lactose, typically a type of sugar found in milk and dairy products.

What is lactose intolerance?

Lactose intolerance is a digestive disorder characterised by the inability to digest lactose, a sugar found in milk and dairy products. It results from a deficiency in lactase, the enzyme produced in the small intestine that is responsible for breaking down lactose into glucose and galactose, which can then be absorbed into the bloodstream.

When individuals with lactose intolerance consume lactose-containing foods or beverages, they often experience a range of gastrointestinal symptoms due to undigested lactose passing into the colon. There, it is fermented by bacteria, leading to the production of gas and other by-products.

Is lactose intolerance an allergy?

People often mistake lactose intolerance for a milk allergy. Lactose intolerance is not an allergy but results from insufficient enzyme lactase in your small intestine.

What are the causes?

Lactose intolerance typically occurs when the body does not produce sufficient amounts of lactase. Lactase is an enzyme, a type of protein that facilitates chemical reactions, normally produced in the small intestine to help digest lactose. 

Types of lactase deficiency 

A lactase deficiency indicates that the body produces inadequate levels of lactase. Some people have lower lactase enzyme levels, making it difficult to break down lactose into usable sugars like glucose and galactose. Enzyme deficiency has four leading causes.

1. Primary lactase deficiency

   Primary lactase deficiency, the most prevalent cause of lactose intolerance globally, is due to an inherited genetic defect that is passed down through families. This condition occurs when lactase production declines as the diet shifts away from milk and dairy products. Typically, this reduction happens after the age of two, once breastfeeding or bottle-feeding has ended, though symptoms might not appear until later in life.

2. Secondary lactase deficiency

   This can result from injury to the lining of the intestine, resulting in secondary lactase deficiency that can result from various infections, inflammations, or other illnesses. Some common reasons for this include:

   • Gastroenteritis
   • Celiac disease
   • Crohn’s disease
   • Ulcerative colitis
   • Chemotherapy
   • Antibiotics
3. Congenital lactase deficiency

   Congenital lactase deficiency is a rare hereditary condition that affects newborns. It results from an inherited genetic defect that causes affected infants to produce little to no lactase. The genetic mutation causing congenital lactase deficiency follows an autosomal recessive inheritance pattern, meaning both parents must carry a copy of the faulty gene to pass the condition on to their child.

4. Developmental lactase deficiency

   This condition occurs in premature babies born before the 37th week of pregnancy when the baby’s small intestines were not fully developed, making it difficult to break down lactose. However, as the baby grows, their intestines mature, and they develop enough lactase activity to digest lactose properly.

What are the symptoms?

Symptoms of lactose intolerance usually become noticeable within thirty minutes to one or two hours after consuming dairy products:

• Diarrhoea
• Bloating 
• Abdominal pain
• Nausea or vomiting
• Feeling overly full
• Excessive gas

The severity of the symptoms may vary, and not everyone with lactose intolerance will experience all these symptoms. If you have any doubts or uncertainties, do consult a doctor. 

How is it diagnosed?

Diagnosing lactose intolerance typically involves a combination of clinical assessment and specific tests.

Hydrogen breath test

After consuming a lactose-rich drink, you breathe into a device that measures the amount of hydrogen in your breath. Higher levels of hydrogen indicate that lactose is not being digested properly and is instead being fermented by bacteria in the colon, which suggests lactose intolerance.

Lactose tolerance test

The standard lactose tolerance test assesses how well your digestive system absorbs lactose by measuring your blood sugar levels after you consume a lactose-containing liquid. If your blood sugar does not increase significantly during this time, it may indicate lactose intolerance.

How is lactose intolerance treated and managed?

Dietary modifications

• Limit lactose-containing foods: Avoid or reduce the intake of dairy products such as milk, cheese, ice cream, and yoghurt to 10g a day. Check food labels for lactose content, as it can be present in unexpected products like bread, cereals, and processed foods.
• Lactose-free alternatives: Opt for lactose-free or lactose-reduced milk and dairy products. There are also many non-dairy alternatives available, such as almond milk, soy milk, oat milk, and coconut milk.
• Introduce dairy gradually: Some people with lactose intolerance can tolerate small amounts of lactose. Gradually reintroducing dairy into the diet can help identify the threshold of lactose you can handle without symptoms.

Dietary balance

• Since dairy is a primary source of calcium, individuals with lactose intolerance should ensure they get enough calcium and vitamin D from other sources or supplements.
• Foods rich in calcium include leafy green vegetables (kale and broccoli), almonds, tofu, and fortified foods (orange juice and cereals).
• If dairy intake is reduced, consider vitamin D supplements to support calcium absorption and bone health.

Use of lactase supplements

• Over-the-counter lactase enzyme supplements can be taken to help break down lactose, reducing symptoms. 

Make an appointment at Pantai Hospitals

Consult our doctors if you are experiencing symptoms of lactose intolerance. A dedicated and expert team of Gastroenterologists at Pantai Hospitals is available for consultation to provide the best care and assistance.

Get in touch with us to book an appointment today if you have concerns or questions regarding lactose intolerance. We assure you the best possible care tailored to your specific needs.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.