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What Is Lactose Intolerance?

Medically Reviewed by Neha Pathak, MD on September 20, 2021

Millions of Americans can’t digest a certain sugar in milk and milk products called lactose. If you’re one of them, you have lactose intolerance.

The condition isn’t harmful, but it can be uncomfortable and may be embarrassing. There’s no cure, but you can manage it by watching how much milk or milk products you drink or eat.

Being lactose intolerant is not the same as being allergic to milk.

What Is Lactose?

Lactose is the sugar that’s in milk.

Our bodies use an enzyme called lactase to break down that sugar so we can absorb it into our bodies. But people with lactose intolerance don’t have enough lactase. It’s produced in the small intestine.

Even with low levels of lactase, some people can digest milk products just fine. For people who are lactose intolerant, their low lactase levels gives them symptoms after they eat dairy.

What Happens In My Body If I’m Lactose Intolerant?

When we drink milk or have a milk-based product, lactase in our small intestines breaks down the milk sugar. It then gets absorbed into the body through the small intestines.

But people who are lactose intolerant don’t have it so easy. In them, the lactose doesn’t get broken down. Instead, it goes on to the colon, where it mixes with normal bacteria and ferments. It can cause things like gas, bloating and diarrhea.

The symptoms are no fun, but they’re not dangerous. Most people can manage their symptoms by changing their diet and limiting the amount of lactose they consume. Some people do better by cutting lactose out of their diet altogether.

Your body may be able to handle some lactose without symptoms. Experiment to find out the types and amounts of products with lactose you can eat and drink.

There are some steps you can take to test yourself:

  1. Go without milk or milk products for a couple of weeks.
  2. If your symptoms disappear, bring dairy products back into your diet a little at a time to take note of how you react.
  3. If your symptoms continue after cutting out the dairy -- or if they return -- see your doctor to find out what’s going on.

Who Develops It?

Believe it or not, most adults around the world can’t digest milk -- 40% of humans stop producing enough lactase to digest milk between the ages of 2 and 5.

In the United States, it’s estimated that just over one-third of people are lactose intolerant. It is most common among:

  • Asian Americans
  • African Americans
  • Mexican Americans
  • Native Americans

It can also be inherited or associated with other specific diseases.

How Do I Know If I’m Lactose Intolerant?

Our bodies react to milk in ways that are easily measured. Two common tests for adults are:

  • Breath test. This will show if you have high levels of hydrogen when you exhale. If you do, you might be lactose intolerant. That’s because hydrogen is given off when lactose is broken down in the colon. The hydrogen gets taken by the blood up to your lungs, and then you exhale it.
  • Blood test. This can show how your body reacts after you drink something with a lot of lactose. However, this test is usually not done.

Doctors can also take a stool sample from babies and young children.

What If I Have It?

You may still be able to eat or drink small amounts of milk. Some people do better if they have their dairy with a meal. And, some dairy products, like hard cheese or yogurt, may be easier to digest.

Also, there are lots of lactose-free dairy products at the supermarket. Or you can take commonly found over-the-counter supplements (like Lactaid) to break down the milk sugars if you still want the real thing.

Talk to your doctor about a liquid lactase replacement. These are over-the-counter drops that you add to milk.

But if you give up milk completely, you can still get plenty of calcium, vitamin D and other nutrients in a healthy diet.

Instead of milk, you can substitute these foods:

  • Almonds
  • Dried beans
  • Tofu
  • Collards
  • Kale
  • Calcium-fortified orange juice and soy milk
  • Fatty fish, like salmon, tuna and mackerel
  • Egg yolks
  • Beef liver

Watch for Hidden Lactose

Always read labels. Many foods have lactose, including snack foods, bakery products, candy, dry mixes, dried vegetables, and infant formulas.

Many medicines also have lactose, which is used as a filler, especially in white tablets. Many birth control pills and medications used to treat gas and stomach acid contain lactose. Your doctor or pharmacist can let you know if any prescription medications you take contain lactose.

Some high-lactose foods to watch out for:

  • Milk and heavy cream
  • Condensed and evaporated milk
  • Ice cream
  • Cottage cheese
  • Ricotta cheese
  • Sour cream
  • Cheese spreads

Some milk substitutes you could try:

If you have symptoms of lactose intolerance, see your doctor. And if you’re diagnosed with it, talk with them about how to be sure you’re eating right.

WebMD Medical Reference

Sources

SOURCES:

Cleveland Clinic: “Lactose Intolerance.”

Mayo Clinic: “Lactose intolerance.”

Johns Hopkins Medicine: “Lactose intolerance.”

National Institutes of Health: “Lactose intolerance.”

National Institutes of Health:  “Evolution of lactase persistence: an example of human niche construction.”

National Institute of Diabetes and Digestive and Kidney Diseases: "Definition & Facts for Lactose Intolerance."

Foodreactions.org: “Hidden Milk and Lactose.”

Go Dairy Free: “How to Substitute Milk (Skim, Low Fat, Whole).”

International Foundation for Functional Gastrointestinal Disorders: “Lactose Intolerance.”

FDA: “Problems Digesting Dairy Products?”

 

 

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