Everything You Need To Know About Lactose Intolerance (And What To Do About It!)

Often mistaken with a dairy allergy, lactose intolerance is one of the most common conditions in the world. It is estimated that around 75 percent of the global population is affected. If you experience uncomfortable symptoms like abdominal cramps, gas, or even headaches every time you consume milk products, you might be suffering from lactose intolerance.

Here, we’ll discuss what lactose intolerance is, how you can tell if you’re affected by it, and what might be causing it. We’ll also recommend some natural remedies like dietary adjustments and digestive supplements that will help you manage your lactose intolerance symptoms.

What is lactose intolerance

Lactose intolerance, also known as lactose malabsorption, is a condition that affects people’s ability to adequately digest lactose, which is a sugar that is found in milk products ^[1].

Almost everybody is born with the ability to digest lactose since it is found in breast milk. However, as we age, many of us lose that ability, depending primarily on genetic backgrounds ^[2]. People that aren’t able to digest dairy products sufficiently are said to be lactose intolerant.

Although close to 75 percent of the global population is lactose intolerant, the condition is more prevalent within specific demographics than others. In the United States, it is estimated that 30-50 million people are affected, including 75-90 percent of American Indians, African Americans, and Asian Americans ^[3].

What are the symptoms of lactose intolerance?

Here are some of the symptoms of lactose intolerance ^[4].

• Abdominal cramps
• Gas
• Diarrhea
• Bloating
• Headaches
• Skin inflammation

The severity of lactose intolerance symptoms varies from person to person, with onset happening typically within a few hours of consuming dairy.

What causes lactose intolerance?

When you consume dairy products, your small intestine produces a digestive enzyme called lactase, which is responsible for breaking down lactose into two simpler forms of sugar – glucose, and galactose. They are subsequently absorbed into your bloodstream and used by your body for various functions.

Many people lose the ability to produce enough lactase as they age, depending on various factors like genetics, ethnicity, diseases, certain medications, and more. A decreased lactase production means they can no longer break down lactose into glucose ^[5]. When the undigested lactose remains in the intestine, it draws large amounts of water and causes diarrhea. In other cases, the lactose is broken down by bacteria in the colon, producing gas and abdominal cramps.

In some cases, people experience symptoms like headaches, gas and bloating for an extended period. This is likely if you have a leaky gut, which is another term for increased intestinal permeability. A leaky gut will allow undigested particles to enter your bloodstream, and trigger inflammation ^[6].

Another possible cause of lactose intolerance is an illness or disease. If you’ve recently suffered from the stomach flu, or if you have an underlying condition like celiac disease or Crohn’s disease ^[7], you may have inflammation in the intestinal wall which can result in temporary lactose intolerance.

What increases the risk for lactose intolerance?

Certain factors can increase your risk of developing lactose intolerance.

Age – The risk of lactose intolerance increases with age when many people lose their ability to produce enough lactase. It is very rare in young children.

Ethnic background – You have a higher risk of lactose intolerance if you’re Asian American, African American, Hispanic, or of American Indian descent.

Premature birth – Infants don’t develop the lactase producing cells until the third trimester. So, being born prematurely puts them at a higher risk of lactose intolerance.

Underlying medical conditions – Certain medical conditions that damage the intestinal lining can cause lactose intolerance. Examples include Crohn’s disease, celiac disease, giardiasis, and leaky gut.

How is lactose intolerance different from a milk allergy?

Lactose intolerance is a digestive disorder, while a milk allergy involves the immune system. Lactose intolerance is caused due to a deficiency in digestive enzymes, and while uncomfortable and inconvenient, it is typically not serious.

If you have a dairy allergy, your immune system reacts negatively to specific proteins found in dairy and causes a reaction. Symptoms include rash, hives, trouble swallowing, wheezing, and more ^[8]. In some severe cases, one can experience difficulty breathing and loss of consciousness.

How is lactose intolerance diagnosed?

Many people mistakenly believe that they are lactose intolerant, when they are really suffering from another condition like Irritable Bowel Syndrome (IBS), or Small Intestinal Bacterial Overgrowth (SIBO). It’s easy to confuse these conditions with lactose intolerance because they share similar symptoms like diarrhea, bloating, and abdominal cramps. Consequently, they might be avoiding dairy products unnecessarily ^[9].

To diagnose you with lactose intolerance, your healthcare provider will ask you about your past and present symptoms, and about your family’s history with the condition. They might recommend that you stay away from all dairy products for a period. If you do not experience any symptoms when you’re not eating dairy, but the symptoms return as soon as you reintroduce dairy, it’s likely that you are lactose intolerant.

Beyond eliminating dairy, your doctor can also use the following tests to check for lactose intolerance.

Hydrogen breath test – You’ll drink a liquid that contains lactose, and then do a breath test several times at set intervals. A high level of hydrogen in your breath indicates that you might be lactose intolerant.

Lactose intolerance test – This test is designed to check your ability to digest lactose. You’ll refrain from eating or drinking anything overnight, and then drink a liquid with lactose. Your doctor will measure your blood glucose level after two hours. If your blood glucose does not rise, that will indicate you’re not digesting lactose properly, since it’s supposed to be broken down into sugar and absorbed into your bloodstream.

Should I stay away from dairy altogether if I’m lactose intolerant?

If you have lactose intolerance, it might seem like a logical solution to avoid all things that contain lactose. Even some popular diets encourage people to stay away from dairy. They point to the fact that many of our ancestors consumed no dairy, and enjoyed excellent health. However, some of those past cultures were often adapted to require lower amounts of calcium than we do today ^[10].

Dairy is an excellent source of calcium, a mineral that is vital in maintaining bone health. It is difficult to get enough calcium on a typical western diet without consuming dairy. Some studies have suggested that people with lactose intolerance are at a higher risk of osteoporosis, a disease in which bones become fragile due to reduced density ^[11]. Calcium deficiency is the likely cause of the association between osteoporosis and lactose intolerance. Additionally, calcium has many other health benefits like maintaining optimal blood pressure, heart rhythm, muscle function, and more ^[12].

So, avoiding dairy altogether might not be the best course of action, since you don’t want to become deficient in calcium. It might be a better idea to take steps to manage your lactose intolerance with some of the tips we’ll discuss below. Also, research has indicated that some lactose intolerant people are still capable of consuming moderate amounts of dairy without experiencing any significant symptoms ^[13].

What are some common treatments for lactose intolerance?

The most common way people manage their lactose intolerance symptoms is by limiting their dairy intake. A few sources of dairy are cow and goat milk, cheese, yogurt, ice cream, and butter.

If you’ve been diagnosed with lactose intolerance, you can experiment with consuming dairy in small amounts, up to 4 ounces at a time. It is unlikely that a small serving of milk will cause any significant gastrointestinal issues.

You can also try dairy products that have a lower amount of lactose. Swiss and cheddar cheeses have relatively small amounts of lactose and are unlikely to cause any symptoms. Lactose-free or lactose-reduced products are also an option.

What are some natural remedies to manage lactose intolerance?

Eat more probiotic-rich foods

Probiotics are the beneficial bacteria that line the intestinal wall in your gut. They help you absorb nutrients from food and support your immune system ^[14]. Probiotics break down lactose into short-chain fatty acids to facilitate better absorption by the colon ^[15], help improve digestion, and increase energy due to vitamin B-12 synthesis.

There are several kinds of probiotics bacteria, but a few of them are especially helpful for people that are lactose intolerant ^[16].

• Lactobacillus acidophilus
• Lactobacillus bulgaricus
• Lactobacillus reuteri
• Streptococcus thermophilus

The research is ongoing, but there is some evidence to suggest that taking probiotics might help with symptoms of lactose intolerance. In a systematic review of 15 randomized, double-blind studies, researchers concluded that probiotic bacteria had a positive effect on alleviating some of the symptoms ^[31]. Studies have also shown that probiotics might increase the frequency of bowel movements in people with constipation, which is a common symptom of lactose intolerance ^[36].

Yogurt is typically one of the best sources of probiotics. If your lactose intolerance is relatively mild, you can try eating plain yogurt. Otherwise, you can opt for non-dairy sources of probiotics like sauerkraut, kimchi, kombucha drinks, and kefir.

Drink fermented dairy

Fermentation is the process of using microorganisms like bacteria or yeast to break down sugars into alcohol and organic acids. It is a tradition that has been around for ages, and it is still heavily prevalent in some countries around the world. Fermented foods contain healthy probiotics and enzymes that promote digestion and a robust immune system ^[17]. Dairy products are among the most popular fermented foods, and they are often referred to as cultured dairy. Not only does fermented dairy last longer, but it is also easier to digest.

Dairy is fermented by allowing it sour through a natural process, or by adding lactobacillus, a probiotic bacteria ^[18]. As mentioned before, lactobacillus is healthy bacteria that is found in the gut lining. When added to dairy, it feeds on the lactose in the dairy and creates lactic acid. It preserves the milk and also releases healthy enzymes and nutrients.

Fermenting also enhances nutritional availability. It increases B vitamins and glutathione ^[19], an antioxidant that has various benefits like improving psoriasis, and fighting autoimmune diseases ^[20].

Here are 2 of the best fermented dairy products for lactose intolerance.

Kefir – Typically made by fermenting cow milk or goat milk. It is considered by many to be healthier than yogurt, and it has an abundance of bacteria that is beneficial for the gut and digestion. For lactose intolerant people, kefir has the added benefit of improving bone health and lowering the risk of osteoporosis ^[21], since it is an excellent source of calcium and vitamin K2, both of which are critical components of maintaining bone tissue.

Goat cheese – While cheeses made from both cow’s milk and goat’s milk will have a lower amount of lactose because of the fermentation process, some people find goat cheese easier to digest than cow milk cheeses. This could be because the fat molecules found in goat milk are shorter and easier to digest for some.

Eat foods rich in calcium and vitamin K

Calcium is a mineral that is known primarily for the critical role it plays in maintaining healthy bones, and for its potential link with the reduced risk of osteoporosis. However, it has many other functions as well, such as muscle contraction, regulating blood coagulation, maintaining heart health, and others. Dairy is one of the primary sources of calcium, especially on a regular western diet. For people are lactose intolerant, regularly getting an adequate amount of dietary calcium can be challenging.

Fermented dairy, as we discussed, is an excellent source of calcium for people with relatively mild lactose intolerance. Some other non-dairy sources of calcium include sardines and canned salmon with edible bones, beans and lentils, almonds, and sesame seeds ^[22].

Vitamin K is another vital fat-soluble vitamin that helps maintain optimal heart and brain function, along with promoting bone density. Vitamin K2 helps the circulation of calcium to the right parts of your body. It also regulates proper calcium levels in your body by removing any excess deposits in your arteries and soft tissues ^[23]. Additionally, vitamin K supports heart health, helps with menstrual pain and bleeding, blood clotting, and improves brain function. While most healthy adults have adequate levels of vitamin K, it can be disrupted by certain medications like antibiotics, and by medical conditions like IBS and leaky gut, both of which are associated with lactose intolerance.

Some excellent sources of vitamin K are dandelion greens, mustard greens, brussel sprouts, spinach, broccoli, kale, and sea vegetables like kelp.

If you aren’t able to add these calcium and vitamin K rich foods to your diet, consider taking them in supplement forms. If you take a calcium supplement, it is critical also to take vitamin K2 to maintain the correct levels and avoid excess calcium in your arteries and tissues ^[24].

Heal your gut

Leaky gut, which is another term for increased intestinal permeability, is a digestive disorder where toxins, bacteria, and other undigested substances are absorbed into the bloodstream through a porous intestinal wall. It is not a condition that is yet recognized by mainstream medical professionals, but there is some research that suggests a link between leaky gut and various health issues ^[25]. Leaky gut can occur due to a variety of reasons including excessive alcohol consumption, medications, and Inflammatory Bowel Diseases (IBD) like Crohn’s disease ^[26].

If you have a leaky gut, then you’ll have a decreased ability to digest lactose. If you’re already lactose intolerant, then a leaky gut will make the symptoms worse, and you’re more like to suffer from Irritable Bowel Syndrome (IBS) ^[37]. The undigested lactose combines with bacteria in your stomach and results in gas, cramping, bloating, and diarrhea. Healing your gut will not only increase your ability to digest dairy better, but it will also improve your immune system, and other aspects of your health.

Here are some of the best foods to improve your gut health. You might want to incorporate these foods into your diet even if you do not have a leaky gut, as they will protect your intestinal lining from future damage.

Bone broth – Helps heal the damaged cells on your intestinal wall with amino acids and by promoting collagen synthesis ^[27]. Bone broth is also a great source of minerals like potassium and sodium, that are beneficial for your digestive health.

Kimchi – Kimchi is a traditional Korean spicy dish made with fermented cabbage, garlic, and other vegetables. It contains probiotics, the gut-friendly bacteria, and it also prevents harmful bacteria from gathering in your stomach. Probiotics will begin healing your gut and improve your digestion ^[28].

Avocados – Avocados, along with other healthy fats like pasture-raised egg yolks, are easy to digest and they promote gut healing.

Fresh fruits – Fruits are loaded with various vitamins and minerals that are beneficial to your digestive health. Try to eat a variety of fruits to get a wide range of nutrients.

Wild fatty fish – Wild fatty fish like salmon are a vital source of omega-3 fatty acids, and vitamin D. Omega-3 have an anti-inflammatory effect, and research has suggested a link between vitamin D deficiency and leaky gut ^[29].

The GAPS diet

The GAPS diet is a restrictive diet that eliminates grains, pasteurized dairy, refined sugar, and starchy vegetables like potatoes. GAPS stands for Gut and Psychology Syndrome, and it is a diet that was introduced by Dr. Natasha Campbell-McBride with the idea that gut health has an effect on the brain. She argues that by healing the gut, we can potentially treat certain neurological conditions. While those claims remain controversial, the GAPS diet can possibly help reduce intestinal inflammation and improve digestion.

The GAPS diet is made up of many of the foods that we’ve already discussed above, such as wild fish, vegetables rich in nutrients, fresh fruits, and fermented dairy. The diet progresses in stages, with the initial phase being the most restrictive. Gradually, you’ll be able to add food groups back to your diet. For detailed instructions and a comprehensive list of all the foods you can and cannot eat, you can do an online search for the GAPS diet.

Consume coconut oil

Coconut oil is one of the most versatile foods on the planet. It helps with digestion, regulates blood sugar, balances hormones, and eliminates harmful bacteria from the body. It contains something called medium-chain fatty acids (MCFAs) ^[30], which are responsible for most of its benefits.

If you’re lactose intolerant, consuming coconut oil can help your digestion by improving gut bacteria, and by destroying candida, which is a yeast responsible for various fungal infections. Coconut oil has also been shown to help treat and prevent stomach ulcers and ulcerative colitis.

An added benefit of coconut oil is that it helps in the fight against osteoporosis, which is associated with lactose intolerance due to calcium deficiency, as we discussed above ^[35]. Coconut oil has high amounts of antioxidants to fight oxidative stress caused by free radicals, which is also a contributing factor for osteoporosis.

You can use organic cold pressed coconut oil for cooking or baking, or you can add a tablespoon to your morning smoothie.

Cook with ghee instead of butter

Ghee is a form of clarified butter that is commonly used in Indian and middle eastern cuisine. It is made by simmering butter, and the milk solids are almost entirely discarded in the process. What’s left behind is healthy fats, vitamins A, D, E, and K2, and conjugated linoleic acid (CLA), which has been shown to reduce the risk of heart disease. In addition to having a negligible amount of lactose, there are many health benefits of ghee that can help people with lactose intolerance. Ghee helps improve digestion, reduce inflammation, and strengthen bones.

Take probiotic supplements

In addition to the probiotic-rich foods discussed above, taking probiotic supplements is another convenient way to get more of the beneficial gut bacteria. Probiotic-rich foods like kimchi and kefir aren’t always easily accessible, and a supplement might help with improved digestion and better nutrient absorption. Research has also suggested that probiotic supplements can increase metabolic activities of the gut bacteria which helps break down lactose, and they can alleviate symptoms of lactose intolerance ^[32].

When picking a probiotic supplement, check the label to make sure that it contains the types of bacteria that are most beneficial for lactose intolerance. They are Lactobacillus acidophilus, Lactobacillus bulgaricus, Lactobacillus reuteri, and Streptococcus thermophilus. It’s even better if they contain prebiotics, which are bacteria that the probiotics feed on to thrive in your gut.

Take lactase supplements

Lactase is the digestive enzyme that is produced naturally in the small intestine, and it is responsible for the breakdown of lactose, the sugar in dairy. Inadequate production of lactase is the biggest reason for lactose intolerance.

Lactose intolerant people often take lactase supplements to avoid symptoms like bloating, cramps, and diarrhea. The supplements also help them absorb calcium from the dairy to maintain strong and healthy bones.

While the research is still ongoing, there is some evidence that suggests that lactase supplements, along with probiotics, can be useful in reducing symptoms of lactose intolerance. In a study conducted in 2010 that was published in the European Review for Medical and Pharmacological Sciences, researchers assigned one of three treatments to a group of sixty subjects that were lactose intolerant. One group was given probiotics, one was given lactase supplements, and the other was given a placebo. Both the lactase and probiotics groups had better results than the placebo group, and the lactase group experienced significantly greater reduction in gas from lactose intolerance ^[33].

Lactase supplements are widely available at pharmacies, natural food stores, and online. You can get them as capsules or as a chewable. For best results, take them at the beginning of each meal to facilitate better digestion.

While lactase supplements are generally safe, they might cause allergic reactions in some people. It is recommended that you consult with a medical professional before you begin taking lactase supplements.

Final thoughts on lactose intolerance

Lactose intolerance is a widespread condition that affects close to three-quarters of the global population. If you’re one of them, and you experience gas, cramps, diarrhea, or other digestive problems every time you consume dairy, you might feel like your food choices are limited. You might be tempted to avoid dairy altogether. However, since dairy has some critical health benefits, especially for your bones, it is recommended that you find a way to incorporate some dairy in your diet. Besides, there’s no reason why you shouldn’t also be able to enjoy an occasional scoop of ice cream without having to worry about digestion issues.

Try some of the remedies discussed above. You can begin by adding fermented dairy and probiotic-rich foods to your diet. Then you can start implementing a gut-friendly diet to improve your overall digestive health. Finally, for added measure, you can take probiotic and lactase supplements to help you digest dairy and reduce symptoms of lactose intolerance.

Reference List

1. ^ https://www.mayoclinic.org/diseases-conditions/lactose-intolerance/symptoms-causes/syc-20374232
2. ^ https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1000491#abstract1
3. ^ http://news.cornell.edu/stories/2005/06/lactose-intolerance-linked-ancestral-struggles-climate-diseases
4. ^ https://www.ncbi.nlm.nih.gov/pubmed/19388523
5. ^ http://ddc.musc.edu/public/diseases/small-intestine/lactose-intolerance.html
6. ^ https://www.health.harvard.edu/blog/leaky-gut-what-is-it-and-what-does-it-mean-for-you-2017092212451
7. ^ https://journals.lww.com/jcge/Abstract/2002/01000/Lactose_Intolerance_in_Active_Crohn_s_Disease_.9.aspx
8. ^ https://www.mayoclinic.org/diseases-conditions/milk-allergy/symptoms-causes/syc-20375101
9. ^ https://www.hopkinsmedicine.org/gastroenterology_hepatology/diseases_conditions/small_large_intestine/small-intestinal-bacterial-overgrowth
10. ^ http://www.cmaj.ca/content/cmaj/168/9/1141.full.pdf
11. ^ https://www.ncbi.nlm.nih.gov/pubmed/14753735
12. ^ https://www.webmd.com/diet/supplement-guide-calcium#1
13. ^ https://consensus.nih.gov/2010/lactosestatement.htm
14. ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045285/
15. ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423028/
16. ^ https://clinicaltrials.gov/ct2/show/NCT01593800
17. ^ https://www.healthline.com/nutrition/fermentation#benefits
18. ^ https://www.ncbi.nlm.nih.gov/books/NBK234703/
19. ^ https://www.ncbi.nlm.nih.gov/pubmed/6590586
20. ^ https://www.healthline.com/health/glutathione-benefits#glutathione-benefits
21. ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675497/
22. ^ https://www.nhs.uk/conditions/vitamins-and-minerals/calcium/
23. ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566462/
24. ^ https://www.bmj.com/rapid-response/2011/11/01/need-vitamin-k-calcium-supplements
25. ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3458511/
26. ^ https://www.nhs.uk/conditions/leaky-gut-syndrome/
27. ^ https://www.ncbi.nlm.nih.gov/pubmed/28174772
28. ^ https://www.ncbi.nlm.nih.gov/pubmed/24456350
29. ^ https://www.ncbi.nlm.nih.gov/pubmed/24755435
30. ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283167/
31. ^ https://www.ncbi.nlm.nih.gov/pubmed/29425071
32. ^ https://www.ncbi.nlm.nih.gov/pubmed/17927751
33. ^ https://www.europeanreview.org/article/719
34. ^ https://www.ncbi.nlm.nih.gov/pubmed/18521965
35. ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3457741/
36. ^ https://academic.oup.com/ajcn/article/100/4/1075/4576460
37. ^ https://www.verywellhealth.com/leaky-gut-syndrome-and-ibs-1945200