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Kirsten Jackson Consultant BSc Hons PG Cert RD

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Lactose Intolerance – What is it? How Is It Diagnosed? How Do I Manage It?

by Kirsten Jackson Consultant Dietitian BSc Hons, RD, PG Cert Leave a Comment

Lactose intolerance is a common gastrointestinal complaint. Find out what lactose intolerance is and how to manage it safely.

milk for lactose intolerance article

What is Lactose?

Lactose is a type of sugar that is naturally found in milk and milk products such as yoghurts, cheese, ice cream and chocolate.

Lactose is broken down by an enzyme called lactase, which is produced in the lining of the small intestine. Lactose is then absorbed into the body (1).

What is Lactose intolerance?

Lactose intolerance is an impaired ability for the body to breakdown lactose. This may be due to a lactase enzyme deficiency which can be present from birth (congenital lactase deficiency) or may be present itself in adulthood due to a reduced production of lactase by the gut.

A reduced production of lactase in the gut occurs in people with coeliac disease, inflammatory bowel disease (such as Crohns disease) or gastritis. In these conditions, the gut lining is damaged and unable to make lactase to break down lactose.

In most conditions, the gut is only temporarily damaged, individuals are usually able to go on to manage lactose again, i.e. in gastritis or in coeliac disease (1, 2).

Symptoms and diagnosis

If lactose containing foods are eaten in those with lactose intolerance, lactose can build up in the intestines. The built up lactose attracts water molecules into the gut – causing diarrhoea. Whilst gut bacteria works to break down the lactose – producing gas.

Symptoms of lactose intolerance;

  • Diarrhoea
  • Bloating
  • Abdominal pains
  • Stomach cramps
  • Flatulence
  • Nausea

These symptoms are very similar to many other digestive conditions and therefore a number of tests need to occur to confirm your diagnosis. Failure to do this may lead to you not being diagnosed correctly and you could suffer with some serious long-term health conditions (1, 2, 3).

Diagnosis can be done by your doctor via a hydrogen breath test. This test measures how much gas (hydrogen) is produced by your gut bacteria when you have lactose. A higher reading can confirm lactose intolerance.

Lactose intolerance can also be confirmed by following a lactose free diet for around 2-4 weeks and monitoring if your symptoms are relieved. Confirmation of lactose intolerance would then be made by reintroducing milk based foods into your diet and assessing if your symptoms return. The best way to assess this is via a food and symptom diary under direction of a dietitian (1, 2, 3).

Lactose Intolerance vs Milk Allergy

We now know lactose intolerance occurs due to a lactase deficiency. However, a milk allergy is when our bodies produce an immune reaction to a cow’s milk protein present in milk products causing eczema and gut symptoms.

This usually presents itself in childhood on exposure to either formula milk, cow’s milk as a toddler or in more sensitive cases breastmilk from a mother who has cow’s milk in her diet. The confusion between the two arises as the treatment is also a milk free diet however the cause is the symptoms is very different (3, 4).

Can You Have Any Lactose?

In short, yes!

The amount of lactose tolerated varies between all adults. However, those with a lactose intolerance can manage around 12g of lactose a day. This is the same as around 200mls of milk (a small glass) or a small tub of yoghurt (125g).

To find out what your ‘tolerance’ level is, start by reintroducing a small amount and over several days increase it slowly until you find your symptoms are flared up.

What Does This Mean For My Diet?

It is essential that you replace lactose containing foods with lactose free alternatives in order to make sure that you are not missing out on the nutrition provided from the dairy food group – calcium, protein and vitamin B12.

Many lactose free products are now widely available for alternatives to milk, yoghurts, cheese and butter. These are usually made from oats, soya, rice, coconut, cashews, hazelnuts or almonds, so it is important to try a range of products to see which one you like the taste of the best. Ensure that the product you choose is fortified with calcium and vitamin B12. Ensure that you are having around 2- 3 portions of lactose free alternatives a day to meet your calcium requirements (see BDA diet sheet below for further details).

Unlike a milk free diet for those with an allergy, those with a lactose intolerance can have small amounts of lactose as previously discussed. There are also dairy foods which, you may be surprised to find, have hardly any lactose in them at all –  cheddar, feta, mozzarella, edam, brie, goats cheese, camembert, pecorino, Swiss cheese, blue cheese, butter, margarine, sour cream, crème fraiche and dark chocolate (2,4,5).

Please note, those with coeliac disease have higher daily calcium requirements but you should be under a dietitian who will help you with meeting this (1, 2, 3, 4).

Bottom Line

If you have any of the symptoms above, please seek advice from your GP. After they rule out other digestive health issues, you may be offered a hydrogen breath test or you can seek out a dietitian to support you through a lactose restriction and reintroduction diet.

If you have lactose intolerance, then ensure your calcium and vitamin B12 levels are sufficient. Depending on the cause of your intolerance, you may overcome lactose intolerance in the future. However, all those with lactose intolerance can tolerate small amounts of lactose in their diet.

Article Written Dietitian Olivia Done

Edited & Reviewed by Dietitian Kirsten Crothers

For more information:

Coeliac UK: Coeliac Disease and Lactose Intolerance

BDA Factsheet on Milk allergy and Lactose intolerance

References

  1. Truby,H., Hart, K. and Dart,J. (2015) Malabsorption. In J. Gandy (Ed) The manual of dietetic practice (5th edition) (pp. 420-425). Oxford, United Kingdom. John Wiley and Sons Ltd.
  2. National and Dietetic Resources UK (2014) Milk-free Zone information leaflet

Filed Under: Dietary Advice (non Low FODMAP) Tagged With: lactose intolerance

About Kirsten Jackson Consultant Dietitian BSc Hons, RD, PG Cert

Kirsten Jackson is a UK registered Consultant Gastroenterology Dietitian and founder of The Food Treatment Clinic. She has undergone many qualifications to get where she is today, including a UK BSc Honours Degree in Dietetics and Post-Graduate Certificate in Advanced Dietetics. In addition to this, she has FODMAP Training from Kings College London University. Kirsten set up The Food Treatment Clinic in 2015 after first experiencing digestive problems herself. She felt that the NHS was unable to provide the support individuals needed and went on to specialise in this area before opening a bespoke IBS service. Kirsten also participates in charity work as an Expert Advisor for the IBS Network. In addition, she can be seen in publications such as Cosmopolitan and The Telegraph discussing IBS as an Official Media Spokesperson to the IBS Network.

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the.ibsdietitian

the.ibsdietitian
🤔 WHAT IS YOUR EXPERIENCE WITH THE FODMAP DIET? 🤔 WHAT IS YOUR EXPERIENCE WITH THE FODMAP DIET? COMMENT 👇 
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👉So you tried the low fodmap diet with the hopes and promises that it would fix your IBS. You stuck with the relentless restrictive diet for what felt like weeks…but yet achieved no results 😞 Leaving you feeling hopeless and defeated. 
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👉 but I’m here to tell you that the low FODMAP diet doesn’t work for everyone and thats OKAY! There are other options that we use for individuals who follow the Take Control Programme. There is hope so please hold on in there 🙏🏻.
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🎉 🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.⠀
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#ibs #ibsdietitian #lowfodmap #lowfodmapdiet #lowfodmaprecipe #irritablebowelsyndrome #guthealth #guthealthdiet
CAN YOU RELATE? ​​​​​​​​​​​​​​​​
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😭 I think this post emphasises the point that NOT EVERY DISABILITY IS VISIBLE. As IBS sufferers we often hide our pain in silence day in day out, hoping nobody notices or asks questions. When people ask how we’re doing, we do the polite thing and reply with “I’m fine”. Leaving the burden of IBS to be dealt with alone…​​​​​​​​​​​​​​​​
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🤔 But what about instead of struggling alone in silence, you embody the Take Control Method whereby you prioritise emotional support. Open up to a friend, a colleague or a loved one - problem shared is a problem halved. ❤️​​​​​​​​​​​​​​​​
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🎉 🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.⠀⠀⠀⠀​​​​​​​​
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😳WHAT ELSE WOULD YOU ADD? Comment below! ​​ 😳WHAT ELSE WOULD YOU ADD? Comment below! ​​​​​​​​​​​​​​​​
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☹️This starter pack is the daily reality for IBS sufferers 😔. Living with IBS can cause anxiety, and this anxiety then leads to worsening of symptoms, leading to you developing what some would see as ridiculous coping mechanisms like only wearing baggy clothing and always carrying a spare pair of underwear wherever we go…​​​​​​​​​​​​​​​​
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🤩But what if it doesn’t have to be this way. What if you didn’t have to feel that looming anxiety Every. Single. Day. The Take Control Method can take you through making small sustainable changes so you can ditch the extra pair of underwear.​​​​​​​​​​​​​​​​
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🎉 🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.⠀⠀⠀⠀ ⠀⠀⠀⠀⠀⠀⠀​​​​​​​​
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#ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #lowfodmapdiet #bloating #irritablebowelsyndrome #fodmapfree  #gutinstinct #healthygut #ibsd #ibd #tea #5steps #chronichealth #multifactorial. #chronicallyunwell #endo #ibstype #ibstyping #ibsc
🤔WHICH OF THESE TRUTHS SURPRISE YOU? ​​​​​​​​​​​​​​​​
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😠There is a lot of misinformation out there on gut health/IBS and it drives me mad. And it’s this type of misleading information that can leave individuals worth off with their IBS than where they originally started. 😔 ​​​​​​​​​​​​​​​​
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😍Instead of wasting your time and money on supplements, fad diets and intolerance tests (the list goes on) why not focus on the core foundations of IBS management - diet, movement, sleep and mental health. In the Take Control Method we make small changes in each of these areas which leads to life-changing differences.​​​​​​​​​​​​​​​​
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🎉 🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.⠀​​​​​​​​
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🐶Comment below if you think doctors should star 🐶Comment below if you think doctors should start prescribing dogs🤷‍♀️⠀⠀⠀⠀⠀⠀⠀⠀⠀​​​​​​​​​​​​​​​​
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🙃OK - disclaimer here - there is no research on dogs and their impact on IBS but if this goes ahead I am so signing up! They double up as a hot water bottle and a cuddling companion - perfect after a rough day of IBS symptoms 🙏🏻.​​​​​​​​​​​​​​​​
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🥰If you find your dog can help you when you’re in a rut with your IBS symptoms then the Take Control Programme supports you! Emotional support, whether that is in the form of a human being or a fluffy animal is key to mastering your IBS symptoms.​​​​​​​​​​​​​​​​
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🎉 🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.⠀ ⠀⠀⠀⠀⠀⠀⠀⠀​​​​​​​​​​​​​​​​
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WHAT ELSE WOULD YOU ADD? 😔
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😥 IBS not only impacts your life but it  impacts those around you too…and it can lead you to feeling really guilty when your IBS gets in the way of your relationship even though it’s not your fault…
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👩‍❤️‍💋‍👨This is why explaining to your partner what is going on can be crucial to having a harmonious relationship. You may even find that opening up to them helps you to manage your IBS as you’re less stressed about letting them down. In the Take Control Programme we emphasise that it is crucial that you have this support in place to manage your IBS 🙏🏻. 
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🎉 🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.⠀
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#ibs #irritablebowelsyndrome #lowfodmapdiet #lowfodmaprecipes #guthealth #ibsdietitian #ibsdietician
🤔 DO YOU HAVE AN ACTUAL DIAGNOSIS OF IBS? ​​​​​​​​
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🙁A lot of people assume that they have IBS when their digestive system isn’t working the way that it usually should be. You may think this is a fair assumption, but your symptoms may actually be red flags for other conditions such as Inflammatory Bowel Disease (IBD). This is not good as a misdiagnosis leads to inappropriate treatment.​​​​​​​​
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❤️ In the Take Control Programme we always ensure that IBS has been officially diagnosed prior to starting your management journey. Look up ‘How to Get an Official IBS Diagnosis’ on my website if you’re unsure where to start.​​​​​​​​
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🎉 🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE top 10 IBS mistakes! Link in bio.⠀​​​​​​​​
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#ibs #irritablebowelsyndrome #lowfodmapdiet #lowfodmaprecipes #guthealth #ibsdietitian #ibsdietician
📺 Last weekend I was on UK TV being interviewed 📺 Last weekend I was on UK TV being interviewed by the legendary @therealtrishagoddard all about the recent salmonella outbreak.

⏩ Overview of what we discussed.
👉 Salmonella is a bacteria which can live in the intestines of animals (including us humans).
👉 It is passed on via infected faeces contaminating your food.
👉 Good hand hygiene and safe food storage and prep is vital to prevent this.
👉 Do NOT wash raw chicken as this can lead to contamination of your kitchen with salmonella
👉 Symptoms of salmonella can range from none to fatal (rare). But typically people will get a fever, vomitting and diarrhoea for 5-7 days.

⏩ For further concerns over this particular outbreak please do check out the @foodgov website

#salmonella #publichealth @bda_dietitians
HAVE YOU HEARD SOMETHING LIKE THIS BEFORE? 🥺​ HAVE YOU HEARD SOMETHING LIKE THIS BEFORE? 🥺​​​​​​​​
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☹️ IBS is often belittled as a condition that 'isn't that bad'. by friends, by family and even by healthcare professionals. It leaves you feeling frustrated but also second guessing your own pain and struggles... ​​​​​​​​
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💪I am here to tell you that you have every right to advocate for your own health - if you won't, no one else will. Surrounding yourself with people who understand what you're going through, and defying those who belittle it is key. Social support is a key element of my Take Control Programme.​​​​​​​​
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🎉 🎉 Have you downloaded my FREE IBS guide yet? The link is in the bio. 🤩 ​​​​​​​​
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#ibs #irritablebowelsyndrome #ibsdiet #lowfodmap #lowfodmaprecipe #ibsdietitian #ibsdietician
Have you been impacted by this? 😔 ❤️​​​​​​​​
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😞As I’m sure lots of you can relate, IBS has a close link with our mental health, including the link between IBS and depression. Poor mental health can lead to worsening of our symptoms, and our IBS symptoms can lead to worse mental health…it’s a vicious circle 😥. ​​​​​​​​
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🙏🏻 the good news is there are multiple ways to help manage your mental health. Adopt the Take Control Approach and prioritise your mental health. Not tomorrow, not next week but now as it is a core element to IBS management ❤️. ​​​​​​​​
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🎉 🎉 Are you ready to FINALLY master your IBS? Book a FREE 15 minute discovery call with me or my colleagues. 🤩 ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀​​​​​​​​
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#ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #lowfodmapdiet #bloating #irritablebowelsyndrome #fodmapfree  #gutinstinct #healthygut #ibsd #chronichealth #multifactorial #ibstype #ibstyping #ibsc
DO YOU MOVE FOR YOUR GUT HEALTH? Comment below 👇​​​​​​​​​​​​​​​​
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🥵We all know exercise is good for us, but the thought of intensive HIIT workouts doesn't exactly appeal to all of us...in fact intense exercise can actually contribute to IBS symptoms for some.​​​​​​​​​​​​​​​​
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🤔But what if it didn't have to be so complicated? Instead of seeing movement as a scary and intense activity, why not try walking? - this counts as movement and has so many fabulous benefits for IBS as listed above  Movement is one of the KEY pillars of IBS management that we tackle in my Take Control Programme.​​​​​​​​​​​​​​​​
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🎉 🎉 Are you ready to FINALLY master your IBS with guidance? Book a 15 minute enquiry call with me or my colleague (link in bio). 🤩 
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#ibs #walking #movement #irritablebowelsyndrome #ibsexpert
🤔 Have you ever tried to eat intuitively? ​​​​​​​​
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🤝 Myself and @wholistic_health_and_wellness have teamed up to look at how intuitive eating could help you with your IBS. Because there is such a strong relationship between IBS and disordered eating behaviors, it’s important to look at our relationship with food when working to reduce IBS symptoms.​​​​​​​​
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🥰Learning to eat intuitively is a great way to improve your relationship with food, remove guilt and stress from the eating experience, reconnect with hunger and fullness cues, and find the foods that work best with your body!​​​​​​​​
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#intuitiveeating #healthyeating #mindfulness #disorderedeating #eatingdisorder #ibs #ibsdiet #lowfodmap
DO YOU DO ANY OF THESE? 😔 ​​​​​​​ DO YOU DO ANY OF THESE? 😔 ​​​​​​​​
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👉 In IBS, there are a lot of subtle behaviour changes that we make in order to hide our struggle 😕. We are scared if the judgement and we are scared of being singled out 😭. ​​​​​​​​
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👉 Instead of making behaviour changes to mask your symptoms, why not try making small changes to reduce your symptoms? In the Take Control Method we encourage individuals to be open about their problems, instead of hiding them from others so that they can receive the the support they need to put these changes in place ❤️. ​​​​​​​​
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🎉 🎉 Are you ready to FINALLY master your IBS with guidance? Book a 15 minute enquiry call with me or my colleague (link in bio). 🤩 ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀​​​​​​​​
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#ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #lowfodmapdiet #bloating #irritablebowelsyndrome #fodmapfree  #gutinstinct #healthygut #ibsd #ibd #tea #5steps #chronichealth #multifactorial. #chronicallyunwell #endo #ibstype #ibstyping #ibsc
WHICH ONE ARE YOU? Comment below!​​​​​​​​​​​​​​​​
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👉I will say it time and time again... IBS is SO individualised and personal. No 2 clients ever look the same. This is why generic IBS advice often does not lead to the results that you are hoping for. Taking a random probiotic, eating more fibre or even trying the low FODMAP diet (without professional help) can leave many IBS sufferers no nearer to symptom relief than they were...​​​​​​​​​​​​​​​​
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🤩This is why working with an expert in the field of IBS is so crucial in order to get that specific advice that you need to achieve your symptom relief - we value that everyone is different and it is not a one size fits all world❤️.​​​​​​​​​​​​​​​​
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🎉 🎉 Are you ready to FINALLY master your IBS? Book a FREE 15 minute discovery call with me or my colleagues. 🤩​​​​​​​​
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#ibs #irritiablebowelsyndrome #ibsdiet #lowfodmap #lowfodmaprecipes #ibsc #ibsd
Do you suffer with any of these other symptoms? CO Do you suffer with any of these other symptoms? COMMENT BELOW.
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🤦‍♀️Your 'IBS' may actually be a histamine intolerance as some symptoms are similar. Additional symptoms include headaches, itchy skin and sinus problems - symptoms vary though.
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🤦‍♀️A histamine intolerance is caused by a lack of the enzymes which would normally break histamine down. Leading to an overload of histamine in the body.
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🤦‍♀️Histamines are found naturally occurring in certain foods and how a food is processed can impact the histamine quantity.
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🤦‍♀️This intolerance is diagnosed by symptoms improving whilst avoiding histamines and these symptoms then come back with the reintroduction of histamines (to confirm). Please note though that you should always visit your doctor first to rule out other conditions that can also cause these symptoms.
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🤔Having a histamine intolerance is not like having an allergy. You will have a certain tolerance level and it is important to work this out in order to avoid an overly restrictive diet. 
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🤩We cover histamine intolerances in my NEW histamine intolerance E-Book! 
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#ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #lowfodmapdiet #bloating #irritablebowelsyndrome #fodmapfree  #gutinstinct #healthygut #mumlife #dubaimom #constipation #chronicpain #chronicallyunwell #women'shealth #histamine #foodchemicalintolerances
👇Do you get any symptoms of histamine intoleran 👇Do you get any symptoms of histamine intolerance? Comment below?​​​​​​​​
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🤓Histamine intolerance impacts 1-3% of the population (more than coeliac disease which you would have been tested for as part of your IBS diagnosis).​​​​​​​​
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🙃The symptoms of histamine intolerance do have some overlap. If you have IBS but have seen no relief with typical IBS treatments you may well have histamine intolerance.​​​​​​​​
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🎉Check out our new E-Book all about this condition, how to diagnose it and how to manage it (link in bio).​​​​​​​​
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#histamineintolerance #ibssymptoms #guthealthdiagnosis #histamineguide
🎉 Histamine Intolerance E Book - on sale now 🔗 link in bio.​​​​​​​​
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→58 pages​​​​​​​​
→Histamine intolerance diagnosis protocol​​​​​​​​
→Meal plan​​​​​​​​
→Recipes​​​​​​​​
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‼️ A step by step guide based on scientific facts to help people get accurately diagnosed with histamine intolerance.​​​​​​​​
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#histamineintolerance #ibs #guthealth #dietitians #refractoryibs #itchyskin #foodintoleranceguide
Anyone investing in this?🤷‍♀️ comment bel Anyone investing in this?🤷‍♀️ comment below 👇 ​​​​​​​​​​​​​​​​
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​​​​🤩🤩Fed up of being fed up with your IBS? Download my free top 10 IBS mistakes! - link in bio!​​​​​​​​​​​​​​​​
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#onions #elonmusk #ibs #ibsmemes
WHAT IS YOUR BINGO LOOKING LIKE? 😔 comment belo WHAT IS YOUR BINGO LOOKING LIKE? 😔 comment below 👇 ​​​​​​​​
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😥 IBS can be unpredictable in nature and it can feel like you never know if you’re going to have a good or bad day…You try to pinpoint a trigger but gosh is it hard 😫.​​​​​​​​
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😊 But what if you could predict the future? Identifying YOUR personal triggers and how to manage these is key to Taking Control of your IBS and is an integral part of the Take Control Programme. Why not try filling out a food and mood diary this week to see if you can pinpoint if what you eat and/or your feelings play a role? ​​​​​​​​
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🤩🤩Fed up of being fed up with your IBS? Download my free top 10 IBS mistakes! - link in bio!​​​​​​​​
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#ibs #ibsdiet #irritablebowelsyndrome #guthealth #guthealing #lowfodmap #lowfodmaprecipes #gutissues #healthygut
❤️As April is IBS awareness month, myself and ❤️As April is IBS awareness month, myself and @dieteticallyspeaking have teamed up to spread the word about the relationship between disordered eating and IBS.
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➡️Swipe for information about the overlap between these conditions and also how this relationship can go in either direction i.e. there’s s higher risk of gut issues with disordered eating or an eating disorder and a higher risk of disordered eating with IBS.
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🥰For more information go to @dieteticallyspeaking bio for a full article about this important topic! 
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#ibs #ibsawarenessmonth #guthealth #guthealing #disorderedeating #eating disorder
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