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

by Kirsten Jackson Specialist Dietitian 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
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Filed Under: IBS Dietary Advice Tagged With: lactose intolerance

About Kirsten Jackson Specialist Dietitian

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.

Previous Post: « What Are Prebiotics & Should You Be Taking Them?
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CONSTIPATION vs LOW FODMAP DIET - share this post. CONSTIPATION vs LOW FODMAP DIET - share this post.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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💩The low FODMAP diet is not a 1 size fits all approach and can worsen constipation.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙋‍♀️The low FODMAP diet works by reducing gas production in your large bowel (the bit at the end) and reducing the amount of fluid drawn into your large bowel. But, this gas and fluid may actually help you open your bowels so if you simply remove it then your constipation will likely get worse.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🤓Instead, you need to use a balance of fiber, fluid and movement to allow your bowels to open regularly. THEN you can use the low FODMAP diet to reduce gas (and the flatulence and pain that comes with this).⠀⠀⠀⠀⠀⠀⠀⠀⠀
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DID YOU GET DIAGNOSED PROPERLY? - share this post. DID YOU GET DIAGNOSED PROPERLY? - share this post.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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💩Sadly, there is no 1 test for IBS diagnosis. Instead, it is diagnosed by eliminating other conditions. Conditions such as coeliac disease, IBD, infections and even bowel cancer have similar symptoms. So, your doctor will do routine 'first line' testing for these.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙋‍♀️I often hear from clients that they are not sure if they have had the correct tests or not. The tests above come from UK medical guidelines called NICE (IBS 2008 Guidelines) and are considered 'gold standard' for IBS diagnosis. ⠀⠀⠀⠀⠀⠀⠀⠀⠀
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👩🏽‍⚕️There are times that your doctor may wish to do additional testing if they feel that your symptom history indicates it or one of these initial tests come back positive. For example, if you have issues with your periods then your doctor may consider a gynae issue and want to do an ultrasound scan.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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✅BUT the main point is, you should be getting the above tests done and anything else should have a strong reasoning behind it.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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THE REALITY OF IBS - share this post. ⠀⠀⠀⠀ THE REALITY OF IBS - share this post.
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💩IBS is a condition that others do not see. The things that others may see is an individual who is low in mood, perhaps often cancels last minute and seems to avoid many foods.
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🙋‍♀️So to all those people who have a friend / colleague / partner / relative in their life who has IBS. Please know that they are not trying to be this way, it is the uncontrolled IBS that has this impact. Please know that people with IBS need your support.
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‼️If you have IBS, please do check out my free gut healthy morning routine. Starting the day off the right way can really help (link in bio).
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SHARE THIS POST 🙏 - raise awareness of fads ⠀ SHARE THIS POST 🙏 - raise awareness of fads
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💩Colonic hydrotherapy / irrigation.
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🧐This is an alternative therapy offering whereby the therapist inserts a tube up your rectum. Warm water is then flushed through your colon. It is claimed to 'detox' or 'cleanse' your bowel. Sometimes this water contains herbs or even coffee.
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🤓There is no research backing up these claims at all. In fact, the research shows there is a risk of bowel perforation. There has even been cases of serious digestive infections and death.
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🙋‍♀️There is 1 small study looking at IBS. Symptoms appear to improve.  BUT when we look at the study closer, it is small, doesn't show what would happen long term and participants had to have 2 colonics a day for 6 days a week! (you can find more information and references on this in my latest blog post www.thefoodtreatmentclinic.com).
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👩🏽‍⚕️The NHS also warn against this intervention for people with several health conditions such as kidney disease, IBD and haemorrhoids.
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🙋‍♀️My conclusion is this..please do not go down this route. If you are severely impacted then speak to your doctor.
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🎉If you want to start the day off right, download my FREE morning guide (link in bio).
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CAN YOU RELATE?. Comment below ⬇️⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙋‍♀️Confession time,  I actually thought like this until I got it myself - urgh what a difference that insight makes hey!.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙋‍♀️What I find is that my clients (like I did) try to down play the issue.  They don't allow themselves to feel like its ok to feel like crap because IBS 'isn't that serious.' BUT realistically it impacts every area of your life from the moment you wake up each day. SO allow yourself to feel crap about this condition.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙃THEN..take a breath. What can you do next? I would always advise seeking a dietitian out to guide you because quite frankly, this situation can not continue.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🎉If you would like to start each day the right way for your IBS, please download my FREE Morning routine guide - link in bio.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙏Pic credit: @youvegutthis⠀⠀⠀⠀⠀⠀⠀⠀⠀
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CLIENT TESTIMONIAL.⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀ CLIENT TESTIMONIAL.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙏Thank you for your kind words.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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😀This lady really deserves this outcome. She took onboard advice and always respected the process, never looking for overnight success.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙋‍♀️Please DM me if you would like further information about my 1:1 programme.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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WHAT WOULD YOU MAKE? COMMENT BELOW ⬇️⠀⠀⠀ WHAT WOULD YOU MAKE? COMMENT BELOW ⬇️⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙋‍♀️Personally I love a good winter salad with warm root vegetables and feta cheese OR a soup - both of these options will give you a good range and quantity of fiber and by using low FODMAP options you can avoid the bloat to go along with this.⠀⠀⠀⠀⠀⠀⠀⠀⠀

🤓Remember to always check safe portions with @monashfodmap ⠀⠀⠀
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‼️ If you are confused about your IBS and wish to gain more clarity, sign up for my FREE IBS webinar - link in bio.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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‼️GLUTEN IS NOT AN IBS TRIGGER - SHARE THIS PO ‼️GLUTEN IS NOT AN IBS TRIGGER - SHARE THIS POST 🙏.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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👇Comment below if 1/ You have been told to avoid gluten for your IBS or 2/ You thought gluten triggers your IBS.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🤷‍♀️Firstly, what is gluten? Gluten is a protein found in wheat, barely and rye.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🤓Gluten only causes digestive problems for those with either coeliac disease or a gluten allergy (the later of which I have never seen in my career to date).⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🤯You may think gluten causes you issues BECAUSE many foods which contain gluten also contain fructans. These are a type of FODMAP which cause cause bloating, loose stools and stomach pain in those with IBS.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🤯You may eat many 'gluten free' foods on the low FODMAP diet because you are avoiding wheat in order to avoid the fructans, not the gluten.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙋‍♀️So why do I care? Being gluten free is very restrictive, especially if you do not need to be. If you are intolerant to fructans you will be able to manage small amounts which means your diet will be more varied, contain more prebiotic foods and probably cheaper also!⠀⠀⠀⠀⠀⠀⠀⠀⠀
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‼️If you are confused about your IBS and wish to gain more clarity, sign up for my FREE IBS webinar - link in bio.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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#ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #bloating #irritablebowelsyndrome #fodmapfree  #healthygut #goodguthealth #gutfood #trustyourgut #chronichealth #microbiome #chronicallyunwell #glutenfree #glutenintolerant #gluten #dubailife #glutenphobia
ANYONE? - Please share to raise awarness that no o ANYONE? - Please share to raise awarness that no one should feel guilty for eating.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🤷‍♀️Anyone knowingly do this? Comment below ⬇️⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙋‍♀️Yep me also! Because, it is a normal human thing to do.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙋‍♀️So my client the other day was telling me how guilty they felt for eating a pizza despite being on the restriction phase of the low FODMAP diet. They felt ashamed and useless. But, we talked through this feeling. Sometimes our thoughts are not really based on any viable facts. The facts being that she had 1 pizza, was bloated and had looser stools the next day. THE END. No one died and she didn't 'mess up' the whole process.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙃So next time this happens (because you are human and there will be a next time). Just think of the facts before you let your emotions run away. Then move on .⠀⠀⠀⠀⠀⠀⠀⠀⠀
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‼️If you are confused about your IBS and wish to gain more clarity, sign up for my FREE IBS webinar - link in bio.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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#ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #bloating #irritablebowelsyndrome #fodmapfree  #healthygut #goodguthealth #gutfood #trustyourgut #chronichealth #microbiome #fermentedfoods #dubaidietitian #londondietitian #dubailife #glutenfree #dairyfree #prebiotics #yoga
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