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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

Table of Contents

  • What is Lactose?
  • What is Lactose intolerance?
  • Symptoms and diagnosis
  • Lactose Intolerance vs Milk Allergy
  • Can You Have Any Lactose?
  • What Does This Mean For My Diet?
  • Bottom Line
  • For more information:
  • References

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, crΓ¨me 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
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.

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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I would love to know - how does your work impact y I would love to know - how does your work impact your gut health?πŸ‘‡πŸ‘‡β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹
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😳 Despite the multiple tests out there claiming to diagnose food intolerances, you can't actually test for an intolerance πŸ˜…. This means many people are wasting πŸ’°πŸ’° and following restrictive diets unnecessarily.

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😊️ Instead of going through this alone, adopt the Take Control approach of community..​this could look like taking a step to reach out to a loved one that will you trust or joining an online group of other people with IBS who 'get it'. Doing this will make you feel seen when your IBS takes you for a ride. 
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Having IBS can really take a toll on your mental​​​​​​​​​​​​​​​​
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πŸ™Œ In the Take Control Approach 2.0 focuses on research proven advice around the 4 pillars of IBS management - sleep, movement, nutrition and diet. By following research based advice that you can trust, you can start to see improvements and feel like you again. ​​​​​​​​
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πŸ§…πŸΉπŸŽ Whilst this article points out 10 common IBS triggers, it's important to note that everyone will have different tolerance levels and there is no 1 cookie cutter diet for people with IBS.

πŸ™ To find out your intolerances it is important to work through the low FODMAP process which will give you specific answers.

πŸ‘€ Read the full article https://www.cosmopolitan.com/uk/body/diet-nutrition/a13057878/foods-to-avoid-ibs/

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πŸ‘‰Anyone else feel like they just can't catch a break from IBS for just one minute? IBS is a debilitating condition that can impact so many aspects of your life, the big and the small things - they can all be a struggle when you have IBS!​​​​​​​​
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πŸ‘ But what if you could fully understand your IBS so you were able to identify your triggers AND improve your gut health so it was less sensitive? This would allow you to get on with tasks big or small without feeling overwhelmed. The Take Control 2.0 approach allows you to look at all aspects of your life to give you back control of your life!​​​​​​​​
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πŸŽ‰ πŸŽ‰ I am giving away a FREE IBS morning routine guide which you can download via the link in my bio. ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀​​​​​​​​​​​​​​​​​​​​​​​​
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πŸ˜ͺ When following a low FODMAP diet, consuming enough fibre may be challenging as often high fibre foods are restricted. However, eating enough fibre is essential for helping bulk and soften stools! ​​​​​​​​​​​​​​​​
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🀩 Life should not have to be this challenging! ​​​​​​​​Using the Take Control 2.0 approach can allow you to discover foods and drinks which you can tolerate to improve your fibre intake - which is so important for gut health!​​​​​​​​
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πŸ₯³ Fed up of trying everything you can but nothing seems to be working? Download my FREE IBS morning guide! Link in bio.​​​​​​​​​​​​​​​​
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πŸ™‹πŸΌβ€β™€οΈ I am a huge advocate of the Mediterranean diet because it is repeatedly shown to be the best option for our health regardless of what is studied. AND especially in gut health.

πŸ’© Including wholegrain, oily fish, plenty of veggies, fruits, nuts and olive oil is easy with a few tweaks to any diet!

βœ… Swap your white carbs to brown
βœ… Add 2 portions of fish per week - one should be oily like mackerel or salmon
βœ… Eat the rainbow with fruit and veg
βœ… Snack on nuts
βœ… Switch your oil to olive oil

πŸ’©πŸ’© What could you do this week to make your diet more in line with the Mediterranean diet? comment below πŸ‘‡
DO YOU MOVE FOR YOUR GUT HEALTH? Comment below πŸ‘‡β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹
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πŸ₯΅ We get told that the more intense we exercise, the better. But exercising intensely can trigger our IBS, making us feel confused about the best way to stay healthy and control our symptoms. ​​​​​​​​
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πŸ€” In reality, people like to over complicate exercise. This is why we use the term 'movement' in the Take Control method. Avoid the confusion and keep it simple by going for a daily 30 min gentle walk and you will see the benefits!​​​​​​​​
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πŸŽ‰ Fed up of trying everything you can but nothing seems to be working? Download my FREE IBS morning guide! Link in bio.​​​​​​​​​​​​​​​​​​​​​​​​
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πŸ€” Can you relate to any of these comments? Let πŸ€” Can you relate to any of these comments? Let me know below πŸ‘‡ ​​​​​​​​
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πŸ˜” When you have IBS, you may feel that how you come across appears rude at times. IBS impacts every area of your life and you can feel you are constantly having to cover it up. Over time, this style of 'coping' can leave you feeling pretty isolated.​​​​​​​​
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πŸ™ Instead of treading water with your symptoms, use research proven methods such as the low FODMAP diet process and mindfulness (part of the Take Control approach) to move forward with your symptoms and regain confidence in yourself and your social life!​​​​​​​​
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πŸŽ‰ πŸŽ‰ I am giving away a FREE IBS morning routine guide which you can download via the link in my bio.​​​​​​​​
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#ibs #ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #lowfodmapdiet #bloating #irritablebowelsyndrome #fodmapfree  #gutinstinct #healthygut #ibsd #ibd #chronichealth
⏩ Do you suffer from bloating? Comment below πŸ‘‡β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹
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🀰 Bloating is a common symptom for those suffering with uncontrolled IBS. Having bloating which is unpredictable and there everyday will make you feel tired, impact your relationship with your body and give you real anxiety about eating food.​​​​​​​​
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⏩ Instead of suffering with unpredictable bloating try the Take Control 2.0 approach of using the low FODMAP diet to identify your dietary triggers. By doing this, you can avoid foods which cause you bloating and start to feel more confident in your body.​​​​​​​​
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πŸŽ‰ Would you like to start the day in a way which would benefit your gut? Download my FREE IBS morning guide! Link in bio.​​​​​​​​​​​​​​​​
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#ibsbloattips #ibsbloat #ibs #ibsdiet #ibsmanagement #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #lowfodmapdiet #bloating #irritablebowelsyndrome #fodmapfree #gutinstinct #healthygut #ibsd #ibsmanagement #ibssymptomrelief #ibshelp
WHAT WOULD YOU ADD? Comment below πŸ‘‡ ​​​​​​​​​​​​​​​​
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😣 IBS is a condition that others cannot see. As humans, we struggle to understand or truly believe in things that we can't touch, hold or see. As a result, IBS sufferers often feel quite alone.⠀⠀⠀⠀⠀⠀⠀⠀⠀​​​​​​​​​​​​​​​​
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πŸ˜‡ IBS is estimated to affect 5-10% of the worldwide population - so you really aren’t alone! Follow the Take Control process of finding a community to support you - there are lots of online forums where you can chat and share your worries with other people who completely understand. ​​​​​​​​
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πŸŽ‰ πŸŽ‰ Fed up of trying everything you can but nothing seems to be working? Download my FREE IBS morning routine guide! Link in bio.⠀⠀⠀⠀⠀⠀​​​​​​​​​​​​​​​​
⠀⠀⠀⠀⠀⠀⠀⠀⠀​​​​​​​​​​​​​​​​
#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 #ibswishes
⁉️ Have you heard of these symptoms before?

😳 Both of these symptoms can be caused by a few things and one of them is bowel cancer. But we don't know based on symptoms alone so please go and get checked.

🩸Blood can appear on a toilet tissue, in the toilet bowl or it can look like part or all of your stool is black.

βš–οΈ Unexplained weight loss means that you have lost weight despite eating adequate calories and not really changing your exercise routine. It can be common in IBS to lose weight but this is due to eating less food and so it is explainable.

πŸ™πŸ™ If you have either of these symptoms please see your doctor to get checked, don't take the chance.

#bowelcancer #cancer #theibsdietitian
😭 Can you relate? Comment belowπŸ‘‡πŸ‘‡β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹β€‹
😫 Suffering from IBS can be difficult and burdensome especially when trying to go about your daily life. IBS is a condition that cannot be seen which makes it even more difficult for others to understand and can often feel very isolating😒. 

πŸ‘‰ Instead of keeping this condition to yourself, adopt the Take Control principle of community and get support from people who also have this condition. You can do this by opening up to friends (1 in 10 people have this!) or joining  online FB groups - this way you won't feel so alone in your fight! 
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πŸŽ‰ πŸŽ‰ Fed up of trying everything you can but nothing seems to be working? Download my FREE IBS morning guide - link in bio.​​​​​​​​

#ibs diet #ibsbehindthescene ibs #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #bloating #irritablebowelsyndrome #fodmapfree  #healthygut #goodguthealth #gutfood #fermentedfoods #trustyourgut #chronichealth #microbiome #dubaidietitian #londondietitian #dubailife #dairyfree #prebiotics
πŸ€” WHICH ONES DID YOU KNOW? Comment below πŸ‘‡ ​​​​​​​​​​​​​​​​
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😞 IBS is a very complex disorder to navigate by yourself. It’s more than just altering your diet, a lot of factors are at play with your IBS. Trying to work out what triggers your IBS is an absolute mind field.​​​​​​​​​​​​​​​​
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Adopting the Take Control Method, where the 4 pillars of IBS relief are all addressed (diet, movement, mental health and sleep), has helped so many of my clients to achieve that ultimate symptom relief because it considers EVERYTHING, not just what you out in your mouth.​​​​​​​​​​​​​​​​
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πŸŽ‰ πŸŽ‰ Fed up of trying everything you can but nothing seems to be working? Download my FREE IBS morning guide - link in bio.​​​​​​​​​​​​​​​​
​​​​​​​​​​​​​​​​
#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
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