You Ask , They Answer
Q
: What ’ s lactose intolerance and why many people develop it in adulthood ?
A
: Lactose intolerance is the inability to digest lactose , a sugar found in milk and dairy products . Due to the activity of a specific digestive enzyme called lactase , we are able to digest this sugar and absorb it in our small intestine . If this is not possible , the sugar will go in the colon undigested , where bacteria will break it down and create excess gas and discomfort . In most cases , during adulthood there is a gradual decrease of lactase production and hence we lose the ability to digest lactose properly . This occurs due to the decreased activity of the LCT gene , which regulates the production of lactase .
Q
: What are the symptoms and when should people see a doctor ?
A
: The most common symptoms are excess of gas , bloating , loose stools or diarrhea , abdominal cramping , or pain . You might seek medical advice when you are experiencing these symptoms , especially after consuming milk and dairy products . Lactose tolerance tests could be done to confirm the intolerance .
Q
: Is there any treatment to cure it or reduce symptoms , especially in the case of lactose intolerance caused by diseases like intestinal infection , coeliac disease , and Crohn ’ s disease ?
A
: In some cases , lactose intolerance can be related to intestinal infections or other conditions associated with reduction of the intestinal ability to produce lactase and digest lactose , like coeliac disease or inflammatory bowel diseases . In this case , treating the underlying condition might increase lactase production and reduce signs and symptoms . In general , when lactose isn ’ t properly digested , a lactose free diet is recommended to improve symptoms . Additionally , digestive enzymes help to alleviate symptoms after ingestion of small amount of lactose .
Q
: What kind of foods can people with lactose intolerance eat to replace the nutritious benefits of lactose ?
A
: People with lactose intolerance don ’ t need to completely avoid milk and dairy products , but they can replace them with lactose free alternatives . Lactose free milk and yogurt contain lactase that breaks lactose down into glucose and galactose , allowing people with lactose intolerance to consume dairy products without having symptoms . Soft cheeses like ricotta cheese , mozzarella , and cottage cheese usually contain lactose in a smaller quantity and they are in general better tolerated than milk and yoghurt . If they cause symptoms , people could use digestive enzymes to improve digestion . Hard cheeses like Parmesan , cheddar , and feta are usually very low in lactose and they can be consumed by people who are lactose intolerant . In the market you can also find different plantbased milk alternatives that can be used as a replacement like almond , rice , oat and soy milks , but we always recommend looking for products with added calcium .
Q
: Are there any preventive measures against lactose intolerance ?
A
: Lactose intolerance cannot be prevented and there isn ’ t a cure for it , but it can be easily treated by limiting or avoiding foods and drinks containing lactose . Healthy diets and maintenance of good microbiota in the gut can improve symptoms and gut wellbeing but cannot increase production of lactase in the intestine .
Dr Andrea Rajnakova
Dr Andrea Rajnakova is a Consultant Gastroenterologist at Andrea ’ s Digestive , Colon , Liver and Gallbladder Clinic in Singapore .
Veronica Cavallini
Veronica Cavallini is a Nutritional Consultant at Andrea ’ s Digestive , Colon , Liver and Gallbladder Clinic .
8 ISSUE 3 | 2023 GlobalHealthAsiaPacific . com