Did you know that a 2023 study in the Journal of Gastroenterology and Hepatology, a whopping 60 per cent of the Indian population is lactose intolerant?

 

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Despite the love for milk tea, coffee, and the abundance of dairy-rich treats during festivals—like paneer, butter, khoya, and traditional sweets—a significant number of people experience digestive discomfort from these beloved foods. It’s a surprising reality that reveals just how common lactose intolerance is, even in a culture where dairy plays such a central role.
Understanding lactose tolerance is important for making better food choices and keeping our digestive systems healthy, helping us enjoy our meals without worry.

 

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Understanding Lactose Intolerance

According to Dr. Prashant Kumar Rai, a gastroenterologist at Apollo Hospitals, individuals with lactose intolerance cannot completely digest lactose, the sugar found in milk. When we consume milk, our intestines rely on an enzyme called lactase, which is responsible for breaking down lactose and facilitating its absorption. Lactose intolerance occurs when the lining of the intestine is damaged or when there is a reduction or absence of lactase. This impairment prevents the proper digestion of lactose, leading to discomfort and digestive issues.

A 2023 study issued in the Indian Journal of Nutrition, the issue arises when the small intestine stops producing enough of an enzyme called lactase, which is responsible for digesting lactose. Without enough lactase, the undigested lactose travels to the large intestine, where it meets bacteria that cause all kinds of trouble—think bloating, gas, and even diarrhoea. This frustrating digestive problem  is also known as lactase deficiency.

As per the Canadian Society of Intestinal Research, the worldwide rate of lactose intolerance at approximately 65 to 70 per cent. Despite its widespread prevalence, many individuals remain unaware of their condition, this makes it important to know the symptoms.

 

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Symptoms of Lactose Intolerance

Symptoms of lactose intolerance typically include:

• Bloating
• Diarrhoea
• Gas (Increased flatulence or burping)
• Abdominal pain (Cramping or discomfort in the stomach area)
• Nausea
• Vomiting
• Stomach gurgling or rumbling 
• Weight loss in children

 

The undigested lactose in your large intestine causes these symptoms. It takes between six to 10 hours for food to reach your large intestine after you eat it, and another 24-36 hours after that to travel through your large intestine. So your symptoms might occur up to a day or two after you eat lactose. If you suspect you have lactose intolerance, it might be helpful to consult a healthcare professional for proper testing and management.

Symptom severity varies greatly between individuals. Some might find symptoms occur after consuming a very small serving of food containing lactose, whereas others might tolerate moderate portions before symptoms begin.

 

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How is Milk Allergy Different from Lactose Intolerance?

According to Canadian Society of Intestinal Research, lactose intolerance is not the same thing as a milk allergy. Individuals who are allergic to milk experience negative reactions to one or more types of milk proteins, such as casein. Milk allergy is less common than lactose intolerance. Exposure to these proteins causes symptoms such as hives, rashes, nausea, vomiting, diarrhoea, stomach cramps, watery eyes/runny nose, upper respiratory tract problems, and even anaphylaxis. It only takes a small amount of dairy products to cause a reaction in those who have milk allergies, whereas lactose intolerant individuals can often tolerate some amount of dairy products, and they are at no risk for anaphylaxis.

 

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Diagnosis of Lactose Intolerance 

Lactose intolerance can be diagnosed through several methods:

• Symptom Review: Doctor will assess symptoms after consuming dairy products.
• Lactose Tolerance Test: This involves drinking a lactose-rich beverage and measuring blood glucose levels over time. A minimal rise in blood sugar indicates lactose intolerance.
• Hydrogen Breath Test: After consuming lactose, breath samples are taken to measure hydrogen levels. Elevated hydrogen indicates improper digestion of lactose.
• Stool Test:This test measures the presence of unabsorbed lactose and other sugars in the stool, indicating the body’s inability to digest lactose effectively.

 

Types of Lactose Intolerance

Lactose intolerance can be categorised into four main types:

Primary Lactose Intolerance

•  This is the most common form, where lactase production decreases after weaning, leading to difficulty digesting lactose in adulthood.

Secondary Lactose Intolerance

• This occurs due to an injury to the small intestine, often from infections, inflammatory bowel disease, or celiac disease, which temporarily reduces lactase production.

Congenital Lactose Intolerance

• A rare genetic condition where infants are born with little or no lactase enzyme, resulting in immediate symptoms when they consume lactose.

Developmental Lactose Intolerance

• It is usually caused by premature birth, when the small intestine is underdeveloped.

 

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Foods You Need to Avoid 

For those with lactose intolerance, it's important to avoid or limit foods that contain high levels of lactose to prevent symptoms like bloating, gas, and diarrhoea. To avoid symptoms, opting for lactose-free or plant-based alternatives can help manage the condition while still enjoying a variety of foods.

Here are some common foods and drinks that people with lactose intolerance should avoid or consume with caution:

1. Milk and cream: Regular cow's milk, goat's milk, and sheep's milk contain high amounts of lactose. This includes all varieties like whole milk, skim milk, and flavoured milk (e.g., chocolate milk). Cream products, such as heavy cream, half-and-half, and whipping cream, also contain significant lactose.

2. Soft cheeses: Soft cheeses like ricotta, cream cheese, cottage cheese, and certain varieties of feta can be high in lactose. Fresh cheeses tend to have more lactose compared to aged cheeses. Cheese spreads, cheese sauces, and processed cheese products may also contain added lactose.

3. Yoghurt: While some people with lactose intolerance can tolerate yoghurt due to its live cultures that help digest lactose, not all yoghurts are suitable. Sweetened, flavoured, or low-fat yoghurts often have higher lactose content. Greek yoghurt may be easier to digest, but it's still worth checking if symptoms occur after consuming it.

4. Butter: Although butter contains lower lactose levels than milk, it still has some lactose and may cause symptoms in highly sensitive individuals.
Ice cream and frozen desserts: Ice cream, gelato, frozen yogurt, and milkshakes contain significant amounts of lactose, as they are typically made from milk or cream. Non-dairy frozen desserts (like those made from almond, coconut, or soy milk) are better alternatives.

5. Whey protein: Whey protein, often found in protein powders and supplements, is derived from milk and contains lactose. If you need a protein supplement, look for lactose-free or plant-based protein powders such as pea, hemp, or brown rice protein.

6. Baked goods and processed foods: Many baked goods like cakes, pastries, pancakes, and biscuits may contain milk or butter as ingredients. Processed foods such as instant soups, sauces, salad dressings, and cereals may also have hidden sources of lactose, often listed as "milk solids" or "whey" on labels.

7. Milk-based beverages: Coffee drinks made with regular milk, hot chocolate, milkshakes, and smoothies made with dairy milk can all be problematic.

 

Treatment or Management of Lactose Intolerance

If you are lactose intolerant, you might be able to manage your symptoms by reducing the quantity of lactose-containing foods you consume. But for some individuals it is best when they avoid all lactose-containing foods and then only their symptoms subside. This includes products made with cow and goat milk, including cheese, ice cream, and yoghurt. Many processed products, such as soups, baked goods,  breads, biscuits, cereals, cheese, chocolates, crackers, candies, dressings can also contain added lactose in small amounts. Generally, most individuals can tolerate some degree of lactose consumption.

Treating the Underlying Cause

In people with lactose intolerance caused by an underlying condition, treating the condition might restore the body's ability to digest lactose, although that process can take months

Dietary Modifications

• Limit Lactose Intake: Avoid or reduce consumption of milk, cheese, yoghurt, and other dairy products.
• Lactose-free alternatives: Use lactose-free milk and dairy products, which have the lactose removed.
• Hard cheeses and yoghurt: Many individuals with lactose intolerance can tolerate aged cheeses (like cheddar and Swiss) and yoghurt with live cultures, which may aid in digestion.
• Consume lactose liquid: Add a liquid or powder lactase enzyme to milk to break down the lactose
• Incorporate probiotics: Probiotics are sometimes used for gastrointestinal conditions, such as diarrhoea and irritable bowel syndrome. They might also help your body digest lactose. Probiotics are generally considered safe and might be worth a try if other methods don't help.
• Eat lactose-containing foods with other foods: If you are digesting other food at the same time, gastric emptying becomes slower, and lactose makes up a smaller proportion of the total food you consume. This means that you need less lactase in the small intestine at any given time to break down the lactose.
• Slowly increase tolerance: You might be able to increase the amount of lactose you tolerate by slowly adding more dairy to your diet. Your body will respond by increasing its lactase production.

Lactase Supplements

• Over-the-Counter Lactase Enzymes: Taking lactase supplements before consuming dairy products may help digest lactose and minimise symptoms. These come in pill or liquid form.

 

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