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How is lactose intolerance diagnosed?

Lactose intolerance can be hard to diagnose based on symptoms alone. People sometimes think they suffer from lactose intolerance because they have the symptoms associated with the disorder, not knowing other conditions such as irritable bowel syndrome can cause similar symptoms. A doctor can use tests to diagnose lactose intolerance but may first recommend eliminating cow’s milk from the diet to see if the symptoms go away.

The most common tests used to measure the absorption of lactose in the digestive system are the lactose tolerance, hydrogen breath, and stool acidity tests.

  • The Lactose Tolerance Test. This test requires fasting (not eating) before the test and then drinking a liquid that contains lactose. Several blood samples are then taken over a 2-hour period to measure the person’s blood glucose (blood sugar) level. These measures indicate how well the body is able to digest lactose.

    Normally, when lactose reaches the digestive system, the lactase enzyme breaks it down into glucose and galactose. The liver then changes the galactose into glucose, which enters the bloodstream and raises the person’s blood glucose level. If, however, lactose is incompletely broken down, the blood glucose level does not rise and a diagnosis of lactose intolerance is confirmed.
  • The Hydrogen Breath Test. This test measures the amount of hydrogen in a person’s breath. Very little hydrogen is normally detectable. However, undigested lactose in the colon is fermented by bacteria and produces various gases, including hydrogen. The hydrogen is absorbed from the intestines, carried through the bloodstream to the lungs, and exhaled. In this test, the person drinks a lactose-loaded beverage and the breath is analyzed at regular intervals. Raised levels of hydrogen in the breath indicate improper digestion of lactose. Certain foods, medications, and cigarettes can affect the accuracy of the test and should be avoided before taking the test. People should check with their doctor to make sure they are not taking medications that may interfere with test results.

The lactose tolerance and hydrogen breath tests are not given to infants younger than 6 months of age. A large lactose load can be dangerous prior to this age, as infants are more likely to become dehydrated from diarrhea that can be caused by lactose intolerance.

  • Stool Acidity Test. This test may be used for infants and young children to measure the amount of acid in their stool. Undigested lactose fermented by bacteria in the colon creates lactic acid and other fatty acids that can be detected in a stool sample. Glucose may also be present in the sample as a result of unabsorbed lactose in the colon.

Lactose - Chemical Makeup

What causes lactose intolerance?

Some causes of lactose intolerance are well known. Primary lactase deficiency is a condition that develops over time. After about age 2 the body begins to produce less lactase, though most people will not notice symptoms until they are much older.

Secondary lactase deficiency occurs when injury to the small intestine or certain digestive diseases reduce the amount of lactase a person produces. These diseases include celiac disease, inflammatory bowel disease, and Crohn’s disease.

Researchers have identified a genetic link for lactose intolerance. Some people are born with a likelihood of developing primary lactase deficiency because it has been passed to them genetically (inherited from their parents). This discovery may be useful in developing a diagnostic test to identify people with the condition.

How is lactose intolerance treated?

Lactose intolerance is easy to treat. No treatment can improve the body’s ability to produce lactase, but symptoms can be controlled through diet.

Young children and infants with lactase deficiency should not consume lactose-containing formulas or foods until they are able to tolerate lactose digestion. Most older children and adults do not have to avoid lactose completely, but people differ in the amounts and types of foods they can handle. For example, one person may have symptoms after drinking a small glass of milk, while another can drink one glass but not two. Others may be able to manage ice cream and aged cheeses, such as cheddar and Swiss, but not other dairy products. People can also tolerate more lactose by having smaller amounts of it at one time. The level of dietary control needed with lactose intolerance depends on how much lactose a person’s body can handle.

For those who react to very small amounts of lactose or have trouble limiting their intake of foods that contain it, the lactase enzyme is available without a prescription to help people digest foods that contain lactose. The tablets are taken with the first bite of dairy food. Lactase enzyme is also available as a liquid. Adding a few drops of the enzyme makes lactose more digestible for people with lactose intolerance.

Lactose-reduced milk and other products are available at most supermarkets. The milk contains all of the nutrients found in regular milk and remains fresh for about the same length of time, or longer if it is super-pasteurized.
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