From the Guidelines
Management options for lactose intolerance should focus on reducing symptoms while maintaining adequate nutrition, primarily through dietary modification by limiting lactose intake, particularly from milk and dairy products, as supported by the most recent evidence 1. The primary approach is dietary modification, which involves limiting lactose intake to reduce symptoms. Patients should gradually reduce lactose consumption to identify their personal tolerance threshold, as many can tolerate small amounts (up to 12g per serving). Some key points to consider in managing lactose intolerance include:
- Lactase enzyme supplements (such as Lactaid) taken with meals can help digest lactose; typically 1-2 tablets (9,000-18,000 FCC units) should be taken immediately before consuming dairy products.
- Lactose-free or lactose-reduced dairy products are widely available alternatives.
- Fermented dairy products like yogurt and aged cheeses are often better tolerated due to their lower lactose content and presence of beneficial bacteria that aid digestion.
- Plant-based milk alternatives (soy, almond, oat) can replace dairy milk.
- Calcium and vitamin D supplementation (1000-1200mg calcium and 600-800 IU vitamin D daily for adults) may be necessary if dairy intake is significantly reduced, as noted in various studies 1. These management strategies work because they either reduce the lactose load or provide the missing enzyme needed to break down lactose into digestible sugars (glucose and galactose), preventing the osmotic diarrhea and fermentation that cause symptoms like bloating, gas, and abdominal pain. It's also important to consider the individual's nutritional needs and ensure they are meeting their daily requirements for essential nutrients, as certain dietary restrictions may lead to deficiencies if not properly managed, as discussed in recent guidelines 1.
From the Research
Management Options for Lactose Intolerance
The management of lactose intolerance involves several approaches, including:
- Reducing or eliminating lactose from the diet until symptoms disappear 2, 3, 4
- Supplementing lactase as an enzymatic food supplement, although its efficacy is still controversial 2, 5
- Using probiotics, which have shown specific β-galactosidase activity, thus aiding in the digestion of lactose 2
- Inducing colon microbiome adaptation by probiotics 3
- Dietary management, including lactose-reduced diet and enzyme replacement, which is effective if symptoms are only related to dairy products 4
- Restricting lactose intake and following a low FODMAP diet for patients with irritable bowel syndrome (IBS) 4
Dietary Considerations
Dietary considerations play a crucial role in the management of lactose intolerance, including:
- Avoiding "hidden lactose" in non-dairy products, such as baked goods, breakfast cereals, drinks, and processed meat 3
- Checking food labels for lactose-free products, although the labeling policy is still controversial 3
- Using lactose-free products with a well-recognized lactose-free logo to guide consumers 3
- Considering the use of specialized formulas and products, such as soy-protein and hydrolysate formulas, for infants and children with lactose intolerance 6
Supplement Analysis
Analysis of lactase in lactose intolerance supplements has shown that: