How to Order Lactaid for Lactose Intolerance
Lactaid (lactase enzyme supplements) should be ordered as an over-the-counter product for patients to take immediately before consuming lactose-containing foods, though dietary modification remains the primary management strategy and lactase supplements have inconsistent efficacy. 1, 2
When to Consider Lactase Supplements
- Only recommend lactase supplements for patients who consume more than 280 ml (0.5 pint) of milk or dairy equivalent daily, as those consuming less rarely experience symptoms even with lactose intolerance 1, 2, 3
- Reserve lactase supplementation for patients with confirmed lactose intolerance via hydrogen breath testing or a successful 2-week dietary restriction trial 1, 2
- Most patients with lactose intolerance can tolerate up to 12 oz of milk daily without symptoms, so supplements may not be necessary for all diagnosed patients 4
Prescribing/Ordering Approach
- Lactaid is available over-the-counter and does not require a prescription - patients can purchase it directly from pharmacies 5
- Instruct patients to take lactase enzyme supplements immediately before consuming lactose-containing foods 5
- The typical lactose challenge dose used in testing is 25-50g, which helps guide the amount of enzyme needed 1
Critical Caveat About Efficacy
- Not all lactase preparations are equally effective - a randomized controlled trial found that different commercial lactase products (Lactaid, Lactrase, Dairy Ease) varied significantly in their ability to reduce symptoms and breath hydrogen excretion 5
- Lactrase was most effective at reducing pain, bloating, and total symptom scores, while Lactaid reduced breath hydrogen but did not significantly improve symptoms in this study 5
- The efficacy of lactase enzyme supplements remains controversial overall 6
Primary Management Strategy (More Important Than Supplements)
- Dietary modification with temporary reduction or elimination of lactose should be the first-line approach, not enzyme supplementation 1, 2
- Patients should avoid fresh milk and most dairy products during symptomatic periods 2
- Yogurt and hard cheeses contain negligible lactose and should NOT be eliminated - they are generally well-tolerated even in lactose-intolerant individuals 2, 3
Alternative Considerations
- At least 50% of patients with presumed lactose intolerance actually have broader FODMAP intolerance, so if lactose restriction alone doesn't resolve symptoms, consider a low FODMAP diet trial 1, 2
- Probiotics (specifically Lactobacillus acidophilus CL1285 + Lactobacillus casei LBC80R) for 4-12 weeks may help with symptom management 1
- Lactose-containing medications rarely need to be avoided, as most people with lactose malabsorption tolerate lactose amounts <12g 2, 3
Common Pitfalls to Avoid
- Don't rely on patient self-reports alone - self-reported lactose intolerance correlates poorly with objective evidence of lactase deficiency 1, 2
- Don't unnecessarily eliminate yogurt and hard cheeses, which are well-tolerated 2, 3
- Don't ignore reversible secondary causes of lactose intolerance including celiac disease, gastroenteritis, NSAID use, chemotherapy, and small bowel disease 1, 2, 3