Treatment for Lactose Intolerance
The primary treatment for lactose intolerance is dietary modification with temporary reduction or removal of lactose-containing dairy products, while preserving yogurt and firm cheeses which are generally well-tolerated. 1
Initial Dietary Management
Avoid milk and dairy products (except yogurt and firm cheeses) to reduce symptom intensity and duration. 2 This selective approach allows patients to maintain some dairy intake while minimizing symptoms, as:
- Yogurt and hard cheeses contain negligible lactose and are universally tolerable even in lactose-intolerant individuals 3
- Hard cheeses should not be eliminated unnecessarily from the diet 1
- Most lactose-intolerant patients can tolerate these fermented dairy products 2
Determining Who Needs Treatment
Only patients consuming more than 280 ml (0.5 pint) of milk or dairy equivalent daily typically require intervention, as those consuming less can generally tolerate moderate quantities even if lactose intolerant. 1, 3 This threshold is critical because:
- Most people with lactase deficiency can tolerate lactose amounts <12g without symptoms 3
- Even confirmed lactose maldigesters can consume 1 serving of milk with meals or 2 servings daily in divided doses without experiencing symptoms 4
Diagnostic Confirmation Before Treatment
If diagnosis is uncertain, a 2-week dietary restriction trial with symptom resolution provides simple and economical confirmation before committing to long-term dietary changes. 1 Alternatively:
- The hydrogen breath test is the most widely used diagnostic method, though false negative rates can reach 25% 1
- Patient self-reports correlate poorly with objective evidence and cannot be relied upon 1
Important Clinical Pitfall: FODMAP Intolerance
At least 50% of patients with presumed lactose intolerance actually have broader intolerance to FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). 1 This means:
- Lactose restriction alone may be insufficient if symptoms persist 5
- A low FODMAP diet trial should be considered when lactose restriction fails to resolve symptoms 1
- Symptoms alone (bloating, abdominal pain, diarrhea) are not specific to lactose intolerance and may overlap with irritable bowel syndrome 1
Enzyme Replacement and Probiotics
Lactase enzyme supplements may be helpful as adjunctive therapy for patients who wish to consume lactose-containing foods. 6 Additionally:
- Lactobacillus acidophilus CL1285 + Lactobacillus casei LBC80R can be administered for 4-12 weeks, with discontinuation if no improvement occurs after 12 weeks 1
Medication Considerations
Do not unnecessarily avoid lactose-containing medications, as amounts are typically <12g and rarely cause symptoms. 1, 3 Caution should be exercised in de-prescribing lactose-containing drugs, particularly in cancer patients. 2
Secondary Causes Requiring Different Management
Reversible lactose intolerance can occur with underlying conditions including celiac disease, gastroenteritis, NSAID use, small intestine disease, or chemotherapy. 1, 3 In these cases:
- Lactose intolerance is generally reversible once the underlying condition is treated 1
- Chemotherapy-induced lactose intolerance is fully reversible after therapy discontinuation 3
Nutritional Safeguards
Complete dairy elimination risks calcium deficiency and bone disease (osteopenia, osteoporosis). 7, 8 Therefore: