What medication can I start for lactose intolerance?

Medication Management for Lactose Intolerance

The primary "medication" for lactose intolerance is lactase enzyme supplements taken with dairy-containing meals, though dietary modification remains the cornerstone of management. 1, 2

Lactase Enzyme Replacement

• Lactase enzyme supplements (beta-galactosidase) can be taken immediately before consuming lactose-containing foods to provide the missing enzyme and prevent symptoms 3, 4
• These are available over-the-counter as tablets or drops that can be added directly to milk 4
• The enzyme works by breaking down lactose in the small intestine before it reaches the colon where it would otherwise cause fermentation and symptoms 4
• Effectiveness varies between individuals and depends on the dose of lactose consumed and the amount of enzyme supplemented 5, 4

Probiotic Therapy

• Lactobacillus acidophilus CL1285 + Lactobacillus casei LBC80R is specifically recommended by the American Gastroenterological Association for potential symptom relief 1
• Administer probiotics for 4-12 weeks; discontinue if no improvement is seen after 12 weeks 1
• Probiotics work through their bacterial lactase activity and may promote colonic adaptation to lactose 2, 4, 6
• Yogurt with live cultures and other fermented dairy products contain bacterial beta-galactosidase that improves lactose digestion and eliminates symptoms in lactose maldigesters 6

Dietary Approach (First-Line Management)

• Dietary modification with lactose reduction or elimination should be the primary management strategy 1, 2
• Most lactose-intolerant patients can tolerate up to 12 oz (approximately 280 ml) of milk daily without symptoms 3, 1
• Yogurt and hard/firm cheeses are generally well-tolerated and should NOT be eliminated as they contain negligible lactose 2, 1
• Only patients consuming more than 280 ml of milk or dairy equivalent daily typically need intervention 1, 2

Important Clinical Considerations

• Rule out secondary causes before accepting primary lactase deficiency: celiac disease, gastroenteritis, NSAID use, small bowel disease, or chemotherapy 1, 2
• At least 50% of patients with presumed lactose intolerance actually have broader FODMAP intolerance and will not respond to lactose restriction alone 1, 2, 7
• If lactose restriction doesn't resolve symptoms, consider a trial of a low FODMAP diet 1, 2, 7
• Self-reported lactose intolerance correlates poorly with objective lactase deficiency—confirm diagnosis with hydrogen breath testing or a 2-week dietary elimination trial before long-term treatment 1, 2

Common Pitfalls to Avoid

• Don't unnecessarily eliminate all dairy products—this creates calcium deficiency and nutritional disadvantages 4, 3
• Don't avoid lactose-containing medications, as most contain <12g lactose and rarely cause symptoms 1, 2
• Don't rely on patient self-report alone—objective testing or systematic dietary elimination is essential 1, 2
• Don't ignore the possibility of IBS with visceral hypersensitivity causing symptoms independent of lactose malabsorption 1, 7