Lactose intolerance is a common condition caused by a decreased ability to digest lactose
, a sugar found in
Dairy products or milk products, also known as lacticinia, are food products made from (or containing) milk. The most common dairy animals are cow, water buffalo, nanny goat, and ewe. Dairy products include common grocery store food items in ...
[ Those affected vary in the amount of lactose they can tolerate before symptoms develop.] [ Symptoms may include ] abdominal pain
Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues.
Common causes of pain in the abdomen include gastroenteritis and irritable bowel syndrome. About 15% of people have a more ..., bloating
Abdominal bloating (or simply bloating) is a short-term disease that affects the gastrointestinal tract. Bloating is generally characterized by an excess buildup of gas, air or fluids in the stomach. A person may have feelings of tightness, pressu ..., diarrhea
Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ..., flatulence
Flatulence, in humans, is the expulsion of gas from the intestines via the anus, commonly referred to as farting. "Flatus" is the medical word for gas generated in the stomach or bowels. A proportion of intestinal gas may be swallowed environm ..., and nausea
Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of th .... [ These symptoms typically start thirty minutes to two hours after eating or drinking milk-based food.] [ Their severity typically depends on the amount a person eats or drinks.] Lactose intolerance does not cause damage to the gastrointestinal tract
The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans a ....
Lactose intolerance is due to the lack of the enzyme
Enzymes () are proteins that act as biological catalysts by accelerating chemical reactions. The molecules upon which enzymes may act are called substrates, and the enzyme converts the substrates into different molecules known as products. ... lactase
Lactase is an enzyme produced by many organisms. It is located in the brush border of the small intestine of humans and other mammals. Lactase is essential to the complete digestion of whole milk; it breaks down lactose, a sugar which gives m ... in the small intestines
The small intestine or small bowel is an organ in the gastrointestinal tract where most of the absorption of nutrients from food takes place. It lies between the stomach and large intestine, and receives bile and pancreatic juice through the p ... to break lactose down into glucose
Glucose is a simple sugar with the molecular formula . Glucose is overall the most abundant monosaccharide, a subcategory of carbohydrates. Glucose is mainly made by plants and most algae during photosynthesis from water and carbon dioxide, u ... and galactose
Galactose (, '' galacto-'' + ''-ose'', "milk sugar"), sometimes abbreviated Gal, is a monosaccharide sugar that is about as sweet as glucose, and about 65% as sweet as sucrose. It is an aldohexose and a C-4 epimer of glucose. A galactose molec .... There are four types: primary, secondary, developmental, and congenital. [ Primary lactose intolerance occurs as the amount of lactase declines as people age.] [ Secondary lactose intolerance is due to injury to the small intestine. Such injury could be the result of infection, ] celiac disease
Coeliac disease (British English) or celiac disease (American English) is a long-term autoimmune disorder, primarily affecting the small intestine, where individuals develop intolerance to gluten, present in foods such as wheat, rye and barle ..., inflammatory bowel disease
Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine, Crohn's disease and ulcerative colitis being the principal types. Crohn's disease affects the small intestine and large intestine, as well ..., or other diseases. Developmental lactose intolerance may occur in premature babies
Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between ... and usually improves over a short period of time. [ Congenital lactose intolerance is an extremely rare ] genetic disorder
A genetic disorder is a health problem caused by one or more abnormalities in the genome. It can be caused by a mutation in a single gene (monogenic) or multiple genes (polygenic) or by a chromosomal abnormality. Although polygenic disorders ... in which little or no lactase is made from birth. [ The onset of primary lactose intolerance, the most common type, is typically in late childhood or early adulthood,] [ but prevalence increases with age.] [
Diagnosis may be confirmed if symptoms resolve following eliminating lactose from the diet.] [ Other supporting tests include a ] hydrogen breath test
A hydrogen breath test (or HBT) is used as a diagnostic tool for small intestine bacterial overgrowth and carbohydrate malabsorption, such as lactose, fructose, and sorbitol malabsorption.
The test is simple, non-invasive, and is performed afte ... and a stool acidity test. [ Other conditions that may produce similar symptoms include ] irritable bowel syndrome
Irritable bowel syndrome (IBS) is a "disorder of gut-brain interaction" characterized by a group of symptoms that commonly include abdominal pain and or abdominal bloating and changes in the consistency of bowel movements. These symptoms may ..., celiac disease
Coeliac disease (British English) or celiac disease (American English) is a long-term autoimmune disorder, primarily affecting the small intestine, where individuals develop intolerance to gluten, present in foods such as wheat, rye and barle ..., and inflammatory bowel disease
Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine, Crohn's disease and ulcerative colitis being the principal types. Crohn's disease affects the small intestine and large intestine, as well .... [ Lactose intolerance is different from a ] milk allergy
Milk allergy is an adverse immune reaction to one or more proteins in cow's milk. Among the possible symptoms is anaphylaxis, a potentially life-threatening condition that requires treatment with epinephrine, among other measures. However, .... [ Management is typically by decreasing the amount of lactose in the diet, taking lactase supplements, or treating the underlying disease.] People are able to drink at least one cup of milk without developing symptoms, with greater amounts tolerated if drunk with a meal or throughout the day.
Worldwide, around 65% of adults are affected by lactose malabsorption. Other mammals
Mammals () are a group of vertebrate animals constituting the class Mammalia (), characterized by the presence of mammary glands which in females produce milk for feeding (nursing) their young, a neocortex (a region of the brain), f ... usually lose the ability to digest lactose after weaning
Weaning is the process of gradually introducing an infant human or another mammal to what will be its adult diet while withdrawing the supply of its mother's milk.
The process takes place only in mammals, as only mammals produce milk. The infan ... and this was the ancestral state of all humans before the recent evolution of lactase persistence
Lactase persistence is the continued activity of the lactase enzyme in adulthood, allowing the digestion of lactose in milk. In most mammals, the activity of the enzyme is dramatically reduced after weaning. In some human populations, though, lac ..., which extends lactose tolerance into adulthood. Lactase persistence evolved in several populations independently, probably as an adaptation to the domestication
Domestication is a sustained multi-generational relationship in which humans assume a significant degree of control over the reproduction and care of another group of organisms to secure a more predictable supply of resources from that group. ... of dairy animals around 10,000 years ago. Today the prevalence of lactose tolerance varies widely between regions and ethnic groups. [ The ability to digest lactose is most common in people of European descent, and to a lesser extent in some parts of the Middle East and Africa.] [ Lactose intolerance is common among people of Jewish descent, as well as in many ] African countries
This is a list of sovereign states and dependent territories in Africa. It includes both fully recognised states, states with limited or zero recognition, and dependent territories of both African and non-African states. It lists 56 sovereign state ..., the majority of Arab countries
The Arab world ( ar, اَلْعَالَمُ الْعَرَبِيُّ '), formally the Arab homeland ( '), also known as the Arab nation ( '), the Arabsphere, or the Arab states, refers to a vast group of countries, mainly located in Western As ..., Greece
Greece,, or , romanized: ', officially the Hellenic Republic, is a country in Southeast Europe. It is situated on the southern tip of the Balkans, and is located at the crossroads of Europe, Asia, and Africa. Greece shares land borders with ... and Italy. Traditional food
Traditional foods are foods and dishes that are passed on through generations or which have been consumed for many generations. Traditional foods and dishes are traditional in nature, and may have a historic precedent in a national dish, regio ... cultures reflect local variations in tolerance [ and historically many societies have adapted to low levels of tolerance by making ] dairy product
Dairy products or milk products, also known as lacticinia, are food products made from (or containing) milk. The most common dairy animals are cow, water buffalo, nanny goat, and ewe. Dairy products include common grocery store food items in ...s that contain less lactose than fresh milk. The medicalization
Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new ev ... of lactose intolerance as a disorder has been attributed to biases in research history, since most early studies were conducted amongst populations which are normally tolerant, as well as the cultural and economic importance of milk in countries such as the United States.
''Lactose intolerance'' primarily refers to a syndrome with one or more symptoms upon the consumption of food substances containing lactose sugar. Individuals may be lactose intolerant to varying degrees, depending on the severity of these symptoms.
''Hypolactasia'' is the term specifically for the
The small intestine or small bowel is an organ in the gastrointestinal tract where most of the absorption of nutrients from food takes place. It lies between the stomach and large intestine, and receives bile and pancreatic juice through the ... producing little or no lactase enzyme. If a person with hypolactasia consumes lactose sugar, it results in ''lactose malabsorption''. The digestive system is unable to process the lactose sugar, and the unprocessed sugars in the gut produce the symptoms of ''lactose intolerance''.
Lactose intolerance is not an allergy
Allergies, also known as allergic diseases, refer a number of conditions caused by the hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic dermat ..., because it is not an immune response, but rather a sensitivity to dairy caused by a deficiency of lactase enzyme. Milk allergy
Milk allergy is an adverse immune reaction to one or more proteins in cow's milk. Among the possible symptoms is anaphylaxis, a potentially life-threatening condition that requires treatment with epinephrine, among other measures. However, ..., occurring in about 2% of the population, is a separate condition, with distinct symptoms that occur when the presence of milk proteins trigger an immune reaction.
Signs and symptoms
The principal manifestation of lactose intolerance is an adverse reaction to products containing lactose (primarily milk), including abdominal
Abdominal bloating (or simply bloating) is a short-term disease that affects the gastrointestinal tract. Bloating is generally characterized by an excess buildup of gas, air or fluids in the stomach. A person may have feelings of tightness, pressu ... and cramps
A cramp is a sudden, involuntary, painful skeletal muscle contraction or overshortening associated with electrical activity; while generally temporary and non-damaging, they can cause significant pain and a paralysis-like immobility of the af ..., flatulence
Flatulence, in humans, is the expulsion of gas from the intestines via the anus, commonly referred to as farting. "Flatus" is the medical word for gas generated in the stomach or bowels. A proportion of intestinal gas may be swallowed environm ..., diarrhea
Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ..., nausea
Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of th ..., borborygmi
A stomach rumble, also known as a bowel sound, peristaltic sound, abdominal sound, bubble gut or borborygmus (pronounced ; plural borborygmi), is a rumbling, growling or gurgling noise produced by movement of the contents of the gastro-intestinal ..., and vomiting
Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose.
Vomiting can be the result of ailments like food poisoning, gastroenterit ... (particularly in adolescents
Adolescence () is a transitional stage of physical and psychological development that generally occurs during the period from puberty to adulthood (typically corresponding to the age of majority). Adolescence is usually associated with the ...). These appear one-half to two hours after consumption. [ The severity of these signs and symptoms typically increases with the amount of lactose consumed; most lactose-intolerant people can tolerate a certain level of lactose in their diets without ill effects.]
Because lactose intolerance is not an allergy, it does not produce allergy symptoms (such as itching, hives
Hives, also known as urticaria, is a kind of skin rash with red, raised, itchy bumps. Hives may burn or sting. The patches of rash may appear on different body parts, with variable duration from minutes to days, and does not leave any long-lasti ..., or anaphylaxis
Anaphylaxis is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of use of emergency medication on site. It typically causes more than one of the foll ...).
Lactose intolerance is a consequence of
Lactase is an enzyme produced by many organisms. It is located in the brush border of the small intestine of humans and other mammals. Lactase is essential to the complete digestion of whole milk; it breaks down lactose, a sugar which gives m ... deficiency, which may be genetic ( primary hypolactasia and primary congenital alactasia) or environmentally induced ( secondary or acquired hypolactasia). In either case, symptoms are caused by insufficient levels of lactase in the lining of the duodenum
The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear, and the terms anterior intestine or proximal intestine .... Lactose, a disaccharide
A disaccharide (also called a double sugar or ''biose'') is the sugar formed when two monosaccharides are joined by glycosidic linkage. Like monosaccharides, disaccharides are simple sugars soluble in water. Three common examples are sucrose, lac ... molecule found in milk and dairy products, cannot be directly absorbed through the wall of the small intestine into the bloodstream, so, in the absence of lactase, passes intact into the colon. Bacteria in the colon can metabolise lactose, and the resulting fermentation
Fermentation is a metabolic process that produces chemical changes in organic substrates through the action of enzymes. In biochemistry, it is narrowly defined as the extraction of energy from carbohydrates in the absence of oxygen. In food p ... produces copious amounts of gas (a mixture of hydrogen
Hydrogen is the chemical element with the symbol H and atomic number 1. Hydrogen is the lightest element. At standard conditions hydrogen is a gas of diatomic molecules having the formula . It is colorless, odorless, tasteless, non-toxi ..., carbon dioxide
Carbon dioxide ( chemical formula ) is a chemical compound made up of molecules that each have one carbon atom covalently double bonded to two oxygen atoms. It is found in the gas state at room temperature. In the air, carbon dioxide is tr ..., and methane
Methane ( , ) is a chemical compound with the chemical formula (one carbon atom bonded to four hydrogen atoms). It is a group-14 hydride, the simplest alkane, and the main constituent of natural gas. The relative abundance of methane on ...) that causes the various abdominal symptoms. The unabsorbed sugars and fermentation products also raise the osmotic pressure
Osmotic pressure is the minimum pressure which needs to be applied to a solution to prevent the inward flow of its pure solvent across a semipermeable membrane.
It is also defined as the measure of the tendency of a solution to take in a pure ... of the colon, causing an increased flow of water into the bowels (diarrhea).
Lactose intolerance in infants (congenital lactase deficiency) is caused by mutations in the LCT gene. The ''LCT'' gene provides the instructions for making lactase. Mutations are believed to interfere with the function of lactase, causing affected infants to have a severely impaired ability to digest lactose in breast milk or formula. Lactose intolerance in adulthood is a result of gradually decreasing activity (expression) of the LCT gene after infancy, which occurs in most humans. The specific DNA sequence in the '' MCM6'' gene helps control whether the ''LCT'' gene is turned on or off. At least several thousand years ago, some humans developed a mutation in the ''MCM6'' gene that keeps the ''LCT'' gene turned on even after breast feeding is stopped. Populations that are lactose intolerant lack this mutation. The ''LCT'' and ''MCM6'' genes are both located on the long arm (q) of chromosome 2 in region 21. The locus can be expressed as 2q21. The lactase deficiency also could be linked to certain heritages and varies widely. A 2016 study of over 60,000 participants from 89 countries found regional prevalence of lactose malabsorption was "64% (54–74) in Asia (except Middle East), 47% (33–61) in eastern Europe, Russia, and former Soviet Republics, 38% (CI 18–57) in Latin America, 70% (57–83) in the Middle East, 66% (45–88) in northern Africa, 42% (13–71) in northern America, 45% (19–71) in Oceania, 63% (54–72) in sub-Saharan Africa, and 28% (19–37) in northern, southern and western Europe." According to Johns Hopkins Medicine, lactose intolerance is more common in Asian Americans, African Americans, Mexican Americans, and Native Americans. Analysis of the DNA of 94 ancient skeletons in Europe and Russia concluded that the mutation for lactose tolerance appeared about 4,300 years ago and spread throughout the European population.
Some human populations have developed lactase persistence
Lactase persistence is the continued activity of the lactase enzyme in adulthood, allowing the digestion of lactose in milk. In most mammals, the activity of the enzyme is dramatically reduced after weaning. In some human populations, though, lac ..., in which lactase production continues into adulthood probably as a response to the benefits of being able to digest milk from farm animals. Some have argued that this links intolerance to natural selection
Natural selection is the differential survival and reproduction of individuals due to differences in phenotype. It is a key mechanism of evolution, the change in the heritable traits characteristic of a population over generations. Char ... favoring lactase-persistent individuals, but it is also consistent with a physiological response to decrease lactase production when it is not needed in cultures in which dairy products are not an available food source. Although populations in Europe, India, Arabia, and Africa were first thought to have high rates of lactase persistence because of a single mutation, lactase persistence has been traced to a number of mutations that occurred independently. Different alleles for lactase persistence have developed at least three times in East African populations, with persistence extending from 26% in Tanzania
Tanzania (; ), officially the United Republic of Tanzania ( sw, Jamhuri ya Muungano wa Tanzania), is a country in East Africa within the African Great Lakes region. It borders Uganda to the north; Kenya to the northeast; Comoro Islands an ... to 88% in the Beja pastoralist population in Sudan
Sudan ( or ; ar, السودان, as-Sūdān, officially the Republic of the Sudan ( ar, جمهورية السودان, link=no, Jumhūriyyat as-Sūdān), is a country in Northeast Africa. It shares borders with the Central African Republic .... [
The accumulation of ] epigenetic
In biology, epigenetics is the study of stable phenotypic changes (known as ''marks'') that do not involve alterations in the DNA sequence. The Greek prefix '' epi-'' ( "over, outside of, around") in ''epigenetics'' implies features that are "o ... factors, primarily DNA methylation
DNA methylation is a biological process by which methyl groups are added to the DNA molecule. Methylation can change the activity of a DNA segment without changing the sequence. When located in a gene promoter, DNA methylation typically acts t ..., in the extended ''LCT'' region, including the gene enhancer located in the ''MCM6'' gene near C/T-13910 SNP, may also contribute to the onset of lactose intolerance in adults. Age-dependent expression of ''LCT'' in mice intestinal epithelium has been DNA methylation in the gene enhancer.
Lactose intolerance is classified according to its causes as:
Primary hypolactasia, or primary lactase deficiency, is genetic, only affects adults, and is caused by the absence of a lactase persistence allele. In individuals without the lactase persistence allele, less lactase is produced by the body over time, leading to hypolactasia in adulthood.
The frequency of lactase persistence, which allows lactose tolerance, varies enormously worldwide, with the highest prevalence in Northwestern Europe, declines across southern Europe and the Middle East and is low in Asia and most of Africa, although it is common in pastoralist populations from Africa.
Secondary hypolactasia or secondary lactase deficiency, also called acquired hypolactasia or acquired lactase deficiency, is caused by an injury to the
The small intestine or small bowel is an organ in the gastrointestinal tract where most of the absorption of nutrients from food takes place. It lies between the stomach and large intestine, and receives bile and pancreatic juice through the .... This form of lactose intolerance can occur in both infants and lactase persistent adults and is generally reversible. It may be caused by acute gastroenteritis
Gastroenteritis, also known as infectious diarrhea and gastro, is an inflammation of the gastrointestinal tract including the stomach and intestine. Symptoms may include diarrhea, vomiting, and abdominal pain. Fever, lack of energy, and dehydrat ..., coeliac disease
Coeliac disease (British English) or celiac disease (American English) is a long-term autoimmune disorder, primarily affecting the small intestine, where individuals develop intolerance to gluten, present in foods such as wheat, rye and barl ..., Crohn's disease
Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea (which may be bloody if inflammation is severe), fever, abdominal distension, ..., ulcerative colitis
Ulcerative colitis (UC) is a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary symptoms of active disease are abdominal pain and diarrhea mixed with blood (hematochezia). Weight loss, fever, and a ..., chemotherapy
Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs ( chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemother ..., intestinal parasites (such as giardia
''Giardia'' ( or ) is a genus of anaerobic flagellated protozoan parasites of the phylum Metamonada that colonise and reproduce in the small intestines of several vertebrates, causing the disease giardiasis. Their life cycle alternates between ...), or other environmental causes.
Primary congenital alactasia
Primary congenital alactasia, also called congenital lactase deficiency, is an extremely rare,
In genetics, dominance is the phenomenon of one variant (allele) of a gene on a chromosome masking or overriding the effect of a different variant of the same gene on the other copy of the chromosome. The first variant is termed dominant an ... enzyme defect that prevents lactase expression from birth. People with congenital lactase deficiency cannot digest lactose from birth, so cannot digest breast milk. This genetic defect is characterized by a complete lack of lactase (alactasia). About 40 cases have been reported worldwide, mainly limited to Finland
Finland ( fi, Suomi ; sv, Finland ), officially the Republic of Finland (; ), is a Nordic country in Northern Europe. It shares land borders with Sweden to the northwest, Norway to the north, and Russia to the east, with the Gulf of Bot .... Before the 20th century, babies born with congenital lactase deficiency often did not survive, but death rates decreased with soybean
The soybean, soy bean, or soya bean (''Glycine max'') is a species of legume native to East Asia, widely grown for its edible bean, which has numerous uses.
Traditional unfermented food uses of soybeans include soy milk, from which tofu ...-derived infant formula
Infant formula, baby formula, or simply formula (American English); or baby milk, infant milk or first milk (British English), is a manufactured food designed and marketed for feeding to babies and infants under 12 months of age, usually prepar ...s and manufactured lactose-free dairy products.
In order to assess lactose intolerance, intestinal function is challenged by ingesting more dairy products than can be readily digested. Clinical symptoms typically appear within 30 minutes, but may take up to two hours, depending on other foods and activities. Substantial variability in response (symptoms of nausea, cramping, bloating, diarrhea, and flatulence) is to be expected, as the extent and severity of lactose intolerance varies among individuals.
The next step is to determine whether it is due to primary lactase deficiency or an underlying disease that causes secondary lactase deficiency.
Physicians should investigate the presence of undiagnosed coeliac disease
Coeliac disease (British English) or celiac disease (American English) is a long-term autoimmune disorder, primarily affecting the small intestine, where individuals develop intolerance to gluten, present in foods such as wheat, rye and barl ..., Crohn disease
Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea (which may be bloody if inflammation is severe), fever, abdominal distension, ..., or other enteropathies when secondary lactase deficiency is suspected and infectious gastroenteritis has been ruled out.
Lactose intolerance is distinct from milk allergy
Milk allergy is an adverse immune reaction to one or more proteins in cow's milk. Among the possible symptoms is anaphylaxis, a potentially life-threatening condition that requires treatment with epinephrine, among other measures. However, ..., an immune response to cow's milk proteins. They may be distinguished in diagnosis by giving lactose-free milk, producing no symptoms in the case of lactose intolerance, but the same reaction as to normal milk in the presence of a milk allergy. A person can have both conditions. If positive confirmation is necessary, four tests are available.
Hydrogen breath test
hydrogen breath test
A hydrogen breath test (or HBT) is used as a diagnostic tool for small intestine bacterial overgrowth and carbohydrate malabsorption, such as lactose, fructose, and sorbitol malabsorption.
The test is simple, non-invasive, and is performed afte ..., the most accurate lactose intolerance test, after an overnight fast, 25 grams of lactose (in a solution with water) are swallowed. If the lactose cannot be digested, enteric bacteria metabolize it and produce hydrogen, which, along with methane, if produced, can be detected on the patient's breath by a clinical gas chromatograph or compact solid-state detector. The test takes about 2.5 hours to complete. If the hydrogen levels in the patient's breath are high, they may have lactose intolerance. This test is not usually done on babies and very young children, because it can cause severe diarrhea.
Lactose tolerance test
In conjunction, measuring blood glucose level every 10 to 15 minutes after ingestion will show a "flat curve" in individuals with lactose malabsorption, while the lactase persistent will have a significant "top", with a typical elevation of 50% to 100%, within one to two hours. However, due to the need for frequent blood sampling, this approach has been largely replaced by breath testing.
After an overnight fast, blood is drawn and then 50 grams of lactose (in aqueous solution) are swallowed. Blood is then drawn again at the 30-minute, 1-hour, 2-hour, and 3-hour marks. If the lactose cannot be digested, blood glucose levels will rise by less than 20 mg/dl.
Stool acidity test
This test can be used to diagnose lactose intolerance in infants, for whom other forms of testing are risky or impractical. The infant is given lactose to drink. If the individual is tolerant, the lactose is digested and absorbed in the small intestine; otherwise, it is not digested and absorbed, and it reaches the colon. The bacteria in the colon, mixed with the lactose, cause acidity in stools. Stools passed after the ingestion of the lactose are tested for level of acidity. If the stools are acidic, the infant is intolerant to lactose.
Stool pH in lactose intolerance is less than 5.5.
An intestinal biopsy must confirm lactase deficiency following discovery of elevated hydrogen in the hydrogen breath test.
Modern techniques have enabled a bedside test, identifying presence of lactase enzyme on upper gastrointestinal endoscopy instruments. However, for research applications such as mRNA
In molecular biology, messenger ribonucleic acid (mRNA) is a single-stranded molecule of RNA that corresponds to the genetic sequence of a gene, and is read by a ribosome in the process of synthesizing a protein.
mRNA is created during t ... measurements, a specialist laboratory is required.
Stool sugar chromatography
Chromatography can be used to separate and identify undigested sugars present in faeces. Although lactose may be detected in the faeces of people with lactose intolerance, this test is not considered reliable enough to conclusively diagnose or exclude lactose intolerance.
Genetic tests may be useful in assessing whether a person has primary lactose intolerance. Lactase activity persistence in adults is associated with two polymorphisms: C/T 13910 and G/A 22018 located in the ''MCM6'' gene.
These polymorphisms may be detected by molecular biology
Molecular biology is the branch of biology that seeks to understand the molecular basis of biological activity in and between cells, including biomolecular synthesis, modification, mechanisms, and interactions. The study of chemical and phys ... techniques at the DNA extracted from blood or saliva samples; genetic kits specific for this diagnosis are available. The procedure consists of extracting and amplifying DNA from the sample, following with a hybridation protocol in a strip. Colored bands are obtained as result, and depending on the different combinations, it would be possible to determine whether the patient is lactose intolerant. This test allows a noninvasive definitive diagnostic.
Lactose intolerance is most common in people of East Asian descent, with 70 to 100 percent of people affected in these communities. Lactose intolerance is also more common in people of West African, Arab, and Jewish descent, while only about 5 percent of people of European descent are lactose intolerant.
When lactose intolerance is due to secondary lactase deficiency, treatment of the underlying disease may allow lactase activity to return to normal levels.
In people with celiac disease, lactose intolerance normally reverts or improves several months after starting a gluten-free diet
A gluten-free diet (GFD) is a nutritional plan that strictly excludes gluten, which is a mixture of proteins found in wheat (and all of its species and hybrids, such as spelt, kamut, and triticale), as well as barley, rye, and oats. The inclu ..., but temporary dietary restriction of lactose may be needed.
People with primary lactase deficiency cannot modify their body's ability to produce lactase. In societies where lactose intolerance is the norm, it is not considered a condition that requires treatment. However, where dairy is a larger component of the normal diet, a number of efforts may be useful. There are four general principles in dealing with lactose intolerance: avoidance of dietary lactose, substitution to maintain nutrient intake, regulation of calcium intake, and use of enzyme substitute. Regular consumption of dairy food by lactase deficient individuals may also reduce symptoms of intolerance by promoting colonic bacteria adaptation.
The primary way of managing the symptoms of lactose intolerance is to limit the intake of lactose to a level that can be tolerated.
Lactase deficient individuals vary in the amount of lactose they can tolerate, [ and some report that their tolerance varies over time, depending on health status and pregnancy.] However, as a rule of thumb, people with primary lactase deficiency and no small intestine injury are usually able to consume at least 12 grams of lactose per sitting without symptoms, or with only mild symptoms, with greater amounts tolerated if consumed with a meal or throughout the day.
Lactose is found primarily in dairy product
Dairy products or milk products, also known as lacticinia, are food products made from (or containing) milk. The most common dairy animals are cow, water buffalo, nanny goat, and ewe. Dairy products include common grocery store food items in ...s, which vary in the amount of lactose they contain:
* Milk – unprocessed cow's milk is about 4.7% lactose; goat's milk
Goat milk is the milk of domestic goats. Goats produce about 2% of the world's total annual milk supply. Some goats are bred specifically for milk. Goat milk naturally has small, well-emulsified fat globules, which means the cream will stay in ... 4.7%; sheep's milk
Sheep's milk (or ewes' milk) is the milk of domestic sheep. It is commonly used to make cultured dairy products such as cheese. Some of the most popular sheep cheeses include feta (Greece), ricotta (Italy), and Roquefort (France).
Sheep breed ... 4.7%; buffalo milk 4.86%; and yak milk
The domestic yak (''Bos grunniens''), also known as the Tartary ox, grunting ox or hairy cattle, is a species of long-haired domesticated cattle found throughout the Himalayan region of the Indian subcontinent, the Tibetan Plateau, Kachin Sta ... 4.93%.
* Sour cream and buttermilk – if made in the traditional way, this may be tolerable, but most modern brands add milk solids.
* Butter – the process of making butter
Butter is a dairy product made from the fat and protein components of churned cream. It is a semi-solid emulsion at room temperature, consisting of approximately 80% butterfat. It is used at room temperature as a spread, melted as a condimen ... largely removes lactose, but it is still present in small quantities; clarified butter
Clarified butter is milk fat rendered from butter to separate the milk solids and water from the butterfat. Typically, it is produced by melting butter and allowing the components to separate by density. The water evaporates, some solids (i.e ... contains a negligible amount of lactose.
* Yogurt – lactobacilli
The ''Lactobacillaceae'' are a family of lactic acid bacteria. It is the only family in the lactic acid bacteria which includes homofermentative and heterofermentative organisms; in the ''Lactobacillaceae,'' the pathway used for hexose fermentati ... used in the production of yogurt
Yogurt (; , from tr, yoğurt, also spelled yoghurt, yogourt or yoghourt) is a food produced by bacterial fermentation of milk. The bacteria used to make yogurt are known as ''yogurt cultures''. Fermentation of sugars in the milk by these bac ... metabolize lactose to varying degrees, depending on the type of yogurt. Some bacteria found in yogurt also produce their own lactase
Lactase is an enzyme produced by many organisms. It is located in the brush border of the small intestine of humans and other mammals. Lactase is essential to the complete digestion of whole milk; it breaks down lactose, a sugar which gives m ..., which facilitates digestion in the intestines of lactose intolerant individuals.
* Cheese – fermentation also reduces the lactose content of cheese
Cheese is a dairy product produced in wide ranges of flavors, textures, and forms by coagulation of the milk protein casein. It comprises proteins and fat from milk, usually the milk of cows, buffalo, goats, or sheep. During productio ...s and aging
Ageing ( BE) or aging ( AE) is the process of becoming older. The term refers mainly to humans, many other animals, and fungi, whereas for example, bacteria, perennial plants and some simple animals are potentially biologically immortal. In ... reduces it further; traditionally made hard cheese
There are many different types of cheese. Cheeses can be grouped or classified according to criteria such as length of fermentation, texture, methods of production, fat content, animal milk, and country or region of origin. The method most comm ...s might contain just 10% of the lactose found in an equivalent volume of milk. However, manufactured cheeses may be produced using processes that do not have the same lactose-reducing properties.
There is no standardized method for measuring the lactose content of food. The stated dairy content of a product also varies according to manufacturing processes and labelling practices, and commercial terminology varies between languages and regions. As a result, absolute figures for the amount of lactose consumed (by weight) may not be very reliable. Kosher
(also or , ) is a set of dietary laws dealing with the foods that Jewish people are permitted to eat and how those foods must be prepared according to Jewish law. Food that may be consumed is deemed kosher ( in English, yi, כּשר), fro ... products labeled '' pareve
In ''kashrut'', the dietary laws of Judaism, pareve (from yi, פאַרעוו for "neutral", in Hebrew , and also parve and other variant English spellings) is a classification of edible substances that contain neither dairy nor meat ingredients ...'' or '' fleishig
Mixtures of milk and meat ( he, בשר בחלב, basar bechalav, meat in milk) are forbidden according to Jewish law. This dietary law, basic to kashrut, is based on two verses in the Book of Exodus, which forbid "boiling a (goat) kid in its ...'' are free of milk. However, if a "D" (for "dairy") is present next to the circled "K", "U", or other '' hechsher
A hechsher (; he, הֶכְשֵׁר "prior approval"; plural: ''hechsherim'') is a rabbinical product certification, qualifying items (usually foods) that conform to the requirements of halakha.
A hechsher may be a printed and signed certi ...'', the food product likely contains milk solids, although it may also simply indicate the product was produced on equipment shared with other products containing milk derivatives.
Lactose is also a commercial food additive
Food additives are substances added to food to preserve flavor or enhance taste, appearance, or other sensory qualities. Some additives have been used for centuries as part of an effort to preserve food, for example vinegar ( pickling), salt ( ... used for its texture, flavor, and adhesive qualities. It is found in additives labelled as casein
Casein ( , from Latin ''caseus'' "cheese") is a family of related phosphoproteins ( αS1, aS2, β, κ) that are commonly found in mammalian milk, comprising about 80% of the proteins in cow's milk and between 20% and 60% of the proteins in human ..., caseinate, whey
Whey is the liquid remaining after milk has been curdled and strained. It is a byproduct of the manufacturing of cheese or casein and has several commercial uses. Sweet whey is a byproduct resulting from the manufacture of rennet types of hard c ..., lactoserum, milk solids
Powdered milk, also called milk powder, dried milk, or dry milk, is a manufactured dairy product made by evaporating milk to dryness. One purpose of drying milk is to preserve it; milk powder has a far longer shelf life than liquid milk and do ..., modified milk ingredients Modified milk ingredients also called natural milk constituents are umbrella terms for a group of milk products which have an altered chemical state from that which is naturally found in milk. This includes casein, caseinates, whey products (includ ..., etc. As such lactose is found in foods such as processed meats ( sausage
A sausage is a type of meat product usually made from ground meat—often pork, beef, or poultry—along with salt, spices and other flavourings. Other ingredients, such as grains or breadcrumbs may be included as fillers or extenders.
...s/ hot dog
A hot dog (uncommonly spelled hotdog) is a food consisting of a grilled or steamed sausage served in the slit of a partially sliced bun. The term hot dog can refer to the sausage itself. The sausage used is a wiener (Vienna sausage) or a fr ...s, sliced meats, pâté
''Pâté'' ( , , ) is a paste, pie or loaf filled with a forcemeat. Common forcemeats include ground meat from pork, poultry, fish or beef; fat, vegetables, herbs, spices and either wine or brandy (often cognac or armagnac). It is often served ...s), gravy stock powder, margarine
Margarine (, also , ) is a spread used for flavoring, baking, and cooking. It is most often used as a substitute for butter. Although originally made from animal fats, most margarine consumed today is made from vegetable oil. The spread was or ...s, sliced bread
Bread is a staple food prepared from a dough of flour (usually wheat) and water, usually by baking. Throughout recorded history and around the world, it has been an important part of many cultures' diet. It is one of the oldest human-made foo ...s, breakfast cereals, potato chip
A potato chip (North American English; often just chip) or crisp (British and Irish English) is a thin slice of potato that has been either deep fried, baked, or air fried until crunchy. They are commonly served as a snack, side dish, or ap ...s, processed foods, medication
A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, treat, or preventive medicine, prevent disease. Drug therapy (pharmacotherapy) is an imp ...s, prepared meals, meal replacements (powders and bars), protein supplements (powders and bars), and even beer
Beer is one of the oldest and the most widely consumed type of alcoholic drink in the world, and the third most popular drink overall after water and tea. It is produced by the brewing and fermentation of starches, mainly derived from cer ...s in the milk stout
Stout is a dark, top-fermented beer with a number of variations, including dry stout, oatmeal stout, milk stout, and imperial stout.
The first known use of the word ''stout'' for beer, in a document dated 1677 found in the Egerton Manuscri ... style. Some barbecue sauces and liquid cheeses used in fast-food restaurants may also contain lactose. Lactose is often used as the primary filler (main ingredient) in most prescription and non-prescription solid pill form medications, though product labeling seldom mentions the presence of 'lactose' or 'milk', and neither do product monograms provided to pharmacists, and most pharmacists are unaware of the very wide scale yet common use of lactose in such medications until they contact the supplier or manufacturer for verification.
Plant-based milks and derivatives such as
Soy milk (simplified Chinese: 豆浆; traditional Chinese: 豆漿) also known as soya milk or soymilk, is a plant-based drink produced by soaking and grinding soybeans, boiling the mixture, and filtering out remaining particulates. It is a sta ..., rice milk
Rice milk is a plant milk made from rice. Commercial rice milk is typically manufactured using brown rice and brown rice syrup, and may be sweetened using sugar or sugar substitutes, and flavored by common ingredients, such as vanilla. It is com ..., almond milk
Almond milk is a plant-based milk with a watery texture and nutty flavor manufactured from almonds, although some types or brands are flavored in imitation of cow's milk. It does not contain cholesterol or lactose and is low in saturated fat. Alm ..., coconut milk
Coconut milk is an opaque, milky-white liquid extracted from the grated pulp of mature coconuts. The opacity and rich taste of coconut milk are due to its high oil content, most of which is saturated fat. Coconut milk is a traditional food i ..., hazelnut
The hazelnut is the fruit of the hazel tree and therefore includes any of the nuts deriving from species of the genus '' Corylus'', especially the nuts of the species '' Corylus avellana''. They are also known as cobnuts or filberts accordin ... milk, oat milk, hemp milk
Hemp milk, or hemp seed milk, is a plant milk made from hemp seeds that are soaked and ground in water. The result resembles milk in colour, texture, and flavour. Hemp is conducive to being organically grown and labelled. Plain hemp milk may be ..., macadamia nut milk, and peanut milk are inherently lactose-free. Low-lactose and lactose-free versions of foods are often available to replace dairy-based foods for those with lactose intolerance.
When lactose avoidance is not possible, or on occasions when a person chooses to consume such items, then enzymatic lactase supplements may be used.
Lactase enzymes similar to those produced in the small intestines of humans are produced industrially by fungi
A fungus ( : fungi or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms. These organisms are classified as a kingdom, separately from ... of the genus
Genus ( plural genera ) is a taxonomic rank used in the biological classification of living and fossil organisms as well as viruses. In the hierarchy of biological classification, genus comes above species and below family. In binomial no ... '' Aspergillus
' () is a genus consisting of several hundred mold species found in various climates worldwide.
''Aspergillus'' was first catalogued in 1729 by the Italian priest and biologist Pier Antonio Micheli. Viewing the fungi under a microscope, Mich ...''. The enzyme, β-galactosidase
β-Galactosidase (EC 220.127.116.11, lactase, beta-gal or β-gal; systematic name β-D-galactoside galactohydrolase), is a glycoside hydrolase enzyme that catalyzes hydrolysis of terminal non-reducing β-D-galactose residues in β-D-galactosides.
� ..., is available in tablet form in a variety of doses, in many countries without a prescription. It functions well only in high-acid environments, such as that found in the human gut due to the addition of gastric juices from the stomach. Unfortunately, too much acid can denature it, so it should not be taken on an empty stomach. Also, the enzyme is ineffective if it does not reach the small intestine by the time the problematic food does. Lactose-sensitive individuals can experiment with both timing and dosage to fit their particular needs.
While essentially the same process as normal intestinal lactose digestion, direct treatment of milk employs a different variety of industrially produced lactase. This enzyme, produced by yeast
Yeasts are eukaryotic, single-celled microorganisms classified as members of the fungus kingdom. The first yeast originated hundreds of millions of years ago, and at least 1,500 species are currently recognized. They are estimated to constit ... from the genus '' Kluyveromyces
''Kluyveromyces'' is a genus of ascomycetous yeasts in the family Saccharomycetaceae. Some of the species, such as '' K. marxianus'', are the teleomorphs of '' Candida species''.
The genus name of ''Kluyveromyces'' is in honour of Albert Jan Kl ...'', takes much longer to act, must be thoroughly mixed throughout the product, and is destroyed by even mildly acidic environments. Its main use is in producing the lactose-free or lactose-reduced dairy products sold in supermarkets.
Rehabituation to dairy products
Regular consumption of dairy foods containing lactose can promote a colonic bacteria adaptation, enhancing a favorable microbiome, which allows people with primary lactase deficiency to diminish their intolerance and to consume more dairy foods.
The way to induce tolerance is based on progressive exposure, consuming smaller amounts frequently, distributed throughout the day. Lactose intolerance can also be managed by ingesting live yogurt cultures containing lactobacilli
The ''Lactobacillaceae'' are a family of lactic acid bacteria. It is the only family in the lactic acid bacteria which includes homofermentative and heterofermentative organisms; in the ''Lactobacillaceae,'' the pathway used for hexose fermentati ... that are able to digest the lactose in other dairy products.
Worldwide, about 65% of people experience some form of lactose intolerance as they age past infancy, but there are significant differences between populations and regions. As few as 5% of northern Europeans are lactose intolerant, while as many as 90% of adults in parts of Asia are lactose intolerant.
Some populations, from an evolutionary perspective, have a better genetic makeup for tolerating lactose than others. In northern European countries, early adoption of dairy farming conferred a selective evolutionary advantage to individuals that could better tolerate lactose. This led to higher frequencies of lactose tolerance in these countries. For example, almost 100% of Irish people
The Irish ( ga, Muintir na hÉireann or ''Na hÉireannaigh'') are an ethnic group and nation native to the island of Ireland, who share a common history and Culture of Ireland, culture. There have been humans in Ireland for about 33,000 years ... are predicted to be lactose tolerant. Conversely, regions of the south, such as Africa, did not adopt dairy farming as early and tolerance from milk consumption did not develop the same way as in northern Europe. Lactose intolerance is common among people of Jewish descent, as well as from West Africa, the Arab countries, Greece, and Italy. [ Different populations will present certain gene constructs depending on the evolutionary and cultural pre-settings of the geographical region.]
Greater lactose tolerance has come about in two ways.
[ Some populations have developed genetic changes to allow the digestion of lactose: ] lactase persistence
Lactase persistence is the continued activity of the lactase enzyme in adulthood, allowing the digestion of lactose in milk. In most mammals, the activity of the enzyme is dramatically reduced after weaning. In some human populations, though, lac .... [ Other populations developed cooking methods like milk fermentation.]
Lactase persistence in humans evolved relatively recently (in the last 10,000 years) among some populations. Around 8,000 years ago in modern-day Turkey, humans became reliant on newly-domesticated animals that could be milked; such as cows, sheep, and goats. This resulted in higher frequency of lactase persistence. Lactase persistence became high in regions such as Europe, Scandinavia, the Middle East and Northwestern India. However, most people worldwide remain lactase ''non''-persistent. Populations that raised animals not used for milk tend to have 90–100 percent of a lactose intolerant rate. For this reason, lactase persistence is of some interest to the fields of anthropology
Anthropology is the scientific study of humanity, concerned with human behavior, human biology, cultures, societies, and linguistics, in both the present and past, including past human species. Social anthropology studies patterns of behav ..., human genetics
Human genetics is the study of inheritance as it occurs in human beings. Human genetics encompasses a variety of overlapping fields including: classical genetics, cytogenetics, molecular genetics, biochemical genetics, genomics, population g ..., and archaeology
Archaeology or archeology is the scientific study of human activity through the recovery and analysis of material culture. The archaeological record consists of Artifact (archaeology), artifacts, architecture, biofact (archaeology), biofacts ..., which typically use the genetically derived persistence/non-persistence terminology.
The rise of dairy and producing dairy related products from cow milk alone, varies across different regions of the world, aside from genetic predisposition. The process of turning milk into cheese dates back earlier than 5200 BC.
DNA analysis in February 2012 revealed that Ötzi
Ötzi, also called the Iceman, is the natural mummy of a man who lived some time between 3350 and 3105 BC, discovered in September 1991 in the Ötztal Alps (hence the nickname "Ötzi") on the border between Austria and Italy.
Ötzi is believed to ... was lactose intolerant, supporting the theory that lactose intolerance was still common at that time, despite the increasing spread of agriculture and dairying.
Genetic analysis shows lactase persistence has developed several times in different places independently in an example of convergent evolution
Convergent evolution is the independent evolution of similar features in species of different periods or epochs in time. Convergent evolution creates analogous structures that have similar form or function but were not present in the last com ....
History of research
It is not until relatively recently that
Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care p ... recognised the worldwide prevalence of lactose intolerance and its genetic causes. Its symptoms were described as early as Hippocrates
Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history ... (460–370 BC), but until the 1960s, the prevailing assumption was that tolerance was the norm. Intolerance was explained as the result of a milk allergy, intestinal pathogens, or as being psychosomatic
A somatic symptom disorder, formerly known as a somatoform disorder,(2013) dsm5.org. Retrieved April 8, 2014. is any mental disorder that manifests as physical symptoms that suggest illness or injury, but cannot be explained fully by a general ... – it being recognised that some cultures did not practice dairying, and people from those cultures often reacted badly to consuming milk. Two reasons have been given for this misconception. One was that early research was conducted solely on European-descended populations, which have an unusually low incidence of lactose intolerance and an extensive cultural history of dairying. As a result, researchers wrongly concluded that tolerance was the global norm. Another reason is that lactose intolerance tends to be under-reported: lactose intolerant individuals can tolerate at least some lactose before they show symptoms, and their symptoms differ in severity. The large majority of people are able to digest some quantity of milk, for example in tea or coffee, without developing any adverse effects. Fermented dairy products
Fermented milk products or fermented dairy products, also known as cultured dairy foods, cultured dairy products, or cultured milk products, are dairy foods that have been fermented with lactic acid bacteria such as '' Lactobacillus'', ''Lactoco ..., such as cheese, also contain significantly less lactose than plain milk. Therefore, in societies where tolerance is the norm, many lactose intolerant people who consume only small amounts of dairy, or have only mild symptoms, may be unaware that they cannot digest lactose.
Eventually, in the 1960s, it was recognised that lactose intolerance was correlated with race in the United States. Subsequent research revealed that lactose intolerance was more common globally than tolerance, and that the variation was due to genetic differences, not an adaptation to cultural practices.
Mammals () are a group of vertebrate animals constituting the class Mammalia (), characterized by the presence of mammary glands which in females produce milk for feeding (nursing) their young, a neocortex (a region of the brain), fu ...s normally cease to produce lactase and become lactose intolerant after weaning
Weaning is the process of gradually introducing an infant human or another mammal to what will be its adult diet while withdrawing the supply of its mother's milk.
The process takes place only in mammals, as only mammals produce milk. The infan .... The downregulation of lactase expression in mice
A mouse ( : mice) is a small rodent. Characteristically, mice are known to have a pointed snout, small rounded ears, a body-length scaly tail, and a high breeding rate. The best known mouse species is the common house mouse (''Mus musculus' ... could be attributed to the accumulation of DNA methylation
DNA methylation is a biological process by which methyl groups are added to the DNA molecule. Methylation can change the activity of a DNA segment without changing the sequence. When located in a gene promoter, DNA methylation typically acts t ... in the '' Lct'' gene and the adjacent '' Mcm6'' gene.
Conditions diagnosed by stool test
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