Pediatric Lactose Intolerance Treatment & Management
- Author: Stefano Guandalini, MD; Chief Editor: Carmen Cuffari, MD more...
Treatment of lactose intolerance may include the following:
- Lactase deficiency: The Lactase enzyme expression can be induced by lactose, but only during the newborn period. Studies demonstrate the use of inducing lactase activity by tube feedings with milk-containing lactose in premature infants. Early initiation of half-strength lactose-containing formula or breast milk results in rapid induction of lactase activity in the brush border and less feeding intolerance. One study suggested that full-strength lactose formula resulted in more feeding intolerance than low-lactose formula in premature infants; thus, the precise lactose concentration of lactose for inducing lactase activity is still undetermined.
- Lactose intolerance: This can be improved by dietary manipulation. If the quantity of lactose is increased slowly over time, lactobacilli are stimulated to grow in the colon. A greater number of lactobacilli allow the lactose to break down into monosaccharides. Although this allows much of the sugar to be absorbed, some of the resulting monosaccharides are still fermented by colonic bacteria; however, the relative amount of colonic fermentation is decreased.
- Dietary aids
- Lactase derived from yeast can be added to milk products as drops or ingested as chewable tablets prior to ingestion of lactose-containing substances. Studies demonstrate varying success. Digestive supplementations are apparently limited in their ability to digest large quantities of lactose.
- Yogurt with live cultures is generally well tolerated by individuals with lactose intolerance. Dairy products with reduced or no lactose are widely available.
- In addition, research is ongoing that is evaluating the clinical effects of feeding a highly purified, short-chain galactooligosaccharide (GOS/RP-G28) on lactose intolerance and changes in the composition of the colonic microbiota. Intolerant adults fed this sugar showed major changes in their intestinal microbiota, and this was associated with improvement in lactose digestion and overall symptoms of lactose intolerance.
- The risks of drastically limiting or excluding all dairy products in populations such as blacks, who may be at risk for nutritional deficiencies, have been illustrated. The importance of maintaining a good intake of dairy products in the face of lactose intolerance has been stressed.
Consultation with a pediatric gastroenterologist is suggested if the patient has symptoms that do not resolve after dietary elimination of lactose or if the patient has severe symptoms.
Lactose is believed to enhance the absorption of several minerals, including calcium, magnesium, and zinc. In addition, milk products that contain a large amount of lactose also contain a high amount of calcium. Because calcium is extremely important in bone growth, children can quickly become deficient if adequate calcium intake is not maintained; thus, calcium supplementation is required in anyone restricted from dairy products. In fact, primary adult hypolactasia has been associated with decreased serum calcium level and lower bone mineral density in postmenopausal women.
In children and teenagers, however, there is less evidence that those who are lactose intolerant are at risk of low calcium intake or bone mineralization. In fact, a study on 76 children and adolescents found no statistically significant difference between the groups (lactose malabsorbers and lactose absorbers) with respect to the intake of total calcium, milk calcium, milk, cheese, yogurt, ice cream, and calcium density of the diet. Additionally, there was no difference with respect to the bone mineral content and the bone mineral density of the lumbar spine.
Campbell AK, Waud JP, Matthews SB. The molecular basis of lactose intolerance. Sci Prog. 2009. 92:241-87. [Medline].
[Guideline] Brannon PM, Carpenter TO, Fernandez JR, et al. NIH Consensus Development Conference Statement: Lactose Intolerance and Health. NIH Consens State Sci Statements. 2010 Feb 24. 27(2):[Medline].
Bailey RK, Fileti CP, Keith J, Tropez-Sims S, Price W, Allison-Ottey SD. Lactose intolerance and health disparities among African Americans and Hispanic Americans: an updated consensus statement. J Natl Med Assoc. 2013. 105(2):112-27. [Medline].
Seppo L, Tuure T, Korpela R, et al. Can primary hypolactasia manifest itself after the age of 20 years? A two-decade follow-up study. Scand J Gastro. 2008. 43:1082-1087. [Medline].
Montalto M, Gallo A, Santoro L, et al. Low-dose lactose in drugs neither increases breath hydrogen excretion nor causes gastrointestinal symptoms. Aliment Pharmacol Ther. 2008 Oct 15. 28(8):1003-12. [Medline].
Gijsbers CF, Kneepkens CM, Büller HA. Lactose and fructose malabsorption in children with recurrent abdominal pain: results of double-blinded testing. Acta Paediatr. 2012 Sep. 101(9):e411-5. [Medline].
Wilder-Smith CH, Materna A, Wermelinger C, Schuler J. Fructose and lactose intolerance and malabsorption testing: the relationship with symptoms in functional gastrointestinal disorders. Aliment Pharmacol Ther. 2013 Jun. 37(11):1074-83. [Medline].
Krawczyk M, Wolska M, Schwartz S, et al. Concordance of genetic and breath tests for lactose intolerance in a tertiary referral centre. J Gastrointestin Liver Dis. 2008 Jun. 17(2):135-9. [Medline].
Aragón JJ, Hermida C, Martínez-Costa OH, Sánchez V, Martín I, Sánchez JJ. Noninvasive Diagnosis of Hypolactasia With 4-Galactosylxylose: A Multicentre, Open-Label, Phase IIB-III Nonrandomized Trial. J Clin Gastroenterol. 2013 May 29. [Medline].
Marton A, Xue X, Szilagyi A. Meta-analysis: the diagnostic accuracy of lactose breath hydrogen or lactose tolerance tests for predicting the North European lactase polymorphism C/T-13910. Aliment Pharmacol Ther. 2012 Feb. 35(4):429-40. [Medline].
Griffin MP, Hansen JW. Can the elimination of lactose from formula improve feeding tolerance in premature infants?. J Pediatr. 1999 Nov. 135(5):587-92. [Medline].
Petschow B, Doré J, Hibberd P, Dinan T, Reid G, Blaser M. Probiotics, prebiotics, and the host microbiome: the science of translation. Ann N Y Acad Sci. 2013 Nov 22. [Medline].
Lactose intolerance and African Americans: implications for the consumption of appropriate intake levels of key nutrients. J Natl Med Assoc. 2009 Oct. 101(10 Suppl):5S-23S. [Medline].
Bacsi K, Kosa JP, Lazary A, et al. LCT 13910 C/T polymorphism, serum calcium, and bone mineral density in postmenopausal women. Osteoporos Int. 2008 Aug 13. [Medline].
Medeiros LC, Lederman HM, de Morais MB. Lactose malabsorption, calcium intake, and bone mass in children and adolescents. J Pediatr Gastroenterol Nutr. 2012 Feb. 54(2):204-9. [Medline].
Setty-Shah N, Maranda L, Candela N, Fong J, Dahod I, Rogol AD. Lactose intolerance: lack of evidence for short stature or vitamin d deficiency in prepubertal children. PLoS One. 2013. 8(10):e78653. [Medline].
Bodlaj G, Stocher M, Hufnagl P, et al. Genotyping of the lactase-phlorizin hydrolase -13910 polymorphism by LightCycler PCR and implications for the diagnosis of lactose intolerance. Clin Chem. 2006. 52:148-151. [Medline].
Guandalini S. Treatment of acute diarrhea in the new millennium. J Pediatr Gastroenterol Nutr. 2000. 30:486-9. [Medline].
He T, Venema K, Priebe MG, Welling GW, Brummer RJ, Vonk RJ. The role of colonic metabolism in lactose intolerance. Eur J Clin Invest. 2008 Aug. 38(8):541-7. [Medline].
Kuokkanen M, Kokkonen J, Enattah NS. Mutations in the Translated Region of the Lactase Gene (LCT) Underlie Congenital Lactase Deficiency. Am J Hum Genet. 2006. 78:339-44. [Medline].
Montalto M, Curigliano V, Santoro L. Management and treatment of lactose malabsorption. World J Gastroenterol. 2006. 14:187-91. [Medline].
Savaiano DA, Boushey CJ, McCabe GP. Lactose intolerance symptoms assessed by meta-analysis: a grain of truth that leads to exaggeration. J Nutr. 2006. 136:1107-13. [Medline].
Shulman RJ,, Wong WW, Smith EO. Influence of changes in lactase activity and small-intestinal mucosal growth on lactose digestion and absorption in preterm infants. Am J Clin Nutr. 2005. 81:472-9. [Medline].
Srinivasan R, Minocha A. When to suspect lactose intolerance. Symptomatic, ethnic, and laboratory clues. Postgrad Med. 1998 Sep. 104(3):109-11, 115-6, 122-3. [Medline].