Pediatric Lactose Intolerance Treatment & Management

  • Author: Stefano Guandalini, MD; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: Mar 30, 2010
 

Medical Care

Treatment of lactose intolerance may include the following:

  • Lactase deficiency: This can be induced by lactose 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;[7] 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.
    • 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.[8] The importance of maintaining a good intake of dairy products in the face of lactose intolerance has been stressed.[8]
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Consultations

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.

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Diet

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.[9]

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Contributor Information and Disclosures
Author

Stefano Guandalini, MD  Director, University of Chicago Celiac Disease Program, Section Chief of Gastroenterology, Hepatology and Nutrition; Professor, Department of Pediatrics, University of Chicago Comer Children's Hospital

Stefano Guandalini, MD is a member of the following medical societies: American Gastroenterological Association, European Society for Paediatric Gastroenterology, Hepatology & Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Coauthor(s)

Richard E Frye, MD, PhD  Assistant Professor, Departments of Pediatrics and Neurology, University of Texas Health Science Center at Houston

Richard E Frye, MD, PhD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and International Neuropsychological Society

Disclosure: Nothing to disclose.

Delia M Rivera, MD  Assistant Professor, Department of Pediatrics, Division of Infectious Disease and Immunology, University of Miami Leonard M Miller School of Medicine

Delia M Rivera, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Stephen Borowitz, MD  Professor of Pediatrics and Public Health Sciences, Department of Pediatrics, Division of Gastroenterology and Nutrition, University of Virginia

Stephen Borowitz, MD is a member of the following medical societies: American Academy of Pediatrics, American Gastroenterological Association, American Pediatric Society, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Alan D Schmetzer, MD  Professor and Vice-Chair for Education, Director of Residency Training, Department of Psychiatry, Indiana University School of Medicine

Alan D Schmetzer, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, American Society of Transplant Surgeons, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

B UK Li, MD  Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin

B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Steven M Schwarz, MD, FAAP, FACN, AGAF  Professor of Pediatrics, Children's Hospital at Downstate, SUNY-Downstate Medical Center

Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research

Disclosure: Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor; Johnson & Johnson, Inc. Grant/research funds Independent contractor

Chief Editor

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

References

  1. Campbell AK, Waud JP, Matthews SB. The molecular basis of lactose intolerance. Sci Prog. 2009;92:241-87. [Medline].

  2. [Best Evidence] [Guideline] Brannon PM, Carpenter TO, Fernandez JR, et al. NIH Consensus Development Conference Statement: Lactose Intolerance and Health. NIH Consens State Sci Statements. Feb 24 2010;27(2):[Medline].

  3. 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].

  4. 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. Oct 15 2008;28(8):1003-12. [Medline].

  5. 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. Jun 2008;17(2):135-9. [Medline].

  6. Hovde O, Farup PG. A comparison of diagnostic tests for lactose malabsorption--which one is the best?. BMC Gastroenterol. Oct 31 2009;9:82. [Medline].

  7. Griffin MP, Hansen JW. Can the elimination of lactose from formula improve feeding tolerance in premature infants?. J Pediatr. Nov 1999;135(5):587-92. [Medline].

  8. Lactose intolerance and African Americans: implications for the consumption of appropriate intake levels of key nutrients. J Natl Med Assoc. Oct 2009;101(10 Suppl):5S-23S. [Medline].

  9. Bacsi K, Kosa JP, Lazary A, et al. LCT 13910 C/T polymorphism, serum calcium, and bone mineral density in postmenopausal women. Osteoporos Int. Aug 13 2008;[Medline].

  10. 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].

  11. Guandalini S. Treatment of acute diarrhea in the new millennium. J Pediatr Gastroenterol Nutr. 2000;30:486-9. [Medline].

  12. He T, Venema K, Priebe MG, Welling GW, Brummer RJ, Vonk RJ. The role of colonic metabolism in lactose intolerance. Eur J Clin Invest. Aug 2008;38(8):541-7. [Medline].

  13. 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].

  14. Montalto M, Curigliano V, Santoro L. Management and treatment of lactose malabsorption. World J Gastroenterol. 2006;14:187-91. [Medline].

  15. 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].

  16. 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].

  17. Srinivasan R, Minocha A. When to suspect lactose intolerance. Symptomatic, ethnic, and laboratory clues. Postgrad Med. Sep 1998;104(3):109-11, 115-6, 122-3. [Medline].

 
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The small intestine is a major site of absorption.
 
 
 
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