Medical Care

Dietary adjustment is the primary form of therapy for patients with lactose intolerance.^{[27, 28]}Advise patients to reduce or restrict products containing lactose. Prehydrolyzed milk (LACTAID) is available and is effective. Yogurt and fermented products, such as cheeses, are better tolerated than regular milk. Soy-based milk or food products are well tolerated.

Commercially available lactase enzyme preparations (eg, LACTAID, Lactrase) are effective in reducing symptoms; however, they may not be effective in some patients, partially due to insufficient dosing.

Plant-based milk alternatives are emerging; however, although these products show some potential, technologic, palatability, and/or nutritional balance issues remain a concern.^{[29, 30]}

Probiotics (DDS-1 strain of Lactobacillus) have been shown to improve symptoms.^{[31, 32]}

Supplemental calcium and vitamin D should also be recommended.^[15]

In secondary lactase deficiency, treatment is directed at the underlying cause.^[33]

Consultations

Consider consulting with a gastroenterologist and a nutritionist in the management of patients with suspected lactose intolerance.

Diet

Note the following dietary considerations in patients with lactose intolerance:

Patients should read labels on commercial products.
Patients should avoid or reduce intake of lactose-containing foods.
Most patients who are lactose intolerant can ingest as much as 240 mL of milk without an exacerbation of their symptoms.^[34]
Whole milk and chocolate milk may be better tolerated than skim milk.^[35]
Certain medications and foods contain hidden lactose, such as breads, margarine, salad dressings, and candies.

Medication

Vesa TH, Marteau P, Korpela R. Lactose intolerance. J Am Coll Nutr. 2000 Apr. 19(2 Suppl):165S-175S. [QxMD MEDLINE Link].
Newcomer AD, McGill DB, Thomas PJ, et al. Tolerance to lactose among lactase-deficient American Indians. Gastroenterology. 1978 Jan. 74(1):44-6. [QxMD MEDLINE Link].
Di Stefano M, Miceli E, Mazzocchi S, et al. Visceral hypersensitivity and intolerance symptoms in lactose malabsorption. Neurogastroenterol Motil. 2007 Nov. 19(11):887-95. [QxMD MEDLINE Link].
Micic D, Rao VL, Rubin DT. Clinical approach to lactose intolerance. JAMA. 2019 Sep 26. [QxMD MEDLINE Link].
Malik TF, Panuganti KK. Lactose intolerance. Stat Pearls. 2019 Jan. [QxMD MEDLINE Link]. [Full Text].
Zhong Y, Priebe MG, Vonk RJ, et al. The role of colonic microbiota in lactose intolerance. Dig Dis Sci. 2004 Jan. 49(1):78-83. [QxMD MEDLINE Link].
Ponte PR, de Medeiros PH, Havt A, et al. Clinical evaluation, biochemistry and genetic polymorphism analysis for the diagnosis of lactose intolerance in a population from northeastern Brazil. Clinics (Sao Paulo). 2016 Feb. 71(2):82-9. [QxMD MEDLINE Link]. [Full Text].
Delacour H, Leduc A, Loucano-Perdriat A, Plantamura J, Ceppa F. Diagnosis of genetic predisposition for lactose intolerance by high resolution melting analysis. Ann Biol Clin (Paris). 2017 Feb 1. 75(1):67-74. [QxMD MEDLINE Link].
Auricchio S, Rubino A, Landolt M, Semenza G, Prader A. Isolated intestinal lactase deficiency in the adult. Lancet. 1963 Aug 17. 2(7303):324-6. [QxMD MEDLINE Link].
Upton J, Mackay R, George P. A simple gene test for lactose intolerance/adult hypolactasia. N Z Med J. 2007 Nov 9. 120(1265):U2817. [QxMD MEDLINE Link].
Corgneau M, Scher J, Ritie-Pertusa L, et al. Recent advances on lactose intolerance: tolerance thresholds and currently available answers. Crit Rev Food Sci Nutr. 2017 Oct 13. 57(15):3344-56. [QxMD MEDLINE Link].
Xiong L, Wang Y, Gong X, Chen M. Prevalence of lactose intolerance in patients with diarrhea-predominant irritable bowel syndrome: data from a tertiary center in southern China. J Health Popul Nutr. 2017 Nov 21. 36(1):38. [QxMD MEDLINE Link]. [Full Text].
Harvey L, Ludwig T, Hou AQ, et al. Prevalence, cause and diagnosis of lactose intolerance in children aged 1-5 years: a systematic review of 1995-2015 literature. Asia Pac J Clin Nutr. 2018. 27(1):29-46. [QxMD MEDLINE Link]. [Full Text].
Kern F Jr, Struthers JE Jr. Intestinal lactase deficiency and lactose intolerance in adults. JAMA. 1966 Mar 14. 195(11):927-30. [QxMD MEDLINE Link].
Kudlacek S, Freudenthaler O, Weissboeck H, et al. Lactose intolerance: a risk factor for reduced bone mineral density and vertebral fractures?. J Gastroenterol. 2002. 37(12):1014-9. [QxMD MEDLINE Link].
Di Stefano M, Veneto G, Malservisi S, et al. Lactose malabsorption and intolerance and peak bone mass. Gastroenterology. 2002 Jun. 122(7):1793-9. [QxMD MEDLINE Link].
Alharbi O, El-Sohemy A. Lactose intolerance (LCT-13910C>T) genotype is associated with plasma 25-hydroxyvitamin D concentrations in caucasians: a Mendelian randomization study. J Nutr. 2017 Jun. 147(6):1063-9. [QxMD MEDLINE Link].
Bayless TM, Rothfeld B, Massa C, et al. Lactose and milk intolerance: clinical implications. N Engl J Med. 1975 May 29. 292(22):1156-9. [QxMD MEDLINE Link].
Deng Y, Misselwitz B, Dai N, Fox M. Lactose intolerance in adults: biological mechanism and dietary management. Nutrients. 2015 Sep 18. 7(9):8020-35. [QxMD MEDLINE Link]. [Full Text].
Mishkin S. Dairy sensitivity, lactose malabsorption, and elimination diets in inflammatory bowel disease. Am J Clin Nutr. 1997 Feb. 65(2):564-7. [QxMD MEDLINE Link].
Portincasa P, Bonfrate L, de Bari O, Lembo A, Ballou S. Irritable bowel syndrome and diet. Gastroenterol Rep (Oxf). 2017 Feb. 5(1):11-9. [QxMD MEDLINE Link]. [Full Text].
Beyerlein L, Pohl D, Delco F, et al. Correlation between symptoms developed after the oral ingestion of 50 g lactose and results of hydrogen breath testing for lactose intolerance. Aliment Pharmacol Ther. 2008 Apr. 27(8):659-65. [QxMD MEDLINE Link].
Hermans MM, Brummer RJ, Ruijgers AM, et al. The relationship between lactose tolerance test results and symptoms of lactose intolerance. Am J Gastroenterol. 1997 Jun. 92(6):981-4. [QxMD MEDLINE Link].
Arola H. Diagnosis of hypolactasia and lactose malabsorption. Scand J Gastroenterol Suppl. 1994. 202:26-35. [QxMD MEDLINE Link].
Carroccio A, Montalto G, Cavera G, et al. Lactose intolerance and self-reported milk intolerance: relationship with lactose maldigestion and nutrient intake. Lactase Deficiency Study Group. J Am Coll Nutr. 1998 Dec. 17(6):631-6. [QxMD MEDLINE Link].
Suarez FL, Savaiano DA, Levitt MD. A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med. 1995 Jul 6. 333(1):1-4. [QxMD MEDLINE Link].
Patel YT, Minocha A. Lactose intolerance: diagnosis and management. Compr Ther. 2000 Winter. 26(4):246-50. [QxMD MEDLINE Link].
Suarez FL, Savaiano DA, Levitt MD. Review article: the treatment of lactose intolerance. Aliment Pharmacol Ther. 1995 Dec. 9(6):589-97. [QxMD MEDLINE Link].
Sethi S, Tyagi SK, Anurag RK. Plant-based milk alternatives an emerging segment of functional beverages: a review. J Food Sci Technol. 2016 Sep. 53(9):3408-23. [QxMD MEDLINE Link]. [Full Text].
Paul AA, Kumar S, Kumar V, Sharma R. Milk analog: plant based alternatives to conventional milk, production, potential and health concerns. Crit Rev Food Sci Nutr. 2019 Oct 16. 1-19. [QxMD MEDLINE Link].
Pakdaman MN, Udani JK, Molina JP, Shahani M. The effects of the DDS-1 strain of lactobacillus on symptomatic relief for lactose intolerance - a randomized, double-blind, placebo-controlled, crossover clinical trial. Nutr J. 2016 May 20. 15(1):56. [QxMD MEDLINE Link]. [Full Text].
Shi LH, Balakrishnan K, Thiagarajah K, Mohd Ismail NI, Yin OS. Beneficial properties of probiotics. Trop Life Sci Res. 2016 Aug. 27(2):73-90. [QxMD MEDLINE Link]. [Full Text].
Vonk RJ, Priebe MG, Koetse HA, et al. Lactose intolerance: analysis of underlying factors. Eur J Clin Invest. 2003 Jan. 33(1):70-5. [QxMD MEDLINE Link].
Suarez FL, Savaiano D, Arbisi P, et al. Tolerance to the daily ingestion of two cups of milk by individuals claiming lactose intolerance. Am J Clin Nutr. 1997 May. 65(5):1502-6. [QxMD MEDLINE Link].
Jarvinen RM, Loukaskorpi M, Uusitupa MI. Tolerance of symptomatic lactose malabsorbers to lactose in milk chocolate. Eur J Clin Nutr. 2003 May. 57(5):701-5. [QxMD MEDLINE Link].
Beja-Pereira A, Luikart G, England PR, et al. Gene-culture coevolution between cattle milk protein genes and human lactase genes. Nat Genet. 2003 Dec. 35(4):311-3. [QxMD MEDLINE Link].
Born P, Sekatcheva M, Rosch T, et al. Carbohydrate malabsorption in clinical routine: a prospective observational study. Hepatogastroenterology. 2006 Sep-Oct. 53(71):673-7. [QxMD MEDLINE Link].
Hammer HF, Hammer J. Diarrhea caused by carbohydrate malabsorption. Gastroenterol Clin North Am. 2012 Sep. 41(3):611-27. [QxMD MEDLINE Link].
Lomer MC, Parkes GC, Sanderson JD. Review article: lactose intolerance in clinical practice--myths and realities. Aliment Pharmacol Ther. 2008 Jan 15. 27(2):93-103. [QxMD MEDLINE Link].
Mattar R, de Campos Mazo DF, Carrilho FJ. Lactose intolerance: diagnosis, genetic, and clinical factors. Clin Exp Gastroenterol. 2012. 5:113-21. [QxMD MEDLINE Link]. [Full Text].
Bayless TM, Brown E, Paige DM. Lactase non-persistence and lactose intolerance. Curr Gastroenterol Rep. 2017 May. 19(5):23. [QxMD MEDLINE Link].
Szilagyi A, Galiatsatos P, Xue X. Systematic review and meta-analysis of lactose digestion, its impact on intolerance and nutritional effects of dairy food restriction in inflammatory bowel diseases. Nutr J. 2016 Jul 13. 15(1):67. [QxMD MEDLINE Link]. [Full Text].
Szilagyi A. Adult lactose digestion status and effects on disease. Can J Gastroenterol Hepatol. 2015 Apr. 29(3):149-56. [QxMD MEDLINE Link]. [Full Text].

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Praveen K Roy, MD, MSc Clinical Assistant Professor of Medicine, University of New Mexico School of Medicine

Praveen K Roy, MD, MSc is a member of the following medical societies: Alaska State Medical Association, American Gastroenterological Association

Disclosure: Nothing to disclose.

Coauthor(s)

Sarah D Komanapalli, MBBS Resident Physician in Internal Medicine, Marshfield Clinic

Sarah D Komanapalli, MBBS is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Homayoun Shojamanesh, MD Former Fellow, Digestive Diseases Branch, National Institutes of Health

Homayoun Shojamanesh, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Showkat Bashir, MD Assistant Professor, Department of Medicine, Division of Gastroenterology, George Washington University, Washington, DC

Showkat Bashir, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Chief Editor

Burt Cagir, MD, FACS Associate Regional Dean and Professor of Surgery, Geisinger Commonwealth School of Medicine; Director, General Surgery Residency Program, Executive Director, Donald Guthrie Foundation for Research and Education, Guthrie Robert Packer Hospital; Medical Director, Guthrie/RPH Skills and Simulation Lab; Associate in Surgery, Guthrie Robert Packer Hospital and Corning Hospital

Burt Cagir, MD, FACS is a member of the following medical societies: American College of Surgeons, Association of Program Directors in Surgery, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Additional Contributors

Ronnie Fass, MD, FACP, FACG Chief of Gastroenterology, Head of Neuroenteric Clinical Research Group, Southern Arizona Veterans Affairs Health Care System; Professor of Medicine, Division of Gastroenterology, University of Arizona School of Medicine

Ronnie Fass, MD, FACP, FACG is a member of the following medical societies: American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Neurogastroenterology and Motility Society, American Society for Gastrointestinal Endoscopy, Israeli Medical Association

Disclosure: Received grant/research funds from Takeda Pharmaceuticals for conducting research; Received consulting fee from Takeda Pharmaceuticals for consulting; Received honoraria from Takeda Pharmaceuticals for speaking and teaching; Received consulting fee from Vecta for consulting; Received consulting fee from XenoPort for consulting; Received honoraria from Eisai for speaking and teaching; Received grant/research funds from Wyeth Pharmaceuticals for conducting research; Received grant/research funds f.

Douglas M Heuman, MD, FACP, FACG, AGAF Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, American Gastroenterological Association

Disclosure: Received grant/research funds from Novartis for other; Received grant/research funds from Bayer for other; Received grant/research funds from Otsuka for none; Received grant/research funds from Bristol Myers Squibb for other; Received none from Scynexis for none; Received grant/research funds from Salix for other; Received grant/research funds from MannKind for other.

Abhishek Choudhary, MD Resident Physician, Department of Internal Medicine, University Hospital of Missouri-Columbia

Abhishek Choudhary, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Lactose Intolerance Treatment & Management

Medical Care

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