Lactose intolerance has become a common disease, even more than the milk industry is prepared to accept. It is not a severe health condition, but its symptoms are quite annoying. And, to cap it all, they can be mistaken with milk allergy and other hypersensitivity reactions.
The root cause of lactose intolerance is that these patients do not synthesize a particular enzyme in our body: lactase. This enzyme is responsible for breaking down lactose (an essential component of milk) into two smaller sugar particles, called glucose and galactose. Adults in general have little lactase in our body; thus, we do not adequately process lactose in the small intestine, and this is why it is likely you have experienced one or more symptoms of lactose intolerance at least once, but very mildly.
The signs and symptoms associated with lactose intolerance are as follows:
1) Abdominal pain
Statistically, this symptom affects millions of men and women around the world, and it may be explained by many ailments. Lactose intolerance is especially thought in patients 20 years old and over who report a history of eating milk and dairy. Although the primary cause of lactose intolerance is congenital, it can also be acquired throughout a lifetime (secondary) and associated with different intestinal pathologies such as malabsorption syndromes, celiac disease, gastroenteritis, or Chron’s disease.
Abdominal pain generally ranges from moderate to intense. This symptom has to do mostly with other gastrointestinal abnormalities, so a proper diagnosis would require the assessment of many other symptoms hereby described, triggered by drinking milk or consuming dairy products.
2) Burping
This symptom is especially uncomfortable for those who are beginning to notice a digestive problem after consuming milk or its derived products. Now, regarding the issue, burping helps to get a more accurate diagnosis, since the easiest way to confirm the inability to process lactose is through an exhaled hydrogen test (or breath test with hydrogen). The person blows into a tube to give a sample of one’s breath and, after drinking a solution of lactose or eating food containing lactose, and later on, he burps into another tube to give another sample.
When an individual suffers from lactose intolerance, the test will indicate that the breath has a concentration of hydrogen and methane higher than the average population. This is because undigested lactose causes higher levels of these gases in the digestive system. It can be detected in the breath, which will usually be noticed in the frequency of belching. Since taking certain foods and medications, and exposure to tobacco smoke can affect the accuracy of this test, your doctor may recommend taking some precautions before testing your breath.
3) Sickness
As it has been seen, it is not easy to know the real incidence lactose intolerance has, because the symptoms can be confused with other digestive diseases. Additionally, many people try to self-manage their intolerance symptoms without going to the doctor.
They usually suffer from diarrhea, meteorism, headaches, fatigue, and obviously, dizziness. That is why, given the suspicion of intolerance, it is necessary to go to a specialist to rule out other digestive problems. This will help the patient to take the most appropriate measures for their case.
4) Abdominal distension
Abdominal distension is a visible sign that can be verified by looking at and touching the abdomen. This usually happens when your gastrointestinal tract is filled with air or gas. An individual can recognize this symptom by experiencing the sensation of uncomfortable sense of satiation or fullness with pressure in the abdominal area and often accompanied by belching. At some point, the sensation can go from uncomfortable to painful. Depending on your natural complexion, your belly may look larger, and even your clothes might look tighter.
Burping might also be accompanied by abdominal noises or gurgling. This is because the lack of lactase does not allow the monosaccharide to be “split,” and it remains in the intestinal lumen untouched and impossible to be absorbed. Thus, your intestinal bacteria take over and ferments these carbohydrates to obtain energy, filling the abdomen with gas. However, this symptom can get progressively worse by swallowing air (such as when someone chews gum), smoking, or eating too fast.
5) Diarrhea
As you may know, diarrhea is a symptom characterized by increased stool frequency and decreased consistency. Generally, it responds to an infectious syndrome. It occurs as a process of active secretion of fluids in the intestinal wall, associated or not with a condition in which water absorption is diminished. Although it is evident that more serious problems related to the digestive system are suspected, the history of this symptom in the case of lactose intolerance and the characteristics of the clinical picture are confirmed by laboratory studies. The test for routine use in the clinic is the test strip, which identifies the presence of reducing substances (for example, sugar) in the stool.
This procedure allows you to monitor a person’s ability to tolerate lactose continuously. The test is recommended as soon as a liquid fraction of the stool is obtained; If it is not possible, it is suggested to freeze the sample to prevent bacteria from consuming the sugar that could be present. With this procedure, only the presence of reducing substances, such as lactose and glucose, is identified.
6) Abdominal Gas
In our stomach, specific cells produce pepsinogen. And, in contact with hydrochloric acid, it is transformed into pepsin, an enzyme that degrades proteins. In the pyloric antrum, they secrete gastric lipase, which acts on some lipids.
However, since lactase, which is responsible for processing milk sugar, is not found, that sugar is fermented by the gut microbiota. The warm and acidic environment of the intestine causes gases to be produced to a greater extent than estimated in a healthy digestive process.
7) Stool with a foul odor
Depending on the amount of undigested lactose within the intestinal lumen (although a small amount will be enough in some people), an increase in osmolarity will occur and, to make things even for it, there is an outflow of water from the body into the digestive tract. This mechanism stimulates the contraction movements of the gastrointestinal tract and the subsequent progression of lactose and water to the large intestine, with diarrhea. Once there, the intestinal flora is in charge of minimize lactose and also process the monosaccharides.
These liquid stools, mixed with gases, will tend to be greenish-yellow, foamy, acidic, noisy and of a very particular smell. Its contact with the perineal skin can cause sunburn, known as diaper erythema. Due to the increased movement of the intestines, the intestinal transit time is shortened. Additionally, there is increased abdominal pain, and feeling of urgency to defecate.
8) Weight loss
Lactose intolerance has various conditions, associated symptoms and health problems that trigger weight loss. One of them is diarrhea, other is malnutrition. Diarrhea leads to an accelerated bowel movement that does not allow for nutrients and water to be properly digested in the small intestine and the large intestine. Thus, these patients end up with a severe imbalance in electrolytes, dehydration, and poor nutrition. Moreover, lactose intolerance is associated with an increased susceptibility for certain nutrient deficiencies, and may lead to a poor functioning of the body and alterations in the metabolic system.
Weight loss is the final result, especially in cases when lactose intolerance is severe (caused by total absence of the enzyme lactase) and when the condition is not properly managed. Thus, if you have the symptoms we have described in this article or have lost 5% of your body weight without any change to your diet or exercise pattern, talk to your doctor as soon as possible to rule out lactose intolerance, which is one of many chronic conditions associated with this symptom.
9) Constipation
After the accelerated release of the first feces with remnants of milk sugar, the opposite of diarrhea can occur: constipation.
That is the presence of hard stool, along with a feeling of incomplete bowel movements, stomach upset, swelling, and excessive exertion. Constipation may be another indication of lactose intolerance, although it is a much uncommon symptom compared to diarrhea. It is mainly caused by an increase in methane production in the colon, and it is precisely the presence of that methane that slows the transit time in the intestine.
10) Abdominal sounds
Abdominal sounds are a natural part of the digestive process. The movement of the intestines produces them as they drive food. Since those organs are hollow, the noise they produce is usually similar to an echo through the abdomen. We can compare them to the sounds produced by water pipes. The fact that they produce sounds is proof that the digestive tract is working. In fact, as part of a medical examination, auscultation can be performed to register whether or not there are normal abdominal sounds. This is nothing but an evaluation of abdominal sounds by listening to the abdomen with a stethoscope.
Needless to say, these sounds are generally harmless. But in lactose intolerance, the accelerated movement of the intestines by the intestines causes normal sounds to intensify both in frequency and intensity. Increased abdominal sounds are often associated with diarrhea because they signal speedy bowel movements, and it is important to differentiate the symptom with other diseases featuring increased intestinal sounds, as in intestinal obstruction.
11) Esophageal reflux
Esophageal reflux occurs when the valve that separates the esophagus and stomach (lower esophageal sphincter) opens spontaneously. This is frequent in certain cases, and may or may not be associated with feeding. In infants and children with reflux, the lower esophageal sphincter opens inappropriately, although there is no swallowing and allows the passage of substances such as food and stomach acids into the esophagus. When this symptom is present, whether moderate or intense after consuming milk, the intervention of a specialist is necessary and people tend to believe that the infant suffers from lactose intolerance. Thus, this symptom is especially important to detect congenital lactose intolerance in newborns and infants.
However, according to specialists, in newborns it is normal that, during the maturation of the gastrointestinal tract, two to three regurgitation events occur during the first six months. This reflux is known as physiological and there’s no problem about it. If they are children who generally sleep well, eat and gain weight normally, there should be no cause for concern. In many cases, poor feeding technique, intestinal malformations, infections, or allergies are the leading causes of reflux. These and other inflammatory conditions in turn inflame the digestive tract, causing esophageal reflux symptoms.
12) Somatomorphic disorder
It is a mental disorder in which there are various physical symptoms that appear to be pointing out to a given disease but no test proves there’s an actual alteration to the organs or body systems. According to Italian researchers, some people who believe they are lactose intolerant, actually suffer from this condition. Both people who actually have a somatomorphic disorder and those who are lactose intolerant may experience symptoms described in this article, such as bloating, gas, stomach pain, and nausea when eating or drinking products containing lactose.
In the aforementioned study, whose results were presented in 2011, 102 patients were evaluated, 77 of them were women. All of them underwent the respiratory test that is commonly used to detect lactose intolerance. Patients also completed a questionnaire on somatization, anxiety, and depression. Either lactose intolerance or malabsorption was detected in only 29 and 33 percent of patients. So, the combination of physical symptoms with depression in a person may be due rather to somatization.
If you or any of your children ever get a positive diagnosis of lactose intolerance, there is no reason for to giving up on dairy products, and it would not be wise to do so due to the importance milk and dairy has as a source of nutrition. In the food market, there are a variety of lactose-free products. Our modern technology has allowed lactose to be partially or completely eliminated in some cases and hydrolyzed in others. And, in this way, you can find presentations of milk and dairy products such as cheeses, or yogurts suitable lactose-intolerant persons.
On the other hand, the pharmaceutical industry offers lactase supplements in drops, pills, or capsules. These enzymes help you digest lactose. We must clarify though: if you are going to take these types of supplements, make sure you do it sporadically. For example, they are appropriate if you are going to eat out and you are not sure if the foods you are going to consume have lactose. If you want to be informed about the appropriate dose in your case, you should go to the doctor and ask for his advice.