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Lactose Intolerance

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What is Lactose Intolerance?

If you have ever felt bloated or gassy after drinking a glass of milk or eating a slice of cake, you are probably lactose intolerant. Lactose is a type of sugar present in milk – it is broken down by the enzyme lactase (produced by the small intestine), the byproducts of lactose are then absorbed by the small intestine.

Lactose intolerance is caused by the inability to digest lactose. It affects approximately 57-65% of the world’s population with a higher prevalence in certain countries compared to others.

What are the common causes?

In general, lactose intolerance is due to the small intestine’s inability to digest lactose. If your body does not produce or does not produce enough lactase, lactose cannot be broken down into the byproducts, glucose and galactose.
These byproducts are usually absorbed by the small intestine and into our bloodstream where they can eventually be used for energy. If lactose is not digested, it passes to the large intestine where it is fermented by the bacteria there and forms into short-chain fatty acids and gas.
Despite insufficient lactase being the main cause of lactose intolerance, there are still 3 types of lactose intolerance:
  • Congenital lactose intolerance: a rare and inherited condition that occurs from birth; having reduced or absent lactase production.
  • Primary lactose intolerance or adult-type lactase deficiency: occurs as a result of the gradual decline in lactase production, this is often due to genetics and lactose intolerance occurs over a period of time.
  • Secondary lactase deficiency: decline in lactase production due to certain medical conditions such as Crohn’s disease and coeliac disease, infections, radiotherapy, chemotherapy, and small intestine bacterial overgrowth (SIBO).

What are the common symptoms of Lactose Intolerance in Singapore?

The symptoms of lactose intolerance are quite common and well-known, they usually appear within 2 hours of the consumption of milk products, these include:

  • Bloating 
  • Gassiness
  • Nausea
  • Increased gut movements (feels like a rumbling in your stomach)
  • Abdominal pain
  • Diarrhoea 
  • Headache
  • Vertigo 
  • Memory impairment
  • Lethargy 

The severity of symptoms depends on the amount of lactose you consumed – more lactose, more symptoms or severity of symptoms. 

Is Lactose Intolerance painful?

Yes, lactose intolerance can cause abdominal pain.

Who is at risk of Lactose Intolerance in Singapore?

Lactose intolerance is incredibly common and there are certain factors that puts you at a higher risk of lactose intolerance:

  • Being ethnically Asian: approximately 90% of Asians are lactose intolerant.
  • Family history: if you have relatives who are lactose intolerant, you could be at a higher risk of it.
  • Some medical conditions: individuals with coeliac disease and Crohn’s disease have an increased risk of lactose intolerance.
  • Aging: lactase production can decrease in some people as they age (e.g., primary lactose intolerance)

How is Lactose Intolerance diagnosed?

There are 4 ways in which lactose intolerance can be diagnosed, namely:

  • Lactose hydrogen breath test: checks how much hydrogen is present when you breathe out after you consume lactose. Increased hydrogen signifies lactose intolerance.
  • Genetic test: checks for any genetic causes of lactose intolerance.
  • Lactose intolerance test: if your blood sugar level does not increase after consuming lactose, it means you are lactose intolerant.
  • Lactase activity at jejunal brush border: considered the gold standard of tests for lactose intolerance, it is an invasive test that involves the biopsy of the jejunal brush border, part of your small intestine.

The most commonly used test is the lactose hydrogen breath test, it is non-invasive and easy to conduct.

What are the treatment options for Lactose Intolerance in Singapore?

There are various ways in which lactose intolerance can be treated. These are:

  • Lactose exposure: Removing lactose products can help to alleviate symptoms, however, lactose products should be replaced with nutritional alternatives to prevent deficiencies. You may begin to reintroduce lactose at small amounts initially and then slowly increase the amounts as your body adapts to it.
  • Enzyme supplements: may help your body to digest glucose, however, results are not unanimous
  • Prebiotics and probiotics: prebiotics are the food for probiotics. While probiotics are the healthy bacteria that aids digestion. Both have been shown to alleviate the symptoms of lactose intolerance.

Frequently asked questions

Can lactose intolerance be cured?
There is no cure for lactose intolerance. There are certain treatment options that can alleviate symptoms, but it cannot be completely cured.
What food triggers lactose intolerance?
Milk or milk products such as chocolate, cheese, yogurt, butter, some processed foods, bread, etc. Always read food labels and be on the lookout for lactose containing products.

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