AI Summary Overview
What is Lactose Intolerance?
Lactose intolerance is a deficiency of lactase, the digestive enzyme responsible for breaking down the natural sugar (lactose) that is found in all milk and dairy products.
Lactase digests lactose, allowing the body to absorb it into the bloodstream. With lactose intolerance, there is too little lactase enzyme present, and undigested lactose goes to the large intestine. In the large intestine, it is fermented by the bacteria there. This fermentation process produces gas, bloating, and diarrhoea.
Lactose intolerance is a digestive disorder that must not be confused with a milk or dairy allergy. Most people who are lactose intolerant can eat small amounts of dairy products with no discomfort.
What Are the Types of Lactose Intolerance?
Lactose intolerance can be divided into 4 types depending on the cause:
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Primary Lactose Intolerance This is the most common type, especially in India. In adults, the amount of the enzyme that breaks down lactose naturally reduces with age. They have a decreased ability to digest milk and milk products. It is a hereditary condition.
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Secondary Lactose Intolerance This type occurs when an illness or injury damages the small intestine, such as Crohn’s disease or a serious gut infection, which might decrease the lactase enzyme production. This condition can be resolved if the underlying problem is treated.
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Congenital Lactase Deficiency This disorder is a very rare hereditary condition in which infants are born with little or no lactase enzyme production capacity. Symptoms are observed soon after birth, as soon as the infant is given any feed containing lactose.
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Developmental Lactose Intolerance This type occurs in premature babies, whose digestive systems are underdeveloped. However, lactase enzyme production in such cases usually resolves on its own as the baby grows older.
How Common is Lactose Intolerance in India?
The problem of lactose intolerance is extremely widespread in India, with a prevalence of 66% in the southern states and 27% in the northern states. The higher prevalence in the south is due to diet and genetics.
Globally, about 65% of the population has some degree of lactose malabsorption. The figures in India are about the average world figures. What is surprising is that there is no proper identification, and many cases are diagnosed with other gastric problems, such as indigestion and Irritable Bowel Syndrome (IBS), thereby preventing a correct diagnosis and treatment.
What are the Symptoms of Lactose Intolerance?
Lactose intolerance symptoms usually develop from 30 minutes to 2 hours after eating foods that contain lactose. Their severity depends on how much lactase the body produces and how much lactose is consumed. In mild cases, symptoms are a minor inconvenience. In more severe cases, they can significantly disrupt daily life and nutrition.
The common symptoms of lactose intolerance are classified below:
| Early Warning Symptoms | Advanced Stage Symptoms |
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What are the Causes and Risk Factors of Lactose Intolerance?
The underlying reason behind lactose intolerance is either a lack of or low levels of the lactase enzyme. The reasons for this condition vary and include:
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Age-Related: The body naturally reduces its levels of lactase enzyme as it gets older. This phenomenon is the most common cause of primary lactose intolerance.
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Genetics: Lactose intolerance can be inherited from your family. Certain ethnic groups, many of whom are South Asian, have genes that make them naturally more likely to have low levels of lactase enzyme production.
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Intestinal Damage: Conditions like coeliac disease, inflammatory bowel disease (IBD), or intestinal infections can damage the lining of the small intestine. Such damage can affect lactase production.
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Prematurity: Premature babies' digestive systems might be too immature to produce sufficient lactase.
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Certain Medications: Some antibiotics and drugs used for chemotherapy can temporarily affect the gut lining and, therefore, on lactase production.
What are the Complications of Lactose Intolerance?
Although lactose intolerance itself is not life-threatening, mismanagement of it could lead to some health issues over the long term. Possible complications caused by unmanaged lactose intolerance include:
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Calcium Deficiency: An abrupt decision to cut out all dairy products without any substitution may lead to an increased calcium deficiency. Osteoporosis and bone weakness may be consequences of calcium deficiency.
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Vitamin D Deficiency: Dairy products are an important source of vitamin D in the Indian diet, apart from sunlight exposure, which helps with nutrient synthesis. The deprivation of dairy products without adequate substitution can affect bones and the immune system.
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Nutritional Deficiencies: A sustained refusal to consume dairy products without proper management can also result in deficiencies in proteins, riboflavin (vitamin B2), and phosphorus.
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Diminished Quality of Life: Sustained digestive complaints could restrict social activities, food selection, and mental well-being.
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Mistaken Diagnosis & Delays in Care: The symptoms of lactose intolerance are common to IBS, coeliac disease, and other intestinal disorders. It may take time for the true cause to beidentified and properly treated.
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Dehydration in Children: Persistent diarrhoea from untreated lactose intolerance can lead to severe dehydration in infants.
Lactose Intolerance in Children and During Pregnancy
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In Children Lactose intolerance is rare in children under five; if and when it appears, it tends to be secondary to bowel infection or gastroenteritis. Diet needs to be carefully managed under the guidance of a paediatrician to ensure the child continues to consume sufficient calcium for healthy bone development.
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During Pregnancy Some women become more tolerant of dairy during pregnancy due to changes in their gut and metabolism; others may develop symptoms they did not have previously. Any changes to the diet during pregnancy should be made in consultation with a gynaecologist or nutritionist; the importance of calcium in the diet for the mother and foetus must be considered.
Diseases Similar to Lactose Intolerance
It is possible to confuse lactose intolerance with other digestive conditions like irritable bowel syndrome (IBS) or a milk allergy, as they often produce similar symptoms after eating. To avoid such confusion, it is important to understand the distinct features of each condition.
A basic overview of the diseases is given below for easier identification:
Lactose Intolerance Vs Irritable Bowel Syndrome (IBS) Vs Milk Allergy
| Feature | Lactose Intolerance | Irritable Bowel Syndrome (IBS) | Milk Allergy |
| How It Happens | Insufficient lactase enzyme to digest lactose (a sugar in dairy), causing fermentation in the large intestine | A functional gut disorder where the brain-gut connection is disrupted, causing irregular bowel activity | An immune system reaction to proteins in cow's milk (casein or whey), not the sugar |
| Location | Large intestine - undigested lactose is fermented by bacteria, producing gas | The gut overall - affects how the intestines move and feel | Immune system response that can affect the gut, skin, airways, and entire body |
| Associated Symptoms | Bloating, gas, diarrhoea, stomach cramps, and nausea - only triggered by dairy | Abdominal pain, bloating, diarrhoea, and/or constipation - triggered by multiple foods or stress | Hives, swelling, vomiting, diarrhoea, and in severe cases, anaphylaxis - triggered by any dairy or milk protein |
| Severity | Generally mild to moderate; not life-threatening | Chronic and variable; can significantly affect quality of life | Can be severe and life-threatening in cases of anaphylaxis |
| Can It Be Reversed? | Primary type is permanent; secondary type may resolve with treatment of the cause | Not curable, but manageable with diet and medication | May resolve in some children with age; adults may need lifelong avoidance |
Note: If you experience symptoms beyond the digestive tract, such as skin reactions, swelling, or breathing difficulty, seek immediate medical attention, as these may indicate a milk allergy rather than lactose intolerance.
When Should I See My Healthcare Provider?
In most cases, lactose intolerance is a minor problem, but seek medical advice if:
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Symptoms regularly occur after eating dairy foods and do not improve despite cutting down on dairy.
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There is noticeable, unintentional weight loss.
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You are suffering from chronic or severe diarrhoea, or if the diarrhoea contains blood.
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You are experiencing symptoms despite cutting dairy from your diet. You may have another illness.
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A child is suspected of having lactose intolerance if they are not putting on weight, are persistently crying after feeds, or are showing chronic diarrhoea.
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The symptoms interfere with work, life, or social activities.
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You wish to obtain a definite diagnosis by having tests done before embarking on significant changes to your diet.
How is Lactose Intolerance Diagnosed?
A doctor can confirm lactose intolerance based on symptoms, a dietary history, and, if necessary, investigations like the hydrogen breath test.
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Hydrogen Breath Test This is the preferred diagnostic test for detecting lactose intolerance, in which the patient consumes a lactose-containing drink after overnight fasting. Breath samples are collected 2 to 3 hours after drinking the solution. A high hydrogen level in breath samples suggests that lactose is being fermented in the colon.
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Lactose Tolerance Blood Test This test is used to analyse the patient’s blood glucose level after a lactose solution is administered. A low or absent blood glucose rise will suggest impaired lactose digestion. At least 8 hours of fasting before this test is needed.
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Stool Acidity Test This test is mostly done for infants and young children, as they cannot tolerate the breath test. This test detects acids in the colon produced by the undigested lactose.
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Dietary Elimination Trial The patient may be advised to stop taking all dairy products for two to four weeks, and if the symptoms disappear, the patient is likely to be lactose intolerant. The doctor would then ask the patient to start consuming milk products and observe for the symptoms again.
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Small Intestinal Biopsy A small intestinal biopsy is rarely needed and usually only done if conditions like coeliac disease are suspected, rather than to diagnose lactose intolerance itself.
How is Lactose Intolerance Treated?
There is no cure for primary lactose intolerance. However, it can be managed quite effectively by a careful balance of dietary changes and medical management:
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Dietary Modifications
- Avoid or significantly reduce high-lactose foods like normal cow milk, ice cream, and soft cheese.
- Opt for lactose-free milk or plant-based milk alternatives like almond, oat, or soy milk.
- Hard cheeses like parmesan and cheddar have low lactose content, and most patients tolerate it well.
- Curd/Yoghurt might be better tolerated than milk, as the lactose content gets reduced due to fermentation.
- Read labels of packaged food items, biscuits, snacks, and medicines carefully, as lactose is also found in these.
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Lactase Enzyme Supplements Lactase tablets are available over the counter and can be taken just before a milk-based meal to digest the lactose. This approach is beneficial when strict dietary control is not possible.
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Calcium and Vitamin D Supplementation If there is a need to drastically reduce milk consumption, calcium and vitamin D supplements might be recommended to avoid osteoporosis and weakened bones.
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Probiotics Certain probiotic strains can enhance tolerance of lactose over time. These may help alter gut flora in the intestine. It is advisable to consult a physician before using these.
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Managing Secondary Lactose Intolerance If the condition is secondary to an underlying disease like coeliac or Crohn's, treating the primary disease can restore lactase production, and the patient may be able to tolerate milk again.
Supportive Medication for Lactose Intolerance
No drug can boost the body’s ability to produce lactase. But there are some supplements and drugs that can help deal with symptoms and let people eat dairy products without discomfort. All supplements must be taken under the supervision of a physician or pharmacist. Common supportive medicines for lactose intolerance include:
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Lactase Enzyme Supplements: These OTC tablets are taken right before you consume any milk products and contain lactase enzymes, which facilitate the digestion of lactose in the body before it moves to the large intestine.
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Probiotics (e.g., Lactobacillus acidophilus, Bifidobacterium longum): Some strains of probiotics can improve lactose digestion by altering the bacteria in the large intestine.
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Anti-spasmodics (e.g., dicyclomine, mebeverine): Used to treat stomach cramps caused by lactose fermentation. Prescribed in cases where cramps are painful.
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Antidiarrhoeal Drugs (e.g., loperamide): Used temporarily to address diarrhoea caused by inadvertent ingestion of lactose. This is not a permanent cure and should only be taken on a doctor’s recommendation.
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Calcium and Vitamin D Supplements: Taken in cases where there is reduced intake or complete absence of dairy in the diet. The reason behind this recommendation is that these supplements play an important role in preventing osteoporosis, calcium deficiency, and vitamin D deficiency.
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Vitamin B12 Supplements: Suggested for people who avoid dairy in their diets, as dairy is one of the key dietary sources of B12 vitamins.
Note:The selection of supplements and medications is based on the type of lactose intolerance and other underlying medical conditions. It is important to always consult a doctor before taking any supplements or medications.
Living with Lactose Intolerance: Challenges and Caregiving
For most people, lactose intolerance can be handled with appropriate food management. However, in India, where milk products are a key ingredient in daily meals, individuals with lactose intolerance face several difficulties. The details are provided below:
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Challenges
- Indian Dietary Modifications: Milk, curd, paneer, ghee, and butter are integral parts of the Indian diet. Abstaining from these foods requires considerable meal planning and reading labels on foods, as lactose can be hidden in many food products.
- Nutritional Deficiencies: Eliminating dairy from the diet without adequate substitution over time can result in nutritional deficiencies.
- Eating in Public Places: Variety of Indian food includes dairy, such as gravies, sweets, tea, breads, etc. Controlling symptoms in public places, parties, weddings, or restaurants may become a challenge.
- Misdiagnoses and Delayed Diagnosis: Symptoms associated with lactose intolerance are similar to IBS, coeliac disease, and other gastrointestinal disorders. Many people take months or even years to get the right diagnosis.
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Caregiving and Patient Safety
- Nutritional Monitoring of Children’s Health: Parents of children with lactose intolerance need to consult with a paediatrician or a nutritionist and monitor the nutritional content of their food.
- Labelling and Food Cooking: It would be reasonable to teach people how to read labels to spot lactose in biscuits, breads, medicines, and any other products that contain lactose. Homemade food prepared without dairy products will be helpful for avoiding symptoms.
- Lactase Enzyme Supplements Administration: Lactase enzyme supplements can be administered by caregivers just before any meal that contains dairy products.
- Emotional Support: Food restrictions can cause anxiety and even social isolation. Patients, especially teenagers, should be told that the condition is manageable and will not negatively affect their overall health.
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Expenses
- Monthly Expenses: The management of lactose intolerance for the majority of people includes consuming lactose-free or soy milk, consumption of lactase supplements occasionally, and visits to the doctor. Monthly expenses related to this condition are quite modest, ranging from ₹500 and ₹3,000.
- Secondary Diseases: If lactose intolerance is associated with another primary health problem, such as Crohn’s disease or coeliac disease, the expenditure on managing the primary health problem will make the total medical expense much higher.
What is the Prognosis for Lactose Intolerance?
The long-term prospects for lactose intolerance are favourable. Lactose intolerance is not a disease that can seriously or fatally harm you and, for the vast majority, is quite manageable with appropriate dietary modification. Secondary lactose intolerance may sometimes go away if the underlying cause is successfully treated.
Primary lactose intolerance, on the other hand, is permanent. In some cases, it does not significantly worsen with age. Careful dietary management is essential. Most patients find their own threshold and determine how much dairy product they can eat before experiencing symptoms and adapt their eating habits accordingly.
Lactose Intolerance Treatment Cost in India
Managing lactose intolerance in India usually does not require expensive costs, especially for simple cases. The majority of the cases just need some modifications in diet, taking lactase preparations, and some visits to the doctor. However, the treatment for complications or lactose intolerance caused by an underlying health issue may cost more. Here are the estimated costs:
| Treatment / Procedure | Approximate Cost Range |
| Gastroenterologist / General Physician Consultation | ₹800 - ₹1,500 per visit |
| Hydrogen Breath Test (Lactose Intolerance) | ₹1,200 - ₹3,500 per test |
| Lactose Tolerance Blood Test | ₹500 - ₹1,500 per test |
| Stool Acidity Test (for infants) | ₹300 - ₹800 per test |
| Lactase Enzyme Supplements (Monthly) | ₹300 - ₹1,200 per month |
| Calcium + Vitamin D Supplements (Monthly) | ₹200 - ₹800 per month |
| Nutritionist / Dietitian Consultation | ₹500 - ₹2,000 per session |
| Small Intestinal Biopsy (Rare Cases) | ₹5,000 - ₹15,000 per procedure |
| Hospitalisation (If Secondary Condition Requires Admission) | ₹20,000 - ₹2,00,000+ per admission |
There is considerable variability in treatment expenses, depending on the city, whether at a public or private hospital, and whether the problem is isolated or associated with a chronic underlying illness. Those with secondary lactose intolerance due to Crohn’s disease or coeliac disease are likely to incur more expenses.
Can Lactose Intolerance Be Prevented?
There is no known way to prevent primary lactose intolerance because it is mostly due to ageing and genetics. However, secondary lactose intolerance can often be prevented by promptly treating intestinal infections and certain diseases, such as coeliac disease and IBD.
The following recommendations can help lower the risk of developing complications:
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Prompt treatment of intestinal infections is necessary to prevent intestinal damage.
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The causes of the disease should be controlled. For example, those suffering from an underlying gut issue should consult their doctor for lifestyle and dietary management.
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The use of antibiotics is advised against without a doctor's supervision.
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A well-balanced and diversified diet should be considered.
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Symptoms should be watched carefully after returning to consuming dairy.
Does Health Insurance Cover Lactose Intolerance?
Yes, health insurance in India covers lactose intolerance if it leads to hospitalisation or requires treatment. Diagnostic tests for lactose intolerance, like the hydrogen breath test and the blood lactose tolerance test, are often included in most comprehensive health insurance policies, provided they are recommended by a medical practitioner.
If your lactose intolerance is due to a pre-existing digestive disorder, then the expenses to treat this condition will be covered after you serve the necessary waiting period. According to the IRDAI guidelines, the waiting period for pre-existing conditions is up to 36 months.
OPD benefit riders of respective plans can also cover outpatient consultations with a gastroenterologist, referrals to a nutritionist, and dietary counselling. Read your policy details to understand the inclusions and exclusions, and compare plans to find the right one for you.
How Much Health Insurance Coverage is Needed for Lactose Intolerance Treatment?
The level of cover required will differ according to whether lactose intolerance is the only issue or a symptom of an existing chronic medical condition. You'll need to consider the extent of the symptoms, how frequently you have to attend doctor appointments, and the location of the clinic where you are being treated.
If you only have an isolated lactose intolerance problem, health insurance cover between ₹3 and ₹5 lakh would normally be sufficient. This should cover doctor's fees, tests, and any necessary dietary therapy.
On the contrary, the cost of treatment may increase significantly in cases of secondary lactose intolerance associated with serious medical conditions. In this scenario, a higher sum assured, such as ₹10 lakh or more, may be more beneficial. Comparing plans before buying is a useful strategy.
FAQs
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Q1. What is lactose intolerance?
Ans: Lactose intolerance is a digestive condition in which the body cannot properly digest lactose, the natural sugar found in milk, because it does not produce enough lactase enzyme. It commonly causes bloating, gas, diarrhoea, and stomach pain after consuming dairy products. -
Q2. What is a normal vs abnormal hydrogen breath test result for lactose intolerance?
Ans: A normal hydrogen breath test shows hydrogen levels below 20 ppm after drinking a lactose solution. An increase of 20 ppm or more from the baseline suggests lactose malabsorption and indicates lactose intolerance. -
Q3. Can lactose intolerance be cured?
Ans: No. Primary lactose intolerance cannot be cured, but it can usually be managed with a low-lactose diet, lactase supplements, and dairy-free calcium sources. Secondary lactose intolerance may improve after treating the underlying condition.
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References
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12740768/
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https://www.medicoverhospitals.in/diseases/lactose-intolerance/
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https://irdai.gov.in/health-dept
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https://ckbirlahospitals.com/rbh/gastro-science/subspeciality/lactose-intolerance
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https://hindujasindhihospital.com/gastroenterology-consultation-cost-in-bangalore/
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https://www.manipalhospitals.com/specialities/gastrointestinal-science/hydrogen-breath-test/
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