Bloating, abdominal cramps and diarrhoea make life miserable for many people after a meal containing dairy products. These unpleasant symptoms are often signs of lactose intolerance, i.e. sensitivity to milk sugar. In Hungary, this condition is thought to affect a significant proportion of the population – estimates suggest as many as 30–40% – yet many people are unaware of the exact cause of their symptoms. In this article, we explain in detail what lactose intolerance is, what symptoms it involves, how it can be diagnosed, and what treatment options are available to help you enjoy a symptom-free daily life.
From Endomedix Gastroenterology Centre Our experts are committed to providing an accurate diagnosis and personalised treatment so that you can enjoy your meals again without any worries. Join us to find out all the important details about lactose intolerance!
What exactly is lactose intolerance?
Lactose intolerance is a digestive condition that develops when the body is unable to properly digest lactose, the sugar that occurs naturally in milk and dairy products. This problem is caused by a lack of, or reduced activity of, an enzyme called lactase.
The role of the enzyme lactase
The lactase enzyme is produced in the small intestine, and its role is to break down lactose into two simpler sugars: glucose and galactose. These simple sugars are then easily absorbed through the intestinal wall and provide the body with energy.
If there is not enough lactase in the body, lactose passes undigested into the large intestine. There, gut bacteria begin to ferment it, producing gases (hydrogen, carbon dioxide, methane) and short-chain fatty acids. These processes cause the characteristic and unpleasant symptoms of lactose intolerance. It is important to emphasise that lactose intolerance is not the same as a milk allergy, which is an immune system reaction to milk proteins and can be much more severe, even leading to life-threatening symptoms.
Types of lactose intolerance
There are several possible causes of lactase deficiency; accordingly, we distinguish between three main types.
1. Primary lactose intolerance
This is the most common type, which is genetically determined. In infancy, the body still produces large amounts of lactase, as breast milk is the main source of nutrition. However, with the introduction of solid foods and as a child grows older, lactase production naturally decreases. The extent of this process varies from person to person; some people experience only a slight reduction, whilst in others enzyme production ceases almost entirely, which can cause severe symptoms even after consuming small amounts of dairy products.
2. Secondary (secondary) lactose intolerance
This type develops as a result of an underlying condition or damage to the small intestine. The mucous membrane of the small intestine is damaged, which temporarily or permanently reduces lactase production. Secondary lactose intolerance is often reversible if the underlying cause is successfully treated.
Common causes:
- Gastroenteritis: Acute gastroenteritis (e.g. viral or bacterial infection).
- Irritable bowel syndrome (IBS): The symptoms of IBS and lactose intolerance often overlap.
- Inflammatory bowel diseases (IBD): Examples include Crohn’s disease and ulcerative colitis.
- Coeliac disease (gluten sensitivity): Damage to the intestinal mucosa caused by gluten can also lead to lactase deficiency.
- Certain medicines: Antibiotics and chemotherapeutic agents can also damage the gut flora and the intestinal wall.
- Bowel surgery: Surgical procedures involving the small intestine.
3. Congenital lactase deficiency
This is a very rare, hereditary genetic disorder in which the infant does not produce the lactase enzyme from birth. Breastfeeding leads to severe diarrhoea and dehydration, so immediate diagnosis and a special, lactose-free formula are required.
The most common symptoms of lactose intolerance
Symptoms usually appear within 30 minutes to 2 hours of consuming a food or drink containing lactose. The severity of the symptoms depends on several factors, such as the amount of lactose consumed and the individual’s degree of lactase deficiency.
Typical symptoms:
- Abdominal bloating and flatulence: Due to the fermentation processes taking place in the large intestine, the abdomen becomes tight and bloated.
- Abdominal cramps and pain: Increased bowel movements and the strain on the bowel wall caused by gas can trigger pain.
- Diarrhoea: Undigested lactose draws water into the gut (osmotic effect), resulting in loose, watery stools.
- Nausea, occasional vomiting: It can occur mainly after consuming large amounts of lactose.
- Borborygmus: Loud, „gurgling” bowel sounds caused by increased gas production and bowel movements.
Less commonly, headaches, difficulty concentrating or skin symptoms may also occur, although the link between these and lactose intolerance is still the subject of research.
Making the diagnosis: How can lactose intolerance be identified?
If you experience the symptoms listed above, it is important to consult a gastroenterologist to obtain an accurate diagnosis. These symptoms may be caused by other digestive disorders, which is why a specialist examination is essential. The Endomedix Gastroenterology Centre It helps to reliably identify lactose intolerance using modern diagnostic methods.
Exhalation test for hydrogen (H2)
This is the most commonly used, painless and reliable diagnostic method. During the test, the patient is asked to drink a specific amount of lactose solution. They must then breathe into a special device at regular intervals (usually every 20–30 minutes), which measures the hydrogen content of their exhaled breath.
If lactose reaches the large intestine undigested, the gut bacteria produce hydrogen gas. This gas is absorbed into the bloodstream and is then excreted from the body via the lungs. Elevated hydrogen levels in exhaled air are a clear indicator of lactose malabsorption, i.e. a disorder affecting the absorption of milk sugar.
Genetic testing
This method involves a simple buccal swab or blood sample. The test analyses certain variations in the LCT gene, which are responsible for the decline in lactase production in adulthood. The test shows whether the patient has a genetic predisposition to primary lactose intolerance. It is important to note that a positive genetic result does not necessarily mean that the person has symptoms; it merely confirms the predisposition. It is not suitable for detecting secondary lactose intolerance.
Lactose tolerance test (oral glucose tolerance test)
This older method is now used less frequently. The patient is asked to drink a lactose solution, after which blood samples are taken at specific intervals to measure their blood glucose levels. If the lactase enzyme is functioning properly, the lactose is broken down into glucose, which raises blood glucose levels. If blood glucose levels do not rise significantly, this indicates a lactase deficiency.
Treatment options and modern therapeutic approaches
Lactose intolerance cannot currently be cured, but the symptoms can be effectively managed and prevented through an appropriate diet and therapeutic treatments. The aim is to achieve symptom-free living and to ensure an adequate intake of nutrients, particularly calcium.
1. A lactose-free or low-lactose diet
The treatment is based on avoiding foods and drinks containing lactose, or reducing the amount consumed. Individual tolerance levels can vary: some people feel unwell after just a sip of milk, whilst others can consume small amounts of dairy products (e.g. yoghurt, cheese) without any symptoms. It is worth keeping a food diary to find out your personal tolerance limit.
Foods with a high lactose content that are best avoided:
- Milk (cow, goat, sheep)
- Cream, sour cream, milk-based ice creams, ice lollies
- Cottage cheese, cream cheeses, block cheeses
- Milk-based desserts (pudding, rice pudding)
- Whey, buttermilk
- Processed foods (many ready-made products, baked goods, cold cuts and soup powders may contain hidden lactose)
Dairy products with a lower lactose content, which are easier to digest:
- Matured cheeses: During the long maturing process, the lactose breaks down (e.g. Parmesan, Cheddar, Swiss cheese).
- Yoghurt, kefir: The bacteria found in live-culture (probiotic) products help to break down lactose.
- Vaj: Due to its high fat content, it contains only a small amount of lactose.
Lactose-free dairy products are now widely available; the lactose is enzymatically removed or broken down during production, meaning they can be consumed safely.
2. Lactase enzyme supplementation
Preparations containing the lactase enzyme (tablets, drops, chewable tablets) form an important part of modern treatment. These should be taken immediately before a meal containing lactose. The enzyme helps to break down lactose in the gut, thereby preventing the onset of unpleasant symptoms. This solution offers great freedom, as it allows us to occasionally consume foods containing dairy products, for example when dining out or at social events.
3. The use of probiotics
Research suggests that certain strains of probiotic bacteria (e.g. _Lactobacillus_ and _Bifidobacterium_ species) can improve the digestion of lactose and alleviate symptoms. Probiotics help to maintain a healthy gut flora, which is also key to the management of secondary lactose intolerance.
Ensuring an adequate intake of calcium
Cutting out dairy products can lead to a reduction in calcium intake, which may increase the risk of osteoporosis in the long term. It is therefore particularly important to obtain calcium from other sources.
Excellent plant-based sources of calcium:
- Green leafy vegetables (e.g. kale, spinach, broccoli)
- Oilseeds (sesame seeds, almonds, poppy seeds)
- Dried pulses (beans, lentils)
- Plant-based milks and fruit juices enriched with calcium
- Tofu
If necessary, taking calcium and vitamin D supplements may also be advisable on medical advice.
Consult an expert for a symptom-free life!
Lactose intolerance is a manageable condition that does not have to prevent you from living a full, symptom-free life. Don’t let digestive problems hold you back in your daily life! An accurate diagnosis and personalised treatment are key to effectively managing your symptoms.
From Endomedix Gastroenterology Centre Our experienced specialists and modern diagnostic procedures will help you identify the cause of your symptoms and find the most suitable treatment strategy. Book an appointment today and take the first step towards balanced and worry-free meals!
