Lactose intolerance: symptoms, causes and treatment tips

Many people experience unpleasant digestive symptoms after eating certain foods, especially dairy products. Bloating, abdominal cramps and diarrhoea are often signs of lactose intolerance, a condition that affects many people in Hungary. Although the symptoms can be disturbing, it is important to understand what is behind them and how they can be effectively managed.

In this article, we take an in-depth look at lactose intolerance. We look at the typical symptoms, medical causes, diagnostic options and treatment strategies. Our aim is to provide you with clear and reliable information to help you recognise the problem and regain control of your digestion. If you're struggling with similar complaints and are looking for a solution, read on to find out all about lactose intolerance and how to live a complaint-free lifestyle. Visit Endomedix Gastroenterology Centre experts are committed to your health and will help you get an accurate diagnosis and personalised treatment.

What exactly is lactose intolerance?

Lactose intolerance is a digestive disorder that occurs when the body cannot properly digest lactose, the sugar found in milk and dairy products. This inability results from a lack or reduced function of an enzyme called lactase.

The role of the enzyme lactase

Lactase is an enzyme produced in the small intestine whose job is to break down lactose into two simpler sugars, glucose and galactose. These simple sugars are now easily absorbed through the intestinal wall and provide energy to the body.

If the body does not have enough lactase, lactose passes undigested into the large intestine. There, intestinal bacteria ferment it, leading to the formation of gases (hydrogen, carbon dioxide, methane) and short-chain fatty acids. These by-products cause the characteristic and unpleasant symptoms of lactose intolerance, such as bloating, gas formation and diarrhoea.

It is important to distinguish lactose intolerance from milk protein allergy. While lactose intolerance is a digestive problem, milk allergy is an abnormal reaction of the immune system to the proteins in milk. Symptoms of milk allergy can be more severe (e.g. skin rash, difficulty breathing, anaphylactic shock) and can be triggered by consuming even small amounts of dairy products.

Types and causes of lactose intolerance

There are several possible causes of lactose intolerance, which can be divided into three main types.

1. Primary lactase deficiency

This is the most common form. The majority of people are born with sufficient lactase enzyme, which is essential for infant nutrition as breast milk also contains lactose. After breastfeeding, as the diet becomes more varied, lactase production begins to decline in a genetically determined way. This process usually becomes noticeable in adolescence or young adulthood, but can occur at any age. The extent of the decrease in lactase production varies from individual to individual.

2. Secondary (secondary) lactase deficiency

This type develops when the production of lactase is temporarily or permanently reduced due to damage to the small intestine or disease. The mucous membrane of the small intestine produces the enzyme, so any damage can affect its function.

Common triggers can include:

• Gastroenteritis: Gastroenteritis (e.g. viral or bacterial infection) can cause inflammation of the intestine.
• Coeliac disease (gluten sensitivity): The autoimmune reaction triggered by gluten damages the lining of the small intestine.
• Crohn's disease: This chronic inflammatory bowel disease can also affect the small intestine.
• Certain medicines: Lactase deficiency can also occur as a side effect of some antibiotics or chemotherapy drugs.

The good news is that secondary lactase deficiency is often reversible. If the underlying underlying disease is successfully treated and the lining of the small intestine regenerates, lactase production can be restored.

3. Congenital lactase deficiency

It is an extremely rare, inherited genetic disorder in which the baby does not produce lactase enzyme from birth. This makes it unable to digest breast milk or formula containing lactose. Symptoms are severe diarrhoea and dehydration after the first feedings. The condition requires immediate medical intervention and special lactose-free feeding.

Typical symptoms of lactose intolerance

Symptoms of lactose intolerance usually appear between 30 minutes and 2 hours after eating a food or drink containing lactose. The severity of symptoms depends on several factors, such as the amount of lactose consumed and the degree of individual lactase deficiency.

The most common symptoms are:

• Bloating: In the large intestine, gases produced by bacteria (hydrogen, carbon dioxide, methane) stretch the intestinal wall, resulting in an unpleasant feeling of fullness and a visibly bloated abdomen.
• Abdominal cramps and pain: Increased gas production and changes in bowel movements can cause painful spasms, most often around the navel or in the lower abdomen.
• Increased gas formation (flatulence): Gas build-up in the bowel can be unpleasant and frequent.
• Diarrhoea: Undigested lactose has an osmotic effect, which means that it draws water into the large intestine. This increases the water content of the stool, causing a watery, watery diarrhoea. The stools often have a sour smell due to bacterial fermentation.
• Nausea and occasional vomiting: Although less common, excessive intestinal gas and discomfort can provoke nausea and vomiting.

It is important to note that these symptoms are not specific, meaning that other digestive diseases such as irritable bowel syndrome (IBS) or coeliac disease can cause similar symptoms. An accurate diagnosis is therefore crucial so that the right treatment can be started. If you experience these symptoms regularly, you should consult a specialist gastroenterologist. Visit Endomedix Gastroenterology Centre specialists to help you find the background to your complaints.

How is lactose intolerance diagnosed?

As symptoms may also indicate other diseases, an accurate diagnosis is essential. After taking a medical history and performing a physical examination, the gastroenterologist may recommend several tests to confirm lactose intolerance.

Exhalation test for hydrogen (H2)

It is the most commonly used, reliable and non-invasive diagnostic method. The procedure is as follows:

• The patient must come to the examination on an empty stomach.
• First, the baseline hydrogen level in the exhaled air is measured.
• The patient then ingests a solution containing a fixed amount of lactose.
• Over the next 2-3 hours, the hydrogen concentration in the exhaled air is measured repeatedly at 15-30 minute intervals.

The principle of the test: If there is a lactase deficiency in the body, the undigested lactose is released into the large intestine where it is broken down by intestinal bacteria. During this process, hydrogen gas is released, which is transported into the bloodstream and then exits the body through the lungs. If the level of hydrogen in the exhaled air rises significantly after ingestion of a lactose solution, this indicates lactose intolerance.

Genetic testing

This test can be performed from a simple swab of the oral mucosa or a blood sample. The test identifies the polymorphism in the LCT gene (C/T-13910) responsible for primary adult lactase deficiency. If someone has the C/C genotype, they are genetically predisposed to lactose intolerance. The advantage of the test is that it requires no preparation and causes no symptoms, but it can only detect the primary type, not the secondary.

Blood glucose test for lactose load

This method is less commonly used today. The patient drinks a lactose solution and then has their blood glucose levels measured at regular intervals. If the lactase enzyme is working properly, the lactose is broken down into glucose, which raises the blood sugar level. In lactose intolerance, blood glucose levels do not rise or rise only slightly.

Management of lactose intolerance and dietary advice

There is currently no cure for lactose intolerance, but symptoms can be effectively controlled through appropriate lifestyle and diet. The aim of treatment is to minimise symptoms without compromising quality of life.

1. Reducing lactose intake

The most important step is to limit your intake of lactose-containing foods and drinks. It is important to know that most lactose intolerant people do not need to give up dairy products completely. Individual tolerance levels vary. It is worth keeping a food diary to find out how much lactose your body can tolerate without symptoms.

High lactose foods to avoid or limit:

• Milk (cow, goat, sheep)
• Cream, sour cream, whipped cream
• Soft cheeses (e.g. cottage cheese, ricotta, cream cheese)
• Yoghurts (although the live cultures in them may help digest lactose)
• Ice creams, milk-based desserts
• Milky drinks, cocoa, smoothies

Hidden sources of lactose: Look out for food labels, as many processed foods may also contain lactose:

• Bakery products, pastries
• Sliced meats, sausages
• Salad dressings, sauces
• Preparations, soup powders
• Certain medicines and food supplements

2. Lactase enzyme supplementation

Formulations containing lactase enzyme (tablets, drops) can be of great help. These should be taken just before a meal containing lactose to replace the missing enzyme and help break down lactose in the gut. This way, you can occasionally eat dairy products without guilt or discomfort, for example at a restaurant dinner or a celebration.

3. Lactose-free and low lactose products

Fortunately, there is now a wide choice of lactose-free dairy products (milk, yoghurt, cheese, cottage cheese), which are produced by adding a lactase enzyme during production to break down the lactose in advance.

In addition, certain dairy products are naturally low in lactose:

• Ripened, hard cheeses: (e.g. Parmesan, cheddar, Swiss cheese) During the ripening process, most of the lactose is broken down.
• Vaj: Due to its high fat content, it contains only traces of lactose.
• Live-flower yoghurts and kefirs: The beneficial bacteria they contain also produce lactase themselves, aiding digestion.

4. Supplementing calcium

Eliminating dairy products from the diet can lead to calcium deficiency, which increases the risk of osteoporosis in the long term. It is therefore important to ensure adequate calcium intake from other sources:

• Plant milks: Almond, soy, rice or oat milk, often fortified with calcium.
• Green leafy vegetables: Spinach, kale, broccoli.
• Oily seeds: Almonds, sesame seeds.
• Halak: Sardines, salmon (eaten with the spines).
• Foods fortified with calcium: E.g. orange juice, cereal.

If necessary, your doctor may also recommend taking calcium and vitamin D supplements.

When should you see a doctor?

If you experience the above symptoms regularly after consuming dairy products, you should consult a specialist gastroenterologist. An accurate diagnosis is essential as the symptoms may be caused by other, more serious diseases.

Turn to the Endomedix Gastroenterology Centre professionals, if you:

• Your symptoms are severe or impair your quality of life.
• Concerns about adequate nutrient intake, especially calcium deficiency.
• You experience „alarming” symptoms such as unintentional weight loss, bloody stools or severe, constant abdominal pain.
• You want to get a definitive diagnosis and personalised dietary advice.

Don't let digestive complaints control your life! With expert help and the right lifestyle choices, the symptoms of lactose intolerance can be effectively managed and you can enjoy everyday life again.

Concluding thoughts: what next?

Lactose intolerance is a common but manageable condition. The key is awareness, proper diagnosis and a personalised diet. You don't have to completely give up the taste and nutritional value of dairy products, you just need to make smart choices. Lactase enzyme substitutes and the wide range of lactose-free products available allow you to have a flexible and enjoyable diet.

If you are unsure about your symptoms or need help diagnosing and planning your diet, don't hesitate to consult a specialist. Visit Endomedix Gastroenterology Centre experienced doctors and dieticians are ready to support you on your journey. Book in for a consultation to find the cause of your symptoms in trusted hands, using the latest diagnostic techniques, and help you achieve a fuller, symptom-free life.