Lactose Intolerance: A Case Study

by Tanya Lewis, Staff Writer | April 22, 2015 06:56pm ET

Read the case study below and answer the questions at the end!
Lactose intolerance is the inability to digest the main sugar found in milk and other dairy
products. This is caused by a deficiency of lactase, the enzyme responsible for metabolizing
lactose in the small intestines, according to the National Institutes of Health (NIH).
The prevalence of lactose intolerance in adults varies from less than 5 percent to almost 100
percent among different populations, according to research published in the Scandinavian
Journal of Gastroenterology. The lowest prevalence is in northwestern Europe, around the
North Sea, and the highest prevalence is in Asians and American Indians. About 30 million
American adults are somewhat lactose intolerant by the age of 20, according to the NIH.
People can be acquire lactose intolerance
at any point in their life, and some people
develop it over time, said Dr. Sophie
Balzora, a gastroenterologist at NYU
Langone Medical Center in New York City.
Lactose intolerance is different from
having a milk allergy, since the latter is a
reaction to the proteins in milk rather than
lactose. It's also not like celiac disease, an
autoimmune disease caused by gluten,
which can have detrimental effects if
ingested.
Symptoms and causes
People can be genetically predisposed not
to produce the lactase enzyme, or the condition can result from illness or injury to the small
intestine, including surgery or infections, according to the NIH.
In lactose-intolerant adults, the lactose is fermented and metabolized by bacteria in the colon
to produce gas and short chain fatty acids. This results in abdominal cramps, bloating,
diarrhea, flatulence and nausea, Balzora said. The severity of symptoms largely depends on
how quickly the lactase available in the digestive system is used up.
Although reduced levels of lactase could result in improper absorption of lactose, only people
with low lactase levels who exhibit the common symptoms would be properly considered
lactose intolerant. According to the Mayo Clinic, most people with lactase deficiencies do not
display any signs or symptoms.
Premature babies can also be intolerant to breast milk, but full-term babies don't show signs of
the problem before the age of 2, according to the NIH. The intolerance can develop earlier in
African American children than in Caucasian ones.

Diagnosis & tests

Lactose intolerance should be suspected in people with abdominal symptoms such as
cramps and bloating after consuming milk and other dairy products. The initial diagnosis of
lactose intolerance can be very simple.
"The quick and dirty way is to have a patient avoid lactose products for a certain amount of
time," usually about two weeks, Balzora said. Then, these foods can be gradually reintroduced
into the diet again, and if the symptoms return, the person is likely somewhat lactose
intolerant, she said. Most patients do not need a referral to a specialist, or diagnostic
laboratory tests. However, the symptoms of lactose intolerance can overlap with other
gastrointestinal problems, such as irritable bowel syndrome and Crohns disease.
Treatment & medication
Cutting lactose out of the diet is an option, but patients should make
sure they aren't depriving themselves of calcium and vitamin D,
Balzora said.
Over-the-counter pills or drops that contain lactase can be taken
before meals to help alleviate or eliminate symptoms. For example,
Lactaid pills or Lactaid milk allow many people to process dairy products without any
difficulty, Balzora said. Some people find that taking probiotics
can help them digest lactase better, but Lactaid is really the
standard, Balzora said.
However, according to the Mayo Clinic, these products do not
help all patients. Adults who are lactose intolerant can
ultimately recondition their digestive system to tolerate up to
8.5 fluid oz. (250 milliliters) of milk about a glass if they
drink the milk in gradually increasing amounts. According to a
21-day intervention study conducted in 2000, most people who
do this will experience minimal or no discomfort.
Coping strategies
Lactose intolerance can be treated with simple dietary changes. The most straightforward way
is for a person to reduce the amount of milk or daily products in his or her diet. Also, it may
help to divide daily milk and dairy products into several small portions and consume them with
other foods.
Think About It
How does the absence of one enzyme effect a lactose intolerant patients life? One little
enzyme
Questions: (answer on a separate page)
What causes lactose intolerance?
Which enzymes are involved in lactose intolerance?
What are treatment methods?
Why might some people be more susceptible for an intolerance than others? (consider:
genetics)
5. What organs in the body are connected with lactose? Use the article to site
evidence.
1.
2.
3.
4.