Lactose Intolerance

Dear Dr. B: I have chronic diarrhea. Is it possible that I may have lactose intolerance?

Answer: Many conditions can cause diarrhea. It can be acute or chronic in nature.

Acute diarrhea is more likely to be the result of a viral illness such as infection with rotavirus, adenovirus, or astrovirus. Bacterial or parasitic infection can also cause acute diarrhea. These may be contracted from exposure to contaminated water and food.

Chronic diarrhea can result from malabsorption, food allergy, celiac disease, bacterial overgrowth, lactose intolerance, chronic Giardia infection, short-bowel syndrome, inflammatory bowel disease, malignancy and irritable bowel syndrome.

Lactose intolerance is a condition where a person has inability to digest lactose, the natural sugar found in milk. Normally, the enzyme lactase breaks down lactose in the intestines to form the sugars glucose and galactose, which are easily absorbed through the intestinal wall.

Persons with lactose intolerance are unable to digest significant amounts of lactose because of a genetically inadequate amount of the enzyme lactase. As a result, the lactose remains undigested in the intestines and causes abdominal pain, diarrhea, bloating and excessive flatus.

The condition most commonly develops in adolescence and adulthood. It is more common in non-Caucasians than in Caucasians. It is present in up to 15 percent of persons of northern European descent, up to 80 percent of blacks and Latinos, and up to 100 percent of American Indians and Asians.

A diagnosis of lactose intolerance is usually not too difficult. It can usually be made with a careful history supported by dietary changes. If necessary, diagnosis can be confirmed by using a breath hydrogen or lactose tolerance test.

Individuals with chronic diarrhea believe they are lactose intolerant but do not actually have impaired lactose digestion, and some persons with lactase deficiency can tolerate moderate amounts of lactose, up to 250 mls. of milk daily without symptoms.

Lactose intolerance is usually a permanent condition. Treatment consists primarily of avoiding lactose-containing foods. Lactase enzyme supplements can be helpful. If one has to go off milk and milk products completely then one must maintain adequate body calcium balance by taking oral calcium supplements.

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