dietary changes the most obvious means of treating lactose intolerance is by reducing the amount of lactose in the diet. fortunately most people who are lactose intolerant can tolerate small or even moderate amounts of lactose. it often takes only elimination of the major milk-containing products to obtain sufficient relief from their symptoms. thus it may be necessary to eliminate only milk yogurt cottage cheese and ice cream. though yogurt contains large amounts of lactose it often is well-tolerated by lactose intolerant people. this may be so because the bacteria used to make yogurt contain lactase and the lactase is able to split some of the lactose during storage of the yogurt as well as after the yogurt is eaten (in the stomach and intestine). yogurt also has been shown to empty more slowly from the stomach than an equivalent amount of milk. this allows more time for intestinal lactase to split the lactose in yogurt and at least theoretically would result in less lactose reaching the colon. most supermarkets carry milk that has had the lactose already split by the addition of lactase. substitutes for milk also are available including soy and rice milk. acidophilus-containing milk is not beneficial since it contains as much lactose as regular milk and acidophilus bacteria do not split lactose. for individuals who are intolerant to even small amounts of lactose the dietary restrictions become more severe. any purchased product containing milk must be avoided. it is especially important to eliminate prepared foods containing milk purchased from the supermarket and dishes from restaurants that have sauces. another means to reduce symptoms of lactose intolerance is to ingest any milk-containing foods during meals. meals (particularly meals containing fat) reduce the rate at which the stomach empties into the small intestine. this reduces the rate at which lactose enters the small intestine and allows more time for the limited amount of lactase to split the lactose without being overwhelmed by the full load of lactose at once. studies have shown that the absorption of lactose from whole milk which contains fat is greater than from non-fat milk perhaps for this very reason. nevertheless the substitution of whole milk or yogurt for non-fat milk or yogurt does not seem to reduce the symptoms of lactose intolerance. lactase enzyme caplets or tablets of lactase are available to take with milk-containing foods. adaptation some people find that by slowly increasing the amount of milk or milk-containing products in their diets they are able to tolerate larger amounts of lactose without developing symptoms. this adaptation to increasing amounts of milk is not due to increases in lactase in the intestine. adaptation probably results from alterations in the bacteria in the colon. increasing amounts of lactose entering the colon change the colonic environment for example by increasing the acidity of the colon. these changes may alter the way in which the colonic bacteria handle lactose. for example the bacteria may produce less gas. there also may be a reduction in the secretion of water and therefore less diarrhea. calcium and vitamin d supplements milk and milk-containing products are the best sources of dietary calcium so it is no wonder that calcium deficiency is common among lactose intolerant persons. this increases the risk and severity of osteoporosis and the resulting bone fractures. it is important therefore for lactose intolerant persons to supplement their diets with calcium. a deficiency of vitamin d also causes disease of the bones and fractures. milk is fortified with vitamin d and is a major source of vitamin d for many people. although other sources of vitamin d can substitute for milk it is a good idea for lactose-intolerant persons to take supplemental vitamin d to prevent vitamin d deficiency.
how is lactose intolerance treated?