Lactose intolerance

Poornima asked about lactose intolerance and supplements: “Does a lactose intolerant child need calcium supplements? If so, which ones? I thought the soy milk is calcium fortified- but I do understand that there are brands that are not.”

I looked at labels at the grocery store today, and the common brands of soy milk are calcium and vitamin D fortified—they have essentially the same content of these nutrients as cow’s milk. There are probably smaller brands that are not fortified, so it’s best to check the label.

Lactose intolerance is common in adults, especially among African- and Asian-Americans. However, it is virtually non-existant in babies. Human breast milk is loaded with lactose, and our babies are very good at digesting this natural sugar. Their guts are loaded up with lactase, the enzyme needed for lactose digestion. As children get older, many start to lose this lactase activity and may begin to have trouble digesting lactose. When that happens, symptoms like bloating, abdominal pain, and gassy diarrhea can occur. Because many adults are lactose intolerant, baby formula companies take advantage of this fear to sell special lactose-reduced formulas. Don’t fall for this—the chance of baby being lactose intolerant is probably one in a million.

Diagnosing lactose intolerance is best done by trial and error. If you think your older child has this, take her off milk for a week or so. Then on a day without other big plans, give her a nice big milkshake. Yum! If an hour or so later she’s in the bathroom miserable, she’s probably lactose intolerant. Though there are medical tests to confirm this, they’re difficult to do in children and rarely necessary.

Treatment consists mainly of avoiding lactose sources—that is, all dairy products. Items that are cooked or heated will have less lactose than ordinary milk. Everyone who is lactose intolerant has a “threshold level,” beyond which symptoms will occur. This threshold will be very low for some people (say, only ½ a slice of cheese pizza), while others might be able to tolerate a bit more (maybe one small glass of milk, but no more.) Experiment to find out what the threshold is so you can avoid going over the limit.

There are supplements sold to help with lactose intolerance, usually enzymes that are said to be able to replace the natural effect of lactase. Some people find these effective, but most do not. Almost all natural lactase activity occurs far into the small intestine, and most of any swallowed enzyme is likely broken down long before the food makes it that far down. Still, lactase supplements are safe and feel free to use them if they seem to help.

In a typical American diet, diary products are the major source of both calcium and vitamin D. For infants, milk and dairy are also a significant source of protein and calories. If your child can’t tolerate dairy, you should discuss her individual needs with her pediatrician to make sure that she’s getting enough of these nutrients.

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7 Comments on “Lactose intolerance”

  1. Kelly Says:

    Dr. Roy – how do you tell the difference between lactose intolerance vs. a milk allergy? I’m curious because my 17-month-old year old breaks out with skin rashes/excema if consuming anything with cow’s milk, but I’ve rarely noticed stomach problems. My child has always reacted to cow’s milk, but the cheese reactions took longer to develop and have grown in intensity. I’m still unsure which is the culprit – milk allergy or lactose intolerance. Regardless, I do hope she grows out of it as it’s hard to find foods she can eat and likes!

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  2. Carmen Says:

    Don’t forget that broccoli and calcium fortified orange juice are great sources of calcium for kids!

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  3. Dr. Roy Says:

    Kelly, lactose intolerance will only cause GI problems (pain, gas, diarrhea). Skin rashes related to food exposures are usually allergies caused by proteins in the food. Kids who are milk allergic will have the same reactions to lactose-reduced milk (eg Lactaid) as they would to regular milk.

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  4. Tracy! Says:

    My son (who is now 2.5) was on regular milk-based formula as an infant, switched to whole milk at 1 and had no problems. At around 1.5 he had a bit of a stomach bug, vomiting and diarrhea, and my pediatrician suggested a few days on soy milk to help calm his tummy. Well that worked, but now anytime he gets non soy milk he gets diarrhea again! Can we just wean him back onto real dairy slowly? I’d hate to create a problem where there isn’t one, but no one likes diarrhea, especially when we are trying to potty train.

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  5. Dr. Roy Says:

    Tracy, see if he can tolerate small amounts of milk, and gradually increase the volume. If he’s lactose intolerant, he’ll have some “threshold” amount of milk that’s OK. Once you learn how much he can take, you’ll know you can’t push it further.

    Another option would be to substitute a lactose reduced milk like Lactaid 100.

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  6. bbgg Says:

    It is neither natural nor necessary for humans to consume milk after weaning

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  7. Dr. Roy Says:

    bbgg, animal’s milk has been consumed by humans since the earliest time of recorded history. I am not sure how much more natural you can get.

    Is milk “necessary” past weaning? No, as long as nutritional needs are fulfilled. It’s difficult to get enough calcium without dairy products, and many people rely on milk intake as an important source of vitamins A and D.

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