Lactose intolerance is a prevalent yet often misunderstood condition and affects up to 70% of the population worldwide. People often mistake intolerance, allergies, and sensitivities because they have similar symptoms, such as gas, bloating, and other digestive symptoms. This confusion stresses the importance of clarification and accurate lab testing to effectively manage any of these issues based on their specific causes.

Not to worry, though. This article will lay out lactose intolerance and what the differences are to provide some clarity. It will help you determine which labs are best to run if your patients are experiencing similar symptoms and need some guidance to point them in the right direction. Functional labs are an excellent tool in helping people decipher the precise underlying causes of these and other symptoms, enabling you to improve your patient's overall health.

[signup]

What is Lactose Intolerance?

Lactose intolerance is a condition where there are gastrointestinal symptoms after eating foods or drinks that contain lactose. Lactose is a type of sugar that is typically found in milk or dairy products. These symptoms happen because of lactose malabsorption, where the small intestine cannot fully digest the lactose consumed due to a deficiency in a digestive enzyme called lactase. It's important to note not everyone with lactose malabsorption experiences these symptoms; only those who do are considered lactose intolerant. Unlike a milk allergy involving the immune system, lactose intolerance is solely a digestive enzyme deficiency problem. People with lactose intolerance can usually tolerate varying amounts of lactose before experiencing symptoms. Therefore, eating large quantities of cheese from a charcuterie board may be out of the question in order to prevent digestive issues. However, these individuals may still be able to consume small or moderate amounts.

What Causes Lactose Intolerance? 

Lactose intolerance occurs due to lactose malabsorption, where the small intestine produces low lactase levels, the enzyme responsible for breaking down lactose. As a result, undigested lactose reaches the colon, where bacteria break it down, causing fluid and gas formation that leads to lactose intolerance symptoms.

Genetics, such as lactase non-persistence, can influence the condition, where lactase levels decrease with age and occurs in most of the population. In contrast, congenital lactase deficiency is a rare condition where little to no lactase is produced from birth.

Non-genetic factors like injuries to the small intestine from infections, diseases like Crohn's or celiac disease, or treatments like surgery or radiation therapy can also cause lactose intolerance by damaging cells that produce lactase, termed secondary lactose intolerance. Additionally, premature birth can result in temporary low lactase production in infants, improving as they grow older.

Lactose Intolerance Symptoms

Symptoms of lactose intolerance can occur suddenly or gradually over time, or they can be more likely to transpire with other digestive conditions like IBS. You may be wondering how serious symptoms can be. Fortunately, while lactose intolerance can be uncomfortable, they do not cause serious life-threatening issues. Another interesting point about lactose intolerance is that symptoms may not show up for one to two days after consuming lactose because of transit time. It can take that long to travel to and through your large intestine. Signs and symptoms of lactose intolerance include:

●  Abdominal distention, bloating, pain, or cramping

●  Gas

●  Nausea

●  Vomiting

●  Rumbling or gurgling in the stomach

●  Diarrhea

What Are The Benefits of Regular Lab Testing For Patients With Lactose Intolerance?

Regular testing for patients with lactose intolerance can be very beneficial. Testing can aid in identifying true intolerance and rule out other digestive issues like IBS. Functional labs can provide an in-depth analysis of underlying causes that lead to the development of lactose intolerance, enabling the development of personalized treatment and nutritional plans. Monitoring progress over time through regular testing can also help pinpoint other health consequences like nutrient deficiencies that can occur with lactose intolerance. Overall, lab testing empowers patients to assess and monitor secondary causes, make necessary adjustments, and improve lactose intolerance management.

Top Labs To Run Bi-Annually On Patients With Lactose Intolerance

Lactose intolerance can be clinically diagnosed when digestive symptoms occur after consuming lactose-containing foods, improve after removing lactose products from the diet, and reappear upon reintroduction. Providers frequently use functional laboratory tests to confirm lactose intolerance diagnoses, exclude other conditions with similar symptoms, and determine the causes of secondary lactose intolerance. Additionally, these tests help identify any health issues that may occur due to lactose intolerance. Below are functional labs that practitioners often use for their lactose intolerance patients:

Lactose Breath Test

The lactose hydrogen breath test is the primary method for diagnosing lactose intolerance. This test involves the patient taking a dose of lactose and collecting breath samples at home. The test measures hydrogen gas levels in the breath, and a positive result is indicated if hydrogen concentrations exceed 20 ppm over the baseline within three hours. Repeating labs may not be necessary for patients who respond well to therapy. However, they can be beneficial for monitoring treatment progress. Those who acquire lactose intolerance might consider repeating the lactose hydrogen breath test to evaluate their recovery from lactose intolerance.

SIBO Breath Test

SIBO, small intestinal bacterial overgrowth, causes complex malabsorption of carbohydrates, fatty acids, proteins, and vitamins, resulting in symptoms like diarrhea, bloating, flatulence, and abdominal discomfort similar to lactose intolerance. SIBO can lead to inaccurate results in lactose breath and tolerance tests due to carbohydrate malabsorption, making this test vital to rule out SIBO and to ensure an accurate diagnosis. This digestive condition can cause mucosal damage and altered motility, which can also initiate lactose malabsorption. The SIBO breath test is an at-home test that measures methane, hydrogen, and hydrogen sulfide gas levels after taking glucose to assess three subtypes of SIBO. Testing can be repeated after therapy to ensure eradication and effectiveness of treatment along with improving absorption.

Comprehensive Stool Test

A comprehensive stool test can detect intestinal infections and indications of underlying inflammatory bowel disorders like Celiac, IBS, and IBD. It detects microbiome health and imbalances that can contribute to digestion, absorption, and inflammation issues. This test is beneficial to assess for secondary causes, such as inflammatory bowel conditions that can result in lactose intolerance. Retesting can help evaluate the effectiveness of treatment and to monitor intestinal inflammation, which can contribute to issues with lactose absorption.

Micronutrient Panel

Nutrient deficiencies can often be a consequence of lactose intolerance which can impact bone function, the nervous system, and immune regulation. A micronutrient panel can assist practitioners in identifying any deficiencies and nutrient imbalances related to lactose intolerance. This test is completed through a serum sample and can assess for 40 different vitamins and minerals that may be deficient. A micronutrient panel is recommended for people with digestive issues and should be evaluated bi-annually to determine absorption and to continue to adapt nutritional plans based on the results.

Food Allergy and Sensitivity

Although this test doesn't need to be completed regularly, food sensitivities and allergies should be ruled out as they are often a differential diagnosis for food intolerance, such as lactose intolerance. Food sensitivities and allergies are an immune response, and intolerances are due to enzyme deficiencies. The food sensitivity and allergy panel measures IgG (food sensitivity) and IgE (food allergy) immune responses to 88 common foods to help practitioners personalize patient dietary plans.

[signup]

Summary

Lactose intolerance is not a disorder but rather a natural variation in how our gastrointestinal systems function. It stems from a recent genetic adaptation in humans, allowing some to digest lactose beyond infancy while others cannot, and that's perfectly normal. Living a healthy life with lactose intolerance is entirely possible.

If your patients are experiencing digestive symptoms and you suspect they may be related to dairy products, functional medicine testing can help you confirm lactose intolerance or explore other potential causes for those symptoms. Testing can also help you create a root cause medicine treatment plan focused on gut health and nutrition to help your patients make lifestyle adjustments to avoid those troublesome symptoms.