Does lactose intolerance get worse as you age? Understanding the Facts

Worldwide, the prevalence of lactose malabsorption is estimated to be over 65%, with a natural decline in lactase production occurring with age. So, does lactose intolerance get worse as you age? For many, the answer is yes, as the body's ability to produce the digestive enzyme lactase diminishes over time.

Quick Summary

Yes, for many people, the symptoms of lactose intolerance can become more noticeable or worsen with age, a result of the gradual and natural decrease in the body's production of the lactase enzyme.

Key Points

• Lactase Decline with Age: As you age, your body naturally produces less of the lactase enzyme, which can make lactose intolerance symptoms more noticeable.

• Worsening Symptoms, Not Condition: The severity of your symptoms may increase over time, even if the rate of lactase decline has stabilized.

• Distinguish from Milk Allergy: Lactose intolerance is a digestive issue, while a milk allergy is a potentially severe immune response to milk protein.

• Manage with Dietary Changes: Strategies like eating smaller portions, choosing low-lactose dairy (aged cheese, yogurt), and taking lactase supplements can help manage symptoms.

• Prioritize Bone Health: Ensure adequate calcium and vitamin D intake from non-dairy sources like fortified alternatives and leafy greens to prevent osteoporosis.

• Confirm with a Doctor: If you experience persistent digestive issues, consult a healthcare provider for a proper diagnosis, which may involve a hydrogen breath test.

The Link Between Aging and Lactase Decline

Lactose intolerance is the inability to fully digest lactose, the sugar found in milk and milk products. This condition is caused by a deficiency of the enzyme lactase, which is produced in the small intestine and is needed to break down lactose into simpler sugars. For most mammals, and a large portion of the human population, lactase production naturally decreases after infancy, a genetic trait known as lactase nonpersistence.

While this decline begins in childhood, it continues throughout a person's life. The older you get, the more likely your body is to produce less lactase, meaning that a sensitivity you once barely noticed could become more pronounced, with symptoms appearing more frequently or with greater severity. This is a key reason why many individuals start experiencing noticeable symptoms for the first time in their adult years.

Primary vs. Secondary Lactose Intolerance

It is important to distinguish between the two most common types of lactase deficiency:

• Primary Lactase Deficiency: The most common cause, this is the result of the natural, gradual decline in lactase production over time. This condition is genetically determined, and its onset and severity can vary widely among different ethnic groups.
• Secondary Lactase Deficiency: This form occurs when an illness, injury, or surgery involving the small intestine damages the intestinal lining and reduces lactase production. Conditions like celiac disease, Crohn's disease, or a severe intestinal infection can cause secondary lactose intolerance. Unlike the primary form, symptoms from secondary lactase deficiency may improve if the underlying condition is treated.

Symptoms: Why They Seem to Worsen

The classic gastrointestinal symptoms associated with lactose intolerance—bloating, gas, stomach pain, and diarrhea—are caused by undigested lactose passing into the large intestine. Here, bacteria ferment the lactose, producing gases and other byproducts that lead to discomfort. As lactase levels continue to decrease with age, less lactose is digested in the small intestine, leaving more for the colon's bacteria to ferment. This can lead to a higher volume of gas and more pronounced symptoms, even with the same amount of dairy consumption.

It's also worth noting that other age-related factors can influence digestive health and symptom perception. Conditions like irritable bowel syndrome (IBS) or certain medications can produce similar symptoms, complicating the diagnosis. For this reason, it is crucial to consult a healthcare provider for an accurate diagnosis, often confirmed with a hydrogen breath test.

Managing Lactose Intolerance in Later Life

Navigating lactose intolerance as you age doesn't have to mean completely eliminating dairy. Many strategies can help manage symptoms and allow you to continue enjoying some dairy products without discomfort.

Dietary Strategies

1. Start with Small Servings: Many people with lactose intolerance can handle small amounts of lactose. Start with a tiny serving, such as a splash of milk in your coffee, to test your tolerance.
2. Pair Dairy with Other Foods: Consuming milk or other dairy products with a full meal can slow the digestive process, which can reduce or delay symptoms.
3. Choose Low-Lactose Dairy: Hard cheeses like cheddar, Swiss, and Parmesan contain very little lactose and are often well-tolerated. Yogurt with live and active cultures is also a good choice, as the bacteria help break down the lactose.
4. Explore Lactose-Free Products: Most supermarkets offer a wide range of lactose-free milk, cheese, and ice cream products, which contain added lactase to aid digestion.
5. Use Lactase Supplements: Over-the-counter lactase enzyme tablets or drops can be taken right before eating or drinking dairy to help your body break down the lactose.

Ensuring Adequate Calcium for Bone Health

For older adults, especially those avoiding dairy, it is crucial to ensure adequate calcium and vitamin D intake to prevent osteoporosis.

• Non-Dairy Calcium Sources: Include dark leafy greens (kale, collard greens), almonds, dried beans, canned salmon with soft bones, and calcium-fortified foods like orange juice and cereals.
• Vitamin D: Get vitamin D from fortified products, fatty fish (salmon), and safe sun exposure, or consider a supplement.

Lactose Intolerance vs. Milk Allergy

For those newly experiencing digestive issues with dairy, it is vital to understand the key differences. Lactose intolerance is a digestive issue, while a milk allergy is an immune system response.

Aspect	Lactose Intolerance	Milk Allergy
Cause	Inability to digest the sugar (lactose) due to lactase deficiency.	Immune system reaction to milk protein.
Severity	Ranges from mild to severe discomfort; not life-threatening.	Can be severe, potentially leading to anaphylaxis in sensitive individuals.
Onset	Symptoms appear 30 minutes to 2 hours after consuming dairy.	Reaction can be immediate or rapid, sometimes within minutes.
Symptoms	Digestive issues: gas, bloating, diarrhea, cramps.	Multi-system: hives, swelling, wheezing, vomiting, or anaphylaxis.

Conclusion

While the underlying cause of lactose intolerance doesn't necessarily get worse as you age, the effects often become more prominent as lactase levels diminish over time. Understanding this process empowers you to take control of your digestive health. By employing smart dietary management strategies, from portion control to utilizing lactase supplements, you can mitigate symptoms and maintain proper nutrition, including essential calcium for bone health. Working with a healthcare professional can help you develop a personalized plan that ensures comfort and well-being in your later years. For more information on managing digestive health, you can visit the National Institute of Diabetes and Digestive and Kidney Diseases.

Frequently Asked Questions

Why does lactose intolerance get worse as you age?

Lactose intolerance often appears or seems to worsen with age because the body's production of the lactase enzyme, which digests milk sugar, naturally and gradually declines over time. This leaves more undigested lactose in your gut, which leads to more pronounced digestive symptoms.

Are there different types of lactose intolerance?

Yes, there are three main types. Primary (age-related decline) is the most common. Secondary is caused by an injury or illness affecting the small intestine. Congenital or developmental intolerance is rare and present from birth or in premature infants.

Can I still eat dairy if I have lactose intolerance?

Most people with lactose intolerance can tolerate some amount of dairy. You can manage symptoms by consuming small portions, eating dairy with meals, choosing low-lactose products like hard cheeses, or using lactase enzyme supplements.

How can I tell if my symptoms are lactose intolerance or something else?

While symptoms like gas and bloating are common, a hydrogen breath test can confirm lactose intolerance. However, other conditions like Irritable Bowel Syndrome (IBS) or milk allergy can have similar signs. A healthcare provider can help with an accurate diagnosis.

What foods can I eat to get calcium if I avoid dairy?

Good non-dairy sources of calcium include dark leafy greens (kale, broccoli), fortified juices and cereals, tofu made with calcium sulfate, canned salmon, sardines, and almonds.

Is there a cure for age-related lactose intolerance?

For primary lactose intolerance, there is no cure, but symptoms can be effectively managed with dietary changes and lactase enzyme supplements. For secondary lactose intolerance, treating the underlying condition may lead to an improvement in lactose tolerance.

How do lactase supplements work?

Lactase supplements are over-the-counter tablets or drops that provide the lactase enzyme your body lacks. When taken before consuming dairy, they help break down the lactose, reducing or preventing digestive symptoms.