Probiotics and Lactose Intolerance
Lactose Intolerance or Malsorption is a prevalent condition that is thought to affect up to 68% of the world's population with people of Asian ethnicity thought to be more likely to have the condition. It can negatively impact the life of an adult or kids life by interrupting social events, work, or school with symptoms like diarrhea or vomiting.
There has been some research on the use of Lactobacillus bacteria as a potential solution but research is still limited. This probiotics for lactose intolerance guide will look at the studies on the microbiome and lactase enzyme to see what probiotic strains may be able to help.
What Is Lactose Intolerance?
Lactose intolerance is a condition that prevents the body from digesting lactose. Lactose is a natural sugar that is commonly found in milk, and dairy products.
People who suffer from lactose intolerance are unable to consume any milk or dairy products and may often complain of flatulence, stomach cramps, and bloating especially after consuming dairy products.
During the digestion process lactose is broken down into two monosaccharides - glucose and galactose in the small intestine by an enzyme known as lactase.
If there is an insufficient amount of the digestive enzyme lactase to break down lactose, then the lactose is moved to the colon (large intestine) where its metabolized by bacteria.
This undigested lactose is the main reason behind bloating, stomach cramps, flatulence, and increased acidity that commonly affect people with lactose intolerance.
While some people may have lactose intolerance since birth, one can also develop lactose intolerance at any point in life.
Our body has an inherent ability to digest lactose and this ability is at its highest during the initial years of our life. With time though, the body’s ability to digest lactose starts to decrease and this may be caused by a number of factors like not enough short-chain fatty acids.
This sort of age-related decrease in the body’s ability to digest lactose is known as primary lactose deficiency/non-persistence and is thought to be genetic as the gene responsible for the production of lactase (LCT gene) tends to become dormant with time.
While there is another form of lactase deficiency that is caused by damage to the small intestine where lactase is primarily produced. This sort of lactase deficiency is usually a result of malnutrition, inflammatory bowel disease, infections, and gastroenteritis.
Some Probiotic strains may be effective in dealing with some lactose intolerance symptoms as some studies shared later on suggest. In particular, probiotics used as a starter culture in yogurt or non-dairy probiotic supplements may help the digestive system with lactose.
Best Probiotic For Lactose Intolerance
When trying to find the best probiotics for lactose intolerance it's important to find a supplement that has clinically studied probiotic strains in human participants with lactose intolerance. From my research, the best probiotics to help you digest and eat dairy foods like ice cream are Lactobacillus Acidophilus and a mix of Bifidobacterium bacteria.
Dr. Sara Mesilhy, Gastroenterologist and member of our medical team told me that "Milk, yogurt, and cheese have a unique dairy matrix that contains essential nutrients and materials that support our gut health. Yogurt is probably the most popular probiotic. It's made when good bacteria are added to milk."
Bifidobacterium Longum & Bifidobacterium Animalis
Many of the probiotics for Lactose Intolerance studies were conducted using Lactobacillus bacteria but this 2020 meta-analysis from Spain had some interesting findings on the B. Longum & B. Animalis probiotic strains.
They stated that a deficiency in the lactase enzyme was what causes things like delayed gut transit time and this could be confirmed when no symptoms occur after having no digestive side effects from Lacto fermented foods like Kefir and some cheeses.
It was found that both B. Longum & B. Animalis were effective in attenuating clinical symptoms in vivo / vitro settings. It's thought that B. Animalis had better mucus adhesive properties allowing it to better stick to the intestines to enhance lactose digestion and increase gut transit time.
The meta-analysis also mentioned some other Lactobacillus strains and the overall conclusion of the analysis was that there were beneficial effects of probiotic supplementation for Lactose Intolerant Symptoms. This was mainly for flatulence, cramping, diarrhea, bloating, and vomiting but they also stated that further long-term trials were still needed.
Lactobacillus Acidophilus DDS-1
In 2016 a randomized controlled trial was published in the peer-reviewed Nutrition Journal looking at the efficacy of Lactobacillus Acidophilus DDS-1 probiotics on alleviating symptoms like diarrhea, bloating, cramping, gas, vomiting, and even those stomach gurgling sounds a lactose intolerant person will often get after drinking animal dairy.
The motivation for the study was that previous research had shown the DDS-1 probiotics strain to have effects on fermenting sugars that could potentially help with digesting lactose.
To test this hypothesis 126 individuals who claimed to have Lactose Intolerance responded to online ads looking for study participants.
After in-clinic visits, the 126 participants were narrowed down to 38 who definitely had Lactose Intolerance confirmed via a lactose challenge test score. 18 unknowingly took 10 Billion CFU of the DDS-1 strain and 20 took a placebo for 12 weeks with 8 follow-up visits during the experiment to check lactose intolerance symptoms.
During the first 4-weeks of the trial, the placebo group started to notice abdominal cramping after drinking animal dairy whilst the probiotics group had increased flatulence. Both groups had increased overall symptom scores.
The significant difference in benefits came with diarrhea, vomiting, abdominal cramping, and general abdominal symptom scores in the probiotics group versus placebo groups.
Lactobacillus Acidophilus
This next probiotics study dates way back 25+ years in August 1995 and was carried out by Pediatric and Gastroenterology departments in the USA. It tested the effects of Lactobacillus Acidophilus starter cultures used in milk/yogurts on children with Lactose-Maldigestion. It's not clear if the strain was Lactobacillus Acidophilus LA-05 or Lactobacillus Acidophilus NCFM but both may be helpful in different ways.
The 20 children were diagnosed with not having enough of the Lactase digestive enzyme through a hydrogen breath test. The children were given 250ml of cow milk fermented with either 10 Billion CFU L. Acidophilus, 1 Billion CFU L. Lactis, or 20 Billion CFU Streptococcus thermophilus.
The results were pretty clear in that 9 out of 19 children who took the Lactobacillus Acidophilus probiotics milk had a reduction in their digestive symptoms but not with any of the other strains. If you have ever tried Kefir Milk and not experienced any symptoms it may be because of the Lactobacillus Bacteria reduces the lactose content.
Lactobacillus Rhamnosus Rosell-11
This PDF document comes from Lallemand Health Solutions a company from Canada that makes probiotic formulations.
They claimed that the L. Rhamnosus Rosell-11 and L. Helveticus 52 probiotic strains were able to improve the quality of life in Lactose Intolerant patients by improving lactose absorption, bowel movements, and abdominal pain.
They cited the "26- Kocian J. (1994) Further possibilities in the treatment of lactose intolerance-lactobacilli. Prakticky Lekar. 74:212-214" to back up these claims but I couldn't find a copy of this study published online anywhere.
Therefore I cannot share study design details and these claims should be taken with a pinch of salt meaning it's not entirely if Lactobacillus Rhamnosus probiotics can help or not.
Probiotics For Lactose Intolerance Reddit Thread
10 years ago in the r/Fitness subreddit, a Redditor called goshogun shared a personal insight into their experience with probiotics and lactose intolerance.
They shared they are Asian which they thought made them more susceptible to lactose intolerance. They were absolutely right in this assumption with some in-depth research from Ketaki Bapat finding that up to 90% of east Asians have lactose intolerance.
It's thought the reason for this was that the weather conditions did allow dairy farming resulting in their ancestors not developing lactase enzymes responsible for digesting lactose.
Usually, when Goshogun ate ice cream or milk they would experience diarrhea but at the time of posting they had a craving for some dairy and did not experience any digestive symptoms this time round.
The only change this person had made this time round was taking a probiotic supplement around 2-weeks prior and greek yogurt for one year prior.
They had tried Lactaid pills before the probiotics but they did not help and also mentioned that they did not have issues with some types of cheeses probably because the probiotic bacteria during fermentation eliminates the lactose. Parmesan, Swiss & Cheddar are some of the best cheeses for lactose-intolerant people.
Final Thoughts
The studies that we currently have access to in 2023 seem to suggest that Lactobacillus Acidophilus may be able to help in two ways.
The first being that as a starter culture for dairy products it can break down lactose which a lactose-intolerant person can then later eat or drink without issue.
The second way is that having more of the Lactobacillus bacteria in your microbiome may assist in breaking down & metabolize the lactose disaccharide sugar once it enters your gastrointestinal tract.
It is however worth noting that there are no human clinical trials that can back up this claim so nobody can say for certain if probiotics will work or not.