Your microbiome and lactose intolerance

The symptoms of lactose intolerance include diarrhea, stomach pain, cramps, bloating and flatulence, all of which result from failure to break down lactose in the small intestine. As undigested lactose moves into the large intestine, water enters to reduce the lactose concentration, producing diarrhea. The lactose is eventually eaten by microorganisms in the large intestine, producing, as byproducts, various gases that cause bloating, cramping and flatulence.

Recent studies have shown that the symptoms of lactose intolerance can be relieved in some people by changing the population of their intestinal microbes, called the microbiome, to encourage lactose-digesting bacteria. Specifically, bacteria, called “lactic acid bacteria,” eat the lactose but produce the byproduct lactic acid instead of gas. While lactic acid has no nutritional value, it does not produce the unpleasant symptoms of lactose intolerance. This adaptation of the intestinal microbiome may be how some ancient pastoral populations with no genetic evidence of lactase persistence tolerated a dairy-rich diet.

Ingesting lactic acid bacteria as a probiotic can alleviate the symptoms of lactose intolerance, but these bacteria may not persist in the colon. A promising new strategy is to “feed” the lactic acid bacteria a complex sugar that they can digest but humans cannot. In initial clinical trials, subjects using this “prebiotic” reported improved lactose tolerance and had a corresponding shift in their intestinal microbiome. Larger clinical trials are in progress.

So there is hope for lactose-intolerant people that real ice cream may be on the menu again.