Prebiotic Strategies to Manage Lactose Intolerance Symptoms
This review highlights the exciting potential of prebiotics and microbiome-targeted dietary interventions to help the large proportion of people worldwide struggling with lactose intolerance. It provides a helpful synthesis of the current evidence while identifying areas for further research to enable real-world applications of this approach.
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Highlights
- Prebiotics like galactooligosaccharides (GOS) can enhance the growth of beneficial lactose-fermenting gut bacteria such as Bifidobacterium and Lactobacillus in individuals with lactose intolerance. Increasing these bacteria may help reduce symptoms of lactose intolerance. This finding suggests prebiotics could be a useful dietary approach to manage symptoms for the 65-75% of the global population with lactose intolerance.
- Low-level continuous consumption of lactose itself may also act as a prebiotic by promoting the growth of lactose-metabolizing bacteria in the gut. Several studies found lactose supplementation increased fecal β-galactosidase activity and Bifidobacterium levels while reducing breath hydrogen after a lactose challenge, indicating improved lactose digestion. This suggests gradually increasing lactose intake could be another dietary strategy to improve tolerance.
- The proposed mechanism is that GOS and lactose enhance Bifidobacterium and Lactobacillus which ferment lactose efficiently without producing gas. This may reduce symptoms caused by bacterial gas production and osmotic pressure from undigested lactose.
- More research is still needed to fully elucidate the mechanisms and verify the ability of prebiotic approaches to consistently reduce lactose intolerance symptoms. However, the existing evidence points to prebiotics as a promising dietary method to manage this widespread condition affecting most of the global population. Prebiotics may provide an additional tool alongside lactase enzyme supplementation and lactose avoidance/reduction.
Abstract
Lactose intolerance, which affects about 65–75% of the world’s population, is caused by a genetic post-weaning deficiency of lactase, the enzyme required to digest the milk sugar lactose, called lactase non-persistence. Symptoms of lactose intolerance include abdominal pain, bloating and diarrhea. Genetic variations, namely lactase persistence, allow some individuals to metabolize lactose effectively post-weaning, a trait thought to be an evolutionary adaptation to dairy consumption. Although lactase non-persistence cannot be altered by diet, prebiotic strategies, including the consumption of galactooligosaccharides (GOSs) and possibly low levels of lactose itself, may shift the microbiome and mitigate symptoms of lactose consumption. This review discusses the etiology of lactose intolerance and the efficacy of prebiotic approaches like GOSs and low-dose lactose in symptom management.