How should I manage a patient with lactose intolerance who is experiencing significant dietary restrictions?

Management of a patient with lactose intolerance who is experiencing significant dietary restrictions should focus on ensuring adequate nutrition while minimizing symptoms. First, confirm the diagnosis of lactose intolerance through clinical history and, if needed, appropriate testing to exclude other causes such as cow's milk allergy or irritable bowel syndrome ¹,². Once lactose intolerance is established, advise a tailored dietary approach that limits lactose-containing foods but avoids unnecessary broad dietary restrictions to prevent nutritional deficiencies, particularly calcium and vitamin D insufficiency ¹,².

Referral to a dietitian is recommended to provide specialist guidance on maintaining a balanced diet, identifying suitable lactose-free or low-lactose alternatives, and ensuring adequate intake of essential nutrients, including calcium and vitamin D supplementation if dietary intake is insufficient ¹,². The dietitian can also help manage any cultural or personal dietary preferences and prevent over-restriction that may lead to malnutrition ¹,².

Gradual reintroduction of lactose-containing foods may be considered to assess individual tolerance levels, as some patients tolerate small amounts of lactose or lactose in baked or processed forms better than fresh milk products ¹. This approach aligns with the concept of a 'milk ladder' used in cow's milk allergy management, which may be adapted cautiously for lactose intolerance to improve dietary variety and quality of life ¹.

Symptom management strategies include advising patients to consume lactose-containing foods with other foods to slow digestion and reduce symptoms, and considering lactase enzyme supplements if appropriate ² (Montalto et al., 2006). Avoidance of unnecessary exclusion diets without specialist supervision is important, as this can lead to inadequate nutrient intake and persistent symptoms ²,⁴.

Patient education and support are essential, including information on reading food labels, identifying hidden sources of lactose, and strategies for eating out or travelling ¹,³. Regular monitoring of nutritional status and symptom control should be arranged, with re-evaluation of dietary restrictions as needed to avoid long-term complications ¹,².