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.

Dietary advice should include a tailored reduction of lactose-containing foods rather than complete elimination, as many patients tolerate small amounts of lactose without symptoms. Lactose-free or lactose-reduced dairy products and suitable calcium and vitamin D supplementation should be recommended to prevent nutritional deficiencies ¹[(Montalto et al., 2006)].

Referral to a dietitian is essential to provide individualized dietary guidance, prevent unnecessary broad dietary restrictions, and ensure balanced nutrition, especially if the patient has other dietary limitations or cultural considerations ¹,². The dietitian can also advise on suitable lactose-free alternatives and monitor growth or nutritional status if relevant.

Consider gradual reintroduction of lactose-containing foods to assess tolerance levels, as some patients may tolerate baked or processed dairy products better due to reduced lactose content, similar to the milk ladder approach used in cow's milk allergy management ¹.

Symptom management may include the use of oral lactase enzyme supplements before lactose ingestion, although evidence varies, and this should be discussed with the patient (Perino et al., 2009).

Monitor for and address any psychological or social impacts of dietary restrictions, providing support and education to reduce anxiety related to food avoidance ¹.

Overall, the approach balances symptom control with maintaining nutritional adequacy and quality of life, avoiding overly restrictive diets that can lead to malnutrition or unnecessary food avoidance ¹,²[(Montalto et al., 2006); (Perino et al., 2009)].