must be exercised in interpreting reported symptoms and making the diagnosis of lactose intolerance. There can be considerable crossover between individuals who self-identify as intolerant to lactose and are not diagnosed as lactose intolerant versus those in whom the diagnosis was carefully established. More attention to identifying and categorizing symptoms better may help. A Finnish study noted flatulence as the most severe symptom in maldige-sters, whereas abdominal bloating was most frequently reported by individuals self-identifying as lactose digesters. Moreover, microbiota may play a role in the presence and intensity of lactose-related symptoms. Data suggest that increased levels of colonic bacteria, as well as their diversity, may play a role as a result of increased fermentative capacity in reducing the symptoms associated with lactose intolerance.

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