WHAT EXACTLY IS LACTOSE INTOLERANCE?
Lactose intolerance is a digestive disorder caused by the inability to digest lactose, the natural “sugar” in milk and milk products like cheese and ice cream. Lactose intolerance is sometimes called lactose malabsorption; it is not the same as being allergic to milk which is an immune system disorder (body reacting to one or more proteins in milk).
Lactose is a disaccharide, which means it has two sugar molecules, glucose and galactose. People who are lactose intolerant don’t make enough of the enzyme lactase in their small intestines which is needed to digest (breakdown) the lactose into glucose and galactose so they can be absorbed into the bloodstream and used for energy.
WHAT ARE SOME OF THE SYMPTOMS OF LACTOSE INTOLERANCE?
Symptoms usually begin about 30 minutes to two hours after eating foods that contain lactose. People may experience bloating, diarrhea, gas, abdominal cramps and sometimes nausea or vomiting because the lactose is moving through the digestive tract undigested and water moves into the digestive tract. When the undigested lactose reaches the colon, the lactose is fermented by bacteria in the gut leading to gas and can cause bloating, gas, and pain.
HOW PREVALENT IS LACTOSE INTOLERANCE?
About 68% of the world’s population is lactose intolerant. It’s estimated that in the United States 30 – 50 million people are lactose intolerant. Lactose intolerance usually appears in adults and increases with age. Lactose intolerance is most common in people from Asian, African, Hispanic, and American Indian descent.
WHY DO BLACK PEOPLE SEEM TO SUFFER FROM IT DISPROPORTIONATELY? IS THAT A MYTH?
Lactose intolerance in adulthood is actually most prevalent in people of East Asian descent; it affects up to more than 90 percent of adults in this group. But people of African descent do experience more lactose intolerance in comparison to other populations like people from Northern European descent.
Why some groups experience more lactose intolerance than others comes down to genes. Lactose intolerance in adults occurs because of decreasing activity or expression of the LCT gene (the gene that provides instructions on making the lactase enzyme). The decreased activity or expression of the gene leads to reduced ability to digest lactose as you get older.
WHAT FOODS CONTAIN LACTOSE?
Dairy products or products made from milk including cow’s milk, goat’s milk, cheese, ice cream, yogurt, butter. Foods that may contain lactose include foods made with sauces from milk, biscuits, processed meats, cookies, breads, baked goods, cakes, breakfast cereals, soups, sauces, desserts and custards . There are also other names for dairy that may be on labels such as: whey, whey protein, milk casein, curds, milk sugar, buttermilk, cheese, malted milk, dry milk solids, sour cream whey protein concentrate.
IT’S HOT! WHAT ARE SOME DAIRY OR LACTOSE FREE OPTIONS FOR ICE CREAM!
There are a lot of options out there. There’s lactose free ice cream; soymilk ice cream; ice cream made with lactose treated milk; rice milk ice cream; and tofu and soy protein ice cream. Generally, look for ice cream made with alternative milks like almond, coconut, hemp, rice, or soy. Finally, you can also try goat’s milk – goat’s milk does contain lactose but many people who are lactose intolerant can tolerate goat’s milk.
AS CHILDREN, MOST OF US DRINK MILK. WHAT HAPPENS AS WE GET OLDER THAT CAUSES A PROBLEM?
Lactose intolerance in adults occurs because of decreasing activity or expression of the LCT gene (the gene that provides instructions on making the lactase enzyme). The decreased activity or expression of the gene leads to reduced ability to digest lactose as you get older.
WHAT ARE GOOD NON-DAIRY SOURCES OF CALCIUM?
Non-dairy sources of lactose include: calcium fortified foods (juices, non-dairy milks); canned fish with soft bones; plant foods/leafy greens like cooked collard greens; kale and broccoli (watch out for oxalates which bind to calcium and makes it unavailable); seeds (chia seeds); beans and lentils; almonds; rhubarb (watch out for oxalates); amaranth; edamame; tofu; and figs.
HOW IS LACTOSE INTOLERANCE DIAGNOSED?
The test that is usually done in adults is called the hydrogen breath test. It takes about 2 hours. The hydrogen breath test measures the amount of hydrogen in your breath after you drink a liquid that has high amounts of lactose. If you have lactose intolerance, you’ll have high levels of hydrogen in your breath and that will be detected.
HOW CAN YOU TREAT LACTOSE INTOLERANCE?
You can limit lactose containing foods. Avoid consuming lactose containing foods on an empty stomach; consumption with other foods may lessen the symptoms because the digestive process is slowed down. Lactase enzyme supplements – drops you add to drinks or tablets that you chew, or swallow may also help. Exposing your body to small amounts of lactose on a regular basis may help your body to adjust to lactose over time.
Finally, probiotics may help with lactose intolerance; Probiotics are live bacteria or yeasts that supplement the gastrointestinal tract. Probiotic bacteria in fermented and unfermented milk products seem to lessen the clinical symptoms of lactose intolerance but more research is needed. One of the most beneficial probiotics is believed to be Bifidobacteria, usually found in probiotic yogurts and some supplements.
HOW DO YOU KNOW WHEN TO SEEK TREATMENT?
Seek treatment if you frequently have symptoms of lactose intolerance after eating foods with dairy and especially if you’re concerned about getting enough calcium in your diet.
WHAT IS THE BEST OVER THE COUNTER MEDICATION YOU CAN TAKE FOR LACTOSE INTOLERANCE?
Over-the-counter tablets or drops containing the lactase enzyme may help you better digest lactose. You take the tablets just before eating lactose containing foods. The drops can be added to milk or something milk-based. Lactase enzymes offer help to some but not to everyone with lactose intolerance.
CAN THE SYMPTOMS GET WORSE WITH AGE?
Yes, the symptoms can get worse with age. Lactose intolerance in adults occurs because of decreasing activity or expression of the LCT gene (the gene that provides instructions on making the lactase enzyme). The decreased activity or expression of the gene leads to reduced ability to digest lactose as you get older.
CAN LACTOSE INTOLERANCE BE MISDIAGNOSED?
It’s possible. Irritable bowel syndrome (IBS) and lactose intolerance symptoms can be similar: bloating or swelling in your stomach, pain, diarrhea, and gas. However, the two are different in why they happen and how they are treated.
The cause of IBS is not clear, but some doctors believe that it occurs when the muscles in your colon aren’t working properly. Lactose intolerance happens when your small intestine doesn’t produce enough lactase. It’s best to see your doctor so he/she can determine what the cause of your symptoms are by getting some more history from you, doing a physical exam and conducting tests.
WHAT QUESTIONS AND TESTS SHOULD A PERSON ASK THEIR DOCTOR IF THEY BELIEVE THEY’RE SUFFERING FROM LACTOSE INTOLERANCE?
You should discuss symptoms that you’re experiencing after eating foods with milk or dairy and ask about a hydrogen breath test. Symptoms that can occur about 30 minutes to 2 hours after eating foods with milk or dairy can include an upset stomach, bloating, gas, diarrhea, and sometimes vomiting. You may also want to keep a journal of your intake and symptoms to share with your doctor. Lactose intolerance is just one of other diagnosis that could be causing your symptoms.
Dr. Porter answers your “Text Tom” questions on the next page.
My question for the doctor is what type of protein shake can I take to gain weight being that I am lactose intolerant?
You’ll want to use protein shakes that are lactose free like vegan protein, egg white, beef protein isolate or whey protein isolate. Whey protein can be separated from casein in milk to form a whey protein isolate that is lactose free. Lactase enzymes may also help if you choose to use regular milk. You could also make protein shakes with alternative milks.
Do you recommend using over the counter products like Lactaid?
Yes, they can help with lactose intolerance symptoms. You can use the drops or the tablets. Lactase enzymes offer help to some people but not to everyone with lactose intolerance. You may also notice that if you consume larger amounts of lactose, lactase enzymes may not be as effective.
Dr. Lori – what about kefir for someone who’s lactose intolerant.
Yes, kefir is an option and can help with getting calcium in your diet. Like yogurt, kefir may be tolerable for people with lactose intolerance because it has lots of good bacteria which help with digesting lactose.
I’m lactose intolerant does that mean all my children will develop it? My son is 36 years old and has it. My daughters are 9 & 6 years old. Will they possibly develop it?
Yes, it is possible they will develop lactose intolerance as they grow into adulthood. The ability to digest lactose as adults depends on the genes they’ve inherited from their parents. Some people may inherit a gene variation that allows their bodies to continue to produce lactose into adulthood while others do not. As to whether your daughters have the genes that would allow them to continue to digest lactose as adults could be confirmed through genetic testing.
It seems that there are occasions when dairy is cooked, I don’t have any issues. Such as when I made oatmeal with egg nog & it didn’t bother me. Does cooking make a difference?
Cooking does not affect lactose. The lactose still needs to be broken down by lactase from your small intestine to glucose and galactose (simple sugar molecules) in order for your body to digest them. You may experience less symptoms because of the amount of lactose you’re consuming (most people who are lactose intolerant can tolerate small amounts of lactose without noticeable symptoms) or because you’re consuming it as part of a mixed meal which helps to slow down the digestive process.
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Dr. Lori Porter is a Registered Dietitian Nutritionist (RDN) and a Registered Yoga Teacher (RYT). She received her B.S. in Dietetics from Michigan State University and completed her Dietetic Internship at Indiana University – Purdue University Indianapolis.
She is the owner of Rhythm of Life Nutrition and Yoga which focuses on helping mid-life women manage menopause weight gain and related health issues through nutrition, yoga and active living. Lori has an EdD in Organizational Leadership from Northcentral University and is currently the Director of Interprofessional Education and Practice at Ball State University’s College of Health.
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