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.