Dealing with Lactose Intolerance

Q: I started having stomach upset and diarrhea, especially after eating meals. When my doctor suggested I stop drinking milk or eating any dairy products, I did, which completely fixed it. This is puzzling because I've drunk milk all my life without any trouble. What’s going on?

Most dairy products from cows and goats, including milk, ice cream, yogurt, and cheese, contain lactose or milk sugar. We digest lactose in our small intestine with the help of a particular enzyme our body makes called lactase.

Without enough lactase enzyme available, the lactose in dairy products can create gas, triggering abdominal pain, flatulence, and diarrhea.

When we are very young, our bodies make plenty of lactase, but that ability drops off after age 5. With less lactase enzyme available, you may eventually lose the ability to digest lactose. At that point, eating dairy products can trigger stomach distress and diarrhea.

Not everyone loses the ability to make lactase as they mature. Some genetic adaptations occur in specific human populations that live closely with domesticated cows and other milk-producing animals. In those groups, adults who still consume milk products are likely to maintain lactase levels adequate to digest the lactose they get in their diet.

Only 7 to 20% of Caucasian adults are estimated to be lactase deficient. In contrast, nearly 90% of adults in both Native American and some Asian populations have lactase deficiency, 65 to 75% of African-American adults and 50% of adult Hispanics.

Once you develop lactose intolerance, what can you do? Many people with a lactase deficiency can tolerate foods that contain lactose, just as long as they avoid getting too much at any one time. It helps to reduce the serving size of dairy products, space them out throughout the day, or both.

Foods with the highest lactose concentrations include milk, ice cream, ice milk, some commercial yogurts, and cottage cheese. A one-cup serving of cow milk contains between 9-14 grams of lactose, while goat milk is similar at 11-12 grams. A one-half cup serving of cottage cheese contains less than half of that, and other cheeses have much less, with barely 1 gram lactase per serving.

Live-culture yogurt without additives is well tolerated by most lactose deficient people because it naturally contains lactase. Many commercial low-fat yogurts have milk added after the fermentation process and contain more lactose per serving than a glass of milk.

Lactose is used in the pharmaceutical and supplement industry as an inert powder to add volume to medicines and supplements packaged as gelatin capsules. Most capsules contain about 400 mg of lactose, the amount found in 2 teaspoonfuls of milk. Since most lactose-intolerant people can tolerate up to 12 grams of lactose if it’s distributed throughout the day, the amount of lactose in a capsule is unlikely to cause most people problems.

Commercial lactase supplements produced from bacteria or yeast can also help you digest dairy products. Lactase tablets (Lact-Aid®) can be taken at meals. You can also add lactase drops directly to milk or drink milk with lactase already added.

Most groceries now offer lactase-supplemented milk as non-fat, skim, 2% fat, and whole milk. Along with the help of the supplemental lactase enzyme, Lact-Aid® milk has less than one-third the amount of lactose found in standard milk.

If decreasing lactose intake and using supplemental lactase doesn't relieve intestinal distress when eating dairy products, the issue might not be lactose deficiency.

At least two studies have reported finding normal lactase levels in people experiencing severe intestinal upset after drinking milk. The problem could be trouble with digesting other carbohydrates like fructose or sorbitol or possibly a sensitivity to the protein in milk.

Here are 5 Tips on Dealing with Intolerance to Dairy Products:

1. Eat dairy in small amounts spread out over the day.

Minimize your intake of milk. Except for cottage cheese, cheeses have far less lactose than milk or commercial yogurts.

2. Try a lactase supplement.

Last-Aid® is available as tablets and drops. You can take pills at any meal containing dairy products or add drops directly to your milk.

3.  Drink milk with supplemental lactase already added.

Warning: acidophilus milk is not the same as lactase fortified milk Acidophilus milk contains the same amount of lactose as standard milk.Look for “lactase added” on the label.

4. Use dairy substitutes.

Coconut, almond, or cashew milk can be used as non-dairy milk substitutes.

5. Consider goat milk.

If taking lactase doesn’t help, you may be sensitive to the protein in cow-sourced milk. Goat milk is another alternative.

Dr. Louise Achey, Doctor of Pharmacy, is a 42-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog TheMedicationInsider.com.® 2021 Louise Achey