Monday, July 22, 2024

Lactose Intolerance


My stomach gets upset after I eat meals, sometimes with cramping and diarrhea. When I stopped drinking milk and eating dairy products, I got better. I’ve drank milk all my life without any problems. What’s going on?

Dairy products like milk, ice cream, yogurt, and cheese contain lactose or milk sugar. To digest lactose, we need the help of a particular enzyme called lactase. Without the help of lactase in your small intestine, milk sugar will create gas. This triggers abdominal pain, flatulence, and diarrhea.

When we are very young, our bodies make plenty of lactase. The ability to produce lactase starts decreasing after the age of 5. With less and less lactase enzyme available, at some point, you can lose the ability to digest lactose. This results in stomach distress and diarrhea whenever you eat dairy products.

Not everyone loses the ability to make lactase as they mature. In genetic populations with domesticated cows and other milk-producing animals, adults who regularly consume milk products generate enough lactase to digest the lactose they get in their diet.

Interestingly, it's estimated that only 7 to 20% of Caucasian adults are lactase deficient. In comparison, nearly 90% of adults in Native American and some Asian populations have lactase deficiency. Within other genetic groups, lactase deficiency is estimated to affect 65 to 75% of African American adults and 50% of adult Hispanics.

If you suspect you are lactose intolerant, what can you do?

Many people with a lactase deficiency can tolerate foods containing lactose as long as they avoid getting too much at a time. For best results, reduce the serving size of dairy products and space them out throughout the day.

Foods with the highest lactose concentrations include milk, ice cream, flavored commercial yogurts, and cottage cheese. A one-cup serving of cow milk contains between 9-14 grams of lactose. Goat milk has a similar amount of lactose, about 11-12 grams. A one-half cup serving of cottage cheese contains less than half of the lactose in a cup of milk. Other cheeses contain much less lactose, with barely 1 gram per serving.

Live-culture yogurt without additives is well tolerated by most lactose deficient people because it naturally contains lactase. In contrast, many commercial low-fat yogurts contain more lactose per serving than a glass of milk.

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

Commercial lactase enzyme supplements from bacteria or yeast can help you digest dairy products. One popular lactase supplement is Lact-Aid®. It is available as tablets to be taken at meals, drops you can add to milk, and milk with lactase. Most groceries offer lactase-supplemented milk as non-fat, skim, 2%, and whole milk. In addition to the extra lactase enzyme, Lact-Aid® milk has less than one-third of the lactose of standard milk.

Suppose you have decreased your lactose intake and are taking an enzyme replacement but don't notice an improvement in your intestinal distress. This suggests that your issue might not be lactose deficiency after all.

At least two studies have reported finding normal lactase levels in people experiencing severe intestinal upset after drinking milk. Instead of lactase deficiency, you could have trouble digesting other types of carbohydrates like fructose or sorbitol. Another possibility is developing a sensitivity to the protein found in milk. Switching to goat milk or cheeses could help if you react to cow-sourced milk.

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

1. Choose dairy with less lactose.

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

2. Spread your lactose intake over the day.

Avoid more than one serving of dairy at a time.

3Try a lactase supplement.

Lact-Aid® is available as drops or tablets. You can take supplemental lactase at any meal containing dairy products or add the drops directly to your milk.

4. Drink lactase-supplemented milk.

Warning: don't confuse acidophilus milk with lactase-supplemented milk. Acidophilus milk has no added lactase and contains the same amount of lactose as standard milk.

5. Try a dairy substitute.

Plant-based lactose-free milk-like product options include soy, almond, hazelnut, coconut, and other nuts. Dr. Louise Achey, Doctor of Pharmacy, is a 43-year veteran of pharmacology and the 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, Ó2022 Louise Achey

lactose intolerant, Ask Dr. Louise, E32


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