Lactose intolerance is very common, particularly in certain ethnic groups. For example, lactose intolerance may affect 95-100% of Southeast Asians, and 90% of Asian Americans.
What is lactose intolerance?
Technically it is a deficiency of lactase activity. Lactase is the enzyme that breaks down lactose, the sugar found in milk. Lactase is produced in the first part of your small intestine. When you consume a milk product, the milk sugar lactose should meet up with the enzyme lactase. The lactase helps break down the lactose, so it can be absorbed by the body.
There are several types of lactose intolerance…
1. Primary- Usually found in societies where milk and dairy products are not available commercially. Once a child is weaned from mother’s breastmilk, the body loses it’s ability to digest the lactose.
2. Secondary- Caused by another disorder, such as Celiac Disease or other type of small intestinal malabsorption. Many times, once the initiating disease is healed and the malabsorption is corrected, the ability to produce lactase (and thus digest lactose) returns.
3. Congenital- a genetic disorder an infant is born with, usually discovered shortly after birth.
If you have lactose intolerance and you consume lactose, the milk sugar is not properly broken down. So, when it gets to your colon, the bacteria in your colon try to ferment the excess sugar. They are overpowered, which results in the gas and bloating. Then, the intestine senses the concentrated sugar in the colon and sucks in extra water from cells outside to thin out the sugar. This results in the watery diarrhea that occurs with chronic lactose intolerance.
How is it diagnosed?
One way is to have a Hydrogen Breath Test, usually conducted at a Medical University facility, or at a gastroenterologist’s office.
The easiest test is a Lactose Challenge. It’s simple to do. Three or four days of no lactose at all. None. Then, three or four days of maximum lactose (think daily ice cream, cheese, milk, yogurt, etc.) Keep a food journal and note your symptoms on all of the days. Did you feel significantly better with no gas, bloating, or diarrhea on the lactose free days? Did you feel awful on the high lactose days? You may have your answer.
It is not always clear cut for everyone. Remember, lactose intolerance can be a secondary problem if you have a greater undiagnosed problem, such as Celiac Disease, Crohn’s Disease, or Ulcerative Colitis. (I will post discussions on those diseases another day.)
If I do have lactose intolerance, what can be done about it?
You have several options. One option, of course, is to avoid milk products long term. But truthfully, that may not be realistic or practical.
You may need to experiment to determine your particular tolerance level. Many people can consume small amounts of lactose without problems. Such as having a little milk on cereal in the morning. Others are extremely sensitive. They practically look at milk and get diarrhea!
There are lots of lactose free options on the market… like Lactaid milk, soy milk, and rice milk, soy cheese, soy yogurt, etc. Find whatever works best for you, but remember that if you decide to avoid milk products, you will definitely need supplemental Calcium and Vitamin D long term.
Another modified option is to use the Lactaid (or generic brand lactase) enzymes with your food. They merely replace the enzymes your body is lacking. The key is to take them properly, and to take adequate amounts. Many of my patients complain that they don’t work, then I find out they are taking either too few, or at the wrong time. They need to be taken at the beginning, then again the middle of the meal to ensure that the enzymes and food are in the intestine at the same time. If you take them 10 minutes before or after the meal, the food and the
enzymes will not be together in the intestine, and they will not work effectively.
I will also point out that milk products have different quantities of lactose. Often, people can eat yogurt without any problems because the active cultures (bifidus, lactobaccilus, etc.) help digest the lactose within the yogurt. The dairy products causing the most problems tend to be ice cream and milk, while others such as cream, cream cheese, and butter, contain little or no lactose and can be consumed without problems. Also, some people tend to tolerate goat’s milk better than cow’s milk.
Keywords: lactose, lactose intolerance, milk, yogurt, hydrogen breath test