LACTOSE INTOLERANCE

What is lactose intolerance?  Lactose intolerance is a condition where you cannot properly digest the sugar in milk called LACTOSE because of a deficiency in your digestive tract of a digestive enzyme called LACTASE.  Those with lactose intolerance experience gas, diarrhea or vomiting and mild to severe cramping when consuming milk products. A series of tests can confirm this condition.

Who get’s lactose intolerance?   Interestingly there is a strong genetic component which predisposes people of Eastern European, Northern Indian, and Mediterranean descent, to lactose intolerance. It is particularly common amongst those of African and Asian descent.  This correlates with zones that historically were dairying or non-dairying.  We are all born with sufficient lactase enzymes, but our production slows down in some of us as early as a year old or later. This can occur suddenly or gradually. 

Is lactose only in milk products?  Because lactose helps preserve the taste of foods and is a good carrier of flavor, it is in over 300 prescription medications, in Equal Sweetener tablets, whey proteins, and numerous foods. You will find lactose in many baked products. Dried milk products are up to 80% lactose and are used in many packaged foods.  Note that ‘calcium lactate’ is not lactose.  Be aware that labels saying “no lactose added” only reflect that the company in question did not add lactose to the raw materials they received which may already have lactose in them. 

Should we always avoid dairy if lactose intolerant?  Since we have different degrees of lactase deficiency our personal thresholds differ widely.  In general, the lower the fat contents of a dairy product, the higher the lactose content.  Aging lowers the lactose content in cheeses.  Cheeses such as Blue, Brie, Cheddar, Colby, Gouda, Mozzarella, Muenster, Provolone and Swiss are easier to digest than whey cheeses like Ricotta or Mysost.  Soured milks (yogurt, kumis, kefir and acidophilus milk) are relatively low in lactose because their bacterial cultures make their own lactase enzymes and drop the lactose content by 50-80%. Traditional yogurts are superior to commercial ones. The yogurt must say “active yogurt cultures”, “living yogurt cultures” or “contains active cultures”. If it says “made with active cultures” this is meaningless and does not ensure they were not destroyed during pasteurization and therefore are not available to break down lactose.  Allowing yogurt to sit 30 minutes at room temperature helps since lactase producing bacteria are inactivated by refrigeration. Pine Hedge Farms yogurt is my favorite for both taste and quality. 

Any product containing casein, a milk protein, contains some lactose.  This is usually added to commercial cheeses.  Its content in dairy products itself is very variable, so you may be able to eat some dairy and not others. 

Fast food soft yogurts and frozen yogurts are unreliable in terms of predicting their lactose content.

What alternatives are there to dairy?  There are numerous soy, rice and grain based products available in health food stores as substitutes for milk, ice cream, yogurt, cheese and the like.  Be aware that although these substitutes may be tolerable for those with lactose intolerance, they can be highly processed.  Read the ingredients to make sure they are whole and unsweetened.  Many milk substitutes contain sugar and additives.  The worst are commercial dairy substitutes such as Carnation and Coffee-Mate.  My favorite soy milk is Eden’s unsweetened version.   A wonderful book called “Not Milk… NUT MILKS!” by Candia Lea Cole contains 40 very healthy and original nut milk recipes. 

Lactose supplements.  One can always try lactose pills to enable you to digest the lactose in dairy products.  It is difficult to compare brands but pharmaceutical grade is more reliable.  Take them with food at the start of a meal.  Studies show you get some relief if taking them at the first sign of symptoms.  Lactase drops made of k. lactis enzymes can be added to milk and left for 24 hours.  Try 10-15 drops or experiment. This is cheaper than buying commercially made lactose free milk. 

Can lactose intolerance be cured?  There are mixed studies, some of which suggest that regular small doses of lactose can help control symptoms somewhat whereas avoiding diary all together will mean harsher symptoms when ingested later on.  Nevertheless lactose intolerance is for life.   Your choice is to either experiment with the lesser aggravating dairy products, to use lactase supplements, or to try the many diary alternatives.  

Reference: “Milk is not for Every Body: Living with Lactose Intollerance” by Steve Carper.