LACTOSE INTOLERANCE

LACTOSE INTOLERANCE, which is the inability to properly digest milk and milk products, can cause symptoms ranging from mild abdominal discomfort to flatulence, bloating, stomachache, and diarrhea. Many people who suffer from these symptoms never learn what’s causing them. I’ve had any number of patients who were surprised to learn that they were lactose intolerant and were delighted when a few simple measures ended their symptoms.

Lactose, the name of the carbohydrate in milk, is digested with the help of an enzyme called lactase. Almost all babies have lactase in their digestive system. Shortly after being weaned, however, many people start producing less and less lactase. Nearly 70 percent of all adults are lactase deficient. Only people of Western European descent tend to maintain high levels of lactase through life. This does not mean that all lactase-deficient people will develop symptoms from drinking one glass of milk or eating a cheese pizza, because the natural bacteria in their intestines will process lactose when the lactase enzyme is missing. It’s only when people consume too much lactose for the natural bacteria to handle (or when antibiotics, which kill the “good” bacteria along with the “bad”, have destroyed the natural bacteria) that they develop gas, cramps, and diarrhea.

Here’s how one of my patients discovered she suffered from lactose intolerance. Because of a dental problem, Mary was on antibiotics for a while, and she noticed that her regular breakfast of oat bran cereal seemed to be causing gas and bloating. Mary is very health-conscious, and she guessed that the antibiotics had killed the natural bacteria in her system so she took acidophilus to replenish the missing organisms. The acidophilus relieved the symptoms, but even after she discontinued the antibiotics her digestion didn’t return to normal. Mary described these symptoms to me and I realized that her problem was being caused by more than just an antibiotic reaction. Suspecting that lactose intolerance played a role in her digestive problems, she gave up all dairy products for a week and her symptoms were completely relieved.

Unfortunately, many people with lactose intolerance don’t realize that is what they have. They feel bloated and uncomfortable, and may have terrible cramps and diarrhea. They may have gone to a succession of doctors and gotten very little help, because the symptoms of lactose intolerance mimic those of irritable bowel or spastic colon. There is a test for lactose intolerance that consists of ingesting a large amount of lactose and then checking the blood to determine how much sugar was absorbed. But the test is not necessary for most people. If you have gas, bloating, or flatulence here’s my simple recommendation: Try giving up all milk products for two weeks. Watch out for hidden sources of milk, such as cream sauces or salad dressings. Unfortunately, lactose is frequently used as a filler in many pharmaceutical preparations, both those available by prescription and over-the-counter. Check the labels for lactose, or, in the case of prescription medication, ask your doctor or pharmacist to rule out the presence of lactose in the drug.

If the symptoms clear up, your problem was probably due to lactose intolerance and you should limit your intake of milk and dairy products. You can experiment with various milk products such as cheese or yogurt to determine your tolerance level and see if some milk and dairy foods can be reintroduced into your diet. Remember, not all foods have the same levels of lactose. Milk, for example, has a lot; cream cheese has a little; ice cream is in the moderate range. Try one food at a time, and wait two or three days to see if the symptoms reappear. If not, go on to the next food, and so on.

Some people with lactase deficiency can drink as much as a glass of milk or its lactose equivalent (9 to 14 g.) without side effects, and most dairy products contain less lactose than a glass of milk. Hard cheese, for instance, contains just 1 g. of lactose for a l l/2-ounce serving, and two tablespoons of sour cream contain 1 g. Yogurt, while high in lactose (5 to 19 g.), is easier to digest than milk, because the bacteria that turn milk into yogurt digest some of the lactose as the milk is fermented and stored, and continue to digest it once it’s in your small intestine. But frozen yogurt doesn’t act the same way, because most of the bacteria are destroyed in the freezing process.

While some people can tolerate certain amounts of lactose, others are unable to tolerate any, and just a little Parmesan cheese sprinkled on pasta will give them gas and bloating. Everybody’s sensitivity is different and you’ll learn by trial and error exactly how much your own body can tolerate. The chart shows how much lactose is in a variety of common foods.

LACTOSE CONTENT OF COMMON DAIRY FOODS

(The amounts shown for lactose vary because ingredients in products can vary, affecting the lactose content.)

PRODUCT                                          LACTOSE IN GRAMS

Whey, dry (1 oz.)…………………………………………….19-21

Milk, acidophilus skim (1 cup)…………………………….11

Yogurt, whole milk (1 cup)………………………………….10-12

Milk, whole (1 cup)……………………………………………9-14

Buttermilk (1 cup)…………………………………………….9-12

Ice Milk (3/4 cup)……………………………………………..8

Yogurt, lowfat (1 cup)………………………………………..5-19

Velveeta cheese (11/2 oz.)…………………………………4

Ice Cream (3/4 cup)………………………………………….3-8

Orange sherbet (3/4 cup)…………………………………..1-2

Half-and-Half, cream, or sour cream (2 Tbs.)…………..1

Most hard cheeses (11.5 oz.)……………………………..1

American cheese, pasteurized processed (1’/2 oz.)….0-6

Ricotta cheese (1/2 cup)……………………………………0-6

Cottage cheese, creamed (1/2 cup)……………………..0-4

Cream cheese (1.5 oz.)……………………………………..0-1

Butter or margarine (1 Tbs.)………………………………..0





Copyright 1991, CSPI. Adapted from Nutrition Action Healthletter (1875 Connecticut Ave., N.W., Suite 300, Washington, D.C. 20009-5728. $20.00 for 10 issues)

While experimenting with your tolerance level, you can try lactose-reduced milk such as Lactaid, or take lactase in capsules along with the milk. Acidophilus capsules, which contain lactic acid bacteria similar to those used for fermenting yogurt, will also relieve the symptoms by supplementing the natural bacteria in your intestines.

If you decide to stay away from all milk products, be sure you are getting enough calcium by eating foods such as sardines, salmon, tofu, broccoli, and kale. In addition, take a calcium supplement each day.

NATURAL PRESCRIPTION FOR LACTOSE INTOLERANCE

• Reduce your consumption of milk and milk products.
• Try yogurt or lactose reduced milk, but avoid acidophilus milk (which is not lactose free).
• Try acidophilus capsules; three capsules daily,
• Try lactase capsules as directed on package.
• If you reduce your milk intake because of lactose intolerance, you should be careful to take calcium supplements. Monitor how much calcium you get from other sources (salmon, sardines, tofu, broccoli) and then take supplements to equal about 1,200 mg. calcium daily.