Lactose Intolerance

By Dr. Loretta Lanphier, ND, CN, HHP, CH

“Got milk?” is probably one of the most famous advertising slogans of the past twenty years. We American’s love our milk and dairy products, but many of us “got “ more than just milk. The intestinal discomforts that come along with lactose intolerance are an all too common problem.

What is Lactose Intolerance?

Lactose intolerance refers to the inability to properly digest a type of milk sugar called lactose that is a component of dairy products. Another name for lactose intolerance is “lactase deficiency” because the condition is caused by insufficient levels of an enzyme called lactase that is necessary to break down and absorb lactose.

Intolerance to lactose is not the same as being allergic to it. Allergies involve a reaction of the immune system, and usually require total avoidance of the allergen. Lactose intolerance allows some individuals that suffer from it to consume certain kinds of dairy products in certain amounts. The parameters differ for each person. Not everyone who has abnormally low levels of lactase is technically considered lactose intolerant. Likewise, everyone who has digestive symptoms associated with dairy consumption is not necessarily lactose intolerant. To justify a true diagnosis of lactose intolerance, a person must have the symptoms and test positive for low levels of lactase.

Lactose intolerance is a very common condition. It is thought to affect about 70% of adults worldwide, and lactase is the most common enzyme deficiency in the world. An estimated 30-50 million Americans suffer from lactose intolerance. This malady is found at much higher rates in some nationalities than in others. Up to 90% of Asian Americans have lactase deficiency, and the rate is about 75% for African Americans, Hispanics, Jewish Americans, and Native Americans. The reason for this racial disparity is not well understood. It is known that people of Northern European and certain Mediterranean regions do not generally become lactose intolerant.

What Are the Symptoms of Lactose Intolerance?

If you are lactose intolerant, symptoms will typically appear about 30 minutes to several hours after eating dairy foods. Most often they are fairly mild, but in some folks they can be more significant. You would think that the severity of symptoms would be a result of the degree of lactase deficiency. Actually, there are several factors involved. Some folks seem to inherently digest food at a faster or slower pace. This can definitely affect the intensity and timing of the symptoms. It is also thought that age and ethnicity can impact symptoms as well. The most common signs of lactose intolerance are:

  • Diarrhea is the most universal symptom.  Sugars like lactose that are not fully broken down tend to draw fluid into the intestinal tract and produce watery diarrhea (osmotic diarrhea). If diarrhea is intense, not only can it lead to dehydration, but it can also cause nutrients to be swept out of the colon before they can be fully absorbed, resulting in malnutrition.
  • Nausea
  • Cramps in the abdominal area
  • Bloating
  • Gas
  • Flatulence

Many of these symptoms are the result of undigested lactose being fermented by the bacteria in the colon, causing that “volcanic” feeling in the stomach. Sometimes lactose intolerance can be mistaken for the flu or other intestinal disturbances. The clue for lactose intolerance is, of course, if the unwelcome signs appear in association with eating dairy foods.

There are basically three main types of lactose intolerance: primary, secondary, and congenital.

  • Primary lactose intolerance is the result of the natural decline of the body’s production of lactase after early childhood. As babies, our primary source of nutrition is (hopefully) mother’s breast milk. Therefore, the need for lactase is greater at this stage of life. In fact, about 75% of individuals over the age of five stop producing lactase. Perhaps we are not designed to continue drinking milk after childhood. But even if we were, wouldn’t we need human milk and not cow’s milk? Big Dairy would have us believe we are missing out on one of nature’s greatest nutritional miracles if we don’t get our milk every day, even as adults. But isn’t cow’s milk engineered for baby cows? Besides, the milk most of us drink today is laced with chemicals and other toxins that were never intended to be in milk (or in our bodies). Even the “calcium factor” associated with milk is propaganda. Most of the calcium found in milk cannot be absorbed by our bones because it is not associated with magnesium.  A balanced diet composed of such foods as whole grains, beans, green leafy vegetables, nuts, and seeds will provide plenty of calcium, along with the necessary magnesium without which the body cannot properly absorb calcium.
  • Secondary lactose intolerance is caused by a temporary reduction in the amount of lactase due to a trauma of the small intestine, such as surgery or an injury. It can also happen due to intestinal tract illnesses such as Crohn’s disease, celiac disease, or other inflammatory bowel diseases. Once the cause of the reduced lactase is resolved, the intolerance usually improves in it’s own. The exception to this is chronic illness, which may cause permanent intolerance.
  • Congenital lactose intolerance is a rare inherited condition whereby a newborn is unable to produce sufficient lactase, and therefore cannot tolerate its mother’s breast milk. One of the reasons this is so rare, is that in order for it to be inherited, this genetic abnormality must be passed on by a defective gene in both parents. This type of genetic pattern is called “autosomal recessive,” and the odds of this happening are very minimal. Prematurely born babies (28-32 weeks) often have a problem with lactose intolerance because lactase is not usually produced in the fetus in sufficient quantities until very late in pregnancy.

What Causes Lactose Intolerance?

Enzymes are important substances produced by the body that enable certain chemical reactions to take place. Lactase, the enzyme necessary for the complete digestion of the milk sugar called lactose, is produced by cells in the lining of the small intestine. Lactose is a disaccharide or complex sugar that must be broken down into two simple sugars called glucose and galactose in order for the bloodstream to be able to absorb it, and this process cannot occur without lactase. If insufficient lactase is present, lactose will pass into the colon with only the normal bacteria of the intestinal tract to deal with it. They are not up to the job, so incomplete digestion of the lactose occurs, along with the associated symptoms.

How Can I Know for Sure if I Have Lactose Intolerance?

Symptoms associated with the consumption of dairy foods may tip you off to the possible presence of lactose intolerance.  Before consulting a health care practitioner, you can run a self-test referred to as a “lactose challenge test.” The challenge is to eliminate all lactose- containing foods from your diet for two full weeks. Make sure you don’t forget hidden sources of lactose such as certain foods like canned soups and some cereals. After purging your system of lactose, try eating some ice cream or having a glass of milk. If nothing happens after twelve hours or so, try having another type of dairy food. It should be relatively easy to tell if you are lactose intolerant or not. One advantage to this approach is that you may discover that some dairy foods affect you, whereas others do not. It works sort of like an elimination diet to determine foods you are allergic to. If you are not satisfied with the results, there are several lab tests that can help to confirm the diagnosis:

  • Lactose intolerance test:  This test involves fasting all food the night before and the morning of the test. First you will have some blood drawn. Then you will be given a liquid to drink that has a very high level of lactose, about 50 grams (a glass of milk has about 12 grams). Then in two hours, another blood sample will be taken to compare your blood-sugar levels before and after consuming the beverage. If you are lactose intolerant, your blood sugar will not have risen at all, or very little. This shows that your body was not able to digest and absorb the lactose. You will probably also suffer the usual symptoms several hours later.
  • Hydrogen breath test:  This also involves consuming a small amount of a lactose-rich beverage. Before drinking it, you breath into a bag, then again into another bag after the lactose cocktail. Both breath samples are analyzed in the lab for levels of hydrogen gas and methane gas. If the levels are higher than normal, it means you are not properly digesting lactose. Some of these tests are only designed to test for hydrogen, but make sure the one you are given measures methane too, if at all possible, as this type of test is more accurate and definitive. Do not schedule this test if you are currently taking antibiotics, as this can lead to false readings.
  • Stool acidity test:  This test is especially good for infants and young children. The amounts of lactose given in the lactose intolerance test and hydrogen breath test can be dangerous for them. Undigested lactose ferments in the intestines, and produces acids such as lactic acid and others that can be measured in the stool to determine the probability of lactose intolerance.

What Can I Do to Prevent Lactose Intolerance?

If you choose to, you can eliminate all dairy products from your diet, or only the ones that are offensive to you. We do not need milk or dairy to have a nutritious, balanced diet, and as mentioned above, we do not need the calcium from milk either. However, if you desire to consume milk and dairy, here are few tips to make life easier:

  • Try a good probiotic to build up the “friendly” bacteria in your gut, and improve your digestive process. This is a good idea whether you suffer from lactose intolerance or not.
  • Sip milk in small amounts, drinking it slowly. It is a good idea to drink it at meal times too, and not on an empty stomach.
  • Try different types of dairy foods. For example, hard cheeses like cheddar or Swiss generally have less lactose than soft cheeses.
  • There are many excellent dairy substitutes at your health food store and in many grocery stores. Rice, almond, or oat milk are some of the available choices.

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