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Understanding Lactose Intolerance

Jun 16 2021
6 min read
pouring milk into iced coffee

In a world filled with cheese, ice cream and milk, people with lactose intolerance may find themselves frustrated by...

...the dietary limitations of their disorder. Others may not even realize that they have it. Though it affects more than 30 million Americans, lactose intolerance is one of the most misunderstood and misdiagnosed digestive conditions. That’s because it can cause symptoms — like nausea, cramps, bloating, gas and diarrhea — that are also caused by other digestive disorders, such as irritable bowel syndrome and celiac disease.

What is Lactose Intolerance?

Some people are unable to digest lactose, the predominant sugar in milk. This is caused by a shortage of the enzyme lactase in the small intestine per medical experts. Without this enzyme, the body can’t break down lactose into glucose and galactose, sugars that your bloodstream absorbs. The result is that most of the lactose from your food goes unprocessed to your colon, where it interacts with bacteria to cause an array of digestive discomforts. Most symptoms flare up 30 minutes to two hours after you consume foods containing lactose.

Who's at Risk for Lactose Intolerance?

Lactose intolerance is least common in people of northern European descent, but is quite common in Asian-Americans, African-Americans and American Indians. Researchers are investigating why, but suspect that a historically dairy-rich diet may have helped those of northern European descent build up a tolerance over time. Other potential risk factors include damage to the small intestine from surgery, abdominal chemotherapy and diseases such as celiac and Crohn’s.

How Lactose Intolerance is Diagnosed

If you suspect that you’re lactose intolerant, talk to your doctor. After discussing your symptoms, he or she may order a lactose tolerance test. You’ll drink a lactose-rich liquid and, two hours later, give a blood sample so your doctor can measure the amount of glucose in your bloodstream. If your glucose level doesn’t increase, you may not be digesting and absorbing lactose properly.

Some doctors may ask you to take a hydrogen breath test, which — as the name suggests — measures the amount of hydrogen in your exhalations. Doctors measure this because the gas is produced when undigested lactose in the colon is fermented by bacteria. You’ll be asked to avoid laxatives and antibiotics for up to a month leading up to the test, and will need to fast for 12 hours beforehand.

You’ll breathe into a balloon-shaped container to establish a baseline level of hydrogen in your exhalations, and then drink a lactose-spiked liquid. A sample will be taken every 15 minutes during a two-hour period. If your hydrogen level rises too much, you may be lactose intolerant. However, about 20 percent of people who have the disorder don’t exhale excess hydrogen, so this test can miss some cases.

Healthy Living Strategies

While there is no drug or magic bullet that improves the body’s ability to digest dairy, that may not mean that you have to nix it completely if you are lactose intolerant. Use these tips to live well with your condition:

Test your dairy tolerance. Eliminating milk and milk products from your diet and then slowly reintroducing them in small doses can help you determine which foods your body is most sensitive to and how much lactose you can tolerate, says Hensley. It may turn out that you can drink small amounts of milk but ice cream causes problems, for example. Because symptoms and severity vary greatly from person to person, experiment until you learn your limits.

Try cow’s milk alternatives. If you can’t tolerate cow’s milk, try sheep’s milk, goat’s milk, or soy, almond, soy, rice or lactose-free cow’s milk in a bowl of cereal, a mug of coffee or however else you choose. Not all milks taste the same, nor do they all behave similarly when cooked. Check out the website of the brand you select for advice (many have suggestions for use readily available), or ask your vendor.

Choose the right cheese. Lucky for cheese lovers, not all varieties contain high amounts of lactose. Opt for hard cheeses such as Swiss and cheddar, which are low in lactose and therefore less likely to cause stomach troubles.

Buy lactose-free products. Fortunately, food manufacturers are savvy to how widespread lactose intolerance is. A wide variety of milk-based products have had lactose removed or reduced with little change to flavor or texture.

Be a label sleuth. Milk and lactose are sometimes hidden in cereals, baking mixes, processed meats, salad dressings and even non dairy creamers, so check ingredient lists before dropping items in your shopping cart. Lactose can even be present in some medications, so notify your doctors and pharmacist of your intolerance to be safe.

Count your calcium. Calcium is essential for strong bones, so if you cut out dairy altogether, be sure to incorporate other calcium-rich foods into your diet, such as kale, broccoli, sardines and tofu, as well as calcium-fortified products like orange juice and whole wheat bread. Ask your doctor if a calcium supplement is also recommended.

Try over-the-counter aids. If the diet and lifestyle changes above aren’t helping, you may want to try an OTC product (like Lactaid) that contains the enzyme lactase. You’ll take a tablet before a meal or while eating dairy products to help promote digestion and reduce gas, bloating and other symptoms.