Nothing seems more wholesome than a big glass of fresh, cold milk! And who doesn’t love a frosty ice cream cone or sundae on a hot summer day? Dairy foods, including milk, butter, cheese, yogurt, cottage cheese and ice cream are more than delicious additions to our diet, they are packed with important vitamins and minerals, such as calcium, protein, potassium, vitamin D and other nutrients, so they deliver a real bang for the nutrition buck. But for some 75 percent of the adult population who suffer from lactose intolerance, milk and other dairy products can cause digestive problems that are anything but enjoyable.
What is the primary cause of lactose intolerance? Lactose is the complex, natural sugar found in milk and milk products. When people have difficulty digesting dairy foods, the problem may be a lack of the amino acid lactase needed to digest lactose, resulting in a condition known as lactose intolerance.
Normally, the cells that line the small intestine produce lactase. The lactase enzymes attach to lactose molecules in the food you eat and break them into two simple sugars – glucose and galactose – which can be absorbed into the bloodstream. Without enough of the lactase enzyme, most of the lactose in your food moves unprocessed into the colon, where the normal intestinal bacteria interact with it, and that’s when the trouble begins. Symptoms of lactose intolerance include gas, bloating, nausea, diarrhea and abdominal pain. These symptoms may begin as early as thirty minutes after eating something containing lactose or may take as long as several hours before their onset.
Well-Being talked with Dr. Reed Hogan III, Gastroenterologist at GI Associates and Endoscopy Center, about what can be done to alleviate the symptoms of lactose intolerance and potentially allow patients to slowly add nutrient-rich dairy foods back into their diets. Dr. Hogan focuses on 4 general concepts when treating patients with lactose intolerance: (1) temporary dietary reduction of lactose intake; (2) substitution of alternative food sources to maintain nutritional needs; (3) use of commercially available lactase enzyme substitutes; (4) supplementation of calcium and Vitamin D. “After focusing on these basic principles for approximately one month,” says Dr. Hogan, “I will encourage my patients to slowly re-introduce lactose containing foods into their diets to determine what quantity of lactose intake they can tolerate moving forward.”
How is lactose intolerance treated? As Dr Hogan III mentioned, both dietary changes and medications can help relieve the symptoms of lactose intolerance. One of the easiest ways to avoid the discomfort is by reading labels. Food labels contain information about how much calcium is found in a particular food. Specific ingredients to look for are milk, milk by-products, milk solids, nonfat dry milk powder, whey, curds, caseinate or lactoglobulin. Some of the most obvious foods to avoid are milk and milk products such as ice cream, butter and cheese. However, lactose is also found in hidden sources such as sauces, dried mixes (for cakes, pancakes, biscuits and cookies), candies, processed sandwich meats, bread and other baked goods, processed breakfast cereals, instant potatoes, soups, breakfast drinks, margarine, and salad dressings.
Interestingly, lactose is found in the pill formulations for nearly 20 percent of prescription drugs and 6 percent of over-the-counter drugs. Because of this, many individuals with lactose intolerance will avoid taking medications in the pill form. However, per Dr Hogan III, clinical studies have shown that the small amount of lactose found in some pill forms is unlikely to cause symptoms even in patients with lactose intolerance. If you are on multiple medications and feel symptomatic after ingesting pills, talk to your doctor or pharmacist about which medications may contain problematic amounts of lactose.
Over-the-counter products are available which can supplement your body’s amount of lactase, the enzyme needed to digest lactose. Your primary care physician or gastroenterologist can help you determine which of these products works best for you. Also, keep in mind that avoiding lactose may result in decreased Calcium and Vitamin D levels. It is important to discuss your treatment plan with your doctor to make sure you are getting adequate daily nutrition from non-lactose containing foods / supplements.
What about “lactose-free” milk products?
Lactose-free cow’s milk and other lactose-free dairy products are treated with the enzyme lactase, ensuring that the milk sugars are broken down into simpler sugars. Basically the digestion is taken care of before it hits your lips. Lactose-free cow’s milk is comparable to regular cow’s milk because it is protein-rich and has a similar nutritional profile overall. Alternatives to lactose-free cow’s milk include: soy milk, almond milk, rice milk and cashew milk. While these products provide a choice for people who cannot tolerate lactose or who are allergic to products derived from cow’s milk, most do not deliver the same nutritional value found in dairy products. Ultimately, it is important to read food labels and know what you are eating. If you are not getting enough nutrients to meet your daily needs, then talk with your doctor to determine a plan for supplementing your diet.
While it may seem easy to pinpoint lactose intolerance as the culprit of your pain, it is important to discuss any digestive problems with your primary care doctor or gastroenterologist. There could be underlying conditions that can create more problems if they are ignored. Many intestinal disorders have similar symptoms, so it is important to determine the root cause of your discomfort and not just assume that symptoms are a result of lactose intolerance.
A good first step is to keep of log of what you eat for a week and note how soon after eating your symptoms appear. Then talk to your doctor so he or she can assess the severity of your discomfort and recommend the best course of action for diagnosis and treatment. There are specific lab tests that can help determine if lactose intolerance is present. Also, keep in mind that even if you were not lactose intolerant in the past, intolerance can develop and symptoms can change simply as a normal part of the aging process.
Dr. Reed Hogan III, M.D., Gastroenterologist with GI Associates and Endoscopy Center received his Doctor of Medicine degree from University of Mississippi School of Medicine. He then completed internship, residency and fellowship at Baylor University Medical Center in Dallas, TX. Dr. Hogan is board certified in Internal Medicine and Gastroenterology.