Lactose intolerance involves the digestive system. Some folks have little or none of the lactase enzyme, which is responsible for the breaking down and digesting the milk sugar lactose. Instead of the lactose sugar breaking down in the stomach and small intestine, the lactose, or milk sugar moves directly into the large intestine, also known as the colon. There, in the colon, the lactose is broken down by bacteria. This can cause a variety of symptoms like: gas, bloating, cramps, nausea, and diarrhea.
On the other hand, a milk allergy involves the immune system of the body. The body reacts to the dairy protein casein as if it is under attack from an invader. It defends itself with rashes, blisters, vomiting, blood in the stool, diarrhea, or even trouble breathing. The most severe forms of a dairy allergy can result in the closing of the throat, called an anaphylactic response, where one cannot take in air. Loss of consciousness can occur in the severe onset of allergic responses.
The mild symptoms of gas, bloating, cramps, nausea, and diarrhea can occur in both intolerances and in allergies to milk products.
Today we are going to focus on lactose intolerance. Lactose intolerance can appear at any age, although most humans have enough lactase enzymes as infants in order to digest their mothers’ breast milk. As we age, our body makes less and less lactase. Some infants cannot produce the lactase enzyme at all, and this may result in bloody stools, severe diarrhea, dehydration, and malnutrition. In these cases, the infant must be fed a completely dairy free formula because they cannot use his or her own mother’s milk as fuel. On a personal note, my mother was diagnosed in her 60s as lactose intolerant. Everybody produces their levels of lactose less and less at varying degrees and speeds throughout life.
When we look at particular cultures and societies around the theme of lactose intolerance, we find that societies dependent upon dairy products have a low incidence of lactose intolerance, but it may still occur. The diseases caused by consuming a lot of dairy products like milk, cream, full fat cheeses, and dairy desserts still persist at higher rates in those areas of the world, most notable the USA, and in Western and Northern Eurpoe. Surprisingly, the highest rate of infant lactose intolerance comes from one of the highest dairy consuming countries in the world. (Any guesses?) Finland.
Besides outgrowing the lactase production as we age, we can also become lactose intolerant with regular use of antibiotics. Antibiotics wipe out the bad bacteria as well as the good bacteria in the intestines. It takes time to grow back the good bacteria and enzyme production may be diminished.
Societies where dairy products are not part of their culture for centuries have the highest rate of lactose intolerance. Highest on the list of lactose intolerance is coming from the East Asian cultures. It is also common in West African countries and their descendants, Jewish populations, and in Middle Eastern heritages.
How do we test for lactose intolerance?
- The most common way to diagnose lactose intolerance is by eliminating all dairy containing foods for two weeks, keeping a strict daily food diary. Then add only one type of dairy product into the diet daily to see if there are symptoms. If there are, eliminate that type of dairy from the diet altogether.
- Another diagnostic tool is a hydrogen breath test administered at the doctor’s office.
- A third test used is giving a blood glucose test before and after consuming a high dose of liquid lactose. If the blood glucose levels do not rise after one hour of consumption, the lactose is not being digested properly. Then one is considered lactose intolerant.
How can we enjoy the flavor and texture of creamy dairy products if lactose intolerant?
- Consume low lactose dairy like live, raw, unpasteurized yogurts, with live cultures in them.
- Enjoy extra aged, extra hard cheeses like unpasteurized raw milk Parmigianino, Asiago, and hard cheddar. These usually do not affect those with lactose intolerance. Fermenting dairy reduces the lactose considerably.
- Consider taking a lactase enzyme supplement before eating dairy.
- Drink lactose free milks.
Ingredient names on product labels can be deceiving. Many foods that are marked as whole foods may actually contain milk in the ingredients list, but one may not recognize it in its scientific term.
Some surprising dairy containing foods:
- Baby Cereals
- Potato Chips/Popcorn
- Tomato Sauce
- Fish Sticks/Chicken Nuggets
- Granola/Breakfast Bars
- All Beef Hot Dogs
How are we to get calcium into our diet if we cannot tolerate lactose? Luckily for us, there are non dairy calcium rich foods which also contain vitamin D, helping our bones to absorb and use calcium for strength and flexibility. If we do not obtain enough calcium in the bones and teeth, they may become weakened and brittle. Our bones are constantly being broken down and rebuilt throughout our lives. The Recommended Dietary Allowance for calcium is about 1000 mg a day in healthy adults. The Recommended Dietary Allowance for vitamin D is 600 international units a day in healthy adults.
Non dairy calcium and vitamin D containing foods:
- Soy products
- Fortified juices and milks (non-dairy)
- Sesame seeds
- Canned cooked fish with soft edible bones, like herring, sardines, mackerel, and salmon
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