According to the National Institutes of Health (NIH), 65% of the worlds population is moderately lactose intolerant. In the U.S. alone over 30 million people suffer from this frustrating disorder and in many cases (like mine) lactose intolerance goes undiagnosed. The prevalence of lactose intolerance is strongly associated with genetics and ethnicity. For example, most folks of eastern Asian descent are lactose intolerant which will make more sense later on in the post. But think diet! Is dairy a large part of the Asian diet? Hmmm…? So if your tummy gets upset after a glass of milk or a grilled cheese sandwich, you could have an intolerance to lactose. But you don’t necessarily have to say goodbye to dairy all together – understanding lactose intolerance is the basis for living happily with this inconvenient disorder!
Where is lactose found?
Lactose is a carbohydrate made up of two sugar molecules, which is called a disaccharide (di- meaning two). Have you ever looked at the nutrition facts for a gallon of milk and noticed the amount of sugar is much greater than 0? Did you ever think, they really add sugar to milk?! Well, unless you’re buying flavored milk, the answer is no, they do not conventionally add sugar to milk here in the U.S. The sugar content on the label actually accounts for the naturally occurring lactose (remember a form of sugar) in milk. Lactose is found in almost all milks produced by mammals. Most commonly consumed here in the U.S. is cows milk. However, our first real exposure to lactose occurs either from breast milk or baby formula. I will talk about this a bit later on.
From cows milk, other dairy products such as cheese, yogurt, sour cream, ice cream, etc. are produced. However, there are other consumable animal milks us humans can indulge in, all of which have altering lactose levels and diverse chemical compositions. Some of these include: breast milk like I mentioned above, goat, sheep, buffalo, llama, camel, even reindeer milk – who knew?! Although most of us won’t be consuming reindeer or llama milk on a daily basis, goats milk is also fairly common and happens to contain slightly less lactose as opposed to cows milk. Depending on the person, some sufferers from a slight lactose intolerance can actually tolerate goats milk – myself included. I love my goats milk!
What is lactose intolerance?
So what is lactose intolerance and what are the signs of it? To explain the normal digestion of lactose simply, follow along with the figure to the right. Lactose is made up of two sugar molecules (glucose and galactose). In order to yield energy from this lactose molecule it must be broken down via an enzyme called lactase. Lactase will split lactose in half, leaving glucose and galactose to be free to enter glycolysis and create energy – it’s that simple.
However, in lactose intolerance (shown to the right) our bodies either don’t make it’s own lactase enzymes or simply don’t make enough of these enzymes. When this happens, lactose remains in it’s two sugar molecule form and makes it’s way to the large intestine where our gut bacteria live. This undigested lactose makes our gut bacteria very happy as lactose is a form of food for them to ferment! And boy do they love to ferment lactose. How do we know? Well… gas, bloating, and diarrhea let us know when our gut bacteria are having a party that we clearly where not invited to! Of course the symptoms mentioned above ultimately describe lactose intolerance.
You Don’t Have to be Full-Blown Lactose Intolerant
When most people think of lactose intolerance we think of someone consuming one little morsel of cheese and running straight to the restroom. However, this is usually not the case. In fact, most people can tolerate small amounts of lactose and be fine. Yet, if they consume high amounts of lactose at once they have tummy troubles. This is simply described as, slightly lactose intolerant – which is something I myself suffer from. Imagine drinking a gallon of milk in under 5 minutes (which I think is an actual social media challenge), just don’t try it ladies and gentlemen. Of course, there are those who cannot tolerate any lactose otherwise they get severe GI distress. And then there are those who have an allergy to milk products meaning they cannot have ANY milk products at all or they have a systemic allergic reaction – however this involves the protein(s), casein and/or whey, NOT the sugar, lactose. A milk allergy is far more serious, instantaneous, and dangerous as opposed to an intolerance. The point is, everyone is different and you have to become familiar with what your body can tolerate.
Why Are Some People Lactose Intolerant?
All mammals (including humans) consume milk as their first food. Interestingly, intestinal lactase activity is highest during the first 6 months of a normal child’s life. However, after this stage, lactase activity begins to drop off. Why is this? Evolutionarily speaking, it makes sense. After about 4-6 months babies are normally weaned off of milk and begin to rely solely on pureed and/or solids foods to sustain them. This increases the need for other digestive enzymes and decreases the need for the lactase enzyme. Further, if a child continues to follow a diet absent of dairy products, the digestive tract has absolutely no need for the lactase enzyme so it simply stops producing it all together. Why would the body waste energy on producing something it no longer needs? Physiologically, it wouldn’t.
This leads me into the point I mentioned above – genetics and ethnicity playing a strong role in whether or not someone becomes lactose intolerant. In some Asian and African communities the prevalence of lactose intolerant can be 100%! Although this is a shocking statistic, it makes sense. It makes sense because most Asian and African food cultures do not include any dairy and thus overtime these folks lose all their intestinal lactase activity. Again, why would the body produce lactase when there is no lactose coming in to be digested? Overtime, these genetics are passed along from generation to generation thus the high prevalence of lactose intolerance in those populations.
I’ve heard some theories claiming if one introduces a small amount of lactose from a spoonful of milk for example, everyday, eventually the body will begin to produce the lactase enzyme again. However, this has not been proven and I think it could work, however on a person to person basis. It’s something to try if you have the patience and willingness to do so.
I’m Lactose Intolerant – Now What?
If you’re full blown lactose intolerant than you probably know by now. You can purchase lactose free milk such as Lactaid and other lactose free dairy products which are basically dairy products with added lactase enzyme already in them. Fun Fact: lactose free dairy tastes sweeter than regular dairy because that larger sugar molecule, lactose has been converted to glucose and galactose which are smaller sugar molecules and thus register as sweeter to our taste buds! Another consideration is supplemental lactase enzyme which can be purchased online or at most drug, grocery, health, and convenience stores. These enzymes come in tablet, capsule, or chewable form which can be taken before consuming lactose. There are also liquid forms which can be dropped into any lactose containing beverage before consumption. However, some severe sufferers choose to completely avoid dairy out of convenience. This is fine and calcium supplements, dark leafy greens, or other dietary sources of calcium should be consumed on a daily basis.
If you’ve discovered yourself to be like me and can tolerate some lactose, consider yourself lucky. Dairy contains the highest and most absorbable form of dietary calcium – meaning you get more bang for your buck and so do your bones! Plus dairy is a great source of quality protein, meaning it contains all the essential amino acids which are important for building and maintain healthy muscle. So rest assured, there are a lot of options for those who can tolerate small amounts of lactose. Certainly, ruling out all dairy does not have to be your fate! Here are some foods/methods to try with considerations specific to why they may work for you!
- Smaller amounts of lactose
- Like I mentioned above, those who are slightly lactose intolerant may be able to handle small amounts of lactose without issues. Get to know your own body and know what you’re able to handle. This is the basis to living with a lactose intolerance!
- Lactaid or other Lactose Free milks
- Explained above – these milks have lactase enzyme already added to them. However, they do taste a bit sweeter!
- Lactaid Ice Cream or Frozen Yogurt
- Enjoy your favorite sometimes food lactose free, or very low in lactose in regards to the frozen yogurt. Just as yummy without the discomfort!
- Opting to take a Lactase Enzyme before consuming dairy
- I do this fairly regularly if I consume something like ice cream, high amounts of lactose, or a lot of soft cheeses. It comes in very handy and helps me to continue to enjoy all foods 🙂
- Cultured dairy products such as Yogurt, Kefir, and Sour Cream
- The bacteria in these cultured products are somewhat like the bacteria in our gut and use lactose as an energy source! During the culturing process, bacteria utilize lactose from the milk and break it down so our bodies don’t have to! Thank you bacteria!
- Harder Cheeses
- The harder the cheese the lower lactose content. Why? When cheese is made the solid curds made up of casein are separated from the liquid whey. Lactose is soluble in the liquid whey which is normally drained off from the solid curds, thus making cheese. Of course the dryer the cheese the lesser amount of whey left in the final product, which ultimately means less lactose!
- Lactose Free Whey Protein Powder
- Many high quality whey protein powders are lactose free. Be sure to check your labels to make sure they are lactose free before purchasing. Because dairy is also a great source of quality protein (contains all the essential amino acids – important for building and maintaining muscle) whey protein powder is a dairy source you don’t want to miss out on!
- Fortified Nut Milks and Fruit Juices
- These are of course naturally lactose free as they are not derived from animals. However, be sure to read your labels and look for fortified with calcium.
- Other animal milks such as Goat or Sheep
- Like I said above, this does not always work for everyone and varies on a person by person basis. If you can get your hands on some goat or sheep’s milk, give it a go and introduce it slowly to your diet. Usually most health food stores or Coop’s carry goats milk, I’ve even seen commercial goats milk at Walmart!
- Raw Milk
- This may not be everyone’s cup of tea. Further, it entails some health risks such as bacterial contamination. But it does work for some folks who are slightly lactose intolerant. However, it may not work for everyone and it’s something you should try with caution. Although science does not know why some people have less trouble with raw milk as opposed to conventional milk, they believe it has something to do with the commensal bacteria in raw milk that is normally killed off in the pasteurization process. Like I mentioned above, there is a risk for dangerous bacteria to be in raw milk but this normally happens when unsanitary practices are used. It’s best to get raw milk from a reputable vendor who you know is impeccably clean. In some states like CT, raw milk vendors can become certified which entails very strict sanitation regulations – so more often than not these vendors are ones you can definitely trust!
- Contrary to popular belief eggs are NOT considered dairy and do not and have never contained lactose! I put them on the list because so many folks think eggs contain lactose and should be avoided by lactose intolerance sufferers and even those with milk allergies. This is totally false!
- Mayonnaise is not considered dairy and does not contain lactose! Unless it’s buttermilk mayonnaise or something different from your standard ole mayonnaise, mayonnaise is nothing more than an emulsion of egg yolks, vegetable oil, and some type of acid such as vinegar or lemon juice.