Lactose: that devilish, disaccharide sugar found in dairy products that has brought many a meal to an unhappy end.
For many, lactose presents nary an issue, but an estimated 20 percent of folks in the U.S. suffer from lactose intolerance, according to the National Institutes of Health. These people are mostly of European descent but the rate spikes higher among African Americans, Hispanics/Latinos, Native Americans, and Asian Americans.
People with lactose intolerance don’t have enough of the enzyme lactase to successfully break down the milk sugar in their intestines. So instead of cleaving the milk sugar neatly into its component parts glucose and galactose, the lactose moves along the digestive tract, from the stomach to the small and then large intestine.
What Are Some Signs I Might Be Lactose Intolerant?
In the small intestine, lactose has an osmatic effect, drawing in water from the rest of the body. This swells the gut, speeds the passage of intestinal contents to the large intestine, and contributes to the condition’s telltale diarrhea.
In the large intestine, bacteria have a field day on the stuff (remember, they’re basically eating sugar) gobbling up the lactose to produce short-chain carboxylic acids, like lactic acid and formic acid. Other enzymes convert this into hydrogen gas and carbon dioxide, which colonic bacteria can reconfigure to produce methane. End result: copious amounts of gas, painful bloating and a “rumbling tummy” effect.
Fun, right? And, there’s no cure for lactose intolerance. And no one’s entirely safe, either, because our bodies naturally cut the amount of lactase we produce after getting weaned from breast milk. Some people also lose their ability to produce lactase faster than others. In addition, certain stomach bugs can cause secondary lactose intolerance, with precisely the same results.
Dr. Jamie Elson, a board-certified Family Medicine physician in Santa Monica, CA, said most patients do an initial self-diagnosis by avoiding dairy and seeing whether it relieves their symptoms. But they sometimes will come in for medical confirmation.
Marissa Contreras, a dancer and Web producer in Los Angeles, had been struggling with dairy but one day she knew it was no joke. “I was probably in my early thirties when I realized I couldn’t handle things I loved – especially ice cream and cereal – the way I used to,” said Contreras, whose condition was confirmed by her doctor. “I recall one episode in particular in which I ate nearly a pint of ice cream, got terribly sick, and had to call in sick to work the next day. That’s when I finally realized, ‘Yeah, this is real.’”
Do You Even Need Lactose?
So what’s the big deal? Don’t drink milk, right? But for many people, dairy provides up to two-thirds of dietary calcium – critical for bone health, blood clotting, healthy nerve impulses and heart rhythm. So unless they double- or triple-down on dark leafy vegetables (a good source of plant-based calcium) or start taking supplements, they could be at greater risk of osteoporosis.
Whey or casein protein powders aren’t really a solution either. Higher quality supplements filter out most, if not all, of the lactose. But the other nutrients, including calcium, are filtered out as well.
And despite its bad rap, lactose actually has some winning qualities. Lactose promotes the growth of beneficial intestinal bacteria like Bifidobacterium bifidum and Lactobacilli, while inhibiting some types of pathogenic bacteria and endotoxins. Lactose may also increase resistance to intestinal infections among infants and children, and help maintain healthy intestinal flora.
For adults, lactose has a low glycemic index and only about a quarter of the sweetness of sucrose. Diets containing low glycemic foods, which cause a slow and modest rise in blood sugar, have been shown to have health benefits.
Finally, lactose helps with the absorption and retention of minerals like calcium, magnesium, zinc and manganese. These are all needed for healthy growth and development, particularly in children.
While there’s no cure for lactose intolerance, over-the-counter lactase supplements like Lactaid are widely available. But that means popping pills, if you want to enjoy dairy. Also, allergic reactions are reported side effects to Lactaid-like supplements.
Other alternatives include lactose-free dairy products – milk, cheese, ice cream — which have lactase added in the manufacturing process.
“Ten or 15 years ago you really would feel like you couldn’t partake or have the same food experiences as everyone else,” Dr. Elson said. “But today your friend may be drinking a soy latte, too, even if they’re not lactose intolerant.”
No one would ask to be lactose intolerant, but given the treatment and diet options, it doesn’t have to be a showstopper. “It certainly forces me to think before I bite into anything,” Contreras said. “I try to plan ahead by keep lactose pills in my purse, just in case, but mostly I just try to watch what I eat.”