Lack of lactase enzyme = Lactose intolerance

Ask Dr. Louise

Q: I have been having stomach upset and diarrhea more and more frequently, especially after eating meals. When my doctor suggested I stop drinking milk or eating any dairy products, my stomach and intestinal problems went away. This is puzzling because I’ve drank milk all my life without any problem. What’s going on?

Most dairy products from cows and goats including milk, ice cream, yogurt and cheese contain lactose, or milk sugar. We digest lactose in our small intestine with the help of a special enzyme our body makes called lactase. Without enough lactase enzyme available, the lactose present in dairy products can create gas, triggering abdominal pain, flatulence and diarrhea.

When we are very young our bodies make plenty of lactase, but that ability drops off after the age of 5. With less and less lactase enzyme available, at some point you may lose the ability to digest lactose and start experiencing stomach distress and diarrhea whenever you eat dairy products.

Not everyone loses the ability to make lactase as they mature. In genetic populations that domesticated cows and other milk-producing animals, adults who still consume milk products are likely to maintain lactase levels adequate to digest the lactose they get in their diet.

Although only 7 to 20% of Caucasian adults are estimated to be lactase deficient, nearly 90% of adults in both Native American and some Asian populations have lactase deficiency, along with 65 to 75% of African-American adults and 50% of adult Hispanics.

Once you develop lactose intolerance, what can you do? Many people with a lactase deficiency can tolerate foods containing lactose as long as they avoid getting too much at any one time. It helps to reduce the serving size of diary products, space them out throughout the day, or both.

Foods with the highest concentrations of lactose include milk, ice cream, ice milk, some commercial yogurts, and cottage cheese.  A one-cup serving of cow milk contains between 9-14 grams of lactose, while goat milk is similar at 11-12 grams. A one-half cup serving of cottage cheese contains less than half of that, and other cheeses contain much less, with barely 1 gram lactase per serving.

Live-culture yogurt without additives is well tolerated by most lactose deficient people because it naturally contains lactase. Many commercial low-fat yogurts have milk added to them after the fermentation process and contain more lactose per serving than a glass of milk.

Lactose is used in the pharmaceutical and supplement industry as an inert powder to add volume to medicines and supplements packaged as gelatin capsules. Most capsules contain about 400 mg of lactose, the amount found in 2 teaspoonfuls of milk. Since most lactose intolerant people can tolerate up to 12 grams of lactose if it’s distributed throughout the day, the amount of lactose in a capsule is unlikely to cause most people problems.

Commercial lactase supplements produced from bacteria or yeast can also help you digest dairy products, including Lact-Aid® tablets to be taken at meals, lactase drops you can add to milk, or milk with lactase already added. Most groceries now offer lactase-supplemented milk in non-fat, skim, 2% and whole milk versions. Along with the help of supplemental lactase enzyme, Lact-Aid® milk has less than one-third the amount of lactose found in standard milk.

If decreasing your lactose intake and taking an enzyme replacement doesn't reduce your intestinal distress after eating dairy products, your issue might not be lactose deficiency. At least two studies have reported finding normal lactase levels in people experiencing severe intestinal upset after drinking milk. The problem could be trouble digesting other types of carbohydrates like fructose or sorbitol, or possibly a sensitivity to the protein in milk.

Here are 5 Tips on Dealing with Intolerance to
Dairy Products:
1. Eat dairy in small amounts spread out over the day.
Minimize your intake of milk. Except for cottage cheese, cheeses have far less lactose than milk or commercial yogurts.
2.Try taking a lactase supplement.
Lact-Aid® is available as drops or tablets. You can take tablets at any meal containing dairy products or add the drops directly to your milk.
3. Drink milk with supplemental lactase already added.
Warning: acidophilus milk is NOT the same as supplemental lactase milk; it doesn't have lactase and contains the same amount of lactose as standard milk.
4.Use a dairy substitute.
Coconut or almond milk can be good non-dairy substitutes for milk.
5.Consider goat milk.
Switching to goat milk may help if you have become sensitive to the protein in cow-sourced milk.

Dr. Louise Achey, Doctor of Pharmacy is a 40-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Your questions and comments are always welcome at www.AskDrLouise.com.  ®2019 Louise Achey

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