Was It Something I Ate?
Do three scoops of ice cream tantalize you one minute and torture you the next? Does a slice of pizza with extra cheese send you over the moon and then running for the ladies’ room? Would you invite sour cream to dinner more often if it didn’t leave you feeling rather sour? That abdominal pain and bloating, nausea, excessive gas and diarrhea after eating dairy products may indicate a classic case of lactose intolerance, especially if your negative physical reaction is not immediate. “Symptoms appear two to three hours after ingesting lactose-containing products,” explains Dr. Katrina Nguyen, M.D., a pediatric gastroenterologist and assistant professor at Georgia Health Sciences. “Very rarely do people who have lactose intolerance have constipation,” she adds.
Lactose is a sugar found in milk and foods made from it. In the digestive process, the enzyme lactase, which is produced in the small intestine, breaks down lactose so the body can absorb it. Interestingly, most everyone over age 2 has a lactase deficit. “The amount of the enzyme lactase declines as you become less dependent on dairy products for all of your calories,” says Dr. David Curtis, M.D., with Gastroenterology Consultants of Augusta. Dr. Nguyen says, “Lactase deficiency is the most common kind of carbohydrate mal-digestion and mal-absorption.”
Genetically programmed lactase deficiency, which is normal and progressive with age, does not necessarily dictate that a person is or will become lactose intolerant. The presence of symptoms following consumption of lactose-containing foods is the diagnostic indicator. The occurrence and severity of symptoms depend heavily on how much lactose is consumed and how much of the lactase enzyme the small intestine still makes. Even a lactose intolerant individual can usually handle a small amount of milk, yogurt, cheese, etc. because the body continues to produce minimal levels of lactase.
Certain races and ethnic groups are far more likely than others to experience lactose intolerance symptoms. People of northern-European descent have a low incidence of lactose intolerance, about two to15 percent of the population. On the other hand, lactose intolerance affects nearly 50 to 80 percent of Hispanics. An estimated 90 to 100 percent of Asian and American Indian populations and approximately 60 to 80 percent of those of African-American ancestry suffer from lactose intolerance. Infants born before the third trimester of pregnancy are also at greater risk for lactose intolerance since lactase production doesn’t increase until the final weeks of gestation.
Three types of lactase deficiency can cause the disorder. Congenital lactase deficiency presents shortly after birth and is very, very rare. “It’s more likely that symptoms of other things are mimicking lactose intolerance,” cautions Dr. Nguyen. Secondary lactase deficiency results from damage to the lining of the small intestine, preventing proper production of lactase. Chemotherapy, severe diarrhea or illnesses such as celiac disease and Crohn’s disease can injure small intestine tissue. Primary lactase deficiency has an onset in adolescence or adulthood and is the most common of the three. It is marked by the normal, natural decline of lactase. As noted earlier, lactase deficiency does not unavoidably translate to lactose intolerance. Symptoms are the determining factor.
One of the simplest, most cost-effective ways to determine if the bloating, cramps, gas and diarrhea are related to lactose intolerance is to remove lactose-containing foods from the diet. Adults struggling with these symptoms can try this tactic on their own. If symptoms persist in the absence of dairy foods, then other explanations for the patient’s discomfort, such as irritable bowel syndrome, inflammatory bowel disease, celiac disease and Crohn’s disease, should be explored. Seek medical intervention to rule these out. Dr. Nguyen is very clear that when lactose intolerance, or other digestion impairment, is suspected in a child, a doctor’s evaluation should be sought. Vitamin deficiencies and impaired bone growth and development may result from a child’s wholesale avoidance of dairy foods.
The hydrogen breath test is frequently used for clinical medical diagnosis of lactose intolerance. When bacteria in the colon are exposed to unabsorbed food, mainly sugars and carbohydrates, hydrogen is produced. Large amounts of undigested foods reaching the colon result in high levels of hydrogen, which can be detected in a person’s exhalations. Other, more invasive procedures (endoscopy, for example) might also be prescribed to determine the exact nature of a patient’s digestive problem.
In any case, “It’s easily treatable,” says Dr. Curtis, “if [lactose intolerance] is the only thing causing the symptoms.” He points out, nonetheless, that no cure exists. Symptom management is the main approach. A couple of treatment options are available: Either reduce the amount of lactose in the diet or increase the amount of lactase in the small intestine. In some cases, a combination of these strategies works well. To increase lactase in the small intestine, over-the-counter lactase pills or drops are taken whenever lactose-containing foods are eaten and are safe to use with every meal.
Managing lactose intolerance by altering the diet is also highly effective. “[Patients] don’t have to avoid lactose period,” Dr. Nguyen asserts. Most people with lactose intolerance can eat small amounts of dairy, especially if ingested with other foods. What many people don’t know is that lactose hides in foods not readily associated with dairy products, for example hot dogs, lunch meats and sausage. Many other processed foods contain lactose as well, including potato chips, corn chips, salad dressings, soups, margarine, instant potatoes, non-dairy creamers and non-dairy whipped toppings. Lactose is also in breads and baked goods. Read ingredient lists on food labeling and look for the words milk, lactose, whey, curds, milk by-products, dry milk solids or non-fat dry milk powder. These are lactose red flags.
One of the primary issues pertaining to people with lactose intolerance is that when they remove dairy foods from their diets and the symptoms subside, they may decide to permanently eliminate these foods altogether. Dairy foods provide many nutrients for healthy muscles and bones, such as potassium, calcium and vitamin D. Without these in the diet, other health concerns, osteoporosis in particular, can arise. “It’s very important,” advises Dr. Curtis, “to get a supplemental form of the nutrients.”
Alternative dietary sources of calcium include salmon, sardines, tuna and other soft-boned fish, along with leafy greens like broccoli and spinach. Oranges and pinto beans can also replace a portion of the calcium normally supplied by milk. Eggs and sun exposure (about 15 minutes a day) can provide vitamin D necessary for calcium absorption. By reducing consumption of processed foods containing lactose, small amounts of dairy products can be added back to the menu. Hard cheeses, like Swiss and cheddar, along with yogurt with live cultures are great alternatives to drinking milk, which is more difficult to digest.
“The greatest myth is that infants have it,” says Dr. Nguyen. “It is very unlikely that a baby [in the U.S.] is lactose intolerant.” Lactose intolerance is more likely to occur in adulthood, with a higher incidence in older adults. She believes the glut of lactose-free formulas on the market confuses parents and she estimates “a very, very small chance babies would benefit from lactose-free formula.” On the other hand, lactose-free/lactose-reduced milk does benefit lactose intolerant adults. It has the same vitamin D, calcium and potassium content with lactase added to aid digestion.
There’s no cure and no prevention for lactose intolerance. “If it’s going to happen, it’s going to happen,” says Dr. Curtis, matter-of-factly. While it isn’t a life-threatening condition, it can be uncomfortable and embarrassing. Fortunately, especially for people in the high risk groups, symptoms are manageable.