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Lactose is a type of natural sugar in milk. During digestion, lactose is normally broken down by lactase, an enzyme that is produced in the small intestine. However, some people are deficient in lactase, so they have difficulty digesting lactose, a condition referred to as “lactose intolerance,” or LI. LI can cause a variety of unpleasant symptoms, including abdominal pain, bloating, gas, nausea, and diarrhea, within 30 minutes to two hours after eating lactose-containing foods.
Diagnosing Lactose Intolerance
If you suspect you may have LI, report it to your primary care physician and ask to be tested. The hydrogen breath test for LI is a simple test that can be performed in a doctor’s office. Another test involves drinking a liquid that contains high levels of lactose and then having a blood test that measures the amount of glucose (sugar) in your bloodstream. If test results confirm you are lactose intolerant, you will need to make adjustments in your diet. You may want to consult a registered dietitian, who can help you formulate a dietary plan that will prevent symptoms but ensure that you’re getting all of the essential nutrients you need.
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Some people self-diagnose themselves with LI and avoid all dairy products; however, it’s a good idea to have this confirmed by a doctor, so you aren’t unnecessarily following a diet that may be lacking in important nutrients, such as calcium.
WHAT YOU CAN DO
If you are lactose intolerant:
Keep a food journal in which you write everything you eat and any LI symptoms you experience, so you can pinpoint foods to avoid.
If you eat little or no dairy foods, ask your doctor about whether you need to take calcium supplements.
Have your bone mineral density checked; a diet low in calcium can cause bones to weaken and become fragile.
Degrees of Lactose Intolerance
Lactose-rich foods include milk, cream, ice cream, yogurt, cheese, and butter. In addition, some packaged, prepared foods, such as breads, cookies, snack chips, and salad dressings, may be made with ingredients that contain lactose (see sidebar).
Not everyone with LI experiences the same symptoms or the same degree of severity. People have varying levels of lactase enzyme production, which causes varying levels of LI, and certain foods are better tolerated by some than others. Many people with LI are able to tolerate yogurt, especially Greek yogurt, since it contains about half the lactose of regular yogurt. Some people with LI also tolerate aged cheeses, Parmesan, Asiago, Swiss, cheddar, and gouda. Some people even tolerate ice cream in small quantities.
Eating other foods along with the food that contains lactose also may help minimize symptoms. For example, you may be able to tolerate drinking a small amount of milk with your breakfast cereal or having cheese on a slice of pizza. If you are diagnosed with LI, you can do a trial and error with different types and amounts of dairy foods to determine exactly what you can eat without suffering from symptoms—you may find you can eat more dairy than you think.
If you suffer from lactose intolerance, but you enjoy dairy foods, you can try taking lactase enzymes prior to eating foods that contain lactose. One popular brand name is Lactaid, which is available in tablets and liquid form. These enzymes are available without a prescription and can be found in pharmacies and health food stores. In addition, most supermarkets carry lactose-reduced or lactose-free milk that are in the same area as the regular milk products.
Also, be sure to consume some non-dairy foods that contain calcium, to prevent a calcium deficiency. Foods that contain calcium include sardines, shellfish, canned salmon with bones, leafy greens such as kale, spinach, and collard greens, broccoli, black-eyed peas and other beans and peas, almonds, and sesame seeds. Some beverages, such as plant-based milks and orange juice, are often fortified with calcium.
When reading a product’s ingredient list, look for labels that include milk, butter, cream, dry milk solids, milk by-products, and nonfat dry milk powder. Also be alert for whey and curds, which both contain lactose. And, take a closer look at products labeled “non-dairy” before putting them in your shopping cart: Some “non-dairy” coffee creamers and whipped toppings contain sodium caseinate, a product derived from milk. However, the U.S. Food and Drug Administration classifies sodium caseinate as a non-dairy product, because it is altered so much during processing that it is no longer regarded as a true dairy substance. Also, some whipped toppings contain skim milk and/or cream.