We've been hearing quite a bit about allergies and intolerances thanks to recent public enemy number one: gluten. But one intolerance has been on our radars for quite a bit more time, and it might be time to readdress it: lactose intolerance isn't all it seems.
But before delving into myth-busting, it's important to know what we're up against. Mercy gastroenterologist Dr. Matilda Hagan offers up this definition of lactose: "Lactose is a sugar (a disaccharide made up of two simple sugars glucose and galactose)," she says. "Most mammals, and humans specifically, have the enzyme to break down the lactose with the help of the enzyme lactase into the two simple sugars which is then absorbed in the small intestine."
In other words, lactose itself is undigestible, but thanks to this enzyme, it can be broken down and digested, at least for most of us. And that's where intolerances come into play.
1. Lactose Intolerance is a Milk Allergy
Lactose intolerance is not an allergy to milk. The intolerance is caused by a lactase deficiency: when one has not enough lactase enzyme in the body, less lactose can be adequately digested, and the results aren't too pleasant.
"Undigested lactose can cause bloating, pain or cramps, rumblings in your tummy, gas and distension, loose bowels (diarrhoea) and even nausea and vomiting," says Tom Irving, nutritionist and fitness expert for Discount Supplements. "Most people will notice these symptoms within 30mins to 2 hours after eating or drinking foods containing lactose. The majority of these symptoms result from bacteria in your gut unsuccessfully trying to digest the lactose, a by- product of which is the persistent release of gas within the gut."
The deficiency of lactase leading to these problems can be caused by a number of factors, according to our experts. Dr. Hagan says that some people, such as those of African American or Asian descent, are more genetically predisposed to intolerance.
Dr. K. Virdee is a natural men's health and wellness expert who claims that sometimes the culprit is merely time. "Generally, younger people have higher levels of the lactase enzyme and as we age these levels taper off," she says. "This is why many people find that they experience gas, bloating, cramping and diarrhea after eating dairy products as they get older."
Shaistha Zaheeruddin is a registered dietitian, accredited in both U.S. and Canada, and currently practicing as a consulting dietitian and owner of Modest Nutrition, in Toronto. She explains the connection between undigested lactose being present in the colon and these unfortunate side effects.
"Lactose tends to draw water towards itself in the colon, which results in loose stools," she says. "The lactose that is not digested is food for the intestinal bacteria, when the bacteria digests the lactose it produces volatile fatty acids and gases, which result in flatulence. When too much gas is produced in the intestine it triggers cramps in the abdomen."
Not so fun, right? That being said, it's important not to negate the presence of another real problem: a true milk allergy. Milk allergies are not linked to lactose intolerance, or even to lactose at all, but rather to the protein casein, found in milk, cheese and other dairy products. Allergies to casein can be serious and even life threatening; symptoms include hives, swollen lips and throat, or anaphylaxis.
2. People Who Have Lactose Intolerance Can't Eat Any Dairy
Lactose is present in all milk products, and yet many people who cannot drink a glass of milk are fine eating a piece of cheese. Why is that?
According to Dr. Hagan, it has to do with the fact that the lactase enzyme isn't controlled by an on-off switch.
"People can have varying levels of the enzyme," she says. It's not an all or nothing situation.
The second reason has to do with the fact that not all dairy contains the same amount of lactose. "Some people might even be able to tolerate some products but not others," says Dr. Hagan. This includes special Lactaid milks or tablets, which, as Irving explains, have either had lactose removed or lactase added, or, as Zaheeruddin explains, some processed dairy products.
"Most dairy products have some level of lactose," she says, "However, some processing does remove lactose, especially hard aged cheeses can have very low levels of lactose."
"In just a few hours of processing, cheese is 15-20% lower in lactose because the majority of it has been converted to lactic acid and other non-lactose components," says Irving. "According to The American Journal of Clinical Nutrition, ripened cheeses such as Camembert and Limburger is known to only contain around 0.4% lactose, whilst grated parmesan is 2.9%."
Other products, such as yogurt with probiotics, can be tolerated by some sufferers, and Irving explains that the milks of some animals do not contain nearly as much lactose as cow's milk. He cites the California seal lion -- though it's rare you'll see sea lion milk on your grocery store shelf! -- but other milks that have less lactose include goat's milk and sheep's milk.
However, the difference between a little and none can be very important to certain sufferers. "For people with no enzyme they may not be able to tolerate any amount of milk products," says Dr. Hagan.
3. Lactose Intolerance is an Incurable Disorder
We have often assumed that lactose intolerance can be treated by avoiding certain foods, but not cured. After all, if your body is not producing an enzyme, how can you teach it to?
If you expect you may have lactose intolerance, always see your doctor, who can refer you to a dietician. It's important to create a tailored plan to suit your needs. But don't lose hope! You might not have to say goodbye to dairy forever.
Zaheeruddin says that if your body produces even some lactase enzyme, you may be able to overcome the intolerance. "Milk or milk products can be more tolerable when taken with meals," she explains. "By taking small amounts of dairy products everyday you could help train your body to produce more lactase enzyme."
In order to do this, eat small amounts, between 1/4 and 1/2 cup, of foods containing some lactose. These foods include cottage cheese, hard aged cheeses, yogurt with live bacterial cultures, pudding and sour cream. By eating small amounts of these foods you can essentially train your body to overcome the intolerance.
One of the key foods to retain from this list is probiotic yogurt, according to Dr. Virdee. "Some individuals who suffer from lactose intolerance are able to tolerate cheese, ice cream and other dairy containing products with minimal symptoms if they follow the meal with a probiotic capsule," she says. "Others notice a complete resolution of their gastrointestinal symptoms by taking a daily probiotic." Whether in capsule form or from natural sources, probiotics may be the key to overcoming this intolerance once and for all.
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