Lactose Intolerance

Lactose Intolerance

Making Peace
with the Dairy Family

During your twenties you barely gave milk a second thought. But now that you're over 30, you're making a concerted effort to get enough calcium, and milk is a major part of your plan. So are cheese and yogurt--in their low-fat forms, of course. Finally, they're all becoming a regular part of your daily diet.

Only your body doesn't seem too happy about it.

Drink some milk before bedtime and you get a lot of gas. Have a bowl of ice cream and diarrhea sets in. With dairy foods, sometimes you get bloating, other times an upset stomach.

So what's all the gastrointestinal fuss about?

It's related to lactose, a type of sugar found in milk and milk products. Sometimes the body has a hard time digesting it, a condition doctors refer to as lactose intolerance. The problem affects an estimated 50 million Americans and is most prominent in people of African American, Asian and Indian descent. Researchers don't know how many women are affected.

Milk-Induced Mayhem

Lactose intolerance develops when your body makes insufficient amounts of lactase, the digestive enzyme responsible for breaking down milk sugar into a form the body can easily absorb. Without lactase, the milk sugar remains in the digestive tract, where it attracts water, causing bloating and diarrhea. And when the enzyme is lacking or absent, bacteria in the intestines try to pick up the slack and go to work on the milk sugar in an effort to digest it. Their activity produces gas, and flatulence and cramping result.

Some women are born with lactose intolerance and have to stick to a lactose-free diet for their entire lives. Others develop a temporary form of the condition that appears during gastroenteritis, an inflammation of the stomach and intestines caused by infection or food poisoning, or after surgery. This type generally lasts for several weeks.

And some women develop lactose intolerance as adults, says Daryl Altman, M.D., an allergist and immunologist and director of Allergy Information Services, an allergy consulting service in Lynbrook, New York. Women who have consumed milk for years may develop the problem in their twenties, thirties, forties or fifties. "It's really just part of the aging process," she says. "The enzymes that we used to have in our gut, the lactase enzyme that breaks down milk sugar, just gradually decreases."

How a woman feels when she has lactose intolerance varies from person to person, says Chesley Hines, M.D., a staff physician at the Center for Digestive Diseases at Southern Baptist Hospital and clinical associate professor of medicine at Louisiana State University Medical School, both in New Orleans. Some women lack quite a bit of the enzyme, so very little lactose gets broken down and their symptoms are more severe. Others have a little bit more lactase, so some lactose is digested and their symptoms are milder.

How you feel also depends on how much milk sugar you ingest: While a little might be okay, larger quantities may cause problems, says Dr. Hines.

There are other sources of lactose aside from milk and dairy products. Some medications contain lactose as filler, says Dr. Altman. And it is an ingredient in some other foods, namely breads and salad dressings.

But What about Calcium?

Women don't necessarily have lactose intolerance more than men do. And their symptoms aren't really any different, either. Yet lactose intolerance can pose some special challenges for them.

A particular concern for women is maintaining bone strength. One out of every four women develops osteoporosis, a disease in which the strength of the bone, particularly in the wrists and hips, declines. And each year, an estimated 1.5 million Americans suffer osteoporosis-related fractures.

Milk and milk products are often a primary source of calcium and a major weapon, along with exercise, in the war against osteoporosis. So if you have trouble with milk products, getting the right amount of calcium can become more complicated.

But there are ways you can do it.

That's because the good news about lactose intolerance is that there's a pretty easy, straightforward solution: Replace the enzyme that's missing from the gut. You can do this by drinking Lactaid, a milk product that contains lactase. Or you can replace the lactase your body lacks by taking lactase caplets or adding lactase drops to milk.

Yogurt with live and active cultures--bacteria, that is--can also be substituted for milk. While yogurt does contain lactose, actually more per gram than whole milk does, the bacteria in yogurt release the lactase necessary to break down milk sugar.

You can also turn to nondairy sources of calcium, such as broccoli, kidney beans, tofu with calcium salts and dark green leafy vegetables such as kale, says Rosemarie Bria, Ph.D., director of nutrition at Allerex, a Greenwich, Connecticut, company that advises food companies about adverse reactions to food. Calcium is also found in sesame seeds, sardines, nuts and dried figs, she says.

Finally, an easy way to get calcium is to take calcium carbonate, such as Tums or Mylanta, says Dr. Altman. While ideally food sources are best, it can be difficult to get the recommended 1,000 milligrams or more of calcium that way, so taking calcium carbonate is a quick and simple way to make sure women get the calcium they need, she says.

Pregnant women and nursing moms who have lactose intolerance need to be extra careful about getting adequate calcium, says Dr. Altman. "In order for your body to make milk, it needs calcium," she says. If it can't find it in the bloodstream, it will draw it from your bones, she says. Women can take calcium carbonate or go for calcium supplements. But avoid dolomite-derived calcium substitutes, Dr. Altman says, since they may contain lead.

Know the Difference

Sometimes lactose intolerance is confused with milk allergy, and it's important to distinguish between the two, experts say. While lactose intolerance is a digestive problem, milk allergy, the number one food allergy, involves a change in the immune system. If you're lactose-intolerant, you'll have discomfort, but it's not life-threatening, and you can solve the problem by ingesting lactase. But with milk allergy, it's possible to have a severe, life-threatening reaction called anaphylaxis, in which the throat swells, breathing is blocked, blood pressure drops and the body goes into shock.

Milk allergy may go away, but you have to avoid milk as long as you have it. And if you do stay off milk as long as you have the allergy, it's likely to go away faster.

Regain the Calm

Lactose intolerance can cause a lot of misery for the people who have it, says Dr. Hines. But it is a manageable condition. Here's what you can do for relief.

Test yourself. If your symptoms are limited to gastrointestinal problems, there's a simple test you can give yourself to see if you're lactose-intolerant. Try eliminating milk and dairy products from your diet for one week, says Dr. Hines. If your symptoms go away or decline, it may be lactose intolerance. Try slowly reintroducing dairy products into your diet and see if your symptoms return.

See your doctor. The best way to know for sure whether your discomfort is from lactose intolerance is to see your doctor. She can perform tests, including a lactose intolerance test and a breath hydrogen test. The lactose intolerance test is a blood test that measures your glucose level after a lactose challenge. Doctors often use other tests after this one because it has a low rate of accuracy. The breath hydrogen test measures the amount of hydrogen you expel after ingesting lactose. Hydrogen is produced by the bacteria that try to break down lactose when lactase is missing, so the higher your rate of hydrogen, the more severe your condition.

Drink Lactaid. Once your doctor has diagnosed lactose intolerance, you can replace the milk you usually drink with Lactaid, milk that's been fortified with lactase. It's available in most supermarkets in the dairy case.

Go for yogurt. Yogurt with live and active cultures is generally okay for those with lactose intolerance, says Dr. Altman. Check the label; it should specify "live and active cultures."

Pop some drops or pills. You can also replace missing lactase with enzymes that come in drop, caplet or capsule form. Supermarkets and drugstores carry a variety of brands. You can add the drops to dairy products 24 hours before you plan to consume them. The foods may be slightly sweeter than normal, but the lactose content will be reduced by nearly 100 percent. You can also take lactase as a caplet or capsule before or within 30 minutes of consuming milk products. Generally, two caplets are recommended to tackle the lactose in an eight-ounce glass of whole milk, but follow directions on the label.

Read food labels. If you've got lactose intolerance and it's on the severe side, check the labels of the food and medicine products you use. Some medicines, as well as some breads, cereals and salad dressings, contain lactose, says Dr. Altman.

Get your calcium. If you cut back on dairy products, be sure to turn to other sources for calcium. The National Institutes of Health recommend that premenopausal women get at least 1,000 milligrams of calcium a day, though many doctors recommend increasing that to 1,200 milligrams. Menopausal and postmenopausal women need more--about 1,500 milligrams.

In addition to Lactaid, you can get calcium from a number of possible food sources, says Dr. Bria. Tofu made with calcium salts has about 154 milligrams in four ounces, a cup of broccoli has about 178 milligrams, a half-cup of kidney beans contains about 110 milligrams, and a cup of collard greens has about 350 milligrams, she says. You can also take calcium supplements.