Valley Health Magazine

By Lisa Smith

The National Institutes of Health defines lactose intolerance as the body’s inability or insufficient ability to digest lactose, a sugar found in milk and milk products. It is estimated that 70 percent of the world’s population suffers from some degree of lactose intolerance.

This statistic may seem contradictory to the dairy-focused culture in the United States where more than 1,000 dairy products are introduced each year and the “Got Milk?” campaign has been named the most culturally influential tagline since the advent of broadcast television. But, lactose intolerant people cannot enjoy dairy products without experiencing some degree of intestinal distress. Lactase, the enzyme usually present in the inner lining of the small intestine that breaks down the lactose in dairy products, is lacking in these numerous individuals.

Our genetic makeup (among other factors) decides our tolerance for dairy products. Ethnicity plays a major role as African American, Native American, Mexican American, and Asian Americans have a higher rate of lactose intolerance than individuals of European descent. Age also plays a role because as we get older, the likelihood of developing intolerance to lactose increases. After age two, the body begins to produce less lactase, meaning the condition may develop any time  between childhood and old age. For this reason, some children may be deemed lactose intolerant from virtually the time they begin consuming solid foods; while other sufferers will suddenly struggle with identifying the cause of stomach upset during adulthood and beyond.

Classic symptoms of lactose intolerance include bloating, abdominal pain, diarrhea, nausea, and gas. It is also worth stating that milk allergies differ from lactose intolerance. A food allergy is an abnormal response to a food triggered by the body’s immune system. People with milk allergies experience an immune reaction to the proteins contained in cow’s milk. These symptoms include skin reactions such as hives and rashes, or respiratory problems such as wheezing. Treatment for allergic reactions often requires medical attention. On the other hand, food intolerances affect the GI tract and are an adverse reaction to certain foods or ingredients that occur every time the food is eaten, particularly if larger quantities are consumed. Although uncomfortable, intolerances are less threatening than allergies and are treated by avoiding the trigger food, i.e. dairy products.

There are different types of lactose intolerance, determined by how and when the problem was first identified. Congenital/Primary intolerance is a rare distinction and is present at birth. Secondary refers to intolerance that results from damage to the intestine or as a consequence of a gastrointestinal disease such as celiac disease. Intermediately, lactase “non persistence” is the term used for a decline noted in the lactase enzyme.

While it may seem like common sense (and a frustrating burden) for sufferers to simply avoid cheese, milk and dulce de leche, there are legitimate potential dangers associated with lactose intolerance. However, eating smart and staying educated can mitigate these. As we know, dairy products qualify as most people’s primary source of calcium. Calcium is a mineral necessary to both the earth and our bodies. Interestingly, it makes up both 3.5 percent of the earth’s crust as well as two percent of our entire body weight.

Fortunately, in addition to the list at the right, calcium today is often added to foods that don’t naturally contain it. This means the products are fortified. Fortified means that vitamins or minerals have been added to the food in addition to the levels originally found before refinement. Some common fortified foods include bread,  cereal, and orange juice. All food labels are required to list calcium content so if you are concerned with your daily calcium intake, this should be the first thing you check. If you are still unsure if you are meeting your daily calcium requirement, check out a free quiz by The Dairy Council of California at www.mealsmatter.org that evaluates your food sources and intake.

It is equally important to know the role calcium plays in relation to vitamin D. As stated earlier, it’s great to know the RDI for your age group, but you must also consider that only 500mg of calcium can be absorbed at any given time. Vitamin D is an essential partner to make this absorption happen. When vitamin D is lacking, the body cannot make the hormone calcitriol, which is the active form of vitamin D. Without calcitriol, calcium is not absorbed from your food sources. This forces the body to draw out stored calcium from the bones, which over time may lead to weakened bones and osteoporosis.

According to the National Institutes of Health, there are three ways to obtain vitamin D: through the skin, diet, and supplements. Fifteen minutes of bare skin in the sun (without sunscreen) a few days a week is enough exposure to allow the body to make and store all the vitamin D it needs. Remember, as winter months approach, this method of getting vitamin D may  become more difficult. This is when it  becomes increasingly important to obtain vitamin D through food. Egg yolks, saltwater fish, liver, and fortified milk are all good sources.

Additionally, it may still be possible  to consume calcium while still enjoying dairy products. For people that are lactose intolerant, giving up dairy products may be an excruciating battle. Consider these ways to still enjoy your favorite foods while getting the calcium without the discomfort:

- Take a lactase supplement before consuming dairy products. This will provide the missing lactase enzyme for you to  digest dairy.

-  Shop for lactose-free products at the grocery store. Lactaid brand items include milk, cottage cheese, ice cream, coffee creamer, and even egg nogg. Other brands include Green Valley Organics, which has products such as lactose-free yogurt and kefir (a pro-biotic beverage similar to yogurt). Generic store brand products are widely available and may be cheaper, as well.

-  Visit www.lactaid.com for recipes using lactose free products.

- Search for food labels that are titled vegan, such as cheese and margarine.

- Dining out is something many of us  enjoy and can be a major component of our social life. It might also be the final frontier in fighting lactose intolerance. While supermarkets and food products have caught on to the growing market of people identified as lactose intolerance, it’s unlikely that your favorite French or Italian restaurant will stop using heavy cream or cheese any time soon. Consider these tips while dining out recommended by www.godairyfree.org:

• Ask questions about what ingredients are in the dishes. Think about items such as butter. Make sure that it’s not added to vegetables or meats and if so, request vegetable oil. This option will provide fats that are heart healthier as well.

• Choose tomato and olive oil based sauces instead of cream sauces. This option will save you a load of saturated fat and the tomatoes will provide an extra serving of vegetables.

• Instead of ordering the potato with sour cream, butter and cheese, choose the roasted or steamed potatoes. If you still need more flavor, try topping with salsa, salt and pepper.

• Restaurant desserts are usually ladened with heavy cream and butter. See if they serve sorbet as an alternative.

• Go Ethnic. Thai, Chinese, Vietnamese, and Japanese cuisine don’t often contain dairy products.

Having a perfect bill of health is a goal for everyone, and there’s no reason why being lactose intolerant should pose an additional obstacle. There is a great variety of non-dairy sources of calcium to keep your bones strong and body at optimum functioning. There are also lactase supplements and lactose-free milk products for those who choose not to give up dairy. These contain the necessary enzyme to break down dairy products in your digestive system. By choosing this route, your body is still adequately absorbing calcium in the foods you are eating. Also, keep enjoying your favorite restaurants, but be sure to ask questions regarding ingredients and preparation method. By asking if they have any dairy-free dishes to recommend you may discover a fantastic new meal. And, you may start pushing them  to provide alternative choices. Because lactose intolerance is so prevalent, there are plenty of dairy-free cookbooks on the market as well. Choose recipes with ingredients containing non-dairy sources of calcium and you will not only be enjoying a delicious home-cooked meal but can feel good knowing that you are promoting your own health

About the Author: Lisa Smith is a Fresno State Dietetic Intern with a degree in  Nutrition and Food Science from Chico State. She has always had a passion for health and working at the Center for  Nutrition and Activity Promotion as an undergraduate sparked her interest in dietetics. This article was written under the guidance of Tina Slenders, R.D. and the Madera Community Hospital Clinical Dietitians.