I’m not alone. An estimated 30 to 50 million Americans are lactose intolerant, including up to 80 percent of African Americans, 80 to 100 percent of American Indians, and 90 to 100 percent of Asian Americans. A study published in the journal Alimentary Pharmacology and Therapeutics found that lactose sensitivity occurs in about 70 percent of IBD patients.
What is lactose intolerance?
Lactose intolerance or sensitivity occurs when the small intestine doesn’t produce enough lactase, the enzyme needed to digest lactose, the sugar found in milk. Lactase breaks down lactose into glucose and galactose so that they can be absorbed through the intestinal lining into the bloodstream.
Without lactase, the unprocessed lactose moves from the small intestine into the colon. It then interacts with the gut bacteria in the colon. This interaction causes symptoms of diarrhea, abdominal cramps, bloating, gas, nausea, or vomiting about 30 minutes to two hours after consumption of dairy products with lactose.
Types of lactose intolerance
The Mayo Clinic classifies lactose intolerance, also known as lactase deficiency, into three categories: primary, secondary, and congenital or developmental.
Primary lactose intolerance is genetic. It occurs mostly in people of African, Asian, Native American, Hispanic, Mediterranean, and Southern European descent. Most people have a gradual decrease in lactase production as they age. However, in people with primary lactose intolerance, lactase production reduces suddenly.
Secondary lactose intolerance happens when lactase production decreases after surgery or injury to the small intestine. Illness, including Crohn’s disease, can cause this type of lactase deficiency. Once the small intestine heals or the disease is treated, lactase production may resume at increased levels.
Congenital lactose intolerance occurs when a baby is born with absolutely no lactase productivity. With this type of genetic lactase deficiency, both the mother and father pass a recessive gene to the baby. Premature babies may suffer from developmental lactose intolerance.
Although I’ve told my gastroenterologist about my lactose sensitivity, he has never ordered tests to confirm a diagnosis. Because I was able to tolerate dairy products as a child, I’m assuming I have either primary lactose intolerance because of my ethnic background or secondary because of Crohn’s.
Diagnosing lactose intolerance
Doctors can diagnose lactose intolerance through a blood test, breath test, or stool test. With the blood test, the patient drinks a lactose-laden liquid and then provides a blood sample. If the patient’s glucose level remains stable, the body isn’t absorbing the lactose, indicating intolerance.
The patient also consumes a lactose-based liquid with the breath test. The doctor then measures the hydrogen level in the patient’s breath at regular intervals. If the patient is unable to digest lactose, the sugar will produce hydrogen and other gases as it ferments in the colon.
The doctor can also determine lactose intolerance by testing the acidity of a stool sample. Undigested lactose produces lactic acid and other acids that are passed through the digestive tract.
Managing my diet
I manage my lactose insensitivity by avoiding large amounts of dairy products and drinking lactose-free milk. Through trial and error, I’ve discovered that yogurt, cottage cheese, and most other cheeses don’t bother me as much as ice cream, regular milk, and cream-based foods.
When my Crohn’s was severe, I would take over-the-counter lactase medication before consuming any dairy. I’ve been able to tolerate dairy better since I’ve been in remission. However, every so often, when I indulge in too much dairy, I experience gas, abdominal bloating, and diarrhea. I discovered this when a gelato shop opened a couple of blocks from my house, and I would stop by when they changed flavors every few weeks!
Being lactose intolerant doesn’t mean my nutrition has to suffer. In addition to drinking lactose-free milk, I consume calcium-rich foods, such as broccoli, collard greens, and beans. The Dairy Alliance also suggests that drinking chocolate milk is easier to digest than plain white milk.
A lactose-free diet doesn’t need to be boring. The Dairy Alliance website has enough lactose-free recipes to make a different dairy-free meal or treat for every day of Lactose Intolerance Awareness Month.
During the 1980s, I believed the commercials that claimed, “Milk. It does a body good.” Now that I’m older and wiser and lactose intolerant, I know that’s not true.
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