Lactose intolerance

stock photo via Tri County Health Dept.

photo: ThinkStock via Tri County Health Dept.

Lactose intolerance diagnosis

Are you one of the many people who experience bloating and cramps after consuming dairy products? How can you tell whether you have symptoms because you can’t digest lactose, the sugar in milk, a condition called lactose intolerance, or because of other gastrointestinal problems?

Lactose intolerance is very common in adults, and many have some degree of stomach discomfort by age 20.  The most common cause is genetics, while gastrointestinal issues like bowel surgery, infections in the small intestine, intestinal diseases such as celiac sprue and irritable bowel syndrome can cause lactose intolerance as well. Seniors are also at higher risk for lactose intolerance as they age and lose the ability to digest lactose.

A senior recently complained to me of having diarrhea almost everyday. When she told me she drank 4 to 5 cups of coffee a day, I thought it must be the caffeine from the coffee that caused the problem. But later I learned that people who drink several cups of coffee a day are called “professional” coffee drinkers, who are so used to the caffeine that they don’t get diarrhea from it.  It turned out this person’s symptoms were actually caused by the milk in the coffee!

Recently during my dietetic internship, I did a presentation at a senior center on healthy eating.  I also had a section on lactose-free dairy products with sample tasting. It turned out to be a very interactive event, because many of the seniors experienced gassy stomach and cramps after they drank milk and they were not sure why. After the presentation, a lot of them asked me questions about lactose-free dairy products. It made me realize more education is needed in the community to increase their awareness of the condition.

While many people self-diagnose lactose intolerance based on vague symptoms, according to the NIH National Library of Medicine, the following tests should be done for an accurate diagnosis:

  1. Lactose-hydrogen breath test – the preferred method, it tests the amount of hydrogen in the air you breathe out. First, you drink a liquid containing lactose and your breath is checked to measure the hydrogen level. If your body has trouble breaking down and absorbing lactose, the level of hydrogen in your breath will be high.  Normal ranges may vary depending on each individual but less than 12 parts per million is considered normal.
  2. Lactose intolerance blood test – a test that measures the amount of glucose released from lactose in your blood after drinking a lactose solution. Glucose level rises after lactose digestion.  The normal increase is more than 30 mg/dL within 2 hours of drinking the lactose solution.  If you don’t digest the lactose, your glucose level will not rise.

Lactose in foods

Once you know for sure you have lactose-intolerance, depending on your degree of symptoms, the following products should be avoided:

  • Milk; whole, 2%, 1%, fat free
  • Protein supplements made with whey and casein
  • Milkshakes
  • Cheese; although some people can tolerate certain types of more fermented cheese like parmesan
  • Milk chocolate candy
  • Certain Instant coffee with added cream
  • Some birth control pills and supplements like quick-dissolving vitamin D tablets
  • Processed grain and flour foods like waffle, pancake and cookie mixes, some crackers, breads, potato chips, granola bars and cereals
  • Processed meats

Lactose-free dairy products

  • Lactose-free milk, such as store brand ones and Lactaid, or soy, almond and rice milk
  • Lactose-free margarine
  • Yogurts made with soy, almond or coconut milk

Lactose-free milk is produced is by adding the enzyme lactase, which breaks down lactose into glucose and galactose.  When you use lactose-free milk, remember to gently shake the bottle to allow the enzyme to mix with and work on the lactose!

Lactose can be hidden in many products, especially packaged foods. The bottom line is to read the ingredient labels when you shop and avoid the following ingredients:

  • Milk
  • Dry milk powder
  • Cheese
  • Cream
  • Chocolate
  • Whey
  • Casein.

Lactose intolerance is often different from people to people. Sensitivity may vary as some tolerate certain foods but not others. Instead of eliminating all lactose-containing foods, test them first and only avoid those that you need to.

For more information:

–        NIH National Library of Medicine

–        Best Health Canada

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