Lactose Intolerance A Matter of Degree

Do you like milk but think that milk doesn't like you? Then you may be lactose-intolerant—and not allergic to milk. The good news is: A serving of milk may be "friendlier" than you think!

Lactose is a natural sugar in milk and milk products. During digestion, an intestinal enzyme called lactase breaks down lactose into smaller, more easily digested sugars. People with lactose intolerance produce too little lactase to adequately digest the amount of lactose in foods and beverages containing milk. Left undigested, lactose is fermented by "healthy" bacteria in the intestinal tract. This fermentation produces uncomfortable symptoms—for example, nausea, cramping, bloating, abdominal pain, gas, and diarrhea.

For people with lactose intolerance, symptoms may begin from fifteen minutes to several hours after consuming foods or drinks containing lactose. Their severity varies from person to person—and how much and when lactose is consumed in relation to other foods.

A milk allergy is quite different. It's an allergic reaction to the protein components, such as casein, in milk. People who have a milk allergy usually must avoid all milk products. People with lactose intolerance can eat dairy products in varying amounts; that's because lactose intolerance is a matter of degree. If you suspect lactose intolerance, avoid self-diagnosis. Instead, see your doctor for a medical diagnosis; the symptoms might be caused by another condition. Lactose intolerance is diagnosed with several tests: a blood test, a hydrogen breath test, or a stool acidity test for infants and young children.

Who's Likely to Be Lactose-Intolerant?

Anyone can be lactose-intolerant. From birth, most infants produce the lactase enzyme. With age, however, the body may produce less lactase.

How many people have low levels of lactase? Between thirty to fifty million Americans; however, a large proportion of them have few if any symptoms. And many people who think they're lactose-intolerant really aren't. Certain ethnic and racial populations are more widely affected than others. In the United States as many as 80 percent of African Americans and 75 percent of American Indians, 90 percent of Asian Americans and 60 percent of Hispanics are lactose-

How Much Lactose?

Serving Size Lactose Product (approximate) (gm)

Milk: whole, reduced-fat, low-fat, fat-free, sweet acidophilus milk, or buttermilk 1 cup 10-12

Goat milk 1 cup 9

Lactose-treated milk 1 cup 1

Nonfat dry milk V3 cup 12

Half-and-half V2 cup 5

Whipping cream V2 cup 3

Sour cream Vicup 4

Sweetened condensed milk 1 cup 30

Evaporated milk 1 cup 24

Butter, margarine 1 tsp. Trace

Cottage cheese V2 cup 2-3

Yogurt, low-fat 1 cup 5 Cheese: American, Swiss, blue, Cheddar,

Parmesan, or cream cheese 1 oz. 1-2

Ice cream, regular and low-fat V2 cup 6-9

Sherbet, orange V2 cup 2

Lactose-free foods include:

  • Broth-based soups
  • Plain meat, fish, and poultry
  • Fruits and vegetables, plain
  • Tofu and tofu products
  • Soy and rice beverages
  • Breads, cereal, crackers, and desserts made without milk, dry milk, or whey intolerant to some degree. The condition is least common among persons of northern European descent who tend to maintain adequate lactose levels throughout their lives. Researchers have identified a genetic link with lactose intolerance.

Lactose intolerance is sometimes linked to other issues. For example, some medications lower lactase production in the body. Lactose intolerance can be a side effect of certain medical conditions, such as intestinal disease or gastric (stomach) surgery. Depending on the cause, lactose intolerance may be short-term.

Lactose in Food: Which "Whey"?

Lactose usually comes from foods containing milk or milk solids. The chart "How Much Lactose?" on page 524 suggests how much. Prepared foods, even those labeled "nondairy," may contain lactose. If you're very lactose-intolerant, check labels carefully.

  • Look for label ingredient terms that suggest lactose: milk, dry milk solids (including nonfat milk solids), buttermilk, lactose, malted milk, sour or sweet cream, margarine, whey, whey protein concentrate, and cheese.
  • Spot baked and processed foods that often contain small amounts of lactose: bread, pancake or baking mixes, candy and cookies, cold cuts and hot dogs (other than kosher), drink mixes, commercial sauces and gravies, cream soups, dry cereals, prepared foods (such as frozen pizza, lasagna, waffles), salad dressings made with milk or cheese, margarine, sugar substitutes, and powdered meal-replacement supplements.
  • Be aware: some medications contain lactose. If you're lactose-intolerant, consult with your doctor or pharmacist about appropriate medications.

Dairy Foods: Don't Give 'Em Up!

So you've been diagnosed as lactose-intolerant. That's not a reason to give up dairy foods! Lactose intolerance isn't an "all or nothing" condition. Instead, it's a matter of degree. Most people with difficulty digesting lactose can still consume foods with lactose. It's just a matter of knowing which foods contain lactose—and knowing your personal tolerance level.

Needlessly avoiding milk and other dairy foods may pose nutritional risks. They're important sources of calcium, protein, riboflavin, vitamins A and D,

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