How do I know if I’m lactose intolerant?

Lactose intolerance is a condition in which you’re unable to digest lactose, a sugar found in milk and dairy products. The intolerance is due to an insufficient amount of lactase, an enzyme in the small intestine that breaks down lactose into simple sugars, glucose and galactose. Only simple sugars are able to be absorbed by our digestive system; therefore, when lactose isn’t split into simple sugars, it can’t be absorbed. It stays in the intestine and, as a result, gas is produced, which leads to the development of symptoms.

Symptoms may include abdominal pain and cramps, nausea, bloating, gas and diarrhoea. These typically start between half an hour and two hours after drinking milk or eating dairy products, and the severity of symptoms depends on the amount of lactose ingested. However, it doesn’t cause damage to the lining of digestive system.

There are four types of lactose intolerance: primary lactose intolerance is when the amount of lactase in the small intestine reduces as one ages; secondary lactose intolerance is due to different conditions affecting the small intestine – for example, infection, celiac disease or inflammatory bowel disease; developmental lactose intolerance may occur in premature babies but can improve over time; and congenital lactose intolerance is a condition in which little or no lactase is made from birth.

Diagnosis may be confirmed if symptoms resolve after eliminating lactose from the diet or replacing milk with lactose-free milk. Other tests are sometimes necessary if the relationship between lactose elimination and symptoms is inconclusive; lactose intolerance is tested by a hydrogen breath test.

It’s important to note that lactose intolerance is different from a milk allergy, which is a more serious condition. Milk allergy is an adverse immune reaction to a mild protein called casein. It’s tested by a skin prick or blood test testing for antibodies.

Lactose intolerance is typically managed by decreasing the amount of lactose in one’s diet or taking lactase supplements available over the counter. People with lactose intolerance are usually able to drink small amounts of milk or eat small portions of yoghurt or hard, matured cheese without developing significant symptoms.

It is not necessary to remove completely milk and dairy from the diet (unless specifically recommended), for two main reasons. First, because this grup of foods contain essential nutrients like calcium, zinc, phosphorus, selenium, vitamin A, vitamin B12 and high quality proteins, which are necessary in each period of our life. Secondly, if our body is able to digest very small amount of lactose, it will be easy eating out without triggering any symptoms and this results in a better management of the new condition and causing less stress.

When diagnosis is made, it is sufficient to reduce the daily intake of lactose following few easy tips:

• spread out during the day the amount of lactose that can be tolerated, instead of consuming different foods with lactose in the same meal;
• replace normal milk with lactose free milk which is available in cold storage or NTUC or use plant-based milk alternatives added with calcium which are naturally lactose free;
• use fresh products which contain lactose in small quantity or trace like yogurt, kefir, butter and hard cheese;
• avoid hidden sources of lactose like processed meat or fish, gravy stock powder, pasta or vegetables with cream/sauces, ice cream, and fast food foods (meat, ham, bread and fries);
• lactose can come under different names, so learn how to read the labels and look for the following ingredients: milk, milk powder, evaporated milk, condensed milk, non-fat dry milk powder, dry milk solids, milk cream, cream, curd, whey, lactose;
• when you are eating out, ask to put sauces aside and choose less elaborated preparations without cream or gravy.

What Is a Lactose Free Diet?

It’s a diet that limits foods containing lactose, such as milk, dairy and processed food.

® Please find below the list of the foods you should replace with the lactose free products:

• milk (you can replace it with lactose free milk, you can find different brand like Arla, Cowhead, Harvey Fresh, Paul’s Zymil, Organic Valley, etc… Alternatively you can also use almond or oat or rice milk with added calcium, but I recommend to use lactose free milk as a first choice if possible);
• yogurt and greek yogurt (usually they are well tolerated, but if you feel discomfort you can replace them with lactose free yogurt or nuts yogurt or coconut yogurt. Please prefer the lactose free yogurt instead of the vegetable alternatives, because it contains good probiotics. You can find it form different brands: Rachel’s organic brand in Redmart, Liddells, Green Valley Organic, Yoplait, etc..);
• fresh soft cheese like cottage cheese, ricotta, melted cheese, mozzarella di bufala, mozzarella and creamy type cheeses, paneer (you can replace them with pasteurised hard cheeses like Parmesan cheese, Emmenthal, Gruyere, Cheddar, Comte or Gauda or Feta or other hard cheeses);
• butter (it contains a little percentage of lactose, so if you use it sometimes in small amount, it should not be a problem, usually ghee butter has less lactose).

® Lactose is also added to a different products. You may need to check the food labels looking for: milk, milk powder, evaporated milk, condensed milk, non-fat dry milk powder, dry milk solids, milk cream, cream, curd, whey, lactose.

List of food:

• processed meat and fish (cooked ham, chicken ham, turkey ham, sausages, hot dogs, meat ball or fish ball, pâtés);
• processed foods (snacks, meal replacement powders/bars, protein powders/bars or energetic bars, vegetarian ready to eat foods, etc..);
• gravy stock powder;
• pasta or vegetables with cream/sauces;
• biscuits, croissants, cakes (if you do them at home you can use lactose free milk or yogurt);
• tea or coffee added with milk or milk powders;
• smoothies (you can do it with lactose free milk or vegetables milk alternatives);
• bread (with milk or cheese);
• breakfast cereals;
• chocolate, also the extra dark;
• ice cream: you can choose the fruit flavours because they are made with water and fruit;
• fast food (meat, ham, bread and fries).

Each type of milk has its advantages and disadvantages, depending on a person’s diet, health, nutritional needs, or personal taste preferences.

Few decades ago the only available milk was whole cow’s milk. Now, dairy milk comes in all sorts of varieties: whole milk, 2 percent, 1 percent, skim (fat-free), and even lactose-free milk.

For those with dietary or allergy concerns, there are also alternatives to cow’s milk. Almond, soy, and rice milk are popular alternatives to dairy, and they’re becoming more available in stores.

Each type of milk has its advantages and disadvantages, depending on a person’s diet, health, nutritional needs, or personal taste preferences.

For example, people in key development years — children over two, teens, and pregnant women — need proteins, vitamin D, and calcium. These are abundant in dairy milk. On the other hand, people who need to watch their calories or cholesterol — for weight reasons or heart health problems — often look to other options. In looking at the differences in these popular types of milks, you can determine which best suits your needs.

Dairy Milk

Whole milk is cow’s milk with none of the fat removed. It contains 8 grams of fat per cup, 8.5 percent nonfat milk solids, and 88 percent water. As none of the milk’s natural components are removed, it is high in natural proteins, fat, calcium, and vitamin D.

Other dairy milk has some or all of the fat removed. While whole milk has 150 calories in one cup, 1 percent milk has 110 calories, and skim milk has just 80 calories. Fat-free milk has all of the nutritional benefits of whole milk — a good source of protein, calcium, vitamins, and minerals — without the saturated fat and calories. Dietitians often recommend skim milk for the majority of their clients.

Lactose-free milk is contains lactase, a natural enzyme to break down the lactose – sugar found in milk products. As with other milks, lactose-free milk is a good source of protein, calcium, vitamins, and minerals. The fat and cholesterol content of lactose-free milk varies, as it comes in 2 percent, 1 percent, and fat-free varieties.

The 3 Best Things About Dairy Milk

1. Whole milk can provide essential proteins and extra calories from fats, as well as vitamins and minerals for infants and the elderly.
2. Lactose-free versions are available for people who are lactose intolerance.
3. Widely available in grocery stores and convenience stores.
Con: Whole milk is high in saturated fat and calories, but low fat version is comparable to other milk alternatives regarding the calories content.

Almond Milk

Almond milk is made from ground almonds and is lower in calories than other milks as long as it is unsweetened. It’s also free of cholesterol, saturated fat, and is naturally lactose free. Even though almonds are a good source of protein, almond milk is not. Almond milk is also not a good source of calcium. However, many of the brands available in the market are supplemented with calcium as well as vitamin D.

The 3 Best Things About Almond Milk

1. It’s low in calories and contains no saturated fat or cholesterol.
2. It’s naturally lactose free.
Con: It’s not a good source of protein and, unless it is fortified, it contains no calcium and no vitamin D, which is important for people with conditions like osteoporosis. (People who are allergic to almonds or nuts should avoid almond milk.)

Soy Milk

Soy milk is made from soybeans. It’s a popular milk alternative for vegans and people who are lactose intolerant. Since it comes from plants, it is naturally free of cholesterol, low in saturated fat, and contains absolutely no lactose. Soybeans and soy milk are a good source of protein, calcium (when fortified), and potassium.

The 3 Best Things About Soy Milk

1. It’s a good source of protein.
2. Soy milk contains almost as much protein as cow’s milk, yet is lower in calories than whole milk and comparable to skim milk.
It contains no cholesterol, which is important for those with heart conditions.
Con: Soy milk does not contain calcium and vitamin D unless fortified. Too much soy may be a problem for those with thyroid disease or other conditions. A 2008 Harvard study showed that higher intakes of soy-based foods caused fertility problems and lower sperm counts.

Rice milk

Rice milk is made from milled rice and water. It is the least allergenic of all of these products, which makes it a good choice for people with lactose or nut allergies. While rice milk can be fortified with calcium and vitamin D, it is not a natural source of either of these, just like soy and almond.

The 3 Best Things About Rice Milk

1. It’s the least allergenic of milk alternatives.
2. It can be fortified to be a good source of calcium.
3. Rice milk can be used by vegetarians.
Con: Rice milk is very high in carbohydrate and very low in protein, so it’s the least desirable choice for people with diabetes as well as people who want more protein, such as athletes or the elderly.

References:

Chavarro, J., Toth, T., Sadio, S., & Hauser, R. (2008, November). Soy food and isoflavone intake in relation to semen quality parameters among men from an infertility clinic. Human Reproduction,23(11),2584-2590.
Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2721724/