When lactose is problematic

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Ten clear answers to your questions on a topic that can be confusing—lactose intolerance

1) What exactly is lactose?
Lactose is the main form of sugar in milk, present in a proportion of 5%. In addition to providing energy, it plays an important role in the intestine where it is transformed into lactic acid—a natural antiseptic. Lactose is composed of two simple sugars: glucose + galactose. To be digested, it must be split in two by an intestinal enzyme called lactase.

2) Is it true that the majority of people cannot digest milk?
It is true that intestinal lactase production decreases significantly after weaning. At one year of age, the level of lactase activity in babies is only half of what it was at birth. Between the ages of three and five, lactase decreases by 90–95% in three-quarters of people around the world. Many people—especially those of African American, Asian, Native American or Hispanic descent—are often considered to have less ability to digest the lactose in milk. This is a normal phenomenon related to human physiology. This condition is less present in the northern populations of Europe and America, as well as in certain nomadic peoples, such as the Bedouins of Arabia and the Tuareg people or blue men of the Sahara.
Because nature is so well designed, the body adapts and manages to tolerate a certain amount of lactose at a time. However, when the consumption of lactose exceeds digestive capacity, which varies from one person to another, gastrointestinal discomfort (cramps, bloating, flatulence, diarrhea) appears 30 minutes to 2 hours after ingesting milk or certain dairy products. This discomfort is caused by the bacterial fermentation of sugars that are not completely absorbed by the small intestine, resulting in the production of gas in the colon.

3) If you suspect you are lactose intolerant
You can have your doubts confirmed by a doctor who will perform a hydrogen breath test or a blood sugar test. “I personally haven’t performed these tests in over 20 years,” states Dr. Patrick Godet, a gastroenterologist practicing in Lasalle. “People who are lactose intolerant don’t really need these tests because they have already associated their discomfort with milk consumption. By removing dairy products from their diet for a few days, symptoms disappear completely.” Doctors should, however, make sure there is no other underlying issue.

In fact, many people—who do not suffer from malabsorption—eliminate milk unnecessarily on their own after suffering diarrhea or poor digestion. According to Dr. Godet, their problem may have been caused by: 1) other foods (e.g.: food in the cabbage or onion family, legumes, strong spices); 2) a digestive disease such as celiac or Crohn’s disease; 3) food poisoning; 4) a side effect of antibiotics or gastroenteritis such as traveller’s diarrhea. In these cases, lactose intolerance is temporary and gradually resolves in most people. Some people will, however, remain intolerant long term.

4) Why is milk so important?
Eliminating all traces of milk from your diet is not without its repercussions. Milk is an economical food, very versatile in cooking (soups, sauces, pancakes, puddings, desserts…) and of great nutritional value. Milk alone provides 16 essential nutrients, including high-quality protein, lots of absorbable calcium and Vitamin D.

In 2010, the highest American health authority, the National Institutes of Health, shared its scientific consensus that people who are lactose intolerant (real or perceived) and avoid dairy products are not ingesting sufficient amounts of calcium and Vitamin D—two nutrients that are extremely important for bone health. Interestingly, lactose intolerant people who consume dairy products have fewer symptoms than those who do not. Before you ban milk and dairy products from your diet forever, read the answer to the next question.

5) Should I just ban dairy products from my diet?
No, it all depends on your tolerance level. Contrary to popular belief, most people who are lactose intolerant can consume certain dairy products with minimal symptoms and improve their tolerance with regular consumption of lactose.
Milk: Even with reduced enzyme activity, many people can tolerate whole milk at meals when ingested a small amount at a time (125 mL or 1/2 cup). Milk with 3.25% M.F. is preferable to skim milk because the fat it contains slows down the milk’s passage through the digestive tract. If you have problems with milk even in small doses, choose ready-to-drink lactose-reduced milk such as Lactaid® and Lacteeze®, available in most grocery stores. Keep in mind, however, that this lactose-reduced milk tastes sweeter than regular milk. There are also lactase drops that can be added to regular milk 24 hours before drinking, which break lactose down into digestible fragments.

Cheese: With the exception of processed cheeses and fresh cheeses (cottage cheese, ricotta, white cheese…), ripened cheeses naturally contain very little lactose. According to agronomist Jacques Goulet, professor of food science and nutrition at Laval University, 80 to 90% of lactose is eliminated in the form of whey during manufacturing and the rest breaks down as the cheese ages. Here’s a good tip to keep in mind: the lower the cheese’s percentage of moisture, the less lactose it contains.

Fermented milk products: Yogurt is usually well tolerated, even in cases of severe lactose intolerance. Look for those with probiotics (all strains except Lactobacillus GG), which are active bacterial cultures that produce the enzymes needed to digest lactose. Probiotic fermented milk like BioK+ also acts the same way as yogurt to help digest lactose. Finally, kefir, a combination of over 30 species of microorganisms, is another good choice, as it contains lactic ferments and yeasts that transform lactose into lactic acid and alcohol (which gives kefir its fizziness).

6) What to do when eating at the restaurant or a friend’s house
Keeping lactase tablets (an artificial enzyme) handy, which are swallowed just before consuming dairy products, is a good idea. They can be purchased over the counter at the pharmacy.

7) Goat, sheep, soy… what about other kinds of milk?
The milk of all mammals, including goat and sheep, contains lactose. Soy is a beverage made from water and soybeans, so it is lactose-free. If you do consume it, be sure to choose a soy beverage fortified with Vitamin D and calcium.

8) Does cooking destroy lactose?
No, lactose is not eliminated through cooking. Foods such as soups, béchamel sauce, rice pudding, crème caramel, tapioca and pancakes all contain significant amounts of lactose.

9) What is the difference between a milk intolerance and allergy?
Food intolerance refers to the appearance of digestive symptoms that occur after the ingestion of certain foods. From a medical perspective, it has no impact on the physical health of the affected individual. In the case of lactose, the intolerance is related to carbohydrates in milk. A milk allergy is caused by the immune system’s abnormal reaction to milk proteins. It begins in infancy, disappears around the age of three and is quite rare in adults. The allergy can manifest itself through reactions such as hives, rash, eczema, diarrhea or constipation, nasal congestion, coughing, difficulty breathing and vomiting. This is a serious problem and must be managed by the child’s pediatrician or an allergist.

10) Is drinking milk unnatural?
Some people believe that humans are the only species to feed on the milk of another mammal. They also argue that after weaning, the body stops producing the enzyme necessary to digest lactose, a sign that should be respected by avoiding dairy products. Others argue that the colon adapts to the presence of lactose and can tolerate it very well. This is also what happens with legumes, as the body does not have the enzymes required to digest their complex carbohydrates. However, as the body gradually gets used to these carbohydrates, digestive discomfort disappears. Humans are also the only species to cook their own food, to wear clothes, to grow vegetables and to have set foot on the Moon. The debate continues… but, ultimately, everyone is free to draw their own conclusions!