How to Manage Lactose Intolerance

Lactose intolerance is a condition in which people have symptoms due to the decreased ability to digest lactose, a sugar found in dairy products. Those affected vary in the amount of lactose they can tolerate before symptoms develop. Symptoms may include abdominal pain, bloating, diarrhea, gas, and nausea. These symptoms typically start thirty minutes to two hours after eating or drinking milk-based food. Severity typically depends on the amount a person eats or drinks. Lactose intolerance does not cause damage to the gastrointestinal tract.

How to Manage Lactose Intolerance – Causes, Symptoms and Treatment

Lactose intolerance is a prevalent and distressing condition that affects a surprisingly high percentage of adults. The U.S. Department of Health & Human Services approximates that about 65 percent of the human population has a reduced ability to digest lactose after infancy.

Lactose intolerance is not the same as a milk allergy and is more of a discomfort than a real over-reaction by the immune system, according to the FDA. Many people with lactose intolerance can even have small amounts of the offending foods/drinks without having symptoms.

What sort of signs of lactose intolerance may indicate that you have this common problem? Lactose intolerance symptoms typically include bloating, gas, diarrhea and other GI issues. Fortunately, by following a lactose intolerance diet and treatment plan, it’s possible to reduce (and in some cases even eliminate) the symptoms of lactose intolerance.

What Is Lactose Intolerance?

The definition of lactose intolerance, according to The National Institute of Diabetes and Digestive and Kidney Diseases, is “a condition in which you have digestive symptoms — such as bloating, diarrhea and gas — after you consume foods or drinks that contain lactose.”

Lactose is a sugar that is found in milk and dairy products. In order to digest this sugar properly, the small intestine must produce adequate amounts of the enzyme called lactase.

Lactose is found in:

• Milk
• Lactose
• Whey
• Curds
• Milk by-products
• Dry milk solids
• Non-fat dry milk powder

Lactase is responsible for breaking down the lactose into glucose and galactose, so the body can absorb it. When the body’s ability to make lactase diminishes, the result is lactose intolerance.

It is important to note that not all dairy products cause these unpleasant symptoms of lactose intolerance. In fact, yogurt or kefir with live active cultures typically do not produce these symptoms, as the active cultures help to break down lactose prior to consumption. Also, the longer the food is fermented, the less the lactose content will be, as the healthy probiotics survive by eating the lactose sugar.

Lactose Intolerance Causes

What triggers lactose intolerance? As described above, lactose intolerance is caused by the body’s inability to effectively digest lactose due to malabsorption or low levels of lactase produced in the digestive tract. This seems to occur for several main reasons:

1. Genetics/Family History

While it has been documented only rarely, the inability to produce lactase can sometimes be congenital. Researchers believe there are genetic links to lactose intolerance causing symptoms to appear during the teenage years. However, just because you made it through your teen years without affliction doesn’t mean you are immune for life. Lactose intolerance is not very common in children under two years of age, although it’s still possible.

In addition, lactose intolerance seems to run in families, and certain ethnic groups have greater occurrences of lactose intolerance than others. Native Americans, Hispanics, Asians and those from African descent often experience intolerance more often than those of European descent.

2. Aging

As we age lactase production decreases, leading to intolerance in individuals who otherwise never had overt signs of lactose intolerance.

3. Illness and Stress

In some cases, lactose intolerance can also result from surgery, injury, illness and even certain treatments. Common conditions that can contribute include gastroenteritis, IBS, Crohn’s Disease, ulcerative colitis, celiac disease and other conditions of the digestive tract, including candida overgrowth and leaky gut. Even cases of the flu can cause intolerance (however, often the symptoms will fade over time). Additionally, taking medications including some antibiotics for extended periods of time may disrupt gut health and contribute to lactose intolerance.

Diagnosis

How do doctors test for lactose intolerance? To test for lactose intolerance in patients who are experiencing symptoms like bloating and diarrhea, doctors rely on a number of different tests, including:

• A hydrogen breath test, since undigested lactose causes you to have high levels of hydrogen in your breath
• Reactions to an elimination diet, in which you stop eating and drinking milk and milk products to test the effects.
• A test using a stethoscope to listen to sounds within your abdomen
• Discussion of symptoms, family history, medical history and eating habits
• A physical exam to check for any underlying health problems that may be the real cause of symptoms

Keep in mind that a number of other conditions aside from lactose intolerance can cause similar symptoms. These include: irritable bowel syndrome, celiac disease, inflammatory bowel disease or SIBO (small bowel bacterial overgrowth). This is why doctors must rule out these causes before confirming a diagnosis of lactose intolerance.

Symptoms of Lactose Intolerance

What are symptoms of being lactose intolerant? The most common symptoms of lactose intolerance include:

• Diarrhea
• Gas
• Stomach bloating/swelling in the abdomen
• Stomach pain/cramping
• Nausea, vomiting
• Headaches or migraines
• Acne

When do lactose intolerance symptoms start? These warning signs of lactose intolerance can arise anywhere from 30 minutes to two hours after the consumption of dairy products and can range from mild to severe. Most immediate reactions are caused by the body not having the enzymes to digest the lactose sugar, which causes the intestines to contract.

If you have had an ongoing intolerance, you might also experience issues besides digestive upset, such as more extreme headaches, migraines or bloating that can occur over the course of up to two days from these undigested particles entering your body, especially if you have leaky gut syndrome.

Can you become lactose intolerant all of a sudden? This is more common among older adults, but usually lactose intolerance is obvious from an earlier age.

How long do lactose intolerance symptoms last? The severity of lactose intolerance symptoms depends upon personal tolerations and the amount consumed. If you’re intolerant and continue consuming lactose without making any other changes, your symptoms will likely persist.

Lactose Intolerance Treatment & Diet

There is currently no permanent cure for lactose intolerance because no treatment can increase the amount of lactase your small intestine makes. However, there are steps to take to manage symptoms and avoid complications. One major concern for people who have lactose intolerance is they may not get enough of the essential nutrients found in milk products, including calcium, magnesium, vitamin D and vitamin K, for example.

While it’s an option to take dietary supplements called lactase products that help digest lactose, this will not solve the underlying problem and may not be a good long-term solution.

What foods should you avoid if you are lactose intolerant? Do you necessarily need to give up all dairy?

Depending on the severity of your intolerance, it may be necessary to take a break from dairy while you heal; however, by following a healthy lactose intolerance diet, it may not have to be a permanent sacrifice.

Some people with severe lactose intolerance will need to avoid having most or all dairy products. Others can tolerate certain kinds without experiencing a flare-up of lactose intolerance symptoms. For example, some research suggests that many people with lactose intolerance can have up to 12 grams of lactose, the amount in about 1 cup of milk, without triggering any strong symptoms. Some experts also believe that one key to consuming dairy products while eating a lactose intolerance diet is to choose raw and unpasteurized products made from raw cow, goat and sheep milk.

A study published in the Journal of the Dietetic Association indicates that consuming kefir improves lactose digestion and tolerance. Participants in the study perceived a reduction in the severity of gas by 54 to 71 percent. While kefir is a dairy product, the fermentation process breaks down the naturally occurring lactose, making it easier for the body to digest and absorb it. The result is that the majority of individuals with lactose intolerance can still enjoy some types of dairy, while reaping the health benefits.

If you need to avoid all lactose, keep a careful eye out for dairy derivatives that hide in common foods — including bread, pastries, crackers, cereals, soups, processed meats, protein bars and candy. Look at ingredient labels and avoid these foods as much as necessary to control your symptoms:

• Milk
• Cream
• Butter
• Evaporated milk
• Condensed milk
• Dried milk
• Powdered milk
• Milk solids
• Margarine
• Cheese
• Whey
• Curds

There is no FDA definition for the terms “lactose-free” or “lactose-reduced.” Even products advertised as “non-dairy” could contain trace amounts of dairy products that can lead to the disrupting symptoms of lactose intolerance. Additionally, healthy natural foods that you have eaten for years may be at the root of your lactose intolerance. When transitioning to a lactose intolerance diet, it is important to carefully read the labels of all processed foods to ensure dairy products aren’t lurking.

Ideally, the best dairy products to consume if you have lactose intolerance are the types made from raw cow or goat’s milk that have been fermented for a minimum of 24 hours.

• Raw milk myths continue to cause controversy; however, many of the claims of illness are greatly exaggerated. It is estimated that raw milk is responsible for less than 50 cases of food-borne illnesses each year, while nearly 10 million Americans regularly consume raw milk.
• Raw milk benefits include immune system support, healthy skin, hair and nails, increased bone density, weight loss, muscle development and neurological support.
• Raw milk is beneficial because the pasteurization process dramatically reduces essential nutrients, including vitamins A, C, E and B as well as minerals such as iron, zinc and, of course, calcium. The natural enzymes that help our bodies digest dairy products are destroyed while the protein and immunoglobulin’s are damaged.

Below are additional steps to take to help manage lactose intolerance:

1. Use Organic Fermented Dairy

Fermented dairy improves the digestibility of the lactose, fats and protein in dairy, but also helps to spur healthy digestion of other foods. While the idea of drinking fermented dairy may be off-putting to some, high-quality, organic kefir is slightly tangy, creamy and ultimately satisfying.

It is similar to yogurt, just thinner and drinkable. Probiotic foods are rich in vitamins, minerals and essential amino acids. Kefir contains high levels of thiamin, B12, folate and the secret bone-builder, vitamin K.

Vitamin K2 specifically helps calcium to metabolize, creating stronger bones, which is essential to people on a lactose intolerance diet. Organic fermented dairy also helps to increase magnesium levels. Magnesium deficiency is common in people with digestive tract disorders, including celiac and Crohn’s disease and IBS … as well as lactose intolerance.

You may choose to eliminate all dairy products for a time to help reduce symptoms and help your body heal, but ideally you can begin to swap out regular dairy for fermented dairy, which can help to restore the health of the digestive tract and has enzymes that will actually aid in digestion.

2. Try Goat Milk

For many people, goat milk may be easier on the digestive system than cow milk. Goat milk is high in fatty acids, and it is more easily absorbed and assimilated in the body. The actual fat particles in goat milk are smaller and contain lower concentrations of lactose.

It takes significantly shorter time to digest goat milk products than it does cow milk products. And yet, goat milk is richer in calcium, phosphorus, iodine, potassium, biotin and pantothenic acid. In addition, its casein levels are reduced, making it friendly to those with casein sensitivity.

3. Take Digestive Enzymes That Contain Lactase

Lactase is the enzyme that is lacking in the digestive tract for individuals suffering from lactose intolerance. According to a study published in the Alternative Medicine Review, digestive enzyme supplementation can aid in the breakdown of fats, carbs and proteins, assisting in efficient digestive function

Taking specially formulated digestive supplements provide a safe treatment for digestive malabsorption disorders, including lactose intolerance.

Take a digestive enzyme at the beginning of each meal, to ensure that foods are fully digested. This also helps to decrease the probability that partially digested foods including proteins, fats and carbohydrates will sit in the gut.

4. Supplement with Probiotics 

This is an essential part of a lactose intolerance diet. The live or active cultures in yogurt, kefir, fermented vegetables and supplements help to maintain a healthy digestive tract. Increasing healthy bacteria in your gut may help to spur greater lactase production, or at the very least, aid in digestion.

By adding probiotic supplements and probiotic-rich foods to your diet, you can change the balance in the gut, leading to greater nutrient absorption. Managing lactose intolerance with yogurt and probiotics is possible, according to a study published in the Journal of Applied Microbiology.

However, probiotic supplements can do significantly more for overall health and wellness than just gut health. In fact, according to a study published in Science Daily lead by Dr. Collin Hill from the University of College Cork in Ireland, probiotics may be used in the future to help control disease, without relying on antibiotics.

It is important to look for a supplement that contain probiotics plus prebiotics derived from heat resistant soil-based organisms.

5. Incorporate Calcium-Rich Foods

While calcium is often considered a powerful mineral in the fight against osteoporosis, it is much more vital to our health than just our bones. In fact, calcium-rich foods help promote heart health and manage body weight. Calcium rich foods, which everyone should incorporate in their lactose intolerance diet include raw milk, yogurt, kefir, dark greens like cooked kale, raw cheese, sardines and broccoli.

6. Add Foods Rich in Vitamin K

As mentioned above, vitamin K plays a major role in calcium absorption and bone health, but its benefits do not end there. It also helps promote brain functioning and improve insulin sensitivity. This fat-soluble vitamin is stored in the liver, and proper levels can be disrupted by antibiotic use, certain prescription cholesterol medications and IBS and leaky gut. Many people who are lactose intolerant are also vitamin K deficient, so it is important to make sure you are getting enough in your daily food routine.

Foods rich in vitamin K to add to your lactose intolerance diet include green leafy vegetables, scallions, Brussels sprouts, cabbage, broccoli, cucumbers and dried basil. In addition, fermented, organic dairy is also rich with this essential vitamin.

7. Add Bone Broth to Your Diet

Central to helping restore the gut is bone broth. This simple and tasty broth helps the body overcome food intolerances, sensitivities and even allergies, while improving joint health, boosting the immune system and reducing cellulite.

Long simmering of grass-fed beef bones or organic free-range chicken transforms the calcium, magnesium, phosphorus, sulfur and other minerals, making them easier to absorb. In addition, the natural collagen and gelatin found in the bones help to support the GI tract. Aim to consume 8 ounces to 12 ounces each day.

8. Jumpstart Your Gut Health with the GAPS Diet

The GAPS diet plan was designed by Dr. Campbell to help reduce inflammation, treat autoimmune diseases, support healthy neurological function and minimize digestive disorders. If you have experienced the symptoms of lactose intolerance for months, or years, you can jumpstart your transition by following this eating plan.

The foods consumed include many of those mentioned above, like raw fermented dairy, fruits and vegetables rich in vitamins and minerals, healthy nuts and beans, wild fish, grass-fed beef and free-range chicken.

9. Add Non-Dairy, Probiotic-Rich Foods to Your Diet

Probiotic-rich foods increase the overall health of the digestive system and can help ease common digestive upset symptoms (including poor nutrient absorption), strengthen the immune system, support weight loss and increase energy due to more vitamin B12 in the body.

Sauerkraut and kimchi are both made from fermented cabbage and other vegetables that are nutrient rich, and rich with enzymes that help digest foods. Probiotic drinks, including kvass and kombucha, are rich with healthy bacteria, which help with liver detoxification, along with coconut kefir.

Coconut kefir is easy to make at home with the same types of kefir grains used in dairy kefirs and is rich with the healthy bacteria found in organic fermented dairy products.

10. Use Coconut Oil for Cooking

Coconut oil is one of the most amazing foods on the planet, and is easily converted to energy in the body. In addition, it helps to improve digestion, burn fat, kill bad bacteria and fungus and regulate candida in the body. Coconut oil can be used for high-heat cooking, it can replace dairy in coffee and tea and it is easy to bake with. It helps to fight inflammation throughout the body, boost the immune system and even prevent bone loss. For individuals that are limiting their traditional dairy intake, coconut oil should be included in their diet.

11. Substitute Ghee for Butter

Ghee has been used for thousands of years to improve digestion function, reduce inflammation, support weight loss, strengthen bones and so much more. But the most important factor for individuals with lactose intolerance — ghee contains only trace amounts of lactose that most aren’t likely to react to. The long simmering process and skimming of the butter removes most lactose and casein, so individuals with sensitivity or allergies to dairy products should try ghee. In addition, when created from milk from grass-fed cows, levels of conjugated linoleic acid or CLA, are double or triple that of traditional grain-fed cows.

Ghee is versatile and can be used for everything from high-heat cooking to “buttering” toast. Like coconut oil, ghee is part of my healing foods diet.

Final Thoughts

• Lactose intolerance is a condition in which you have digestive symptoms — such as bloating, diarrhea and gas — after you consume foods or drinks that contain lactose, including milk and dairy products.
• Symptoms of lactose intolerance include bloating, gas, stomach pains, diarrhea and sometimes other issues like headaches. They usually start within about 30 minutes to two hours after consuming lactose.
• Lactose intolerance is caused by factors including genetics, aging, eating a diet that contributes to leaky gut, illnesses and stress
• Lactose intolerance treatment typically involves following an elimination diet to avoid dairy and addressing underlying causes. It’s important to read labels carefully and look out for all types of dairy milk, lactose, whey, curds, milk by-products, dry milk solids and non-fat dry milk powders.

The Best Milk Alternatives, According to a Dietitian

Plant-based alternatives to cow’s milk have been a thing for a while now, and the benefit of this trend is that there’s something for everyone. Whether you’re lactose-free, vegan, or allergic to tree nuts, soy, or coconut, grocery stores in 2019 definitely have something to suit your needs. But how are you supposed to navigate the growing non-dairy aisle? And are these milk alternatives any healthier than cow’s milk?

When it comes to nutrients, commercially available versions of nut, seed, and legume-based milks contain varying amounts of protein and fiber (usually 1-4g each per 1-cup serving) since they’re made by blending the predominant ingredient with water. They can contain around 100 calories or less depending on the ratio.

Consuming fewer calories can be a good thing if you’re guzzling iced coffee with unsweetened almond milk all day, but may be less desirable if you’re looking for a nutritious addition to your morning bowl of steel-cut oats. Many of these alternative milks also cost more than dairy milk, but they may be worth the spend depending on how often and where you’re using them.

As a registered dietitian, my main piece of advice is this: Don’t be swayed by trendy marketing claims on packaging. Depending on the brand and type, these milk substitutes can be sneaky sources of added sugar, so it’s crucial to check labels before you swap out a dairy-based option for a plant-based one. Here’s everything else you should be scanning the label for.

What to Look for in Alternative Milks

? At least 7-8g protein per serving

? As few ingredients as possible

? The word “unsweetened” and “0g added sugar”

? Limited saturated fat (especially in ones made with coconut or added protein)

? Less than 140mg of sodium per cup

? Fortification with calcium and vitamin D

? Nutrients you’re personally concerned about (like the omega-3’s)

The best milk alternatives are typically unsweetened soy or pea-based blends (yep, you read that right!) that are fortified with calcium and vitamin D. These two nutrients are better absorbed when consumed together and are beneficial for strong bones, hormone regulation, and general immunity — especially for your little ones. If you’re adhering to a vegan diet, you’ll want to look for blends that have vitamin B12, vitamin A, and DHA/EPA omega-3’s, as well. Be sure to skip “barista blend” milk alternatives. They’re better for frothing but often come with loads of added sugar. Instead, spice up a hot beverage with vanilla, clove, or a cinnamon stick.

Keep reading to get the low-down on the best plant-based milks you can buy (and order):

1. Soy

Arguably the OG milk substitute (and the most nutritionally similar to dairy milk), unsweetened soy packs about 80 calories per cup with 8g plant-based protein from soybeans. Soy milk is made by soaking and blending these little beans and straining out the leftover pulp before consuming. Filled with antioxidants and fiber, soy alternatives are often super nutritious and provide key polyunsaturated fats.

2. Pea Milk

A new kid on the block in the world of plant-based milks, pea milk is made from pea protein isolate, water, and other emulsifiers like algal oil, sunflower oil, and guar and gellan gums. It’s as creamy as soy with a slightly less nutty taste for 70 calories per cup. The use of algal oil provides DHA, a key omega-3 fatty acid that’s linked to immunity, heart health, and cognition. The unsweetened versions pack up to 8g protein from a nutrient-dense source.

3. Coconut Milk

Coconut milk is made from water and coconut cream (VitaCoco’s uses coconut water, too), so it has a tropical taste compared to other plant-based milks. Nutritionally, coconut milk is higher in fat and lower in carbohydrates than nut- or grain-based milks. Most of the calories come from saturated fat — just one cup has up to 4g, which is 20% of your daily value. That said, the creamy consistency and fat content help boost satiety, so you’re likely to use less of it — especially if you’re adding it to coffee and tea.

4. Oat Milk

The trendiest blend of the bunch, oat milk is a creamy, lightly flavored addition to coffee, tea, cereal or a homemade smoothie. It contains added fiber, which may make it more filling than other alternative milks, according to early research. That said, oat milk is lower in protein than non-fat cow’s milk or soy-based versions (2-4g versus 8g per cup). It also has slightly more calories than unsweetened almond milk, which can add up if you swig it frequently.

5 Almond Milk

Most commercial almond milks range between 35-90 calories per cup and there are loads of blends and unsweetened versions to choose from. They’re mostly made from almonds and water, plus other emulsifiers and fortifying nutrients. The lower-cal versions give you about 1g each of protein and fiber per serving (though Elmhurst’s blend is about 5g protein). The low protein content is something to keep in mind if you’re using almond milk as a dairy swap in homemade smoothies — you may want to pump up the protein by adding nut butter or chopped nuts.

6. Cashew Milk

Cashew milk is particularly tasty in tea or homemade tea lattes. Try it with matcha for a little midday boost of L-theanine, a compound found in matcha which is linked to cognition and focus. Cashew milk is made the same way as almond (soaking, blending with water, and straining) and is similar in nutritional composition, ranging from around 40-50 calories per cup. Cashews themselves provide zinc, copper and magnesium, which help support your immune system. The real difference between cashew and almond milk? The flavor! Go with whichever you prefer, so long as you’re choosing an unsweetened version.

7. Peanut Milk

Peanuts are like the crown jewel of foods, since they’re good for both you and the planet. They have a similar taste and nutrient profile as tree nuts (almonds, walnuts, cashews, and hazelnuts), but these legumes actually grow underground and use way less water. The best thing about peanut-based products is they’re often more cost-effective than other dairy alternatives and are higher in protein (plus, they have a creamy taste and texture).

8. Flax Milk

At 70 calories per cup, flax milk contains a little more than meets the eye. Most store-bought versions are made from a combination of water, flaxseed oil, and pea protein, which makes it similar in nutrient composition to pea milk. The alpha-linolenic acid found in flax also helps support immunity and has been linked to reducing the risk of heart disease.

9. Hemp Milk

Out of all of the hemp products currently on the market, hemp milk is a solid choice from a nutritional POV. It’s made by blending hulled hemp seeds with water, and packs magnesium, calcium, and vitamin D, depending on fortification. You’ll also get omega-3 and omega-6 fatty acids — essential nutrients for your immune system and cognition — plus about 3g of protein at 60 calories per cup. However, there’s very little fiber in hemp milk compared to ones made from other seeds. The main objection to hemp milk is the taste: Its ultra-nutty flavor can be bitter to some, especially if you’re used to the sweeter notes of other plant-based alternatives.

10. Rice Milk

Rice milk is made by blending rice with water. It’s often lower in calories than other milk alternatives in its unsweetened form, but since the flavor is very mild, most versions contain added sugar. You may be better off with an alternative grain blend unless you’re avoiding nuts, seeds, or legumes because of an allergy.

11. Walnut Milk

Walnut milk is a top pick if you’re looking to boost your intake of plant-based omega-3’s. It tastes a little more earthy than other types of milks and packs 3g of plant-based protein for 120 calories. Use it in tea or coffee to shake up your morning routine, or in smoothies to balance out sweet-tasting fruits.

Source: https://www.hiwamag.com/health/7-symptoms-lactose-intolerance-plus-11-tips-manage/