Could you be lactose intolerant?

Could you be lactose intolerant?

What is lactose and how is it normally digested?

Lactose is the sugar found in dairy products, including milk, yogurt, cheese, cream, sour cream and ice cream. Eggs, contrary to what some folks I’ve worked with have thought, are not dairy products, despite being found in the dairy aisle in most grocery stores.

When you eat dairy products, the lactose is broken down by an enzyme called lactase, which is produced by the cells lining your small intestine.

Lactase breaks the lactose down into glucose and galactose, which your body can then absorb and use for energy.

What are the symptoms of lactose intolerance?

When the lactose digestion process doesn’t work right, there’s either not enough or no lactase present at all, and some amount of lactose passes on to your large intestine undigested. At this point, bacteria start working on it and they produce gases including hydrogen, methane and carbon dioxide, as well as fatty acids.

Two of the most common symptoms of lactose intolerance are bloating and gas, which can happen between 30 minutes and 2 hours after eating dairy, and that’s one of the early signs that you are losing your ability to digest lactose.

Full blown lactose intolerance, where you have completely lost your ability to digest lactose, like I believe I have, can be much less pleasant than just some gas. In fact, I thought up the topic for this while having what I describe as my lactose poops, which I had by accident about a week ago after having dairy-free ice cream which I believe was scooped with an ice cream scooper that had touched regular ice cream.

I now can recognize when I’ve been lactosed because it’s particularly awful the next morning with my morning constitutional. Sometimes the first few pieces of stool come out okay, but then by the end it’s like having molten lava exit my body, both in consistency and perceived temperature because of the increased acid in the stool. And in the past, if I had a lot of lactose or my lactose digestant tablets didn’t work for some reason, which I often think was because they were expired, my bowel movements could last up to as much as 45 minutes, with waves of hot liquid slowly coming out, as I’d go through hot flashes, sometimes soaking sweats, nausea and extreme sudden and flulike weakness that sometimes forced me to take a quick wipe and collapse on the bathroom rug to recover.

I usually don’t get this painfully graphic about my bowel issues on the blog but I wanted to share about this in detail because I think that there may be people out there who have lactose intolerance who think they have IBS or some other issue, so I wanted to make sure you really understood what full-blown lactose intolerance feels like.

What are primary and secondary lactose intolerance?

There are actually two types of lactose intolerance: primary and secondary. Primary is when you don’t have the gene for lactase persistence, which means that your body will slowly lose its ability to digest lactose between ages 5 and 20. I actually ran my raw 23andme DNA data through Genetic Genie, a free DNA analysis tool, and have confirmed that I don’t have the gene for lactase persistence. I ran both my parents’ data too and was surprised to find that my dad, who has always had stomach pain and GI issues, does have the gene, but my mom, who is of Italian descent, does not. Thanks mom for my crappy genetic inheritance. I mean the lactose intolerance, not the Italian part. But it’s funny that my mom still eats dairy and hasn’t mentioned any specific issues with it. I guess her microbiome is making up for her genetics.

It’s estimated that by adulthood, 70 to 90% of African-Americans are lactose intolerant, 80-95% of Asians, 100% of Native Americans and somewhere between 12 and 25% of Caucasians. If you want to find out if you have the gene for lactase persistence, you can upload raw data from 23andme or ancestry.com to Genetic Genie and find out about that and a lot more. Just be aware that you could find out disturbing things like that you have the BRCA genes that put you at risk of breast and ovarian cancer, so make sure you have the necessary support to receive that information when and if you do this. If you want to have access to raw data with 23andme you have to choose the $199 ancestry + health report or it appears that on ancestry.com the AncestryDNA® and AncestryHealth provide raw data, and the Ancestry DNA is only $99, but there may be other reasons to choose the 23andme, so do your research.

Secondary lactose intolerance is when you lose your ability to digest lactose because of damage to your small intestine. Possible causes include surgery, chemotherapy, or a bout of gastroenteritis, or what we call in the US, intestinal flu. It can also be caused from damage to the villi lining your small intestine from eating gluten when you celiac disease. If this is the case, you should go off both gluten and dairy until your gut seems healed up based on other symptoms or a doctor’s confirmation and slowly add dairy back in to see if you can tolerate it.

Secondary lactose intolerance can also be caused by bacterial overgrowths like SIBO or small intestinal dysbiosis, where you’re struggling with too much or the wrong type of bacteria in the small intestine overfermenting certain hard-to-digest carbohydrates including lactose, as I discussed in the last episode of my podcast with Norm Robillard.

Other conditions that can cause damage to your intestines or impact your ability to digest lactose include Crohn’s disease, Ulcerative Colitis and long courses of antibiotics. Some people who have secondary lactose intolerance may be able to recover their ability to digest lactose but others won’t ever recover it.

How do you diagnose lactose intolerance?

Officially, for adults the two ways of diagnosing lactose intolerance are a hydrogen breath test or a lactose tolerance test. But if you’re already suffering when you eat dairy, both of these tests involve you ingesting lactose, and that prospect seems pretty miserable to me, not to mention it may be hard to find a doctor who offers the test. And there could be some cost to you, even if it’s covered by insurance. My recommendation is a much cheaper and simpler method. Eat some dairy and take lactose digestant tablets* (which contain lactase, the enzyme needed to digest lactose). Eat your dairy with these tablets, per the package instructions, and see if you don’t have the usual digestive upset you’re used to. If that’s the case, it’s a pretty sure bet you have lactose intolerance. You may want to isolate the dairy when you test it and not eat it on top of a slice of pizza, for instance, as you could be confounding a gluten and a dairy reaction in that case.

Once you’ve confirmed that these pills are helpful, my best advice is to be very diligent about taking them, always having them with you, or avoiding dairy carefully and completely. And make sure you keep the original bottle and check the expiration date as I’ve had bad experiences when my pills had expired.

How much lactose is in different dairy foods?

It’s also worth noting that not all dairy foods are created equal with regard to lactose. While a cup of milk has 15 grams of lactose, a half cup of yogurt has around 6, and it’s believed to be easier to digest if it has live bacteria in it because they break the lactose down to some extent. Ice cream has about 4 grams for a half a cup but let’s be real, most people aren’t eating only ½ cup of ice cream at a time. And speaking of ice cream, I just want to say I’m in love with the So Delicious dairy-free coconut milk, sugar-free mint chocolate chip (and they’re not paying me to say that). That got me through the summer of Covid on a nightly basis. Soft cheeses in general have more lactose. Cottage cheese, for example, has 2.3 grams in ½ cup, whereas an ounce of cheddar cheese has less than 0.1 grams. And higher fat dairy has less, so a tablespoon of whipped cream, for example, has 0.1 grams as well, and butter has less than 0.1 grams per tablespoon. And as lactose intolerant as I am, I can tolerate butter, but I do avoid all other forms of dairy, and when I can at home, I use ghee or clarified butter, which has no lactose or casein. Casein is the primary protein found in milk and represents about 80% of the protein, with whey making up the other 20%. I’m sure you’ve heard of curds and whey from the nursery rhyme. If you’ve ever tried making cheese, which I did back when I was still eating it, you heat milk and then add something like lemon juice, vinegar or rennet to make it curdle and then the curds separated from the whey, which is the liquid you usually pour off.

Could I also be reacting to casein?

If you have eliminated lactose from your diet by moving to lactose-free dairy products or you always eat your lactose with lactase enzyme, but are still have reactions when you eat dairy, you may have an intolerance to casein. This is a common cross-reacting protein with gluten, so if you’re intolerant to one, you may be intolerant to the other.

Symptoms of casein intolerance may be similar to lactose intolerance, like bloating, gas and soft stool or diarrhea, but also abdominal cramps and pain and possibly constipation or blood in the stool. It can also manifest in allergic type symptoms like a runny nose, congestion or post-nasal drip, or in skin conditions like eczema, rashes or adult acne. And for kids, casein intolerance could show up as behavioral problems. Or you could have systemic symptoms like fatigue, joint pain and brain fog.

If you suspect this is the case, and it’s still not enough to get you off dairy, there’s one more thing you could try, which is A2 milk. One of the subtypes of casein, beta-casein, has two types, A1 and A2, and a lot of the symptoms of casein intolerance are from the A1 type. You could try A2 milk, which is found in most grocery stores now, and a quick internet search shows that there are now A2 cheeses out there and even one company doing both lactose and A2 ice cream called Re:THINK. It’s not in stores near me but it looks like you can order it online 4 pints at a time or more. If you still react to that then it may be the whey or you may be allergic to dairy and you need to accept that dairy just isn’t for you.

It took me a long time to get to that place mentally, which was aided by a statement from my French friend Martine that kept echoing through my head. She asked me “If you have to take pills to eat something, should you be eating it?” So about a year after that wise statement, I finally gave up dairy, along with a bunch of other stuff, and saw my post-nasal drip decrease, the constant phlegm in my throat go away, and my acid reflux, whose primary symptom was a constant cough, and hemorrhoids disappear. And I’ve reintroduced everything else except gluten and dairy and remain symptom-free. Now, when I do occasionally cheat and eat cheese, almost always accompanied by gluten and in the form of pizza or burrata cheese + pizza, I take GlutenEase* which is made by Enzymedica, and contains enzymes to digest both gluten and casein, along with my lactase pills. This isn’t something you should try if you’re celiac or have active autoimmune disease, but since I’ve brought my antibodies for Hashimoto’s down to normal and my platelets for my other autoimmune disease, ITP, are also normal, I feel like I can cheat a bit. But we’ll find out more about that decision at my next doctor’s appointment.

Are there probiotics I can take to help with lactose intolerance?

You may be wondering what the role of the gut microbiome is in digesting lactose. So there are bacteria that can help digest lactose, and they are the ones commonly found in the majority of probiotics, from the genera Lactobacillus or Bifidobacterium, not to mention found in a healthy gut eating a western diet that hasn’t been decimated by antibiotics. If your gut is lacking in these bacteria, which will often be the case, in particular for lactobacillus if you don’t consume fermented dairy products or fermented foods like sauerkraut, kombucha, water kefir, beet kvass or kimchi, you could try taking probiotics and see if that helps. There is one brand called Optibac* that seems to particularly aim to help with lactose digestion and points to research on two of its unique strains, Lactobacillus acidophilus Rosell-52 and Lactobacillus rhamnosus Rosell-11. But I followed their links and couldn’t find anything conclusive. I did try them years ago but was so past willing to eat dairy without taking my lactase pills, I couldn’t really tell you if it helped. They do seem to get good reviews on Amazon though. I also found one called Lacto-Freedom* that boasts a study showing a reduction in symptoms after a week of the probiotic that lasts for 3 months, but the study only had 8 participants. But any type of multi- strain lacto or bifido probiotics could be helpful and if you want really a really high CFU count, you could try Grace Liu’s probiotic, Bifido Maximus, which is also all histamine-free strains.

Will stopping dairy make my symptoms worse when I eat dairy?

The last question that may be burning in your mind is whether no longer eating dairy means you’re going to have even more problems eating it in the future. And the answer is yes. If you stop feeding your probiotic bacteria lactose, they will reduce in number and you’ll lose what’s called colonic adaptation, although these bacteria can consume other carbohydrates. But given the typical quantities of dairy people eat, a sharp reduction will impact these probiotic bacteria and then you’ll likely have worse symptoms if you’re accidentally lactosed. So if you’re determined to keep eating dairy, or want to restart eating it, do start slowly and add in fermented vegetables or probiotics to build up these bacteria, especially before completely withdrawing support like lactase tablets.

How do I avoid dairy?

If you’re going to give this a try and eliminate dairy, of course you want to read labels closely and avoid anything with the word milk, including goat’s milk and sheep’s milk. And if you have access to it, camel’s milk has lactose as well, but much less. You should also avoid anything that includes ingredients containing the words whey, casein, caseinate, cream, galactose, hydrolysate, high protein flour, anything starting with lacta- (except lactase), lacto-, lactu- , lacti- or lacty- , nisin, nougat, sherbet, pudding, quark, recaldent and rennet. And if you really want to be strict, beware of natural flavoring, flavoring and caramel flavoring, although I don’t know that the quantities of lactose in those last few food additives is significant enough to cause problems. And this is counter-intuitive, but many non-dairy cheeses actually contain casein, which I really don’t understand, but I guess it’s for the lactose intolerant market that’s not casein intolerant and not vegan. Who knows?

What can I replace dairy with?

Lastly, if you’re struggling mentally with how to give up your beloved dairy, believe me, I was there. Feta cheese, burrata, Neopolitan pizza, fresh mozz, brie, my homemade rosewater and lemon yogurt. I was totally there with you, but I made the transition and I’d never go back. So what do I do? Well I tend to use avocado where I would have used cheese, like with slices of it in sandwiches or with eggs. I use guacamole and chips as a snack instead of cheese and crackers. I haven’t really found a great replacement for feta in salads but I’m currently loving salads with pumpkin seeds in them. And then when it comes to pizza, that’s when I cheat, because if you take the gluten and dairy away from pizza, it’s really even pizza anymore. It’s some kind of freakish frankenfood I’m not interested in. But I get that some people don’t have the luxury of ever cheating, so shop around, some substitute cheeses are workable for some people. And then I pretty much stay away from yogurt, although there are decent coconut yogurts and kefirs. And there are good dairy-free substitutes for sour cream. For recipes, coconut milk works well as a substitute for cream and there are now really good coconut whipped creams on the market. And then in general, I tend to cook a lot more Asian food that’s naturally dairy-free rather than trying to substitute and recreate dairy foods. I do make a vegan parmesan with cashews though. There’s a bit of a learning and new recipe curve but it’s totally doable and I really rarely think about or miss dairy anymore. And I certainly don’t miss the many symptoms. So if you have acid reflux and have already tested negative for H. Pylori, or have bloating, gas, nasal congestion, post-nasal drip or you have hell on earth liquid lava poops, and haven’t given up dairy, that’s been a reliable go to for me as a health coach in helping people get rid of these symptoms, so it’s definitely worth a try.

As always, if you’ve hit a brick wall with traditional or allopathic doctors and you want some help with your gut at the microbiome level, or in reversing autoimmune disease or other health issues naturally, you can set up a free 30-minute Breakthrough Session with me (Lindsey) to share what you’ve been going through and decide whether my 5-appointment gut health coaching program or a longer program for autoimmunity or weight loss is a good fit for you. Individual 1-hour consultations may be scheduled directly here.

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