Are you lactose intolerant?

Maneka Sanjay Gandhi

Do you experience bloating, intestinal cramps and excessive gas in your stomach often? This could be lactose insensitivity which is a very common reason for digestive problems.

Lactose is a sugar found in milk and milk products.

Lactose should be broken down in your upper intestine by the enzyme lactase. Most people in India have varying degrees of lactose insensitivity, making it difficult for them to digest sugar. But since the pain and bloating differs, people often don’t connect the two.

Technically, as infants, humans produce lactase in our digestive systems and can digest milk.

As we enter adolescence the enzyme in the body starts decreasing and with it the ability to break down lactose. This is natural because milk is for infants and humans are the only animals that drink milk beyond infancy. All Asians and 75% Africans and Caribbeans, 50% Europeans and 35% Americans have degrees of lactose intolerance. The only people who can really digest milk are Northern European whites and Americans of North European descent who have a genetic mutation to deal with lactose. Unfortunately, it was these North Europeans who colonized much of the world and they brought their eating habits with them; which is why America, colonial Africa and Asia started drinking milk.

So, while your background defines whether you can tolerate dairy or not, most governments push milk aggressively, and food manufacturers find milk sugar a cheap ingredient and add it to wide variety of processed products; which is why the largest selling medicine in the world is a lactose digestive.

How sensitive you are depends on how much lactase enzyme your system is still producing. Some people can drink a glass of milk without apparent side effects. Some can have just a spoonful in their tea or coffee or on their cereal and it triggers off a gastric upset.

Why does lactose cause gas and abdominal pain?

When your body does not produce enough lactase in your small intestine, all your milk/milk products pass through to the large intestine undigested. Bacteria in your colon love lactose and quickly ferment it. This fermentation creates lots of gas. Due to the high levels of protein in the milk, the gas is very smelly. These extra gases bloat the intestine causing spasms and cramps. When the pressure from the gas interferes with water absorption in the colon it causes diarrhoea. Some people experience bloating and flatulence in 15 mins.-2 hrs. after ingesting milk or its products. Gurgling or rumbling sounds in your belly, loose stools or throwing up are common symptoms.

While passing wind almost immediately is the best thing to happen, apart from being uncomfortable it is also embarrassing for you - both the smell and the noise are not socially acceptable. Smell has a decisive role in changing mood and it becomes very annoying for people to share your space.

Since this is such a common problem, why do most people not realize it. One of the reasons is that since food containing lactose (paneer with vegetables for instance) travels much slower than liquid, it may take hours for the symptoms to appear. You could have eaten something in the morning and end up with gas in the evening without making any connection between the two.

Here is a list of food and drinks that contain lactose.

Milk is obviously the first product that you should avoid, especially cow and goat milk. All dairy milk, even skimmed milk, has extremely high levels of milk sugar. All protein powders have concentrated lactose. Butter and all cream contain slightly less than milk but enough to cause you trouble. Freshly made cheese- feta, paneer etc. has a large amount.  The harder the cheese, the less lactose it contains. For instance, parmesan will have much less than mozzarella.  Ice cream is particularly bad because not only is it made from milk, but manufacturers add extra milk sugars to sweeten it. Good quality curd, made at home and without any flavouring has the least amount of lactose. But commercial yogurt is simply thickened, sweetened milk with very little beneficial bacteria in it. All yogurts are made with live cultures, but many yogurts go through a process called "heat treatment" that kills the bacteria. Check the label for the words "contains live and active cultures.". Canned soup has lactose – especially if it is “creamy”. So do packaged savoury snacks, especially if they are cheese flavoured. Milk chocolate, cakes, puddings, biscuits, doughnuts have lactose, as do premade sauces, gravies and salad dressings like mayonnaise. Breakfast cereals are sometimes made with milk powder or solids and then you eat them with more milk. Bread, baked goods, instant breakfast drinks, instant potatoes, instant soups, pancake, cookie, and biscuit mixes, margarine and salad dressings too. Even processed meats like sausages, luncheon meat have lactose. Pizza with its combination of soft cheese, bread and perhaps processed meat is the worst thing you can eat. Start looking at labels for the words lactose, milk solids, milk powder, milk protein, non-fat dried milk, casein, sodium caseinate and whey. Strangely enough, birth control pills, headache tablets and some drugs and supplements also contain lactose. By themselves they are unlikely to have a major effect but if your food is bad, it all adds up.

If you are lactose intolerant, it is far more serious that just cramps, bloating and flatulence. If the colon is constantly deluged by fermenting lactose it can leave the digestive system permanently weakened with harmful bacterial overgrowth and weakened immunity. If you are Indian, take it for granted that you have some level of intolerance. Sometimes the small intestine stops making lactase after a short-term illness such as stomach flu or as part of a lifelong disease such as cystic fibrosis. Or the small intestine sometimes stops making lactase after a surgery to remove a part of the small intestine. In rare cases, new-borns are lactose-intolerant – this is serious because diarrhoea causes dehydration. Some premature babies have temporary lactose intolerance because they are not yet able to make lactase. Lactose intolerance increases as you get older.

You need to check out what harm you are doing to yourself. The best way to check this is to avoid eating all milk and dairy products to see if your symptoms go away. If they do, then you can try adding small amounts of milk products to see if your symptoms come back.

There are two tests that doctors have: the Hydrogen Test Breath Test. Before the test, you need to avoid certain foods, medicines and cigarettes. On the day of the test, you will drink a liquid that contains lactose and then breathe into a machine several times over a couple of hours. If the hydrogen levels in your breath are high, you may have lactose intolerance. The other test is the Lactose tolerance test. This test measures your blood sugar after you eat or drink lactose. After midnight on the night before the test, you should not eat or drink anything. On the day of your test, you will drink a liquid that contains lactose, which may cause gas or pain in your belly. Then your blood will be tested every 30 minutes for 2 hours. If your blood sugar levels do not rise, you may be lactose-intolerant. You may also be asked to bring in a sample of your faeces. The faeces of a person who has lactose intolerance is usually loose or watery and foamy.

There is no cure for lactose intolerance. But you can treat your symptoms by replacing milk products; with soy milk/cheese. If you are worried about getting enough calcium, you can easily get it from all greens, bhindi, broccoli, saag, almonds, and all soyas. You can use non-dairy creamers in your coffee. If you cannot bear the thought of life without milk, ice cream, cheese and pizzas you can take lactase supplements of which the best known is Lactaid 9000 Fc. You need to take these pills just before your lactose based food.  The capsules start at 1000 FC for those with slight insensitivity. But pills always have their own fallout.

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