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August 24, 2019

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What to do when dairy is the enemy

Milk prices

Associated Press

Lactose in medication

Lactose is also included in many medications as a filler for pills. Many birth control pills contain lactose, as do many medications to treat stomach problems, such as acid reflux.

Red flags

Be wary of these ingredients if you are lactose intolerant: whey, whey protein concentrate, dry milk solids, casein, caseinates, nougat, curds, buttermilk, nonfat dry milk powder, malted milk, milk byproducts, margarine.

The replacements

Avoid: Cow milk, goat milk

Try lactose-free milk (supplemented with lactase), soy milk, almond milk, rice milk

• • •

Avoid: Soft or fresh cheeses (ex. ricotta, cottage, feta, American, Velveeta)

Try aged or hard cheeses (ex. Brie, Parmesan, cheddar and Swiss)

• • •

Avoid: Ice cream, frozen yogurt

Try coconut milk ice cream, rice milk ice cream, popsicles

• • •

Avoid: Commercially prepared yogurt

Try Greek yogurt, kefir, homemade yogurt. Yogurt containing active cultures also can lessen gastrointestinal symptoms. Make homemade yogurt nearly lactose-free by extending fermentation time up to 24 hours, which allows the bacteria to eat most of the lactose.

Why me?

Retaining the ability to digest lactose is genetic. Scientists believe a genetic mutation that allowed lactase persistence began in Northwestern Europe, where dairy farming was common and it was evolutionarily favorable to be able to digest milk.

But I used to eat ice cream all the time

While the vast majority of people are born with the ability to digest lactose, many lose it as they age and their body’s lactase production dwindles.

Bloated. Gassy. Sick to the stomach. Does this sound like you feel after drinking a glass of milk or eating a slice of pizza?

If so, you may be among the 30 to 50 million Americans who are lactose intolerant.

People are considered lactose intolerant when their intestines lack the enzyme lactase, which is needed to digest lactose, the sugar in milk and other dairy products. The shortage of lactase makes it difficult to break down lactose, causing flatulence, bloating, cramps and diarrhea.

It’s not pleasant, but there are ways to control the symptoms, even while enjoying your favorite foods.

Whom does it affect?

Anyone can be lactose intolerant, but in the United States, some racial and ethnic populations, including blacks, Jews, Hispanics, American Indians and Asians, are more susceptible. The condition is least common among Americans of European descent.

What happens in your body

The small intestine is where most food digestion and nutrient absorption takes place. Normally, lactase turns milk sugar into two simple sugars — glucose and galactose — which are absorbed into the bloodstream through your intestinal lining.

But if you’re lactase deficient, the lactose in your food moves into your colon. There, normal bacteria interact with the undigested lactose, leading to a buildup of gas, which can cause stomach cramps and diarrhea, the two main symptoms doctors use to diagnose lactose intolerance.

Symptoms typically occur 30 minutes to 2 hours after consuming milk products and can be mild or severe, and include: abdominal pain, bloating or swelling; feeling of fullness; nausea, diarrhea and gas.

How to diagnose lactose intolerance

If you think you may be lactose intolerant, try cutting dairy products from your diet for a few days to see if your symptoms cease. There also are medical tests:

• Lactose tolerance test. This gauges your body’s reaction to a liquid that contains high levels of lactose. A patient drinks the liquid, then two hours later undergoes blood tests to measure the amount of glucose in his or her bloodstream. If the glucose level doesn’t rise, it means the body isn’t properly digesting and absorbing lactose.

• Hydrogen breath test. This test also requires drinking a liquid high in lactose. Afterward, doctors measure the amount of hydrogen in your breath at regular intervals. Normally, very little hydrogen is detectable. However, if your body doesn’t digest lactose, it ferments in your colon, releasing hydrogen, which is exhaled.

• Stool acidity test. Typically used for infants and children. As undigested lactose ferments, it creates lactic acid that can be detected in a stool sample.

Is there a cure?

There’s no way to boost your body’s production of lactase, but changes in diet can help you avoid the discomfort of lactose intolerance.

• Gradually introducing small amounts of milk or milk products may help some people adapt to dairy with fewer symptoms.

• Most people can better tolerate milk products by consuming them with meals.

• Using lactase products also can help some people manage their symptoms. Try adding over-the-counter lactase enzyme drops to milk at least 24 hours before consumption. The drops reduce lactose by 70 to 90 percent.

• Or take over-the-counter lactase enzyme tablets at the beginning of a meal to help your body digest solid foods that contain lactose.

• Many doctors also recommend consuming probiotics, which are living organisms in yogurts and supplements that often are used for gastrointestinal conditions and may help the body digest lactose.

Are you allergic?

Some people confuse milk allergies with lactose intolerance. Milk allergies most commonly occur during the first year of life, whereas lactose intolerance typically begins during adolescence or adulthood.

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