Wrong, Wrong, Wrong!
Myths About Lactose Intolerance
Lactose Intolerance Is A Disease.
Lactose Intolerance is for most people as normal a part of aging as getting wrinkles or turning
gray. It's all in your genes: if you inherited from both your parents a gene that stops production
of lactase - the enzyme that digests lactose - you are Lactose Intolerant. The symptoms may
appear in children as young as ages 3 or 4 or they may not be noticed until you're in your 70's,
but you are either Lactose Intolerant from birth or not, simple as that.
You Can Tell If You're Lactose Intolerant by Your Symptoms.
If only that were true. Sure, the symptoms of Lactose Intolerance are straightforward and quite
noticeable: gas, diarrhea, cramps, flatulence, and the rumbling of gas through the intestines that's
called borborygmi. Problem is, these are also the symptoms from dozens of problems, ranging
from reactions to other foods to some truly serious diseases. Don't take chances with your
health. Don't self-diagnose. See a doctor (your family physician can refer you to testing or to a
specialist gastroenterologist; if you don't have a family physician, you can go to a clinic, which is
how I learned I was LI) and make sure that Lactose Intolerance is your one and only problem.
If You Don't Have Symptoms, You're Not Lactose Intolerant.
Here's where it gets tricky. How you react to milk seems to involve the psychological as well as
the physical. Some people who test positively for Lactose Intolerance can drink a glass of milk
and never notice a thing. Others whose tests show that they are not Lactose Intolerant get sick
anyway. Other people get symptoms at some times and not others. There's no one answer to
explain this, so here's a few:
- Hardly anyone produces zero lactase. Virtually all of us can digest at least some lactose with
our remaining lactase. Only if we eat too much do we go over our lactose threshold and start
- Some lactose-containing foods are easier to digest than others. The bacterial cultures that turn
milk into yogurt and other cultured foods actually produce lactase that will help digest the lactose
in yogurt after you eat it.
- Some people may be able to accustom themselves to milk products by eating them on a regular
basis. The gas that is the most noticeable symptom is actually produced by the bacteria in your
colon, which feed on undigested lactose. Regular doses of milk products may encourage a
different set of bacteria to grow, ones that don't produce the gases.
- You may have other problems, like the common Irritable Bowel Syndrome, that cause you to
have symptoms for reasons unrelated to milk products.
You Can Recover From Lactose Intolerance By Changing Your
See above. You may be able to cut back on your symptoms, but as far as anyone knows, nothing
you can do will increase your production of lactase once it has begun to decline. You can't even
slow down the rate of decrease. If you decrease the severity or frequency of your symptoms,
however, you may think you're cured, but it's just not so.
There Are Federal Regulations Concerning Lactose Labeling on
Well, yes and no. Mostly no. There's only one formal federal regulation concerning lactose: if
it's added to a food, the word lactose must appear in the ingredients listing. (Yes, believe it or
not, many packaged foods have actual pure lactose as part of their ingredients.)
After that it gets
complicated. The NLEA (Nutrition Labeling and Education Act of 1990) established regulations
about fat and sugar and salt and other nutrients, but not about lactose. Why? Because (and I
quote from the Jan. 6, 1993 Federal Register) "lactose intolerant consumers know to avoid milk
and milk products."
Wrong, wrong, wrong. Most of us just plain do not avoid all milk products.
We either take lactase pills, keep our milk drinking to a minimum, or eat only better tolerated
foods. But since lactose is cumulative, we desperately need to know how much lactose is in any
given food so that we do't accidently wind up over our thresholds. People don't eat foods in
isolation. Two grams of lactose here, three grams there, a bunch over there, can add up to
trouble without our ever being aware we've gone too far.
(If you don't like this state of affairs, write to the
Consumer Affairs Office at your local district Food and Drug Administration office and complain.
They will keep these comments on record until the next time they formally look at labeling
requirements. OK, that won't be until sometime in the next century, but the time is now to start puttting pressure
What the feds did say was that manufacturers could voluntarily label a food as "lactose free,"
assuming of course that it is true. To quote: "Any product labeled as 'lactose free' must not
contain lactose as an ingredient or as a component of an ingredient and should adhere to the
provisions of 21 CFR 105.62 on hypoallergenic foods." That's why foods containing the milk
derivative caseinate will sometimes post a reassuring "not a source of lactose" on the ingredients
100% Lactose Reduced Means 100% Lactose Reduced.
Lactaid, the leader in lactose-reduced milks, has brought out a product whose label proclaims it to
be 100% Lactose Reduced Nonfat Milk and Lactose Free.
Is it, really? No. As Lactaid freely admits, there may be up to half a percent of lactose left in it.
Deceptive packaging? Not at all, let
me hastily say. Despite what I quoted above, many states have their own set of rules. And state
rules on milk supersede general federal regulations. (Yes, the milk lobby is a marvelous thing.)
Anyway, the state rules realistically admit that getting every last bit of lactose out of milk is a
difficult proposition, so they allow up to that half a percent of lactose in "Lactose Free" milk.
There's nothing inherently shady about this. In fact, the feds do something almost exactly equivalent. In the
NLEA, "free" was usually defined in bureaucratic terms as "a trivial amount." "Fat Free" foods
can really have up to half a gram of fat a serving; "Calorie Free" foods up to 5 Calories, and so
on. (Although remember that a food that claims to be "lactose free" must actually be lactose free.)
So "Lactose Free" milk can have up to a maximum of 60 milligrams left in a glass of 100%
lactose reduced milk. That's not much. It's about equivalent to the lactose in one gram of milk.
Let me explain how small that is. If you're baking and you need a tablespoon of milk, the film
that sticks to the spoon after you've poured out the milk is probably more than one gram. You
will never notice that it's there unless you're the one in a million with no lactase at all or who who
must rigorously avoid all lactose because of other medical conditions.
You Only Have to Worry About Finding Lactose in Food.
Guess again. Hundreds of prescription and over-the-counter medications also contain lactose.
Lactose is an almost tasteless, not-very-sweet sugar, and one that doesn't cake the way table
sugar does. That makes it an ideal filler and bulker for medications. Lactose is also used to coat
pills. Now, the amount of lactose in any single pill is going to be extremely tiny. In almost all
cases, the value of taking the medication is going to be much higher than the risk of ingesting a
tiny amount of lactose. But if you are taking dozens of pills a day or you have an extreme
sensitivity to lactose or need to avoid animal products, talk to your doctor. There is almost
always an alternative medication that does not contain lactose.
Quick plug: My book
Milk Is Not For Every Body: Living with Lactose Intolerance contains the
only listing of all lactose-containing prescription medications in the Physician's Desk Reference,
the standard reference for doctors, with lots more information besides.
You Can't Get Lactose Intolerance Unless You Are Born With It.
Well, it's not a disease, so it's not contagious. Unfortunately, the term Lactose Intolerance is a
pretty elastic one. Usually it means a specific genetic condition, as I explained above. But it can
also be used to refer to anyone whose lactase production has been knocked out for any reason at
all. This condition is called Secondary Lactose Intolerance (SLI). Since lactase is produced only
in the part of your intestines called the jejunum, any disease or operation that affects the jejunum
can halt lactase production. This can be a temporary or permanent lose of lactase depending on
the specific problem and its severity. Fortunately, SLI is relatively rare among adults and usually
disappears when the condition that caused it is cured. Parents will be more familiar with the
problem, since the gastrointestinal diseases so commons to infants aged 6-18 months can
temporarily make them Lactose Intolerant. Again, once their little insides recover (usually no
more than two weeks), they can go right back to drinking milk.
If You Don't Drink Cow's Milk, You Don't Have to Worry About
Don't want lactose in your milk? You don't have many choices. You could try the milk from
seals, walruses, or sea lions, except that with a 35% fat level, you probably wouldn't find them
very palatable. Or you could try to find a nursing platypus, but that would involve licking the
milk from her fur. Face it, with those couple of exceptions, the milk from every mammal contains
lactose. And so do their byproducts, like goat's milk or sheep's milk cheeses. (Both goat and
sheep's milks, by the way, have lactose contents very similar to cow's milk.) Milk is a vehicle for
getting lactose into babies; there's really no way around it.