Ten Top Questions About Lactose Intolerance
1) What are Lactose and Lactase?
2) What Are the Symptoms from Insufficient Lactase?
In consequence, what reaches the colon is a large volume of lactose-laden water rather than a small volume of semi-dry solid. Trillions of normally beneficial colonic bacteria leap upon the lactose as if it were a gourmet meal, producing bubbles of gas for hours on end until all the lactose is devoured.
Gas and bloating are bad enough, but excess water and gas in the colon creates pressure that can lead to an almost immediate need to explosively expel loose, watery stools. Even without diarrhea, the continual production of trapped gas can also produce an accompanying and long-lasting medley of bloating, pain, cramps and borborygmi, those embarrassing rumbling noises from moving gas that make you wonder what in the world is going on inside your body. Of course, in practice, some people will have minimal symptoms or none at all. Others will suffer through pain and cramps that even a doctor has described as "unbearable." And these symptoms can start almost immediately and last for hours, even days, or they can hold off for the ten to twelve hours it takes food to reach the colon. Everybody's symptoms are their own, and may vary from meal to meal. You have to learn how to read your own body.
Note that all these symptoms are lower intestinal complaints. If you have vomiting, burping, heartburn, reflex, or any other true stomach problems, you need to look elsewhere for the cause.
3) How Can I Tell if I Have LI?
In those places, an alternate test, the Blood Glucose Test (BGT) is
used. This measures whether your blood sugar increases after drinking
lactose, as it will if you digest it. The big disadvantage is that
it is a blood test, which means collecting several blood samples. It
is also not quite as reliable as the BHT. But it should be available
everywhere. For more info, see my
Tests for Lactose Intolerance page.
4) Is LI the same as Milk Allergy?
As I've said, LI is simply an insufficient amount of lactase needed to digest the milk
sugar, lactose. Allergies come from proteins. The body's immune systems treat proteins
that leak through the intestines and into the bloodstream the same way they treat
truly dangerous invaders, like bacteria. True allergies cause mainly skin (rashes, hives)
and respiratory (wheezing, asthma) symptoms. However, there is more than one immune
response system in the body. Some of these create what are called hypersensitivities, and
these can produce symptoms much like LI, especially in young children. For a much fuller
discussion, see my
Lactose Intolerance versus Milk Allergy page.
5) When Do Most People Stop Producing Lactase?
6) Who is Likely to Develop LI?
The U.S. is a milk-drinking nation with generally low levels of LI precisely because the vast majority of Americans are descended from northwestern Europeans who brought their cows and their Lactose Persistent (LP) genes with them when they settled the country. Even so, LI is probably at its highest levels today since the time when the universally LI Native Americans were sole possessors of the continent. Changing patterns of immigration have greatly increased the number of Americans who boast ancestors from historically moderate and high LI areas of the world, such as Africa, Asia, Arabia and southern and eastern Europe.
But anybody can develop what is called Secondary LI if their intestines have been damaged by drugs, disease, or surgery. Most people who don't naturally have LI will soon regain their ability to drink milk, although a few have serious enough damage that they never recover. Young children often have temporary bouts of Secondary LI because their intestines are so delicate that even a bad case of diarrhea from a "stomach flu" can known out their lactase-making ability.
7) Will All Dairy Products Create LI Symptoms?
And even if you drink milk, which is probably ten times higher in lactose than butter is, whether you developed symptoms would still depend on how much milk you drink, how much lactase production you have left, whether you drank the milk with a meal or all by itself, and other variables. Studies show that about one-fifth to one-third of people with LI develop symptoms from a whole 8-ounce glass of milk. But two glasses will cause symptoms in about 90% of those who are LI. Overindulging in any dairy product will almost assure unpleasant consequences.
Be sure to check out my
Dairy Facts section. It describes every milk product in existence, gives lactose
percentages, and tries to sort out some tricky issues about what is really milk-derived
and what isn't.
8) Can Anything be Done to Cure LI?
9) Can Anything be Done to Alleviate LI Symptoms?
Prevention is the key. You can reduce symptoms by reducing the amount of lactose entering your intestines by doing the following:
Your other choice is to break the lactose down before it can do any damage. Since you can't get your body to produce more lactase, a reliable outside source of it is needed. Lactase pills exist that are cheap and efficient. They most definitely work, although you may have to experiment to find the one that works best for you and the number that you must take with any given food. You can also buy lactase drops to add to milk to pre-digest the lactase there, although you have to let the milk sit for a day in the refrigerator before you drink it. I carry pills with me everywhere I go, just in case. See my Lactase page for more information.
You can also try changing the bacteria in your colon from those that ferment lactose,
producing gas, to those that digest lactose and so produce no symptoms. See two important
A Lactose Intolerance Cure!? and
The DairyCare Controversy.
10) So, Really, How Serious a Problem is LI?
If you believe the doctors, these numbers are wildly overinflated. Dr. Michael Levitt, a veteran in gastrointestinal research, says that the marketers are "overdoing the severity of the problem." Another well-known LI scholar, Dr. Douglas McGill, says, "From my perspective, lactose intolerance has been a fad for 30 years now. There is nothing new except that business is after it".
So who should you believe? Neither side. They're both wrong.
The truth lies somewhere in the middle. For millions of Americans LI is a real problem. Needing to think about every morsel of food you put into your mouth, needing to deal with the consequences if enough milk slips by, needing to look for special products and needing to adapt recipes and forego some favorite foods makes LI a constant trial, even with the wealth of milk alternatives and lactase products on the market. It is easier to not have milk than to hope you've gauged a dose of lactase correctly or to remember to carry lactase with you at all times. Children are especially bothered by being thought of as different due to their LI. A world in which milk was easier to avoid would be preferable to one in which measures must constantly be taken to avoid feeling ill.
LI may be a problem, but it is not one of an epidemic scale. 80 million people are not descending onto their local supermarkets demanding alternatives to milk. That big a market just doesn't exist. But guesstimates from marketers who specialize in selling to the LI and extrapolation off census data suggest that we number maybe 10 million strong. That's a vast pool of dollars that could be swung toward restaurants who feature milk-free meals, bakeries that market milk-free breads and desserts, food giants who list amounts of lactose on their products' nutrition labels or smaller firms who target the LI in their advertising. Our numbers are large enough to command attention and respect if only we could make our voices heard.