Thursday, June 4, 2015

Sensitive to Dairy: Got Lactose?

Consuming dairy products (milk, cheese, yoghurt, kefir, butter and ghee) in any form has been a controversial issue within recent times. Despite this, there are persons who enjoy dairy out of habit, convenience and for its nutrient composition. 

On the upside, dairy products contain two forms of protein (whey and or casein), vitamin B12, riboflavin, choline, vitamin D, calcium, phosphorus, potassium and selenium. On the downside, it lacks fibre, it is rich in saturated fat and may contain hormones. Persons who have trouble digesting dairy fall into two major groups:  lactose intolerant and lactose maldigestion.  Lactose is the primary sugar (carbohydrate) found in dairy products. Lactose makes up 5% of milk's weight as such products made with milk will contain some level of lactose. 

The difference between lactose intolerance and lactose maldigestion, reside with the symptoms and amount of lactase [enzyme] present in the gastrointestinal tract. Lactose intolerant persons lack the enzyme-lactase to fully digest lactose. Lactose is normally broken down by lactase [enzyme] in the small intestine; when there is no lactase present, lactose is broken down by the bacteria in the large intestine resulting in persons experiencing a number of symptoms ranging from loose stools, flatulence,  bloating, lower abdominal cramping, nausea etc. Persons with lactose maldigestion, contain very small amounts of lactase [enzyme] and are able to tolerate varying amounts of lactose with zero to minimal side-effects. 

However, for persons who enjoy diary but have trouble digesting it, there is hope. 
Strategies to seamlessly cope with lactose containing products are:
1) Determining your lactose limit
2) Consuming dairy with other foods
3) Switching to lactose-free/lactose-reduced dairy products
4) Investing in over-the-counter- lactase supplements
5) Avoiding all dairy products

Option 1: Know your lactose limit
 It is difficult to control when a food with lactose will be consumed, thanks to cross-contamination as such it is best to determine how much lactose your body can tolerate on a daily basis. 

Doing this requires you to be very strategic with your food intake. Choose a day, record the amount of dairy product consumed, the type of product, and the symptoms experienced.  This can be done once a week or how often you desire. While it may seem like an experiment, it is the best way to determine your lactose limit.

Monday: The only dairy product consumed for the day is as followed:
Type of dairy: Milk, full-fat                                    Amount of dairy: 1 1/2 cups
Side-effects 3 hours later:  bloating, flatulence (gassey), felt queasy, slight lower abdominal cramping and diarhoea 

Friday: The only dairy product consumed for the day is as followed:
Type of dairy: Milk, full-fat                            Amount of dairy:  2 ounces (1/8 cup)
Side-effects 3 hours later: only bloating and flatulence 

  The following poster shares the lactose content in the different dairy products (click image to enlarge). 
Data sourced from USDA nutrient database

Option 2: Consume dairy with other foods.
Combining small amounts of dairy with other foods slows down the rate at which lactose reaches the intestines, thus giving the body enough time to breakdown enough lactose so that it does not cause an issue. Research indicates that most people with low levels of lactase can increase their lactose tolerance and comfortably consume 1 to 2 cups (8 oz.-16 oz.) of milk (or 24 g of lactose) with a meal daily (Suarez 1995 & Suarez 1997).  However, this requires as little as 1/4 cup of milk to be consumed with a meal, 3 times a day over a consistent period (Purdue University, 2000).
It should be noted, dairy products containing primarily casein (e.g. cheddar or  cottage cheese) and probiotics (e.g yoghurt and kefir) are the most tolerated forms of dairy in  persons with lactose intolerance & maldigestion. 
EXAMPLE of how to combine dairy include:  Spoon some Greek yoghurt over a fruit bowl, eat a spoonful of yoghurt with a spicy meal or add a dallop of yoghurt to oatmeal etc.

Option 3:  Consume lactose-free or lactose-reduced dairy products.
These are made from ultra-pasteurised, regular milk but the enzyme lactase is added during the processing. Lactose-free or lactose-reduced dairy products are often easier to digest and do not cause any side-effects because the added enzyme, breaks down 70-100% of lactose present.

It should be noted, these products tend to have a sweeter taste than regular milk because the lactase converts lactose into glucose, thus increasing the sweetness. 
Next time you purchase lactose-free dairy milk, look at the ingredient list you would find  a disclaimer saying: 'this ingredient [lactase] is not found in regular milk.
Please bear in mind, these lactose-free dairy products can be quite pricey compared with regular milk, regular yoghurt and regular cottage cheese. 
Option 4: Invest in some lactase-enzymes e.g. Lactaid or Dairy Ease
These are great items to have on hand especially when dining-out, as they breakdown about 70-90% of the lactose present. These lactose-enzyme tablets or drops can be purchased over the counter without a prescription. Some are fast acting, while others are slow acting, be sure to take it in an appropriate time frame to minimise any potential discomfort.

Option 5: Avoid all dairy products
Once dairy is avoided, the best way to get the vitamins and minerals present in dairy, is to incorporate fortified non-dairy ‘milks’ such as almond, soy, coconut, hemp etc. and eat a variety of food from other food groups. Non-dairy ‘milks’ aim to mimic the texture and appearance of dairy-milk but be aware, the nutritionally quality of non-dairy ‘milks’ varies greatly:
Most are low in protein (except soy and hemp) and total carbohydrates (except rice, oat-blends and the sweetened flavours)
Most have under 200 mg sodium per 1 cup
All are lactose-free and cholesterol-free
All have calcium, vitamin D & vitamin B12 added
Aside from this,
They can be pricey depending on the brand
May contain controversial ingredients (e.g. carrageenan, artificial flavours, BHT etc.) 
Protein content of 'milk' alternatives from highest to lowest (L-R)
May have a creamy to watery taste and mouth-feel
Whether these 'milk' alternatives can be used in the same way as milk, varies and requires experimentation.  For example: using rice milk in recipes calling for buttermilk, may not work as well but using full-fat coconut milk  instead of dairy creamers well in coffee drinks.

Hope this post helps however, please talk with a health care provider or a registered dietitian, if more information is needed.

Disclaimer: While the consumption of dairy is not a requirement for adults, these strategies are aimed at those who enjoy dairy products or those who are tired of experiencing the side effects of the unintentional ingestion of lactose.

Thank you for reading! 
Leave a ⓒⓞⓜⓜⓔⓝⓣ below

Suarez F, Savaiano D, Levitt MD. A comparison of symptoms after the consumption of milk or lactose‐hydrolyzed milk by people with selfreported severe lactose intolerance. N Engl J Med. 1995;333:1‐4.
Suarez F, Savaiano D, Arbisi P, Levitt MD. Tolerance to the daily ingestion of two cups of milk by individuals claiming lactose intolerance. AmJ Clin Nutr. 1997;65:1502‐1506.
Purdue University. "Lactose Intolerant? Get Milk." ScienceDaily. ScienceDaily, 27 January 2000.

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