Did lactose intolerance creep up on you?

It crept up on me. Several years ago I finally had to admit that dairy foods were causing digestive upset. Milk on cereal was suspect. So was yogurt. The final straw was butterscotch pudding. I have a killer recipe for homemade butterscotch pudding from a relative. Milk is a main ingredient. Uh oh. I included the recipe below.

It’s a “Catch 22” of aging: You need more calcium to maintain bone strength, so you consume more high calcium dairy foods. Milk and many other dairy products contain the natural sugar lactose: one glucose molecule attached to one galactose molecule. During digestion, the glucose-galactose bond is split by the enzyme lactase, which is secreted by cells in the intestines. Without lactase, lactose is fermented by gut bacteria. The byproducts created by gut microbe fermentation can cause digestive upset, bloating, gas and general discomfort. The term for this is “lactose intolerance.”

Temporary lactose intolerance can be caused by diseases that disrupt the intestinal lining, such as severe infection, immune dysfunction or adverse reaction to medication. Lactase production may return to normal after the intestinal lining recovers. Aging can also cause lactose intolerance, as lactase secretion decrease gradually over time. If you’ve consumed dairy foods for years with no trouble, you might not link your symptoms to those familiar foods. Adding to the confusion, different dairy foods have different amounts of lactose, so they don’t all cause the same severity of symptoms.

What to do?

If you suspect dairy foods are causing you problems, you could cut all dairy foods out of your diet. If your symptoms persist, lactose intolerance might not be your problem. A lactose intolerance breath test, which is ordered by a physician, would help to confirm a diagnosis.

Even if you have some lactose intolerance, complete avoidance of dairy foods may not be necessary. Some dairy foods, such as cheese, cottage cheese and kefir, have minimal lactose and are not likely to cause problems. Other foods, such as cream or half and half, are typically consumed in small amounts, limiting lactose exposure.

Another option: lactose-free milk, available in grocery stores. Or you could try lactase supplements, available over-the-counter as tablets or chewables. Lactaid is one brand name product, and most chain stores have generic versions. You simply take/chew one tablet at the time you consume a dairy food.

Fermented foods and lactose

One solution to lactose intolerance: let bacteria ferment the lactose before you eat it. Yogurt and kefir are produced when lactic acid-producing bacteria are added to milk. These bacteria ferment the lactose, creating the tangy acidic flavor we associate with these foods, while reducing the lactose content. Some people with lactose intolerance can eat yogurt and kefir with no problems. But don’t assume that all the lactose in a yogurt has been fermented. Lactose will vary considerably from one brand of yogurt to another. You may be fine with one brand, but have problems with another.  One relatively recent solution: lactose-free yogurt.  Many brands offer this choice.

Here’s an interesting twist on yogurt. Greek-style yogurt has less lactose than regular. Why? Greek yogurt is made by straining much of the whey out of the yogurt. Lactose is concentrated in the whey, so straining removes lactose. Added benefit: Greek yogurt is higher protein. But: Greek yogurt has less calcium, because that’s also concentrated in the whey.

Lactose in common foods

This list is organized by the grams of lactose in a typical serving of the food. The lactose content of some of these foods — notably yogurt and kefir — are rough estimates.

• whole milk, 8 oz cup – 12 g
• 2% milk, 8 oz cup – 12 g
• evaporated milk, 1/2 cup – 12 g
• buttermilk, 8 oz cup – 12 g
• yogurt, low-fat, 6 oz – 5-10 g*
• kefir, 6 oz serving – 6 g*
• yogurt, plain low-fat Greek-style, 6 oz – 4 g
• cottage cheese, 1/2 cup – 3 or less g
• Cream, 1 TB – 0.5 g
• half and half, 1 TB, 0.6 g
• sour cream, 2 TB -1 g
• cream cheese, 1 oz – 1 g
• cheese, most varieties, 1 oz – 1 gram or less (negligible)

*lactose in fermented foods like yogurt and kefir will vary with brand, flavor and fermentation process

Other foods with lactose content

Obviously any food prepared with milk will include lactose. The amount depends on dairy content. For example a quiche made the classic way, with cream, will have less lactose then one made with milk. The catch: more fat and calories (but tasty!).

Whey is another potential source of lactose in some prepared foods and protein powders.

• pudding
• custard
• ice cream
• bakery products made with milk, such as cakes or some quick breads
• cream style soups and chowders
• cream sauces
• milk shakes and smoothies made with milk or yogurt
• eggnog
• quiche
• coffee creamers
• mashed potatoes
• whey protein powder and foods containing whey protein

You don’t have to give up dairy!

Dairy foods are great. High protein, high calcium, plenty of other nutrients (B12, zinc, phosphorus,…). They fit into a vegetarian diet. They add variety and flavor. I’d hate to do without them. My solution is lactase enzyme supplements for foods like milk or yogurt or butterscotch pudding. Low lactose foods like cheese aren’t a problem. I’d probably consider a supplement if I were consuming a significant portion of a cream soup or some other food with significant milk content.

Speaking of butterscotch pudding, here’s the recipe. I don’t take credit for it; it was passed on by a relative. I might only make it once a year, for a treat. A little bit goes a long way, so stick to tiny portions if it’s dessert. Perhaps serve in an espresso cup. It’s a good choice for people with poor appetites who need to boost food intake. Frail elderly people or cancer patients who have lost significant weight during treatment or anyone who is recovering from a debilitating illness.