Tuesday, August 04, 2009

Lactose Intolerance

I decided I had to write this today, after seeing a post on The Kitchn which again infuriated me on this topic. People just don’t seem to understand lactose intolerance. It’s been turned into a joke (just watch Burn After Reading). Even people who try to look like experts don’t always know what they are talking about.

What bothered me today in particular was an article written by an ex-cheesemonger, with an introduction paragraph that basically said that people who have symptoms after eating cheese are probably allergic to dairy, not lactose-intolerant. That is not true. First of all, the symptoms of an allergy are not the same as those of a food intolerance. Second of all, as I’ve said on many occasions, some cheeses have lactose and others don’t. In general, the more aged a cheese is, the less lactose it contains, because during fermentation, some bacteria break down the lactose. So an aged cheese like parmesan or Swiss should be fine for most lactose-intolerant people, but many fresher cheeses (like cottage cheese, ricotta or mozzarella) still contain a lot of lactose. You also need to keep in mind that there are varying degrees of lactose intolerance. I know people who describe themselves as only mildly lactose-intolerant and who can digest dairy much more easily than I can. However, I’m not at the extreme end of the spectrum either, because I’ve never reacted to the lactose in my birth-control pill (for example), whereas some people need special prescriptions for medication that does not contain lactose.

Then, to make matters worse, the comments following the article made me realize just how stupid/misinformed/ignorant people are about this condition. One person says, “I roll my eyes when a certain person I know turns down foods with CHEDDAR because of ‘lactose intolerance’. Come on! Just because cheese makes you gassy, doesn't mean you are lactose intolerant! Geesh!” Well, what do you think symptoms of lactose intolerance are, exactly? Spontaneous combustion? Gas is actually one of the major symptoms of lactose intolerance, along with bloating, cramps and diarrhea. So yes, someone with lactose intolerance will most probably either turn down mild cheddar or take lactase pills with it. There is some aged cheddar that is easier to digest, however, and the Live Active cheddar from Kraft is also lactose-free, thanks to all the probiotics in it.

Someone else also suggested cheese made from sheep or goat milk, saying that is was okay for people with lactose intolerance. It is not, and I wish people would stop repeating such nonsense! All mammals produce lactose in their milk. Someone who is intolerant to lactose will have trouble/be unable to digest milk, be it from a cow or a goat. As a matter of fact, even goats can be lactose-intolerant. I’ll also give you a link to a great article that I recommend you read, in order to have more information on this subject.

So, what is lactose intolerance? It is when your body cannot digest lactose. Lactose is a sugar found in milk. In most people of Northern-European descent, the small intestine contains an enzyme called lactase. Lactase breaks down the lactose into smaller molecules called glucose and galactose, which can then be absorbed by your body. But when there is no lactase to break down the lactose, as is the case for people who are lactose-intolerant, the lactose stays in the intestine and starts to ferment, causing bloating and producing a gas with a distinctive smell (which can actually be used to diagnose lactose intolerance). In some cases, there is so much air that the body reacts by evacuating the content of the intestines a.s.a.p., which causes diarrhea. Here is a really good explanation, even though the author is neither a doctor nor a scientist.

Again, there are two kinds of lactose intolerance. Primary lactose intolerance is hereditary and it usually becomes noticeable when a person is in his/her early twenties. This is because as a general rule, adult mammals lose the ability to digest lactose, to a certain degree (though there is such a thing as lactase persistence). When it becomes noticeable (which happens more often in populations that are Asian or African than in Northern European ones), the adult is said to be lactose-intolerant. There is also secondary lactose intolerance, which can be temporary and is usually caused by some trauma (disease, surgery, drugs, etc.). In either case, treatment is the same: either avoid lactose, or ingest the correct quantity of lactase alongside it to counter its effects. Unfortunately, the only way to find the correct dosage for your level of intolerance (depending each time on which product you eat and on how much of it you eat) is by trial and error.

I feel the need to repeat that just because someone is lactose-intolerant doesn’t mean that he/she can’t drink dairy milk. Grocery stores have a relatively good selection of lactose-free cow milk, and it usually tastes just the same (I recommend Natrel brand; I did not like Lactaid brand, which had a weird aftertaste; I have yet to try the Lactancia). This is also nothing new; it had been in stores alongside regular milk for years by the time I became lactose-intolerant, in 2004. Yet I still meet people, some of whom are even lactose-intolerant, who have no idea this product exists. But in order to eat dairy again, you just need to understand what lactose is and how it is broken down. For example, most yogurts that have active bacteria in them will be easy to digest, because the lactose will be broken down before you eat it. But you have to read the label, because some yogurts on the market do not have live cultures. Similarly, traditional sour cream was made through fermentation, and the lactose in it was broken down before it ever reached the store. These days, however, most companies cut costs by adding an acidic component to cream in order to make it curdle and sell it as sour cream, so that product is still full of lactose. As a general rule, the more dairy is processed, the more likely it is to still contain lactose (for example, real parmesan is fine, but parmesan from a green can is not). You just have to educate yourself about this condition and open your eyes in the stores – the variety of lactose-free dairy products or dairy replacements increases all the time.


R!!! said...

I heartily agree with your comments.
I often find people and mass media can be dismissive and make fun of assorted food related problems (lactose intolerance, allergies, gluten enteropathies, etc..), which is truly a shame as these conditions can seriously interfere with people's eating habits.
As a side note, lactose tolerance in predominantly people of european descent is often considered one of the most recent and most noticeable elements of human evolution. Due to more limited diets in the cold northern European climates, alternate food sources needed to be found, so those who were able to consume animal milk were more likely to survive to reproduce and pass on their lactose tolerant genes. Voila, evolution!
Natural selection, actually.
By the way, I've always been curious about how much milk can be tolerated. Are products that contain scant amounts of lactose acceptable (such as gravy that contains "milk products" or things that contain "whey")?

Amélie said...

In reply to your question... It depends. There are two basic types of whey in food: whey protein concentrate (which contains a lot of lactose, over 50%) and whey protein isolate (maybe 1% lactose). So the latter should be okay for most people who are lactose-intolerant.
That being said, it can be difficult, if not impossible, to figure out how much lactose is in a manufactured product just based on the ingredient list! I tend to err on the side of caution. Of course, since people have different degrees of intolerance, it might be different for everyone.

Danny Vogel said...

I totally agree about what you said about okay cheeses for the lactose intolerant. I was completely ignorant myself and avoided all cheese for 20 years. Then I read the website of the cheese company Cabot which says its aged cheddars are okay for the lactose intolerant because during a year of fermentation aged cheddars' lactose break down into galactose and other sugars. I would guess ANY cheddar aged for at least 1 year that says 0g sugar on the label should be okay for any lactose intolerant person. I am bravely trying the different ones and so far so good. But when you mention probiotic rich yoghurts, are you sure? Yoghurts are not aged, after all. The health food store sells lots of yoghurts with added cultures - are you sure I am not going to get major diarrhea on those? I would love to eat yoghurt again too. I will have to do more research on that one... danny

Amélie said...

Well, regarding the yogurts...

The brand I know I can eat without any problem is Activia, which does have probiotics. But I think what really makes a difference is yogurts containing live cultures versus ones that don't. It is the same as with sour cream: the manufacturer can do things the old-fashioned way, with live cultures that happen to break down the lactose, or cut corners and offer a product with no live cultures, which tastes the same but has lactose. You really have to read the package to figure it out. I've seen yogurts labelled "live cultures", while others say "contains sugar (lactose)" or nothing at all, so clearly there's a difference.

A lot of companies that make yogurts with live cultures will say "probiotics", because it's fashionable right now and it gets them more customers than just saying "live cultures", but they're usually the same thing. You could try a small serving and see if you can tolerate it.

Amélie said...

I decided to link to another article from Steve Carper's blog, written very recently and broaching the topic of yogurt and probiotics: http://planetlactose.blogspot.com/2009/09/yogurt-and-probiotics-part-1.html

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