Lactose Intolerance (cont.)
What are the sources of lactose in the diet?
Although milk and foods made from milk are the only natural sources of
lactose, lactose often is "hidden" in prepared foods to which it has
been added. People with very low tolerance for lactose should know about the
many food products that may contain lactose, even in small amounts. Food
products that may contain lactose include:
- Bread and other baked goods
- Processed breakfast cereals
- Instant potatoes, soups, and breakfast drinks
- Margarine
- Lunch meats (except those that are kosher)
- Salad dressings
- Candies and other snacks
- Mixes for pancakes, biscuits, and cookies
Some products labeled nondairy, such as powdered coffee creamer and whipped
toppings, also may include ingredients that are derived from milk and,
therefore, contain lactose.
Smart shoppers learn to read food labels with care, looking not only for milk
and lactose among the contents but also for such words as whey, curds, milk
by-products, dry milk solids, and nonfat dry milk powder. If any of these are
listed on a label, the item contains lactose.
In addition to food sources, lactose can be "hidden" in medicines.
Lactose is used as the base for more than 20% of prescription drugs and about 6%
of over-the-counter drugs. Many types of
birth control pills, for example, contain lactose, as do some tablets for stomach
acid and gas. However, these
products typically affect only people with severe lactose intolerance.
How is lactose intolerance treated?
Dietary changes
The most obvious means of treating lactose intolerance is by reducing the
amount of lactose in the diet. Fortunately, most people who are lactose
intolerant can tolerate small or even moderate amounts of lactose. It often
takes only elimination of the major milk-containing products to obtain
sufficient relief from their symptoms. Thus, it may be necessary to eliminate
only milk, yogurt, cottage cheese, and ice cream. Though yogurt contains large
amounts of lactose, it often is well-tolerated by lactose intolerant people.
This may be so because the bacteria used to make yogurt contain lactase, and the
lactase is able to split the lactose during storage of the yogurt as well as
after the yogurt is eaten (in the stomach and intestine). Yogurt also has been
shown to empty more slowly from the stomach than an equivalent amount of milk.
This allows more time for intestinal lactase to split the lactose in yogurt,
and, at least theoretically, would result in less lactose reaching the colon.
Most supermarkets carry milk that has had the lactose already split by the
addition of lactase. Substitutes for milk also are available, including soy and
rice milk. Acidophilus-containing milk is not beneficial since it contains as
much lactose as regular milk, and acidophilus bacteria do not split lactose.
For individuals who are intolerant to even small amounts of lactose, the
dietary restrictions become more severe. Any purchased product containing milk
must be avoided. It is especially important to eliminate prepared foods
containing milk purchased from the supermarket and dishes from restaurants that
have sauces.
Another means to reduce symptoms of lactose intolerance is to ingest any
milk-containing foods during meals. Meals (particularly meals containing fat)
reduce the rate at which the stomach empties into the small intestine. This
reduces the rate at which lactose enters the small intestine and allows more
time for the limited amount of lactase to split the lactose without being
overwhelmed by the full load of lactose at once. Studies have shown that the
absorption of lactose from whole milk, which contains fat, is greater than from
non-fat milk, perhaps for this very reason. Nevertheless, the substitution of
whole milk or yogurt for non-fat milk or yogurt does not seem to reduce the
symptoms of lactose intolerance.
Lactase enzyme
Caplets or tablets of lactase are available to take with milk-containing foods.
Adaptation
Some people find that by slowly increasing the amount of milk or
milk-containing products in their diets they are able to tolerate larger amounts
of lactose without developing symptoms. This adaptation to increasing amounts of
milk is not due to increases in lactase in the intestine. Adaptation probably
results from alterations to the bacteria in the colon. Increasing amounts of
lactose entering the colon change the colonic environment, for example, by
increasing the acidity of the colon. These changes alter the way in which the
colonic bacteria handle lactose. For example, the bacteria produce less gas.
There also may be a reduction in the secretion of water and, therefore, less
diarrhea.
Calcium and vitamin D supplements
Milk and milk-containing products are the best sources of dietary calcium, so
it is no wonder that calcium deficiency is common among lactose intolerant
persons. This increases the risk and severity of osteoporosis and the resulting
bone fractures. It is important, therefore, for lactose intolerant persons to
supplement their diets with calcium. A deficiency of vitamin D also causes
disease of the bones and fractures. Milk is fortified with vitamin D and is a
major source of vitamin D for many people. Although other sources of vitamin D
can substitute for milk, it is a good idea for lactose-intolerant persons to
take supplemental vitamin D to prevent vitamin D deficiency.
Next: What are the long-term consequences of lactose intolerance? »
- Birth Control Pills (Oral Contraceptives) - Read about the different types of birth control pills (oral contraceptives) such as monophasic, biphasic, and triphasic. Find out which birth control pill may be the best for you.
- Endoscopy (Esophagogastroduodenoscopy, EGD) - Learn about the endoscopy procedure which examines the esophagus, stomach and duodenum to detect gastrointestinal and digestive disorders on MedicineNet.com
- Abdominal Pain - Learn about abdominal pain (pain in the stomach / abdomen) including causes, symptoms, how abdominal pain is diagnosed, and how abdominal pain is treated.
Latest Medical News
Digestion RSS