Lactose Free Diet
What is lactose?
The two syllables in the word ‘lactose’ come from the Latin name for milk, ’lactis’, combined with the –‘-ose’ ending given to sugars – and that is exactly what it is, a sugar found in milk. More specifically, lactose is a disaccharide derived from the galactose and glucose found in whey. Most milk contains 2-8% lactose and milk rich in lactose is essential for nursing mammals to stay healthy. Infants release an enzyme, ‘lactase’, in order to break down the lactose into its component parts, the simple sugars galactose and glucose, and absorb them. In most mammals, production of lactase decreases slowly as their consumption of lactase reduces with age.
However, many human cultures in the world rely on mammalian milk as an important food source for adults as well as children. As a result, people have developed genes which allow for life-long production of lactase, although these genes have evolved independently across different ethnic groups, so tolerance to lactose in adulthood varies widely around the globe.
Lactose is found in most dairy produce, with the exception of some well-aged cheeses which are matured so that the bacteria consume almost all the lactose protein. Lactose is not commonly added to our foods because of its relatively poor solubility compared to other sugars (except for baby formula, where it is included in order to more closely mimic mothers’ milk). It is occasionally added to stout beer because it is not fermented during brewing to create milk or cream stout. It is also used as a stabiliser in perfume because of its bland flavour and in the manufacturing pills for the pharmaceutical industry because it’s cheap and easily compressed.
What is lactose intolerance?
Lactose Intolerance is when the body doesn’t produce enough lactase to digest lactose properly, causing the lactose to be fermented and resulting in uncomfortable gastrointestinal symptoms. It affects approximately 5% of the population of the United Kingdom and is most common amongst people of African-Caribbean descent. Globally, it more common amongst people of certain ethnic groups, affecting only 15% of northern Europeans, compared to 90% of Asians. There doesn’t seem to be a difference according to gender, but it normally develops between 20 and 40 years of age and is more prevalent in the elderly as the body naturally produces less lactase with age. Certain health conditions also decrease the production of the lactase enzyme.
How do I know if I’m lactose intolerant?
Common symptoms of lactose intolerance include flatulence (wind) and diarrhoea; less commonly: bloated stomach, abdominal pains or cramps, stomach rumbling and nausea. Which symptoms you experience, as well as their immediacy and severity, varies from person to person and depends on how much lactose you have consumed. The symptoms can be similar to irritable bowel syndrome (IBS) or a milk (casein or whey) allergy. Try excluding lactose from your diet for a couple of weeks to see if your symptoms improve. You should also consult your doctor for proper tests as, if you have an allergy, even a very small amount of milk protein could trigger a reaction. Unlike people with an allergy, people who are lactose intolerant may still consume small amounts of lactose without experiencing adverse effects. Lactose in milk and dairy produce are also a common trigger for irritable bowel syndrome.
What does the lactose-free diet entail?
Eating lactose-free is the best way to handle being lactose intolerant. This means excluding dairy products like milk, cheese and ice-cream from your diet. Not many foods have lactose added, but do check the labels of items like salad dressings, cereals, snacks and baked goods for lactose or lactose-related ingredients. You also need to watch out for anything containing whey, curds or anything with ‘milk’ in the name.
There are lactase substitutes in the form of pills or drops that lactose intolerant individuals who simply can’t do without dairy can ingest to assist in the digestion of lactose. If you simply love cheese, it’s good to know that some well-aged hard cheeses, like Cheddar, Swiss and Monterey, contain live cultures that digest the lactose in the dairy, and so are safe to eat. They will often be labelled ‘lactose-free’. Other cheeses contain very little lactose and may not cause symptoms to develop even if you're lactose intolerant.You can also buy soy or tofu-based milk and cheese that is lactose-free, and these are often fortified with vitamin D or calcium to replace any nutrients lost by the exclusion of dairy from diet. Manufacturers also make dairy-free, lactose-free brands that are readily available in the shops. Yoghurt and yoghurt-based cheeses are often also very low in lactose as the live cultures in the yoghurt also help digest the lactose in the produce.
Medications, such as the contraceptive pill and over-the-counter remedies for stomach acid and gas, can contain a hidden source of lactose. Be careful with sweets and flavourings in snack foods as well.
What are the benefits of a lactose-free diet?
The advantages of a lactose-free diet for a lactose-intolerant individual are self evident. Going lactose-free will eliminate your symptoms almost immediately.
As a lactose-free diet is essentially a dairy free one, it is beneficial to look at the advantages of eating dairy-free. Although concerns over the pasteurized, homogenized, pesticide and hormone ridden milk can be overcome by the consumption of raw, whole, organic milk and dairy, it is also important to examine dairy consumption from an evolutionary perspective. Dairy wasn’t a normal part of human diet until the domestication of animals 10,000 years ago and most humans stop producing lactase (the enzyme needed to break down lactose) during early childhood. If you are lactose intolerant or have irritable bowel syndrome that is triggered by milk products, cutting dairy out of your diet will quickly alleviate your symptoms.
A massive benefit of eating dairy-free is that you are cutting out a lot of saturated fat from your diet, one of the major causes of heart disease. Proponents for the consumption of dairy as part of a healthy, balanced diet cite it as an important source of calcium, historically believed to be essential for healthy bones. However, studies have shown that a high calcium intake doesn’t necessarily lower the risk of osteoporosis or bone fractures. Instead it is vitamin D, which aids in the absorption of calcium that is emerging as the champion for healthy bones. Furthermore, some people argue that dairy products are acid forming after being metabolised, forcing the body to battle harder to retain it’s delicately balanced blood pH level of 7.35-7.45. One of the mechanisms our bodies use to do this is through the release of calcium from our bones (which is ideally then replaced). Proponents of the alkalizing diet will argue that, because of this, consumption of dairy actually weakens bones rather than strengthens them, and researchers have argued that the animal protein in dairy causes bone loss. Furthermore, there are more effective and nutritious ways of ensuring your body has the correct level of calcium and vitamin D than by consuming dairy.
In children, there is evidence that links incidents of anaemia with a high dairy intake. Dairy is also suspected of aggravating allergies and congestion problems like sinusitis and ear infections, as well as chronic constipation. Type 1 diabetics are advised to avoid it completely.
What are the risks of a lactose-free diet?
Studies have shown that a moderate consumption of calcium via dairy can reduce the risk of colon cancer, although high consumption doesn’t seem to reduce it even further. Many people view milk and dairy as a convenient source of calcium. However, it is unclear what the optimal method is for the consumption and absorption of calcium so cutting dairy out of your diet doesn’t necessarily lead to calcium deficiency. There are plenty of supplements out there and it is easy to subsidise your calcium intake by eating foods naturally high in calcium and vitamin D, such as dark green leafy vegetables like kale, as well as legumes and beans. Milk and dairy are also a good source of protein, as well as vitamin A, but it is relatively easy to source these nutritional essentials elsewhere in your diet.