RX For Readers: Lactose intolerant?
Does having lactose intolerance mean I have to give up milk and cheese completely?
Cheese fondue Photo: Laura Frankel
I am a 32-year-old man and have just been diagnosed with lactose intolerance,
even though I never had such a problem before. But I’m a vegetarian and have
loved milk products – from ordinary milk to yogurts and cheeses – since I was a
child. Does having the condition mean I have to give them up completely?
Chavi Kramer, a nutritionist from Atid, the Israel dietetic association,
Lactose intolerance is a condition that affects a large proportion of
the adult population around the world. In the Caucasian population,
approximately one in 20 people is lactose intolerant. By comparison, the
prevalence in South America, Africa and Asia reaches a massive 50 percent, and
100% in some Asian countries. Thus there is a huge number of people affected by
It is common for many to assume they might suffer from
this condition if they feel unwell after consuming milk or dairy in some form.
Lactose is what we call a simple sugar. It is mainly found in dairy foods such
as milk. Normally, the body breaks down lactose and uses it for energy with the
help of an enzyme called lactase.
Interestingly, the majority of mammals
do not produce lactase once they are weaned, but most humans continue to produce
it throughout life.
For those of us who do not have enough of the lactase
enzyme, or don’t produce it at all, problems such as diarrhea, flatulence,
bloating and abdominal pain can occur if too much lactose is consumed at a meal.
This condition is known to doctors as lactose intolerance or lactase
What happens when the lactose isn’t properly digested?
Usually, lactose is broken down by lactase into two components called glucose
and galactose. These compounds can be used by our body for energy.
lactase isn’t around to break down the lactose, lactose remained undigested and
is broken down by the bacteria in our body for their own nutrition. This
process, called fermentation, causes the symptoms commonly experienced by those
who are lactose intolerant.
Many people with lactose intolerance can
actually consume a small amount of lactose and still not have
Depending on the person (everyone experiences different levels
of tolerance), often one can have one third of a cup of milk (3.8 grams of
lactose), while cheese and yogurt (the bacteria in the yogurt break down the
lactose themselves) are usually well tolerated.
Full-fat milk is better
tolerated than skim milk because the fat in the milk slows down the travel time
of the lactose, allowing any lactase enzymes more time to break down the
lactose. It is also recommended to spread consumption of milk products evenly
throughout the day and consume them with other non-dairy products to improve
There are three options when it comes to eating dairy
products: 1. Choose milk alternatives, like soy.
Remember to check that
there is added calcium.
2. Choose lactose-free or lactose-reduced dairy
products, items available in most supermarkets or health-food shops.
There are also lactase enzymes (Lacteeze), which can be taken before eating any
lactose-containing product to help digest the lactose. The Lacteeze temporarily
replaces the lactase enzyme in your digestive system, available as tablets or
powder form. The tablets are taken before eating anything containing lactose,
while the powder is mixed with dairy that is in a liquid form. For most adults,
two tablets are sufficient, but the dose can be adjusted to meet your
A healthy friend of mine who is 64 told me her doctor suggested
that she take zinc supplements because about two out of five people over 60 have
a deficiency in the mineral because they don’t eat enough whole grains, nuts,
beans and low-fat dairy products. Her doctor says it is good for reducing the
risk for cancer, gastrointestinal problems, dementia and inflammation, and for
strengthening the immune system. I asked my doctor, and he didn’t recommend it
because he said he didn’t know much about the subject. Do experts recommend that
older people take the supplement?
Dr. (PhD) Olga Raz, chief
clinical dietitian of Tel Aviv Sourasky Medical Center, replies:
I don’t think
any research on zinc has been conducted on Israelis. If I find patients who have
hair loss or mouth sores, I prescribe it. But logically, there is likely to be a
deficiency if there is stress, rapid growth of the body and as people get older.
Zinc supplementation is an interesting issue that has not been studied enough.
The problem is that zinc is an intracellular element, so when you check it in
blood, extracellularly, you aren’t really checking the actual values, so that
even if a value is normal, it doesn’t mean much. More studies are needed, but
getting more zinc from one’s diet, at least, is certainly recommended.
for Readers welcomes queries from readers about medical problems. Experts will
answer those we find most interesting. Write Rx for Readers, The Jerusalem Post,
POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02)
538-9527, or e-mail them to email@example.com, giving your initials, age and
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