RX For Readers: Lactose intolerant?

Does having lactose intolerance mean I have to give up milk and cheese completely?

Cheese fondue  370 (photo credit: Laura Frankel)
Cheese fondue 370
(photo credit: 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? A.R., Rehovot
Chavi Kramer, a nutritionist from Atid, the Israel dietetic association, replies:
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 this condition.
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 deficiency.
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.
If 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 symptoms.
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 tolerance.
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.
3. 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 needs.
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? V.A., Ashkelon 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.Rx 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 protected], giving your initials, age and place of residence.