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Lactose Intolerance

By Alan S. Peterson, MD
Walter L. Aument Family Health Center

What is lactose intolerance?

If you have lactose intolerance, you have trouble digesting milk, cheese, and other dairy products.  This condition is most common in people of Asian, American Indian, Hispanic, South American, or black heritage. 

What causes lactose intolerance?

If you have lactose intolerance, you have trouble digesting milk because your body does not make enough lactase.  Lactase is an enzyme that breaks down the natural sugar in milk.  This sugar is called lactose.

What problems does lactose intolerance cause?

The main problems caused by lactose intolerance in adults are:

  • Rumbling tummy sounds
  • Gas
  • Stomach cramps
  • Stomach bloating
  • Diarrhea

The condition is different in each person. Some people with this problem can safely drink small amounts of milk, especially if they eat food with it. Other people can’t drink any milk or eat any dairy at all without having problems. Problems can often start as early as two years of age, when the body naturally starts making lactase. However, it is not uncommon to find lactose intolerance beginning as one becomes older—especially those in their 50’s and up. 

How is lactose intolerance treated?

You can make changes in your diet that will help you digest milk, or you can get your calcium from other foods. 

Milk products are an important source of calcium. Your goal should be to get 1200 to 1500 milligrams of calcium each day. Children, teenagers, women who are pregnant or breastfeeding, and women who have gone through menopause should take calcium supplements if they can’t drink enough milk (4-5 glasses of skim milk) or eat enough dairy products to get this much calcium.

Ask your doctor if you should take calcium supplements. There are many kinds. Calcium citrate may be absorbed a bit better, but it is also more expensive. Check the amount of calcium on the product label.  Some antacids have a lot of calcium in them. They make a good calcium supplement if you have to take antacids anyway for heartburn. Hormone research is showing that we are not getting enough vitamin D into our bodies these days. One may want to take a calcium supplement that has added vitamin D.

If you can, eat and drink smaller servings of dairy products, but have them more often to see if your body will tolerate them. The smaller the serving, the less likely that you will have problems. 

Eat food when you drink milk if you have a lactose intolerance. This slows the digestive process, and you will have less chance of having problems with digesting the lactose if you have a lactose intolerance.

You may not have any trouble eating yogurt if it includes an active culture. Check the label to see if an active culture is included. 

Ice cream, milk shakes, and aged (hard) cheeses are easier to digest than milk for most people with lactose intolerance, but these foods are high in fat. If your weight and cholesterol and triglyceride levels are normal, and there is no history of cholesterol or heart problems in your family, you might try them, especially in your younger years.

Look for lactose-reduced milk in your grocery store if you have lactose intolerance. Many of these have 70% less lactose than regular milk, but it costs a little more. Some are so sensitive to lactose that they need 100% lactose-free milk.  That can also be obtained at the grocery store.

One can also try adding lactase to regular milk. You can buy lactase at drug stores. This is an over-the-counter item. Some people like the flavor of milk with added lactase because it tastes sweeter.

Instead of drinking milk you could otherwise eat foods that are high in calcium, like leafy greens (such as collards, kale, and mustard greens), oysters, sardines, canned salmon (if you eat the salmon bones), shrimp, broccoli, and Brussels sprouts. You can buy orange juice also with added calcium. 

Where can I get more information?

Talk to your primary care provider concerning this. Many times he or she will just tell you to go on a lactose free diet (no ice cream, cheese, milk or other dairy products) for a week or two to see if your symptoms disappear. This is probably the cheapest way to diagnose lactose intolerance. During that time, of course, you can drink 100% lactose free milk obtained from the grocery store. 

An interesting and fine website is found at the National Digestive Diseases Information Clearing House, telephone number 1-800-891-5389. Its website is http://digestive.niddk.nih.gov/.


Dr. Peterson is a doctor of Family and Community Medicine at the Walter L. Aument Family Health Center, 317 S. Chestnut St., Quarryville.


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