Got Gas? It Could be Lactose Intolerance

Learn to avoid dairy but get your calcium, even if you're lactose intolerant.

How is LI diagnosed?

There are three tests most commonly used to diagnose LI: the lactose tolerance test, the hydrogen breath test and the stool acidity test.

The lactose tolerance test. This test is appropriate for both older children and adults. Patients will fast for several hours before the test begins. Blood is drawn to measure the current blood glucose level. Next, the patient will drink a liquid that contains up to 50 grams of lactose. For the next two hours, more blood samples are taken to measure blood glucose levels. If the lactose is being broken down in the body by the enzyme lactase, the blood glucose level will rise. If the blood glucose level does not rise, that means that the lactose is not being broken down into simple sugars and the patient has LI.

The hydrogen breath test. This test is very similar to the lactose intolerance test and might be done on children as young as 6 months as well as adults. After fasting for several hours, the patient will exhale in to a mouthpiece connected to a foil bag that looks like a balloon. This bag is to be used as a comparison for the second part of the test. Next, the patient will drink a liquid that can contain up to 50 grams of lactose. More breath samples will be taken at various intervals for up to 6 hours.

Normally, there is no hydrogen present in a person's breath. When a lactose intolerant person ingests lactose, it stays in their intestines and ferments, ultimately producing hydrogen gas. Therefore, if hydrogen is present in the breath samples taken after drinking the lactose, the diagnosis of LI can be made.

The stool acidity test. This test is normally done on infants and small children. It is noninvasive and presents no problems, such as dehydration caused by diarrhea, from ingesting large amounts of lactose. A stool sample is collected and tested for lactic acid, glucose and other short-chain fatty acids that may be present when lactose remains undigested by the body.

How about treatments?

LI is most often controlled through adjustments to the diet. For small children, all foods that contain lactose should be avoided. For adults and older children, the amount of lactose that can be tolerated will vary. Some people may be able to eat butter and aged cheeses, which have low levels of lactose, while others may find one glass of milk won't bother them, but two will. Only through trial and error can people with LI discover the type and amounts of dairy products that are tolerated.

Tips for reducing dairy intake:

• Eat foods that contain lactose with other foods.
• Read food labels carefully.
• Eat smaller portions of foods that contain lactose.
• Try a milk substitute (soy or rice milk).
• Try yogurts with "live cultures;" they may be better tolerated.

If avoiding dairy is a problem, there are several commercial products available that contain the enzyme lactase. These products come in several different varieties. One type is a liquid drop that can be added to milk to break down the lactose content. The lactose can be reduced anywhere from 70 to 90%. Another is in a pill form that's swallowed just before or with the first bite of dairy. Still more are chewable tablets that are also taken at the beginning of a meal containing dairy. Lactose reduced milk, ice cream, cheeses and other dairy products are also readily available.

Be on the lookout for hidden lactose. Up to 20% of medications use lactose as a base. Your pharmacist will know which ones. Read food labels carefully, because foods containing whey, curds, milk by-products, dry milk solids and nonfat dry milk powder will contain lactose. Other foods that may contain lactose are:

• Bread and other baked goods
• Breakfast drinks
• Candies and snacks
• Chewing gum
• Commercial pie crusts
• Cookies and sandwich cookie fillings
• Cream cordials and liquors
• Creamed vegetables
• Dips
• French fries (lactose is a browning agent)
• Instant coffee (with sugar, creamer, flavoring)
• Instant potatoes
• Lunch meats
• Margarine
• Pancakes, biscuits and cookie mixes
• Powdered coffee creamers
• Processed breakfast cereals
• Pudding and mixes
• Salad dressings
• Soups

But don't I need to get calcium from milk?

• Infants to 6 months: 210 mg
• 6 to 11 months: 270 mg
• 1 to 3 years old: 500 mg
• 4- to- 8-years-olds : 800 mg
• 9- to- 18-years-olds: 1,300 mg
• 19- to- 50-year-olds: 1,300 mg
• 51 and older: 1200 mg
• 50-year-old women and older not taking HRT: 1,500 mg
• Pregnant and nursing women: 1,000 mg (younger than 18 years old: 1,300 mg)

Calcium, as we all know from the famous commercials, is necessary for "strong bones and healthy teeth." Women and girls, in particular, need to make sure they get the proper amount of calcium every day.

People avoiding or cutting back on dairy foods need to get their calcium from other sources. Fortunately, drinking a glass of milk is not the only way to get calcium! A physician or nutritionist may recommend a daily calcium supplement. There are numerous varieties of supplements, and enlisting the help of a healthcare professional to choose the appropriate one is essential. For those who would like to get calcium from a food source, I have listed below several foods that have significant amounts of calcium, yet are nondairy.

To sum up

There are many myths, fallacies and controversies surrounding dairy and lactose intolerance. It's not known why our bodies stop being able to digest milk sugars, but we do know the result can be embarrassing and distressing. The best way to combat LI is to be armed with knowledge about what foods cause symptoms and how to avoid them.

_Source:

The National Digestive Diseases Information Clearinghouse. ”Lactose Intolerance.” National Institute of Diabetes and Digestive and Kidney Diseases Mar 2006. 4 Nov 2008.

US Food and Drug Administration. “ Problems Digesting Dairy Products?” FDA.gov 25 March 2008. 4 Nov 2008.

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