How to Know If You Are Lactose Intolerant - Ask a Nutritionist

Transcript:

Amy: Welcome back to “Ask a Nutritionist”, our weekly mini episode of Dishing Up Nutrition. I am Amy Crum, a Registered Dietitian with Nutritional Weight & Wellness, and today we're tackling the question, am I lactose intolerant, or is something else going on?

If you've ever wondered if your GI issues are related to dairy, that glass of milk you've had, or the meal with a lot of cheese on it, then this episode is for you. Lactose intolerance is very common, and the good news is it's usually manageable once you know what's going on.

We'll walk through what lactose intolerance actually is, how to distinguish between lactose intolerance and a dairy sensitivity, and what you can do about it if you have an intolerance or a sensitivity.

What is lactose intolerance?

First, let's start with the basics. Lactose intolerance is your digestive tract’s, inability to properly digest lactose. Lactose is the natural sugar found in milk and dairy products. To digest lactose, your body means an enzyme called lactase. Which is produced in the small intestine. Lactase breaks lactose down into two smaller sugars, glucose, and galactose, so your body can use them for energy. If you don't produce enough of the enzyme, lactase, lactose doesn't get digested properly, and that's where the trouble begins.

How do you know if you’re lactose intolerant?

So how do you actually know if you're lactose is intolerant? The biggest clue is how your body responds after eating dairy. If you consistently notice digestive discomfort after consuming foods like milk, ice cream, soft cheeses, or creamy sauces, that's a strong sign.

Here are a few patterns to look for. If your symptoms show up 30 minutes to two hours after eating dairy, and then the symptoms improve when you avoid dairy, but then the symptoms return when you reintroduce dairy, lactose might be an issue for you.

This sounds simple, but it's the clearest indicator. Some of the most common symptoms of lactose intolerance to look for are bloating, gas, diarrhea, stomach cramps, nausea and loud rumbling, or gurgling sounds in your stomach. The severity can vary a lot here. One clue could be the dose. Some people can tolerate small amounts of dairy better than large amounts.

A sprinkle of cheese on chili might be fine for some, but a large glass of milk might cause a lot more symptoms. Some people react to even tiny amounts of dairy. Here's an important distinction. These symptoms of lactose intolerance are digestive only. That distinction will matter when we talk about dairy allergies and sensitivities in a minute.

There are more complex ways to diagnose lactose intolerance with a medical provider, such as a hydrogen breath test where you drink a lactose containing beverage and your breath is measured for hydrogen gas. In this test, high levels suggest lactose isn’t being digested properly.

There's also a lactose tolerance test where blood sugar levels are measured after consuming lactose. If they don't rise, it suggests poor digestion. In real life, most people can self-identify lactose intolerance based on symptoms and responses to diet changes without needing medical testing.

Keeping a food and symptom log for one to two weeks can be helpful to notice patterns. Write down the dairy products you ate, the amount, the time, and any symptoms that follow. When you see it on paper or in an online food journaling app, it can make it easier to figure out if lactose is the trigger for you. If you're seeing a dietitian, we'd be happy to look over that food log with you and look for those patterns.

Another way to determine if you’re lactose intolerant is to take a short break from lactose. Try cutting back on lactose for two weeks, and then re-introduce it. If your symptoms improve when you took out the lactose, but then returned when you added it back, that could be a strong clue.

What happens when lactose isn't broken down properly?

Now let's zoom in for a closer look on what's actually happening inside your body. When lactose isn't broken down on the small intestine by lactase, it moves into the large intestine where your gut bacteria take over. The bacteria in the gut ferment the lactose, which produces gas, bloating, and could pull water into the colon leading to diarrhea.

Think of the fermentation process of beverages like kombucha. It creates those fizzy bubbles. That's what's happening in your large intestine if lactose isn't broken down properly in the small intestine where it's supposed to be broken down, so essentially if lactose isn't broken down properly in the small intestine, it travels down to the large intestine and becomes fuel for that bacteria, which then produces gas.

What causes someone to be lactose intolerant?

So what causes someone to be lactose intolerant? There are a few reasons. First is called primary lactose intolerance, which is the most common. This is genetic. Many people just naturally produce less lactase as they age.

Next is secondary lactose intolerance. This happens when something damages the small intestine, like celiac disease, Crohn's disease, or gastrointestinal infections. In more rare cases, some babies are born without the ability to produce lactase. For most adults, it's simply a normal decline in lactase over time, not something wrong with your body.

Lactose intolerance vs. a dairy allergy

Now, let's talk about lactose intolerance versus a dairy allergy, because these are two very different things and they often get confused. Lactose intolerance is a digestive issue. A dairy allergy is an immune system reaction. Here's the difference.

Lactose intolerance involves the digestive system. Symptoms are gas, bloating, and diarrhea. It's not an allergic immune response, and it's dose dependent, meaning you may be able to tolerate small amounts. A true dairy allergy, on the other hand, involves the immune system reacting to milk proteins, casein or whey.

Symptoms can include hives, swelling, wheezing, vomiting, or in severe cases, anaphylaxis, which can be life-threatening. A true dairy allergy requires strict avoidance, and you have to be really careful. So if symptoms go beyond digestion, think skin, breathing or systematic reactions, that's not lactose intolerance.

If you're having symptoms that are frequent, it's severe, like blood in the stool, unexplained weight loss, vomiting, or fever, you definitely want to talk to your healthcare provider because digestive symptoms can come from many other causes, and it's better not to assume lactose is the only issue.

And now there is an in-between dairy sensitivity. It's not necessarily lactose intolerance, but your body doesn't react well to eating dairy products. More so from the proteins, casein and whey. Many people experience dairy sensitivity without it being a true allergy.

Common symptoms of dairy sensitivity are fatigue, brain fog, headaches, skin issues like acne and eczema, joint pain, and sinus congestion. These appear even up to a day or two after eating dairy. Whereas lactose intolerance would happen within a few minutes to a couple hours after eating dairy.

People with lactose intolerance can often tolerate low lactose dairy foods like butter, yogurt, and aged cheeses. However, people with the dairy sensitivity often can't tolerate these foods because they're reacting to the dairy protein, which is in all dairy foods in varying amounts. And lactase digestive aids won’t help in the case of a dairy sensitivity.

Is there anything you can take to help with lactose intolerance?

We work with a lot of clients who have some mild symptoms of lactose intolerance, but they really love dairy foods, so they'll ask, is there anything I can take to help me digest dairy foods on occasion? The good news is, yes you can.

There are over the counter lactase enzyme supplements that you can take before eating dairy. These help your body to break down lactose more effectively. You'll often see them labeled as lactase tablets or dairy digestive aids. There are also lactose removed milks and other dairy products. These digestive aids are not perfect for everyone, but many people find them helpful, especially when eating out or traveling when you're not as in control of what's going into your food as you are in your own kitchen.

Practical tips for managing lactose intolerance

So let's talk about practical tips for managing lactose intolerance. If you are lactose intolerant, you don't necessarily have to eliminate all dairy. Here are some practical strategies. See what your tolerance level is. It helps to choose lower lactose dairy options like yogurt or hard cheeses such as cheddar, Parmesan, and Swiss.

Try lactose free milk and dairy products. And there are plenty of dairy alternative milks and other dairy products on the market to choose from. When you're looking at non-dairy milk products, make sure to look at the ingredients. You want to be careful about added sugars and other additives like gums that might cause digestive upset. You can also pair dairy foods with other foods to slow digestion, and use lactase supplements when needed.

I do want to point out an important piece to remember. You don't need dairy foods in your diet to get all of your nutrients. For example, there are plenty of sources of non-dairy calcium foods, and supplementing with calcium is always an option. If you are lactose intolerant, the best option is to limit dairy rather than relying on lactase digestive aids, which are meant to be used on occasion.

Recap

So to recap, if you're experiencing digestive discomfort after dairy, especially bloating, gas, or diarrhea, it could be lactose intolerance. It's common, manageable, and not dangerous, but understanding what's going on in your body can make a huge difference in how you feel day to day.

If you're unsure, try a simple elimination experiment, and a dietitian like me can work with you on making sure you're getting all the nutrients you need if you do need to avoid dairy.

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Thanks for tuning in today. If you found this episode helpful, please share it with someone who's been wondering about their relationship with dairy.