DEAR DOCTOR K:
I’ve recently become lactose-intolerant. Is there a treatment for this? Or do I have to say goodbye to cheese and milkshakes forever?
Yes, there is a treatment. But whether it will allow you to eat cheese and drink milkshakes occasionally depends on your gut.
Lactose intolerance occurs when your gut does not have enough of an enzyme called lactase. Lactase breaks down lactose, the main sugar in milk. When lactose isn’t properly broken down, it can cause abdominal cramping, bloating, gas and diarrhea.
There are two main ways to treat lactose intolerance. The first option is to reduce the amount of lactose you eat by limiting milk and dairy products.
You’ll need to read labels of all prepared foods to see if they contain lactose. Milk and ice cream contain the most lactose. (Interestingly, ice cream tends to be tolerated better than other foods that contain lactose.) Cheeses typically have lower amounts of lactose.
Some products listed as “nondairy” may contain lactose if they have ingredients that are derived from milk. These include powdered coffee creamer and whipped toppings. Look for words on food labels such as whey, curds, milk byproducts, dry milk solids and nonfat dry milk powder. If any of these ingredients are listed, the product probably contains lactose.
If you completely avoid lactose, your symptoms should go away. But of course you’re not interested in completely avoiding cheeses or milkshakes. Nor would I be, if I were you.
So the second treatment option is to use a lactase replacement product. If your gut isn’t making enough natural lactase, you can take lactase drops or pills. They replace at least some of what your gut isn’t making. For example, you can add lactase drops to milk and then refrigerate the milk for 24 hours before use.
Lactase replacement can reduce your symptoms significantly, although it rarely gets rid of symptoms completely. Many of my patients on lactase replacement tell me they are willing to tolerate the much milder symptoms they do get.
Pretreated dairy products are an effective alternative. You can purchase dairy products that have already been treated to reduce the lactose (“lactose-free” milk, for example).
But before you eliminate dairy products or turn to enzyme tablets, make sure that you really are lactose-intolerant. Similar symptoms can be caused by fructose, sorbitol or other sugars that are not easily digested.
Your doctor can do testing for lactase deficiency. When you swallow lactose, do you develop symptoms? Does your blood sugar go up a lot? If it does, that means you are not deficient in lactase: The enzyme has broken down the lactose to the simple sugars measured in the blood. Does the hydrogen in your breath go up a lot? If so, you’ve got lactase deficiency.
The easiest way to check — and to avoid a visit to the doctor — is to try a lactose-free diet for a week or two. If your symptoms improve dramatically, you’re probably lactose-intolerant. You can get the lactase treatment without a prescription. Who needs doctors? (Did I say that?)