- Treatment – Lactose intolerance
- Sources of lactose
- Managing Symptoms
- Treatment for Lactose Intolerance
- How can I manage my lactose intolerance symptoms?
- How do doctors treat lactose intolerance?
- Lactose Intolerance Diet and Treatment
- Lactose-Containing Foods
- The Lactose Intolerance Diet
- Other Lactose Intolerance Treatments
- Can Lactose Intolerance Be Cured?
- Can changing the microbiome reverse lactose intolerance?
- How is Sodium Caseinate Made?
- In Summary: Watch Out for “Dairy-free” Products
- How is this non-dairy creamer really non-dairy when it has sodium caseinate?
Sources of lactose
A major source of lactose in our diet is milk, including cows’ milk, goats’ milk and sheep’s milk.
Depending on how mild or severe your lactose intolerance is, you may need to change the amount of milk in your diet.
- you may be able to have milk in your tea or coffee, but not on your cereal
- some products containing milk, such as milk chocolate, may still be acceptable in small quantities
- you may find that drinking milk as part of a meal, rather than on its own, improves how the lactose is absorbed
Products made with milk, such as cream, cheese, yoghurt, ice cream and butter, also contain lactose and may need to be avoided if you’re lactose intolerant.
But the level of lactose in these products varies and is sometimes quite low, so you may still be able to have some of them without experiencing any problems.
It’s worth experimenting with different foods to find out if there are any dairy products you can eat, as they’re a good source of essential nutrients like calcium.
Other foods and drinks
As well as milk and dairy products, there are other foods and drinks that can sometimes contain lactose.
- salad cream, salad dressing and mayonnaise
- boiled sweets
- some types of bread and other baked goods
- some breakfast cereals
- packets of mixes to make pancakes and biscuits
- packets of instant potatoes and instant soup
- some processed meats, such as sliced ham
Check the ingredients of all food and drink products carefully, as milk or lactose are often hidden ingredients.
The word “lactose” will not necessarily be listed separately on the food label, so you need to check the ingredients list for milk, whey, curds and milk products such as cheese, butter and cream.
Some ingredients may sound like they contain lactose when they do not, such as lactic acid, sodium lactate and cocoa butter.
These ingredients do not need to be avoided if you’re lactose intolerant.
Some prescription medicines, over-the-counter medicines and complementary medicines may contain a small amount of lactose.
While this is not usually enough to trigger the symptoms of lactose intolerance in most people, it may cause problems if your intolerance is severe or you’re taking several different medicines.
If you need to start taking a new medication, check with your GP or pharmacist in case it contains lactose.
The gas, bloating and cramps of lactose intolerance are no fun, but they’re not dangerous. Most people can manage their symptoms by changing their diet and limiting the amount of lactose they consume. Some people do better by cutting lactose out of their diet altogether.
Your body may be able to handle some lactose without symptoms. Experiment to find out the types and amounts of products with lactose you can eat and drink.
Some high-lactose foods to watch out for:
- Milk and heavy cream
- Condensed and evaporated milk
- Ice cream
- Cottage cheese
- Ricotta cheese
- Sour cream
- Cheese spreads
Some milk substitutes you could try:
- Soy milk — it’s high in protein, potassium and antioxidants
- Rice beverages
- Lactose-free milk — it’s high in calcium and protein and contains many other vitamins, such as A, B, and K, zinc, potassium and magnesium
- Almond milk
- Coconut milk
Learning how to manage your symptoms through diet is key, but it can be a bit tricky.
When you have a meal, try having a small amount of milk or other dairy product along with it. Sometimes lactose can be tolerated more easily when eaten with other foods.
Try a lactose-free diet for 2 weeks. After 2 weeks, add foods with lactose back into your diet gradually and watch your results. This can give you a clearer idea of what and how much of certain foods and beverages you can consume without problems.
Talk to your doctor about taking a dietary supplement that contains lactase.
Try a liquid lactase replacement. These are over-the-counter drops that you add to milk.
Treatment for Lactose Intolerance
How can I manage my lactose intolerance symptoms?
In most cases, you can manage the symptoms of lactose intolerance by changing your diet to limit or avoid foods and drinks that contain lactose, such as milk and milk products.
Some people may only need to limit the amount of lactose they eat or drink, while others may need to avoid lactose altogether. Using lactase products can help some people manage their symptoms.
Lactase products are tablets or drops that contain lactase, the enzyme that breaks down lactose. You can take lactase tablets before you eat or drink milk products. You can also add lactase drops to milk before you drink it. The lactase breaks down the lactose in foods and drinks, lowering your chances of having lactose intolerance symptoms.
Check with your doctor before using lactase products. Some people, such as young children and pregnant and breastfeeding women, may not be able to use them.
Lactase products are tablets or drops that contain lactase.
How do doctors treat lactose intolerance?
Treatments depend on the cause of lactose intolerance. If your lactose intolerance is caused by lactase nonpersistence or congenital lactase deficiency, no treatments can increase the amount of lactase your small intestine makes. Your doctor can help you change your diet to manage your symptoms.
If your lactose intolerance is caused by an injury to your small intestine, your doctor may be able to treat the cause of the injury. You may be able to tolerate lactose after treatment.
While some premature babies are lactose intolerant, the condition usually improves without treatment as the baby gets older.
Lactose Intolerance Diet and Treatment
Avoiding lactose is the best way to manage lactose intolerance.
Research suggests that people who are lactose intolerant can still consume a 12-gram dose of lactose — about equal to the amount that’s in a cup of milk — and experience few or no symptoms.
The best way to manage your lactose intolerance is to maintain a lactose-free diet or keep your periodic consumption of lactose below the 12-gram limit.
Aside from milk (including evaporated and condensed), there are many other foods that commonly contain lactose, such as:
- Ice cream
- Yogurt and kefir
- Heavy, light, whipping, and sour creams
The amount of lactose varies between products, making some products safer to eat than others.
For example, cheddar cheese has far less lactose than feta cheese.
In addition to these milk-based products, many processed foods have lactose added to them, according to the Food and Drug Administration (FDA).
These sometimes include:
- Non-kosher lunch meats
- “Instant” products, such as soups and potatoes
- Powdered meal replacements
- Mixes for pancakes, biscuits, cakes, and cookies
- Baked goods
- Dressings and creamy sauces
- Frozen dinners
- Snack food, including candy
You can generally tell if a product contains lactose by looking at its ingredient list.
It likely has lactose if it contains milk, cream, butter, margarine, cheese, whey, or curds.
Some “non-dairy” products may also contain milk derivatives, such as sodium caseinate, which may have low levels of lactose.
Carefully review the ingredients of products with “hidden” lactose, such as:
Also, so called “non-dairy” products such as powdered coffee creamers and whipped toppings may also contain dairy proteins and lactose.
The Lactose Intolerance Diet
In the past, it’s been standard practice for people with lactose intolerance to avoid all dairy products.
But experts now recommend that you keep some cheese, yogurt, and even milk in your diet.
If you do consume a dairy product, try to do so with other foods, as this helps to slow down digestion, giving your body more time to break down the lactose.
It’s also very important to make sure you maintain a nutritionally well-balanced diet.
Milk contains numerous vital nutrients, including calcium, protein, and vitamins A, B12, and D.
Therefore, you should make sure to supplement your diet with foods enriched with these nutrients — especially calcium and vitamin D — if you’re on a lactose free-diet.
Without enough calcium or vitamin D, you may develop osteoporosis late in life, a medical condition in which your bones become brittle and fragile.
To maintain healthy bones, children and adults require 1000 to 1300 milligrams of calcium and 600 to 800 international units of vitamin D each day, depending on age and sex.
There are several “lactose-free” products that are sources of calcium and/or vitamin D:
- Soy, almond, rice, and coconut milk
- Collard greens
- Fatty fish (tuna, mackerel, and salmon)
- Fish liver oil
- Calcium-fortified orange juice
Vitamin D can also be obtained through sun exposure.
If you’re concerned you are not getting adequate amounts of calcium, vitamin D, and other essential nutrients found in dairy, talk to your doctor or work with a registered dietitian.
Dietary supplements can also help you obtain the recommended amount of nutrients you may be missing while on a lactose-free diet.
The amount of lactose you can tolerate is often determined by trial and error, but almost everyone — regardless of whether or not they are lactose intolerant — needs to keep dairy proteins in check.
These strategies can help you manage dairy in your diet:
- Try dividing your daily lactose intake into four-ounce to eight-ounce servings and spacing them out during the day.
- Solid food slows down emptying of the stomach and allows extra time for lactase to break down lactose. For example, have a small glass of milk along with a full lunch.
- Lactase tablets help digest lactose and are available over-the-counter. You can also opt to drink a brand of milk that contains pre-digested lactose, such as Lactaid.
- Yogurt with live and active cultures is low in lactose and may not give you any problems. The bacterial cultures in yogurt pre-digest lactose, making it a suitable food for many people with lactose intolerance.
The more dairy protein you eliminate, the more you need to add in dairy-free foods that are rich in calcium and other nutrients.
Other Lactose Intolerance Treatments
Though there is no cure for lactose intolerance, various treatments may help you safely consume milk products.
Dietary supplements containing lactase may help you digest lactose if you take the tablets immediately after consuming dairy.
Some research suggests these tablets can help eliminate your lactose intolerance symptoms if you’re consuming up to 20 grams of lactose at a time.
However, the pills don’t appear to be effective for larger amounts (50 grams or more) of lactose, according to a 2010 report produced by the Agency for Healthcare Research and Quality, which also notes that studies investigating the efficacy of lactase supplements generally have small numbers of participants.
Another option for dealing with lactose intolerance is to drink hydrolyzed milk, or lactose-reduced milk, which is produced by adding lactase to the milk hours before consuming it.
But research on this milk alternative shows inconsistent results, the report notes.
Ingesting probiotics (beneficial bacteria), eating yogurt containing live bacteria, and incrementally adding more lactose to your diet may also be effective.
But, again, the research on these treatments has yielded mixed results.
However, these treatment options don’t have any major side effects, so they’re safe to try.
Can Lactose Intolerance Be Cured?
Cheese, ice cream, Greek yogurt-so many of women’s favorite foods can’t be enjoyed by those who are lactose intolerant-or so we’ve been told. But a group of researchers says those with the condition may be able to have their ice cream cake and eat it too.
The 14-member panel at the Development Conference on Lactose Intolerance and Health concluded that diagnosing lactose intolerance isn’t as simple as it sounds: Many people lacking the digestive enzymes necessary to digest dairy tolerate the foods just fine, while some who have problems with dairy produce plenty of enzymes.
Even better, they say that “avoiding dairy products isn’t even necessary for lactose-intolerant individuals.” Instead, they may be able to eat dairy in moderation and-get this-lactose intolerance may even be able to be cured.
Sounds crazy, but it may be true. “The key to successfully overcoming this is to not just eliminate dairy for a time but to ‘heal and seal’ the gut before trying it again,” says Jill Grunewald, a holistic health coach and expert in treating food intolerances. Thanks to an unhealthy diet, illness, or antibiotic useage, many people suffer from “leaky gut syndrome” where the lining of the intestinal wall has thinned, thereby allowing pathogens and undigested food into the blood stream, Grunewald explains. She offers five steps for helping cure your dairy issues:
RELATED: 7 Foods to Ease an Upset Stomach
1. Identify. To figure out if dairy is the real issue, eliminate it entire for at least 21 days. Be sure to check for the bold “Contains milk” under the allergy warning to weed out sneaky sources that you may not realize have dairy in them. After the elimination period, it’s time for elimination provocation. Eat a large serving of whatever type of dairy you like, such as 1 cup milk, 1/2 cup ice cream, or two ounces of cheese, and see if you experience pain, bloating, diarrhea, brain fog, skin problems, fatigue, and/or irritability within 72 hours of eating the food. If you experience any of these symptoms, move on to step 2.
2. Eliminate. This step is as simple as it is hard: Remove dairy-even minute sources like icing on a granola bar-out of your diet for a minimum of six months in order to give your body plenty of time to “seal and heal” the intestinal lining.
3. Substitute. During the elimination period, find healthy substitutes. Grunewald likes coconut, such as coconut milk, coconut oil instead of butter, and coconut yogurt, which are gentle on your sensitive system and offer healthy medium-chain fatty acids. If coconut isn’t your thing, almond milk and goat milk are also good substitutes, but stay away from soy, as it can mess with your hormone balance.
RELATED: Find the Best Milk for You
4. Heal. To fix the “leaky gut,” Grunewald recommends bone broth, probiotics, fish oil, apple cider vinegar, and fermented foods such as kimchi, sauerkraut, and kombucha on a daily basis. While there isn’t any strict amount of the foods to take daily, she says that the more you eat, the quicker your gut will mend, as these are all high in prebiotics or probiotics, as well as other compounds that encourage a healthy immune system and intestinal function.
5. Reintroduce. After six months, baby-step your way to eating dairy again. The National Institutes of Health recommends starting with a couple of tablespoons of yogurt because it comes with digestive enzymes built in. You can also try other foods, but always start with one tablespoon and work up to two or three small servings of dairy a week, slowing adding another tablespoon every three days until you’re eating a normal serving size. Depending on how severe your reaction was to lactose and how well your gut has healed, you still should eat it in moderation-which frankly is good advice even if you don’t have tummy troubles.
- By Charlotte Hilton Andersen
Can changing the microbiome reverse lactose intolerance?
Reversing lactose intolerance might make it possible for adults to enjoy a milkshake again. Credit: YAKOBCHUK VIACHESLAV / .com
After childhood, about two-thirds of the world’s human population loses the ability to digest milk. As far as we know, 100 percent of nonhuman mammals also lose this ability after weaning. The ongoing ability to digest lactose, the main sugar in milk, into adulthood is a biological abnormality.
Lactose cannot be directly absorbed in the intestinal tract and must, instead, be broken down into its two smaller component sugars by an enzyme called lactase. Normally, the activity of the gene that produces lactase, LCT, declines after infancy. New evidence suggests that this decline occurs not because the genetic code is changed, but because the DNA is chemically modifiedso that the lactase gene is switched off. Such modifications that affect gene activity while leaving the DNA sequence intact are called epigenetic. The epigenetic modification that turns off the lactase gene does not happen in lactose-tolerant individuals. This new finding gives an important insight into how lactose intolerance develops with age or after trauma to the intestinal tract.
I’m a microbiologist, and I became interested in the causes of lactose intolerance because it afflicts a close friend. He is of Norwegian descent and, like most Norwegians, is genetically lactose tolerant. But, he became permanently lactose intolerant at the age of 45 after a long regimen of antibiotics.
There are other cases of people who should be able digest lactose because of their genetics, but lose that ability late in life, either spontaneously or when the small intestine is damaged by disease or other traumas. In most cases, the lactose intolerance goes away when the underlying cause is treated, but some people become permanently lactose intolerant.
The lactase enzyme breaks down the sugar lactose into two smaller sugars that can be absorbed in the small intestine. Credit: http://www.evo-ed.com, CC BY-NC
It seems possible, even probable, that such trauma to the digestive tract can trigger the same epigenetic change that normally turns off the lactase gene in childhood. Scientists have found other cases of such environmentally induced epigenetic changes, although more research is needed to establish the persistence and consequences of these alterations.
Lactose intolerance is mostly due to your genes
While the ability to produce the lactase enzyme persists into adulthood in only about 35 percent of adults worldwide, this proportion varies widely among ethnic groups. In the U.S., the proportion of lactose-tolerant people is about 64 percent, reflecting the mixture of ethnic groups that populate the country.
The ability of adults to digest lactose appeared in humans relatively recently. Specific genetic changes – known as single-nucleotide polymorphisms, SNPs – conveying lactase-persistence arose independently in various populations around the same time as their domestication of dairy animals. None of these SNPs are in the lactase gene itself, but instead are in a nearby region of the DNA that control its activity. Scientists have been trying to figure out how these changes exert their influence over this gene’s behavior.
his SNP, located 13910 base pairs in front of the lactase gene, has the DNA base pair C:G replaced by a T:A. The change apparently prevents the DNA from being methylated at this site, and so the lactase gene stays active. Credit: http://www.evo-ed.com, CC BY-NC
Recently researchers have shown that one of the SNPs changes the level of epigenetic modification of the DNA in the lactase gene control regions. Specifically, the SNP prevents small chemical units, called methyl groups (which consist of one carbon and three hydrogen atoms) from being attached to the DNA. Methyl groups are especially important in regulating gene activity because when they are added to the DNA, they turn off the gene.
These studies imply that after early childhood, the lactase gene is usually shut off by DNA methylation. The SNPs that alter the DNA sequence in the control region, however, prevent this methylation from happening. This, in turn, results in the production of lactase because the gene is kept on.
To date, five different SNPs have been strongly associated with lactase persistence, and another 10 or so have been found in isolated populations. The estimated times of appearance of these SNPs in different cultures range from 3,000 (Tanzania) to 12,000 (Finland) years ago. That the trait persisted and spread in these populations indicates that the ability to digest milk beyond infancy had a significant selective advantage.
Lactic acid bacteria can digest the sugar lactose and produce lactic acid as a byproduct. Credit:Dr. Horst Neve, Max Rubner-Institut, CC BY-SA
Your microbiome and lactose intolerance
The symptoms of lactose intolerance include diarrhea, stomach pain, cramps, bloating and flatulence, all of which result from failure to break down lactose in the small intestine. As undigested lactose moves into the large intestine, water enters to reduce the lactose concentration, producing diarrhea. The lactose is eventually eaten by microorganisms in the large intestine, producing, as byproducts, various gases that cause bloating, cramping and flatulence.
Recent studies have shown that the symptoms of lactose intolerance can be relieved in some people by changing the population of their intestinal microbes, called the microbiome, to encourage lactose-digesting bacteria. Specifically, bacteria, called “lactic acid bacteria,” eat the lactose but produce the byproduct lactic acid instead of gas. While lactic acid has no nutritional value, it does not produce the unpleasant symptoms of lactose intolerance. This adaptation of the intestinal microbiome may be how some ancient pastoral populations with no genetic evidence of lactase persistence tolerated a dairy-rich diet.
Ingesting lactic acid bacteria as a probiotic can alleviate the symptoms of lactose intolerance, but these bacteria may not persist in the colon. A promising new strategy is to “feed” the lactic acid bacteria a complex sugar that they can digest but humans cannot. In initial clinical trials, subjects using this “prebiotic” reported improved lactose tolerance and had a corresponding shift in their intestinal microbiome. Larger clinical trials are in progress.
So there is hope for lactose-intolerant people that real ice cream may be on the menu again.
Epigenetic study of lactose intolerance may shed light on the origin of mental illness Provided by The Conversation
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Citation: Can changing the microbiome reverse lactose intolerance? (2019, April 11) retrieved 2 February 2020 from https://medicalxpress.com/news/2019-04-microbiome-reverse-lactose-intolerance.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.
Dairy-Free and Non-Dairy: Milk-Allergic Consumers?
Milk-allergic consumers and the parents of milk-allergic consumers should be somewhat cautious about the use of food products labeled as dairy-free or non-dairy. These terms can appear rather prominently on the labels of food packages. However, these terms should not be used as a short-cut to examination of the ingredient statement that appears on the package label.
What do these terms mean?
No regulatory definition exists for the term, dairy-free. That means that the Food & Drug Administration (FDA) has not established any regulations regarding use of that terminology on package labels. Of course, the FDA does not allow the use of false and misleading terms in general on food labels. But without a regulatory definition in place, there can be no assurance that foods labeled as “dairy free” are in fact free from any milk proteins.
Should milk-allergic consumers purchase dairy-free products? Not without first reading the ingredient statement. Although such products generally should be okay, the Food Allergy Research & Resource Program (FARRP) has, in the past, identified products from several smaller manufacturers that contain milk even though they are labeled as dairy-free. Some companies may use this term to describe lactose-free or low-lactose products for those consumers with lactose intolerance. Or they may use it on products that are free of traditional dairy ingredients such as milk and cream but not free of milk derivatives such as caseinates or whey. However, if the products contain milk protein, they are unsafe for individuals with milk allergy. Unfortunately, those with milk allergies cannot rely on “dairy free” claims and will need to scrutinize the ingredient statement for evidence of milk.
A regulatory definition does exist for the term, non-dairy. But, incredibly, the regulatory definition actually allows the presence of the milk protein, casein, in such products. Non-dairy is commonly used on coffee creamers made from caseinate, a milk protein, rather than milk or cream. The term, non-dairy, is a long-standing byproduct of the strong dairy lobby that wanted to assure that substitute milk and cream products could not bear the dairy name.
Non-dairy definitely does not mean that the product is milk-free. FDA regulations specifically allow the use of caseinates (and casein is one of the major milk allergens) in non-dairy products. However, the term, caseinate, will appear in the ingredient statement and must be followed by a parenthetical explanation, such as (a milk derivative). While non-dairy is a term that is frequently used on coffee creamers, it is also used similarly on various other products containing caseinates. Once again, careful inspection of the ingredient statement is the consumers best defense.
By the way, many professionals in the food industry would agree that the FDA regulation for the term, non-dairy, is ludicrous. However, changing regulations that actually exist in the Code of Federal Regulations is a long and tortuous process.
It’s pretty obvious that sodium caseinate is not vegan-friendly when you hear its other name – milk powder.
On ingredients list, milk powder is the more common term, but sodium caseinate is sometimes listed.
It’s often used in powdered coffee mixes, lactose-free milks, and even in the cream versions of instant oatmeal.
If you buy coffee (and related products), you need to be read the ingredients carefully to check for sodium caseinate because the product still might be labeled “dairy-free”. This is allowed in some places for some reason if a product doesn’t have lactose.
Note that even if you’re interested in vegan creamers just for allergy reasons, it’s still very possible to have an allergic reaction to sodium caseinate in “lactose-free” products.
How is Sodium Caseinate Made?
Milk from animals has many types of proteins.
From cows, which almost all dairy products come from, there are 2 main ones: whey and casein.
Casein makes up about 80% of the proteins in cow’s milk.
Sodium caseinate is just a specific form of casein (which describes a family of proteins) that’s the most popular form used in foods.
It’s has many useful properties for food products, like as a foaming agent or emulsifier.
There are only 2 main steps needed to make sodium caseinate:
- Acid coagulation – A common technique in cheese making that causes casein micelles (bunches of molecules) to clot and essential form blobs.
- Alkaline sodium reaction – The extract casein is reacted with sodium hydroxide, which forms a casein salt (sodium caseinate).
The reason for the second step is because pure casein doesn’t dissolve well in water, but the salt version dissolves easily.
Can Vegan Sodium Caseinate Be Made?
In theory, a vegan version of just about any ingredient can be made in a lab.
All we’d need to do is recreate its molecular formula (C47H48N3O7S2Na).
And while that’s probably possible, there’s no easy way to do it, so it’d be expensive.
In other words, there won’t be a vegan version of sodium caseinate for a LONG time.
In Summary: Watch Out for “Dairy-free” Products
Let’s be very clear: Sodium caseinate is never vegan, although it would be fine for a lacto-vegetarian.
It often hides near the end of ingredient lists, so check carefully.
You’ll find it most often in:
- Coffee products (powdered coffee or lactose-free creamers)
- Ice creams
- Grains in general.
To make things even more annoying, it’s allowed to go in “dairy-free” products in certain places.
I know it’s not convenient, but you have no other choice than to be diligent checking the ingredient label of any grain or milk product you buy.
How is this non-dairy creamer really non-dairy when it has sodium caseinate?
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