THE DETAILS: First, the panel noted that it's difficult to estimate the number of people suffering from lactose intolerance, a condition characterized by gas, bloating, abdominal pain, and diarrhea after eating dairy products, due to a lack of representative studies and adequate diagnostic tests. They add that many people who lack lactase, the enzyme needed to digest the lactose in dairy products, don't exhibit symptoms of lactose intolerance, whereas others who diagnose themselves as being lactose intolerant often have appropriate levels of lactase and wouldn't always qualify as clinically intolerant. The problem with patients and physicians relying on self-diagnosed lactose intolerance is that many people avoid dairy unnecessarily, putting themselves at risk for osteoporosis and vitamin D deficiency—which may in turn put them at greater risk of prostate, colon, breast, and esophageal cancers. And some of the newer research suggests that calcium from dairy products could lower blood pressure and reduce colon polyps, possibly leading to lower rates of colon cancer.
In fact, said the panel, avoiding dairy products isn't even necessary for lactose-intolerant individuals. The experts concluded that someone with lactose intolerance could tolerate as much as 50 grams of lactose, the same amount found in a quart of milk, per day before exhibiting symptoms.
Read on for more ways to cope with lactose intolerance.
WHAT IT MEANS: There's a great deal of confusion surrounding lactose intolerance, says Robert P. Heaney, MD, professor of medicine at Creighton University School of Medicine and one of the contributing experts on the panel. Starting with how to know if you have it. "It's an entirely subjective problem," he says, "and there isn't any test that will tell you if you're intolerant." You may be intolerant if you suffer from gas, bloating, or diarrhea every time you drink a glass of milk—but the symptoms have to be consistent. There are various other forms of indigestion that are similar to lactose intolerance, Dr. Heaney says, so don't give up milk entirely if one or two glasses have upset your stomach in the past. And if you've been off of dairy for awhile, it's worth giving it another try. Even kids with milk allergies can drink milk after going off of it for a year or so, he says.
That's important, Dr. Heaney adds, because eliminating dairy from your diet—even if you are intolerant—could be a bad nutritional decision, given the highly processed nature of the average American diet. "If you eliminate dairy from your diet, you're almost certain to have a bad diet," he says. "Milk protein is the richest source of branch chain amino acids in the diet, and dairy is a tremendously good source of phosphorous, vitamin B12, and riboflavin. It's hard to find any other single food that will give you the levels of nutrients you get in dairy."
People who are lactose intolerant can become tolerant again by easing milk back into their diets, which you can do with the following steps:
• Start with half a cup. Research has shown that lactose-intolerant people can tolerate about 12 grams of lactose in a single dose without experiencing any symptoms. That's the equivalent of a cup of milk, and Dr. Heaney says that drinking milk with food cuts down on symptoms even more. However, if you do suffer unpleasant symptoms and have given milk up entirely, gradually ease it back into your diet by drinking one half-cup of milk with a meal once a day. The following week, increase it to two half-cups at two meals, and the third week, to three half-cups with food. Gradually adding milk back helps reestablish the intestinal flora that help you digest lactose, Dr. Heaney says, which makes it easier for you to tolerate.
• Eat yogurt. Both Dr. Heaney and the panel of experts noted that even lactose-intolerant individuals can tolerate yogurt because its live cultures help maintain healthy levels of intestinal bacteria. And one cup of yogurt has more calcium than a cup of milk. The panel also noted that 1.5 ounces of hard cheese, such as cheddar, provolone, or mozzarella, could be well tolerated, but look for low-fat versions, as these are often high in saturated fat.
• Buy lactose-free milk and tablets. Lactose-free milk and lactase tablets, which you swallow while drinking regular milk, are both good alternatives to ordinary milk. But, says Dr. Heaney, "all those are more expensive, and the easiest fix is just to build up your tolerance for milk."
• Find other dietary sources of nutrients. Often, Dr. Heaney says, people who are lactose intolerant won't drink milk because they don't like it, and the panel wrote that it's difficult to get people who have diagnosed themselves as intolerant to eat or drink foods they think will aggravate their symptoms. In those cases, he adds, "there's no point in trying to get them to drink it." Eat other high-calcium foods such as calcium-fortified soy or rice drinks and fruit juices, as well as dried beans and leafy greens, which are both full of calcium and other nutrients. But try to at least give milk a shot. "The key here is not just calcium but the other nutrients that are in milk," he says.