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When dairy makes you sick

Lactose, a naturally occurring sugar in milk and milk products, can often leave you gassy and bloated, a condition called lactose intolerance. Here is how you can manage it

Lactose intolerance occurs when the body doesn't produce enough lactase, an enzyme that breaks down lactose (Unsplash)

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I can't eat this, but I am still going to

We all have a friend with a stomach that cannot tolerate different foods, yet it doesn't stop them from trying their luck. It's almost as if their food intolerance has become a personal challenge: to eat and persevere through the most uncomfortable side effects. If that food intolerance is milk and dairy products, I will make a polite excuse and leave. No, I am not being unsympathetic. But, honestly, if someone chooses to challenge their gut, over and over again, with lactose when it is proven that they can't handle it, I rather not stick around for the seismic gut activity that is likely to occur.

Also read: Do I really have to switch to brown rice?

So, what exactly is lactose? Lactose is a naturally occurring sugar in milk and milk products. High levels of lactose are found in milk, but dairy products such as fresh, sour, and ice cream also contain high levels. However, that doesn't mean that all dairy products contain high levels of lactose, and they may not have the same effect if it does. Products that have gone through fermentation, such as kefir and yoghurt, contain lactose, too but lack the gastrointestinal consequences of liquid milk products.

According to the Mayo Clinic, lactose intolerance occurs when the body doesn't produce enough lactase, an enzyme that breaks down lactose into two different sugars (galactose and glucose). The undigested lactose then makes its way to your large intestine, where it begins to ferment. If you're familiar with fermentation, you'll know it produces gas. Therefore, it should be no surprise that the byproduct of this fermentation inside the body is the production and build-up of hydrogen, carbon dioxide, and methane. All these, in turn, can create intraabdominal pressure. In real terms, this fermentation process produces gas that can clear a room, bloating that can painfully distend our abdomens to double their size, nausea, and cramping. 

None, I must admit, are particularly pleasant for the person suffering from it or the people in the same room. How badly you suffer from your lactose intolerance is based on a number of factors, including how much lactose you ingest, intestinal transit time, the variability of your gut bacteria, psychological factors, and the unique variables that make up your overall health and genetics.

Unfortunately, despite all of the delicious milk-based foods that exist, lactose intolerances are incredibly common. A sad fact is that most of us can't handle lactose. According to the paper titled Development of Personalized Nutrition: Applications in Lactose Intolerance Diagnosis and Management, almost 70% of the global population cannot digest lactose properly. But what's incredibly interesting about this finding is that milk tends to be tolerated by babies, and our ability to tolerate it progressively declines as we age. This distinction is incredible from an evolutionary standpoint since it ensures that babies can tolerate milk products when their need for sustenance and nutrients needs to come in liquid form.

The interesting facts about milk and lactose intolerance don't stop there. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), whether or not you can handle your milk may also depend on your ethnicity. There are sections of people worldwide who have a higher risk of lactose intolerance, such as African Americans, American Indians, Asians, and Hispanics/Latinos. Europeans, and people involved in generational dairy farming, according to NIDDK, are more likely to have a gene that allows them to digest lactose after infancy, sometimes known as "lactase persistence" (LP). Lucky them!

Also, according to the Mayo Clinic, are three categories of lactose intolerance, two types relate to age, and one refers to disease and dysfunction. Being lactose intolerant from birth is a rare disorder classified as congenital lactose intolerance. Primary lactose intolerance refers to our body's gradual decline of lactose intolerance. Secondary lactose intolerance is associated with conditions and diseases such as celiac disease, irritable bowel syndrome, chemotherapy, and antibiotic treatments.

It's easy, however, to associate all discomfort around ingesting milk and milk products with lactose intolerance. However, it may not be the case. Lactose intolerance shouldn't be confused with a milk protein allergy, which can be much more severe. A milk protein allergy is an excessive autoimmune response to proteins present in milk, like casein or whey, which can cause an allergic reaction. These range from slight (skin rash, acne, or mucous build-up) or severe (anaphylactic shock). 

Also read: Can you build muscle on a plant-based diet?

If you suspect you have an intolerance to lactose, one of the best ways to check if you do is to conduct a basic food elimination test. The best way to conduct one of these self-tests is to treat yourself to a science experiment. Set your experiment duration (approximately a month), write down what foods you will eliminate, and then record your food and physical symptoms during the elimination and reintroduction periods. The key to your reintroduction period is to start slowly – adding a small amount to your diet daily. If your physical symptoms come back with the reintroduction of lactose-based products, you're like to be a sufferer.

Once you've discovered that you and lactose aren't compatible, here are some ways to start minimizing your intake and maximising your relief.

Understandably, it's tough to give up lactose-based foods. Some of the best foods in the world are dairy-based (read between the lines, I'm referencing cheese primarily). Dairy products are also action-packed with vitamins, minerals, proteins, and essential fatty acids that help hydrate and satiate us, so giving them up isn't necessarily the answer. We mostly think of calcium when it comes to the benefit of dairy products, which strengthen and maintain our bone strength, so we are less at risk from fractures and breaks as we age and live. 

Here is what you can do

Know your dairy 

You can maintain adequate calcium levels by reducing your milk, which has a higher lactose content and replacing it with milk products such as yoghurt, curd, kefir, and some hard cheeses.

Lactose-free milk 

There are now plenty of varieties of lactose-free milk on supermarket shelves these days. Alternatively, sheep or goat's milk tends to be easier on your digestive system, so if you can handle a slight change in flavour, this may also be a good option.

Plant-based milk 

Our coffee shops and food shops are flooded with plant-based milk alternatives, which allow us to enjoy our favourite milk-based beverages and foods without the fear of discomfort. There are many varieties of plant-based milk, the most common being almond milk.

Combine with a meal 

Some people notice that their discomfort decreases when they consume milk products with a meal rather than on their own. Once again, stay mindful of the side effects and keep a food journal recording your intake and consumption to track your results.

Find hidden sources 

According to Johns Hopkins Health, there is hidden lactose inside some processed foods such as bread, cereals, and salad dressings to make things a little more complicated. If you discover that you're intolerant to lactose, start getting comfortable with reading the back of labels of the foods you traditionally buy to help you make better choices for your gut.

Ultimately, if you're the friend who challenges their digestive system (and the strength of your friendships) by continually having milk-based products, that choice is yours. You can determine what foods you're willing to risk the comfort for and which aren't worth the trouble. Keep these foods in light moderation in your diet to minimise your symptoms.

Jen Thomas is a Chennai-based weight-loss coach

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