Prepping for Lactose Intolerance: Diagnosing and Managing It When Things Fall Apart

I got to thinking about the issue of lactose intolerance because my father-in-law has problems with it and wondered what we would do if my husband developed the same condition.  I didn’t think it would be addressed in any of the off-grid medical references, and I was right about that.  After all, it’s not really a life-or-death issue.  And the general answer for such an inconvenience is just to avoid milk.  Right?

Well, not quite.

It’s not just as simple as not drinking any milk.  What about cheese? What about the beneficial probiotics found in yogurt and which are especially helpful when taking a course of antibiotics?  What about calcium?  We in the US get most of our calcium from dairy products.  What about milk used in baking and cooking?  If a person develops a serious lactose intolerance, how does s/he compensate for the loss of nutrients?  (Studies have shown that people with lactose intolerance are at greater risk for osteoporosis and bone fractures.[1])  What about the powdered milk stored for that person and all the menu items planned around it?

So before proceeding any further, what exactly is lactose intolerance?

Lactose intolerance is the inability of the body to digest lactose, a sugar occurring in milk and many other dairy products. 

Diagnosing

The classic symptoms of lactose intolerance include:

• Abdominal pain
• Diarrhea
• Nausea
• Vomiting
• Gas
• Bloating[2]

However, these symptoms are common to many other illnesses.  What distinguishes lactose intolerance, and is thus a big clue that the person is indeed suffering from lactose intolerance, is that the symptoms appear within 30 minutes to 2 hours after consuming foods high in lactose.  Unfortunately, conclusive tests—the lactose tolerance blood test and a hydrogen breath test won’t likely be available with a collapsed medical system.  A less conclusive DIY test is to have the patient drink two glasses of milk without eating or drinking anything else.  Ask the patient how he feels in two hours.[3]  If he has any of the above symptoms, lactose intolerance is a pretty good guess. 

However, even if lactose intolerance is suspected as the reason for the patient’s discomfort, keeping a food journal for a couple of days will be invaluable.  The patient will need to record everything he eats and drinks and the amounts and time as well as how he feels after eating those foods.[4]  It may well be that the patient can still consume moderate amounts of lactose with meals.[5]  In other words, he will not have to completely avoid milk and other dairy products.

There are several types of lactose intolerance.

Congenital lactose intolerance (congenital alactasia) occurs in infants who cannot digest breast milk or formula.  It is an extremely rare condition, affecting less than 1 in 60,000 newborns.[6]  Symptoms include severe diarrhea which will lead to weight loss and serious dehydration if afflicted infants are not switched to a lactose-free formula.[7] 

Developmental lactase deficiency sometimes occurs in infants born prematurely, usually before 34 weeks of gestation.  It is usually short-lived and ends when the intestinal mucosa becomes fully developed.[8]

Primary lactose intolerance manifests by the time this group of people reaches adulthood.  They start life off being able to digest milk properly but as these children age and replace milk with other foods, the amount of lactase produced diminishes significantly.  It affects a startling 65-70% of adults worldwide.[9]  People with lactose intolerance who consume dairy products may experience abdominal pain, bloating, flatulence, diarrhea, and/or nausea beginning 30 minutes to 2 hours after consuming the dairy products.[10]

Secondary lactose intolerance arises when the small intestine decreases lactase production after an illness, injury, or surgery affecting the small intestine.    Diseases affecting the small intestine and associated with secondary lactose intolerance include celiac, Crohn’s, irritable bowel syndrome, bacterial overgrowth, and intestinal infections.  Managing the cause of secondary lactose intolerance may resolve the condition and it may take weeks to months before the patient returns to normal.

Risk factors for lactose intolerance

• Family history
  
• Increasing age
• Ethnicity East Asian, West African, Native American, Greek, Italian, Arab, Jewish[11] [12]
• Premature birth
• Diseases affecting the small intestine
• Certain cancer treatments[13] [14]

Managing

• Cut back on lactose consumption, while still drinking milk.  There are several lactose-free powdered milk choices on Amazon.
• Consume dairy products with meals to slow digestion of the lactose and dilute the effects.[15] (“The solution to pollution is dilution.”)
• Lactase enzyme supplement pills help a great many people.  Of course, they would need to be stocked in advance. 
• Consume lactose regularly.  One study found that lactose-intolerant young women who consumed lactose daily for three weeks were eventually able to tolerate it.[16]  This is because the bacteria in the large intestine will adapt to what they are being fed.[17]
• Beware of fillers.  Lactose is a common filler for many medications and nutritional supplements.[18]
• Many people with lactose intolerance can still consume dairy products to varying degrees without experiencing adverse symptoms.  So these people may still be able to happily eat foods made with powdered milk.

Frequently those with lactose intolerance are not able to drink fresh milk, but digesting cheese or yogurt doesn’t present any noticeable problems.[19] Dairy foods with low levels of lactose that may often be consumed in moderation by the lactose-intolerant include:

• Butter
• Buttermilk
• Aged/hard cheeses (Parmesan, Swiss, cheddar)[20]
• Yogurt (Make sure it’s real yogurt—that it contains the active yogurt cultures.  Frozen yogurt doesn’t count—it’s more like ice milk than yogurt.)[21]
• Kefir
• Heavy cream
• Whey protein powders[22]
• Dark chocolate[23]
• Cottage cheese[24]

Links to related posts:

Rice Based Baby Formula

How to Make Yogurt 

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[1] https://pubmed.ncbi.nlm.nih.gov/14753735/

[2] https://news.umiamihealth.org/en/can-you-suddenly-develop-lactose-intolerance/

[3] https://www.prevention.com/health/a20429112/9-tips-for-living-with-lactose-intolerance/

[4] https://news.umiamihealth.org/en/can-you-suddenly-develop-lactose-intolerance/

[5] https://www.prevention.com/health/a20429112/9-tips-for-living-with-lactose-intolerance/

[6] https://medlineplus.gov/genetics/condition/lactose-intolerance/#statistics

[7] https://medlineplus.gov/genetics/condition/lactose-intolerance/#statistics

[8] https://www.medicalnewstoday.com/articles/can-you-develop-lactose-intolerance#causes

[9] https://medlineplus.gov/genetics/condition/lactose-intolerance/#statistics

[10] https://medlineplus.gov/genetics/condition/lactose-intolerance/#statistics

[11] https://medlineplus.gov/genetics/condition/lactose-intolerance/#statistics

[12] https://www.prevention.com/health/a20429112/9-tips-for-living-with-lactose-intolerance/

[13] https://www.mayoclinic.org/diseases-conditions/lactose-intolerance/symptoms-causes/syc-20374232

[14] https://news.umiamihealth.org/en/can-you-suddenly-develop-lactose-intolerance/

[15] https://news.umiamihealth.org/en/can-you-suddenly-develop-lactose-intolerance/

[16] https://www.prevention.com/health/a20429112/9-tips-for-living-with-lactose-intolerance/

[17] https://www.prevention.com/health/a20429112/9-tips-for-living-with-lactose-intolerance/

[18] https://www.prevention.com/health/a20429112/9-tips-for-living-with-lactose-intolerance/

[19] https://medlineplus.gov/genetics/condition/lactose-intolerance/#statistics

[20] https://www.webmd.com/diet/foods-high-in-lactose

[21] https://www.prevention.com/health/a20429112/9-tips-for-living-with-lactose-intolerance/

[22] https://news.umiamihealth.org/en/can-you-suddenly-develop-lactose-intolerance/

[23] https://www.webmd.com/diet/foods-high-in-lactose

[24] https://www.webmd.com/diet/foods-high-in-lactose