Lactose intolerance

Published October 24, 2020, 9:14 PM

by Dr. Jose Pujalte Jr.


Dr. Jose Pujalte, Jr.

“He asked water, and she gave him milk.” – The Holy Bible, Judges 5:25

Taking milk ad libitum knowing you’re lactose intolerant is much like getting into a relationship that you know is bad for you. You get a bum stomach, gas, and diarrhea – and I’m just talking about the bad relationship. In lactose intolerance, you also get nausea, abdominal pain, and bloating.

What is it? A quick look at the US National Institutes of Health (NIH) website gives this succinct definition of lactose intolerance: “the inability or insufficient ability to digest lactose, a sugar found in milk and milk products.” It’s further explained that lactose intolerance is caused by a deficiency in lactase, an enzyme found normally in the small intestine. Without it, the body is unable to break down lactose into two simpler forms of sugar, glucose and galactose which are then easily absorbed in the bloodstream. Incidentally, Filipinos (being Asian), are right smack in that broad swath of the milk-averse.

Two Types. Primary lactase deficiency occurs after the age 2 with full-blown symptoms seen in late adolescence or adulthood. A genetic link is suspected – a scientific way of saying that farting from milk runs in the family. Secondary lactase deficiency occurs after injury to the small intestine (after severe diarrheal illness, celiac disease, or chemotherapy).

Diagnosis. Lactose intolerance can be mistaken for the potentially serious cow milk allergy. In the latter, even just a small amount of milk can cause life-threatening allergic reaction. Milk allergy occurs in the 1st year of life but lactose intolerance is commonly an adult malady. You may bring your child or baby to a pediatrician. Adults may see a family medicine doctor or a gastroenterologist. A visit to a hospital’s registered nutritionist/dietitian should be a wise move. For children, a stool acidity test is mandatory because the doctor will want to detect undigested lactose that creates excess lactic acid. I’m not sure if a hydrogen breath test is available here in which undigested lactose is noted by a heavy concentration of hydrogen in the breath. A good doctor, however, may rely more on her clinical eye.

Treatment. The good news is that the body can tolerate milk (also ice cream, cheese, yogurt) even if lactase is deficient. A good idea is to take it with a meal. It also helps to experiment with just how much milk or milk products you can get away with. Milk products (read the food label!) include lactose, whey, curds, milk by-products, dry milk solids, and non-fat dry milk powder. The calcium that milk provides can be taken from soy milk, sardines, tuna, salmon; spinach, lettuce and beans. In case you’ve forgotten, calcium is needed for strong bones. Osteoporosis in the elderly is already a public health menace because of multiple fractures that cause chronic pain and disability. Calcium is also better absorbed with Vitamin D but without Vitamin D-fortified milk, get it from eggs and liver. Dietary supplements of calcium and Vitamin D are another option.

I suppose that lactose intolerance is one of those inequities in life. We learn to accept what we can have and cannot have and become sturdier for it. Even Epicurus had his “pot of cheese” but only if a friend would bring him and then called the occasion a feast. Now it makes me wonder if he was lactose intolerant.

 Dr. Pujalte is an orthopedic surgeon. E-mail [email protected]