East West - The Asian American Lifestyle Magazine

Examining the prevalence, symptoms and remedies for lactose intolerance
By Riddhi Trivedi-St.Clair

As kids, my brother and I loved milk.

But even as a baby, our younger cousin would refuse to drink milk. I still remember my aunt chasing her with the requisite morning glass of milk in hand. Everyone in the family — kids included — was convinced the youngster was being difficult, but she could have just been lactose intolerant. In fact, recent research shows that 90 percent to 95 percent of Asians and people of Asian descent experience lactose intolerance. 

Lactose intolerance is actually termed as “lactase non-perseverance.” In most people, the enzyme lactase, which helps break down milk’s major sugar, lactose, disappears after infancy leaving the individual unable to digest large amounts of dairy. A recent study by a group of Asian and Finnish scientists found that “most people” equates to 30 million and 50 million North Americans who are lactose intolerant — 75 percent of African Americans and 90 percent of Asian Americans.

The idea of losing the enzyme isn’t as strange as it seems. “Humans are the only mammals that consume milk after infancy. It is quite unique to humans and presumably historically occurred when cows were domesticated,” says Dr. Jean-Pierre Raufman, the head of gastroenterology and hepatology at the University of Maryland Medical Center in Baltimore and professor of medicine at the University of Maryland School of Medicine. “And milk is not a common staple food in many areas of the world. There are no Chinese forms of cheese – at least none that I know of.” 

Lactose perseverance, the opposite of intolerance, is actually caused by a gene mutation found mostly in people living in cold climates where it is hard to grow winter crops. The mutation occurred more than 10,000 years ago when human populations started using dairy culture, according to Dr. Leena Peltonen, a geneticist at the University of California at Los Angeles.

Even without the gene mutation, however, not all people experience the same degree of lactose intolerance. How intolerant someone is and what symptoms they have varies from person to person. Most people who are lactose intolerant can consume yogurt, cheeses and some dairy products without having bad effects, according to Dulcie Ward, staff physician at the Physician’s Committee for Responsible Medicine, a Washington, D.C.-based nonprofit organization. 

“Milk tends to bother people more because it has higher amounts of lactose, but you can see it in varying degrees,” Ward says. “There are people who are severely intolerant with diarrhea, stomach cramps, bloating and gas. Those are the most severe symptoms.” Others have mild stomach cramps or gas and bloating. The variance in symptoms can be so significant that many experts say most people don’t even realize how prevalent lactose intolerance is and they don’t associate their symptoms with it.

However, when the connection between symptoms and dairy intake is made, Raufman says most people can pick and choose what dairy products they can consume without triggering symptoms. But some experts, including Ward, say the best course is to simply avoid all dairy products. She says the long-held belief that dairy is necessary for bone health and for adequate amounts of nutrients is simply not true. “You can just cut dairy out and add other good calcium sources and [put] soy or rice milk on your cereal,” Ward says. 

Dr. Ellen Cutler, D.C., founder and president of the BioSET Institute and author of the book “The Food Allergy Cure,” thinks people’s reactions to milk are not solely based upon their inability to digest lactose, but that it could be sensitivity to the proteins in milk or even sensitivity to the enzyme lactase itself. In some cases, Cutler says, people could even be sensitive to other sugars such as maltose in grains, sucrose or dextrose in fruits. As such, rather than give up dairy she suggests taking a digestive enzyme. Depending on the specific sensitivity the person has, Cutler says, there are sugar-specific or wide-range enzymes that can help with digestion.

If that doesn’t work, she says her own technique, BioSET, does. 

BioSET (BioEnergetic Sensitivity and Enzyme Therapy) is a cleaning process designed to help clear food sensitivities. It works on principles similar to acupressure and helps rid the system of intolerance through a process resembling biofeedback.

Whichever treatment approach is taken, experts agree that the key to beating lactose intolerance is education. There is very little awareness about lactose intolerance, especially regarding the prevalence of the problem among specific populations. 

Intolerance, in fact, varies widely not just among populations but also among generations, Raufman says. “Depending on where people are from and when they immigrated to the U.S., whether they are first- or second- or later-generation immigrants…All of that is going to affect their eating habits and their tolerance,” he says.

The government-endorsed USDA food pyramid also signals the need for more education and awareness. Raufman points out that the widely referred to pyramid encourages the intake of dairy products despite the known prevalence of lactose intolerance in high percentages of the population. 

However, the USDA does note the following selection tip in regard to the pyramid’s recommendation of approximately 3 cups daily from the milk group: “For those who are lactose intolerant, lactose-free and lower-lactose products are available. These include hard cheeses and yogurt. Also, enzyme preparations can be added to milk to lower the lactose content. Calcium-fortified foods and beverages such as soy beverages or orange juice may provide calcium, but may not provide the other nutrients found in milk and milk products.”

While some experts seem to disagree with these suggested alternatives, Raufman’s message seems to be a consistent thread among all the theories and solutions: “We need much better, widespread education of lactose intolerance, its symptoms and options and solutions for people who have it.”  With more education, each individual can find a substitution that is right for them.

Quick Reference: Lactose Intolerance

We touched base with Dr. Rajesh N. Keswani, a gastroenterologist at the University of Chicago, for a rapid review of the symptoms, signs and self-care options. 

What are the common signs/symptoms?

Patients generally complain of crampy abdominal pain, bloating and flatulence soon after ingesting dairy products. Diarrhea may also be present and children may also complain of vomiting.  It is important to know that these symptoms are fairly nonspecific and can be seen in other digestive diseases. 

When should you see a doctor?

When your food intake is significantly limited by your symptoms or if you have symptoms that don't respond to the elimination of lactose, you should see a doctor who specializes in digestive diseases. Because the symptoms of lactose intolerance are seen in a variety of conditions, your doctor may need to perform a breath test, which measures the amount of hydrogen in your breath after eating dairy. If this test does not demonstrate lactose intolerance or your symptoms do not improve, your doctor might begin a workup for other diseases such as celiac disease (intolerance to wheat), colitis (inflammation of the colon) or irritable bowel syndrome (spastic colon).  These diseases can be seen in a patient with lactose intolerance or mimic the symptoms of lactose intolerance.

What are some self-care tips?

The first thing to do is see if you have self-diagnosed correctly. If the elimination of dairy products stops your symptoms, you likely have lactose intolerance. If your symptoms persist, it is helpful to read food labels carefully to make sure you are not accidentally ingesting lactose. If you want to keep lactose in your diet, you can add over-the-counter supplements, which supply the missing lactase protein needed to digest lactose. All over-the-counter products act somewhat differently, so try different ones until you find one that works for you. And finally, remember that if you are limiting the dairy in your diet, it is important to maintain calcium supplementation with vitamin D to avoid osteoporosis.