Q: I have always loved to drink whole milk and until recently consumed, believe it or not, almost a gallon every day. Nothing has changed in my diet or in my life but now when I even have one glass, I suffer from nausea and diarrhea. I’m of the belief I may be lactose intolerant but I’m 53 years old. Why now after such a long time with no problems? I miss milk and would love to have it in my diet again.
A: Lactose intolerance implies you are unable to fully digest the lactose in dairy products. The condition is usually not dangerous but it can present a few problems, as you have discovered. Symptoms include nausea, diarrhea, bloating, cramps, and gas that commonly occur between 30 minutes to two hours following the ingestion of milk or eating foods that contain lactose.
The cause of the intolerance is generally the result of having low levels of the enzyme lactase in the small intestine. Lactase attaches to lactose molecules in the foods we eat, breaking them down into two simple sugars. When there is a lactase deficiency, most of the lactose moves unprocessed through the colon where it interacts with normal intestinal bacteria and the symptoms mentioned occur.
Several factors can make an individual lactose intolerant, including the aging process because we produce less of the enzyme lactase as we age. Celiac disease is an immune reaction to eating gluten. Over time, inflammation from celiac damages the lining of the small intestine and causes malabsorption. Crohn’s disease is an inflammatory disease of the digestive tract that is chronic. Bacteria are normally present in small numbers in the small intestine and in large numbers in the large intestine and are necessary to help digest our food.
Testing to include a hydrogen breath analysis and lactose tolerance analysis can help a physician zero in on a diagnosis. The hydrogen breath test requires drinking a liquid high in lactose, followed by a physician measuring the amount of hydrogen in the breath at regular intervals. In a healthy individual, minimal amounts of hydrogen are detectable; however, if the body fails to digest the lactose, it will ferment in the colon, causing hydrogen and other gases to be absorbed by the intestines and ultimately exhaled. It’s these amounts of hydrogen that are measured during a breath test that indicate whether or not a person is fully digesting and absorbing lactose. Another test that could be used is a blood test called a lactose tolerance test that measures the body’s reaction to a liquid that is high in lactose. Blood is draw at the start of the test and then again at the end. Two hours after drinking the liquid, blood will be drawn and analyzed to determine the amount of glucose in a person’s bloodstream. If glucose levels fail to rise, the body will not be properly digesting and absorbing the lactose drink.
Treatment is in the form of diet modification to reduce the intake of dairy products. If you miss whole milk and as difficult as it might be, consider drinking soy milk or substantially smaller amounts of whole milk with smaller meals or snacks throughout the day. Many supermarkets also carry lactose-free milk products. Consider other cultured milk products or over-the-counter probiotics. Keep in mind that a person should continue to receive sufficient amounts of vitamin D which is best obtained through exposure to sunshine 15 minutes a day three to four times each week.
I suggest you perform your own testing. Eliminate dairy products from your diet for two weeks. See if your symptoms lessen or dissipate altogether. If they do, you will have your answer and will need to take steps to modify your diet. If not, it will be time to speak with your health care provider or a gastroenterologist for some testing to determine just what is going on. Good luck.
