Have your cheese and eat it too

“I’ve never met anyone who is lactose intolerant who is serious about their lactose intolerance”.

WHY can’t some of us tolerate it? What’s actually going on, and are there things we can change in our diet that might impact our tolerance?

Potentially. But you’ll just need to listen to find out!


Welcome back to the Bite Me Nutrition podcast.

Today we're going to be going through lactose intolerance.

Should be a pretty quick one, I feel like, but basically going to take you through what lactose is, what lactose intolerance is, and what you can do, how you should manage your lactose intake if you feel that you might be lactose intolerant. So let's do it.

Basically, lactose is the primary sugar or carbohydrate found in milk and so therefore

in most other dairy products, right. It's what's called a disaccharide so it kind of means a sugar molecule and dimensing two. So it's actually two sugar molecules joined together, a glucose molecule and a galactose molecule. Those combined make lactose.

Right now we need to talk about lactase. Lactase, not to be confused with lactose. Lactase is the enzyme in your body that breaks down lactose. So it breaks down the disaccharide, the glucose combined with the galactose, and it breaks those up into separate glucose and galactose molecules. If you can think of two circles joined together bya line, it comes through and it cuts through that line and helps you break down and digest that lactose. Now, when lactose is broken down into the smaller components of glucose and galactose, they can be absorbed comfortably in your small intestine. So you digest it, you absorb glucose and galactose  in the small intestine and not too much lactose is left undigested. That means that not too much lactose makes it to your large intestine. That's if you've got reasonable amounts of lactose or other things we'll go through in a second, the problem becomes if you don't break down that lactose, then too much of it makes its way to the large intestine, where it can be over fermented by the gut bacteria, right?

So if the lactose isn't broken or cleaved into its separate molecules, it remains intact all the way to the large intestine, gut bacteria, ferment it, get a little bit overexcited and make a bit too much gas, which can cause water to be drawn into the large intestine. And that's why we often see those symptoms of bloating, gas, diarrhea, et cetera, that can be quite common in lactose intolerance. There are two reasons why that might occur. The first is if you don't have enough levels of lactase and or you've taken in too much lactose. So there's very much a dose response relationship going on here. If the amount of lactose that you consume exceeds the amount of lactase, the enzyme that you have available to break down the lactose, you're probably going to have issues.

Now, that means there's two variables here, right? There's one we can control and there's one we can't really control. The one we can't really control is our individual levels of lactase. There are two main reasons why there's such variation in lactase levels in an individual. Generally, what we'll find is over time, they will drop, in fact, in around up to 70% of the population, their lactate levels drop off. Basically, your production of lactate drops off as you age, like I said, almost up to around 70% of people. It can affect it, so it's pretty regular.

And you also find in certain ethnic groups, particularly Asian populations, that 70% of the population might be even close to 80, 90% of the population who have these diminishing lactase levels as they age. Sometimes we can also see a drop in lactase production a little bit more acutely, so generally due to some kind of gut infection. Other gut conditions, such as maybe celiac disease, Crohn's disease, arthritis, which is kind of like inflammation of the small intestine. So in those scenarios, you might also find that the lactate production drops and so your lactose tolerance will also drop.

But the thing with that one is you might find that this is quite a temporary reduction in lactate that just occurs while that condition is around. So if you have a gut infection or you have unmanaged celiac or unmanaged Crohn's, or you've got a Crohn's flare up, then you might find that your lactose tolerance is very different to what it is outside of those times. So in that scenario, your lactose sorry, I knew I was going to stuff those up, I was doing so well. Your lactose tolerance may lower temporarily. So that's your lactase levels, right? That's the enzyme that breaks down lactose.

Like I said, for the most part, there's nothing you can do about your lactate levels.

The thing you can impact, obviously, is your lactose levels based on how much dairy you consume. And also, very importantly, the thing that I find a lot of people neglect to mention or neglect to shift in their own diet the types of dairy foods that you consume, because lactose is very, very and I did say lactose. I thought I said lactase again. Oh, no, it's all come crashing down. Lactose levels of different dairy foods vary wildly from food to food.

So, for example, a glass of milk, about 250 mls of milk will contain anywhere from 9 to 14 grams of lactose, whereas hard cheese, sort of a matchbox sized piece of hard cheese, is going to contain zero, four to zero, 6 grams of lactose. So considerably less. And so there's quite a range in dairy products as well. I'll link something in the show notes that will take you to a bit of a table, but another example is yogurt is a bit of a broad one.

Based on the way that it's produced, it might be anywhere from sort of 2 to 3 grams of lactose, up to 1214 grams of lactose. One of the main reasons why the amount of lactose varies in different dairy foods is generally the more fermented. Dairies typically have lower lactose because lactose is one of the foods that the probiotic bacteria break down and eat as part of the fermentation process. So having a good understanding of the lactose levels in different foods is really, really valuable because what we've found in the literature is most people who have lactose intolerance can still tolerate about 3 to 5 grams of lactose a day, right? And if you remember back to about 25 to 30 grams of cheese giving you zero 4 grams of lactose, it's pretty unlikely that that amount of hard cheese is going to trigger your lactose intolerance.

What can be a problem is if you have a large amount of a high lactose food, you have a lot of milk, or if you stack multiple dairy serves maybe in one go or throughout the day. And so each individual serve stays under your tolerance level, but combined you kind of overdo things. And so that would be where we would outrun our own individual levels of lactates. Now you can't go and get like a lactase test, really, but what you can do is just kind of play, not play it by ear, but do a little bit of your own experimentation and you'll start to understand like, yes, this much dairy is fine. When I exceed that level, bad things happen.

If you do want to include dairy as part of your diet, it is for the most part really nutritious. Good source of protein often, good source of calcium often, and a few other bits and pieces. So it is nice to know that you don't need to eliminate it entirely almost all of the time. And so you can continue to get those benefits, continue to enjoy those foods, maybe just changing the amount of those portions. So being careful with the total serves of those portions is really important. 

Also, just be mindful of combining dairy with other known gut irritants. So things like caffeine, chilli and alcohol may also change your tolerance. So I've got quite a few clients who tolerate dairy fairly comfortably, but if they have a milky coffee, then they will find that they don't tolerate it very well at all. So look at and be careful with the combination of those irritants plus dairy foods as well. There is also a bit of evidence showing that lacteese, I think that's actually the brand name, sorry, but basically a lactate supplement where you can sort of take the digestive enzyme, taking it immediately before a meal that contains a fair amount of dairy may also help your tolerance. So if you're really keen, you can give that a try. And the other bit of advice would be to not advice, but another avenue you could take is to suck it up, right? That's your choice.

It's important to note that the symptoms that you get from your lactose intolerance aren't damaging. Okay? So I completely understand why more often than not you'd want to avoid those symptoms, but I guess just giving you the option to go, you know what, I know what the consequences of eating this whole bowl of ice cream are going to be, but I'm willing to suffer that because that's what I feel like doing. Knowing that the discomfort isn't causing permanent damage can help you make that more informed decision.

It's also important to note that you might be intolerant or sensitive to dairy for other reasons. Sometimes the higher fat content of certain sorts of dairy can make things different. Or often a common allergy, generally more in very young children, is cow's milk protein allergy. That's very different. You don't just have a little bit of dairy. In the case of an allergy, we need to eliminate it entirely.

That's not what this podcast is talking about at all. I'm just talking about your lactose tolerance. So hopefully, if you feel like you've had to eliminate all dairy from your life, this gives you a little bit of ammunition to go back to have a better look and see if maybe you could adjust your serves, you could adjust the spacing you need to see what other things you're combining your dairy foods with. And maybe if your one true love is cheese, which I understand, you'll be able to get that back in your life a bit more comfortably. Damn it. I just looked over. I said this was going to be short. It's gone over ten minutes. I'm so sorry. I'm going to shut up now.

If you found this interesting, though, please share it with your lactose intolerant friends or family members or passively aggressively send it to someone if you wish as well. All for that. Otherwise, if you found it enjoyable, throw in your stories, tag me so we can get the love out there, and I'll catch you next time.