Why You Shouldn’t Ignore Your Lactose Intolerance

We’re not trying to make anyone hangry by suggesting you put down that wedge of brie you’ve been dipping into as you scroll through your newsfeed. But read on, especially if your gut has been suffering from the effects of eating dairy products. Though none of us want to make the leap and give up beloved pizza, lactose can do more harm than good for about 65 percent of the population of the world, dietitians say. Here, experts break down the dos and don’ts of dairy once and for all and suggest smart, nutritious lactose-free swaps so you don’t lose too much of what — let’s be real — is the best part of a meal.

Allergy or Just a Bit of Intolerance?

The main cause of your dairy-related woes, is lactose, the sugar found in cow’s milk and other milk products, especially in ice cream and soft cheeses. “Lactose intolerance is the inability to digest lactose, which is the sugar found in milk. The problem comes from a deficiency of the enzyme lactase, which is necessary for the breakdown of lactose,” says Kristin Koskinen, a registered dietitian based in Kennewick, Washington. When the body can’t process that lactose properly, it sits in the colon undigested, causing those uncomfortable GI symptoms like bloating or cramping, Koskinen explains.

But it’s not common to be born with the intolerance, says dietitian and lactation counselor Catherine Brennan, because it’s present in breastmilk. Lactose intolerance often doesn’t appear until age two or three, once breastfeeding is often definitively over, Brennan explains. “This is known as primary lactase deficiency and is the most common type of lactose intolerance. For select individuals, symptoms of this may not begin until adolescence or even adulthood for unknown reasons,” says Brennan. What’s also partially unknown is why some demographics are disproportionately affected by lactose intolerance than others; hereditarily, many members of the black, Asian, and American Indian communities have more difficulty digesting dairy than other races. This likely has to do with genetics, Brennan says, and how frequently milk products were consumed throughout the population’s history.

You may have an inkling if you do have some degree of intolerance to dairy, but an allergy to dairy is on a different level altogether. “A dairy allergy involves the immune system, as the body doesn’t recognize the proteins in dairy products, seeing them as allergens, and attacks them instead,” says Kajsa Ernestam, a dietician at the health app Lifesum. “To combat these invaders, the body releases chemicals that cause an allergy reaction,” Ernestam says, which can cause typical allergy symptoms like hives or rashes, or more severe symptoms like throat closure. If you have a dairy allergy, taking lactase-increasing pills geared toward lactose intolerant people to help them process dairy won’t work on you, Ernestam points out, because the allergy that develops is to the milk protein and not just to lactose. The only solution, in that case, is finding dairy-free or vegan alternatives to your favorite products.

What to Watch out For

There’s a spectrum of lactose intolerance, and it might take a bit of trial and error to figure out how sensitive your intolerance is and what to definitely avoid. If you’re on the higher end of the sensitivity spectrum, you could be doing permanent damage to your colon by getting in your ice cream fix. While Brennan says that many of the consequences of ignoring lactose intolerance symptoms aren’t severe, there are situations where it could become very unhealthy. “There are some individuals who could experience permanent damage to the microvilli, or finger-like projections lining the intestine, if they regularly consume foods containing lactose. This could present a problem since the microvilli absorb nutrients into our bloodstreams, and damage to them could result in malnutrition,” Brennan says. Koskinen echoes that severe cases of lactose intolerance that go untreated, so to speak, can lead to leaky gut syndrome, which may cause the body to have inflammatory and auto-immune issues.

In those particular cases, it might not be worth it to permanently screw up your digestive system just to enjoy pizza night every week. For milder intolerances, a food program like Whole 30 could work to eliminate dairy and then slowly reintroduce it to see if that’s definitely the culprit of any of your stomach issues. Dietitians also say it may be worth your while to cut dairy completely from your diet even if your only symptoms are intestinal, for no other reason than to avoid frequent trips to the bathroom and the general discomfort, allowing you to enjoy your meals without regret.

On the other hand, if you don’t have to completely eliminate dairy from your diet, don’t, because it’s nutritiously essential to our bodies (which makes sense, because milk is the first food we and most other mammals get in life). “The main issue with cutting out dairy entirely is the fact that you might miss out on key nutrients, which can have implications on your health. For example, a lack of calcium, especially in people over 30, can leave the bones weak and more prone to breaking on impact,” Ernestam says. And don’t forget about probiotics either, a major nutrition factor in dairy products, she says. If you’re not getting them from things like cottage cheese and yogurt, load up on fermented foods like sauerkraut, kimchi, and pickled veggies.

Your Go-To Milk Substitutes

You may actually be safer with some dairy products than you think — just evaluate which are lowest in lactose and you should be good to go. Products with live cultures, like yogurt or kefir, have low lactose content because they are cultured, along with harder cheeses like Parmesan and cheddar, Koskinen says. Lactose-free milks and ice creams that simply have the milk sugar removed and have added lactase to aid digestion could be your answer as well. But if you’d rather be safe than sorry, look for plant-based products to help you digest better. “If you are breaking up with dairy or taking it in limited doses, choose minimally processed, as close to whole as possible, foods to take the place of their dairy counterparts, rather than trying to look for processed dairy replacements,” Koskinen says. She suggests using whole foods to recreate the texture of your favorite dairy treats, like blending frozen strawberries and bananas with a bit of vanilla and almond or another nut milk for a creamy ice cream substitute.

When finding your best options for dairy subs, start with breakfast and work your way through the day. “If you want to reduce the amount of dairy you consume, then I would suggest doing so gradually and starting with smaller things. For example, start with milk; swap for an oat, almond, or coconut milk in your coffee or morning cereal,” Ernestam says. You can even make your own nut milks at home to avoid anything artificial, Koskinen adds. All it takes is soaking your nut of choice overnight and adding the mixture to water and some honey in a blender to achieve a taste that’s fresher than the supermarket. The more whole ingredients you incorporate into your diet, the better shape your gut will be in.

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