Why do so many lactose intolerant people continue to eat dairy?

October 29, 2016 7:04 AM

Although I have almost entirely adjusted to the lactose intolerant lifestyle over the last few months, it never ceases to amaze me that lactose intolerance is supposed to be the default, yet dairy is such a permanent fixture of the American diet! There's cheese and/or milk in nearly everything. My question to is: why do so many lactose intolerant people continue to eat dairy?

After months of merely suspecting lactose intolerance, I finally did the three-hour hydrogen breath test and it turns out that my suspicions (and those of my close friends, who have to deal with me after eating dairy) were right: the hydrogen breath test indeed confirmed that I am lactose intolerant.

Although I have almost entirely adjusted to the lactose intolerant lifestyle over the last few months, it never ceases to amaze me that lactose intolerance is supposed to be the default, yet dairy is such a permanent fixture of the American diet! There's cheese and/or milk in nearly everything.

My question to is: why do so many lactose intolerant people continue to eat dairy?

Do they just not know any better? I didn't, despite the big red warning sign of my own mother being lactose intolerant. Are they just taking Lactaid and/or other dairy relief, as I am now, because cheese is THAT good and impossible to avoid if eating out at particular eating establishments? Or is lactose intolerance not as common as we think it is, at least in the US, thus explaining the crazy amount of cheese and milk in the American diet?

Any thoughts?

posted by Delia to Health & Fitness (60 answers total)

Mildly lactose intolerant person here. Dairy tastes too good to give up. A life without cheese, ice cream, cheesecake, yogurt, pastry cream... a little discomfort is worth the pleasure.
posted by SansPoint at 7:09 AM on October 29, 2016 [49 favorites]

Rates of lactose intolerance are indeed lower in the US than worldwide, and white people with Euro roots are even less likely to be lactose intolerant, and you know how we are about making sure white folks are catered to. When the majority of the population can eat dairy unproblematically, and would be very likely to revolt without it (no ice cream? no cheeseburgers?), producers keep the dairy flowing.

Signed, a white American who drinks ~4 gallons of milk a week.
posted by phunniemee at 7:11 AM on October 29, 2016 [7 favorites]

Cheese is delicious. It literally took a nutritionist to tell my lactose-intolerant wife (who was complaining of a range of digestive issues) to knock it the fuck off first, before reaching for weird obscure ailments. It had literally never crossed her mind to just, you know, give up cheese.
posted by restless_nomad at 7:12 AM on October 29, 2016 [3 favorites]

My sister is mildly lactose intolerant, and takes a pill that mitigates the worst of it. Also, food is delicious, and it's worth it to her to sometimes get a bad reaction.
posted by roomthreeseventeen at 7:13 AM on October 29, 2016 [1 favorite]

Your question assumes that we're mostly all lactose intolerant. Thankfully, many of us are not.
posted by cecic at 7:15 AM on October 29, 2016 [37 favorites]

Ice cream or milk would leave me in agony. A cheeseburger does almost nothing, and is worth the slight amount of discomfort. It's the same concept as people eating spicy or greasy foods even though they risk heartburn later. It's a trade off and it's not what's going to kill me.
posted by AFABulous at 7:21 AM on October 29, 2016 [7 favorites]

I'm very, very mildly lactose intolerant. I have to consume a large quantity of fresh dairy (e.g. multiple servings of milk, ice cream, ricotta) for it to even cause me a minor amount of discomfort, which typically lasts for about as long as a normal trip to the bathroom. Fermented/cultured dairy does not seem to cause me any problems. And spacing the dairy out throughout the day mitigates it, too. So I have no incentives to give up something that tastes so good!
posted by carrioncomfort at 7:22 AM on October 29, 2016 [7 favorites]

There's also a range of lactose intolerance. My black (relevant because lactose intolerance is higher among African American populations) wife can't drink straight milk, but cheese and yogurt and butter are fine.
posted by joycehealy at 7:23 AM on October 29, 2016 [15 favorites]

I'm definitely lactose intolerant when it comes to milk (I usually have an upset tummy in short order), but for some reason my body handles cheese/ice cream/creams much better. My completely unscientific theory is that for some reason milk that has been processed in some way doesn't affect me.

That being said, I do think that rates of lactose intolerance are lower here. I'm Asian, but I have plenty of friends my age--all ethnicities--who continue to happily drink milk.
posted by sprezzy at 7:23 AM on October 29, 2016

Lactose tolerance is pretty closely tied to genetic heritage in ways that overlap with, but aren't identical to, how we define race. Most people of Northern European descent can tolerate lactose, and many people of other backgrounds can't, although to varying degrees. People of Northern European descent have been a dominant force in American culture, and some of our foodways reflect that dominance. And it can be challenging if you do things differently from the dominant food culture, especially if you live in a place that isn't terribly diverse.

Another issue, I think, is that a lot of people start out able to tolerate lactose and then lose that ability in adulthood. So for a lot of us, our formative food memories revolve around things that we can't comfortably eat now. I associate ice cream with happy childhood memories, even though I really should associate it with crippling stomach cramps.

And finally, some of us can tolerate a bit of lactose, and we take the risk and eat yummy things because yummy things are yummy. Sometimes I miscalculate and regret it, but I can usually figure out what I can get away with eating with reasonable accuracy.
posted by ArbitraryAndCapricious at 7:29 AM on October 29, 2016 [5 favorites]

Most hard/aged cheeses contain only trace amounts of lactose. Also lactose intolerance is not evenly distributed across populations, and not all populations within the US eat a "typical American diet."
posted by mskyle at 7:31 AM on October 29, 2016 [16 favorites]

Not all dairy products have the same lactose content. Cheddar cheese, for example, is lower in lactose than milk. So the folks who are mildly intolerant can enjoy cheddar without too much concern. Wiki has a list, not a complete one, on lactose levels in dairy products. It might be that the folks you see enjoying dairy are careful, maybe unknowingly so, about which dairy products they eat.
posted by LOLAttorney2009 at 7:34 AM on October 29, 2016 [7 favorites]

I'm mildly lactose intolerant, my mom is too. Cheese and yogurt don't cause too many problems ( aged cheeses have significantly less lactose than milk, not sure why yogurt is usually fine).

Basically, it's mild enough for me that I don't have to worry about anything besides milk and ice cream, easy enough to avoid without much thought. If I want ice cream, I either take a lactaid or make sure I'm not out and about.
posted by ghost phoneme at 7:34 AM on October 29, 2016

it never ceases to amaze me that lactose intolerance is supposed to be the default

Apparently not in the state of Wisconsin, anyway.

I grew up in downstate IL. I don't believe I had even heard of lactose intolerance until I moved to Chicago (30 years ago).
posted by she's not there at 7:37 AM on October 29, 2016 [3 favorites]

I'm lactose intolerant, but it's generally only an issue if I have fresh dairy or I'm eating on an empty stomach. I usually try to keep milk and cream to a minimum in my diet, but otherwise I can successfully take dairy risks on a case-by-case basis for something I really want because life's too short to give up pizza.

As awkward as it feels to mention this, another reason for eating dairy when you shouldn't is fitting in, especially for people of commonly-lactose-intolerant ethnicities that grew up in places with low rates of lactose intolerance. It's othering enough to be perhaps the only [insert ethnicity here] kid in your class, one doesn't want to make matters worse by also being that weird kid who can't have ice cream cake or milkshakes or cheese strings. This might be less of an issue nowadays, but it's something I recall being a bit conscious of as a child of the '90s.
posted by blerghamot at 7:37 AM on October 29, 2016 [3 favorites]

Response by poster: With regards to all who are saying that dairy (especially cheese--this is the big one for me) is delicious and this is the reason why you ingest dairy anyway, do you take Lactaid to prevent adverse reactions to it?

Re: genetic heritage, yeah, that's the interesting thing. I know higher rates of lactose tolerance are tied to northern European populations (who have dominated the US food culture, and the rest of the US), but I see people of ALL ethnic backgrounds eating cheese/ice cream and drinking milk. What gives?

As for Wisconsin, the state is known for dairy farming and is very, very white.

Totally agree with the comment about fitting in, btw. Complete reason why you take Lactaid beforehand when all your coworkers decide to go for pizza for lunch and invite you. Still definitely an issue.
posted by Delia at 7:48 AM on October 29, 2016

I'm very lactose intolerant. I continue to eat dairy because it's virtually impossible not to -- dairy is in EVERYTHING. Constantly trying to avoid it takes a ridiculous amount of effort. So I just don't even try anymore. Obviously I don't ever have ice cream, yogurt, cottage cheese, things of that nature, but restaurants put butter or cream in goddamn everything, and a huge portion of packaged foods have milk as an ingredient even when there is no apparent need for it.

I think the question you should be asking is "Why do food manufacturers/restaurants/etc keep putting dairy in goddamn everything even though it's guaranteed to make a large percentage of the adult population sick?"
posted by a strong female character at 7:53 AM on October 29, 2016 [10 favorites]

If you're looking for lactose pill recommendations, I've started using these things. I take one in the morning and maybe another one late afternoon and I can mostly eat whatever I want and not get sick.
posted by a strong female character at 7:58 AM on October 29, 2016

I'm lactose tolerant and I don't really need people wondering why I eat cheese but to trust me that I can manage my diet.

That said, the history of US dairy includes massive dairy subsidies, food assistance in the form of "government cheese" and lots of commercials about the health benefits of milk, so I think in this case policy may have shaped culture.
posted by warriorqueen at 8:37 AM on October 29, 2016 [7 favorites]

Part of the reason is specifically because there is a pill that "fixes it". If I'm cooking for 10 friends, I know A is celiac and B is gluten-free if possible, and C is vegetarian, the fact that D has to take a pill before eating cheese is a minor detail. It's part of our food narrative that if you're allergic to shellfish or vegan or very much can't eat something, or will whine like a baby for the whole party because you hate coconut and one of the dishes has coconut milk in it, that's worth fixing - but lactose intolerance was somehow never framed like an allergy. Even before the pills were common on the market, it was more like "John gets heartburn easily" than going out of the way to avoid it, somehow the concept of allergy carried more weight than digestive upset. And now that there's a pill, it's really hard to tell someone you aren't eating the mac and cheese because you're lactose intolerant, they'll say "Isn't there a pill for that? My aunt takes pills for that. Have a pill and some macaroni." It seems like it would be easier to claim a milk allergy if you actually wanted to avoid dairy in public.
posted by aimedwander at 8:38 AM on October 29, 2016 [3 favorites]

Several years ago (so I can't back it up off the top of my head right now) I read that both wheat and dairy activate opioid receptors in (at least some) people's brains - hence why it's so difficult to give up.

There are all sorts of cool scientific and historical impact explanations out there about this. Worth looking in to if you are curious.

Side note: celiac here. You have no idea how often celiacs hear "I would die if up wheat". Sure you would.
posted by Neekee at 8:41 AM on October 29, 2016

I do not use any kind of pill and consume cheese & dairy daily. However, when I was growing up, my brother (also lactose intolerant) and I had special milk that was just for us. I don't remember when we stopped drinking that and switched to regular milk; probably before middle school? He's slightly more lactose intolerant than I am, but is mostly just, well, stinky because of it. He doesn't take pills, either.

I have two friends who are more sensitive; one who avoids all dairy and one who takes a pill so they can eat cheese and ice cream.
posted by carrioncomfort at 8:43 AM on October 29, 2016

I feel like you've answered your own question! Dairy is in everything and cheese is delicious so people either take Lactaid or deal with the consequences if they're intolerant. I'm a lactose lover so this ain't no thang for me!
posted by masquesoporfavor at 8:44 AM on October 29, 2016

I am heavily lactose intolerant and do not take Lactaid and eat dairy all the time. I do so because dairy is delicious, and Lactaid is expensive and inconvenient. If it was a small, prescribed pill I could take in the morning with all my other pills, I would take it, but not when its OTC nature means I have to pay more for it than I pay for antidepressants or painkillers.
posted by corb at 8:52 AM on October 29, 2016

I was looking for a more scholarly cite on the multiple independent evolutions of lactase permanence, but this'll probably do.

Being able to digest lactose in adulthood was very evolutionarily important for a lot of humans, as was being able to live well on grains / agriculture. Milk is a great source of protein and fat, and it's reliably available from a domesticated animal. That article also talks a little about traditional preparation methods to reduce lactose in foods (aka culturing, cheesemaking).
posted by momus_window at 9:00 AM on October 29, 2016 [1 favorite]

Up to a small extent, you can reduce your intolerance for dairy by consuming it regularly.

Another thought: for those who go through the American public school system, dairy/milk is a pretty big factor in school cafeterias and in recommended dietary choices. I'm thinking of the 'Got milk?' campaign. Milk is nutritious, cheap and abundant, and if you grow up consuming it, you tend to keep consuming it.
posted by kinoeye at 9:04 AM on October 29, 2016

It's really not that dissimilar to alcohol to me. I'm genetically predisposed to have a hard time with lactose and booze, but I'm also Japanese-American, so while it's a pretty common issue in my family and other people of Asian descent, I've found it to be pretty rare among my white friends, and I don't find it strange that dairy and alcohol are so common. That's just how the dominant food culture works.

I enthusiastically consume dairy every once in awhile because I enjoy the taste, and for me that's worth the discomfort. I don't drink although I would sometimes like to because the unpleasantness is much more dramatic. I know that's how my body operates, so I pick and choose accordingly. I already get enough friction for not drinking, so now I'm a little paranoid and grumpy that anyone would give me extra side eye if I decide to have some ice cream.
posted by Diagonalize at 9:07 AM on October 29, 2016 [1 favorite]

Best answer: Re: genetic heritage, yeah, that's the interesting thing. I know higher rates of lactose tolerance are tied to northern European populations (who have dominated the US food culture, and the rest of the US), but I see people of ALL ethnic backgrounds eating cheese/ice cream and drinking milk. What gives?

Assimilation and North America's history of subsidized dairy programs (especially school milk) are partly to blame. A a result, some culture's foodways began to include more dairy-centric meals over time. A good example of this is mac and cheese, which somewhat strangely became a key part of African American (and later, Afro-Caribbean) cuisine despite it being pretty common for people of African descent to be lactose-intolerant.
posted by blerghamot at 9:08 AM on October 29, 2016 [2 favorites]

There was a This American Life piece a while back about how common it is for people who are actually allergic to certain foods to still eat them, to the point of having to go to the hospital. They interviewed a few people who were basically like "yeah, I know shrimp could kill me but it's so delicious and I'm careful." It sounds crazy, but I can identify as someone who is not celiac but can't tolerate gluten very well - I still eat it way more than I should because it's delicious and it's a pain not to.
posted by lunasol at 9:26 AM on October 29, 2016 [1 favorite]

With regards to all who are saying that dairy (especially cheese--this is the big one for me) is delicious and this is the reason why you ingest dairy anyway, do you take Lactaid to prevent adverse reactions to it?

I have a lactose intolerant husband and we eat tons of cheese. Many cheeses contain negligible quantities of lactose. Check the nutrition information on the side of the package. Negligible sugars? Very little lactose.

Fresh cheeses (ricotta, etc.) will contain much more.

But yeah, my husband just carries lactase enzyme pills with him wherever we go because, well, dairy. We just buy whatever lactase enzyme generic brand is cheapest and comes in an econo-sized bottle, so that saves a few bucks.
posted by mandolin conspiracy at 9:28 AM on October 29, 2016 [1 favorite]

I am lactose intolerant, but volume matters. I've never eaten enough cheese to cause a problem, so I never worry about it. I've never had a problem with yoghurt, either, but I've also never eaten yoghurt in great volume. I have trained my stomach to accept one latte or glass of milk, but I'm in trouble if I have two.

Adult onset lactose intolerance is not like an allergy; it only means a struggle to digest it. It's not a like a potentially fatal histamine reaction to even trace amounts, or anything. Once you know how much your body can comfortably tolerate, it doesn't have to be that big a deal.
posted by Hildegarde at 9:38 AM on October 29, 2016 [7 favorites]

[...]but I see people of ALL ethnic backgrounds eating cheese/ice cream and drinking milk. What gives?


You don't have any way of knowing whether any individual you see is lactose intolerant, or strongly lactose intolerant.

That being said, most of my friends who have discovered food allergies or intolerance have commented that they always just thought their belly was "funny," or something like that, until they did an elimination trial or for some other reason gave up the food that was bothering them. On top of that, lots of people believe food allergies and intolerance are a myth because so many people go around saying they have an intolerance e.g. to get a chef to leave something out of their dish just because they don't like it. If you're at all contrarian or suspicious of trends, it's going to be hard to sell you on the idea that so many people have digestive issues.
posted by BibiRose at 9:41 AM on October 29, 2016 [2 favorites]

but I see people of ALL ethnic backgrounds eating cheese/ice cream and drinking milk. What gives?

You're not seeing all the people of those ethnicities consuming fresh dairy products. No ethnic group is going to present 100% at the highest level of intolerance, so you're seeing people who are tolerant to some degree eating things they like. Half my ethnic heritage is from the "way less likely to be okay with lactose" end of the scale and yet I can drink milk and eat a stupid amount of cheese (and I do!) without trouble.
posted by rtha at 9:42 AM on October 29, 2016 [5 favorites]

My Chinese friend is not lactose intolerant, and loves ice cream. I'm so white I glow in the dark, but ice cream and straight-up milk give me a bellyache; yogurt and cheese not at all. You can't guess about people's lactose status by their appearance.
posted by zadcat at 10:05 AM on October 29, 2016 [4 favorites]

"... it never ceases to amaze me that lactose intolerance is supposed to be the default..."

What? Since when? Says who? Do you mean among USA residents? Is there science to back up this statement?

Milk by itself is disgusting, but ice cream, cheese some yogurts, pudding, cheesecakes; bring 'em on!
posted by BostonTerrier at 10:09 AM on October 29, 2016 [2 favorites]

I have never liked milk and I think it is from being lactose intolerant all my life. However, I will eat Blue Bell ice cream even though I KNOW it will give me what I call "the blue belly" and cause me great gastric distress, usually in the middle of the night. American take antacids by the handfuls, when a change in diet would solve many of their issues. We are not a culture that likes being asked to deny ourselves any bit of pleasure.
posted by thebrokedown at 10:16 AM on October 29, 2016

Discomfort is a spectrum, and any given individual is going to have a level of tolerance for that discomfort underneath which it goes more or less unnoticed. I think pain and nausea are probably the dividing line for most people, and for a lot of people with mild or even moderate lactose intolerance that just means a little more gas and a less-than-pristine bathroom experience but not any real pain or inconvenience. And the older you get, the more things might cause that and they seem to do so more randomly, so screw it, let's have ice cream because it's just as likely the raw tomatoes or the vinegar in the salad dressing that's going to get me in the end.

I'm not going to eat a big bowl of ice cream and then go hiking in the woods, because I know how that'll end, but in the comfort of my home anything that might happen is pretty unremarkable. On the other hand, I've stopped drinking beer almost ever because it's increasingly likely that even one is going to give me gas so excruciating I cannot sit up.

It's the same sort of risk assessment people make all the time about all kinds of things, and it's a multidimensional decision-making model that involves all kinds of personal and social assessments.
posted by Lyn Never at 10:43 AM on October 29, 2016 [8 favorites]

According to this article from Cornell, 30-50 million Americans are lactose-intolerant. Which leaves 300-320 million Americans who are not lactose-intolerant. Which means that being lactose-intolerant is not the default state in the U.S. So your premise is wrong.

And according to the National Institute of Diabetes and Digestive and Kidney Diseases:

Most people with lactose intolerance can eat or drink some lactose without symptoms....Research suggests that many people could have the amount of lactose in 1 cup of milk in one sitting without symptoms or with only minor symptoms.

So when you see someone walking down the street and eating an ice cream cone, that doesn't mean that they don't know any better or are just choosing to deal with the symptoms later. They may just be using up their safe dairy allowance for the day.
posted by colfax at 11:02 AM on October 29, 2016 [23 favorites]

This is a map of lactose intolerance by region. I'm not sure what the source of the information is, but other maps I've seen have approximately the same distribution represented.

The US has many people with heritage from outside the most lactose tolerant regions, but still, a majority of people in the US can tolerate lactose. We eat a lot of dairy because many of our foodways come from regions in Europe where dairy plays a big role, and because enough of us can still eat it.

Even regions that have very high rates of lactose intolerance can have dairy products, though. E.g. in West Africa yogurt can be very popular, and not just among people who raise cattle. Maybe the process changes the lactase content? I don't know.
posted by Kutsuwamushi at 11:02 AM on October 29, 2016

Yeah, many (most?) lactose intolerant people can tolerate yogurt. I think that I read that some of the bacteria in yogurt aids in the digestion process.
posted by ArbitraryAndCapricious at 11:08 AM on October 29, 2016 [1 favorite]

oh god, that map. that map is frankly bizarre and seems to have little understanding of the demographics of central and south america? it has majority white european descent argentina and uruguay as 80-100% intolerant but majority mixed race/indigenous peru and ecuador as somehow less? what is happen


I think that I read that some of the bacteria in yogurt aids in the digestion process.

fermented dairy products like euro-process butter and kumis and kefir and yogurts eat up the lactose as they are made, making them naturally lower in lactose, but not 100% lactose-free. they're also often made from milks that have less naturally occurring lactose than cow's milk.

not everyone who is intolerant can handle these things (hard cheeses, yogurt, etc) that literally everyone who is not lactose intolerant insists that they can, because they have an asian friend who they saw eat a grilled cheese one time. the amount of lactose on can handle is, even within families, a very individual thing. i personally can't even tolerate lactose being used as an inert filler in medications such as tums or extended release ritalin, much less a yogurt.

people will say "oh you can just take this supplement and you will magically become lactose tolerant again!" which is only true for people who have become lactose intolerant from bacterial or protozoan gastric illnesses like giardia or legionnaire's, and who have the genes for lactase persistance. no supplement is going to turn on a gene that is not present in my body. the only thing that allows me to eat dairy products is taking lactase.
posted by poffin boffin at 11:32 AM on October 29, 2016 [1 favorite]

(also, corb: lactaid is p cheap on amazon compared to at walgreens or similar)
posted by poffin boffin at 11:39 AM on October 29, 2016 [2 favorites]

Lactose intolerance isn't "the default" for people in the US. It's the default globally. More specifically, mainstream Anglo-American foodways were initiated by Northern European immigrants who tend not to be lactose intolerant. As the US becomes less white, and less Northern/Western European, lactose intolerance will probably continue to grow. But historically, and probably even demographically right now, it's not the default. It's just... probably more common than it once was?

For what it's worth, my partner is lactose intolerant, and it has been interesting to see how this manifests in our domestic life. Honestly, unless you obsessively scrutinize the way people eat, it would be pretty hard to determine whether a given person is lactose intolerant or not. He doesn't take milk in his coffee, and there are some cuisines he's not an enthusiastic fan of because there might be surprise unavoidable dairy. That's pretty much it.

The biggest area where there's a difference is in drinking milk, and in my experience most adults don't drink milk by the glass anyway.
posted by Sara C. at 12:04 PM on October 29, 2016

It had literally never crossed her mind to just, you know, give up cheese.

Another interesting fact about lactose intolerance: most people, even most people who actually suffer from it, have NO UNDERSTANDING of how it actually works.

For example most aged/hard cheeses have virtually no lactose in them. If you are lactose intolerant, you most likely can have pretty much any cheese you're familiar with that isn't fresh mozzarella, cream cheese, or maybe chevre. My lactose intolerant partner had a ham and cheese sandwich for lunch yesterday, and it wasn't a compromise. Gruyere does not have enough lactose to present a problem for most lactose intolerant people.

So OP may be noticing what seems like a type of dissonance (lactose intolerant people munching down on grilled cheese sandwiches) that actually isn't because many people are not well informed about what lactose intolerant people can and cannot eat.
posted by Sara C. at 12:09 PM on October 29, 2016 [10 favorites]

I'm mildly lactose intolerant. I also think that cheese - all cheese - is a disgusting substance placed on this planet to poison us from Satan. Consequently, I don't eat a lot of dairy.

I can handle without issue: ice cream/gelato, yogurt (both frozen and nonfrozen).
I can handle, somewhat: half and half in coffee, some chais in some restaurants - maybe they use non-cow's milk.
I can't really handle at all, and I avoid at all costs: any and all cow milk, whether fresh or powdered. Cheese.
I can't really handle at all, but will vacuum up like a Hoover in a sawdust factory: Egg nog, whipped cream. Sorry, relatives at Xmas. At least I remember the LactAid.
posted by spinifex23 at 12:22 PM on October 29, 2016 [2 favorites]

I'm from an ethnic population that is typically lactose intolerant but I am blissfully not bothered by lactose at all. I eat cheese and ice cream in truly alarming quantities, easily enough to compensate for a few people who avoid dairy.
posted by pseudostrabismus at 1:47 PM on October 29, 2016 [2 favorites]

People who are lactose intolerant are generally encouraged to continue eating dairy, because to abstain simply makes you more intolerant. It can take some trial and error finding your personal threshold. Also, it's been observed that symptoms of lactose intolerance might be lesser when the lactose is consumed alongside a significant amount of fat - I found this to be true for myself when I switched from reduced fat milk to regular milk. I am lactose intolerant but I don't intend to cut an entire food group out of my diet. Instead I'm more judicious about the types and amounts of dairy I ingest.
posted by BeeJiddy at 2:05 PM on October 29, 2016 [1 favorite]

I'm from a typically-lactose-intolerant ethnic population and pretty severely lactose-intolerant (although I suspect I might just have less tolerance for minor symptoms than many people do). I avoid all dairy except butter--which I added back successfully this year and I think it has increased my tolerance slightly--and I take Lactaid as a "treat" about once a week.

I rely on this list to determine what's safe to eat. Butter is around 1% lactose, whereas even hard cheeses can contain up to 2% lactose and I tend to eat it in much larger quantities than how butter is typically used. I've also tested live-culture yogurt with pretty painful results.

Thankfully my friends are respectful of my desire to avoid consuming dairy, as they are for vegans and vegetarians, for example. I usually explain it as, "I don't want to become dependent on a pill every time food enters my mouth," which is true. Bonus: lactose intolerance has helped me avoid weight gain in a work environment of numerous free desserts.
posted by serelliya at 3:20 PM on October 29, 2016 [1 favorite]

I don't think that *everyone* is lactose intolerant, but probably more people are than they realize. I've known I was lactose intolerant for almost 20 years, because when I was a kid my dad and I both tried going off dairy and both saw relief from our GI symptoms. I helped my now-husband realize that he was lactose intolerant when we first started dating. Same thing with a previous boyfriend. So I think what you're seeing is a combination of people who *can* eat dairy, people who are quietly taking Lactaid, and people who run to the bathroom a lot.

Why do people continue to eat dairy when they can't process the lactose? I think it's a combination of things. When GI problems creep up, you get used to them being status quo. Ingredients that are tough on the stomach (dairy, spicy food, greasy food, alcohol) are everywhere. We as a population don't really take great care of ourselves or pay close attention to cause-and-effect with food. It can also take some time to play around with an elimination diet and charting, and most people don't have the patience for that. Additionally, some people with sensitive GI tracts sometimes have a couple things going on, so it can be hard to pinpoint the actual causes.

I think a lot of people don't know that Lactaid pills are cheap and effective (for most people). If you buy Lactaid Fast Act on Amazon, they're about $0.15 a pill. I haven't had lactose-induced GI distress in probably 10 years.
posted by radioamy at 6:25 PM on October 29, 2016 [2 favorites]

When GI problems creep up, you get used to them being status quo.

Additionally, some people with sensitive GI tracts sometimes have a couple things going on, so it can be hard to pinpoint the actual causes.

Yep. My stomach is going to be randomly upset literally no matter what I eat or drink, so if I'm going to suffer anyway, I may as well have some tasty cheese.
posted by AFABulous at 9:28 PM on October 29, 2016 [3 favorites]

There's been some breathless science reporting recently about about an opioid casomorphin that's a product of casein protein digestion. It seems plausible that a food that produces opiods in the body like cheese and other dairy does would be a bit addictive. I haven't looked at the original study, though.

As others have mentioned, it's probably very significant that we're basically all born producing lactase and lactose intolerance just sneaks up on some of us. I'm actually allergic to dairy (casein allergy), and people often assume I mean I'm lactose intolerant and try to convince me to eat dairy because they're lactose intolerant "too". People feel bad eating cheese in front of me because I'm obviously so jealous, but I'm utterly revolted by dairy because I associate it with the reactions I've had since birth. (Also, c'mon, it comes out of a cow.) I managed to avoid being diagnosed until I was 9 because I avoided dairy so thoroughly unless forced. I actually got in trouble in kindergarten for refusing to eat a sundae at a class party--I wouldn't even touch soy/coconut/almond ice cream until college because anything creamy is suspect to my taste buds. People who develop lactose intolerance later in life have had positive experiences of dairy (it's in so many fun/celebration foods) and it's rarely a significant enough reaction to create the level of aversion I have.

It's interesting how differently lactose is treated in Europe, though. Lactose is labeled like an allergen in most of western Europe (I suspect an EU guideline), and lactose-free dairy products are very widely available. Literally every cafe offered me lactose-free milk instead of soy in my lattes; some only had lactose-free milk and no non-dairy milk. It seems much easier to avoid lactose while still consuming dairy in Europe. It sucked for me, though, because dairy allergies aren't as common there, the labeling is worse for dairy than in the US, and people don't think in terms of food being dairy-free unless it's supposed to be completely vegan.

Funnily enough, I do have lactase persistence. I can drink milk stouts and take lactose-coated pills all day.
posted by lemonadeheretic at 5:52 AM on October 30, 2016 [2 favorites]

My family's from one of the lactose intolerant regions on that map and we, and all the people we know with the same background, eat dairy without a second thought (barring outright allergies). I was curious about this and came across these two studies. In short, while most of the kids were lactose intolerant according to the hydrogen breath test after ingesting lactose solution, the percentage went way down if it was milk, and in both tests, none of them had any gastrointestinal symptoms after. So it seems like even if most of them were technically lactose intolerant, it was so mild they wouldn't even notice. Of course, lactose intolerance increases with age, but even if they did eventually develop noticeable reactions, having spent an entire childhood without any issues with dairy, lactose intolerance is probably not the first thing that comes to mind.
posted by airmail at 8:19 AM on October 30, 2016 [1 favorite]

Corb, and anyone else: generic Lactaid is also pretty cheap at Costco if there's one near you. I keep a sheet of them stashed in my work bag, the car, my wife's purse, my bike bag, etc because I really fucking love cheese and milkshakes and this is 2016 and I don't have to suffer for it.
posted by a halcyon day at 6:00 PM on October 30, 2016 [2 favorites]

also, corb: lactaid is p cheap on amazon compared to at walgreens or similar)

OMFG you are RIGHT. My future belly thanks you.
posted by corb at 7:24 PM on October 30, 2016 [1 favorite]

There are different levels of lactose intolerance, it's not an either/or. If you've been happily consuming dairy products your entire life without any discomfort, you are functionally lactose tolerant, even if the "hydrogen breath test" tells you otherwise. The only downside to lactose intolerance is lactose intolerance symptoms (bad breath, disgestion problems, cramping, etc), there's nothing inherently harmful about consuming dairy products if you are technically lactose intolerant but present no symptoms.

For example, I am of East Asian descent, and I would probably be lactose intolerant according to your breath test, since something like 99.9% of Asians are supposed to be lactose intolerant. I eat cheese, ice cream, drink lattes, and put milk in my coffee without any issue. I will sometimes get a bit more gassy than normal if I eat too much dairy, but I randomly get gas all the time even without eating dairy, so it doesn't really affect my life.

TL;DR people who are technically lactose intolerant eat dairy because they don't get any symptoms from it, and thus are functionally lactose tolerant.
posted by pravit at 7:54 PM on October 30, 2016 [1 favorite]

I am lactose intolerant to a large degree, but compared to my other food allergy (avocado and mango) which is crippling, lactose is a walk in the park. I take my Costco Lactaid everywhere (every pocket of everything I own has at least one in it) and I eat whatever I want as long as there's no avocado or mango. Dairy is in everydamnthing and I'm already missing out on two foods I have loved my whole life and didn't become sensitive to until my mid-30s. The only thing pills won't mitigate for me are whey protein mixes.

In summary: life is too short to cook without butter.
posted by komlord at 9:02 PM on October 30, 2016

I'm lactose intolerant, but I've also gone through weeks where I was craving cream (or maybe calcium in the form of cream) and would drink tons of milk. I don't take a pill for it but for a while used to buy lactose-free milk, which tastes just the same but is more expensive.

I find that as long as I don't go over say 2 tall glasses of milk (think milkshake-size) a day, I'm fine. It's when I get past that that my digestion starts getting wonky. Also, like others have said, things like cheese or yoghurt are more tolerable.
posted by divabat at 10:55 PM on October 30, 2016

Lactose intolerant person here.

I'm fine with hard cheeses like parmesan and cheddar. If I want to drink milk (rarely) I usually get the lactaid stuff. For icecream I usually take a few lactaid tablets. They don't help completely but they do help with the worst of the effects, and icecream is so delicious it's worth it.
posted by eternalstranger at 12:47 PM on October 31, 2016

Definitely agree that there is a spectrum of intolerance. My dad won't bother with a Lactaid for a Cheeseburger, for example. I take one with every meal, just in case.

Also for some reason, we've never had good luck with generic Lactaid. I only buy brand name Lactaid Fast Act. (Interestingly, the only other OTC med that I don't buy generic is Immodium.)
posted by radioamy at 10:48 AM on November 1, 2016

Lactose intolerant here. My mom and sister are as well. I, like some of the others, eat dairy because it is hard to escape. I will not drink or cook with any type of regular milk if I can help it. I get Smart Beat and margarine instead of butter. I usually buy organic soy milk but will get lactose free milk on occasion. The Cabot cheddar cheeses are lactose free. My boyfriend is lactose tolerant so we usually have a variety of things in our fridge.

I use the lactase enzyme pills from Vitamin World. They have good BOGO sales so I will buy in bulk during those times and save a bunch of money. If you have their customer card you will get credit toward future purchases based on how much you buy. I do try to watch what I eat if there is a particularly important event or something coming up.
posted by Nolechick11 at 6:14 PM on November 1, 2016