Lactose intolerance 101
February 8, 2018 3:25 AM   Subscribe

I seem to have developed lactose intolerance. I have questions.

No one in my family has any trouble with dairy (I am primarily of Eastern European ancestry with some Western Europe thrown in), so I have almost no experience with lactose intolerance. I was fine with dairy as a kid and adult. I then cut out dairy entirely for a little over a year while breastfeeding my daughter as she couldn’t digest the milk proteins properly. Now she can eat dairy just fine and I can’t.

After being ultra careful to have no dairy for a year, I know what foods to watch out for and how to read labels, so no questions there. And small amounts of dairy in processed foods like bread seem to be fine for me for now.

I have the Lactaid Fast Act pills because I read that they’re the most effective type. The instructions say to take one with the first bite of food then another after 30 minutes if you’re still eating dairy. Is that actually the best way to use them? If I’m eating a larger quantity of dairy is it helpful to take more than one? If I forgot to take them with my food is it at all helpful to take them five minutes after eating? 10? An hour?

If I regularly use Lactaid pills am I likely to lose the small amount of lactose tolerance I have left? If I don’t take them, is it possible to rebuild my lactose tolerance?

Some foods are fine some of the time and a problem other times. Are there any patterns you’ve noticed in terms of time or day, full vs empty stomach, eating with/without other foods that I can watch out for? Or is it most likely just a quantity thing? I can experiment of course, but the results are sometimes unpleasant.

I hear that yogurt is usually fine for lactose intolerant folk but I had some Greek yogurt the other day and it was definitely not fine. Is Greek yogurt different? I don’t see why it would be. Any particular brands or styles of yogurt that are more likely to be okay to eat?

I have googled a lot and read most or all of the AskMe questions about lactose intolerance, but I’m happy to be pointed to any helpful past questions or good websites. Thanks!
posted by insectosaurus to Food & Drink (24 answers total) 1 user marked this as a favorite
So my own experience:
I was also fine as a kid, they developed lactose intolerance in my 20's. I've been eating a keto diet for the last 2 years, and magically, my lactose intolerance is all but gone. So in my case, i strongly suspect that cutting out carbs has changed my gut biome and i can now tolerate a whole bunch of dairy just fine. I've also been supplementing with probiotics and digestive enzymes and eating a bunch of fermented foods and i think that's helped as well.

So if you're willing to trade in the carbs for alllllll the cheeeeeeeese, then keto might be for you too ( side effects for me include weight loss, clear skin, stable moods and no cravings... so i recommend it to everyone.)

I've never tried lactaid though so can't comment on that.
posted by PardonMyFrench at 4:38 AM on February 8, 2018 [1 favorite]

I think you aren't thinking about this quite right. Lactose intolerance means that you aren't making enough of the lactase enzyme - and when you are low, which is sounds like is most of the time, you become quite ill. So try to visualize it this way: If you have no enzyme in your belly and you drink a cup of milk and then take the Lactaid pill containing the enzyme, you are basically sending the enzyme down AFTER you have started digesting the milk. I suppose it is better than nothing - but best to send the enzyme down first, and have it ready for the upcoming milk. If you have a big dairy-filled meal, you want to take another pill to ensure you have enough enzyme in your belly to help you digest it all.

Why is dairy sometimes ok? Well, it sounds like you might be producing a small amount of the enzyme right now - in which case you could consume a small amount of lactose when lactase was present. There would be no way to know when you had enough lactase in your system to do so though.

Some dairy foods do have less lactose due to it being consumed by bacteria or fungi while being made - there are some hard cheeses that fall into this category. I've heard that yogurt can as well, but perhaps not enough to help you out. Why risk it, just take the pills.

Why you developed it when you did and will you get over it? That's not clear. I had lactose intolerance as a child, and a dairy intolerance (not lactose related) for both of my pregnancies. Why did I develop and lose it? No clue. Will you ever get better? Perhaps. Can you train your body to create more lactase by easing more dairy in? I wouldn't do that - that would hurt a lot and the pills are easy and not harmful at all - you are just eating an enzyme that will help you digest the food.
posted by Toddles at 4:51 AM on February 8, 2018 [2 favorites]

I am lactose intolerant, and yogurt of any kind is definitely not fine for me. Hard cheeses are, though. You will find that it varies from person to person. I also have difficulties with butter, which many lactose intolerant people say works fine for them. I don't do the Lactaid pills, but I do drink Lactaid milk (and chocolate milk!) daily. There are a range of lactose free products available out there now; Green Valley Organics makes butter and cream cheese, which I buy regularly. Haven't tried the ice cream or yogurt, but they have those too, I believe. Bottom line - your life isn't over! You can still indulge in your favorites.
posted by backwards compatible at 4:53 AM on February 8, 2018 [2 favorites]

I just take a Lactaid with any meal or snack that I'm not 100% sure is clear, and I don't think about it again.
posted by COD at 5:19 AM on February 8, 2018 [2 favorites]

Best answer: I find that taking a Lactaid up to 30 minutes after eating dairy can help offset some of the effects of lactose intolerance. That is, if I forget to take it with my food and catch up after a bit, sometimes the upset stomach just goes away.

Also wanted to put in a plug for Fairlife milk. It's expensive, but in my mind, worth it, especially for those moments when you want a splash in your coffee or tea without taking a pill. It's not only lactose-free but filtered, so it has more protein and less sugar than regular milk.

You might also be interested in this recent piece about someone who, like you, became lactose intolerant after cutting out dairy.
posted by dapati at 5:28 AM on February 8, 2018

Best answer: 100% do not ever go by what someone else tells you is an acceptable amount of dairy, never listen to anyone who says "oh almost all lactose intolerant people can have THIS THING". it is different for everyone and learning your own limitations via hilariously gross trial and error is the single most valuable thing you can do in your new tragically cheeseless life.

some things that are about me personally but may help you:

- only the brand name lactaid pills are consistently useful. i've tried the costco kirkland brand and they are utter fucking shit. name brand lactaid is most economically bought in bulk from amazon.

- i am intolerant enough to get sick from lactose used in medications as an "inert" filler, but european style cultured butter is mostly okay in toast-buttering amounts, via european butter sorcery i guess

- no yogurt is okay, they are all death. a yogurt is a 6-pill meal.

- i can't take a single pill and have it do anything other than make me wish i took more than one pill

- for something like a chai latte i need to take at least 2 lactaid, 4 if it's a big one

- for anything containing regular meal amounts of dairy (pizza, pasta, etc), i take 4-6, depending on previous trial and error

- for dairy rich desserts i take 6 before eating and another 2 immediately afterwards, with the plan of taking 2 more if necessary

- vegan desserts can be surprisingly amazing

- WHEY. fuck whey. whey is the fucking devil. it's in everything that manufacturers decided needs cheap protein or flavoring. it is the single worst dairy product on earth. heavy cream is less painful than whey. whey testing will require bravery imo.

"curing" your lactose intolerance depends on how it happened. if it's genetic then obviously it's forever, no end to your suffering. but people can get temporaryish situations from really bad stomach bugs. in those cases apparently you can do something to reset the tolerance with enzymes? or something? idk? this is constantly recommended to me by people who don't understand that genetic lactose intolerance is the default setting for adult humans on earth and it's super annoying but like. just throwing that out there i guess.

my reactions seem to have calmed down a bit now that my severe GERD is under control but that could also just be that a lot of my (painful, explosive, gross) GERD symptoms were similar to lactose hell.
posted by poffin boffin at 5:33 AM on February 8, 2018 [11 favorites]

Intolerance to lactose is an intolerance to the sugars in milk. Milk also contains proteins (casein, whey).

I know someone who learned about milk protein intolerance the hard way when I fed him a couple canned casein balls from the international grocery store and he balled up on the floor in pain; everyone else in the room was fine.

Greek yogurt is a lot higher in protein than regular yogurt. It's possible that if you stick to low protein dairy, you might manage better.
posted by aniola at 6:33 AM on February 8, 2018

110% to everything poffin boffin has said and then some.

I've been lactose intolerant since at least high school and went through plateaus of tolerance. It used to be just raw milk, then it was raw milk and cream, then it was raw milk, cream & soft cheeses. Now, after probably 10 years of staying at the same hard cheese and butter level, I can't handle anything more than the vaguest whiff of milk product. The Lactaid type pills only help when I pair it with Imodium, and it only prevents the worst of the side effects.

But only cow's milk.

The human body is a weird ass thing.

Good news is I can eat goat cheese, goat yogurt, sheep butter, etc. with minimal issues (it takes like a week to even start to feel bad). There are a lot of good dairy alternatives out there nowadays (thank you Ben & Jerry!). Lots of really great vegan foods as well. It's worth looking into other options for you until you can get your system back under control and figure out what you CAN tolerate.

You may never 'get better', but you absolutely can live it with. You just need to figure out what works and doesn't work for you.
posted by RhysPenbras at 6:37 AM on February 8, 2018 [1 favorite]

Have you tried kefir? It's like yogurt but easier to digest apparently and some studies show it can be helpful for mitigating lactose intolerance. I would start with small amounts.

I'm not lactose intolerant but I went through a phase of not tolerating it very well, it took time for my gut to heal/change and a big trigger for me was butter, but cultured butter is fine.
posted by lafemma at 6:39 AM on February 8, 2018

even if you can tolerate yogurt normally, many grocery brands of greek yogurt use skim milk powder to thicken, which very much contains lactose.
posted by JPD at 6:41 AM on February 8, 2018 [2 favorites]

My spouse has genetic lactose intolerance. In addition to Lactaid milk, ice cream, and cottage cheese and Green Valley Organics sour cream and cream cheese, we are big fans of Buf mozzarella, a buffalo mozzarella that has no lactose (most buffalo mozzarellas are low in lactose).
posted by hydropsyche at 6:57 AM on February 8, 2018

Best answer: Many people become lactose intolerant as they get older and not consuming dairy definitely affects your ability to eat dairy. Lots of people take several lactaid tablets, so try it and see.

I'm lactose intolerant and dairy also seems to promote inflammation for me. Most Asian food has no dairy products in it, so that's an easier choice for going out, and vegan foods, too. I cook from scratch a lot anyway, but especially since I stopped dairy. A lot of margarine has when and other dairy. Earth Balance is pretty good instead of butter. Almond or coconut ice cream substitutes aren't ice cream, but are nice. There's no substitute for cheese. I haven't found great websites for dairy-free cooking. I substitute OJ or cinder for milk in baking, vinegar and water in a pinch.

In her book, Animal, Vegetable, Miracle, Barbara Kingsolver discussed lactose intolerant thoroughly and without woo, and lots of other food issues, if you have any time for reading.
posted by theora55 at 7:03 AM on February 8, 2018 [2 favorites]

i've tried the costco kirkland brand and they are utter fucking shit.

I would like to emphatically second this. I thought Lactaid just wasn’t working but no, it is just that terrible brand.
posted by corb at 7:49 AM on February 8, 2018

As a baby I had problems with milk and my mom had to browbeat the neighborhood grocery store to carry goat's milk for me, but that was the 70s and the science is now pretty clear that goat's milk isn't really that much better. As an adult I can't stand cheese made with only goat's milk, which I blame on some sort of triggered reflex. The taste of it just sets me off.

As an adult I've been tested via stool sample (during a bout of … something) and according to that test I'm not lactose intolerant. Could have fooled me. (The tests weren't conclusive for anything else either, so that was fun).

My experience is less that I'm 100% lactose intolerant, and more that I can tolerate some lactose. That amount seems to vary. I'm able to put regular half & half in my coffee every day, and I never seem to have any problems with cheese. The bane of my existence is ice cream. I think I've finally learned that I can never have a milkshake again, but I'm usually OK with up to two scoops of ice cream (where "OK" means I'm probably still going to be pretty gassy, but I won't have the painful cramps I get with a milkshake).

All of that is to say that what people above said about producing some lactase but not necessarily enough is precisely my experience. I tried the pills, but I can usually prevent symptoms just by carefully limiting my exposure to regular milk. We buy the Lactaid milk at Costco because it lasts forever in the fridge and my wife doesn't mind it.

NB: I also get similar symptoms from an excess of cooked onions (more so than raw onions) and some cereals. It's never been enough for me to work through a FODMAP challenge diet, but I'm aware of that as another potential source of cramps.

Also, Trader Joe's lactase supplements are just as useless as the Costco ones.
posted by fedward at 8:28 AM on February 8, 2018 [1 favorite]

Response by poster: Thanks - this is all very helpful! I just want to add that I don't need advice on dairy- or lactose- free substitutes, as I did lot of experimenting while I was avoiding dairy for my daughter's sake. (Silk Protein Nut Milk is awesome for coffee, I've tried a couple cashew and coconut milk ice creams that are worth eating, Miyoko's Creamy cheese substitutes aren't actually very similar to cheese but taste good, which is more than I can say for most fake cheese.)
posted by insectosaurus at 8:30 AM on February 8, 2018

My kids are part asian and they can't eat anything with cow's milk, but they are just fine with goat's milk products (milk, cheese [chevre], yogurt, kefir). (Like you, I had to go dairy-free for nursing).

You might try the goat's milk if you want to keep dairy in your diet. It's quite dear though, and we've had to adjust our grocery budget accordingly. Regular milk is what - $4-5/gallon? Goat's milk is about $16/gallon. Milk is cheapest at Trader Joe's, chevre is cheapest at Costco, and the only place we've found yogurt or kefir is at Sprouts (Whole Foods probably has it too).
posted by vignettist at 8:36 AM on February 8, 2018

(Shoot, sorry, I posted before I saw your update).
posted by vignettist at 8:59 AM on February 8, 2018

Best answer: There are a lot of variables here, and people's experiences vary WIDELY. Your own experience is going to be the best guide! However, it might help to know about some of the factors affecting your ability to digest lactose. Normally, there are two separate ways your body can metabolize lactose:
1. By using the lactase (lactose-metabolizing enzyme) that your body produces
2. By subcontracting the job to friendly gut bacteria who will metabolize the lactose for you

Your body's lactase production can go wrong in several ways:
- Most humans produce less lactase as they get older, though you might not notice it unless you're eating a ton of dairy.
- Primary lactose intolerance is when your gut stops abruptly stops or dramatically reduces lactase production. If this has happened to you, then your ability to digest lactose is likely to get worse, not better, over time.
- Secondary lactose intolerance is when some trauma (surgery, illness, etc.) temporarily derails your body's ability to produce lactase -- but once you're better, you may regain some or all of your lactase production.

Your lactose-digesting gut bacteria can also have a big impact, though it seems there's much less understanding of this factor at the moment.
- Sickness or antibotics have the potential to temporarily disrupt your gut bacteria.
- There's some evidence that eating dairy, or cutting out all dairy, can change the composition of your gut bacteria dramatically. See this article for a quick overview: Chowing Down on Meat and Dairy Alters Gut Bacteria A Lot, And Quickly
- There's some research that indicates that prebiotics might help people digest lactose by cultivating helpful gut bacteria (see this fascinating podcast).

So, what does this all mean for you? You'll have to experiment and find out! If your body is producing barely any lactase, then even the most dairy-loving gut bacteria might not be able to entirely make up the difference. If you've got some lactase production, then enlisting the help of gut bacteria (by taking prebiotics and eating a moderate amount of dairy) might help you be better able to deal with lactose over time. Either way, taking Lactaid will reduce the amount of lactose that your body has to deal with.
posted by ourobouros at 10:00 AM on February 8, 2018 [1 favorite]

I usually take 2 - 4 lactaid pills with any meal that could potentially contain dairy. This includes basically all restaurant meals, which usually contain some butter. Some foods are completely out: fettuccine alfredo, clam chowder, ice cream (sigh)- basically anything that contains heavy cream. I'm ok with hard cheeses but definitely not yoghurt. For me it's the amount of dairy that is the issue and when or what else I've eaten doesn't make a difference . I don't know if using lactose pills will make you lose any residual tolerance but you don't really have a choice, do you? It's either take the pills or avoid dairy. Unless you're one of those people who gets mild bloating and discomfort rather than, say, explosive diarrhea.
posted by emd3737 at 11:58 AM on February 8, 2018

Best answer: I take 2-6 pills before eating dairy, depending on the lactose load in it. And even then, if I consume dairy for several days in a row, the pills won't be as effective, so I need to ease off for few days before eating dairy again. I've taken pills a short time after starting to eat (like within 10 min) if I realize I've forgotten them, and it usually works but not always.

It's also less likely to be a problem if I eat other foods with the dairy--a block of cheese by itself is a bit worrying, but the same amount of cheese on a thick-crust pizza is less likely to produce symptoms.

Even aged soft(er) cheeses like Cheddar bother me, but aged hard cheeses like Parmesan don't seem to, although I only eat very small amounts because I don't particularly like Parmesan. (I have not tried the Buf Mozzarella mentioned above, but I'll do so if I find it!)

All sorts of yogurt bothers me. Theoretically any yogurt with a *live* Lactobacillus culture should be OK, but I don't trust them. There's a lactose-free brand of yogurt by Green Valley Organics I eat sometimes, and Dannon claims to have a lactose-free version, but I've never seen it.
posted by telophase at 12:30 PM on February 8, 2018

Adding: Butter has never produced any symptoms in me. I get sick from the fat content long before the lactose content. I do not take lactase pills before eating buttery foods or foods cooked in butter. YMMV.
posted by telophase at 12:32 PM on February 8, 2018

I’m fairly lactose intolerant and my theory is, there’s no harm in having too many Lactaid. For a Neopolitan pizza, 6 Ultra Lactaid. Decent serving of ice cream? 4 sounds good. I’m totally thrilled to be able to eat dairy again.
posted by advicepig at 2:23 PM on February 8, 2018

I developed lactose intolerance in my late 20s, and it's waxed and waned in degree. Finally, a year or so ago I went to a specialist, had a full endoscopic investigation with samples and all sorts of shit and... apparently I'm only the tiniest bit lactose intolerant.

((my body still disagrees with this assessment))

What really helped me, though, was giving the FODMAP approach a shot. Although I never did the strict regime, I did enough to realise that I'm actually more intolerant to fructose.

...which is in a shitload of things. Including a lot of things with lactose in it... and I was probably reacting more to that than the lactose.
posted by coriolisdave at 3:33 PM on February 8, 2018

Nthing everyone else who says that you have to experiment for yourself with how many Lactaid pills and what kinds of dairy products you can tolerate.

Personally, I can avoid stomach pain with just a single pill even if I'm eating ice cream or cream-based pasta (I still get bloating, but no cramps; I'm lucky enough not to have major "other end" symptoms). But at my most sensitive, I was reacting to chocolate chip cookies with small amounts of butter and milk. I started testing out butter without pills a few years ago, and my life has gotten a lot easier since being able to eat butter.

And as someone with a "moderate" lactose intolerance, I still can't handle any kind of yogurt, or goat's milk products. Seriously, YMM(will)V.

But one thing seems to be constant, definitely buy name-brand Lactaid. I've yet to meet anyone who didn't see a difference between Costco Kirkland-brand lactase and Lactaid lactase pills.
posted by serelliya at 11:50 AM on February 9, 2018

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