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The lactose dilemma.

If you've been reading the Post, listening to the radio, or watching television recently, you have learned how important calcium is in your diet. You know that calcium has much to do with bone strength and that lack of it may contribute to high blood pressure as much as excessive salt does.

But some people with certain digestive problems cannot get calcium the usual ways. Milk and other dairy products are the prime sources of calcium, yet these same dairy products cause these people's digestive problems. In fact, more than half the adult population may suffer from milk sugar intolerance. Substituting other beverages for milk and leaving the dairy products in the supermarket would eliminate most of these people's calcium. So, what's to be done?

Fortunately, there is a solution to this dilemma. First, however, let's examine what milk intolerance is. Many adults who drink milk have annoying and occasionally severe symptoms of gas and diarrhea. The problem has to do with lactose, the natural sugar in milk. A chemist will tell you lactose is actually two simpler sugars, glucose and galactose, linked together. That linkage needs to be broken so the two sugars can be digested. This is done by the enzyme lactase, found in the gastrointestinal tract. The two sugars are now simple enough to be absorbed into the blood, where they are used as a source of energy.

However, many people don't make enough lactase, so not all the lactose is split. Undigested lactose stays in the gastrointestinal tract and causes the uncomfortable and embarrassing symptoms of gas and diarrhea. In fact many people don't realize the real cause of their problems-they worry they are suffering from more serious ailments, such as colitis or diverticulitis.

Lactose intolerance is usually inherited. It affects most ethnic groups, including Orientals, blacks, Hispanics, and American and Asian Indians. (Caucasians of European ancestry are apparently the only ethnic group with few lactose-intolerance problems.) Some people become intolerant of Lactose because of diseases or surgeries involving the gastrointestinal tract or because of the frequent use of antibiotics or some cancer-fighting drugs. In these cases, the area of the gastrointestinal tract making the lactase enzyme becomes permanently or temporarily damaged.

Keep in mind there are degrees of lactose intolerance. People gradually lose the ability to produce the lactase enzyme. Children and infants usually make enough, but as they grow older, lactase production slowly decreases. Because this process is so slow, the first symptoms may be mistaken for indigestion. Even later, many people may not link their almost daily discomfort with milk, for they have had milk all their lives.

Once a person recognizes he has lactose intolerance, he needs to consider three points:

1. How much lactose can be tolerated? You can find this out most easily by trial and error. Follow a lactose-free diet for five to seven days. Then try a small amount of milk (about 1/2 cup) with a meal. If this amount causes no problems, gradually increase the amount (by about 1/2 cup) until the familiar symptoms reappear. This process gives you an idea of how much leeway you have in including lactose in your diet.

2. Besides dairy products, do any foods contain lactose? Lactose is found in many processed foods. Words to look for on the labels are: lactose, whey, milk, dry milk solids.

Having too many foods containing these ingredients at one time may be enough to cause aggravation. However, in some foods lactose may be present in such minute amounts there will be no problems.

3. Are some dairy products safe to eat? Once a person has figured out the source of his problem, he needs to realize that the easiest, most obvious solution-to stop drinking milk-is not necessarily the most healthful. For those who suffer from lactose intolerance, there are ways to keep milk and other dairy products in your diet and thus ensure a continuing generous intake of calcium.

Dairy Products for the Lactose Intolerant

Milk: Persons with a slight lactose intolerance can often digest milk well if it is part of a meal. Also, for some reason, chocolate in milk may make it easier to digest. Ice cream often poses no problem for those with limited lactase production. Apparently, the high fat content of ice cream acts as a protective agent.

Treated milks: Several specially treated milks are also available.

The Lactaid company has produced a variety of such products. In many parts of the country, stores carry Lactaid milk, usually in quarts. The milk is 70 percent lactose reduced, a level tolerated by many lactose-intolerant people. Lactaid milk is ready to drink, and it can be used as regular milk in recipes as well. It has a slightly sweeter taste, because the lactose has been split into the two simple sugars.

You might prefer to purchase Lactaid drops and add them to regular milk yourself. Refrigerate this milk for up to 24 hours to give the enzymes time to split the lactose. Adding four or five drops makes a quart of milk about 70 percent lactose reduced, or, if needed, you can add more drops for nearly 100 percent lactose-reduced milk. A pamphlet of instructions is provided. You can use this milk either as a drink or in recipes needing milk. Ask for this product at your neighborhood pharmacy; if the store doesn't have it, it can order it for you.

The Lactaid company seems to have all the bases covered; it not only has drops for treating milk, but it also offers tablets. The tablets are a natural source of lactase. Before eating a meal that contains lactose (milk, cream soup, cream sauce, ice cream), take one to three tablets. The enzymes in the tablets will split the lactose apart as you digest your meal. These tablets are particularly helpful when you eat away from home. There are no adverse reactions with these products.

Sweet acidophilus milk is another lactose-reducing product. The milk is processed with a bacteria culture that will change lactose to lactic acid, which is more easily absorbed. Sweet acidophilus milk is not helpful for all lactose-intolerant people; some still have digestive difficulties.

(Several nondairy products resemble milk. They are free of lactose, yet they contain many of the nutrients in milk, particularly calcium. Vitamite can be purchased as a liquid or as a powder. It can be used as a milk-like beverage or substituted for milk in recipes. The fat used in Vitamite, however, is coconut oil, a saturated fat. Because we use saturated fats to make cholesterol, Vitamite would not be a good choice for those on a diet to lower cholesterol in their blood. The other products mentioned above, made with 2 percent milk, have less saturated fat than coconut oil has. In fact, if you are treating your own milk with Lactaid drops, you can use I percent, 1/2 percent, or skim milk with equally good results. Other lactose-free, nondairy beverages, such as Soyamel, include soy milk. They are also high in calcium. Sustacal liquid and Ensure are lactose-free high-calorie nutrition supplements fortified with calcium.)

Yogurt and buttermilk: the fermented milks: Yogurt and buttermilk are worth trying, particularly if you have a slight lactose intolerance. They are "fermented." The bacteria culture used to ferment yogurt has lactase enzymes that will break down the lactose for you. Frozen yogurt might be a better digested product than ice cream; it is certainly worth a try for a cool and refreshing dessert. Buttermilk is also made with bacteria culture, although it may not prove as digestible as yogurt.

Most yogurts and buttermilk are low in fat. They are a good alternative for people trying to cut back on fats, especially on saturated fats. If you are weight conscious and you like the taste of flavored yogurts, look for those with the smallest number of calories. (As an alternative, you could use plain yogurt and add your own fruits, such as unsweetened applesauce or pineapple crushed in its own juices.)

Cheeses: As a group, cheeses have less lactose than milk has. Do you recall the nursery rhyme that starts with "Little Miss Muffet/Sat on a tuffet/ Eating her curds and whey. . . ."? The rhyme refers to milk that has been curdled. The curds are mostly protein and are the base for making cheese; the whey, mostly liquid, contains much of the milk's sugar, lactose. Most people who have a lactose intolerance find they have no problem eating cheese. However, for those who produce very little or no lactase enzyme, the kind of cheese they choose is crucial.

Unripened cheeses: Much of the lactose is removed when unripened cheeses (cottage cheese, ricotta cheese, mozzarella, etc.) are made, so if you have a slight intolerance they may be worth trying. Be careful with "creamed" cottage cheese, for it may have some lactose in the creamy portion. You may tolerate these cheeses better with a full meal than alone. If so, you can add more variety to your meal-time-pizza, lasagne, and cottage cheese.

Naturally aged cheese: As a cheese ages, the remaining lactose is gradually changed to lactic acid, which does not need the lactase enzyme to be digested. Cheeses aged six months or more should cause no symptoms of lactose intolerance. These cheeses include some varieties of Cheddar, Swiss, Gouda, Parmesan, sapsago, blue, Gorgonzola, Roquefort, and Stilton cheeses.

You might try other cheeses not ripened for such a long time; quite a few people can tolerate them, perhaps due to the relatively high fat content. These cheeses include such popular products as muenster, colby, mild Cheddar, Edam, and Brick, to name a few. A diet high in fat tends to extend the time food takes to move through the gastrointestinal tract; the limited number of enzymes may have enough extra time to break down the lactose. Try these cheeses. If you have the same familiar symptoms, then stick with longer-aged cheeses. Cheeses that may pose the most problems are American cheeses, processed cheeses, cheese spreads, and cheese foods, for they have little aging time and thus have more lactose content.

Cheeses, a good source of calcium, can help meet your calcium needs daily-but getting an the calcium you need from cheeses would require about one-fourth pound of cheese every day and, consequently, a high intake of saturated fats. Yet, if you look hard enough, there are options. You might try lower-fat cheeses. More such cheeses are available as manufacturers respond to the demand for lower-fat products. Currently available are Kraft Light Naturals, Borden Lite-Line, and Weight Watchers cheeses. Fisher produces a cheese that has replaced dairy fat with corn oil, substantially reducing the saturated fat. These cheeses, however, tend to have more lactose than the aged cheeses.

This, then, is how people intolerant of lactose can get the calcium they need from dairy products. As you can see from the chart on page 67, it is fairly difficult to supply the recommended amount of calcium day after day from other foods. A simpler solution might be to take calcium supplements. But, as usual, simple solutions are not without problems: calcium supplements, taken with meals, can often interfere with the absorption of other important minerals.


High in Lactose: milk, ice cream, products made with milk: puddings, cream soups, cream sauces.

Moderate In Lactose: cottage cheese, ricotta cheese, Mozzarella cheese, cream cheese, processed cheeses, cheeses aged less than six months.

Low in Lactose: aged cheeses, treated milks: Lactaid, sweet acidophilus.


(Requirement of 800 milligrams per day)

 Food Amount Calcium (mg)
 Nonfat milk 1 cup 300
 Buttermilk 1 cup 285
 Ice cream 1/2 cup 88
 Plain yogurt 1 cup 415
 Flavored yogurt 1 cup 389
 Cottage cheese 1/2 cup 77
 American cheese 1 ounce 174
 Cheddar cheese 1 ounce 204
 Mozzarella cheese 1 ounce 183
 Ricotta cheese 1/2 cup 337
 Collard greens 1/2 cup 150
 Kale, raw 1/2 cup 113
 Green beans 2/3 cup 3
 Green peas 3/4 cup 20
 Dried beans, cooked 1/2 cup 90
 Salmon, with bones 3 ounces 167
 Chicken 3 ounces 11
 Beef 3 ounces 11
 Whole-wheat bread 1 slice 20
 Noodles 1/2 cup 16
 Cantaloupe 1 cup 68
 Orange 1 medium 71
 Peach 1 medium 6
COPYRIGHT 1987 Saturday Evening Post Society
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Copyright 1987 Gale, Cengage Learning. All rights reserved.

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Title Annotation:need for calcium vs. digestive problems
Author:Brining, Carmen
Publication:Saturday Evening Post
Date:Sep 1, 1987
Previous Article:Where are the extraterrestrials hiding?
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