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ASK THE DOCTOR: Diet can aid life with lactose intolerance
By Dr. JIM MITTERANDO
The Patriot Ledger

Editor's note: This is the second of a two-part series on lactose intolerance. Part One

Q.I am lactose intolerance. Do I need to eliminate all dairy or need to worry about cream in my coffee? What about butter and chocolate? Does Lactaid work?

ALiving with lactose intolerance does not necessarily mean doing away with dairy. Most people with lactose intolerance find they can enjoy milk, ice cream, etc., if they take them in small amounts or eat other food at the same time. Through trial and error you will learn what you can tolerate and what you will need to avoid.

Limit dairy products

A cup of milk contains 12 grams of lactose. Most people with lactose intolerance can consume up to 7 grams (and perhaps more) of lactose without any symptoms. So there is no need to fear the small amounts of lactose in the cream in your coffee or in most cheeses.

Try dairy foods that are lower in lactose such as yogurt, cheese, buttermilk or special lactose-free milks. But remember, you will develop cramping or diarrhea if you eat these lower lactose foods in large enough quantities. Moderation is the key.

Lactose content of some dairy food Lactose (in grams):

  • Whole milk, 1 cup -12
  • Ice cream, 1 cup - 12
  • Plain, low-fat yogurt, 1 cup - 5
  • Cottage cheese, 1 cup - 5
  • Cheddar cheese, 1 ounce - 0.06
  • Mozzarella cheese, 1 ounce - 0.02

Yogurt is well tolerated because it has less lactose and contains bacteria (‘‘live cultures'') that make the lactose-digesting enzyme, lactase. Not all yogurts have live cultures and, therefore, may not be as well tolerated. Check the label for live and active cultures. Most yogurt in supermarkets is sweetened by additional milk products such as whey that increase the lactose concentration. Read the label.

Dairy alternatives
Lactose-free or lactose-reduced dairy foods are available in the supermarket for people who need further lactose restriction. Lactose-reduced milks have the same nutritional content of regular milk but the lactose has been broken down to simpler sugars with the lactase enzyme. The milk tastes somewhat sweeter. One-hundred percent lactose reduced milk still contains small amounts of lactose.Fermented milks such as kefir are a lower lactose option. Kefir is a slightly sour, alcoholic milk beverage with a lactose content 50 percent to 80 percent lower than regular milk.

Lactase supplements
Lactase enzyme supplements can aid in the digestion of lactose and help people to better tolerate dairy products. Lactase is sold over-the-counter and comes in pills and drops. Lactaid and Dairy Ease are common brands. The pills are taken with the meal. The drops can be put into milk and over one to two days will breakdown the lactose and make low lactose milk. The drops can only be purchased online.Lactase supplements will not completely relieve symptoms and need to be a part, not a substitute, of dietary restriction.

Read food labels
For more severe cases of lactose intolerance, it is important to read labels. This way you can either save your lactose ‘‘allowance'' for those special foods you can't do without or avoid them if you cannot tolerate any lactose.Smart shoppers search food labels looking not only for milk and lactose among the contents, but also for such words as whey, curds, milk by-products, dry milk solids, and nonfat dry milk powder. If any of these are listed on a label, the product contains lactose.

Chocolate is OK
Most people with lactose intolerance can tolerate milk chocolate. If you have trouble with the small amount of lactose in milk chocolate try semi-sweet or dark chocolate which contain no lactose.

Other lactose pearls

  • Butter has little lactose since it is almost pure fat and should be well tolerated.
  • Avoid products containing whey, which is a milk product that contains mostly lactose.
  • Many processed cheeses are higher in lactose due to additives.
  • Eat non-lactose foods with your dairy to slow digestion and reduce symptoms.
  • Nondairy substitutes such as soy milk and rice milk are good alternatives.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2004 The Patriot Ledger
Transmitted Tuesday, September 28, 2004