The milk delivery business has been kept afloat in Hackney by a rise in almond milk sales and other cow’s milk alternatives. This is not solely due an uptake in veganism. Lactose intolerance affects one to two people in every 10 in the UK, according to the British Nutrition Foundation. Whether you have the food intolerance, or whether you know someone affected by it, consultant gastroenterology dietitian Kirsten Jackson has the answers to all your questions.
Q: What is lactose intolerance?
Jackson: Lactose intolerance is when you are unable to digest lactose, which is a sugar found in dairy. It happens because you stop producing lactase, a digestive enzyme that is produced in the small bowel and is needed to break down lactose.
Q: What are the symptoms?
Jackson: The symptoms tend to be looser stools, pain, gas and bloating.
Q: At what age do people tend to become lactose intolerant?
Jackson: It depends. Very, very rarely in babies: one in 60,000. Then, I’d say the majority are probably around their teens or onwards.
Q: What is the difference between lactose malabsorption, lactose intolerance and a milk allergy?
Jackson: The malabsorption you wouldn’t know because it’s happening inside your gut. So you’re not going to know when the lactose is malabsorbed or not. The time is going to be when that malabsorption starts to cause intolerance. Intolerance would just be when you start to get symptoms.
Even people who do not produce any lactase should be able to manage a small amount of lactose before they get symptoms. So they might be able to have a little bit of milk in a tea or a coffee – and that doesn’t mean it’s getting broken down, it just means that it doesn’t cause any symptoms. Whereas, if you have, for instance, a milk allergy – this is where you are reacting to the milk protein – you can’t have little bits and get away with it.
Q: Can different people manage different amounts of lactose even with lactose intolerance?
Jackson: Yes, absolutely. The difficulty is that there’s no test for that apart from just trial and error to see how much that person can manage.
Q: Can you change your own lactose tolerance level? For example, does slowly adding milk to your diet make you able to tolerate it more?
Jackson: Often, dairy is something that patients with eating disorders will restrict. So, they might not have had dairy for a long time and then their body just basically stops producing lactase because it just doesn’t need it. So, if you were to say to that person, “right, now I want you to drink lots of milk”, then they’re going to get a lot of symptoms. The advice is to slowly increase it overtime and they should start producing lactase enzymes again. However, there’s not really any research that I’ve found to say how long that might take or even if everybody has that opportunity and that’s the difficulty.
Q: Does heating up milk reduce its lactose content and are there foods with different lactose contents?
Jackson: Heat doesn’t change it at all.
However, cheese which is a fermented product, doesn’t contain any lactose. So hard cheeses, like your cheddar cheese, your feta, mozzarella even, will contain very little lactose because it uses a process called fermentation. To make cheese, they add bacteria and the bacteria eats up the lactose. That’s why a lot of people, if they’re lactose intolerant, can manage cheese just fine, but things like milk they can’t and then they get really confused. There’s pretty much no lactose in the cheeses.
Q: How can lactose intolerance be managed?
Jackson: It’s just a case of getting diagnosed. Unfortunately, the only way to diagnose accurately is by taking a clinical history. So, we would look at someone’s genetic background, we would ask them what race they are even. We’ve known, for example, that in people who are Asian, they are at much higher risk of having lactose intolerance compared to Caucasian, which is much lower because of a genetic default in the Caucasian – we’re not supposed to be able to break down all this lactose as we get older. We would also look at their medical history. Have they had a digestive infection? Do they have coeliac disease? Then, if we think from that it’s a high chance of lactose intolerance, we would take the lactose out of their diet for a trial period. If their symptoms go away, that’s a pretty good diagnosis. Then we would bring it back in again in small amounts, slowly increasing to find out what their tolerance level is. They might be able to manage even more than a few drops in their tea or coffee. They might be able to have breakfast with milk in it but anything more than that is too much. So, it’s about finding the tolerance level.
Q: Are there things that people could take right now that could help with their absorption of lactose?
Jackson: You can just take lactase enzyme in pill form. So, say if you wanted a massive bowl of ice cream you could just take some pills with that and they just mix with the food in your stomach, help you to break it down and then you digest it easily. Or you can get lactase drops and those ones you actually add to the food, which are quite good for travelling. Because it might be fine when you’re at home, especially in the UK where we have lactose-free milk in every kind of format you can think of in every shop. But if you go travelling you may not have that option. So, you can take the little bottle of drops, you can put a couple of drops in, leave it overnight and in the morning there’s no lactose in it. But to be honest, to most of my clients, I have to say have plant-based milk instead because they find it easier.
Kirsten Jackson spoke to Amarachi Orie
Find out more information on her website: http://www.thefoodtreatmentclinic.com/
