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Got milk?

Experts wonder: Are you really lactose intolerant?

Your favorite athletes and leggy supermodels may lately be sporting big, white moustaches in glossy magazine ads, but you can’t get within mooing distance of a glass of milk without breaking out in hives. Your doctor, or your know-it-all neighbor, or your favorite prime-time television news magazine has handed down the verdict: You’re lactose intolerant, and you’d better stay away from all things dairy.

Then again, maybe not. Although more than 40 million Americans are lactose intolerant, you may not be among their number. Experts say that many self-diagnosed cases of lactose intolerance are just plain wrong, and that this misconception can lead to low-calcium diets that are detrimental to good health. And, researchers say that even those who are lactose intolerant needn’t cross milk off their shopping list altogether. There are simple dietary adjustments that can allow you to resume your daily consumption of dairy products without any ill effects.

Lactose intolerance is the inability to digest significant amounts of lactose, the predominant sugar found in milk. This inability is caused by a shortage of the enzyme lactase, which is normally produced by the cells that line the small intestine. Lactase breaks down milk sugar into simpler forms that can be absorbed into the bloodstream. When there isn’t enough lactase to digest the lactose you’ve consumed, the results can be rather unpleasant. Symptoms include nausea, bloating, gas, cramps and diarrhea, and usually manifest about a half hour after eating or drinking foods containing lactose.

For most of us, lactase deficiency is a condition that develops naturally over time, as the body gradually produces less of that enzyme. In some cases, certain digestive diseases and injuries to the small intestine can reduce the amount of lactase produced; very occasionally, children are born without the ability to produce lactase.  While medical types know what causes lactose intolerance, there is some question about why so many of us have nixed every trace of dairy from our diets without a proper diagnosis.

Steve Carper, author of Milk is Not for Every Body: Living with Lactose Intolerance, has a theory. “People really became aware of this condition in the mid-1990s,” Carper says, “when two of the larger dairy-substitute companies launched a multi-million-dollar, national ad campaign to promote their lactose-reduced milk products.”

Before then, Carper says, practically no one had heard of lactose intolerance. “Today, it’s something people can pin their symptoms on whenever they have a stomach – or intestine-related illness,” he reports. “A lot of the time, the real trouble goes undiagnosed because people decide they can’t drink milk.”

Greg Miller, Ph.D., vice president of nutrition research for the National Dairy Council, believes we blame milk for our health troubles for psychological reasons. “It’s a simple food aversion,” Miller says. “Everyone has eaten something that disagrees with them, and since lactose is present in so many foods, it gets written off as the culprit. You get sick after eating a whole gallon of ice cream, so you develop an aversion to any and all ice cream, because it’s associated with illness in your mind.”

A simple hydrogen breath-test administered by your physician can determine whether or not you’re able to digest milk properly. After drinking a lactose‑loaded beverage, your breath is analyzed at regular intervals. Raised levels of hydrogen in the breath indicate an inadequate digestion of lactose. Carper recommends an easy, at-home trial to determine whether you should be tested for lactose intolerance. After abstaining from all dairy products for three days, gradually reintroduce dairy products into your diet.

 “You’ll know pretty quickly if you can’t digest lactose,” Carper promises. “If your symptoms return within an hour or so of eating milk-based products, it’s time to visit the doctor for a breath-test.”

A diagnosis of lactose intolerance doesn’t mean you’ll never eat dairy again, Miller says. “We’re beginning to better understand the difference between lactose intolerance and lactose maldigestion,” he says. “We’ve learned that, while lactose intolerance is still relevant, the issue isn’t black and white in terms of who has it and who doesn’t. There are varying degrees of this ailment, and some simple ways with which to address it.”

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This Article appears on the February 2012 issue of LPM under Health

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