IBS--Free at Last!

What If I've Tested Negative for Lactose Malabsorption?

If you've tested negative for lactose intolerance, how does that fit into the FODMAPS picture?

First of all, let's review the test for lactose intolerance. The patient consumes a known amount of lactose. If the lactose is poorly digested and absorbed in the small intestine, it continues "down the line" to the large intestine, where it is fermented by the resident bacteria. They produce hydrogen gas as they ferment the lactose. Some of this gas is absorbed into the patients blood stream, where it travels to the lungs and is exhaled. If there is a sharp rise in the amount of hydrogen exhaled after the patient consumes the lactose, that is considered "positive" for lactose malabsorption. One thing to keep in mind is the fact that approximately 20% of us are not colonized by hydrogen-producing bacteria; instead, our resident bacteria many produce other types of gas such as methane or hydrogen sulfide (bad breath, anyone?).  Lactose-malabsorbing individuals in this category will falsely test negative for lactose intolerance on a hydrogen breath test alone, but might be positive if tested for both hydrogen and methane exhalation. The results of the lactose test really need to be viewed together with the patient's history of symptoms after consuming lactose, both during the test and at other times.

If someone has tested negative for lactose malabsorption AND doesn't particularly have a history of symptoms after ingesting milk products, it is pretty safe to say that individual is not lactose-intolerant.

However, even adults who tolerate lactose well in general do have limits to how much lactose they can handle. Because the effects of FODMAPS carbohydrates are additive, excessive lactose intake could put you over the top, and contribute to symptoms mostly caused by the other FODMAPS.

How much lactose is "excessive"? The answer to that question varies from one person to the next, but to put things in perspective, check out these generalizations about the lactose content of milk products:

Fluid milk: 11-14 grams per cup

Lactose-free milk: 0 grams per cup

Evaporated milk: 24 grams per cup

Yogurt: 5 grams per cup

Ice cream: 12 grams per cup

Butter: trace per 1 tsp

Most cheeses: 0-2 grams per ounce

Whey protein concentrate: varies

Whey protein isolate: trace per serving

Click here for more complete info on lactose content of foods and beverages.

To learn more about lactose intolerance and the FODMAPS elimination diet, visit www.ibsfree.net

Make Your Own Lactose-Free Yogurt

Yes, it is possible to make your own lactose-free yogurt. There are a couple of ways to accomplish this:

1) Make yogurt with any recipe and equipment; make sure to age the yogurt for 24 hours before chilling it to stop the fermentation process. The bacteria in the yogurt culture will have time to eat up all the lactose in the milk, rendering it lactose-free.

2) Make yogurt with lactose free milk; age the yogurt only as long as convenient, until set.

I purchased an inexpensive, 1-quart yogurt maker on Amazon.com (less than $20.00). Bought the yogurt starter in the dairy case at Whole Foods. Followed the directions on the yogurt starter package--easy. The milk I used was lactose-free. The results were absolutely delicious and FODMAPS-friendly.

P.S. If Green Valley Lactose-Free Yogurt is available in your area, you might not have to make your own after all.