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

Comments

[Nutrition to kitchen]

Wow, I had no idea evaporated milk had so much lactose in it. Thanks for the info!

[Julie]

Really interesting! You know I learn something new every time I come to your site. Well done!

[Heather Wiggins]

Is taking a Lactaid pill before dairy okay (instead of drinking Lactaid milk) an okay substitution to make on the elimination diet?

[Patsy Catsos]

Great question. Taking a Lactaid pill before eating dairy is not enough to render the milk or yogurt lactose-free to the same degree it would be in the packaged 100% lactose-free milk products. The lactaid pill method gives less time for the milk product to be contact with the lactase enzyme and less thorough mixing. So...I do not suggest this during the elimination phase.

Later on, though,when you get back to post-challenge phase eating, if you have found out you are lactose intolerant, Lactaid pills are better than nothing if you are away from home. Sometimes you just have to take one for the team and eat some chowder or ice cream when it is served. Yum.