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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

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

Lactose 101

Lactose is known as "milk sugar." It is present in the milk of all mammals, including human, cow, goat, sheep, etc. Most babies and young children all over the world can handle lactose in their diets without a problem. After all, milk is meant to be their primary food! But, as we get older, we may lose the ability to tolerate lactose, especially if we are of Asian, African or Native American descent.

Lactose intolerance can exist on its own, or it can be part of the larger IBS picture. The FODMAPS elimination diet in IBS--Free at Last! can help you figure out how lactose fits into your IBS scenario.

When lactose-intolerant people eat or drink large amounts of lactose-containing foods or drinks, they may get abdominal pain, flatulence, bloating or diarrhea. Small amounts of lactose may be well tolerated, so even lactose-intolerant people may be able to eat cheese or yogurt, or have a little milk in their cereal or coffee.

Milk products are important food sources of protein, calcium and vitamin D, so it's important not to stop consuming milk products without making a plan. One solution might be to drink specially treated, lactose-free milk and milk products. Yogurt is naturally lower in lactose, and most hard cheeses have just a trace. Drinking milk as part of meal helps, too. You might tolerate milk products better on a day that doesn't include a lot of other problem sugars and fibers. All of these variables can make people unsure whether they have a problem with lactose or not!

Diagnostic lactose-tolerance tests are available. But many people figure this one out on their own with a couple of glasses of milk or a big milkshake on an empty stomach! Need I say more?

More technical description of lactose

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Goat's Milk and Goat Cheese

The question often comes up as to whether goat's milk might be tolerated better than cow's milk by lactose sensitive individuals. The short answer is: probably not. Goat's milk does have slightly less lactose than cow's milk, but probably not enough to make a difference for most people. (Note that the proteins in cow's milk and goat's milk are different enough so that some people with an allergy to cow's milk may be able to consume goat's milk, but that is really a separate subject.)

What about that delicious goat cheese that has become so popular? How does that fit into the FODMAPS elimination diet? Like cow's milk cheeses, there is less lactose in cheese because most of it is carried off in the whey, which is separated from the curd during the cheese making process. However, because it is not an aged (or ripened) cheese, goat cheese does have a small amount of lactose in it. It can still be eaten, even on the elimination phase of the diet, if the portion is small. Like other non-aged cheeses, the portion of goat cheese should be limited to 1 oz during the elimination phase of the diet.

Lactose, also know as milk sugar, is the predominant carbohydrate in milk of any species: cow, goat or human. People who don't produce enough of the enzyme, lactase, can't digest lactose. They experience, bloating, gas and diarrhea when they consume it.

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Cheddar Cheese and Lactose

Aged, natural cheddar cheese is allowed on the FODMAPS Elimination Diet.

Have you noticed lactose-free label claims on some brands of cheddar cheese, including Cabot and Kraft? The labels I have before me state "Contains 0 g of lactose per serving."

Today I had the opportunity to speak with a representative of Cabot Creamery Cooperative at a meeting of the Maine Dietetic Association. She explained that during the cheddar cheese-making process, the curds and whey are separated. Lactose is present in the whey, and is therefore drained off. The cheddar cheese is then aged.  During aging, bacteria ferment and break down any lactose that remains. The resulting cheese is lactose free. (The same is less true of softer, un-aged or less-aged cheeses, which may contain more whey and have undergone less bacterial fermentation.)

When you are looking at the Nutrition Facts for any cheese, check the "Sugars" line.  Any lactose (milk sugar) in the cheese would show up on that line.  If it says "Sugars 0g", then the cheese is essentially lactose free.  Enjoy!

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