Piercing cramps. Swollen midsection. Strange stomach groans that everyone in the room can hear. Sound familiar? For millions of Americans, a forkful of cheesecake, a Brie-topped cracker or even a splash of milk in coffee can turn an otherwise pleasant day into a painful slog.
The quick self-diagnosis
When dairy products consistently disrupt the digestive tract, many people assume it’s lactose intolerance—a condition in which the body produces very little if any lactase, the enzyme needed to digest lactose (the main sugar found in dairy). When lactose does enter the system, the body doesn’t know what to do with the sugar, and it basically revolts, causing cramping, bloating and in some cases diarrhea or vomiting.
According to Kristi King, RD, an instructor of pediatrics at Baylor College of Medicine and a spokeswoman for the American Academy of Nutrition and Dietetics, almost everyone is born with the ability to produce lactose so that we can digest breast milk. “In general, most symptoms of intolerance start to appear when a child is around 2 or 3 years old,” she says. “But it can develop at different stages of life and be triggered by various factors such as bowel surgery, chronic conditions like celiac or inflammatory bowel disease and even bad stomach viruses.”
But intolerance may not be the issue
Sometimes the dairy averse are spot-on in their lactose intolerance self-diagnosis, and cutting out cheese, butter, milk and all other dairy-containing foods saves them a lot of bellyache—and social embarrassment. However, according to Jeanette Keith, MD, spokeswoman for the American Gastroenterological Association, many times dairy woes stem from something besides a total inability to digest lactose. “Everything that rumbles is not lactose intolerance,” she says.
Keith explains that many people are lactose maldigesters or malabsorbers, meaning they have hard time with dairy—but that’s not the same thing as the clinical condition of lactose intolerance. She says others actually may be allergic to certain ingredients in dairy, such as the proteins in milk. Also, entirely separate conditions like celiac, irritable bowel and gastroesophageal disease can present in a similar way as lactose intolerance, causing cramps, diarrhea and the works.
But if avoiding dairy keeps you from getting sick, does it really matter whether you’re truly lactose intolerant or something else is causing the problem? Yes, says Keith, for a few important reasons. For one, not realizing you have celiac disease or another serious issue can spell major trouble for your long-term health. She says if celiac goes undiagnosed and unmanaged, it can lead to diabetes and even small bowel cancers.
Secondly, if you’re a lactose maldigester or malabsorber but not completely intolerant, you actually can—and should—slowly work some types of dairy back into your diet, according to Keith. “Using dairy for its nutrient package is one of the smartest ways to ensure health,” she says, explaining that dairy includes calcium, vitamin D and potassium—three out of four of the nutrients the U.S. Department of Agriculture says America is not getting enough of.
If intolerance isn’t the issue
If your doctor has ruled out lactose intolerance, consider re-trying certain types of dairy so you’re not missing out on its nutritional attributes. To test your dairy limits, Keith offers her “tips for tolerance.” First, try drinking milk with meals rather than alone, because fats and proteins can slow digestion enough to help the gut digest lactose. Second, choose aged cheeses like hard cheddar or Parmesan instead of American or cheese sauces, because the aging process breaks down the lactose. Interestingly, Keith also says flavored milks such as chocolate tend to be better tolerated, since the slight amount of fat from the flavoring is enough to slow digestion and aid absorption—but stick to products with 1 percent milk fat so you don’t add tons of calories. Finally, always eat or drink dairy slowly so as not to overwhelm your system. Keith says that after about three weeks of experimenting, you should have a clearer idea of what you can and can’t tolerate.
If intolerance is the issue
Even though lactose intolerance may not be the issue for everyone who has problems with dairy, it’s still a very real and very troublesome issue for a huge number of people. So if you experience intolerance-like symptoms—and your doctor has tested you and confirmed you’re intolerant—then, yes, you’ll want to avoid dairy.
But be mindful of what you’re missing out on. First and foremost, avoiding dairy can result in a deficiency of the key nutrients discussed above. “People who are lactose intolerant tend to be deficient in calcium and vitamin D,” King says. “A lack of calcium intake is associated with osteoporosis and osteopenia, while vitamin D deficiencies have been linked to rickets, osteoporosis, cardiovascular issues, depression and some types of cancer.” According to Keith, ditching dairy can also increase risk of diabetes and hypertension.
Clearly, it’s crucial to get these nutrients elsewhere. Luckily, lactose-free versions of milk and other dairy foods are now widely available. “Lactose-free foods have the same nutrients, but the milk sugar has already been broken down for you,” Keith says. “They might taste slightly sweeter because the lactose is already reduced to glucose and galactose.”
King agrees that lactose-free milk, as well as alternative milk beverages such as soymilk, almond milk and rice milk that are fortified or enriched, can provide calcium and vitamin D. “Calcium-fortified breads and juices can help as well,” she says. “And since vitamin D can be made in the body from sunlight, some exposure to the sun—about 10 minutes—may help to prevent vitamin D deficiency.” King adds that one dairy product you shouldn’t have to skip is yogurt, since the cultures break down lactose before it hits your mouth.
Whatever your reason for avoiding dairy, it’s a good idea to consult with your healthcare provider to make sure you’re not missing key nutrients and putting yourself at risk of more health issues down the road.