Bye bye, ice cream and milk tea? Lactose intolerance gets worse with age – here's why
In this series on digestive health, CNA Lifestyle finds out if you can get your body to accept dairy products again – and what to avoid other than milk, cheese and ice cream.
Eating is one of the greatest pleasures in life, and you might feel like your body has let you down when your digestive system starts to turn in a less-than-stellar performance as you age. What’s up with your body? Here, we look at your increasing intolerance for dairy products.
WHAT’S HAPPENING IN MY GUT?
Since over 90 per cent of East Asians have lactose intolerance, according to the US National Institutes of Health, you’ve probably felt its effects.
After a bubble milk tea or a slice of the recent dessert trend, the basque burnt cheesecake, you might feel bloated, gassy, nauseous, diarrhoeal, pain in the abdomen and/or even heard rumblings from the abdomen, said Dr Alex Soh, a consultant with National University Hospital’s Division of Gastroenterology and Hepatology.
Those uncomfortable – and sometimes, embarrassing – symptoms are caused by lactose, a sugar found in dairy products such as milk, butter, cream and cheese.
Many Asians lack lactase, an enzyme found in the small intestine, which Dr Soh said, is needed to break down lactose into simple sugars.
What happens instead, is that the undigested lactose “rapidly transits through our intestines and gets fermented by gut bacteria, leading to the symptoms of lactose intolerance”.
“These symptoms often occur about 30 minutes to a few hours after consuming the lactose-containing food or beverage,” said Dr Soh. “Its severity depends on how much lactose is consumed – higher amounts of lactose could result in more symptoms.”
Dr Soh highlighted that lactose intolerance is unlike irritable bowel syndrome (IBS), a functional gastrointestinal disorder. However, IBS patients may have a lower threshold for lactose.
WHY IS IT ONLY HAPPENING NOW THAT I’M OLDER?
You might not have too much of a problem after a latte in the past. But as you age, your digestive system starts to produce less lactase and that’s when the problem worsens. “Lactase activity is highest in newborns and is genetically programmed to decline in our early years for the majority of people worldwide,” said Dr Soh.
Aside from age and genetics, he said that there are conditions that affect your small intestine – such as intestinal infections, bacterial overgrowth, surgery, and inflammatory conditions, including celiac disease and inflammatory bowel disease – that alter the intestine’s ability to handle lactose.
WHAT’S THE SOLUTION?
A 2000 study by Purdue University’s School of Consumer and Family Sciences found that the controlled consumption of dairy foods may help you to recondition your digestive system to accept milk and such without discomfort.
"If you only consume dairy products once in a while, you are more likely to have symptoms from them," said Professor Dennis Savaiano, the school’s dean. "Also, if you consume them by themselves, as opposed to as part of a meal, they tend to be transported throughout the intestine more rapidly and are more likely to cause symptoms."
Start by drinking one-quarter to one-half cup of milk with meals two or three times a day, and slowly increase the quantity, he said. “By altering the diet over time, bacteria more effectively digest lactose, making milk very well tolerated."
If you’re not keen to break wind more often than usual, limiting your intake of cheese and yoghurt will certainly help to lessen the symptoms, said Dr Soh. But other than these usual food culprits, lactose can also be found in foods such as salad dressings, biscuits, cakes, cereals and pancake mixes.
To spot lactose in processed foods, look for ingredients such as whey, caseinates, casein, nougat, cheese, milk byproducts, dry milk solids, dry milk powder, butter, curd, and nonfat dry milk on the packaging. Lactose powder, for instance, is a common food additive found in some foods and condiments, said Dr Soh.
Lactose is even used as the base for over-the-counter medicines such as some tablets for stomach acid and gas, according to MedicineNet. The good thing is, such medicines contain small amounts of lactose and typically affect only those with severe lactose intolerance.
However, a strict, non-lactose diet may not be required, said Dr Soh. “People with lactose intolerance are often able to tolerate varying amounts of lactose (up to 12g of lactose) without symptoms, and the tolerance threshold can be increased when lactose is consumed with food.”
You could try supplementing with a lactase enzyme to improve lactose digestion and symptoms, suggested Dr Soh.