The Lactose Lowdown

Back in October 2008 I wrote about how people who are gluten-free also frequently have diets that are free of other things as well: lactose, refined sugar, all dairy, etc. For me, that includes lactose, thanks to a lifelong lactose intolerance.

According to the National Institutes of Health, an estimated 30 to 50 million Americans are lactose intolerant. (With some very rough math, that makes it about 17 times more prevalent than Celiac Disease, for point of comparison.) Not all ethnic groups are equally lactose intolerant, though – African Americans, Native Americans, and Asian Americans are disproportionately lactose intolerant, while Americans of northern European descent have very low rates of prevalence.

In short, people with lactose intolerance don’t produce enough (or any) of the lactase enzyme, which enables the digestion of lactose, also known as milk sugar. Without the lactase, you can’t digest the lactose, and that results in all sorts of gastrointestinal unpleasantness, not to mention other side effects, such as calcium deficiency. Additionally, lactose intolerance often co-indicates with Celiac Disease. This isn’t surprising – your body makes lactase in the small intestine, and since the small intestine is chronically damaged by gluten in people with CD, it then stands to reason that your ability to produce lactase would be hampered or sidelined entirely. (By this same reasoning, people with CD sometimes lose their lactose intolerance and regain the ability to diget lactose once they’ve been on a gluten-free diet and their small intestine has had time to heal.)

Treatment of lactose intolerance usually includes some dietary modification – namely, avoiding high lactose content foods such as milk, ice cream, and many cheeses. (Yogurt, on the other hand, is usually okay, since the live, active bacterial cultures aid in the digestion of lactose.) But it can also include taking over-the-counter dietary supplements that supply your body with the lactase enzyme. I’ve followed that route when indulging in things like a slice of GF pizza. And more often than not, I go with the name brand: Lactaid. They make several versions of the dietary supplement, not to mention milk, cottage cheese, ice cream, and during the holidays, egg nog (delicious!). Most supermarkets also sell a house brand X of the lactase dietary supplement. But read on…this is (another) cautionary tale.

Kelli and I were recently doing some recipe development and testing for a GF, from scratch, Chicago-style deep dish pizza. As usual, I popped a few lactase pills to cope with the mozzarella cheese, and heartily chowed down. Within ten minutes, however, I was sick with symptoms that were unmistakeably gluten-caused. That was puzzling to me, and to Kelli, since we made the pizza ourselves from scratch with certified GF ingredients. There couldn’t possibly be gluten in the pizza, could there? (As it turns out, the pizza was perfectly fine.)

Thinking that I must not have taken enough lactase pills to compensate for all the cheese on the three slices of pizza I ate, I went to the bathroom cabinet and reached for the pill bottle. Instinctively, I spun the bottle around and began to read the label. Then I saw the dreaded words: “Contains: wheat.” Gasp! I had “poisoned” myself. I was in shock – I immediately threw out the bottle and explained the snafu to Kelli, who was equally taken aback. Really? Wheat in a lactase pill? I think I was particularly disturbed given the fact that lactose intolerance and Celiac Disease are often present in the same person. Knowing this, why would a company make a product that in theory would be used by a certain population of people (lactose intolerant Celiacs), and then include an ingredient that excludes them from using it (gluten)?

Thanfully, the name brand Lactaid pills ARE gluten-free. It’s the brand X supermarket versions you have to be careful with. For me, it was a hard lesson learned, but a mistake I won’t make again. Hopefully, now you won’t either.

– Pete