What is lactose intolerance?
Lactose intolerance is a common problem. It happens when your body does not have enough lactase, which is an enzyme produced in the small intestine. Lactase is necessary to digest lactose – the natural sugar found in milk and other dairy products. In the intestines, undigested lactose leads to the buildup of gas. After eating dairy products containing lactose, people with lactose intolerance start to develop stomach cramps and diarrhea.
Lactose intolerance is a common condition that is more likely to occur in adulthood, with a higher incidence in older adults. Some ethnic and racial populations are more affected than others, including African Americans, Hispanic Americans, American Indians, and Asian Americans. The condition is least common among Americans of northern European descent.
What is osteoporosis?
Osteoporosis is a condition in which bones become less dense and more likely to fracture. Fractures from osteoporosis can result in pain and disability. In the United States, more than 53 million people either already have osteoporosis or are at high risk due to low bone mass.
Risk factors for developing osteoporosis include:
- Thinness or small frame.
- Family history of the disease.
- Being postmenopausal and particularly having had early menopause.
- Abnormal absence of menstrual periods (amenorrhea)prolonged use of certain medications, such as those used to treat lupus, asthma, thyroid deficiencies, and seizures.
- Low calcium intake.
- Lack of physical activity.
- Excessive alcohol intake.
Osteoporosis often can be prevented. It is known as a silent disease because if undetected, bone loss can progress for many years without symptoms until a fracture occurs. Osteoporosis has been called a childhood disease with old age consequences because building healthy bones in youth helps prevent osteoporosis and fractures later in life. However, it is never too late to adopt new habits for healthy bones.
The link between lactose intolerance and osteoporosis
One of the primary risk factors for developing osteoporosis is not getting enough calcium in your diet. Because dairy products are a major source of calcium, you might assume that people with lactose intolerance who avoid dairy products could be at increased risk for osteoporosis. However, research exploring the role of lactose intolerance in calcium intake and bone health has produced conflicting results. Some studies have found that people with lactose intolerance are at higher risk for low bone density, but other studies have not. Regardless, people with lactose intolerance should follow the same basic strategies to build and maintain healthy bones and should pay extra attention to getting enough calcium.
Bone health strategies
Calcium and vitamin D. A well-balanced diet rich in calcium and vitamin D is important for healthy bones. Besides low-fat dairy products, good sources of calcium include dark green, leafy vegetables and calcium-fortified foods and beverages. Many low-fat and low-sugar sources of calcium are available. Also, supplements can help people with lactose intolerance meet their daily requirements of calcium and other important nutrients. The Institute of Medicine recommends a daily calcium intake of 1,000 mg (milligrams) for men and women up to age 50, increasing to 1,200 mg for women over age 50 and men over age 70.
Studies have shown that people who have at least some intestinal lactase can increase their tolerance to lactose by gradually introducing dairy products into the diet. These people can often eat small portions of dairy products without developing symptoms. The key for them is to consume small amounts of dairy products at a time so that there is enough lactase available in the intestine to digest the lactose. When the lactose is fully digested, symptoms do not develop.
Also, certain sources of dairy products may be easier for people with lactose intolerance to digest. For example, ripened cheese may contain up to 95 percent less lactose than whole milk. Yogurt containing active cultures also lessens gastrointestinal symptoms. A variety of lactose-reduced dairy products, including milk, cottage cheese, and processed cheese slices, are also available. Lactose replacement pills and liquid are also available to help with the digestion of dairy products.
Vitamin D plays an important role in calcium absorption and bone health. Food sources of vitamin D include egg yolks, fish oil, saltwater fish, liver, fortified margarine, and breakfast cereals. Many people may need vitamin D supplements to achieve the recommended intake of 600 IU (international units) each day. Men and women over age 70 should increase their uptake to 800 IU daily.
Exercise. Like muscle, bone is living tissue that responds to exercise by becoming stronger. The best activities for your bones are weight-bearing and resistance exercises. Weight-bearing exercises force you to work against gravity. They include walking, climbing stairs, and dancing. Resistance exercises – such as lifting weights – can also strengthen bones.
Healthy lifestyle. Smoking is bad for bones as well as the heart and lungs. Women who smoke tend to go through menopause earlier, which triggers earlier bone loss. In addition, people who smoke may absorb less calcium from their diets. Alcohol also can have a negative effect on bone health. Those who drink heavily are more prone to bone loss and fracture because of both poor nutrition and increased risk of falling.
Bone density testing. A bone mineral density (BMD) test measures bone density in various parts of the body. This safe and painless test can detect osteoporosis before a bone fracture occurs and can predict a person’s chances of fracturing in the future. People with lactose intolerance should talk to their doctors about whether they might be candidates for a BMD test, which can help determine whether increased attention to bone health is warranted.
Medication. Like lactose intolerance, osteoporosis has no cure. However, several medications are available for the prevention and/or treatment of the disease, including: bisphosphonates; caclcitonin; estrogen (hormone therapy); estrogen agonists/antagonists (also called selective estrogen receptor modulators or SERMs); parathyroid hormone (PTH) analog; parathyroid hormone-related protein (PTHrp) analog; RANK ligand (RANKL) inhibitor, and tissue-selective estrogen complex (TSEC).
Dairy products are the most concentrated source of calcium, which can make it difficult for people with lactose intolerance to incorporate enough of this important bone-building mineral. Lactose is milk’s natural sugar, which, in lactose-intolerant people, can cause unpleasant digestive side effects. Healthy adults require an average 1,000 mg of calcium a day, according to the National Institutes of Health. You can get enough calcium while avoiding lactose by incorporating low-lactose, calcium-rich foods into your diet .
Even if you are lactose intolerant, fermented dairy, such as yogurt and kefir, is a great way to get more calcium into your diet while getting a good dose of gut-friendly probiotics at the same time. Probiotics are healthy bacteria that contribute to regular bowel movements, prevent gastrointestinal infections and boost your immune system. The probiotics help make fermented dairy easier to digest by digesting some of the lactose for you. Plain yogurt has approximately 350 to 450 milligrams of calcium per cup. Kefir, another type of fermented dairy, supplies a similar amount of calcium. If you still experience side effects with commercially prepared fermented dairy, make your own yogurt and kefir at home, and let it ferment for 24 hours to allow the bacteria to pre-digest the lactose for you.
Cheese is made from milk and therefore contains a significant amount of calcium. If you are lactose intolerant, opt for aged cheeses such as Brie, blue cheese, Cheddar or Parmesan. The increased fermentation time reduces their lactose content to very low levels. A 1.5-ounce serving of cheese provides between 300 and 350 milligrams of calcium. Other dairy products, such as cream and butter, are mostly made of milk fat and do not contain lactose, making them safe to eat for people with lactose intolerance. However, these high-fat dairy products do not constitute a significant source of calcium.
Cow milk is a well-known source of calcium and one of the best options to get enough calcium. Skim milk has approximately 306 milligrams per cup, while partially skimmed milk has about 285 to 290 milligrams per cup. Lactose-free milk contains the same amount of lactose, but the sugar lactose is already pre-digested for you, making it a safe option. Alternatively, you can also take lactase pills, which provide you with the deficient enzyme lactase to allow you to consume lactose without side effects.
If you prefer to avoid dairy, you can still get the calcium you need from non-dairy sources. A 3-ounce tin of sardines contain 325 milligrams of calcium, 1/2 cup of frozen spinach has 146 milligrams and the same serving of cooked collard greens has 178 milligrams of calcium. Each cup of fortified soy milk also contains 368 milligrams of calcium.
Lactose-Free Milk Vs. Soy Milk
If you can’t digest lactose but still want to pour some type of beverage on your morning cereal, you might find yourself scouring the alternative dairy shelves. Both lactose-free milk and soy milk can provide liquid substitutes for regular cow’s milk, but their benefits, drawbacks and nutritional value vary considerably. Lactose-free milk is made from cow’s milk with the lactose removed, while soy milk is made with liquid from the soy plant and isn’t, technically, milk at all.
More than 30 million Americans have lactose intolerance, according to MedlinePlus. If you are among them, either soy milk or lactose-free milk might hit the spot. Intestines absorb lactose, the main sugar in milk, by producing the enzyme lactase, which breaks down the sugar. If you are lactose intolerant, consuming lactose gives you gas, diarrhea and bloating, usually within 30 minutes to two hours after drinking it. Lactose-free milk has lactase added so you can digest the milk. Soy milk contains no lactose since it’s made from soybeans, which are naturally lactose-free.
Lactose-free milk still contains the same amount of calcium, essential for bone growth, as regular milk. Soy milk has no natural calcium but manufacturers often add calcium to help consumers meet their daily calcium needs. However, the calcium in fortified soy milk is absorbed less effectively than the calcium in cow’s milk; you absorb only about 75 percent as much calcium from soy, the Harvard School of Public Health warns. To offset this, choose soy milk with a higher amount of calcium than found in cow’s milk. For example, a cup of skim milk contains 306 milligrams of calcium.