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The reduced ability to digest lactose (lactose intolerance) is very common among adults. We are born with high levels of lactase (the lactose – digesting enzyme) in our small intestine, which supports digestion of the ample lactose in milk, our first food. But as the intestine matures, the amount of lactase normally declines to low levels, and the ability to digest lactose declines accordingly.
When lactose is consumed in amounts larger than can be fully digested, the undigested lactose proceeds to the colon, where the bacteria make a meal of it. The person hosting this meal may suffer the consequences, in the form of diarrhea, gas, and abdominal cramps.
Describing adult populations as lactase deficient is misleading because it implies and abnormality. In fact, about 75% of adults, worldwide, have low levels of lactase. The high level of lactase found in some populations (such as Northern Europeans and the pastoral Fulani tribe of Nigeria) is an anormaly, probably due to a selective mutation thousands of years ago that conferred a nutritional advantage to members of dairying cultures. Low levels of lactase in adults are found in about 90% of Asians and about 75% of American Blacks and Native Americans. In contrast, less than 20% of Caucasian adults of Northern European origin have low levels of lactase.
Milk is the only food that naturally contains lactose. But since milk is made into and added to other foods, lactose is found in a variety of food products. In practical terms, adults with low levels of lactase are concerned with the amount of milk and milk products they can comfortably consume. This is best determined by a person’s own eating experience. Some adults with low lactase levels, for example, cannot tolerate gulping down a glass of milk on an empty stomach but find no discomfort in drinking a glass of milk leisurely throughout a meal.
Yogurt and “acidophilus milk” are better tolerated because the added bacteria (lactobacillus acidophilus) have “predigested” some of the lactose. Cheese and ice cream are also better tolerated because they are high in fat and contain relatively little lactose. The high fat content of these foods slows the passage of the lactose from the stomach to the intestine. (Also, the high fat content ordinarily limits how much we eat).
MD Rosisella Puglisi
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