Starving Dietitian

Dairy Deception

In order to spare those who may be a bit, let’s call it squeamish, I’ve avoided talking about some of the more embarrassing aspects of nutrition. I think it’s time to break that cycle.

Spend enough time in nutrition and sooner rather than later, you’ll find yourself nonchalantly discussing the lower half of the human body. Not the feet, no that’s too easy, I mean the capital I, Intestines.

The old saying goes “you are what you eat”, well not so much anymore. After all, someone with Celiacs Disease (aka gluten intolerance) could hardly consider wheat a part of their bodies. Instead, we tend to say “you are what you digest“.

So let’s breakdown something everyone knows, lactose intolerance.


Depending on where you live, chances are good you probably know someone who has this. It’s commonly accepted that Asian, Black, and Hispanic populations are at significantly higher risk, but no single ethnicity is immune to it’s consequences.

So where does the problem stem from?

Intestines! Well, enzymes… technically enzymes from the pancreas but it’s all one big tube anyway. Once that venti-nonfat-double whip latte gets past your stomach it hits a sea of digestive chemicals. It’s here that the lactose intolerant start to have issues. Milk has a special sugar known as Lactose that your body really wants broken into smaller pieces. The only problem is we need a special Lactase enzyme to break it down.

Herein lies the issue, if you don’t have enough of that enzyme the unbroken sugar feeds a cocktail of bloating and flatulence in the lower intestines. Not your idea of a cocktail party.

So why take the time to explain this? Because most of what you’ve heard about lactose intolerance is probably wrong. I’ll explain in 3 steps or less.

1) The test is curved.


Unless you’ve actually been diagnosed lactose intolerant, there’s actually a good possibility you don’t qualify. However, the test itself is wildly inaccurate. True lactose intolerance is tested in a clinical setting using a 20-25 gram dose of pure lactose on a completely empty stomach.

Now tell me, when was the last time you chugged half a quart of milk in one sitting? It’s doable yes, but it’s what we call a nonphysiological dose. Most people aren’t going to drink that much milk, that quickly, on a completely empty stomach. So now a whole group of people who shouldn’t qualify, are labelled intolerant. Which brings me to my second point.

2) Everyone is intolerant to some extent.

Hedonic Bloating Scale

Hedonic Bloating Scale

Just when you thought it was unique, you join the club. With enough milk, every human shows signs of intolerance. The terminology is no longer “lactose intolerant” but “lactase insufficient“. Pay attention to that distinction, its not that you can’t handle it, but you’re limited by the amount of enzyme you have. Not black or white, but technicolor once again. This means that some can’t handle any, most can handle some, and few can handle a large amount.

3) The food makes a difference.

So often people assume if they can’t handle 2% milk it means they can’t handle any lactose. How very sad those people must feel. The truth is that the amount of enzyme you make is only released so quickly.

Think of it like a sponge. Sponges are pretty good at soaking up the occasional spill, so long as the spill is reasonable. Once your house starts flooding, it’s just another organic floating thing.

This is how your enzymes work. The slower your stomach empties into your intestines, the better they can soak up the dairy products.

Counter to reason, the less watered down they are, the better you can handle it.

Cheese is easier to handle than yogurt which is easier than whole milk which is easier than 2%, nonfat, or skim milk.

Or you could just forgo all of this worrying and buy some Lactaid, an easy to swallow capsulated Lactase enzyme that happily steps in where your own enzymes fail. Either way, it’s worth it to take a few risks and see what your body can tolerate. Just don’t blame me for the stares.

Be good to each other.

– Joshua Iufer, RD

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