Sumathi Reddy came home from Ecuador with a stomach that wouldn't settle. Weeks later she still didn't know if it was a long bug or something new. She began to wonder whether she'd become lactose intolerant. Her column in Wednesday's Journal is what she found out, and most of it is good news.
Lactose is the sugar in milk, and about two of every three people on earth don't digest it well. Most of us make less of the enzyme that breaks it down, called lactase, after infancy. Dr. Eric Sibley at Stanford says the drop is usually set by age 10 to 12. Trouble digesting it and feeling sick from it are two different things. Dr. Aasma Shaukat at NYU says only 5% to 20% of people get symptoms. The body can usually take about 25 grams of lactose a day, roughly two cups of milk, though some react to less. Symptoms show up 30 minutes to two hours after eating and can last a few hours. Rates run higher among Africans, Asians and Latinos.
A lot of what gets called lactose intolerance is something else. Dr. Mark Pimentel at Cedars-Sinai says many people actually have a bacterial overgrowth in the small intestine, called SIBO. It flares after beans and cabbage-family vegetables too. Irritable bowel syndrome gets blamed on milk. Celiac disease can cause the problem as a side effect. And a stomach bug can knock out the enzyme for a while, because it damages the tips of the small hairs in the gut that make it. That version usually lasts about a month, Pimentel says. Reddy's trip may be the whole story.
You can keep the cheese
The fixes are cheap. Lactase pills taken before dairy supply the enzyme you lack. Eat dairy with a meal. A Purdue researcher, Dennis Savaiano, finds tolerance is three times better that way, and the paper notes he has taken research money from the dairy industry. Greek yogurt and yogurts with live cultures go down easier. Hard, aged cheese has almost no lactose left. If cheese still bothers you, Shaukat says the fat may be the real culprit, so try low-fat. Small amounts of lactose may train the gut over time. And if you cut out dairy, get calcium and vitamin D some other way.
Our read
This is Health Costs. Our interest is the money spent on a diagnosis nobody made. The home hydrogen breath test is the common path, and Shaukat says it gives a lot of false positives. Her better test is free. Keep a food diary and write down what you ate and when the symptoms came. A false positive is expensive. It buys a lifetime of lactose-free milk, special ice cream and supplements. The real problem may have been a month-long bug, or a different condition with a different fix. The condition itself carries no long-term health risk, Reddy reports, so there's no rush to spend.
Here's the check for this week. Look at the grocery receipt and the medicine shelf for anything you bought because of a self-diagnosis. The lactose-free milk, the test kit, the enzyme pills on auto-ship. Then start a two-week food diary on your phone before you buy more. If the pattern is real, take the diary to a doctor and spend on the right thing. That's the health-costs line of a plan done right, and it's one we go over at every review. You buy the umbrella when it rains. First make sure it's rain.