In recognition of Lactose Intolerance Awareness Month, Gemma Harris reflects on when she removed lactose for a month in an attempt to improve her gut health
It’s June 2018 and I’m sat in a cute independent cafe in Cardiff with my friends. It is just like many of our get-togethers as we drink tea and enjoy a treat. Although, this time is different — I know I am eating my last cheesecake for a month. As I delicately place the innovative creation of Oreo biscuit, cream and chocolate into my mouth, my tastebuds attempt to savour the delicious yet sickening flavour of one of my favourite indulgences. And like that it is gone, along with the last thing which will taste this good for the next month — or so I thought.
Lactose intolerance is a common problem where the body is unable to digest lactose — a sugar found in milk and dairy products. An estimated 65 percent of us have a reduced ability to digest it following infancy, while in adulthood it is most prevalent in those of East Asian descent. It can mean having to avoid dairy products like cheesecakes.
Registered dietitian Debra Thomas explains this is often because people don’t produce enough of the enzyme lactase.
“This is usually identified by following the low FODMAP diet,” she says.
Lactose is part of the FODMAP foods which also impacts people with the long-term digestive condition Irritable Bowel Syndrome (IBS). It can irritate the gut causing stomach cramps, bloating, diarrhoea and nausea.
IBS symptoms are very individual and as a sufferer myself, mine are primarily bloating and stomach cramps. I experienced stomach issues as a child. My mum recalls me crying even as a baby when she gave me milk. She even reckons my gut issues could run in the family.
“Once you started experiencing problems,” she explains, “I began noticing the similarities with my own stomach problems.
“Neither of us can have McDonalds ice cream,” she adds.
At 58 years of age (back then), she has never been a fan of milk and admits to feeling severe pain when she ate any cream-based foods when she was younger.
She says: “I didn’t know why cheese and onion crisps upset my stomach until I realised they have lactose in them.
“I was traumatised at school when I was made to have milk,” adds Mum.
Debra explains many people of this generation have a negative relationship with milk.
“When children were given free school milk,” she says, “this was often left out all day and, in the summer, this resulted in warm milk. Many found this off-putting and it turned them off milk for life.
“In later life, many find they are unable to tolerate the lactose in milk as their gut no longer produces sufficient lactase,” claims Debra.
Despite not having heard of it until recently, my mum would now consider herself as lactose sensitive.
It was at the age of 20 that I began to occasionally suffer with moderate stomach cramps, during the last year of my undergraduate degree. However, it wasn’t until 2016 — one year later — when I had to go home sick from my then job because of not being able to remove myself from the toilet for long, that I realised something was wrong.
Following my diagnosis of IBS, later that year one friendly doctor changed my life. He recommended I reduce my lactose intake, explaining it is a major cause of bloating.
I wanted to enhance my gut health without having to go through the long-winded process of removing all FODMAPS, reintroducing them and recording my symptoms. This can be time-consuming and as a busy trainee journalist (at the time), time was something I was short of. According to diet specialist FoodMaestro, four weeks is usually long enough to determine if your symptoms respond to a low FODMAP diet. So, I put this theory to the test by removing all lactose for a month — this is what happened.
First step — chucking out all lactose-filled treats within eyesight. For this to work, I needed no temptations. Second, adding lactose-free products to my weekly shopping list. This included Arla Lactofree Long Life Milk Portions — a must for a tea lover — lactose-free cream cheese, mature cheddar and butter and plant-based plain yoghurt, plus a new discovery — lactose-free Greek cheese.
As a self-confessed chocoholic, I often need a pick-me-up to look forward to and so I tried to stock up on necessary lactose-free treats too. When all I could gather from local shops were some dairy-free chocolate chip cookies and Naked’s healthy alternative to carrot cake, reality hit that dark chocolate could be my future.
Admittedly, the first couple of days came as a bit of a shock. On day one, my meals weren’t too different to normal but I went to grab a couple of my favourite chocolate biscuits to have with my afternoon cuppa and quickly realised I had to settle for ginger thins instead.
Meanwhile, day two was a bit of a shambles. I happily ordered a cup of tea in my local coffee shop, not really thinking about the fact they would serve regular milk and I had been drinking it for a while when it dawned on me, I should’ve asked for soya milk. Already, I learnt it is as much about breaking a lifelong habit as it is about following this diet. I definitely learnt from my mistake, however, as I never forgot to ask for dairy-free milk with my tea again!
By the end of the first week, I was having a mild panic about the total of my shopping bills. A tub of the much-loved Ben & Jerry’s Chocolate Fudge Brownie ice cream was £4.40 compared with £6 for the dairy-free alternative. Understandably, this didn’t make an appearance on my receipt. Lesson two learnt — the challenge isn’t just maintaining this diet within a busy lifestyle but maintaining a luxury lifestyle. It seemed we were paying more for the privilege of having lactose-free products.
My friend Richard has been intolerant to lactose from a young age and has also not only battled with milk, but the cost of suitable products. He first noticed his problem during college at the age of 17.
“I used to have milk at lunch everyday and I was getting sick around 1pm,” he said, “the same time everyday.”
One occasion after his daily milk drink, when he was sick during a mock exam, Richard realised he might have a problem. This only worsened when he began drinking protein shakes. This is because protein powders are usually made from the proteins in the lactose-containing milk whey.
Then 28 and studying his PhD in cancer research, Richard can’t even make it through one ice cream without experiencing severe bloating. He also temporarily removed lactose earlier in the year in an attempt to improve his gut health.
“I noticed a difference immediately,” he said, “my appetite shot through the roof and that’s probably because of the science behind it.”
If you consume lactose and struggle to digest it, your gut generates gas which leaves you feeling bloated. Then, because you’re bloated, you feel full and therefore don’t want to eat, Richard explained.
“The moment my bloating disappeared, it felt like there was more capacity so I could just eat more and more.”
Despite his new-found benefits of living lactose-free, cost and availability of products were major hurdles. While he still swears by Arla Lactofree milk, Richard decided not to remain completely lactose-free for those reasons.
“You don’t realise just how many things have milk in them. There’s lactose in everything — even crisps,” he exclaimed, “[Removing lactose] is hard because we are brought up having milk, so it’s second nature.”
While many products contain lactose, during my second week I discovered it’s about knowing where to look.
Pret A Manger had recently launched their first-ever vegan cookie as part of their spring menu. As soon as I heard this, I could not wait to try it and it didn’t disappoint. Their Dark Chocolate & Almond Butter Cookie tasted amazing and the price wasn’t bad either. Plus, I didn’t get the ‘bubbly’ feeling in my stomach which I usually feel after eating chocolate. I honestly didn’t feel the need to eat a milk chocolate cookie again after trying this!
Later in the week, my mum and dad came to visit and — like all good parents supporting my lifestyle choices — they brought emergency supplies including a selection of award-winning dairy-free Lazy Day Foods and vegan chocolate coins from Sainsbury’s. While they were there, I encouraged my dad to try Pret’s cookie without telling him beforehand it was dairy-free.
He said: “If you hadn’t told me, I honestly wouldn’t have known.”
His seal of approval definitely meant something because, like me, he has a sweet tooth.
It was in my third week when I really began to notice the challenges of following this diet. Not only was I moving house — a challenge in itself — but I had to eat at restaurants because of this. From annoying waiters and waitresses by making them fetch ingredients lists, to denying myself meals I would’ve normally ordered from the menu, eating out was not as simple as before. I visited the only place during my trial which didn’t serve soya milk, so I tried oat milk instead. Without this journey, I wouldn’t have discovered it is actually quite pleasant in tea.
Anyone who has moved house will know it can be hard to maintain structure in your life during the process. As a person who finds comfort in treats during stressful times, this was a real test for me. And I failed. I opted for feta cheese sprinkled on top of my brunch at a local cafe. Though only a small amount, which probably wouldn’t have had a noticeable impact, I was disappointed in myself. Part of the reason was because during the disruption of uprooting my belongings, I had been unable to plan my meals as I usually do.
Journalist and blogger Rachel Callen has faced similar challenges during her trial of a low FODMAP diet. Suffering from reflux for several years and IBS more recently are reasons why the (then) 41-year-old adopted this diet.
As features editor of Slimming World Magazine, you would be mistaken in thinking she found it easy. She too found eating out difficult because of the ingredients in meals being unclear.
“The hardest thing was resisting cakes at work,” she added.
Preparation is one thing which Rachel wished she had done more of, initially. She now plans her meals and shopping and does batch cooking at weekends.
Drawing from his own experiences, Richard agreed: “Plan your meals. I can’t stress that enough. If you schedule what and when you’re going to eat, you’re less likely to suffer from missing out.”
Meanwhile, Debra explained it is about making it practical by cooking extra quantities if you’re a busy mum or encouraging the whole family to follow an alternative diet.
“It doesn’t mean they all have to follow it the rest of the time,” added Debra.
As my month-long trial drew to a close, I realised a lot of these dietary changes had become habits as I found myself automatically asking for soya milk with my tea. In terms of my gut health, I noticed a slight reduction in bloating but not as much as I hoped. The experience did help me to realise one thing, lactose was clearly not my main problem. I sometimes suffered from bloating and stomach cramps and I knew it couldn’t be lactose, so it enabled me to identify my individual triggers — overripe avocado, beetroot, white bread and large portions of fruit or nuts.
Clearly something still needed to be done when it came to the cost and availability of alternative products too. A product which I initially hated — lactose-free Greek cheese — didn’t seem to be stocked locally. My parents ended up having to travel to a big superstore to buy it and bring it to me. As much as this product had grown on me and I would’ve continued eating it, realistically, I couldn’t because being a busy student (at that time), without access to a car, it meant I couldn’t easily get to larger supermarkets.
Richard agreed lactose-free products need to be more accessible.
“I went to Germany and they had it spot on there,” he explained.
He believed there were more lactose-free products than not, at no additional cost. Richard hoped the UK would follow suit.
“If you are not lactose intolerant, then you wouldn’t notice a difference anyway,” he added.
Personally, I decided to continue to consume milk alternatives and eat a reduced amount of milk chocolate, but if the experience taught me anything it was that balance is key. Life is too short to deny yourself pleasures.
Debra also claimed following a lactose-free diet permanently could actually result in lactose intolerance.
“The Inuit population are an example of this,” she explained, “after weaning, children traditionally move on to a fish-based diet with milk no longer featuring. So, should they move to a country where dairy is eaten more often, they discover they are unable to tolerate these foods.”
Even when someone is identified as lactose intolerant, they are still able to ingest small amounts of lactose, added Debra.
Researchers have suggested sufferers can usually tolerate up to 12g of lactose at once (approx 250ml of milk) or up to 24g spread across the day (approx 500ml of milk). Therefore, I decided to follow Debra’s advice and not completely remove it.
And like that, the month was over along with all lactose-free products — or so I thought. To celebrate my empowering journey, I baked some tasty dairy-free brownies — make them for yourself using this recipe. I hope you can find comfort from my experience, not allow lactose to disrupt your life and enjoy some yummy brownies while you’re at it!
Almost two years on and, unfortunately, we still seem to be subjected to a higher price for dairy-free products. I was hoping this may have changed more by now. At least the same can’t be said for the availability of products; I have noticed a proliferation in alternative foods and at the end of 2019, I was able to enjoy my first hot chocolate, in three years, in public thanks to Costa trialling Arla Lactofree Semi Skimmed Milk. As for my own commitment, I still solely ask for soya or an alternative milk when ordering at a restaurant or cafe and I have cut down my milk chocolate intake (slightly). But if I really want a bag of dairy milk buttons, I do take the risk and accept there may be consequences.
Do you consume dairy alternatives or lactose-free products? What do you think about the availability? Get in touch.
The Gut Choice advise consulting a registered dietitian before altering your diet. Visit the British Dietetic Association to find someone near you.