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Serious Cheese: Part Two in the Adventures of Lactose Intolerance

"On a couple of occasions I've been bold enough to try a bowl of cereal with one-percent milk."

20090616-cryingcheese.jpgI have been humbled, surprised, and, frankly, a bit overwhelmed by the outpouring of support and advice in response to my post last week about my lactose intolerance discovery. You have shared many ideas, from the practical to the fanciful.

Probably the best advice I received was to make an appointment with my doctor to get tested. Lots of folks said that gallbladder problems, dairy allergies, and celiac disease can all produce symptoms similar to lactose intolerance. I have heeded this advice and will be seeing my doctor soon. I have a feeling he'll send me straight to a gastroenterologist, so I may not have any official updates here for a while, though I do think this is probably the best and safest approach.

But back to my adventures, which is why, I think, you are all tuning in. Apparently lactose intolerance (or whatever is ailing me) isn't so black-or-white. Over the past week I have been experimenting in a somewhat haphazard way with dairy of different stripes.

I was able to eat, without issue, a half-glass of one-percent milk, a small cup of yogurt, and a delicious Queso Blanco Torta from Cinco de Mayo, my local Mexican restaurant.

Let's start with the milk.

On a couple of occasions I've been bold enough to try a bowl of cereal with one-percent milk. Both times I felt nauseous after the meal, but of course nausea can be highly psychosomatic. Neither experiment led to a full-fledged attack, however, which I took as a good sign.

I didn't measure the amount of milk I used each time, but I would guess that I had about 4 ounces, which would equal 5.5 grams of lactose according to the chart on this page from the NIH. So far so good. (By the way, if you're curious, the cereal was Cinnamon Toast Crunch, a guilty pleasure I indulge in whenever our 87-year-old grandmother visits. It's her favorite cereal.)

A couple of days later, I had a 6-ounce cup serving of whole milk Stonyfield Farm Chocolate Underground yogurt (that stuff is really tasty). I had always thought that yogurt was largely lactose-free, due to the activity of lactose-digesting bacteria present in the product. But according to that same chart from the NIH, I consumed about 3.75 grams of lactose in this yogurt. And again, no reaction.

At this point I felt pretty comfortable trying out some cheese.

I wasn't going to overdose on Ukrainian food like I did the last time I had an attack, but I was feeling pretty confident. I probably should have started with a well-aged Parmigiano-Reggiano, which has very little lactose left in it after all that aging, but I like to live dangerously. So my wife and I ordered in a couple of queso tortas from Cinco de Mayo.

These sandwiches start with a toasted and buttered white roll, and are filled with thinly-sliced queso blanco, lettuce, pickled jalapeños, avocado, black beans, and mayo. Something about the creaminess of the avocado and the mayo countering the saltiness of the queso blanco—with the tangy spiciness of the jalapeños cutting through it all—make this sandwich a real marvel. And although I was nervous about trying such a young cheese as queso blanco (young cheeses tend to have more lactose since the bacteria in the cheese haven't had time to digest the lactose), I'm happy to report that I had no issues after this.

So where do we go from here?

Apart from visiting the doctor and getting tested for things that might be more serious, I guess I'll start being a little more bold. I'm going to try a bunch more cheeses (since I would prefer a hunk of cheese to a glass of milk any day), and see what happens. Of course I will include my updates here.

I also plan to seek out and interview some lactose intolerance experts, perhaps a gastroenterologist or nutritionist (if anyone has any good leads, let me know). Judging from the comments on my last post, and from some preliminary investigation online, it seems there are a lot of different ideas about the causes and cures of the ailment, and it would be good to do a post here with expert advice that separates myth from fact.

I'm also very interested to hear from the Serious Eats community about your experimental methodologies with regards to lactose intolerance. It seems that symptoms vary widely among individuals, and everyone has different ways of investigating which products affect them, and which are tolerable. So please share your stories!

About the author: Jamie Forrest publishes Curdnerds.com from his apartment in Brooklyn, New York, where he lives with his wife, his daughter, and his cheese.

View other entries from Serious Cheese.

19 Comments:

Try a bag of cheetos or Cheddar pirate booty and see what happens!

I was lactose intolerant for about 5 years before realizing I was in fact celiac. Once I cleaned up my diet (to a now completely gluten free one), I was again able to digest cheeses, most milk, yogurt, etc. I still go through phases of being lactose problematic, however I have found that mixing some kefir in with my morning smoothie has really helped. Think of it as super-bacteria filled yogurt! I am not saying you are necessarily celiac - hopefully you'll get a good doctor that can help you sort it all out, but just suggesting you try some kefir and see if it helps. The bacteria is supposed to help improve gastrointestinal health and whatnot. Good luck, and be patient! Some days are better than others :-)

So sad. The little crying cheese says it all. My thoughts are with you....

I had volcanic "bathroom" issues every time I ate cheese, milk, and eggs for about 8 years. I took Lactaid, but it did absolutely nothing. Then I read John Sarno's book, "The Mindbody Prescription: Healing the Body, Healing the Pain". Turns out I just absolutely hated my life, and in order to not have to face it my mind created a physical ailment to keep me distracted.

After 2 years of psychotherapy, I can now eat anything I want - especially goat's milk, manchego, and omelettes with Brie... :)

Sporadic lactose intolerance is not necessarily "lactose intolerance". Make sure your **mind** is ok!

I may be totally off base here, but I was under the impression that the older the cheese the better for folks who are lactose intolerant because of the cultures in it - much like yogurt.

@jpolk, you are not off base, which is why I said in the post, "I probably should have started with a well-aged Parmigiano-Reggiano, which has very little lactose left in it after all that aging..."

Lactose intolerance is not uncommon as we age. Humans are the only animal species known to continue to consume milk products after weaning, and our nearest relatives, the Great Apes, are virtually 100% lactose intolerant by the age of 6 or 7. As we get older, our intestines produce less and less lactase (the enzyme which digests lactose), which allows the lactose to pass, unabsorbed, into the lower intestine where bacteria digest it, producing unpleasant byproducts (which are the cause of the diarrhea, gas and cramping). Of note, any condition which causes diarrhea also causes the lactase to be stripped from the intestinal villi; dairy should be avoided for 72 hours after an episode of diarrhea, to allow the lactase time to regenerate.

I had my gall bladder removed in 2003 due to stones and 'disease' (I was 29 at the time) AND had an onset of lactose intolerance at the same time.

Certain foods, generally those that are fattier, go through me very rapidly due to the bile not being there in sufficient quantities. However, over the 6 years, I've become less likely to get sick that way. I don't know if it is being more careful or just adjusting. Still, in many cases, if it is something I really enjoy, I go for it anyway.

I do take a lactase pill, but not daily, only when I have more than a cup's worth of dairy. I can have a glass of milk or cheese, in most cases, and not have the lactose issue. I am more likely to have the gall bladder issue since there would be the fat as a problem. (ie, with pizza).

Get the right diagnosis. And even if it something like lactose intolerance, I daresay you can still eat things you enjoy in moderation. Frankly, I'd rather be uncomfortable in the bathroom a few minutes if it means not giving up things I really enjoy.

If you really want to test it eat a bunch of ice cream. And nausea is not the symptom, it is ridiculous amounts of gas and cramping. It's like you staged Hiroshima in your guts.

@jamieforrest, I may not be off-base, but I should certainly not simply skim (sorry) articles during work hours and then chime in. I hope you have luck with your experiments in finding cheese you can eat.

@jpolk, LOL, apology accepted :)

@redfish, Gas and cramping (and bloating) is exactly what I felt during the full-blown attacks (happened on 3 separate occasions after eating gelato, 1.5 slices of pizza, and crazy dairy-filled Ukrainian meal). The nausea could definitely be psychosomatic, but it does seem to happen when I consume some kind of dairy, but less of it.

I have a friend who is, what I'll call, "lactose-sensitive." In her adult years she has come to the point where she's unable to eat most dairy products. That is, until she went to Italy and tried some over there. No reactions. According to her, based on ethnicity (Caucasian - European ancestry) she should have the genetics to handle the dairy, so she thought it was weird that the Euro varieties didn't produce any adverse effects, but the American types did. Her idea was that it could have something to do with the amount of processing in the American foods (hormones, antibiotics, chemicals, pasteurization, etc) that might contribute to her ills.

She is a doctor, but doesn't have the training to be able to diagnose these issues w/o seeing a specialist on her own. As we've seen with a lot of people here - it depends a lot on the individual. I know a few people who can enjoy milk, cheese, and yogurt all day, but cream will do them in. No ice cream, whipped cream, half and half, etc. THAT, I find, is unexpected.

You should talk to my brother (whom you know). He has a gastroenterologist for his Crohn's disease. He also took the breath test which was negative, supporting my theory that it's all in his head, ha ha! I think I am also slightly lactose intolerant, although the only thing that really seems to give me problems is cream-based soups.

I had an incident with taleggio a week ago that left me worrying that I was lactose-intolerant (though prior to that my only stomach upset in that vein was eating perhaps too much Ben & Jerry's one night in college!), but I think for me, the issue was eating such a young cheese on an empty stomach. The first time I had it in any measurable quantity outside of a slice or two it was after a hearty meal and meant as a dessert, and I felt fine. The same happened with the pizza we made with it--it was the last pizza we had after a bianca and a small sausage, mozzarella and sauce version, so we ate little. The problem happened the next day when I had it for lunch--I was, to little surprise, starving, and the pizza just did a number on me! I've had cheese since to no issue, so I'm going to go the route of "treat young cheese like a dessert, and all will be well."

When I was younger, I was seriously lactose intolerant. I drank lactaid milk, never had pizza, and was forbidden to partake in any ice cream socials. It was horrible. But, eventually, I just grew out of it. Little by little, I tried out different culinary items to see how they effected me, and I re-built my tolerance. Now, I'm not saying that I don't still get sick. I don't even want to share my experience I had after a whole week of cheesy meals(mac and cheese for dinner one night, chicken parmesan another, pizza to finish it off, with ice cream every night...what was I thinking?).

Now my son has the same ailment. Actually, according to his doctors, he has a milk allergy and we were ordered to only give him soy products. I have been doing the same thing with him that I did with myself, giving him bits and pieces of certain hard cheeses and cheesy entrees. Surprisingly, he does very well with these. The doctors sometimes don't know what they are talking about.

All and all, I think the way you are handling it is the best way. See what effects you and what doesn't, and still live your culinary life. It's hard being a foodie with restrictions.

I'm with Mr. Chin. There are certain dairy things that I can eat, and certain ones that I absolutely can't. Ice cream is fine. Yoghurt is fine. Cheese is fine. But milk, either cold from the fridge, or warmed in a latte, will do me in. I used to drink a lot of milk in college, and the class after lunch got progressively more difficult during junior year. Then after a trip to the far east senior year, on which I was the only person not to have, um, issues, I came back to the local convenience store, got a hoagie and a pint of milk. Wow.

Most people blamed the hoagie, and given their general reputation for "quality," I was inclined to agree for a while until my next glass of milk. No good, man.

Well, the thing that finally pushed my gallbladder over the edge and confirmed that was the problem was a little bag of cheese nips from a vending machine. You could always try those and see what happens :)

Aren't bodies mysterious?! I had a few years of serious lactose intolerance (apparently caused by a nasty bout of flu), but it spontaneously started improving after about four years and now doesn't bother me at all! Although seeing a doctor seems wise, you can also test by eliminating all lactose-containing foods for at least a week (which gives you a better idea of what baseline "feeling ok" is) before trying a challenge. If you're concerned about psychosomatic symptoms, you could try having a friend give you a glass of milk without telling you whether it's Lactaid or not :)

In addition to having Celiac Disease (gluten intolerance), I have problems with cow's milk, but goat's milk, including kefir & cheese from it, are very agreeable to me. I had no dairy (cow's milk) at all for two years, and recently started ingesting goat's milk products, and to my surprise I actually feel better than before I started. There are many reasons why it is better than cow's milk, according to experts. The products are a bit expensive, but worth every penny. Can't wait to try come ice cream made from goat's milk!

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