Is Lactose Intolerance Causing Your Gut Issues? with Dr. Elizabeth Boham

Coming up on this episode of the Doctor's Pharmacy.

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Welcome to Doctor's Pharmacy.

I'm Dr. Mark Hyman and that's Farm is for the Neph, a place for conversations that matter. And if you've ever suffered stomach trouble or tummy trouble from eating dairy, you might want to listen up because it's a common problem and we're going to talk a lot about it, what to do about it, how to diagnose it and how to get rid of the problem. So welcome, Dr. Boham. Dr. Boham is joining me today. She's our Medical Director at Tel Chwiwana Center, an incredible physician, friend and colleague for decades. who's also an RD and an exercise physiologist and teaches nutrition all over the world and is on the faculty of the Institute for Functional Medicine and has created some of the most important nutrition curriculum we have in the world, I think. Anyway, I am so excited to have you, Liz, again on another episode of House Call on the Doctor's Pharmacy and to talk about this nasty problem called lactose intolerance. So, get us up to speed about what this is, how common is it, and what causes it and is it something we're born with or we can develop and how does it all work?

Lactose intolerance is so common. It's at least 65% of the world population, you know, and it increases as we get older. It's not, you know, what lactose intolerance means is the inability to digest the lactose in dairy products, that carbohydrate in dairy products. and it really does vary amongst different racial groups and ethnic groups. So it's more common in, we've seen in Africa and South America and Asia, it's less common in Europe, but it is throughout the whole world we see lactose intolerance. And as people get older, we see more and more lactose intolerance. In fact, you know, some people think that by once we reach age 99, everybody has some degree of lactose intolerance. As I mentioned, it's uncommon in younger kids, but there are young kids who have lactose intolerance. And anything that damages the intestines, if you damage the villi in the intestine, so if you get a gastroenteritis, so if you get an infection in the, an inflammation in the intestines, Sometimes if people take antibiotics or have chemotherapy or have inflammation in their intestines, that can result in lactose intolerance starting. So people will always say to me, well, I used to have no problem with dairy, but now I'm having trouble with dairy. And it's because that can happen after a round of antibiotics or after an infection, or we just, as we get older. The other thing to recognize about lactose intolerance is it's dose dependent. So that's what sort of throws people off sometimes is that they may have a little bit of dairy and be fine, but at some amount of dairy, then they start to have a problem. So it is, we have this enzyme in our intestines called lactase and it digests our lactose. And if we don't have enough lactase or if we eat too much lactose, then we get problems with lactose intolerance.

Okay, so I don't know why they call it lactose intolerance because the fact is that most of the world is intolerant to dairy and lactose. And the abnormal situation is being able to consume it and tolerate it. And also, you know, there's an ethnic component to this. If you're African, South American, Asian, you're more likely to be lactose intolerant. if you're of European descent, particularly Northern European, you're certainly better. But we don't really think about the fact that most of the world's population doesn't really do well with dairy. And also, the dairy we're eating is not the greatest dairy. I've talked a lot about that in previous podcasts and my book, the Pegan Diet, as well as food, what the heck should I eat? And the other factors that are causing it to be more common are things that you said, such as damage to our gut from antibiotics and bad diet and bacterial overgrowth and all these other problems. So how do we sort of begin to think about helping people diagnose it and then treating it?

Absolutely. So, you know, one of the things is we start to pay attention to what symptoms somebody has. So when somebody comes in and they complain of abdominal pain, maybe they get fullness or bloating after they eat. Maybe they have diarrhea after they consume or just diarrhea during the day and they may feel nauseous or have excess gas. And so then you get a good detailed history of what they're eating. Sometimes people, it throws somebody off because they may not have had problems with dairy prior to when they, you know, at a younger age and then they developed. and so they're confused as to why they have started to have problems now. But as I mentioned, you can develop problems with issues with lactose and digesting dairy at any point in your life. It increases as we get older and it often can increase after we've had some sort of infection or inflammation or antibiotics in our system. And so you wanna just figure out what is somebody dealing with, the abdominal pain, the bloating and gas, and then you wanna say, okay, when do your symptoms occur? Because typically when there's problems with lactose, it's half an hour to two hours after you consume the lactose-containing food, so the dairy. And the symptoms usually resolve five to seven days after you've removed the dairy from the diet. And what's happening is there's low levels of this lactase enzyme in the small intestine, then the carbohydrate component of dairy, the lactose, does not get broken down. And when it's not absorbed as it should be, it goes into the colon and in the colon, it gets consumed, the bacteria in the colon eat it and produce a lot of gas and a lot of water goes into the colon to deal with these food particles that are too large and as a result, you get a lot of gas and bloating and diarrhea. So it is a very hard food to digest and absorb. We see it all the time. And so it's, the reason we wanted to talk about it and do this podcast is because it's so common and patients are really struggling with it all the time. And even though, you know, to you and I, it's like, okay, we see, you know, of course go off dairy. People often come in in denial. They're like, oh, no, it's not the dairy. And I'm like, yeah, you gotta give it a try.

One of the things that often people wonder about is, well, what about black-taste free milk? Or what about yogurt? Or what about cow or sheep? Or what about A2 versus A1 casein? How do we figure all that out? And how do we determine, what people should be doing if they want to include dairy? Because I know, for example, if I eat regular milk, I'll be in trouble. But if I have goat or sheep yogurt, I seem to do okay. So I wonder, you know, how does that work? And can you explain a little bit about that?

It's such a great question. I mean, what we often start with is pulling away all dairy for somebody because that's how we can see, okay, how much is this going to improve your symptoms? But you're correct, there are some better quality dairies like the A2 milk that people tolerate better. If the dairy is fermented like yogurt, it's broken down. And so many times people can tolerate some plain, whole fat yogurt without problem, but they couldn't drink a glass of milk, for example. And because that fermenting process breaks it down, For other people, they can't tolerate anything. So they can't, they may, some people even have to be a little, they have to watch even butter intake and they have to go with something like a ghee instead. So there's many ways you can react to dairy. So we're talking about reacting to the lactose in dairy, which is the carbohydrate component of dairy. That's what we're talking about here. But people also react to the proteins in dairy, and they can have food sensitivities or food allergies to that dairy as well. So there's multiple ways people can react to dairy. So we always start with pulling it all out and then maybe adding back in some easier to digest dairy if somebody really wants it and they don't have a problem with it, such as a full-fat, non-sweetened yogurt.

And so what about people taking enzymes like lactase? Is that a good idea? Should people just avoid dairy? Are there other issues that happen? And what are the consequences of sort of consuming dairy if you are lactose intolerant?

You know, that's a great question. So the enzymes that are in that, like the lactase enzyme is the enzyme in lactaid is a beta galactosidase and that can help people break down their dairy and tolerate it better. But that's a good question. I typically recommend that people don't consume a lot of these enzymes if they're having problems and just avoid the food. But some people choose to have some of these digestive aids and then have a little bit of the dairy from time to time.

Yeah, I sometimes cheat and eat ice cream and then of course I pay for it later.

Yeah, right?

Yeah.

Yeah. So, you know, I think that these enzymes may be helpful for some people.

But.

I think the reason that we're so focused on dairy is, you know, everybody was like, you got to get your calcium, you got to get your calcium. It was a huge marketing campaign to promote the amount of dairy that we needed to consume. and so it's really important to remind people that there's so many other ways to get their calcium. Almonds, almond butter, great sources of calcium. Sardines, great source of calcium. Salmon in a can has bones in it, great source of calcium. Broccoli and your greens are a good source of calcium. And so there's lots of ways you can get good calcium in your diet and you don't have to feel like you need to be getting it from dairy products. Yeah.

And, I would just underscore that anybody listening who wants to hear about dairy should listen to the podcast I did with David Ludwig where he dug into the article that he wrote with Walter Willett who was one of the leading scientists at Harvard called Milk and Health. And, if you want to Google it, it's New England Journal of Medicine, Milk and Health. We'll put it in the show notes, but there's also a great Medium article he wrote about it as well. And, bottom line is that all the propaganda about milk needing for your bones, it actually increases fractures. you know, it doesn't do a lot of things that it was promoted to do by the Dairy Council and the Got Milk ads. It's not a great sports drink. It's not great for weight loss. It's not great for osteoporosis. In fact, it may cause osteoporosis. It may cause allergies, digestive issues, as we mentioned, even autoimmune diseases, cancer. So, I think there's a lot of reasons to be cautious about dairy. And again, I think just underscore the fact that when we're talking about dairy, we're talking about sort of modern cow dairy. Sometimes heirloom cows have different, you know, grass finished cows have different properties and better tolerated. Sometimes sheep and goat is better tolerated. So it really depends on, on sort of you and a personal decision. But it's not Nature's Perfect Food unless you're a calf.

And it's also, you know, problematic in many, many ways. Absolutely. As we see here with some of these cases, like this first one here was a 25 year old gentleman. who came to see me and, you know, he was relatively, he was really healthy actually. And he was doing well until about a year ago. And he had like a stomach bug. He was traveling and he got some stomach bug. He didn't really think much of it. He recovered from it. But at the time he had like a fever and some diarrhea. He recovered from the bug. But then since that point in time, he still had episodes where he was rushing to the bathroom and had diarrhea and bloating and gas production. And he really couldn't figure out what foods were involved at all. And he didn't think any food was involved. And he was, you know, so he wanted to figure it out. So based on his timeline of symptoms, and you know, that we gathered from him, we said, you know, even without any testing, we said, let's just do a trial off a dairy and see what happens. And within a week, his symptoms got all better and he thought, I, you know, was just, you know, did a wonderful job at, you know, right? I fixed his diarrhea and gas and bloating and, and, you know, he's, he just avoids really most dairy because he feels better at this point in his life. So it's, you know, it's, it sometimes can make a huge difference and something that we really encourage a lot of people to give a trial for.

Yeah, I think we've all been sort of brainwashed that we can't live without milk and dairy and then it's important for all these reasons which turns out not to be. I would say that clinically practicing functional medicine for plus 30 years and you also, it's one of those foods that is really problematic for a lot of people, not just lactose intolerance but eczema, asthma, just general digestive discomfort. acne, autoimmune diseases, all kinds of problems clear up when you stop dairy. So, if you've never done it, I would encourage people to think about just taking a holiday for three or four weeks and just then adding it back and seeing what happens. You'll know. Your body will tell you very quickly whether or not you are intolerant of dairy. Well, I mean, because it may not cause lactose intolerance, but you can get other reactions like congestion, sinus infections, you know, all kinds of skin issues, eczema and so forth. And we did a Pegan diet challenge with Katie Couric and she has eczema and she's like an arthritis and she got off all that junk and it got better.

Oh, good for her, good for her. You know, it is amazing, like you were mentioning, you can have a hard time digesting the carbohydrate in the dairy and have the lactose intolerance and you can also have a sensitivity to the proteins in the dairy. And with a sensitivity with the proteins, a lot of times that will cause acne or it'll cause the eczema or asthma or inflammation in the skin. And of course, you can have an immediate reaction to dairy too. You can have an IgE allergy. So you can have an allergy, a sensitivity, or a lactose intolerance. There's so many ways that people react to dairy. And my second case here was a 20-year-old woman who came in and she got bloated every time she ate. She felt full and she sometimes had diarrhea and stomach pains. So she was just really struggling with her digestion. It would sometimes be constipated, but then sometimes diarrhea, sometimes rushing to the bathroom, really feeling bloated a lot. And when we got her history, we realized that she had this long history of acne. Well, she's only 20, so it wasn't that long, but a history of acne. And so she was placed on antibiotics for the acne at age 18, and she had been on antibiotics for a couple of years. And what we know is that even though those antibiotics may clear up the acne for, you know, immediately at that time, long term, that's a huge concern because it's getting rid of all the good bacteria on our skin that prevents acne in the future. And it's also getting rid of all the good bacteria in our digestive system. that is keeping our digestive system working well. And so that can really mess up the microbiome and result in lots of issues. And for her, over time, she started to have a lot more issues being on those antibiotics with her digestion. So for her, we did a dairy-free trial just for both her skin and her digestion. And we saw a good improvement in her digestion. and her skin, like her digestion got about 50% better, her skin got 60 to 70% better, but she was not 100% better. So then we needed to do more testing. We did testing for small intestinal bacterial overgrowth, we did stool testing, and we found that she had this small intestinal bacterial overgrowth that we needed to treat. And so, you know, I think a lot of times those long-term antibiotics like that can result in this overgrowth of bacteria that then, you know, that then just snowballs into more and more problems. And so we needed to treat that with an herbal approach. And it was at that point when we kept her off of the dairy, treated her bacterial overgrowth, that she, you know, started to get much better in terms of her digestion. Her skin improved, her digestion improved, and her pain and her belly improved. significantly as well. And you know what? She sometimes at this point cheats with a little bit of healthy yogurt, but she mostly stays off of all dairy and is doing much better.

Well, I mean, basically the message you're saying is when in doubt, cut it out. And I think everybody should think about just a trial of no dairy because of the challenges we often see. I think this is such a common problem and people suffer with, I mean, the digestive complaints are the number one reason people go to the doctor. So I think this is an easy thing to try and fix. And I think we just want to highlight in our podcast, I'm super happy that you, you brought it up and that we got to talk about it in some of the cases. I think for listening, if you really struggle with dairy, tell us what your problems are. Leave a comment, share about how you've dealt with your lactose intolerance. Subscribe where you get your podcast, share with your friends and family. And also, we've got a new service called Dr. Iman plus, which is a subscription service where you all sorts of free content and access to me and Dr. Baum and others in our team for deep dives in functional medicine, ask me anythings with me, or you could ask me your questions in small intimate groups, and all kinds of other free stuff. So, check it out, Dr. Hemmer Plus, and thanks for listening to the Doctor's Pharmacy. And, we'll see you next week for another episode of Doctor's Pharmacy and House Call.

Hey everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health. and get healthier and better and live younger longer. Hi everyone.

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