Could my IBS, SIBO or other digestive issues be lactose intolerance?

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons. Before I get to the topic of the day, I have some exciting news. I finally wrote a new free ebooklet on gut health that you can get by popping over to my website, HighDesertHealthCoaching.com. And it's called Finding Your Root Cause Through Stool and Organic Acids Testing. I named it that because I am all about finding your root cause. So even if you have a diagnosis like Crohn's or colitis or gastritis, really that doesn't hit at the root cause of why your body is dysfunctioning. Yes, there's a genetic component to a lot of these conditions, but genetics are only responsible for about 20% of what happens. Your environment, meaning your diet, your stress, your medications, especially prior antibiotic use and its impact on your microbiome. Exercise, toxins inhaled and eaten, and so much more are responsible for the other 80%. So finding the root cause of your illness is the first step in turning it around. So my booklet explains about two of the tests that I use with my clients to get at the root cause of their conditions, and it's yours for the having over at highdeserthealthcoaching.com. So now on to the question of the day: could your IBS or SIBO or dysbiosis or other digestive issues in fact be lactose intolerance. So let's start with what lactose is and how it's normally digested. Lactose is the sugar found in dairy products, including milk, yogurt, cheese, cream, sour cream, and ice cream. Eggs, contrary to what some folks I've worked with have thought, are not dairy products despite being found in the dairy aisle in most grocery stores. So when you eat dairy products, The lactose is broken down by an enzyme called lactase that is produced by the cells lining your small intestine, and lactase breaks the lactose down into glucose and galactose, which your body can then absorb and use for energy. Now, when the lactose digestion process doesn't work right, it's because there's either not enough or no lactase present at all, and some amount of lactose is then going to pass into your large intestine undigested. At this point, bacteria will start working on it, and they'll produce gases including hydrogen, methane, and carbon dioxide, as well as fatty acids. So two of the most common symptoms as a result of lactose intolerance are bloating and gas, which can happen between 30 minutes and 2 hours after you eat dairy, and it's one of the early signs that you're losing your ability to digest lactose. Full-blown lactose intolerance, when you've completely lost your ability to digest lactose, which I believe I have, can be much less pleasant than just some gas. In fact, I thought up the topic for this podcast while having what I describe as my lactose poops, which I had by accident about a week ago after having some dairy-free ice cream at an ice cream store, which I believe was scooped with an ice cream scooper that had been in that vat of water that's usually filled with bits of regular ice cream. And I now can recognize when I've been lactosed, because it's particularly awful the next morning with my morning constitutional. Sometimes the first few pieces of stool come out okay, but then by the end it's like having molten lava exit my body, both in consistency and perceived temperature because of the increased acid in the stool. And in the past, if I had a lot of lactose or my lactose digestion tablets didn't work for some reason, which I often think was because they were expired, my bowel movements could last up to as much as maybe 45 minutes. With waves of hot liquid slowly coming out as I'd go through hot flashes, sometimes soaking sweats, nausea, and then extreme and flu-like weakness that sometimes forced me to just take a quick wipe and collapse on the bathroom rug to recover between those waves. So it was really horrible. I usually don't get this painfully graphic about my bowel issues on podcasts, but I did wanna share about this in detail because I think that there may be some people out there who have lactose intolerance who think they have IBS or some other issue. So I wanted to make sure you really understood what full-blown lactose intolerance feels like from someone who has dealt with it. So there are actually two types of lactose intolerance. There's primary and secondary. And primary is when you don't have the gene for lactase persistence, which means that your body slowly loses its ability to digest lactose between ages 5 and 20. I actually ran my raw 23andMe DNA data through a tool called Genetic Genie, which is a free DNA analysis tool, and have confirmed that I don't have the gene for lactase persistence. I also ran my parents' DNA data and was surprised to find that my dad, who has always had stomach pain and GI issues, does have the gene for lactase persistence, but my mom, who's of Italian descent, does not. So thanks, Mom, for my crappy genetic inheritance. I mean the lactose intolerance, not the Italian part. I love the Italian part. But it is funny that my mom still eats dairy and hasn't ever had any stomach issues or bowel issues that she's mentioned. So I guess her microbiome is making up for her genetics. But anyway, it's estimated that by adulthood, 70 to 90% of African Americans are lactose intolerant, 80 to 95% of Asians, 100% of Native Americans, and somewhere between 12 and 25% of Caucasians. So if you do wanna find out if you have that gene for lactase persistence, you can upload your raw data from 23andMe or ancestry.com to Genetic Genie and find out about that and a lot more. But just to be aware that you could find out disturbing things when you upload your genetic data, like that you have the BRCA mutations that put you at risk of breast and ovarian cancer, or the APOE4 mutation that puts you at risk of Alzheimer's. So you do wanna make sure you have the necessary support to receive that information if you do run your genetic data. And if you wanna have access to your raw data, I know that with 23andMe, you have to choose the $199 Ancestry Health Report, which by the way, went on sale last year around Christmas. Or it seems like the one on ancestry.com, their AncestryDNA also provides raw data and that's only $99. But there may be other reasons to choose the 23andMe. Over the ancestry.com. So do your research. So back to lactose intolerance. Secondary lactose intolerance is when you lose your ability to digest lactose because of damage to your small intestine. So possible causes of that include surgery, chemotherapy, a bout of gastroenteritis, or what we call in the US intestinal flu. It can also be caused from damage to the villi lining your small intestine from eating gluten when you have an undiagnosed gluten sensitivity or intolerance or celiac disease. And if this is the case, you should go off both gluten and dairy until your gut seems to be healed up based on your other symptoms or a doctor confirming it, and then slowly add dairy back in to see if you can tolerate it. Other potential causes of secondary lactose intolerance are bacterial overgrowth, like with SIBO or small intestinal dysbiosis, where you're struggling with too much or the wrong type of bacteria in the small intestine overfermenting certain hard-to-digest carbohydrates, including lactose. As I discussed in my last episode with Norm Robillard. Other conditions that can cause damage to your intestines or impact your ability to digest lactose include Crohn's disease, ulcerative colitis, and long courses of antibiotics. And some people who have secondary lactose intolerance may be able to recover their ability to digest lactose, but others won't ever recover it. So officially speaking, for adults, the two ways of diagnosing lactose intolerance are a hydrogen breath test, or a lactose tolerance test. But if you're already suffering when you eat dairy, both of those tests involve you ingesting lactose. So that prospect seems pretty miserable to me. Not to mention it can be hard to find a doctor who offers the test. And then of course there's the cost. Even if it's covered by insurance, you usually have a copay of some sort. So my recommendation is a much cheaper and simpler method. You eat some dairy and you take lactose digestion tablets, which have the enzyme lactase, which digests the lactose. You can find them at any drugstore, or I used to get the milk digestion tablets at GNC because pill for pill they were a lot cheaper, although they did tend to have sooner expiration dates than the ones I'm, I'm using from CVS now. But you eat your dairy with these tablets per the package instructions, and you see if you don't have the usual upset that you're used to. And if that's the case, it's a pretty sure bet you have lactose intolerance. Now, you may want to isolate the dairy when you test it and not eat it on top of a slice of pizza, for instance, as you could be confounding a gluten and a dairy reaction in that case. But once you've confirmed that the pills are helpful, my best advice is to be very diligent about taking them, always having them with you and avoiding dairy carefully and completely, and making sure you take enough of them for the dairy that you're eating. There's different dosages based on the ones you buy, so, you know, make— check the bottle cuz even the same brand sometimes has different dose pills. Like the more expensive ones, you take one pill, the less expensive ones you have to take two pills. And also always check the original bottle and keep that so you can have the expiration date so that you don't have a bad reaction like I used to when my pills were expired. And it's also worth noting that not all dairy foods are created equal with regard to lactose. So while a cup of milk has 15 grams of lactose, a half a cup of yogurt has around 6. And it's also believed that it's easier to digest because it has live bacteria in it and they break down the lactose to some extent. And ice cream has about 4 grams for half a cup of ice cream. But let's be real, most people aren't eating only half a cup of ice cream at a time. Speaking of ice cream, I did just wanna say that if you're thinking about going dairy-free, I am absolutely in love with the So Delicious dairy-free coconut milk sugar-free mint chocolate chip ice cream, and they are not paying me to say that. That ice cream got me through the summer of COVID on a nightly basis. Anyway, soft cheeses in general also have more lactose. So cottage cheese, for example, has 2.3 grams in half a cup, whereas an ounce of cheddar cheese or harder cheeses like that, um, that only has 0.1 grams. And higher-fat dairy has less. So a tablespoon of whipped cream, for example, has 0.1 grams, and butter has less than 0.1 grams per tablespoon. So even as lactose intolerant as I am, I can tolerate butter. But I do avoid all other forms of dairy. And when I'm at home and I can, I use ghee or clarified butter, which has no lactose or casein. Casein, by the way, is the primary protein found in milk and represents about 80% of the protein, with whey making up the other 20%. I'm sure you've heard of curds and whey from the nursery rhyme. And if you've ever tried making cheese, which I did back when I was still eating it, you heat up the milk and then you add something like lemon juice or vinegar or rennet to make it curdle. And then the curds separate from the whey, and then you pour off the whey. That's the liquid there. So if you have eliminated lactose from your diet by moving to lactose-free dairy products or always eating your lactose with lactase enzyme, but are still having reactions when you eat dairy, you may have an intolerance to casein. This is a common cross-reacting protein with gluten. So if you're intolerant to one, you may be intolerant to the other. Symptoms of casein intolerance may be similar to lactose intolerance, like that bloating, the gas, the soft stool, and diarrhea. But you could also have abdominal cramps and pain, possibly constipation, maybe even blood in the stool. And it can also manifest in allergic-type symptoms like a runny nose, congestion, or postnasal drip, or in skin conditions like eczema, rashes, or adult acne. And for kids, casein intolerance could show up as behavioral problems, or you could have systemic systems like fatigue, joint pain and brain fog. So if you suspect that it may be the case that you are also intolerant to casein and it's still not enough to get you off dairy, there's one more thing you can try, which is A2 milk. So one of the subtypes of casein called beta casein has two types, A1 and A2, and a lot of the symptoms of casein intolerance are from the A1 type. So you could try A2 milk, which is from cows that produce the A2 type, which is found in most grocery stores now. And also, a quick internet search showed that there are now A2 cheeses out there, and even one company doing both lactose and A2 ice cream called Rethink. It's not in stores near me, but it looks like you can order it online, 4 pints at a time, although with shipping it's not cheap. But if you still react to A2 milk, then it may be that you are just not— you're just not meant to be eating dairy, and you just need to accept that. It took me a long time to get to that place mentally, but that was aided by a statement from my French friend Martine that just kept echoing through my head. She asked me, "If you have to take pills to eat something, should you really be eating it?" So about a year after that wise statement, I finally gave up dairy along with a bunch of other stuff and saw my postnasal drip decrease, the constant phlegm in my throat go away, my my acid reflux, whose primary symptom was a constant cough, and hemorrhoids disappear. And I've reintroduced everything except gluten and dairy, and I remain symptom-free. So I'm convinced that it was the dairy that was primarily behind all that. So now when I do occasionally cheat and eat cheese, almost always accompanied by gluten in the form of pizza or burrata cheese and pizza, I take Glutonase, which is an enzyme product made by Enzymetica, and it contains enzymes to digest both the gluten and the casein. Along with my lactose pills. Now, this isn't something you should try if you have celiac disease or have active autoimmune disease, but since I have brought my antibodies for Hashimoto's down to normal and my platelets for my other autoimmune disease ITP are also normal, I feel like I can cheat a bit, but we'll find out more about whether that's a good decision at my next doctor's appointment. So you may be wondering what the role of the gut microbiome is in digesting lactose, and it does have a role. There are bacteria that can help digest lactose, and they are the ones commonly found in the majority of probiotics from the general Lactobacillus or Bifidobacterium, not to mention those that they're also found in a healthy gut if you eat a typical Western diet or just a Western diet at all, and your microbiome hasn't been decimated by antibiotics like mine. So if your gut is lacking in these bacteria, which is often the case in particular for Lactobacillus, if you're not eating fermented dairy products or fermented foods like sauerkraut, kombucha, water kefir, beet kvass, or kimchi, you could try taking probiotics with those strains and see if it helps. There's one brand called OptiBac that seems to particularly aim to help with lactose digestion, and they kind of point to research on two of its unique strains, Lactobacillus acidophilus Roselle 52 and Lactobacillus rhamnosus Roselle 11. But I followed their links and I couldn't really find anything conclusive study-wise. I know I tried them a few years ago, but I was so past willing to eat dairy without taking my lactase pills at that time that I couldn't really tell you if it helped. But they do seem to get good reviews on Amazon. Any type of multistrain lacto or bifido probiotics could also be helpful. And if you want a really high CFU count one, you could try Grace Liu's probiotic Bifido Maximus, which is also histamine-free. If that's an issue for you. The last question that may be burning in your mind is whether no longer eating dairy means you're going to have even more problems eating it in the future. And the answer is yes. If you do stop feeding your probiotic bacteria lactose, they will reduce in number and you'll lose what's called colonic adaptation. Although these bacteria can consume other carbohydrates, given the typical quantities of dairy that people eat, a sharp reduction in that incoming lactose will impact these probiotic bacteria, and then you'll likely have worse symptoms if you're accidentally lactosed. So if you're determined to keep eating dairy or you wanna start reeating it, do start slowly and add in fermented vegetables or probiotics to build up these bacteria, especially before completely withdrawing support like lactase tablets. So if you're going to give it a try and eliminate dairy, of course you wanna read labels closely and avoid anything with the word milk, including goat's milk and sheep's milk. And if you have access to it, camel's milk has lactose as well, although much less. You should also avoid anything that includes ingredients containing the words whey, casein, caseinate, cream, galactose hydrolyzate, anything starting with lacta except lactase, which is the enzyme that digests lactose, or starting with lacto, lactu, lacte with an I or with a Y, nice and nougat sherbet, pudding, quark, rekkjaldur, or rennet. And if you wanna be really strict, beware of natural flavoring, flavoring, caramel flavoring, although I doubt the quantities of lactose in those last few food additives is gonna be significant enough to cause problems. And also beware of high protein flour. And this is counterintuitive, but actually many non-dairy cheeses contain casein, which I totally don't understand, but I guess it's for that lactose intolerant market that's not casein intolerant and not vegan. Who knows? And finally, if you're struggling mentally with how to give up your beloved dairy, believe me, I was there. Feta cheese, burrata, Neapolitan pizza, fresh mozzarella, brie, my homemade rosewater and lemon yogurts. I was totally there with you, but I made the transition and I would never go back now. So what do I do? Well, I tend to use avocado where I would've used cheese, like putting slices of it in sandwiches or with eggs and salads. I use guacamole and chips as a snack instead of cheese and crackers. I haven't really found a great replacement for feta in salads, but I'm currently loving salads with pumpkin seeds or nuts. And then when it comes to pizza, that's when I cheat, because if you take gluten and dairy away from pizza, it's really not pizza anymore. It's some kind of freakish Frankenfood that I'm not interested in. But I get that some people don't have the luxury of ever cheating, so do shop around. Some substitute cheeses are workable for some people. And then I also pretty much just stay away from yogurt, although there's some decent coconut yogurts and kefirs, and they're good dairy-free substitutes for things like sour cream. For recipes, coconut milk works well as a substitute for cream, or you can get coconut cream as well, the non-sweetened kind. They sell, they sell a good one at Trader Joe's. And there's also really good coconut whipped creams on the market. The So Delicious one is my favorite. And then in general, I tend to cook a lot more Asian foods. That are naturally dairy-free rather than trying to substitute and recreate normally dairy foods. I do make a vegan parmesan with cashews though, and I'll link to that recipe for you. So there's a bit of learning and a new recipe curve, but it's totally doable, and I really rarely think about or miss dairy anymore, and I certainly don't miss the symptoms. So if you have acid reflux and have already tested negative for H. pylori, or you've got bloating, gas, nasal congestion, postnasal drip, eczema, things like that, or you have those hell on earth liquid lava poops and you haven't yet given a real good try to giving up dairy and maybe gluten with it, that's been a reliable go-to for me as a health coach in helping people get rid of these symptoms. So it's definitely worth a try. And as always, if you've hit a brick wall with traditional or allopathic doctors and you want some help with your gut at the microbiome level, or in reversing autoimmune disease naturally, or other health issues, You can set up a free 30-minute breakthrough session through the link in the show notes to hear more about what health coaching is about and how I could help you. And I've linked all the things I mentioned in the podcast in the show notes. If you're looking for vetted, high-quality supplements, do check out my Fullscript or Wellmate dispensaries, which helps support the podcast. And with that, here's wishing you all the perfect stool.