A fair number of bariatric patients end up with lactose intolerance after surgery. Lactose is the sugar found in milk from cows and goats.
During the rapid weight loss phase, you do lose some muscle mass. The digestive system is a muscle. Think of the small intestine like a roll of shag carpet, with the carpet fibers inside. Healthy small intestines will have structures more like shag carpet on the inside. These structures are called villi. When you lose muscle mass in the small intestines, the villi will shrink. That means you have less surface area to produce lactase. Lactase is the enzyme that breaks down lactose.
Symptoms of lactose intolerance include stomach and abdominal cramps, bloating, gas and diarrhea. Some people also experience nausea and vomiting.
Where is lactose lurking? The main culprit is milk from cows and goats. Look carefully at the ingredient list of the foods you eat. Examples of these kinds of foods include:
- Ice cream
- A glass of milk
- Powdered milk
- Instant hot cocoa and pudding
Lactose can show up in some of the following:
- Baked goods
- Milk chocolate
- Ice cream
- Frozen yogurt
- Whipping cream
- Sherbet
- Sour cream
- And buttermilk
Carefully check frozen meals, instant potato mixes, cream or cheese-based foods (sauces, soups, gravies), foods made of grains (bread, tortillas, crackers, biscuits, muffins, cookies, pancake mixes, frozen waffles, breakfast cereals), baked goods and desserts, creamed vegetables, coffee drinks, salad dressings and processed meats (hot dogs, bacon, sausages, cold cuts). You may see “Contains Milk” on the label, which will be another clue.
If you have lactose intolerance, have you wondered why you can tolerate yogurt and cheese? Yogurt and cheese go through a fermentation process that actually breaks down some of the lactose. Lactose is sugar when glucose and galactose are joined together. During the fermentation process, glucose and galactose are separated. That means there is less lactose in these foods. That is why people with lactose intolerance can eat some yogurt and cheese. Lactose-free kinds of milk in the stores include Lactaid and Fairlife and other brands. You can also take lactase tablets to decrease the lactose in milk products. Lactaid is perhaps the best known, but many others are on the market.
Many plant-based kinds of milk are now on the market. These include milk made from soy, almonds, rice and cashews. Soy milk is a good source of protein, but the others are not.
What about the protein drinks you are required to have? Milk-based protein supplements will have the words whey, casein or milk in the ingredient list. Some protein supplements will actually state “lactose-free” on the label. Look at the ingredient list. Do you see the words milk, whey, whey concentrate, casein or casein concentrate? That’s your clue it has lactose. Look for whey protein isolate.
Research shows that whey protein isolate typically has less than one percent of its weight as lactose. Whey concentrate may have up to 52 percent of its weight as lactose. Whey protein isolate is generally well tolerated by people with lactose intolerance.
You can look at the Nutrition Facts Label to see if the protein product you choose has any sugar in it. A product with one or two grams of sugar is generally safe. This indicates there is a low amount of lactose in the protein shake. Your small intestine will be the final judge if the protein product really is lactose-free.
If you are lactose intolerant, you’ve now got information to start looking for lactose in all the places that have milk in them. If you still need help, work with your dietitian. Your bariatric dietitian is trained to help you find a protein shake you can tolerate.
Information provided by Rene Norman, RD/LD, bariatric dietitian.