As a person with lactose intolerance, I can tell you one thing: It’s no fun living as a human gas bag. In this age of inclusivity, this is one club I wish were more exclusive. But no, it welcomes one and all – or about nine in every 10 Singaporeans, said Dr Kewin Siah, a senior consultant with National University Hospital’s Department of Medicine, Division of Gastroenterology and Hepatology.
My conferred club membership is thanks to my Asian genes. Somewhere along the human evolutionary path, most East Asians didn’t develop a mutation that allows our bodies to keep producing the milk-digesting enzyme, lactase, right into adulthood. Unlike our Caucasian friends.
Instead, once we get weaned off milk as babies, our ability to digest lactose, which is natural milk sugar, starts to taper off, said Dr Webber Chan, a gastroenterologist from Mount Elizabeth Novena Hospital, leading to lactose malabsorption.
“Lactose malabsorption occurs when the body has trouble digesting or absorbing lactose in the small intestine,” said Dr Chan. The “undigested lactose interacts with the bacteria in the colon, creating gas and other fermentation by-products, leading to abdominal cramps, bloating and diarrhoea”.
Sometimes, lactose malabsorption can be caused by issues affecting the small intestine “such as infections, small intestinal bacterial overgrowth, or inflammatory bowel disease”, said Dr Chan.
(Photo: iStock/fcafotodigital)
For me, it’s a constant battle every day. Shall I be cheeky today and get a splash of real milk instead of oat milk in my flat white? Dare I test the integrity of my jeans’ stud button with pizza quattro formaggi and round off the meal with basque cheesecake? Decisions, decisions.
But the best decision I’ve made so far is lactase supplements. What nature didn’t endow me with, I went to get some of my own. And they work. Even at 12,000m in the air, when even a drop of creamer in the coffee can set me off in the bathroom, they are a godsend.
Here’s the lowdown on how lactase enzyme products work, how much to take, can they lose their effectiveness, and a question I’ve always wondered: Can they work so well at keeping diarrhoea at bay that they swing the other way and create constipation?
It depends on how severe your lactose intolerance is. If it’s bad enough to make you avoid all dairy food and drinks, it’s worth considering because your dietary needs are compromised. “I always tell my patients not to completely avoid dairy as it’s an important source of calcium and Vitamin D,” said Dr Chan.
(Photo: iStock/Rattankun Thongbun)
It’s also worth giving lactase supplements a shot if, like me, you need to run to the bathroom 30 minutes after an iced latte. I can’t count the number of times I’ve saved myself the embarrassment and anxiety, especially when the public toilet’s hygiene level is sus.
Still, don’t dive headlong into the supplement bottle first. Dr Chan’s suggestion is to try cutting back on foods that contain lactose and see if that helps. “Research shows that most people with lactose intolerance can tolerate about 12g to 15g of lactose – or roughly one to two cups of milk,” said Dr Chan.
“If they still have symptoms after reducing lactose, I recommend they try lactase enzyme tablets.”
These supplements can come in capsules, chewable (or not) tablets, gels or liquids. But they all do the same thing – deliver the lactase enzyme into your small intestine to help “break down lactose into glucose and galactose, making it easier to absorb”, said Dr Siah.
It is also important to check the product’s strength, said Dr Chan. “Different brands offer various strengths of lactase enzymes to match different levels of lactose intolerance. If you have mild symptoms, a lower strength might be enough.”
But if you have more severe symptoms or love your teh tarik and cheese prata, a higher-strength supplement might be more helpful. “It is always advised to start at a low dose and increase the dose incrementally,” said Dr Chan.
“Taking lactase enzyme tablets immediately before or with your first bite or sip of dairy is the most effective method,” said Dr Siah.
“This timing ensures the enzyme is present in the digestive tract at the same time as the lactose-containing food, allowing for optimal digestion,” he said. “Taking it after eating might not prevent symptoms as the lactose may already have reached the colon.”
On the flip side, taking your tablet too early may also reduce its effectiveness, said Dr Chan. “If you continue consuming dairy 30 to 45 minutes later, consider taking another dose to maintain its effectiveness.”
If you miss a dose, said Dr Chan, take it as soon as possible during the meal. “However, if symptoms of lactose intolerance have already started, the medication may not be effective in relieving them.”
I recommend asking for directions to the nearest bathroom instead.
(Photo: iStock/wakila)
I have that concern, too, since there’s always some form of milk, cream or cheese in almost every meal of my day. “Lactase enzyme tablets can be used every time dairy-containing foods are consumed, even daily,” said Dr Chan.
Dr Siah agreed. “It is generally safe to take lactase enzyme tablets with every meal containing dairy. However, make sure you follow the recommended dosage provided by the manufacturer.” If you’re super concerned, consult a doctor if you require frequent use, he advised.
“There are no studies that have reported constipation as a side effect of using lactase enzyme replacement,” said Dr Chan.
Dr Siah has the same take but “some formulations with additional ingredients such as binders might theoretically contribute to mild digestive changes”. “If constipation occurs, it is likely due to an unrelated cause,” he said.
(Photo: iStock/AsiaVision)
He also noted that there are “no known contraindications for combining lactase enzyme tablets with common medications or supplements”. If you’re taking antacids or proton pump inhibitors for heartburn – commonly experienced during the festive season of overeating – your lactase supplement might not work as well as before.
“Antacids or proton pump inhibitors might slightly alter the stomach pH, potentially affecting enzyme activity,” said Dr Siah. “Check with a doctor for interactions if you’re on complex medications.”
There is also no evidence that lactase supplements would lose their effectiveness if you’ve been taking them for a long time, said Dr Chan. But “if your symptoms persist, it’s important to consult your doctor as other gastrointestinal conditions may be the cause.”
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My conferred club membership is thanks to my Asian genes. Somewhere along the human evolutionary path, most East Asians didn’t develop a mutation that allows our bodies to keep producing the milk-digesting enzyme, lactase, right into adulthood. Unlike our Caucasian friends.
Instead, once we get weaned off milk as babies, our ability to digest lactose, which is natural milk sugar, starts to taper off, said Dr Webber Chan, a gastroenterologist from Mount Elizabeth Novena Hospital, leading to lactose malabsorption.
“Lactose malabsorption occurs when the body has trouble digesting or absorbing lactose in the small intestine,” said Dr Chan. The “undigested lactose interacts with the bacteria in the colon, creating gas and other fermentation by-products, leading to abdominal cramps, bloating and diarrhoea”.
Sometimes, lactose malabsorption can be caused by issues affecting the small intestine “such as infections, small intestinal bacterial overgrowth, or inflammatory bowel disease”, said Dr Chan.
(Photo: iStock/fcafotodigital)
For me, it’s a constant battle every day. Shall I be cheeky today and get a splash of real milk instead of oat milk in my flat white? Dare I test the integrity of my jeans’ stud button with pizza quattro formaggi and round off the meal with basque cheesecake? Decisions, decisions.
But the best decision I’ve made so far is lactase supplements. What nature didn’t endow me with, I went to get some of my own. And they work. Even at 12,000m in the air, when even a drop of creamer in the coffee can set me off in the bathroom, they are a godsend.
Here’s the lowdown on how lactase enzyme products work, how much to take, can they lose their effectiveness, and a question I’ve always wondered: Can they work so well at keeping diarrhoea at bay that they swing the other way and create constipation?
DOES EVERYONE WITH LACTOSE INTOLERANCE NEED LACTASE SUPPLEMENTS?
It depends on how severe your lactose intolerance is. If it’s bad enough to make you avoid all dairy food and drinks, it’s worth considering because your dietary needs are compromised. “I always tell my patients not to completely avoid dairy as it’s an important source of calcium and Vitamin D,” said Dr Chan.
(Photo: iStock/Rattankun Thongbun)
It’s also worth giving lactase supplements a shot if, like me, you need to run to the bathroom 30 minutes after an iced latte. I can’t count the number of times I’ve saved myself the embarrassment and anxiety, especially when the public toilet’s hygiene level is sus.
Still, don’t dive headlong into the supplement bottle first. Dr Chan’s suggestion is to try cutting back on foods that contain lactose and see if that helps. “Research shows that most people with lactose intolerance can tolerate about 12g to 15g of lactose – or roughly one to two cups of milk,” said Dr Chan.
“If they still have symptoms after reducing lactose, I recommend they try lactase enzyme tablets.”
WHAT ARE LACTASE SUPPLEMENTS AND WHAT SHOULD WE LOOK FOR?
These supplements can come in capsules, chewable (or not) tablets, gels or liquids. But they all do the same thing – deliver the lactase enzyme into your small intestine to help “break down lactose into glucose and galactose, making it easier to absorb”, said Dr Siah.
It is also important to check the product’s strength, said Dr Chan. “Different brands offer various strengths of lactase enzymes to match different levels of lactose intolerance. If you have mild symptoms, a lower strength might be enough.”
But if you have more severe symptoms or love your teh tarik and cheese prata, a higher-strength supplement might be more helpful. “It is always advised to start at a low dose and increase the dose incrementally,” said Dr Chan.
DO WE TAKE THEM BEFORE, WITH OR AFTER FOOD?
“Taking lactase enzyme tablets immediately before or with your first bite or sip of dairy is the most effective method,” said Dr Siah.
“This timing ensures the enzyme is present in the digestive tract at the same time as the lactose-containing food, allowing for optimal digestion,” he said. “Taking it after eating might not prevent symptoms as the lactose may already have reached the colon.”
On the flip side, taking your tablet too early may also reduce its effectiveness, said Dr Chan. “If you continue consuming dairy 30 to 45 minutes later, consider taking another dose to maintain its effectiveness.”
If you miss a dose, said Dr Chan, take it as soon as possible during the meal. “However, if symptoms of lactose intolerance have already started, the medication may not be effective in relieving them.”
I recommend asking for directions to the nearest bathroom instead.
(Photo: iStock/wakila)
CAN WE TAKE TOO MANY LACTASE TABLETS?
I have that concern, too, since there’s always some form of milk, cream or cheese in almost every meal of my day. “Lactase enzyme tablets can be used every time dairy-containing foods are consumed, even daily,” said Dr Chan.
Dr Siah agreed. “It is generally safe to take lactase enzyme tablets with every meal containing dairy. However, make sure you follow the recommended dosage provided by the manufacturer.” If you’re super concerned, consult a doctor if you require frequent use, he advised.
CAN TAKING TOO MUCH LACTASE LEAD TO CONSTIPATION? CAN IT INTERACT WITH OTHER MEDICATIONS?
“There are no studies that have reported constipation as a side effect of using lactase enzyme replacement,” said Dr Chan.
Dr Siah has the same take but “some formulations with additional ingredients such as binders might theoretically contribute to mild digestive changes”. “If constipation occurs, it is likely due to an unrelated cause,” he said.
(Photo: iStock/AsiaVision)
He also noted that there are “no known contraindications for combining lactase enzyme tablets with common medications or supplements”. If you’re taking antacids or proton pump inhibitors for heartburn – commonly experienced during the festive season of overeating – your lactase supplement might not work as well as before.
“Antacids or proton pump inhibitors might slightly alter the stomach pH, potentially affecting enzyme activity,” said Dr Siah. “Check with a doctor for interactions if you’re on complex medications.”
There is also no evidence that lactase supplements would lose their effectiveness if you’ve been taking them for a long time, said Dr Chan. But “if your symptoms persist, it’s important to consult your doctor as other gastrointestinal conditions may be the cause.”
Continue reading...