Digestion: Lactose Intolerance And Irritable Bowel Syndrome
The Better Life Experts | April 14, 2009

Regarding lactose intolerance
Between 30 and 50 million Americans are lactose intolerant and certain ethnic and racial populations are more affected than others. Up to 80 percent of African Americans, 80 to 100 percent of American Indians, and 90 to 100 percent of Asian Americans are lactose intolerant. Whether or not a person develops symptoms appears to be linked to the ability of a certain type of beneficial bacteria, called lactic acid bacteria, to break down lactose. Some people may have more lactic acid bacteria in their intestines than others, so they don't develop symptoms. For those who react to very small amounts of lactose or have trouble limiting their intake of foods that contain it, the lactase enzyme is available without a prescription to help people digest foods that contain lactose. The tablets are taken with the first bite of dairy food. Lactase enzyme is also available as a liquid. Adding a few drops of the enzyme makes lactose more digestible for people with lactose intolerance. Other people find that they can tolerate some lactose in their diet by eating small amounts at a time and/or combining those products with foods that do not contain lactose during a meal.

In planning meals, people with lactose intolerance should make sure that each day’s diet includes enough calcium, even if dairy products are not included. Many non-dairy foods are high in calcium, including dark green vegetables such as broccoli, or fish with soft, edible bones, such as salmon and sardines. To help in planning a high-calcium, low-lactose diet, the table below lists some common foods that are good sources of dietary calcium and shows how much lactose they contain.

Calcium and Lactose in Common Foods
Nondairy Products Calcium Content Lactose Content
Soymilk, fortified, 1 cup 200–300 mg 0
Sardines, with edible bones, 3 oz. 270 mg 0
Salmon, canned, with edible bones, 3 oz. 205 mg 0
Broccoli, raw, 1 cup 205 mg 0
Orange, 1 medium 50 mg 0
Pinto beans, 1/2 cup 40 mg 0
Tuna, canned, 3 oz. 10 mg 0
Lettuce greens, 1/2 cup 10 mg 0
Dairy Products
Yogurt, plain, low-fat, 1 cup 415 mg 5 g
Milk, reduced fat, 1 cup 295 mg 11 g
Swiss cheese, 1 oz. 270 mg 1 g
Ice cream, 1/2 cup 85 mg 6 g
Cottage cheese, 1/2 cup 75 mg 2–3 g
Adapted from Manual of Clinical Dietetics. 6th ed. American Dietetic Association, 2000; and Soy Dairy Alternatives. Available at www.soyfoods.org.

Acidophilus is one of many types of lactic acid bacteria and is available as a dietary supplement. Some people find that while one supplement is not very effective in reducing their symptoms, another works one does a better job. So, if you run into this problem, try a different product.

If you are highly sensitive to lactose, make sure that you get enough calcium in your diet. Many people who are lactose intolerant do not experience symptoms when they eat yogurt, so this should be considered when trying to get enough calcium in your diet. Better yet, eat the kind that contains live bacteria; it releases the enzyme beta-galactosidase (related to lactase) into the intestines, where it facilitates lactose digestion. Since calcium is absorbed and used only when there is enough vitamin D in the body, consult with your doctor to see if a supplement should be added.

Regarding IBS
Not everyone with IBS has the same symptoms and not everyone will benefit equally from the same treatment strategies. Most sufferers of IBS need to work closely with their physician and/or a nutritionist to attain good control of their symptoms. But, with good management of symptoms, individuals having irritable bowel syndrome manage just fine.

Although the cause of IBS is unknown, sufferers soon learn that their symptoms seem to be triggered by particular foods that they eat. The following suggestions may help prevent or relieve some IBS symptoms:
  • Avoid caffeine and alcohol.

  • Limit your intake of fatty foods.

  • If diarrhea is your main symptom, limit dairy products, fruit, and artificial sweeteners such as sorbitol or xylitol. Over-the-counter medications such as Imodium can help control diarrhea.

  • Increasing fiber in your diet may help relieve constipation. Fiber (such Metamucil or Citrucel) should be added gradually because it may initially worsen bloating and gassiness.

  • Avoiding foods such as beans, cabbage, or uncooked cauliflower or broccoli can help relieve bloating or gas.

Additional suggestions offered by most physicians include:
  • Getting regular, vigorous exercise (such as swimming, jogging, or brisk walking) may help reduce tension and make your bowels more regular.

  • If stress triggers your symptoms, some form of psychological therapy or stress management may help you deal more positively with stress and help prevent or reduce stress-related IBS episodes. The Mayo Clinic suggests using the following stress-reducers: Counseling, biofeedback, yoga, meditation, massage, relaxation exercises, deep breathing exercises, hypnosis, or any strategy that helps take your mind off worries and that you find relaxing.

Alternative therapies that may be helpful (according to The Mayo Clinic staff) include:
  • Acupuncture. Although study results on the effects of acupuncture on symptoms of irritable bowel syndrome have been mixed, some people use acupuncture to help relax muscle spasms and improve bowel function.

  • Herbs. Peppermint is a natural antispasmodic that relaxes smooth muscles in the intestines. Study results haven't been consistently encouraging, but if you'd like to try peppermint, be sure to use enteric-coated capsules. Peppermint may aggravate heartburn. Before taking any herbs, check with your doctor to be sure they won't interact or interfere with other medications you may be taking.

  • Probiotics. It's been suggested that people with irritable bowel syndrome may not have enough “good” bacteria, and that adding probiotics to the diet may help ease symptoms. Some studies have shown that probiotics can decrease problems caused by IBS. Not all studies on probiotics have had positive results, however.

Management of symptoms depends on the symptoms and how severe they are. Prescription medications may be necessary in those cases where changes in diet and lifestyle are not enough. Few medications have proven consistently helpful and all medications have side effects, so medicine should be used only for specific symptoms that disrupt normal daily activities.

IBS and weight loss products
While many people think that IBS sufferers are probably underweight, the fact is…they are not. In an effort to avoid foods that can stimulate diarrhea or gassiness, many people give up the fruits, vegetables and fiber-filled foods that we usually associate with healthy nutrition and weight loss. Fortunately, some of these foods may be safe for the person with IBS after all. Consider keeping broccoli, zucchini, lettuce, spinach and pears as foods to eat for fiber. Depending on your specific case of IBS, you may notice that these fruits and vegetables won't bother your stomach too much. The same is true of weight loss products. Since it is neither the food nor the product that causes IBS, a person would have to try it and see how their body reacts to it. However, all of the reputable sources consulted in order to answer your questions gave the same advice: Eat fruits, vegetable, and whole grains to increase fiber content in the diet, drink plenty of water every day, and exercise regularly.
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