Is Lactose Intolerance Causing Your Gut Issues? - Transcript

Dr. Elizabeth Boham: What's really important to remind people that there's so many other ways to get their calcium. Dr. Mark Hyman: Welcome to Doctor's Farmacy. I'm Dr. Mark Hyman, and that's Farmacy with an F, 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 [inaudible 00:00:33] 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. Dr. Mark Hyman: Anyway, I am so excited to have you, Liz, again on another episode of House Call on the Doctor's Farmacy 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? Dr. Elizabeth Boham: Lactose intolerance is so common. It's at least 65% of the world population, and it increases as we get older. 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 throughout the whole world, we see lactose intolerance. And as people get older, we see more and more lactose intolerance. In fact, some people think that once we reach age 99, everybody has some degree of lactose intolerance. Dr. Elizabeth Boham: 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 and inflammation in the intestines... Sometimes 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 as we get older. Dr. Elizabeth Boham: 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 might have a little bit of dairy and be fine, but at some amount of dairy, then they start to have a problem. So 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. Dr. Mark Hyman: 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 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? Dr. Elizabeth Boham: Absolutely. So 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 might 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, at a younger age and then they developed. And so they're confused as to why they have started to have problems now. Dr. Elizabeth Boham: But as I mentioned, you can develop 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 want to just figure out what is somebody dealing with for the abdominal pain and the bloating and gas. And then you want to 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 foods, so the dairy. And the symptoms usually resolve five to seven days after you've removed the dairy from the diet. Dr. Elizabeth Boham: And what's happening is if 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. Dr. Elizabeth Boham: So it is a very hard food to digest and absorb. We see it all the time. And so 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 to you and I it's like, "Okay, 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 got to give it a try." Dr. Mark Hyman: One of the things is often people wonder about is, well, what about lactase free milk? Or what about yogurt? Or what about cow or sheep? Or what about A1 versus A2 Casein? How do we figure all that out? And how do we determine what people should be doing if they want 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, how does that work? And can you explain a little bit about that? Dr. Elizabeth Boham: 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 of plain, whole fat yogurt without problem, but they couldn't drink a glass of milk, for example because that fermenting process breaks it down. Dr. Elizabeth Boham: For other people, they can't tolerate anything. 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. Dr. Mark Hyman: Hey, everybody. It's Dr. Hyman. Thanks for tuning into the Doctor's Farmacy. 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 do is go to to sign up. That's, 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. Now, back to this week's episode. Dr. Mark Hyman: What about people taking enzymes like lactase? Is that a good idea? Should people just avoid dairy? Are there issues that happen? What are the consequences of sort of consuming dairy if you are lactose intolerant? Dr. Elizabeth Boham: That's a great question. So the enzymes, like the lactase enzyme, the enzyme in lactate, 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 to 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. Dr. Mark Hyman: Yeah. I sometimes cheat and eat ice cream, and then, of course, I pay for it later. Dr. Elizabeth Boham: Yeah. Right. Yeah. Yeah. So, I think that these enzymes may be helpful for some people, but I think the reason that we're so focused on dairy is 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. It's great source of calcium. Broccoli and your greens are 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. Dr. Mark Hyman: 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's the 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. Bottom line is that all the propaganda about milk, needing for your bones, it actually increases fractures. 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. Dr. Mark Hyman: 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 to underscore the fact that when we're talking about dairy, we're talking about sort of modern cow dairy. Sometimes heirloom cows have different, or grass-finished cows have different properties and better tolerance. Sometimes sheep and goat is better tolerated. So it really depends on sort of you in a personal decision, but it's not nature's perfect food unless you're a calf. And it's also problematic in many, many ways. Dr. Elizabeth Boham: Absolutely. As we see here with some of these cases, like this first one here was a 25 year old gentlemen who came to see me, and he was relatively, he was really healthy, actually. And he was doing well until about a year ago, and he had 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. So he wanted to figure it out. Dr. Elizabeth Boham: So based on his timeline of symptoms that we gathered from him, we said, even without any testing, we said, "Let's just do a trial off of dairy and see what happens." And within a week, his symptoms got all better and he thought, I just did a wonderful job. Dr. Mark Hyman: You're like a genius. Dr. Elizabeth Boham: I know, right. I fixed his diarrhea and gas and bloating, and he just avoids really most dairy because he feels better at this point in his life. So it sometimes can make a huge difference and something that we really encourage a lot of people to give a trial for. Dr. Mark Hyman: Yeah. I think we've all been sort of brainwashed that we can't live without milk and dairy and that 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. Dr. Mark Hyman: 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, all kinds of skin issues, eczema, and so forth. And we did a Pegan diet challenge with Katie Kirk, and she has eczema and arthritis, and she got off all that junk, and it got better. Dr. Elizabeth Boham: Oh, good for her. Good for her. 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. Dr. Elizabeth Boham: 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. Dr. Elizabeth Boham: And what we know is that even though those antibiotics may clear up the acne 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. Dr. Elizabeth Boham: 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. Her digestion got about 50% better. Her skin got 60 to 70% better, but she was not a hundred percent 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 I think a lot of times, those long-term antibiotics like that can result in this overgrowth of bacteria that then just snowballs into more and more problems. Dr. Elizabeth Boham: And so we needed to treat that with an herbal approach. And it was at that point when we kept her off at a dairy, treated her bacterial overgrowth, that she started to get much better in terms of her digestion. Her skin improved. Her digestion improved, and her pain in her belly improved significantly, as well. And 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. Dr. Mark Hyman: Well, I mean, it basically the message you're saying is when in doubt, cut it out. Right? Dr. Elizabeth Boham: Yep. Dr. Mark Hyman: And I think everybody should think about just a trial of no dairy because of the challenges we often see. And I think this is such a common problem, and people suffer. 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 wanted to highlight in our podcast. I'm super happy that you brought it up and that we got to talk about it. Some of the cases. I think 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, rate your podcast, share with your friends and family. Dr. Mark Hyman: And also we've got a new service called Dr. Hyman Plus, which is a subscription service where you get all sorts of free content and access to me and Dr. Boham and others in our team for deep dives and functional medicine. Ask me anything 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. Hyman Plus, and thanks for listening to the Doctor's Farmacy. And we'll see you next week for another episode of Doctors Farmacy, and House Call. Dr. Mark Hyman: Hey, it's Dr. Hyman. If you enjoyed this video, you're going to want to check out this next video coming up. Speaker 3: You need a gram, a thousand milligrams or more calcium a day to meet requirements. It's almost certainly flat out wrong. These balanced studies were based on very short term studies in 21 days.