I'm Lactose Intolerant, But I Ate Dairy in Italy
I stopped consuming dairy 12 years ago after I suffered a terrible ear infection that lasted three months. I had constant mucous in my sinuses and blocked ears, and after exhaustive tests, it was finally revealed that I was lactose intolerant. I didn’t find it hard to give up dairy, except I missed blue cheese like Roquefort and Gorgonzola. They were my weakness, and I knew they would be deeply missed (more on that later).
Let’s talk about lactose intolerance.
Lactose intolerance is a common digestive disorder that affects a significant portion of the global population.
1. What is Lactose Intolerance?
Lactose intolerance is the inability to digest lactose, a sugar found in milk and dairy products, due to a deficiency of the enzyme lactase. Lactase breaks down lactose into simpler sugars, glucose, and galactose, which the body can easily absorb.
2. Causes and Types of Lactose Intolerance
There are three main types of lactose intolerance:
Primary Lactose Intolerance: This is the most common type and occurs when lactase production decreases naturally with age. I’ve read that this can start to drop as early as the age of 5, and by mid-adulthood, most of us have significantly reduced lactase levels. Is this our body telling us we no longer require milk? Mother cows stop producing milk and wean their calves off. For some reason, we keep going….but not with human milk.
Secondary Lactose Intolerance: It can be caused by certain medical conditions, such as celiac disease, Crohn's disease, or intestinal infections, which damage the intestinal lining and reduce lactase production. Many clients in my clinic with IBS and compromised intestinal health cannot tolerate dairy.
Congenital Lactose Intolerance: This rare genetic disorder is present from birth and prevents lactase production.
3. Symptoms of Lactose Intolerance
The symptoms of lactose intolerance typically appear within a few hours after consuming lactose-containing foods and may vary from person to person. Common symptoms include bloating, flatulence, diarrhea, abdominal pain, and nausea. It's important to note that lactose intolerance differs from a milk allergy, which involves an immune response to milk proteins.
My symptoms included mucous build-up in my sinuses almost immediately following dairy consumption. I also suffered severe abdominal pain. I am sure I have no lactase in my digestive system today, as I can even pick up when milk solids are used to clarify white wine. One sip will cause my sinuses to inflame with mucous.
4. Diagnosis and Testing
If lactose intolerance is suspected, several tests can be conducted to confirm the diagnosis. These include a lactose intolerance test, hydrogen breath test, and comprehensive stool test. It is recommended to consult a healthcare professional or clinical nutritionist to determine the most suitable testing method.
5. Managing Lactose Intolerance Through Diet
While lactose intolerance cannot be cured, dietary modifications can effectively manage it. Here are some strategies:
Gradual Introduction: Some individuals can tolerate small amounts of lactose without symptoms. Gradually introducing dairy products into the diet can help determine personal tolerance levels.
Lactose-Free and Low-Lactose Alternatives: Numerous lactose-free or low-lactose alternatives are available, such as lactose-free milk, cheese, yogurt, and ice cream. These products are treated with the enzyme lactase to break down lactose.
Dairy Substitutes: Non-dairy milk alternatives like almond, soy, coconut, oat or rice can be used as substitutes for cow's milk.
Aged Cheeses and Fermented Dairy: Aged cheeses like Parmesan, Cheddar, and Swiss have lower lactose content due to fermentation. Similarly, fermented dairy products like yogurt and kefir contain beneficial bacteria that help digest lactose.
Why Could I Eat Lactose in Italy?
On my recent trip to Italy, I focused on eating anti-inflammatory food under the banner of the Mediterranean Diet, which is very easy in Italy. We spent a large proportion of our trip in Sicily and Rome, and there was an abundance of seafood, seasonal produce like artichokes, citrus I’d never seen before, and greens cooked in simple yet nourishing ways.
But, towards the end of our trip, we found ourselves at a Roman restaurant that served homemade gnocchi every Thursday. People travelled from all over Rome to taste their gnocchi. I hadn’t had these delicate pillows of yellow-fleshed potatoes for a long time, and when I found out the menu item was ‘gnocchi gorgonzola’, I lost my breath. I hadn’t deliberately had dairy for over ten years and missed blue cheese so much. Here I was in Rome, confronted with a choice – do I give in to the seduction and risk tummy aches, mucous in my sinuses and extended visits to the bathroom, or do I choose something else on the menu?
But, when in Rome….
Something came over me, and I looked at my husband and said, ‘I’m ordering the gnocchi gorgonzola’. He nearly fainted and asked whether I was 100% sure. I said ‘Yes, I am sure,’ and the rest is history (he took this photo of me eating it as he knew it would never happen again)
Surprisingly, I ate the WHOLE PLATE and did not experience ONE SYMPTOM!
As a lactose-intolerant individual, I was thrilled to discover that I could enjoy gorgonzola without experiencing the usual discomfort. Still, I needed to know why so when I returned to Australia last month, I started researching. It turns out that the reason behind this lies in the tradition of Italy's cheese makers.
I learned that gorgonzola and other aged cheeses like Parmigiano-Reggiano and Pecorino Romano undergo a fermentation process, affecting their lactose content. During fermentation, bacteria or enzymes are introduced to the milk, breaking the lactose into simpler sugars, such as glucose and galactose. This transformation significantly reduces the amount of lactose present in these cheeses.
I found it fascinating that as the cheese matures, its bacteria feast on the lactose. This gradual breakdown of lactose is why older cheeses, like gorgonzola, have even lower lactose content than their younger counterparts. So, the more aged the cheese, the more suitable it becomes for someone with lactose intolerance.
Of course, I learned that not all dairy products in Italy are suitable for individuals like me. Fresh dairy products like milk and certain soft cheeses still contain significant amounts of lactose, which can lead to discomfort and digestive issues. It's crucial to exercise caution and be mindful of the specific types of dairy products you consume. But when indulging in Italy, I can confidently say the fermentation and aging process has transformed gorgonzola into a cheese I can digest.
Will I continue eating gorgonzola? Unlikely. I was in Rome, and it was a ‘special occasion’. I know too well that the saturated fat content in cheeses like gorgonzola is enormous, making it a ‘sometimes food’ for me.
