Searching for a milk substitute

For years, Jennifer Albert suffered with stomach pains. The 38-year-old Grand Forks woman was diagnosed with irritable bowel syndrome.

At one point, her doctor asked if she had any issues with milk products.

"I said 'no,'" she recalled. But later, "I started to pay more attention to how my stomach felt after I ate milk products."

She found that not all dairy foods bothered her.

"I typically ate cottage cheese and yogurt daily," she said. "I figured if I was lactose intolerant, I would not be able to eat those" every day.

"Ice cream was always probably the worst. I typically get bad cramps and then have diarrhea for the next few days."

Along with her doctor, she surmised that she was lactose intolerant because of her body's reaction to dairy products.

Albert is among the estimated 30 million American adults who have some degree of lactose intolerance and have uncomfortable digestive problems after consuming milk or other dairy products.

After she quit her daily intake of cottage cheese and yogurt, she said, the bloating and heaviness went away.

"It was such a routine; I didn't realize the impact of eating them."

She is able to tolerate small amounts of milk, or products that contain milk, "if I don't have it consistently," she said. "I do try to eat things that are lactose-free though."

Enzyme deficiency

People with lactose intolerance are deficient in an enzyme, called lactase, which is needed to break down lactose, a type of sugar found in milk and other dairy products.

When they consume some forms of dairy products, the sugar stays undigested and causes symptoms such as flatulence (gas), cramps, bloating, diarrhea and nausea. Symptoms begin 30 minutes to two hours after consuming the product.

Solutions include eating products in which the lactose is already broken down, taking lactase in a pill or tablet, or buying a substitute for these products.

Those who are lactose intolerant can opt instead to drink low-lactose and lactose-free milk products. In lactose-free milk, the milk sugar has been completely broken down; it's nutritionally comparable to regular cow's milk.

They may also avoid lactose by selecting a nondairy alternative such as soy, almond or rice milk. Other less-popular alternatives are oat, multigrain, coconut and hemp milk.

Soy milk, which is lactose-free but not technically milk, is made from soybeans. It's a stable emulsion of oil, water and protein produced by soaking soybeans, then grinding and straining them.

Albert has tried a few of these products.

"Soy milk bothers my stomach," she said. She's also not keen on almond milk ("too sweet") or rice milk.

She prefers Deans Food lactose-free milk.

"That one didn't bother my stomach; I liked the taste of it, and it's convenient to buy. It tastes very similar to skim milk, just a little sweeter."

Filling nutritional gaps

Cow's milk, including lactose-free cow's milk, offers strong benefits, according to Dr. Susan Raatz, research nutritionist at the USDA Grand Forks Human Nutrition Research Center.

In addition to having a lot of calcium and vitamin D -- important components of a good diet that people don't get enough of, cow's milk is a great source of protein, she said.

Not drinking milk can lead to a shortage of calcium, vitamin D, riboflavin and protein.

Cow's milk is considered a "complete protein" because it supplies the body with all the necessary amino acids needed to form proteins. It's often fortified with vitamin D to facilitate absorption of calcium. Vitamin A is usually added, too.

"It's essential that when people make decisions -- because of medical or cultural reasons -- to not drink milk, they make a conscious effort about replacing those products," said Raatz.

"You need to get the nutrients from milk even if you don't get them from cow's milk."

Even if you're lactose intolerant, you should try to get some dairy calcium, she said.

Milk is the primary source of vitamin D in the United States, she said. "The government requires that it (vitamin D) be fortified back to the level that is in the full-fat product."

People who don't consume milk or milk products should eat foods that provide a range of nutrients generally obtained from the milk group, including protein, calcium, potassium, magnesium, vitamin D and vitamin A, according to USDA dietary guidelines.

To boost your calcium intake, eat foods rich in calcium such as leafy greens, oysters, sardines, canned salmon, shrimp and broccoli, drink orange juice that contains added calcium and take calcium supplements.

"The more variety of foods in your diet the more likely you are to get the nutrients you need," Raatz said.

Most critical lack: calcium

Calcium is the greatest nutritional lack for those who don't drink cow's milk, she said.

The body needs 1,000 to 1,500 milligrams of calcium each day, depending on age and gender. An 8-ounce cup of milk provides about 30 percent of your daily calcium needs and about 50 percent of vitamin B12 and riboflavin requirements.

But getting enough calcium from other sources is not always easy.

"First of all, people don't eat enough of the leafy greens" and other foods that replace the needed calcium, she said, "and secondly, (calcium from those foods) is not absorbed as well as calcium from milk...

"No calcium is absorbed as well as milk."

Cutting dairy products from the diet "is particularly problematic in children," she said. "By age 30 to 35, you attain the maximum bone density in terms of calcium per gram of bone."

If they don't drink milk, children may not get sufficient protein. "Sometimes, they don't like meat (another source of protein) and need to get the protein elsewhere."

Soy beverages fortified with calcium and vitamins A and D are considered part of the milk and milk products group because they are similar to milk, both nutritionally and in their use in meals, federal dietary guidelines say.

"Fortified soy milk products are fine," Raatz said. They also have protein that's not replaced in other milk substitutes.

But generally, people do not make dietary choices based on nutritional value.

"We don't think about nutrient composition," she said. "We think about 'does it taste good?' The problem is people replace milk products with sugary drinks, which have no other nutrients."

It's important to check the nutritional value of alternatives to cow's milk. Some have no calcium, she said.

Those who are calcium-fortified do not have the same amount of calcium.

Also "it's not the same calcium as is found in milk, as far as absorbability," Raatz said.

"People need to be careful what they're getting."

For example, "coconut milk is high in saturated fat," she said. "Coconut water has no protein and no calcium."

Lifestyle change

For Albert, lactose intolerance hasn't been too difficult to manage.

"At first, it seemed really hard, but over time it just becomes the normal. I am lucky that I can tolerate a little bit, so it doesn't affect me too much when ordering out either."

She has elected to not depend on over-the-counter products that help in the digestion of lactose, like Lactaid, she said.

"Instead, I decided that I just needed to make a lifestyle change."

For the most part she has cut regular milk, cheese and ice cream from her diet. But because ice cream is one of her favorite snacks, every now and then she will indulge, she said.

"If I am having a craving for something, I will eat it knowing that I will suffer. Over time, you just start eliminating it, because it isn't worth it."

Knudson covers Health and Family for the Herald and can be reached at (701) 780-1107, (800) 477-6572, ext.1107 or pknudson@gfherald.com .