Page 32 - Today's Dietitian (February 2020)

of fluid in the large intestine to dilute the undigested lactose Lactose-Free Fluid Milks
and resultant simple sugars. Lactose-free milk traditionally has been created by treating
Lactase production in the intestine typically is strong in conventional or organic fluid milk with the lactase enzyme.
infancy and begins to decline in early childhood, although Lactaid is among the best known of the lactase-treated milks,
some infants have a defect in the LCT gene that prevents them and the company also produces lactase enzyme tablets to be
from tolerating nonbreastmilk sources of lactose. (Breastmilk taken at the same time as dairy consumption. The introduc-
contains both lactose and the enzyme lactase.) A majority of tion of ultrafiltration as a processing option has opened the
adults around the world are lactose intolerant. door for a wider variety of lactose-free milks. The brands fair-
Across the spectrum of lactose intolerance are people who life, based in Chicago, and Organic Valley, based in La Farge,
can’t digest even small amounts and people who can handle Wisconsin, both use ultrafiltration to remove some of the
a modest dose, according to Kate Scarlata, RDN, LDN, a lactose from fluid milk. The ultrafiltration process also con-
Massachusetts-based digestive health expert and coauthor centrates the protein in fluid milk by removing liquid whey.
of The Low-FODMAP Diet Step by Step. “Monash University in Ultrafiltered milk then is treated with lactase enzyme to con-
Melbourne, Australia, sets a threshold of 0.5 g of lactose per vert the remaining lactose into simple sugars. Both brands
eating occasion for people who cannot tolerate lactose, but promote their lactose-free milk as having 50% more protein
I’ve observed that many of my clients can handle up to 6 g of and 50% less sugar than regular milk. Organic Valley also
lactose, the amount in half a cup of fluid milk, per sitting.” offers a lactose-free, high-protein milkshake.
Body size and genetic differences also influence degree Slate, based in Boston, recently introduced its first prod-
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and symptoms of intolerance. People with a larger body uct line, lactose-free chocolate milk in a shelf-stable can. This
mass and those from dairy-consuming cultures tend to be product is positioned for adults on the go rather than for chil-
able to handle larger amounts of lactose at a time. Globally, dren. Slate’s products are ultrafiltered, followed by treatment
about two-thirds of adults lose some or all of their ability to with lactase. Like other lactose-free chocolate milk produc-
tolerate lactose after infancy because of decreased expression ers, Slate sweetens its products with a combination of cane
of the LCT gene and the regulatory MCM6 gene over time. sugar and a nonnutritive sweetener but adds less sugar than
Lactose intolerance is most common among populations of many other brands. Slate uses monk fruit, popular for its natu-
indigenous North American, East Asian, West African, Arab, ral origins; combinations of nonnutritive sweeteners also are
Jewish, Greek, and Italian descent, and least prevalent in common in chocolate milk products.
populations from Northern Europe and other regions whose Self-described dairy disruptor JoeFroyo, based in Upland,
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diet regularly includes unfermented dairy products. People California, developed a proprietary process for creating a
who are intolerant of lactose are more likely to develop lactose-free cultured dairy base using high-pressure processing,
symptoms after consuming conventional fluid milk, yogurt, a cold-pasteurization technology best known for producing
sour cream, and dairy desserts, as well as whey protein, and bottled fresh juices. The company’s Cold-Pressed Creamery line
least likely to react to hard cheese and other dairy products of cold-pressed dairy products includes milk, probiotic cold
containing only small amounts of lactose. brew-cold pressed milk beverages, and a “clean label” creamer.

Lactose on Labels Yogurt and Kefir
Lactose content is represented by the amount of carbohydrate Some people who can’t tolerate lactose-containing liquid milk
and total sugars on the Nutrition Facts panel of an unsweet- can consume conventional yogurt without developing symp-
ened or dairy product or one sweetened with nonnutritive toms because the live and active cultures in yogurt help break
sweeteners. In milk and dairy products that don’t contain sugar down lactose. In addition, it’s thought that because yogurt
or other nutritive sweeteners, the amount of total sugars listed travels more slowly than milk through the gastrointestinal
on the label represents lactose content. For example, one cup tract and since lactic acid bacteria in yogurt survive the stom-
of plain fluid milk contains 12 g carbohydrate, all from lactose; ach’s acidic environment, lactic acid bacteria have adequate
a lactose-free milk produced traditionally by adding lactase time to help digest lactose before and while it passes through
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contains the same amount of total sugars as in the milk before the small intestine.
treatment with lactase. The now lactose-free milk will taste Lactose-free yogurts typically are made from a base of
sweeter than nontreated milk because the lactose has been con- lactose-free milk. The bacterial cultures used to ferment lactose-
verted to the simple sugars glucose and galactose. Lactose-free free yogurt don’t require lactose to grow and flourish. They
milk doesn’t contain added sugars; any added sugars listed on can feed on all of the macronutrients in milk, as well as on the
the Nutrition Facts panel can be attributed to nutritive sweet- simple sugars generated from lactose or added for sweetening.
eners such as cane sugar, honey, and others. Some lactose-free yogurts differentiate themselves by
Government guidance for a lactose-free claim on fluid milk starting with a base of strained or ultrafiltered milk, with
doesn’t exist in the United States. Globally, lactose-free prod- its concentrated amounts of protein and lower amounts
ucts generally reduce lactose down to 0.5% or 0.1%, although of lactose. Yogurt cultures and lactase then are intro-
some countries require a reduction down to <0.01%. duced to remove the remaining lactose. Certain brands add
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32 TODAY’S DIETITIAN • FEBRUARY 2020