Welcome back to my life, yogurt.

From what I can tell, many people in the nutrition field regard people who claim to be lactose intolerant with a dose of skepticism.  Apparently, some data somewhere shows that many people who think they are actually aren’t, and this data has somehow made its way into nutrition textbooks, causing the aforementioned skepticism.

Now, it is true that it’s very rare for someone to be completely and totally lactose intolerant–as in, they produce zero lactase enzyme and cannot digest even a molecule of lactose.  But that doesn’t change the fact that dairy products in varying forms and varying doses cause a lot of people a lot of grief.  The party line is that people who have some sort of lactase deficiency may not be able to drink a glass of milk, but they can often tolerate yogurt and cheese, since the culturing process helps break down some of the lactose.  My experience has been that this may be true for some people, but certainly not for  everyone.  The only way to know, unfortunately, is through trial and error.  Which means that for some lactose intolerant people, even yogurt may be off limits. Now don’t get me wrong, there are plenty of other ways to get calcium in your diet if you can’t eat dairy, but few of them are quite as convenient, ubiquitous, portable and tasty as yogurt. I’ll confess: when I watch you eat yogurt, I get major yogurt envy.

First, let’s face our tormentor for a moment:

Lactose is the natural form of sugar found in milk, and is composed of two simple sugars (monosaccharides) called glucose and galactose that are bonded together.  Since our guts prefer to digest their sugars in monosaccharide form, we have cells on the tips of the fingerlike projections (called villi) in our intestines that secrete digestive enzymes to break down disaccharides into monosaccharides so that they can be absorbed.  The enzyme responsible for breaking down lactose is called lactase.  Lactase production is essential for human survival, since infants rely exclusively on (human) milk to survive for their first several months of life.  It is incredibly rare–and often fatal–for a baby to be born with lactose intolerance.  But as luck (or evolution) would have it, most people on earth are genetically programmed to produce less lactase as we get older, presumably since milk wasn’t supposed to be our sole source of nutrition anymore.   How much less lactase you produce will determine to what extent you can tolerate foods that contain lactose.  Are you with me?

(As an aside, because the lactase-producing cells are located on the tips of the intestinal villi, anything that damages the villi can result in a temporary form of lactose intolerance until they have the chance to regenerate.  This commonly happens if you have a nasty bout of diarrhea that lasts more than a couple of days– or perhaps if you’ve had undiagnosed celiac disease for awhile that caused inflammation and damage to your intestinal lining.  Now, say, if your child has mild diarrhea for a day or two, there’s absolutely no need to withhold milk.  But if there’s some severe diarrhea going on or a chronic condition, it’s probably a good idea to lay off the cow juice until their guts have a chance to heal a bit.)

Why your intestines freak out when you have lactose intolerance (scientifically speaking)

Now, what happens if you can’t break down lactose in your intestine?  Well, depending on how much you ate, it will increase the sugar concentration in your gut by a little or a lot.  And if you’ll remember back to that lesson on osmosis from your 8th grade biology class, this draws water into your intestines from the little blood vessels that surround them in an attempt to dilute the sugary contents.  Anytime lots of of water rushes into your pipes, diarrhea is not far behind.  Additionally, the undigested lactose keeps moving along into your colon, where it meets the friendly bacteria who live there.  And these bacteria are most delighted to feast on the sugary bounty you’ve fed them.  As they digest the lactose that you couldn’t, they put off gasses as a byproduct.  This is what accounts for the flatulence.  Fun!

Finally!  Some lactose-free yogurt options.

Back to the yogurt dilemma.  I’ve been waiting for years for the Lactaid brand to come out with a lactose-free yogurt.  But I guess they were too busy counting their money from sales of their lactose-free milks, ice creams and cottage cheeses to bother.  Or maybe they read the same textbook I did and believed that all lactose intolerant people could eat yogurt just fine.  (Not all of us can.)  Or maybe they saw how much soy yogurt is sold at supermarkets and thought that lactose-intolerant people had a perfectly acceptable yogurt substitute so they didn’t need to bother making us another one. (Um… have they *tasted* soy yogurt?  It tastes chemically and weird to me.  Plus, it’s not as if soy is a digestive walk in the park.  If I’m going to be gassy anyway, I’d rather just eat real yogurt. Sheesh.)

As the yogurt aisle grew longer, and options proliferated, I became even more despondent that, with all of these choices, there still wasn’t one suitable for the intestinally-challenged.  And then, as I looked across the crowded aisle, my eyes locked with two new yogurts that looked like they were made just for people like me.

The first one was a no-brainer product that I was hoping Lactaid would have come up with eons ago: an organic, cow’s milk yogurt made with low-fat lactose-free milk.  It’s a brand called “True,” it comes from Vermont, and it tastes way better than any conventional yogurt I remember having.  I love that it has a very short ingredient list and no artificial flavors, sweeteners or preservatives.  The vanilla flavor tastes like actual vanilla bean, not that fakey chemically vanilla flavor.  And its sweetened just enough to taste good, but it’s not loaded full of sugar.  It is dee-licious. Unfortunately, I had to pay a premium for this yogurt that met every single criterion on my checklist: it cost $1.79 for a 5 oz container at Whole Foods.  But maybe prices will come down once you all start buying it, too.

*** 2010 update:  since originally posting this, the True Yogurt company had ceased production due to loss of their facilities.  Fortunately, in summer 2010, a new 100% lactose-free yogurt brand called Green Valley Organics hit the market to replace it.   For other ideas on super-low lactose yogurt options made from cow’s milk (but not 100% lactose-free), check out my post on MORE Yogurt Options for the Lactose-Challenged.

The second product I discovered is called  So Delicious, and it’s made from coconut milk instead of cow’s milk, so it’s naturally lactose-free. Because it contains no dairy at all, it’s appropriate for vegans and people who are actually allergic to cow’s milk protein (caesin).  I think it’s a pretty decent product:  one 6oz container has 150 calories, which is the same amount as a Dannon All-Natural vanilla yogurt, but more than one of those light/recuced calorie yogurts; it has too much sugar added for sure, but no more than most other yogurts out there, and actually less than the Dannon we just referenced; and it’s fortified with 25% of your calcium for the day in a form that is very well absorbed. As a bonus, they throw in some vitamin B12, which is a difficult vitamin to get from the diet if you’re a vegetarian.  As far as taste goes, you definitely get the subtle coconut flavor in the background, which I quite like.  It certainly beats the not-so-subtle soybean flavor of soy yogurts in my book.  (This company also makes soy yogurt, though, so don’t confuse the two.)  I liked it, and think it’s a very respectable yogurt substitute for the dairy and soy-challenged.

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