Introduction

For over fifteen years, I was lactose intolerant. I can’t pin-point exactly when it began, because the symptoms were tied up with stress-induced IBS, heavy drinking and, I suspect, undiagnosed coeliac disease.

I’ve always had a squiffy belly. This was different. Far worse. After eating certain foods, I would get stomach cramps, followed by an almighty rumble and would have to rush for the nearest toilet.

At first, I couldn’t figure it out, because it didn’t only happen when I had foods that obviously contained dairy. It happened when I ate quiche and soup and drank hot chocolate (which all contain milk). I feared I had worms! My GP suggested eliminating certain foods, and removing dairy helped.

Since then, until the past six months, I had been eating only lactose free dairy products. The same cheddar cheese. Boring yoghurt. It sucked.

Since I stopped eating gluten, a year and a half ago, along with fully ceasing to drink alcohol, my bowels have been behaving much better. I’ve gradually reintroduced normal dairy and am now able to eat and drink as much as I like.

This got me asking questions. How did I become lactose intolerant in the first place? How did I overcome it? What follows is an account of my research.

Lactose Intolerance

Lactose intolerance is a digestive condition where the body cannot digest lactose. Lactose is a natural sugar, or disaccharide, that occurs in the milk of humans and animals. Normally, lactose is broken down by an enzyme in the small intestine called lactase.

The small intestine is lined by tiny finger-like projections called villi 0.5 – 1.5mm long. These increase the surface area to aid the digestion of food, water and nutrients. On the outermost edges of the villi are microvilli, even tinier projections, which form the ‘brush border’ and make the small intestine soft and velvety.

Lactase, a large transmembrane protein, is produced by cells called enterocytes and anchors to the microvilli.

Lactase breaks down lactose into two monosaccharides – glucose and galactose. They are then absorbed into the bloodstream. Glucose provides energy. Galactose also provides energy and contributes to the building and signalling of cells.

Lactose intolerance occurs when the small intestine fails to produce lactase. This can occur for a number of reasons. Primary lactose intolerance is age-related and occurs when lactase production falls after weaning. It is actually the norm for people to be lactose non-persistent and this is common worldwide. Lactose persistence occurs because of a genetic mutation that took place in Northern European cattle-herders in response to drinking cow milk. Being able to drink milk after weaning is an anomaly and not the norm.

Lactose intolerance, in lactose persistent people, can also be congenital (genetic) or developmental (due to premature birth). Secondary lactose intolerance, which is what I suffered from, can be caused by gastroenteritis, coeliac disease, IBD, and prolonged courses of antibiotics.

When no lactase, or not enough lactase is produced, the lactose is not absorbed. Thus, it goes into the large intestine. It draws water into both intestines, causing the almighty rumbling and ‘osmotic’ diarrhoea. Bacteria in the large intestine ferment the sugar, producing short chain fatty acids, hydrogen gas, carbon dioxide and methane, which cause abdominal cramps, bloating and flatulence (if you have more archaea you make more methane). The science explains the unpleasant symptoms that I was experiencing!

What Caused My Lactose Intolerance?

Looking through the causes, I quickly eliminated most of the medical ones. I had not taken a long course of antibiotics. I suspected heavy drinking might have a role, as it can irritate the lining of the small intestine and lower lactase levels temporarily, as well as causing small intestinal bacterial overgrowth. However, these symptoms usually disappear within 8 – 10 days of stopping drinking. I quit alcohol for much longer, several 9 month periods, between 2020 and 2024, and my lactose intolerance symptoms continued. I thus believe that alcohol exacerbated my condition, but was not the primary cause.

As I read up on the other medical conditions, I was very surprised to see that my symptoms mapped with coeliac disease and that this would fit perfectly because they subsided after I decreased gluten and stopped when I eliminated it. I had never expected coeliac disease because, in extreme, it is associated with severe wasting. However, it can also be ‘silent’ and ‘latent’.

Coeliac disease is a chronic autoimmune condition that triggers an immune response to gluten that damages the villi and disrupts nutrient absorption.

Gluten is a cereal storage protein that is found in wheat, barley and rye. In wheat, gluten is formed from a prolamin fraction called gliadin and glutenin (a glutelin). In barley the prolamin is called hordein and, in rye, secalin. Prolamins are high in glutamine and proline and these trigger the immune response. The prolamin in oats is called avenin and contains less glutamine and proline and more alanine and leucine and does not trigger a reaction.

Coeliac disease is brought about by an enzyme called type 2 transglutaminase (TG2) in persons with a specific genetic predisposition. When the gliadin in gluten reaches the small intestine, TG2 converts neutral glutamine amino acids into negatively charged glutamic acid via a process called deamidation. In persons with the HLA-DQ 2 or HLA-DQ 8 gene, the newly deamidated gluten peptides fit more strongly into the binding grooves of the antigen-presenting receptors. This high-affinity binding activates gluten-specific T-cells, launching an immune response that mistakenly generates anti-TG2 antibodies (IgA and IgG) (which are a diagnostic marker on blood tests). It also causes the release of inflammatory cytokines and the cloning of B cells.

This immune cascade leads to inflammation of the villi and can cause them to atrophy, flatten, and perish. Therefore, nutrient absorption can be severely impaired.

Gastrointestinal symptoms include bloating, abdominal pain, gas, diarrhoea and constipation. As the disease progresses, nutritional deficiency is evidenced by fatigue, weakness, anaemia, weight loss and loss of bone-density.

However, the disease can also be ‘silent’ – where there are raised antibodies and damage to the small intestine but no symptoms, and ‘latent’ – where there are raised antibodies but no damage to the small intestine and no symptoms.

I experienced the gastrointestinal symptoms along with sluggishness and brain fog. Other less common symptoms I had were missed periods and raised liver transamine levels (I had slightly raised ALT levels).

I suspect I inherited the HLA-DQ 2 or HLA-DQ 8 gene from my dad, who has far worse symptoms, but refuses either to give up eating gluten or to see a GP.

How I Overcame Lactose Intolerance

I would love to say that I overcame lactose intolerance by a miracle of shamanic healing. However, it was more a case of luck, trial and error, and learning to listen to the advice of others and to my body rather than continuing to eat and drink things that were clearly bad for it.

As noted, I saw some improvements after giving up alcohol, which not only irritates the gut but often contains gluten. I was drinking a lot of beer, which is commonly made from wheat, barley (this is where malt comes from) or rye.

The big change began when I started cutting down on bread. It was my favourite food. It was safe and comforting. It was easy to count the calories (110 calories per slice). It was very easy to make meals with. Up until 2021, I was eating toast for breakfast and my post-exercise snack, a sandwich for lunch, then having a slice of bread as the carbs for my tea.

At the time, I was struggling with a restrictive eating disorder that had originated as a way of managing binge eating earlier in my life. I wasn’t exactly starving myself, but neither was I eating enough to fuel an active life-style that has generally involved some form of exercise plus physical work.

When I started with a personal trainer at the gym, she told me that eating bread for every meal wasn’t particularly good for me due to the lack of variety and the high levels of starchy carbohydrates that quickly convert into sugars and can cause blood sugar spikes. Indeed, I was getting ups and downs and mood swings combined with cravings for more bread and beer.

I began swapping toast for porridge in the morning and trying pasta, rice or potato with my tea. I began to notice that when I didn’t eat gluten I was less bloated, my mind was less foggy, my cravings subsided, and my mood improved.

In 2024, I decided to ditch gluten altogether. I replaced bread with porridge oats for breakfast, nuts for my snack, oat cakes for lunch, and beans for my tea. My gastrointestinal symptoms got better and so did my energy levels.

Around six months ago, I got the inner impulse to begin experimenting with normal dairy. I started out with trying 50g of cheese containing 0.1g of lactose. I was fine. I then introduced 150g of kefir at 4g of lactose then 250g at 8g of lactose. Again, I was ok. Kefir contains lactic acid bacteria, lactobacilli and bifidobacteria, that can aid in breaking down lactose if it does make its way into the gut. These are transient and stay for 2 – 7 days and may have a helping function. A couple of weeks ago, I tried 250 ml of milk, containing 12g of lactose and had no problems. The final test was a pint of milk, 565ml, with 26g of lactose. It went down better than lactose free.

This has induced a sense of wonder in the ability of my villi to heal, returning to their healthy structure, without any medical or shamanic intervention from me.

Liberation

I’ve been having a pint of whole milk with 75g of porridge oats and an apple for over a week now and feel liberated. Lactose free products are more expensive, more processed, and don’t taste as good. I was also worried about being able to get hold of them in the future as food supply breaks down.

This has come about alongside my liberation from the restrictive eating disorder following a course of CBT-E therapy. I’d never have dared drink whole milk and would have been reluctant to return to milk containing milk sugar, thus more carbs and calories, if I hadn’t gone through the treatment. Whole milk is far better for you because the fat helps absorb the nutrients.

I’m no longer ashamed to confess to my appetite and humungous breakfast, which nurtures my body and provides it with the fuel it needs. Cheers!