For those with lactose intolerance, insufficient amounts of the lactase enzyme prevent lactose from breaking down in the stomach. Thus, the undigested lactose travels to the intestines where bacteria breaks it down, causing bloating, diarrhea, flatulence, abdominal pain, distention and cramping—the most common symptoms of lactose intolerance.
After gastric bypass surgery, a new tinier stomach pouch is reconnected to part of the intestine called the jejunum, causing foods to empty out of the pouch directly into the small bowel at a much higher rate than before surgery. Due to this quick flow of food, the amount of lactase enzyme may not be able to keep up with the amount of lactose and may result in symptoms of lactose intolerance.
There are several unique issues that may affect gastric bypass patients:
- Dumping syndrome, in which foods dump from pouch to intestine rapidly, produces symptoms that are very similar to those of lactose intolerance (abdominal pain, bloating, nausea, diarrhea)
- Liquids empty out of the pouch faster than solids
- Post-op liquid/puréed diet often includes more dairy and whey protein shakes
- Avoiding dairy foods or meat because of perceived intolerance leaves few foods left to promote healing and fullness
- Calcium and vitamin D are critical in post-operative patients who are at greater risk for osteoporosis and metabolic bone disease after losing significant amounts of weight
- Post-operative barriers to taking proper vitamin and mineral supplements
Tips for post-op patients with lactose intolerance:
- Spread out lactose-containing dairy foods into small, frequent meals
- Pair up lactose-rich dairy products with fiber-rich produce
- Choose low-fat, cultured yogurt with live active cultures
- Try thick, low-lactose, strained Greek or Icelandic-style yogurts
- Bulk up by using high-fiber cereal and fruit
- Feast on probiotic-rich, fermented Kefir
- Pick low-fat, hard, aged cheeses like Swiss, Parmesan and Cheddar
- Look for lactase enzymes capsules and lactose-free dairy products
Spacing out dairy foods throughout the day with a few tweaks allows post-operative patients to include low-fat dairy rich in protein, calcium, vitamin D and probiotics to stay fuller longer and optimize weight loss.
Nina Crowley, PhD, RD, LD is a Registered and Licensed Dietitian who lives and works in Charleston, SC. Dr. Crowley is the current Public Policy Coordinator of the South Carolina Academy of Nutrition and Dietetics, and works for Sodexo as a Bariatric Dietitian for the Medical University of South Carolina’s Weight Loss Surgery Program.