Lactose intolerance after sleeve gastrectomy

Lactose intolerance is a common complaint after sleeve gastrectomy. Sadly, there isn’t much data on how common it really is, it is reported regularly by patients of mine and something I thought I should address as there are ways to get around it (even if you love dairy!)

Lactose is the sugar found naturally in milk and is usually broken down by the enzyme lactase in the gut. Due to the changes in the levels of enzymes and stomach acid, as well as the increased speed of food through the stomach into the small intestine lactose intolerance is a common complaint after sleeve gastrectomy.

The most common symptoms of lactose intolerance are cramps, bloating, diarrhoea, nausea or gas. These symptoms usually appear about 30 minutes to two hours after your meal.

What has lactose?

Foods that contain lactose:

• Milk
• Yoghurt
• Cream
• Ice Cream
• Cheese
• Many sauces, soups, salad dressings, and prepared foods (check the labels for “lactose”)
• Lactose is also used in some prescription drugs and medicines

Although all of the above foods contain lactose, some people may only struggle with certain foods (commonly milk or ice cream) and are able to tolerate small amounts of other foods (such as cheese or yoghurt).

What can you do?

Don’t worry! You have a few options:

1. Take Lacteze tablets or drops with your meal. Lacteze is the enzyme Lactase that your stomach is missing, so it breaks down the lactose for you, making it easier on your gut.
   

   Lacteeze tabletes.

2. Choose low lactose alternatives (see below) such as:
   • Lactose-free dairy products (e.g. Zymil or Liddell’s milk, yoghurt, cheese and cream)
   • Calcium fortified soy products (check the label for at least 300mg calcium per serve).
3. Eat dairy in smaller quantities. Everyone with lactose intolerance has a different threshold. You’ll need to test what works for you. You may be able to eat yoghurt and cheese but not milk, or a small amount of milk (in tea) but not a milky coffee.
4. Make sure you are taking your calcium and vitamin D supplements every day (read this post for more info on what and how to take them).