Why lactose intolerant people DGAF about avoiding cheese

Mashable bites into a creamy, nutty, gooey, and sometimes stinky world during our first-ever Cheese Week.

I adore cheese, despite knowing the havoc it wreaks on my body.

Like 65 percent of the human population, I've been cursed with lactose intolerance. And like an undetermined, but probably equally high percentage of the human population, I've also been cursed with an inability to turn down dairy products. While the concept of drinking a glass of straight milk still horrifies me, cheese is something I can't seem to cut out of my life.

If I'm free for the four to six hours after a meal, I'll gladly indulge in cheesy dishes I have no business consuming: tangy lemon ricotta pancakes, pizza topped with basil and fresh mozzarella, decadent mac and cheese baked with a breadcrumb and cheese crust. But my greatest vice is eating cheese on its own. Even though I know it'll kick off a sequence of events that inevitably end in Pompeii-levels of destruction, I'll gladly hit up the cheese section at my local grocery store and stock up on blocks of creamy, salty heaven.

The blatant disregard that lactose intolerant people like myself have for their own dietary restrictions is so common, it's basically a personality trait. Being lactose intolerant and not caring isn't just a form of bonding, it's a meme. There's a primal sense of glee that comes with doing something self-destructive, but low-stakes, and finding others who do the same.

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When I conducted a very informal survey about the matter on Twitter, others agreed with me.

"Honestly I do dairy alternatives for straight milk (on coffee, cereal, etc.) but cheese?" fellow lactose intolerant Palmer Haasch responded. "Ice cream? Anything else? My desire outweighs my knowledge of the pain and I always underestimate the discomfort to justify it."

Short-term rewards for long-term discomfort

Symptoms vary from person to person, but everyone whose body lacks the ability to digest lactose shares a common trait: discomfort. The luckier few may experience some bloating and lighter stomach cramps, while those with more severe intolerances may experience sharp abdominal pain, excruciating gas, dizzying nausea, and horrific bouts of diarrhea. I'm tragically in the latter group, and yet I still lack the self-control to pass up on a slice of cheesecake. I often find myself questioning whether it was even worth it, but in the moments after consuming a dairy product I'll shrug it off because it tastes good.

Janelle Smith, a registered dietitian nutritionist who specializes in gastrointestinal disorders at the University of California, Los Angeles, told me that's usually all the reasoning people need before inflicting digestive armageddon. It's common for her patients to disregard their lactose intolerance and eat dairy products anyway, she said.

"The short-term impulse to eat something that tastes good is sometimes more powerful than the long-term, logical part of yourself that says, 'You know you're not gonna feel good," Smith said in a phone call. "The brain wants the reward immediately and will deal with the consequences later."

Overlooking the impending pain to treat yourself now was a sentiment shared by Twitter users who responded to my call for answers.

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Low stakes

It's worth noting that lactose intolerance isn't the same as a dairy allergy. Lactose intolerance means that the sufferer's body doesn't produce enough, if any, lactase, the enzyme that breaks down sugar found in milk and milk products. When lactose isn't properly absorbed, Smith explained, it "moves through the gut undigested" until gut bacteria can "eat the leftovers." That process results in gas, bloating, diarrhea, and other symptoms that plague the lactose intolerant.

A dairy allergy, on the other hand, is an immune response in which the body attacks itself when it consumes anything with milk proteins. Side effects can include hives, vomiting, bloody stools, and in the most severe cases, fatal anaphylactic shock.

Similarly, gluten intolerance is also an immune response. Those with Celiac disease may experience gas and bloating too, but also more severe symptoms like ulcers, intestinal blockages, and blistering rashes. In some cases, the immune response may extend beyond the digestive tract and can prompt the patient's body to attack its own bones, spleen, joints, and nervous system.

While repeat allergic reactions, like to shellfish or dairy, can result in more severe reactions over time, continuing to consume dairy products despite an intolerance won't have a negative long-term effect, Smith noted.

Age is a factor

Many people don't develop a lactose intolerance until later in life and spend their childhoods blissfully unaware of how uncomfortable they'll be in the years to come. I didn't start experiencing the negative effects of consuming cheese until I was 14, and even then it was just some bloating and cramping. As I got older, my symptoms became more severe.

While humans are born with the ability to make lactase, many lose it as they age thanks to genetics. Lactose intolerance is especially prominent in those of Asian and West African descent, while people who hail from Northern Europe tend to retain the ability to produce lactase. But the intolerance can also be found in people from cultures that do incorporate dairy products, and is common in people of Arab, Jewish, Greek, and Italian descent. A 2014 study in Nature Communications suggests evolutionary adaptation could play a role in why some cultures are plagued by lactose intolerance more than others. Cattle-dependent populations in Northern Europe and East Africa, for example, may have adapted to consuming dairy into adulthood because their climate limited other food.

But if you've spent your whole life eating cheese, why stop just because evolutionary biology says so?

Katie A., who asked Mashable to not use her full last name, didn't develop lactose intolerance until her late twenties. In a Twitter DM, she said she still consumes dairy products out of a "combination of denial and stubbornness." For her and many others with lactose intolerance, developing it so late in life left them more reluctant to give up on eating dairy.

Pushing the boundaries

Some people who responded to my survey said they try to push the boundaries of their dietary restriction. The symptoms can vary day to day, and the severity of the reaction is often dependent on the type of dairy product. Smith explained that the reaction is often "very dose dependent" — a glass of whole milk has a much higher lactose content than a wedge of gouda.

"Lactose intolerance is not always consistent for every person," Smith said, and noted that it's common for her patients to tolerate some amount of dairy. Testing your limits can actually be beneficial in the long run, to better understand what you can and can't eat.

Katie A. had a "testing period" to see just how much cheese she could handle.

"Mozzarella and cheddar I can handle in moderate amounts, like with a sandwich. But heavy creams and cream cheese I know will do me in," she said, acknowledging that she'll try to sneak a taste of it anyway. "I guess I like to see what I can get away with. I used to love Brie cheese until during the testing period it tore my stomach apart."

If your lactose intolerance isn't too severe, Smith says it's OK to experiment, since it doesn't have detrimental long-term effects. Some dairy products have less lactose than others, and may be an option. Goat cheese, for example, is made with milk that has a lower percentage of lactose than cow milk. Aged cheeses — think hard cheeses like Parmesan and Swiss — also have a very low lactose content because the enzymes used in the aging process break down most of the lactose. Lactose intolerant people may even be able to eat Greek yogurt, since the live bacteria cultures used to produce it feed on sugar and leave little lactose in the end product.

That being said, if your lactose intolerance is as severe as mine, Smith cautions against experimenting too much, especially if the negative effects are "impairing your life."

Just take a pill

Those who don't want to deal with the stress and risks just rely on carrying around lactase enzyme pills, usually referred to by the brand name Lactaid.

Lactaid and all of its generic versions, when taken properly, can be the saving grace of group dinners and impulsive late-night ice cream binges. The tiny tablet contains the enzyme your body lacks and breaks down the lactose for you.

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That is, when it's taken properly. Smith said when her patients claim the pill doesn't work for them, it's either because their timing was off or they weren't taking enough. Each tablet is only effective for a certain amount of time (for Lactaid itself, it's only 30 to 45 minutes after the user first ingests it), and it only contains enough enzymes to break down a certain amount of lactose.

"We know that the enzyme is not 100 percent effective, and user error is really high," Smith said. "The timing of when the person uses the enzyme, how the enzyme was stored ... It's also dose dependent. People don't know how much lactose is in the food they're about to eat."

Her solution? Just look for dairy alternatives that incorporate plant-based materials like pea protein, nuts, or oats.

And then there are those who don't even bother with taking lactase pills. As Twitter user @Noxathorius admitted, it's not the most convenient to carry them around.

"I am not very vigilant at keeping Lactaid with me," he said in a tweet. "I usually then try to avoid dairy completely, but sometimes A) You just don't know if it's actually non-dairy, or B) I really want a caprese and maybe it won't hurt me this time."

And like writer Kevin Garcia said on Twitter, as hard as you try to stick with a plant-based diet, sometimes the willpower just isn't there.

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At the end of the day, if you're willing to put up with a brief, but excruciating period of pain, lactose intolerance is just an inconvenience. And who would I be if I let a tiny inconvenience like hours of bloating and regret stand in the way of me and a baked brie?

Many of us who are lactose intolerant share two traits: an inability to consume dairy, and an unrelenting determination to do it anyway.