When I told my family and friends I was going to be moving to Switzerland, there were inevitably jokes about one of two things: cheese or chocolate. As both of these foods are wonderful and delicious, you may wonder what the joke was about. The missing piece: I am lactose intolerant. More than two years into my life in Switzerland and I would actually argue that they make it easier for me here than it was in the states, but we will come back to that later.

Long before my move to Europe, this particular digestive limitation had pushed me to start learning some, and wonder more, about aspects of chemistry, physiology, and nutrition. When I turned 18 I stated experiencing frequent discomfort and even occasional pain after eating. I saw multiple doctors, and they did everything from sample an array of bodily fluids to scanning my abdomen after I drank a glass of barium. For reference, the barium mixture tasted kind of like chalk and sadness. No progress.

It was not until my mother ended up hospitalized for an unrelated issue and the staff realized that she (in her 40s) was lactose intolerant that we figured out what was going on. The scheduled procedure to swallow a camera and look for tumors was cancelled – I was lactose intolerant. Over the next month this helped to explain the digestive issues of three of my other relatives: one aunt and two cousins.

Considering how long it took the doctors to figure out the source of the problem, I thought lactose intolerance must be pretty rare. That turned out to be my first major misconception. With only a little research I found that ~65% of all humans have a reduced ability to digest lactose. The likelihood that this will affect you depends heavily on where your ancestors are from: more than 90% of East Asians are affected, but only about 5% of people from Northern Europe. These differences depend on whether people in those regions depended on milk products as a major food source.

I was shocked – 65% of people lack enough of the enzyme lactase to digest milk without such delightful symptoms as diarrhea, nausea, abdominal cramps, gas, and bloating. It seemed like something this common should be accounted for in the way foods are labelled.

Perhaps you think, as I did, that identifying lactose-containing foods would be as easy as asking whether something “looked creamy.” Alas, food makers are quite fond of removing parts of milk – whey, milk solids, etc – and adding them to everything from hot dogs to medications to bread to sausages. Until I learned the various names these products could take, buying processed foods became a bit of a minefield.

Even after learning these names, there is the issue that ingredient lists only mention whether these products are present – not the levels at which they are contained. Whole milk is not the same a skim milk, yogurt is not the same as cottage cheese, and even different ages of cheddar are not the same. The day I learned that the live cultures in yogurt can help to digest the lactose for me was an exciting one, and one I was grateful was noted on the packaging.

But what is the best way to approach navigating these ambiguous ingredient lists overall? The available answers are not satisfying. The exact phrase on the Mayo Clinic website recommends “experimenting with an assortment of dairy products.” After a few painful rounds of experimentation, I just became a vigilant ingredient reader who avoided any potential threats.

When I moved to Switzerland this process no longer worked, with ingredient lists in German, French, or Italian. I started to memorize all of the critical words, and in looking at the packaging I discovered something wonderful.

Food Labels
Label informing you that this cheese is lactose free - in three convenient languages! 

There on every package of semi-hard or hard cheese is a label that says “naturally lactose free.” No experimentation necessary. I was delighted – more cheese options were available to me than I had known. I could eat fondue! I felt empowered.

Then I got sloppy. I started to fall back on the “does it look creamy” method for foods I was not familiar with. This led to two kinds of errors, one significantly more negative than the other.

Take a moment to look at the two products below.

Image Credits: Robert Kindermann (left) and Rivella AG (right)

Which of these two items would you guess might contain lactose? The first image is actually aioli. While it may look hazardous, it is actually made of garlic, egg yolks, and olive oil. Avoiding this simply means that I would miss out on something delicious. You may have guessed that this is the less negative result.

The second image is of a very popular drink in Switzerland – so popular that the grocery store was handing out free samples of a new flavor. When handed the bottle I held it up, noticed it was transparent, and opened it up without a second thought. What could be the harm in a flavored water? Apparently three days of abdominal pain.

One of the primary ingredients in Rivella is actually milk whey. And when I say primary, I mean 35%. Needless to say I got sick.

So, in moving to Switzerland it was not the chocolate or cheese that did me in, but a transparent soft drink filled with whey. Science enthusiast that I am, this is one area where I prefer not having to do the experimenting myself.