I was shocked when I learned recently that my twin brother, Aaron, had suddenly become lactose intolerant at age 50. He was diagnosed after becoming violently ill from adding cheese to a beef empanada. It was quite a blow to him. As New Yorkers, we grew up on milk and cereal, pizza, and cheeseburgers. Even though Aaron has always been an exercise fanatic, he never embraced healthy eating. Many of his favorite foods include cheese.

This new medical development hit him particularly hard because he’s already had to sacrifice a great deal since being diagnosed with myasthenia gravis (MG) in his 20s. He’s had to learn to mitigate his anger, infuse medications at home, and even adopt a smoothie diet. While his newfound lactose intolerance has nothing to do with MG, it has felt like another unfair sacrifice he must make.

Aaron told me that limiting his cheese intake is challenging because it is a vital ingredient in sandwiches, burgers, and pizza. Although he recently adopted a fruit-and-veggie diet on doctor’s orders, he hadn’t given up on junk food entirely. But now, multiple dietary changes are hitting him all at once. My brother not only needs to eat healthier and minimize the amount of lactose in his diet, but because of the muscle weakness associated with MG, he must also eat softer foods to avoid choking.

Aaron is a stubborn guy who doesn’t like change, so this has been a lot for him to deal with.

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August 1, 2025 Columns by Allen Francis

As my twin with MG and I get older, our diets are an issue

Helping my twin navigate dietary changes

I’ve realized that sometimes, the best thing I can do to help Aaron is to simply listen. But in this case, I can do more by encouraging him to eat healthier and by recommending recipes and substitutions.

So, during a recent video call, we discussed which foods and comfort-food alternatives he should try.

While fried chicken is a no-no, I reminded him that chicken can taste just as good when it’s marinated and roasted in an air fryer or oven.

He mentioned that his doctors want him to eat fruits and veggies rich in potassium, as low potassium levels can worsen MG flare-ups. Bananas and avocados are not only rich in potassium, but also soft, easy to eat, and easy to prepare. That is a plus for someone with chewing or swallowing difficulties.

Beyond Filet-O-Fish and tuna fish sandwiches, Aaron and I have never been seafood eaters. However, fish is a good source of omega-3 fatty acids, which benefit heart and brain health and help reduce inflammation in the body. So, we discussed eating more roasted fish and fish cakes.

While we were chatting, I looked up lactose intolerance and learned that it affects more than 40% of people in the U.S. The condition occurs when a person’s body doesn’t produce enough of the enzyme lactase, which helps digest lactose. There are several ways to manage lactose intolerance, such as by taking Lactaid or other lactase products before consuming foods with lactose. I also learned that Aaron can likely still eat hard cheeses, such as Muenster, Monterey Jack, and Swiss, which contain very little lactose.

I told him to try small samples of these cheeses on a burger or an empanada. We discussed ways to make chicken cordon bleu healthier, and I suggested making shredded spinach or broccoli casseroles with pepper jack and Swiss cheese. I even tried to sell him on fish-flavored tofu.

Finally, I stressed that he doesn’t have to give up cheeseburgers, just American cheese.

“Monterey Jack?” Aaron said.

“It’s awesome on a burger,” I replied.

Note: Myasthenia Gravis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Myasthenia Gravis News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to myasthenia gravis.