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Lactose Intolerance

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What Is Lactose Intolerance?

Lactose intolerance is the inability to digest a sugar called lactose that is found in milk and dairy products.

Normally when a person eats something containing lactose, an enzyme in the small intestine called lactase breaks it down into simpler sugar forms called glucose and galactose. These simple sugars are then easily absorbed into the bloodstream and turned into energy — fuel for our bodies.

People with lactose intolerance do not produce enough of the lactase enzyme to break down lactose. Instead, undigested lactose sits in the gut and gets broken down by bacteria, causing gas, bloating, stomach cramps, and diarrhea.

Lactose intolerance is fairly common and seems to affect guys and girls equally. Little kids are less likely to have it, but many people eventually become lactose intolerant in adulthood — some while they are still teens. Some health care providers view lactose intolerance as a normal human condition and therefore don’t really consider it a disease.

Who Gets Lactose Intolerance?

A person may be or may become lactose intolerant for different reasons:

  • Ethnic background. People of Asian, African, Native American, and Hispanic backgrounds are more likely to develop lactose intolerance at a young age.
  • Other problems with the digestive tract. People who have inflammation of their upper small intestine, such as celiac disease or Crohn’s disease, have a reduced level of the lactase enzyme.
  • Medicines. Certain antibiotics can trigger temporary lactose intolerance by interfering with the intestine’s ability to produce the lactase enzyme.
  • Infection. After a bout of infectious diarrhea, some kids can develop a temporary lactose intolerance that usually improves after a few days or weeks.
  • Age. As people get older, their bodies usually stop producing the lactase enzyme, and most people will naturally become lactose intolerant over time.

What Happens When Someone Has It?

People with lactose intolerance may have a variety of symptoms. It all depends on how much dairy or how many milk-containing foods the person eats and how little lactase the body produces.

Usually within 30 minutes to 2 hours after eating, someone with lactose intolerance will experience nausea, stomach cramps, bloating, gas, and diarrhea. This can be unpleasant, not to mention embarrassing if you’re at school or out with friends.

Because many people may think they’re lactose intolerant when they really aren’t, it helps to see a doctor who can diagnose the condition correctly and advise you on ways to manage it.

How Do Doctors Diagnose It?

If your doctor thinks you might be lactose intolerant, he or she will take your medical history by asking about any concerns and symptoms you have, your past health, your family’s health, any medications you’re taking, any allergies you may have, and other issues. Your doctor will also do a physical exam.

Doctors can test for lactose intolerance by using the hydrogen breath test. Normally very little hydrogen gas is detectable in the breath. However, undigested lactose in the colon ferments (breaks down) and produces various gases, including hydrogen.

If your doctor decides to give you a hydrogen breath test, you’ll be asked to blow into a tube for a beginning sample. You’ll then swallow a drink with lactose in it, wait a while, and breathe into the tube again. You’ll be asked to blow into the tube every half hour for 2 hours in order to measure hydrogen levels in your breath. The levels should go up over time if you have lactose intolerance.

Doctors also can find out if you’re able to digest lactose by testing for the presence of lactase with an endoscopy. During this procedure, doctors view the inside of the intestines by inserting a long tube with a light and a tiny camera on the end into the mouth.

A doctor can then take tissue samples and pictures of the inside of your gut and look for clues to why you’ve been having problems with what you’re eating. The amount of lactase enzyme can be measured in one of these tissue samples.

Living With Lactose Intolerance

Lactose usually can be easily managed if you’re in tune with your body. Everyone’s different, but most people with lactose intolerance can eat a small amount of dairy. The trick is to eat dairy products in combination with other foods that don’t contain lactose and not to eat too much dairy at once. It can also help to keep a food diary to learn which foods your body can or can’t tolerate.

Dairy foods are the best source of calcium, a mineral that’s important for bone growth. Because growing teens need about 1,300 milligrams (mg) of calcium each day, experts recommend that even teens who have lactose intolerance continue to include some dairy in their diet.

Foods like cheese or yogurt may be easier to digest than milk, so try a cup of yogurt for dessert or add a piece of cheese to your sandwich. Lactose-free milk is also a great way to get calcium in your diet without the problems that can come with lactose.

Taking a lactase enzyme supplement might help too. Taking this before eating foods that contain dairy will help the body digest the lactose sugar in dairy so you don’t develop the symptoms of lactose intolerance, like pain, cramping, bloating, gas, and diarrhea.

Teens with the most severe symptoms of lactose intolerance might have to avoid all dairy products. It’s extra important that these teens find other good calcium sources, so talking to a registered dietitian is a good idea. Dietitians are trained in nutrition and they can help people who are lactose intolerant come up with eating alternatives and develop a well-balanced diet that provides lots of calcium for developing strong bones.

Here are some tips for dealing with lactose intolerance:

  • Choose lactose-reduced or lactose-free milk.
  • Take a lactase enzyme supplement (such as Lactaid) just before you eat dairy products. These can be taken in drops or tablets and even added directly to milk.
  • When you do drink milk or eat lactose-containing foods, eat other non-lactose foods at the same meal to slow digestion and avoid problems. (For example, if you are going to have a milkshake, don’t drink it by itself. Have something else with it, like a healthy sandwich.)
  • Drink juices that are fortified with calcium.
  • Eat a variety of dairy-free foods that are rich in calcium, such as broccoli, beans, tofu, or soy milk. Consider hard cheeses such as cheddar, which are lower in lactose.
  • Yogurts that contain active cultures are easier to digest and much less likely to cause lactose problems.
  • Learn to read food labels. Lactose is added to some boxed, canned, frozen, and prepared foods like bread, cereal, lunchmeats, salad dressings, mixes for cakes and cookies, and coffee creamers. Be aware of certain words that might mean the food has lactose in it: butter, cheese, cream, dried milk, milk solids, powdered milk, and whey, for example.

Reviewed by: J. Fernando del Rosario, MD Date reviewed: January 2015

What is lactose intolerance?

Lactose intolerance is when your body can’t break down or digest lactose. Lactose is a sugar found in milk and milk products.

Lactose intolerance happens when your small intestine does not make enough of a digestive enzyme called lactase. Lactase breaks down the lactose in food so your body can absorb it. People who are lactose intolerant have unpleasant symptoms after eating or drinking milk or milk products. These symptoms include bloating, diarrhea, and gas.

Lactose intolerance is not the same thing as having a food allergy to milk.

Lactose intolerance is most common in Asian Americans, African Americans, Mexican Americans, and Native Americans.

What causes lactose intolerance?

Both children and adults can get lactose intolerance. Here are some common causes of this condition:

  • Lactose intolerance often runs in families (hereditary). In these cases, over time a person’s body may make less of the lactase enzyme. Symptoms may occur during the teen or adult years.

  • In some cases, the small intestine stops making lactase after an injury or after a disease or infection.

  • Some babies born too early (premature babies) may not be able to make enough lactase. This is often a short-term problem that goes away.

  • In very rare cases some newborns can’t make any lactase from birth.

What are the symptoms of lactose intolerance?

Each person’s symptoms may vary. Symptoms often start about 30 minutes to 2 hours after you have food or drinks that have lactose.

Symptoms may include:

  • Belly (abdominal) cramps and pain

  • Nausea

  • Bloating

  • Gas

  • Diarrhea

How severe your symptoms are will depend on how much lactose you have had. It will also depend on how much lactase your body makes.

The symptoms of lactose intolerance may look like other health problems. Always see your healthcare provider to be sure.

How is lactose intolerance diagnosed?

Your healthcare provider will talk to you about your past health and family history. He or she will give you a physical exam.

You may be asked not to have any milk or milk products for a short time to see if your symptoms get better.

You may also have some tests to check for lactose intolerance. These may include:

  • Lactose tolerance test. This test checks how your digestive system absorbs lactose. You will be asked not to eat or drink anything for about 8 hours before the test. This often means not eating after midnight. For the test, you will drink a liquid that has lactose. Some blood samples will be taken over a 2-hour period. These will check your blood sugar (blood glucose) level. If your blood sugar levels don’t rise, you may be lactose intolerant.

  • Hydrogen breath test. You will drink a liquid that has a lot of lactose. Your breath will be checked several times. High levels of hydrogen in your breath may mean you are lactose intolerant.

  • Stool acidity test. This test is used for infants and young children. It checks how much acid is in the stool. If someone is not digesting lactose, their stool will have lactic acid, glucose, and other fatty acids.

Treatment


Lactose intolerance

Sources of lactose

Milk

A major source of lactose in our diet is milk, including cows’ milk, goats’ milk and sheep’s milk.

Depending on how mild or severe your lactose intolerance is, you may need to change the amount of milk in your diet.

For example:

  • you may be able to have milk in your tea or coffee, but not on your cereal
  • some products containing milk, such as milk chocolate, may still be acceptable in small quantities
  • you may find that drinking milk as part of a meal, rather than on its own, improves how the lactose is absorbed

Dairy products

Products made with milk, such as cream, cheese, yoghurt, ice cream and butter, also contain lactose and may need to be avoided if you’re lactose intolerant.

But the level of lactose in these products varies and is sometimes quite low, so you may still be able to have some of them without experiencing any problems.

It’s worth experimenting with different foods to find out if there are any dairy products you can eat, as they’re a good source of essential nutrients like calcium.

Other foods and drinks

As well as milk and dairy products, there are other foods and drinks that can sometimes contain lactose.

These include:

  • salad cream, salad dressing and mayonnaise
  • biscuits
  • chocolate
  • boiled sweets
  • cakes
  • some types of bread and other baked goods
  • some breakfast cereals
  • packets of mixes to make pancakes and biscuits
  • packets of instant potatoes and instant soup
  • some processed meats, such as sliced ham

Check the ingredients of all food and drink products carefully, as milk or lactose are often hidden ingredients.

The word “lactose” will not necessarily be listed separately on the food label, so you need to check the ingredients list for milk, whey, curds and milk products such as cheese, butter and cream.

Some ingredients may sound like they contain lactose when they do not, such as lactic acid, sodium lactate and cocoa butter.

These ingredients do not need to be avoided if you’re lactose intolerant.

Medication

Some prescription medicines, over-the-counter medicines and complementary medicines may contain a small amount of lactose.

While this is not usually enough to trigger the symptoms of lactose intolerance in most people, it may cause problems if your intolerance is severe or you’re taking several different medicines.

If you need to start taking a new medication, check with your GP or pharmacist in case it contains lactose.

Managing Symptoms

The gas, bloating and cramps of lactose intolerance are no fun, but they’re not dangerous. Most people can manage their symptoms by changing their diet and limiting the amount of lactose they consume. Some people do better by cutting lactose out of their diet altogether.

Your body may be able to handle some lactose without symptoms. Experiment to find out the types and amounts of products with lactose you can eat and drink.

Some high-lactose foods to watch out for:

  • Milk and heavy cream
  • Condensed and evaporated milk
  • Ice cream
  • Cottage cheese
  • Ricotta cheese
  • Sour cream
  • Cheese spreads

Some milk substitutes you could try:

  • Soy milk — it’s high in protein, potassium and antioxidants
  • Rice beverages
  • Lactose-free milk — it’s high in calcium and protein and contains many other vitamins, such as A, B, and K, zinc, potassium and magnesium
  • Almond milk
  • Coconut milk

Learning how to manage your symptoms through diet is key, but it can be a bit tricky.

When you have a meal, try having a small amount of milk or other dairy product along with it. Sometimes lactose can be tolerated more easily when eaten with other foods.

Try a lactose-free diet for 2 weeks. After 2 weeks, add foods with lactose back into your diet gradually and watch your results. This can give you a clearer idea of what and how much of certain foods and beverages you can consume without problems.

Talk to your doctor about taking a dietary supplement that contains lactase.

Try a liquid lactase replacement. These are over-the-counter drops that you add to milk.

Lactose intolerance: What you need to know

Most milk and milk products have lactose in them, and many processed foods have milk and dairy products added to them.

Any product with milk, lactose, whey, curds, milk by-products, dry milk solids or non-fat dry milk powder listed in their ingredients will have lactose in them.

Foods that commonly contain lactose include:

  • cakes and biscuits
  • cheese sauce
  • cream soups
  • custard
  • milk chocolate
  • pancakes
  • scrambled eggs
  • quiche

A person with a lactose intolerance should check food labels carefully, as some foods may contain “hidden lactose.”

Examples include:

  • muesli bars
  • breads
  • breakfast cereals
  • margarine
  • some instant soups
  • boiled candies
  • chocolate candies and bars
  • some processed meats, such as sliced ham
  • salad cream, salad dressing, and mayonnaise

Ingredients to look out for on a label include milk solids, non-fat milk solids, whey, and milk sugar.

Around 20 percent of prescription medications, such as birth control pills and around 6 percent of over-the-counter drugs, for example, treatments for stomach acid, contain lactose.

People with a severe lactose intolerance should tell their doctor or pharmacist about this when obtaining new medications.

Alternatives to dairy milk include almond, flax, coconut, or soy milk. Grocery stores often stock a range of lactose-free alternatives to various products.

It is safe for women with a lactose intolerance to breastfeed an infant. It will not make the infant sick or increase the risk of intolerance, and breast milk has important benefits for growth and development.

Alternatives to dairy

In many societies, dairy products are an important source of calcium, protein, vitamins A, vitamin B12 and vitamin D. Cutting out dairy products may lead to malnutrition, unless they are replaced with foods of similar nutritional content.

Share on PinterestAlmond or soy milk are suitable for people who are lactose intolerant.

Alternative sources include:

  • Calcium: Seaweeds, nuts and seeds, blackstrap molasses, beans, oranges, figs, quinoa, amaranth, collard greens, okra, rutabaga, broccoli, dandelion leaves, kale, and fortified products such as orange juice and plant milks
  • Vitamin A: Carrots, broccoli, sweet potatoes, cod liver oil, liver, spinach, pumpkin, cantaloupe melon, egg, apricot, papaya, mango, and peas
  • Vitamin D: Levels can be enhanced by exposure to natural sunlight, consuming fatty fish, eggs, fish liver oils, and some fortified plant milks and other fortified products
  • Lactose-free milk: A person with severe symptoms should check the label to ensure that lactose levels are zero, and not just reduced. Vegetable-based milks also contain less protein than cow’s milk

According to Nutrition Australia, most people with lactose intolerance do not need to avoid all dairy products.

Even those with low lactase levels can normally tolerate up to 12 grams of lactose a day, they say, or one cup of milk. Spreading consumption throughout the day, and taking it with meals, can increase tolerance.

Anyone who is considering changing their diet should first consult a doctor or a registered dietitian for advice.

  • People who are poor at digesting lactose may be able to improve their tolerance of dairy products by consuming small quantities of milk or lactose supplements regularly.
  • Only a few, small-scale trials in humans have tested this theory, but the results are encouraging.
  • The good news for those who wish to try this approach is that the daily lactose dose needed to see results might be lower than what prompts the symptoms of lactose intolerance.

The common understanding of the inability to properly digest lactose is that it’s all about genetics: either a particular gene in cells lining your upper intestine—which enables everyone to digest lactose as an infant—becomes inactive as you grow up, or it doesn’t. But the truth is less cut and dry. In fact, there is some recent and gathering evidence to suggest that those who suffer the symptoms of lactose intolerance could be better off by frequently consuming small quantities of the sugar that bothers them.

Theoretically, there should be more than one way of making lactose-intolerant people more lactose-tolerant. One option would be to induce production of lactase, the enzyme that digests lactose, in the cells where it has ceased. But this does not appear to be possible in humans (yet). Instead, the method that Andrew Szilagyi, a gastroenterologist at McGill University, in Quebec, Canada, described in a recent paper involves meddling with the composition of bacteria in the latter stages of the gut.

Szilagyi’s suggestion is simple. Most lactose-intolerant folk avoid dairy, and therefore have somewhat different populations of gut bacteria to lactose-tolerant people. Thus, he thinks that if the lactose-intolerant were to regularly consume small quantities of the sugar that causes them problems, they could gradually improve their tolerance to it over time. This would alter the composition of the bacteria in their guts, such that it more closely resembles that of lactose-tolerant people.

While this sounds plausible, it is worth noting that the mechanistic details of why it might work are poorly understood. Although it has been established that habitual dairy consumption alters colonic bacteria , the details of the changes in species composition and the consequential shifts in the extent of lactose breakdown in different parts of the gut are not thoroughly elucidated.

Nonetheless, the supporting data for this approach is convincing, if limited in its volume. For example, back in 1996, 20 people, with various ethic backgrounds, and who were all poor at digesting lactose, were randomly assigned to take either a small dose of lactose or one of dextrose, a different sugar, for 10 days . After that initial stage, the 20 participants then switched to the sugar they had not yet taken for an additional 10 days. None of them knew which sugar they were taking at any time.

The trial was run by Steven Hertzler, who now works at Abbott Nutrition, and Dennis Savaiano, who is based at Purdue University, in West Lafayette, Indiana. After completing each of the two 10-day courses, the lactose tolerance of each individual in the trial was tested by giving them a large dose of lactose and recording their subsequent flatulence, diarrhea, abdominal pain—and, more formally, their hourly performance on a hydrogen breath test over eight hours. Encouraging, the course of small lactose doses did improve tolerance: after the 10-day course of lactose, the lactose challenge produced much less hydrogen in the breath compared to after the 10-day course of dextrose. Similarly, ‘hourly rectal gas passages’ and ‘severity’ of flatulence (rated on a five-point scale) were much lower.

Elsewhere in the academic literature there’s the anecdotal case of a 32-year-old man from Sicily who had a perfectly normal score on the hydrogen test before he gave up all forms of dairy for three weeks. When he retook the test, after that period, he showed much higher levels of hydrogen in his breath . As with the 20 volunteers, the suggestion is that the change was caused by a shift in the populations of bacterial species in his gut.

Animal studies back up this interpretation. Recent data from studies in pigs and rats link the feeding of lactose to shifts in the animals’ gut bacteria. In rats, for example, metabolic shifts in the bacteria in the part of the gut from which lactose-intolerance symptoms are known to emerge, have been detected as quickly as five hours after lactose consumption. In other words, each meal they eat is shaping the microflora in their innards.

There is the question of how unpleasant the process of becoming more lactose tolerant is likely to be. There, the good news is that it might not be unpleasant at all. The US National Institutes of Health has concluded that most lactase non-persistent people can handle 12g of lactose without noticing symptoms. And the hydrogen breath test does not turn positive until 6g has been consumed. Szilagyi therefore suggests ‘training’ with 5g of lactose per day, based on studies of similar training exercises with another sugar, oligofructose. To put that into perspective, there are 5g of lactose in 100ml, or about a half cup of milk.

Szilagyi also argues that there would be broader health benefits to training, aside from a reduction in the symptoms of lactose intolerance. If people who otherwise don’t consume dairy are newly able to eat it, their risks of developing many diseases should decrease. For example, the odds of getting many cancers decrease, among them colorectal, stomach, breast, and pancreatic cancers . Dairy consumers are also at lower risk of developing Crohn’s disease. Counter-intuitively, a bit less than half a glass of milk a day may be just what the lactose intolerant need.

Contributed by
Anna Petherick
Professional science writer & editor
www.annapetherick.com

Lactose-Intolerant People Should Drink More Milk, Expert Says

The problem, Savaiano says, is that dairy foods can be difficult to digest, and people who don’t eat these foods often enough haven’t acclimated themselves to the foods.

According to the National Institutes of Health, as many as 50 million Americans are lactose intolerant. Although lactose intolerance itself isn’t harmful — it may result in gas, bloating or nausea — it does affect a person’s health in the long-term because avoiding dairy foods reduces calcium intake. According to Savaiano, three-fourths of all calcium in diets in the United States come from dairy foods.

Too little calcium in a diet can reduce bone growth, which can lead to osteoporosis later in life. Osteoporosis, which affects 35 million Americans, can result in weakened bones, causing fractures and injuries. Patients in the United States spend $13 billion a year on osteoporosis treatments.

A big problem with both calcium intake and lactose tolerance, nutritionists say, is that most people, especially teen-age girls, don’t consume enough dairy products.

“If you only consume dairy products once in awhile, you are more likely to have symptoms from them,” Savaiano says. “Also, if you consume them by themselves, as opposed to as part of a meal, they tend to be transported throughout the intestine more rapidly and are more likely to cause symptoms.”

Savaiano has four tips to improve digestion of milk and dairy products. “These approaches can improve lactose tolerance to the point that people can consume diets that are quite rich in calcium and in milk and experience no difference in their symptoms from eating a diet without the milk,” he says. His tips:

  • Don’t overeat dairy foods, and eat them only in moderation.
  • Eat dairy foods as part of a meal, such as a cup of milk over cereal with fruit.
  • If necessary, use over-the-counter digestive aids.
  • Eat yogurts. “Yogurts are very well tolerated because they contain a lactase that helps digest lactose in the intestine.”

Lactose is a form of sugar, or carbohydrate, found in milk and dairy products. This sugar is too large to be absorbed by the intestine, and is broken down by an enzyme, lactase, produced by the body. Most adults don’t produce enough lactase to completely break down the lactose. In fact, up to three-fourths of the world’s population doesn’t produce enough lactase.

However, Savaiano says it is possible to train one’s own digestive system to break down the lactose.

“Our studies have shown a really amazing adaptation of the large intestine of humans,” Savaiano says. “The large intestines contain bacteria that help digest lactose. By altering the diet over time, bacteria more effectively digest lactose, making milk better tolerated.

“The bacteria are very fastidious and very adaptable. An individual who may produce excessive gas may feel uncomfortable after eating milk products. But if they adapt to small amounts of milk for a couple of weeks, at the end of that period, they are producing far less gas than they were two weeks ago from the same amount of milk, and they tolerate dairy products extremely well.”

Research studies on calcium metabolism have shown the effectiveness of this form of treatment, Savaiano says.

“We’ve found that if you do controlled clinical blind trials, where people don’t know what they are consuming, and you take out that placebo effect, you can give subjects a glass of milk with breakfast and another with dinner and they exhibit almost no symptoms.

“Further, we just completed a study at Purdue last summer with a group of African-American adolescent girls who were part of a calcium diet study. On the first day of the study many complained about having to drink the milk — they said they didn’t like the milk and that they were intolerant. When we tested them they had only a very modest level of symptoms, though — almost incidental. Two weeks later, after they had been consuming a dairy-based, high-calcium diet, we tested them again. Every one of these girls had absolutely no symptoms.”

According to Savaiano, although many people think that some babies are lactose intolerant, actually this isn’t the case. “Milk allergy is often confused with lactose intolerance, but they are physiologically different,” Savaiano says. “Babies do not develop lactose intolerance until they are 3 to 5 years old. The intestinal lactase remains high in all infants, except the very rare situation where there is a genetic lack of the enzyme from birth.”

Savaiano says milk allergies appears in 5 percent of newborns, but that almost all infants outgrow this allergy by their first birthday. “The best way to deal with this is to continue breast feeding,” he says.

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Lactose is a sugar found in the milk of humans and other mammals. The ability to digest milk occurs because lactase, an enzyme that’s produced in the small intestine, breaks down lactose into two simple sugars, which are then used by the body. When there is an insufficient amount of lactase, unabsorbed lactose moves to the colon where the bacteria cause it to ferment, leading to bloating and gastrointestinal discomfort.

Virtually all human infants depend on milk for survival and digest the nutrients in it, including lactose. But early in childhood, most people start producing less lactase and consequently cannot digest more than a small amount of milk. In these people, who are termed lactose intolerants or lactose maldigesters, drinking milk (especially drinking it in the absence of food) can produce uncomfortable symptoms—such as gas, stomach cramps, and diarrhea—within 30 minutes to two hours. (A few people, including infants, may be allergic to the protein in milk, but that’s not lactose intolerance.)

There are degrees of tolerance and intolerance for milk; in fact, not all lactose intolerants have to give up milk consumption. Although the ability (or loss of ability) to digest lactose is an inherited trait, drinking habits also depend on custom and preference.

Many Americans who believe they are lactose intolerant are mistaken: The prevalence of lactose intolerance is overestimated, according to a review in the Journal of the American Dietetic Association. But the extent of the problem varies widely among different racial and ethnic groups. Only 15 percent of white Americans are affected by some degree of lactose intolerance; the proportion of African-Americans affected is significantly higher at 60 to 80 percent. The problem occurs with varying severity in about 90 percent of Asian-Americans, 65 to 100 percent of Native Americans, and about 50 percent of Mexican-Americans. Up to 75 percent of adults worldwide may be affected.

Symptoms of Lactose Intolerance

  • Abdominal pain, cramps, and bloating within a few hours of consuming milk or milk products
  • Nausea
  • Excessive gas
  • Diarrhea
  • “Grumbling” abdomen and bowel

What Causes Lactose Intolerance?

While some infants are born with the ailment, lactose intolerance usually develops in childhood beginning at two to five years of age. The production of lactase then steadily decreases until adolescence and remains at low levels throughout life. The ailment can also develop later in life because of chronic digestive disorders such as irritable bowel syndrome, Crohn’s disease, or celiac disease. In both adults and children, a temporary form of lactose intolerance may occur owing to illness (such as gastroenteritis) or side effects of medication (such as antibiotics or NSAIDs like ibuprofen) that affect the intestinal lining and stop lactase production for a few weeks.

What If You Do Nothing?

Lactose intolerance is not a health risk. But if you are truly lactose intolerant, symptoms can occur whenever you consume milk and other dairy products high in lactose. (However, the amount that you consume makes a difference in how much discomfort you experience.)

Home Remedies for Lactose Intolerance

Lactose intolerance cannot be cured, but once lactase deficiency has been diagnosed, there are strategies you can use to avoid or control its symptoms. The most obvious step is to eliminate all dairy products from your diet. However, this is not only difficult for most people but also often unnecessary. Instead, first follow the measures below (including turning to nondairy sources of calcium in your diet if you do reduce your consumption of dairy products).

  • Be sure you are truly lactose-intolerant. Bloating, flatulence, and stomach cramps aren’t always caused by lactose intolerance; it’s not a condition that develops suddenly. You can do a simple test for lactose intolerance at home. Drink two glasses of skim milk on an empty stomach and see if symptoms such as bloating, gas, and diarrhea occur during the next three to four hours; this suggests lactase deficiency is probably the cause. If so, repeat the test using lactase-treated milk. If you then experience no symptoms, you probably have lactose intolerance. But if you have chronic gastrointestinal discomfort, see a doctor for further testing.
  • Consume small portions of milk and milk products. You can eliminate dairy products from your diet, but not only is that difficult, it often isn’t necessary. While many people can’t tolerate large portions of dairy products, they have no problems with smaller servings. In fact, studies have shown that many true lactose maldigesters (classified as such by laboratory tests) can consume moderate amounts of milk and dairy products without symptoms, particularly if the milk is part of a meal. Whole milk causes fewer problems than skim, because its fat slows the rate of stomach emptying.
  • Eat dairy products along with food. This will slow the emptying of the food from the stomach into the intestine, where lactose is digested, and decrease or eliminate symptoms. This strategy allows more time for the available lactase to act upon the lactose-containing food.
  • Try active-culture yogurts. Fermented milk products such as yogurt with active cultures are usually easier to digest than milk. Most yogurt is low in lactose anyway, and the bacteria in it help break down what milk sugar there is. But as much as 30 to 70 percent of the lactose originally in the milk may remain in the yogurt. For lower lactose, look for yogurt that states “Live and Active Cultures” on the label—or just experiment until you find a brand that agrees with you.
  • Cheese is all right. There should be no problems with cheese, especially hard, aged cheeses like Swiss, Parmesan, and Cheddar, since most lactose is removed along with the whey when the cheese is made.
  • Give soy milk a try. This product made from soybeans may be poured on cereal, used for cooking, and consumed as a beverage by infants and adults. Acidophilus milk or buttermilk may not be any better for people sensitive to lactose; the degree of fermentation is variable, and so lactose content also varies.
  • Consider using lactose-reduced and lactase products. If the other strategies don’t work for you, try lactose-reduced milk, which is available in most markets. This type of milk contains about 70 percent less lactose and tastes sweeter than regular milk. You can also buy lactase tablets or liquid in drugstores or grocery stores and add them to the milk yourself; five drops per quart can break down over 70 percent of the milk sugar in about 24 hours (for greater reduction, let the treated milk stand for 48 to 72 hours). If you add drops to commercially treated milk, you can eliminate nearly all the lactose. You can also swallow lactase tablets or capsules just before you consume a milk product, but that’s usually much less effective than adding drops to the milk itself.
  • Read labels carefully. The Food and Drug Administration (FDA) doesn’t require food companies to label their products “lactose free.” Limit or avoid foods containing milk (nonfat milk as well), lactose, whey, dry milk solids, and milk curds. Lactose may be added to prepared and processed foods, including baked goods, breakfast foods, luncheon meats, salad dressings, and soups. Some artificial sweeteners may also contain lactose.
  • Increase the calcium in your diet. If you eliminate or drastically cut back on dairy foods, you must compensate for the lack of calcium and other essential nutrients.

Lactose-Intolerant Children

Lactose intolerance, an inability to break down and absorb sugars found in milk and milk products, is common in infants. A few are born lactase-deficient, but at ages three to five, the incidence increases and about 75 percent of all children worldwide have decreased levels of lactase; an estimated 15 percent of all American school children are thought to be lactose-intolerant. When milk or milk products are ingested by lactose-intolerant children, symptoms develop within eight hours and include explosive watery diarrhea, abdominal distention, and flatulence.

To find out if your child is lactose-intolerant, a physician will first perform a physical examination. The child may then be asked to consume specific foods and the subsequent stool will be analyzed for unabsorbed substances.

Once lactose intolerance has been confirmed, the physician will recommend a reduction of milk and milk products in the child’s diet, along with some of the measures described on these pages—including giving the child soy protein formula, milk products with added lactase, or special lactase supplements that you add to the milk products to aid in digestion.

You can also try adding yogurt and cheese to the child’s diet. These fermented foods are lactose-reduced and consequently may have no negative effects, while offering an excellent source of calcium, vitamin B2 vitamin D, and protein.

Prevention

There is no way known to prevent the condition of lactose intolerance, but the self-care approaches discussed above can prevent symptoms.

Beyond Home Remedies: When To Call Your Doctor

Contact your physician if self-treatment measures don’t provide relief for you (or for your child) and you continue to experience gastrointestinal discomfort. For infants, call your doctor if your baby fails to gain weight or refuses food or formula. If the infant is on a doctor-recommended milk-free diet, be sure to contact the doctor if the diet does not relieve symptoms.

What Your Doctor Will Do

After taking a history, your physician may order a breath hydrogen test to confirm lactose intolerance. Based on the findings, your physician will make recommendations to reduce or eliminate certain foods.

Source:

The Complete Home Wellness Handbook

John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at HealthCommunities.com

Published: 11 Aug 2010

Last Modified: 23 Dec 2014

Can Lactose Intolerance Be Cured?

Cheese, ice cream, Greek yogurt-so many of women’s favorite foods can’t be enjoyed by those who are lactose intolerant-or so we’ve been told. But a group of researchers says those with the condition may be able to have their ice cream cake and eat it too.

The 14-member panel at the Development Conference on Lactose Intolerance and Health concluded that diagnosing lactose intolerance isn’t as simple as it sounds: Many people lacking the digestive enzymes necessary to digest dairy tolerate the foods just fine, while some who have problems with dairy produce plenty of enzymes.

Even better, they say that “avoiding dairy products isn’t even necessary for lactose-intolerant individuals.” Instead, they may be able to eat dairy in moderation and-get this-lactose intolerance may even be able to be cured.

Sounds crazy, but it may be true. “The key to successfully overcoming this is to not just eliminate dairy for a time but to ‘heal and seal’ the gut before trying it again,” says Jill Grunewald, a holistic health coach and expert in treating food intolerances. Thanks to an unhealthy diet, illness, or antibiotic useage, many people suffer from “leaky gut syndrome” where the lining of the intestinal wall has thinned, thereby allowing pathogens and undigested food into the blood stream, Grunewald explains. She offers five steps for helping cure your dairy issues:

RELATED: 7 Foods to Ease an Upset Stomach

1. Identify. To figure out if dairy is the real issue, eliminate it entire for at least 21 days. Be sure to check for the bold “Contains milk” under the allergy warning to weed out sneaky sources that you may not realize have dairy in them. After the elimination period, it’s time for elimination provocation. Eat a large serving of whatever type of dairy you like, such as 1 cup milk, 1/2 cup ice cream, or two ounces of cheese, and see if you experience pain, bloating, diarrhea, brain fog, skin problems, fatigue, and/or irritability within 72 hours of eating the food. If you experience any of these symptoms, move on to step 2.

2. Eliminate. This step is as simple as it is hard: Remove dairy-even minute sources like icing on a granola bar-out of your diet for a minimum of six months in order to give your body plenty of time to “seal and heal” the intestinal lining.

3. Substitute. During the elimination period, find healthy substitutes. Grunewald likes coconut, such as coconut milk, coconut oil instead of butter, and coconut yogurt, which are gentle on your sensitive system and offer healthy medium-chain fatty acids. If coconut isn’t your thing, almond milk and goat milk are also good substitutes, but stay away from soy, as it can mess with your hormone balance.

RELATED: Find the Best Milk for You

4. Heal. To fix the “leaky gut,” Grunewald recommends bone broth, probiotics, fish oil, apple cider vinegar, and fermented foods such as kimchi, sauerkraut, and kombucha on a daily basis. While there isn’t any strict amount of the foods to take daily, she says that the more you eat, the quicker your gut will mend, as these are all high in prebiotics or probiotics, as well as other compounds that encourage a healthy immune system and intestinal function.

5. Reintroduce. After six months, baby-step your way to eating dairy again. The National Institutes of Health recommends starting with a couple of tablespoons of yogurt because it comes with digestive enzymes built in. You can also try other foods, but always start with one tablespoon and work up to two or three small servings of dairy a week, slowing adding another tablespoon every three days until you’re eating a normal serving size. Depending on how severe your reaction was to lactose and how well your gut has healed, you still should eat it in moderation-which frankly is good advice even if you don’t have tummy troubles.

  • By Charlotte Hilton Andersen

Many of the foods that we enjoy in the world are made using milk, cheese and other types of dairy. But imagine having to adjust how you prepare favorite foods like pizza, cheeseburgers and some Italian pasta dishes.

There are people who are either born with or develop lactose intolerance – which is where the body has problems with being able to digest the natural sugar better known as lactose.

People who are dealing with this condition do not have the lactase enzymes – which are often produced in the smaller intestine – that are required to properly break down the lactose from dairy foods.

That production can be part of the short-term effects of stomach flu or the result of a lifelong condition like cystic fibrosis.

The symptoms begin when the improperly digested lactose travels through the intestines and can make people either have to limit their dairy consumption or completely eliminate it.

It is a common condition for several adults and can cause quite a challenge for people who need the calcium for their bones but need to find dairy alternatives.

It is also something that can be passed from generation to generation within a family bloodline.

Then there are some cases where babies born prematurely are temporarily intolerant due to not being able to produce the lactase needed to digest breastmilk or dairy-based formulas.

It seems like this can be a difficult burden to live with, but there are several ways you can naturally help alleviate the side effects of lactose intolerance – that way you don’t have to rely on synthetically manufactured medicines and pharmaceuticals.

Common forms of lactose intolerance

Bacterial gastroenteritis – This gut infection can actually lead to the inflammation of your stomach and the intestinal tract that can lead to a combination of vomiting, diarrhea and extremely painful cramps – many of what you would think is a form of food poisoning.

Causes can also come from not having proper hygiene or eating food that is contaminated with toxins and other types of negative bacteria.

Crohn’s disease – This is a chronic stomach and intestinal condition where there is an inflammation that can occur anywhere from the esophagus to the colon – but it most commonly occurs in the large intestinal tract.

This has no cure and can the side effects can only be alleviated and there might be times where there could be a remission period without the symptoms – which include abdominal pains, diarrhea, and blood in the stools.

Celiac disease – Described as a gluten intolerance, people with this condition cannot handle enjoying the protein that helps compose wheat, rye, barley and other grains and oats.

It is a very common ingredient that is used in a number of medicines, vitamin supplements, and even makeup products.

This condition will actually react to gluten and will damage the villi of the small intestines to the point of not being able to absorb nutrients from food indigestion.

Cystic fibrosis – This disorder can lead to a number of bigger health problems that affect various vital organs – heart, lungs, and pancreas – that can eventually lead to possible death.

The cells known for being able to help produce juices to digest food are damaged and can actually be clogged up to not only prevent production but the backup can lead to other parts of the body.

Why should you use natural remedies to treat lactose intolerance?

There are a large number of treatments that are either prescribed by a primary health care physician or are available over the counter at a number of retail pharmacies that can often include a number of artificially manufactured chemicals that have sometimes been found to cause a number of negative health problems that will make a case of lactose intolerance seem like a minor issue.

In addition to having a safer way to help reduce and eliminate the side effects of lactose intolerance, using supplements and other treatment options that are 100 percent natural provide a number of added benefits that can affect any other conditions you are dealing – you may find that you are more active and losing weight while also improving how the amount of essential vitamins and minerals that can give your body a boost in energy, cognitive functions, and other capabilities.

Common symptoms of lactose intolerance

The most common side effects and symptoms that result from a lactose intolerance reaction include pains and cramps within the stomach region, which are often accompanied by a combination of gurgling, rumbling and other strange sounds emanating from your belly. Bloating and gas secretion are also very common effects.

Among the very severe side effects of lactose intolerance includes diarrhea, other forms of looser stools and vomiting – some people may have a combination of all of the above.

These symptoms can range in how they feel from being somewhat mild to excruciating levels that can make it impossible to accomplish tasks around the house or office.

In most cases, these effects will take place anywhere between 30 minutes and two hours after eating or drinking something with dairy, including milk, cheese, and yogurt.

Option 1 – Consider adding lactase supplements to daily routine

Considering that a big reason for why your body is having trouble digesting lactose is actually due to the body not being able to produce the lactase to break it down, there are a number of supplements out on the market which can help replace the lactase that your body has been unable to produce.

One option is to go with an enzyme powder that can be added to milk, or even a liquid that you use a dropper for, to help you digest properly.

The one thing about adding the drops of the lactase enzymes is that you have to do so at least one day ahead of time before consuming the milk – that way, you are giving the supplement more time to make sure it will work properly.

There are also a number of different tablets that you can take right after eating or drinking something with dairy in it to help provide the lactase your body will need.

Option 2 – The power of chocolate

We all know how good chocolate can be and any excuse we have to enjoy it, many of us will. If that is you, then this will be some great news.

There have been a number of scientific and clinical trials where experts have found that the sugars found in cocoa powder, or any other type of powdered chocolate, can help one properly process lactose within the digestive tract.

What happens is that the stomach’s rate in which it empties the digested foods into the next step inside the intestines is done more slowly than normal.

This change in the emptying rate will actually allow lesser amounts of that lactose to enter your intestinal tract at one time and that means your symptoms will be less often or might not even pop up at all.

If you don’t like mixing the powder with your milk, you can get the same benefits while also making sure you are getting the calcium and protein to your bones and muscles faster thanks to the sugar from the added cocoa.

Option 3 – Open up some of those canned food items

Maybe not the most attractive concept, but eating sardines is just as effective to get everything that you need without having to go through the pains of dairy – a great way to avoid getting the symptoms in the first place.

Sardines have a large amount of calcium, which might be something you don’t have enough of if you are actually avoiding milk and dairy altogether.

There are also a number of different canned foods that offer some of the same healing benefits you can get from calcium without dealing with having to ingest more dairy.

These include salmon, vegetables that are dark green and leafy, nuts, pre-cooked lentils (i.e. beans), dried fruit and tofu.

Option 4 – If you’re going with cheese, go hard

You might be wondering why one would recommend consuming any form of dairy if that’s what is actually causing you to have the lactose intolerance issues you are dealing with in the first place.

But there are some cheeses that you can actually enjoy without having to deal with the effects that the lactose is causing within your digestive system.

If you go with a hard cheese like Swiss, cheddar or Colby, you are selecting a type that does not have a lot of lactose within it.

Not as much as some of the softer cheeses like mozzarella, brie or any other kind that has more of a creamy consistency.

You should also avoid any form of cottage cheese and anything that is processed (i.e. those yellow, individually wrapped squares). The taste might not be as good, but these cheeses are actually quite wonderful in a number of sandwiches, burgers, and wraps.

Options 5 – My big fat Greek yogurt

With the most scientific support after several clinical research trials, yogurt is found to have many amounts of active cultures that provide the calcium your body needs to fight off the effects of lactose intolerance, despite the fact that there is still a lot of lactose in yogurt because it is a dairy product.

So why is yogurt on the list of natural remedies? Because it’s a food that doesn’t need artificial sweeteners or other synthetic ingredients to compose the yogurt.

It also has the right amount of lactase enzymes inside with those live cultures that can help you properly digest most dairy that you consume.

There are even more enzymes and cultures when you go with a Greek yogurt instead of just any other type you find in the grocery store.

Option 6 – Add probiotics as a natural supplement

Research trials have discovered that using probiotics with foods like the yogurt mentioned earlier will help increase the production of several beneficial bacteria that will help reduce the effects and symptoms of lactose intolerance.

These bacteria strains will also help you be able to improve the metabolic activity of microbiota inside your colon and can also help your body be more able to create more lactase to better process the incoming lactose.

The more you use probiotics as a daily supplement, the more your stomach and digestive system will be better equipped for taking on the lactose you consume in the future – which will mean the end of dealing with the pains, aches and other lactose intolerance symptoms so that you can live a much healthier and care-free life.

When starting to add probiotics to your daily routine, you will want to start off slow and work your way up gradually so that you can steadily build up your tolerance to dairy products.

You have to crawl before your stand and walk. A good one to start out with is a probiotic that comes with a bifidobacterium lignum that helps the body’s metabolism better process the lactose you consumed.

Option 7 – Organic and raw provides 100 percent natural benefits

There has been scientific research that has found that drinking raw milk, as opposed to the processed, pasteurized and homogenized milk in most grocery stores, can be easily enjoyed and digested by people who have lactose intolerance.

There are some experts who do have questions about this method because there are mixed reviews.

Yet on paper, the raw milk has a lot more natural cultures and enzymes that are kept straight from the cow and put in the bottle.

Because of that, there are a number of families that prefer to go with the raw milk option.

These can be found in a variety of natural health food stores, just expect to pay a much higher price than you would for the Vitamin D milk found in the normal neighborhood grocery store.

Option 8 – Add some apple cider vinegar

Apple cider vinegar is considered one of the best things to help you decrease or completely eliminate the issues of lactose intolerance thanks to the ability to balance out one’s digestive system and help in dealing with the lactose processing through the colon.

The way you want to take this is to add about a quarter of a teaspoon of baking soda to the apple cider vinegar and then combining that mixture with a glass of water.

You may want to plan for several weeks of this daily use before starting to notice the improvements in your ability to digest dairy products – that means you need to remain committed to the treatment and try not to skip a day.

Option 9 – Coconut oil as a replacement for daily use

This is one of the easiest ways to help reduce the lactose intolerance that you might be dealing with by adding about one or two teaspoons of virgin coconut oil in your daily routine.

For one thing, there are a number of different ways you can add coconut oil to your cooking.

For example, you can use it as a replacement for butter when making macaroni and cheese, baking cookies or other desserts.

You can also use this oil to help grease a skillet for pancakes for an even tastier treat at breakfast.

Option 10 – Adding fermented foods to your diet

In addition to adding fermented dairy products with the live cultures in your yogurt, you can also try eating a number of good bacteria found in fermented foods that use cabbage to create popular items like sauerkraut and kimchi in an effort to help your stomach be better able to have the enzymes for proper digestion and to make it regulated more efficiently.

You can also drink juice from sauerkraut for added benefits. This can take a few weeks to start seeing the effects.

There are a lot of different ways that you can naturally reduce and prevent the negative effects that lactose intolerance can bring to your body.

So how do you choose the best option that is the most efficient in working for you?

That can be quite a challenging question to answer when you consider that each individual body can have a unique physical composition.

The best thing that you can do in your search for what works is to try out different items and foods.

When doing this, give each method some time and chronicle the effects of the day so that you can track and compare what each method does and doesn’t do.

You are also giving yourself, and your digestive system, a chance to see how you can benefit from including different probiotics and combining them with bacteria that ferment the lactose for a better serving of yogurt.

You may find that you don’t like the taste of the yogurt mixture and would rather eat canned fish.

If it works, go for it. Everyone has different reactions to natural treatment methods, just like they have different food allergies and preferences.

Resources

Treatment & medication

Cutting lactose out of the diet is an option, but patients should make sure they aren’t depriving themselves of calcium and vitamin D, Balzora said.

A study published in the June 2017 issue of the Journal of Nutrition found that those with lactose intolerance that cut milk out of their diet have lower levels of vitamin D in their blood. This study of 1,495 Canadian men and women also found that those who cut out milk were also shorter.

Over-the-counter pills or drops that contain lactase can be taken before meals to help alleviate or eliminate symptoms. For example, Lactaid pills or Lactaid milk allow many people to process dairy products without any difficulty, Balzora said. Some people find that taking probiotics can help them digest lactase better, but Lactaid is really the standard, Balzora said.

However, according to the Mayo Clinic, these products do not help all patients. Adults who are lactose intolerant can ultimately recondition their digestive system to tolerate up to 8.5 fluid oz. (250 milliliters) of milk — about a glass — if they drink the milk in gradually increasing amounts. According to a 21-day intervention study conducted in 2000, most people who do this will experience minimal or no discomfort.

A 2017 study by scientists at the North Carolina School of Medicine and North Carolina State University found that probiotics may also be a useful treatment. The study, published in the journal Proceedings of the National Academy of Sciences, found that 70 percent of those that took prebiotics for 35 days had reduced abdominal pain when they resumed drinking milk. Ninety percent of the subjects showed a significant increase in lactose fermenting bacteria, as well.

Coping strategies

Lactose intolerance can be treated with simple dietary changes. The most straightforward way is for a person to reduce the amount of milk or daily products in his or her diet. Also, it may help to divide daily milk and dairy products into several small portions and consume them with other foods. Processed dairy such as yogurt and cheeses are usually better tolerated, because the lactose has been partially metabolized by bacteria during their preparation.

Foods high in lactose, according to The Cleveland Clinic, are:

  • Milk, milkshakes and other milk-based beverages
  • Foods made with milk
  • Whipping cream and coffee creamer
  • Cheese
  • Ice cream, ice milk, sherbet
  • Puddings, custards
  • Butter
  • Cream soups, cream sauces

There are many products on the market that are lactose-free. This is a good option for those that don’t want to give up their favorite milk products. There are more options on the way. The lactose-free food market is predicted to grow 11.10 percent between 2017 and 2021.

There are also other options, such as rice, soy and almond milk, that can be used as an alternative to cow’s milk. Additionally, there are some milk products that can be easier to digest. According to the NIH, they include:

  • Buttermilk and cheeses
  • Fermented milk products, like yogurt
  • Goat’s milk
  • Ice cream
  • Milkshakes
  • Aged or hard cheeses

Additional reporting by Alina Bradford, Live Science Contributor.

Additional resources

  • NIH: Lactose Intolerance
  • The Mayo Clinic: Lactose Intolerance
  • The National Institute of Diabetes and Digestive and Kidney Diseases Health Information Center: Lactose Intolerance

Lactose Intolerance: What It Is and How To Cope

When you’re lactose intolerant, eating dairy products can bring on a whole host of unpleasant symptoms.

What is lactose?

Lactose is the naturally-occurring sugar found in milk and most dairy products (just like fructose is the sugar found in fruit). Lactose and fructose are different from added sugar, which is added during cooking or processing.

What does it mean to be “lactose intolerant?”

Most people have an enzyme in their gut called lactase, which helps to digest lactose. People with lactose intolerance don’t have enough lactase to fully digest lactose, so they get stomach aches, bloating, gas or diarrhea after eating dairy products.

Is lactose intolerance the same as a milk allergy?

No. These two conditions are completely different. A milk allergy is an allergy to the protein component in milk, whereas lactose intolerance is an inability to digest the sugar component of milk. Here’s more on the difference between an intolerance and allergy.

What can you do if you’re lactose intolerant?

Different people have different levels of sensitivity to lactose. Some people may react severely and decide to avoid dairy altogether, whereas others can tolerate dairy in small amounts. Here are a few options for how to deal:

  1. Buy lactose-free milk, cream, ice cream, etc.
  2. Eat dairy products in small amounts.
  3. Choose low-lactose dairy products, like yogurt, kefir and aged cheeses.
  4. Take a lactase pill, like Lactaid, before eating dairy.
  5. Avoid processed foods that contain whey protein concentrate and other dairy derivatives.
  6. Avoid dairy products altogether.

It may take some trial and error to see which of these options will work best for you. Writing down exactly what you eat and when you experience symptoms for a few weeks can help you determine what most triggers your symptoms.

What can you eat if you’re lactose intolerant?
  1. Yogurt. Most people with lactose intolerance can eat yogurt. The good bacteria (live, active cultures) found in yogurt will help digest the lactose for you. Choose a high quality yogurt or Greek yogurt (here’s a guide to help) with very few ingredients.
  2. Kefir. Kefir is like a drinkable yogurt, but with even more probiotics for even better digestion.
  3. Aged cheeses. The harder a cheese, the less lactose it has. Lactose is found in the watery part of milk, and since harder cheeses have less liquid, they naturally contain less lactose. Extra sharp cheddar, Parmesan, Pecorino, aged gouda and other very hard cheeses are nearly lactose-free.
  4. Lactase-fortified dairy products. Lactaid is the most well-known lactose-free milk, but many brands now offer similar products, which makes lactose-free life a lot easier. If you like to buy organic, Organic Valley (pictured above) has some great lactose-free organic dairy products.
  5. Low-fat dairy products in small amounts. Low-fat dairy products can be easier on the system when eaten in small amounts and/or combined with other foods at a meal. (These foods are also higher in protein and calcium than high-fat dairy). Start with small portions so you can see what works for you.
  6. Dairy products eaten with a lactase pill. Not everyone finds lactase pills helpful, but they’re worth a try. Pop a lactase pill 30-60 minutes before consuming dairy to see if this method works for you. (Note: don’t expect lactase to be a miracle pill…in other words avoid downing a huge milkshake after taking a pill).

What foods should be avoided?
  1. Large serving sizes of dairy. Even if you’ve found a food that doesn’t cause bad symptoms, small portions are still best. Your body is more likely to tolerate dairy if you eat only a little at a time.
  2. Very high fat dairy products like ice cream, soft creamy cheeses and cream (or foods made with cream). These actually have less lactose than low-fat products, but tend to be more irritating to those with lactose intolerance or who are sensitive to rich foods. The one exception here is aged cheese, which is high-fat but low-lactose.
  3. Whey protein concentrate. This is a doozy, because it’s added to a lot of processed foods to make them richer and creamier. But it can wreak havoc on a lactose intolerant person’s system (and on a normal person’s system), because it often contains concentrated lactose.
  4. Soft-serve ice cream/frozen yogurt. This is mostly because of reason #3. Many soft-serve desserts, smoothies and protein shakes have significant amounts of whey protein concentrate, and can cause bigtime symptoms. If you love ice cream-style desserts, buy real frozen yogurt from the grocery store (Stonyfield, Julie’s Organic, and Straus Family Creamery all contain live active cultures that will help you digest) or make it yourself.
What milk alternatives are best, if I’m going to avoid dairy?

Here’s a chart of milk alternatives so you can decide which give you the best nutritional bang for your buck.

Disclaimer: This advice should not replace the advice of your doctor or medical provider. These are general recommendations and may or may not be appropriate for you or your health conditions.

Living with lactose intolerance

Food intolerance and food allergies often produce similar symptoms, but they’re not the same. If dairy products leave you feeling gassy and bloated or cause diarrhea or nausea, you may have either condition.

What’s the difference? A dairy allergy is an immune system response to milk protein. In addition to feeling bloated or causing diarrhea, symptoms of a dairy allergy can include hives, wheezing, vomiting, cramps, and skin rashes. Dairy intolerance results from inadequate levels of lactase, the enzyme that breaks down milk sugar. While lactose intolerance can cause a lot of discomfort, it isn’t life threatening, while a milk allergy can be.

The severity of lactose intolerance varies. For some people, consuming any dairy product causes their digestive tracts to rebel. Others can enjoy yogurt, ice cream, or even an occasional glass of milk.

The most successful approach to coping with lactose intolerance is to first avoid all dairy products. If you are lactose intolerant and love milk in all its forms, try experimenting with small amounts of dairy. In general, yogurt, cheese, and sour cream may be easier to tolerate because they contain less lactose than milk. However, several studies suggest that many people who are lactose intolerant can consume the equivalent of eight ounces of milk with no ill effects, and somewhat more when the lactose-containing food is part of a meal.

Supplements containing enzymes produced by lactose-digesting bacteria (Lactaid, Lactrase, others) can be taken as tablets or added to foods. Some milk products (Lactaid, Dairy Ease) to which lactase has been added may contain little or no lactose, and they may taste sweeter than untreated products, because the milk sugar has already been broken down. Probiotics (supplements of beneficial bacteria that normally inhabit the intestines) containing Lactobacillus reuteri may reduce symptoms, but not quite as well as enzyme supplements.

The response to these products is highly individual. What works for your will depend on the amount of lactase your body produces, the type of intestinal bacteria that inhabit your colon, and the product itself. Finding the right approach for you can be a trial-and-error process. While this may take some time and expense, experimenting isn’t likely to be harmful.

For more on food intolerances, buy The Sensitive Gut, a Special Health Report from Harvard Medical School.

Image:iStock

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As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

What to do when you eat dairy and are lactose intolerant

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