Lactose Intolerance and a Healthy Diet

Ditch the Pain, Not the Calcium

-- By Becky Hand, Licensed & Registered Dietitian, with Stepfanie Romine, Staff Writer

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Milk. It does a body good.

Unless it doesn't, that is.

While milk is an excellent source of calcium and protein, up to 75% of the world's population cannot properly digest lactose, the sugar found in milk. When they try, the result is tummy trouble that can range from a mild discomfort to severe pain.

Not drinking milk to appease a sensitive stomach is one option, but the calcium found in milk is essential to good health and a major building block for bones and teeth. It also helps your heart to beat, your muscles to contract (and relax) and your blood to clot.

So what should a person with milk sensitivity do?

Understanding Lactose Intolerance
Lactose intolerance happens when your digestive system lacks the enzyme lactase, which it needs to break down milk sugar (lactose) into simpler forms that can be absorbed into the bloodstream. When the milk sugar is not broken down and absorbed properly, additional water is drawn into the intestinal tract. There, the healthy bacteria found in the intestine ferment the sugar, resulting in symptoms that range in intensity from very mild to severe and usually begin 30 minutes to 2 hours after eating dairy. Gas, nausea, bloating, cramping and diarrhea are the most common symptoms. Lactose intolerance is a matter of degree; some people fall ill after drinking an entire glass of milk, while others would be sick after drinking a small sip.

Production of that important enzyme lactase slows down after age two, but most people don't notice symptoms until they are significantly older. Conditions such as celiac disease, inflammatory bowel disease, and Crohn’s disease can also lead to lactose intolerance. Certain medications or illnesses, such as the flu, can cause temporary lactose intolerance, too.

Caucasians of northern European descent have the lowest incidence of lactose intolerance (about 15%). In contrast, up to 90% of Eastern Asians, 80% of American Indians, 65% of Africans and African-Americans, and 50% of Hispanics have some degree of lactose intolerance, according to Harvard Medical School. Because lactase levels increase during the third trimester of pregnancy, premature infants of all ethnicities at a greater risk of developing the condition.

Today, what is commonly called lactose intolerance is referred to as "lactose maldigestion" by many health professionals. Only a small fraction of people with lactose maldigestion have true intolerance. Most lactose maldigesters are fine unless they eat more than a single serving of dairy products at one sitting. Many people with lower levels of lactase can actually drink up to one cup of milk with a meal without any problems.

Lactose Intolerance Vs. Dairy Allergies: What's the Difference?

Please note that the recommendations in this article are for people with lactose intolerance, not dairy allergies. Lactose intolerance is not the same as a dairy allergy, though they share certain symptoms. Lactose intolerance is a digestive problem, while the immune system triggers serious reactions in people with dairy allergies.

A dairy allergy is an adverse reaction to one or both milk proteins: casein and whey. The body produces antibodies against the proteins, causing rejection. Allergies can result in hives, headaches, eczema, congestion and even respiratory distress, in addition to the gastrointestinal symptoms shared with lactose intolerance. You can only manage dairy allergies with a complete avoidance of dairy; continued consumption of dairy can exacerbate an allergy.

It is therefore very important to get a medical diagnosis if you think you may be lactose intolerant or allergic to dairy products. Other serious health problems have similar symptoms to dairy allergies and intolerances, so avoid self-diagnosis.

Enjoying Dairy Products
Most cases of lactose intolerance are easy to manage, meaning no need to cry over lost milk. These tips will help you keep the dairy and ditch the pain.

Start with a small portion of milk. Slowly increase the serving size of the milk and other milk products you eat. Monitor when symptoms develop. Learn your own limits for how much lactose you can handle at one sitting.
Drink milk with other foods and never on an empty stomach. Solid foods will slow digestion and allow your body more time to digest the lactose, which helps to prevent symptoms.
Say cheese, please. When milk is made into cheese, most of the lactose is removed. Aged hard cheeses, such as cheddar, Colby, Swiss and parmesan, are particularly low in lactose, and therefore more easily tolerated by people with lactose intolerance.
Enjoy yogurt with live, active bacterial cultures. The bacteria in many brands of yogurt provide their own lactose-digesting enzymes and continue to digest the lactose even further once inside your digestive tract. Let the yogurt sit at room temperature for a half-hour before eating it; these healthy bacteria are inactive at refrigerator temperatures.
Purchase reduced-lactose or lactose-free milk in the dairy case. It is an added expense, but it does contain all the same nutrients of regular milk, in a more digestible form.
Lactase enzyme drops are also available at the pharmacy. You can add these drops to milk to break down the lactose.
Dairy digestive supplements or lactase caplets are also available at the pharmacy. Take them according to instructions just before enjoying dairy foods and will help you digest the lactose more easily.

Hidden Sources of Lactose

If you are severely sensitive to lactose, beware of these hidden sources of lactose:

bread and baked goods
breakfast cereals
instant potatoes, soups, and breakfast drinks
margarine
lunch meats (non-kosher)
salad dressings
candies and snacks
mixes for pancakes, biscuits, and cookies
milk chocolate

Getting Your Calcium without Dairy
Learning to understand and manage lactose intolerance makes it easier to get adequate calcium and even—in some cases—eat small amounts of certain dairy foods (see "Enjoying Dairy" below).

Because milk products are such a significant source of calcium in most people's diets, simply removing them can put you at risk for inadequate calcium intake (and the health problems that come with it). If you simply remove milk from your diet, it needs to be replaced with non-dairy sources of calcium, as adults need 1,000-1,200 milligrams of calcium a day.

These days, there are plenty of dairy replacements on the market. The most common dairy analog is soy, and there is a soy version of every dairy product, from yogurt to cheese. Liquid milk replacements are plentiful and diverse: Try soy, almond, oat, rice or hemp milk, which you can use over cereal, when baking, and in pretty much any way you'd use dairy milk. Experiment with brands until you find one you like. You'll most likely find these alternatives in health food stores (or in the health food section of your grocery store). Look for them near other dairy products. Be sure to read labels, selecting only calcium-fortified versions of these non-dairy foods. Choose a milk with 30% on your daily calcium needs in a 1-cup serving, frozen desserts with at least 15% of your daily calcium in a half-cup serving, and non-dairy cheeses with about 20% in a 1-ounce portion to be comparable in nutrition to real milk.

Be sure to monitor your calcium intake using the SparkPeople Nutrition Tracker. If you are still having trouble meeting your calcium needs, follow the advice from your physician about taking an additional calcium supplement. Remember:

A typical multivitamin supplement contains about a third or less of your daily calcium needs (approximately 200-300 milligrams).
Look for a supplement made from calcium carbonate or calcium citrate for best absorption.
Avoid supplements made with bone meal, dolomite, unrefined oyster shell, or coral calcium. These supplements may contain lead or other contaminates.
Do not take more than 500 milligrams of calcium at a time. Your body uses calcium better when you take the supplement in smaller doses throughout the day; it can only absorb so much calcium at once.
Ask your doctor how to stagger your doses if you also take iron supplements or the antibiotic tetracycline because calcium can impede their absorption.

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About The Author

Becky Hand
Becky is a registered and licensed dietitian with almost 20 years of experience. Through her company, An Ounce of Prevention, she makes nutrition principles practical, easy to apply and fun. See all of Becky's articles.

View All Comments (26) Leave a Comment ›

Member Comments

ANDREAYAYA

I've found I can have one dairy containing food (never straight milk or soft cheese or ice cream) if I don't eat any other lactose foods for a week. I also take acidophilus 4x a week to keep my innards healthy. For years I avoided it totally until I learned the importance of a healthy gut. I also eat lots of high fiber foods like beans to keep things "moving!" - 4/11/2013 8:34:52 PM
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LAWLI56

I'm lactose intolerant. I find I get symptoms if Idrink more than 4 fl ozs of milk, a yogurt or soft cheeses so I have soya substitutes. I also like rice milk and goat's milk is ok too. I only eat hard mature cheeses or 85% dark chocolate and I avoid anything else with large amounts of milk or milk products in them.

As for calcium, since I had a gastric bypass I'm prescribed 2 calcium carbonate 1.25g/colecalcife
rol 400iu calcichews at night, so I don't have to worry about that. - 2/1/2013 4:03:07 PM
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LJJ132

I agree. Cow's milk is for baby cows.

There are plenty of vegetable sources of calcium without having to take supplements. It seems a shame to me that most people don't know that they can get calcium from kale and almonds just as easily as they can from cow's milk without all of the dangers of casein, which is a powerful carcinogen.

Don't get me wrong, I used to love milk and cheese, but after learning about all of the harm that it does, I just could not stomach it anymore. It also makes me sad that none of spark's meal plans are dairy free. - 7/17/2012 10:55:01 AM
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OKAYTOKAY

Cow's milk is for baby cows, not humans! I agree with BARBBF!

People who cannot tolerate lactose are the norm! Our bodies slowly turns off the gene to make the lactose enzyme into adulthood after we are weaned off of our mother's milk. Those who can still tolerate milk into adulthood have a mutation that keeps the gene turned on, so they can still break down lactose. - 7/17/2012 8:43:29 AM
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AGIRLCALLEDLUKE

Another hidden source is medication - always check the inactive ingredients. - 5/14/2011 2:41:47 PM
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MISSYGEEN

I sometimes take care of my 5 year old nephew who has always been lactose intolerant. Even the lactose free milk gives him gas. He loves almond milk and ice cream, so I have to buy him sorbet. As I get older I find that I cannot drink it anymore as well. It helps me when I have to take care of him because I am more careful when he is around. This article is very helpful I will share it with his mother, and not to worry I will still encourage her to work with the doctor to find alternatives for him. - 5/14/2011 7:58:23 AM
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JUSFOLK

Thanks for the list of foods one might not consider when seeking to avoid dairy...they can sure wrench you stomach, that's for sure. Although i have a major problem and use Lactaid or Dairy-Ease, I can enjoy yogurt and some cheeses, including cottage cheese. - 5/14/2011 12:21:28 AM
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BASKETLADYBLUE

I am new to this board and and wanted to comment about those of you who have
have problems with cheese. I also had the same issue, but there is a lactose free cheese available. The brand name is Cabot and they are from Vermont but the cheese is available in most grocery stores. I am in PA and I can get in any of our stores around here. I use the seriously sharp and I have no problems after eating it.

I hope this helps

Eileen - 1/23/2011 7:55:00 AM
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SIUSAIDH

Thank you for helping me understand better! I was most likely lactose intolerant my entire life, with severe belly aches that my adoptive parents thought were nerves (and caused nerves!). In my early adult days a doctor told me to "try" eliminating dairy from my diet but, like my parents, I sloughed it off. After childbirth symptoms increased. By early menopause I was fully lactose intolerant but with many respiratory issues. An allergist told me to try lactose free products but I still developed the Asthmatic Bronchitis. That's when he told me I have a Dairy Allergy (and lactose intolerance). I've been about 7 years without dairy now and it is difficult, but tried-and-true, when I have any dairy products, I blossom out with a severe Asthmatic Bronchitis. I didn't understand but your article shed a lot of light on the subject for me. Thanks! - 6/25/2010 11:07:41 AM
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INTEND2LOSE

I had a severe reaction for more than 20 years when I attempted to eat several foods, most especially pork. I eliminated all of them completely from my diet. But now, I have been able to slowly reintroduce them. I do not know - but it has been suggested by doctors - that now that pigs are being fed controlled diets and not refuse/scraps that this has changed the chemical composition of their meat. I have had many others who were just as reactive to pork as I was say that now they can consume some. Granted, there are precatutions I must take - as little grease/oli as possible, etc. But to be able to have sausage or bacon with everyone else for breakfast is a blessing. - 5/25/2010 5:23:37 AM
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BARBBF

I believe that cow's milk is for baby cows. It took me years to realize that I was having stomach discomfort after drinking milk. Milk was "supposed to do the body good". (NO!!!!) Reports published from scientific studies indicate that 70% of African-Americans are lactose intolerant. BUT, there are also other reasons that one might want to avoid dairy products. From Robert Cohen of www.NotMilk.com:

Americans continue to eat increased amounts
of concentrated dairy products containing
enormous amounts of saturated animal fat.

During 1969, the average American drank 229 pounds of whole
milk. By 1999, the average American was drinking just 69
pounds of whole milk per year. Whole milk contains 2.079
grams of saturated animal fat per 100 gram portion.

In 1969, the average American ate ten pounds of cheese.
By 1999, the average American was eating thirty pounds
of cheese per year. (Ten pounds of milk are required
to make one pound of hard cheese.) Wisconsin's cheddar
cheese contains 21.09 grams of saturated animal fat per
100 gram portion. In 2010, the average American will
eat 34 pounds of cheese.

A 2 pound glob of saturated fat multiplied by ten years
of a child's life is equal to 20 pounds. By the time a
child of the 21st century turns 30, he or she will have
eaten 60 pounds more saturated fat than a child of the 60s.

Got liposuction? Got obesity epidemics?
Got heart disease and strokes?

Robert Cohen
http://www.notm
ilk.com - 5/4/2010 6:13:12 PM
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LALALAURA3

I'm lactose intolerant and stay away from most dairy. I do use lactose free milk, and it actually tastes a lot better to me than regular milk.

- 4/18/2010 12:00:32 AM
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TWOOFTHREE

I'm lactose intolerant so avoid milk. I can eat cheese (proper cheese) to some extent since the lactose content in cheese (especially aged cheeses) tends to be quite low.

but yoghurt and milk . . . I have to be very careful. Which is a shame as I do love cream. - 4/14/2010 2:26:28 PM
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CEIGSTI

I'm lactose intolerant. I can eat small doses of cheese. But drinking milk puts under. Some smoothies with milk in them do too. I mainly get the gas and multiple trips tothebathroom. I usually just avoid milk as icant even stand the taste of white milk. In cereals I use milk but drain the spoon of milk and don't drink the leftover. I'm usually ok with that. But a full glass comes with consequences. Lactaid milk works. I just am not a fan of the taste of any milk unless of course it is flavored. - 3/24/2010 10:18:11 PM
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LUCKYLADYKATIE

I'm a little disappointed that they don't mention other vegetable sources of calcium such as dark leefy green, broccoli, nopales. I'm very very sensitive to small amounts of dairy, so I can't "cheat" even with yogurt. - 12/22/2009 7:11:30 PM
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