Walking Guide

Lactose Intolerance and a Healthy Diet

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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Member Comments

I would never try to drink 1 cup of milk in one serving. I can probably deal with 1/3 cup OK. An advantage of lactose intolerance is that I am happy with small (several TBS) servings of ice cream, custard, yogurt, cheesecake, etc. It really takes away the desire to have large servings of some good treats. Report
I am a dairywoman and we have isolated the "A" gene in milk that is giving you trouble. We have bred our cattle to produce mass quantities of milk, however we bred into them the same gene we bred into horses that tend to founder and are classified as "easy keepers". Because everything in the industrial world is closely bred (line bred) most milk has the A1 gene that causes most of this. It ran through the Jersey herds and really hurt their breeding. Now, you can get A2 milk that has consciously cut this from the herd and kept only cattle that have not been adulterated. Look for A2 milk. Report
I am not LI but it was a great article.. Report
Nice article and informative. Didn't realize all the gradations. Report
Good article. Report
good points Report
Thank you for the information! Report
Many people, whether they realize it or not, are sensitive to milk/milk products. It is inflammatory and for those of us with auto-immune diseases, it's just going to aggravate an already overloaded system. Soy is no better. The only calcium you get from the milk alternatives has been added, so just take a supplement. Soy in any form should be avoided due to how it is grown (GMO). It is also mimics estrogen and males should avoid it like the plague! Wonder why you see so many more men with swollen breast tissue? If you eat a wide variety of veggies, you'll get enough calcium without the other complications! Report
Just shouting out a big Thank You foe this information!! Report
My husband can't eat or drink anything dairy. Lactaid milk or yogurt makes him miserable. I bought supplements that was supposed to help but didn't. Now we have gotten away from all dairy products. Report
I forwarded this to my brother, who in his 60's developed lactose intolerance. He was surprised that you did not mention in the article that in an extremely high number of cases, medications (pills) contain lactose - so that a person who is taking a large numebr of pills will probably be consuming a lot of lactose before they even start trying to consume it in foods.
He also was surprised that you make no mention that butter and cottage cheese are fine (note: we are not in the USA so it might be different there).
Just for the record...........
Wishing you all the best of health!
Sue Report
i find that i can drink goats milk i have several places to goats milk alot easier on tummy and taste great with cereal but still small portion only Report
I can not have milk or soy milk. This did not start until last year........ Report
I have found that even with a lactose intolerance/eczem
a caused by milk, my son and I can drink cows milk with no reactions whatsoever...if its Raw milk; no pasteurization or homogenation...ju
st right from the cow. Its still got all the good bacteria that those processes take away...the stuff thats good for your gut, that aids digestion. When you take away the good bacteria during pasteurization it makes it hard to digest the milk itself, which is why so many people have an intolerance. Now I don't know what the concensus on raw milk is here and while I'm a big supporter of it, this in no way means I am trying to tell anyone to drink raw milk...its just what works for us. If you don't like milk, OK, don't drink it. I happen to love it and am overjoyed that we can enjoy it now without any I'll effects! Report
I'm lactose intolerant. I drink almond milk or lactose free milk, which I personally think tastes much better than regular milk. I don't generally have problems with cheese or yogurt as long as I don't eat too much. Ice cream is usually a hit or miss for me regardless of the amount. Some times I can eat it without any problems and then others I have issues with even one spoonful. Report
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About The Author

Becky Hand
Becky Hand
Becky is a registered and licensed dietitian with almost 20 years of experience. A certified health coach through the Cooper Institute with a master's degree in health education, she makes nutrition principles practical, easy-to-apply and fun. See all of Becky's articles.