Lactose Intolerance

By Barbara Gordon, RDN, LD
Woman upset stomach | Lactose Intolerance

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Lactose intolerance is a problem digesting foods that contain lactose. Lactose is a naturally occurring sugar found in dairy products such as milk, yogurt and cheese. Many people are able to have these foods and beverages without problem, but some individuals are unable to break this sugar down.   

Lactose intolerance runs in families—thus if your parents or siblings are affected your risk may be higher. The severity of the condition varies by individual. Different people may have different tolerances for foods and beverages that contain lactose.

Certain health conditions also may lead to lactose intolerance as the result of intestinal damage. For example, celiac disease, some types of cancer treatment and gastrointestinal surgery. As someone recovers from these conditions, they may be able to go back to consuming foods and drinks that contain lactose.

Diagnosis

People with lactose intolerance experience a range of digestive complaints after eating foods or consuming drinks that contain lactose. Symptoms may include:

  • Bloating
  • Diarrhea
  • Gas
  • Nausea
  • Stomach pain

Your health care provider may ask you if certain foods upset your stomach or cause irregular bowel patterns. Often people with lactose intolerance are aware that specific foods and drinks appear to cause GI distress.  The provider may also ask if anyone in your family has food intolerances.

Your physician might order a hydrogen breath test to help diagnose lactose intolerance. Or, they may refer you to a registered dietitian nutritionist, or RDN. An RDN can help you determine how much lactose you may be able to tolerate on a regular basis and ensure you’re getting an adequate amount of nutrients that are needed for good health.

Lactose-Controlled Diet

If you are lactose intolerant, you will need to limit foods containing this milk sugar.

Most people with lactose intolerance can consume small amounts of lactose without experiencing symptoms. Research suggests that the equivalent of one glass of milk per day may be tolerable for many individuals who are lactose intolerant. Many people with lactose intolerance are also able to enjoy yogurt and hard cheeses, such as cheddar or Swiss, without experiencing symptoms.

Sources of Lactose

Milk-based products. This includes milk, cheese, yogurt, cottage cheese and butter, as well as whipped cream, half-and-half, dry milk powder, evaporated and condensed milks. 

Packaged and prepared foods also may contain lactose. Reading the ingredient list can help you identify if a food contains lactose. Dairy products may be used as an ingredient in a variety of foods, including breads, waffles, cakes, instant potatoes, cream soups, protein bars and meal replacement shakes. Lactose may also be present in unexpected items such as non-dairy creamers, margarine and deli meats.

Medicines may contain lactose. If you take prescription or over-the-counter drugs, talk with your health care provider.  Ask if any of these products contain lactose and if the amount might be bothersome to you.

Getting the Nutrients That You Need

Milk and dairy products are common sources of calcium for many people in the United States and are often fortified with vitamin D. If you’re reducing your dairy intake, it’s important to choose other sources of calcium and vitamin D.

Get calcium and vitamin D from foods that do not contain lactose.

Lactose-free versions of dairy products are available in most supermarkets. These products offer a similar amount of calcium as their milk and dairy counterparts. A combination of other foods also may help you to meet your calcium needs throughout the day, including:

  • Fish with edible, soft bones, such as canned salmon or sardines
  • Dried beans
  • Broccoli and leafy green vegetables, such as kale and collard greens
  • Calcium-fortified beverages and foods, such as 100% orange juice, soy milk and tofu
  • Almonds

If you choose lactose-free dairy products, they may already be fortified with vitamin D. Other sources of this nutrient can be gotten from:

  • Eggs
  • Fortified 100% orange juice
  • Salmon and other fatty fishes

Check the Nutrition Facts Label. Sometimes calcium is added to non-dairy beverages made from nuts or rice, as well as 100% fruit juices and cereals. Checking the Nutrition Facts Label is a great way to find out if a food or beverage provides calcium or vitamin D.

Find an Expert

Want help figuring out what foods you may safely enjoy because of a lactose intolerance?  The Academy of Nutrition and Dietetics has a searchable database of RDNs. Enter your zip code to find a list of RDNs in your area.

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Need serious help making a plan? The nutrition experts in our professional membership are ready to help you create the change to improve your life.

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