Lactose Intolerance Diet

According to the National Institutes of Health, between 30 and 50 million Americans suffer from lactose intolerance. Lactose intolerance affects people differently; some people can tolerate lactose in smaller servings, while others cannot digest any lactose.

[Read more about Lactose Intolerance.]
Finding just the right diet after a diagnosis of lactose intolerance, therefore, will be different for each person. People who have trouble digesting lactose will have to learn which dairy products and other foods they can eat without discomfort and which they should avoid.

Why is changing my diet important?
First of all, removing lactose from your diet, especially for those highly intolerant of it, is no easy task. In addition to the obvious dairy products to eliminate, you will need to look for hidden lactose – dairy products used as an ingredient in other foods. (See Hidden Lactose section, below.)

You’ll also need to be careful when removing lactose from your diet is because milk and milk products such as yogurt, ice cream and cheese contribute 73 percent of the calcium in the average American’s diet. Excluding these foods can leave you without enough calcium in your diet. Calcium is essential for the growth and repair of bones throughout life. In your early years, you need calcium to build strong bones as you grow. In the middle and later years, a shortage of calcium may lead to thin, fragile bones that break easily – a condition called osteoporosis. A concern, then, for both children and adults with lactose intolerance, is getting enough calcium in a diet that includes little or no milk.

What changes can I make?
If you are highly lactose intolerant and not able to digest any lactose, you’ll likely have to make some major changes in your eating habits, to remove all dairy and dairy-derivative ingredients from the foods you eat. Most people, however, are not completely lactose intolerant and can live quite comfortably by making a few modifications to the foods they choose.

• Lactase supplements. There are a variety of lactase supplements available over-the-counter today, made especially for those who have a hard time digesting lactose. They contain they enzyme lactase, which is either missing from your digestive tract, or isn’t there in sufficient quantities. By adding lactase, you are helping your body digest the lactose in foods. The most common brand name of lactase supplement is Lactaid, but similar products are made by a number of manufacturers, and many large chain stores also market this under their "house brand" names.
• Lactase caplets (or tablets): Take this supplement just before eating a meal containing dairy ingredients and you’ll have a much easier time digesting your meal (or treat!). Available in caplets and chewable tablets.
• Lactase drops: Add these drops to a container of milk to begin breaking down the milk sugars before you drink it.
• Lactase-added milk: Lactaid sells pre-mixed milk in the dairy section of your grocery store that already contains the lactase enzyme. This may be more expensive than regular milk.

Other options:

• Yogurt: Yogurt contains a live bacteria culture, called acidophilus, which begins breaking down milk sugars. Many people who can’t drink milk find that they can tolerate yogurt well.
• Sweet Acidophilus Milk: Sold in cartons in the dairy section at your grocery store, this milk contains the same acidophilus bacteria found in yogurt, so it has milk sugars that have already begun breaking down into simpler sugars your system can digest. The cost is similar to regular milk, and it tastes like regular milk.
• Soy Milk/Cheese/Yogurt: In the past, these foods were only available at health-food stores, but today you can also find a small selection at your neighborhood grocer. Some are located on the shelf right next to their milk-based counterparts (like yogurt), while others are located in special sections of the store alongside foods for people with other special health concerns (like sugar-free foods, organic products, etc.). Soy milk may be refrigerated, or in cartons on a store shelf.
• Cheese: (especially aged cheese, like cheddar or parmesan) contains little lactose, and many people who can’t drink milk find they can digest small quantities of cheese, especially if eaten with other foods, rather than alone.
• Lactose-free or Reduced Lactose foods: Several manufacturers have begun selling lactose-free versions of dairy foods, such as cheeses, as well as lactose-free foods that typically contain dairy ingredients, such as cookies, puddings, and salad dressings. Look for these in the same places you might find soy-based products. (See above.)
• Eating or drinking dairy products in smaller quantities. Have fewer glasses of milk in a day, and/or smaller amounts in each glass, or maybe a glass in the morning and one with dinner, and have a yogurt (which is easier to digest) at lunch time.
• Eating or drinking dairy products along with other foods. Many people find they can tolerate dairy products if they consume them along with other non-dairy foods. For instance, someone who can’t drink a large glass of milk might be able to eat a bowl of cereal with milk poured on it, or eat cheese when it’s on a pizza, but not cheese alone.
• Look at recipes from other cultures for new ideas. A large percentage of people from Asia and Africa are lactose intolerant, so many of the recipes originating from these regions are high in protein and other necessary nutrients, but contain little or no dairy ingredients.

How much calcium do I need?
The amount of calcium a person needs to maintain good health varies by age group:

Also, pregnant and nursing women under 19 need 1,300 mg daily, while pregnant and nursing women over 19 need 1,000 mg.

Good sources of calcium
When planning meals, make sure that each day's menu includes enough calcium, even if you’re not eating any dairy products. Many nondairy foods are high in calcium. Green vegetables, such as broccoli and kale, and fish with soft, edible bones, such as salmon and sardines, are excellent sources of calcium. To help in planning a high-calcium and low-lactose diet, the table below lists some common foods that are good sources of dietary calcium and shows how much lactose they contain.

Recent research shows that yogurt with active cultures may be a good source of calcium for many people with lactose intolerance, even though it is fairly high in lactose. Evidence shows that the bacterial cultures used to make yogurt produce some of the lactase enzyme required for proper digestion.

Calcium and Lactose in Common Foods

Adapted from Manual of Clinical Dietetics. 6th ed. American Dietetic Association, 2000; and Soy Dairy Alternatives. Available at: www.soyfoods.org. Accessed March 5, 2002.

Clearly, many foods can provide the calcium and other nutrients the body needs, even when intake of milk and dairy products is limited. However, factors other than calcium and lactose content should be kept in mind when planning a diet. Some vegetables that are high in calcium (Swiss chard, spinach, and rhubarb, for instance) are not listed in the chart because the body cannot use the calcium they contain. They contain substances called oxalates, which stop calcium absorption.

Calcium is absorbed and used only when there is enough vitamin D in the body. A balanced diet should provide an adequate supply of vitamin D. Sources of vitamin D include eggs and liver. However, sunlight helps the body naturally absorb or synthesize vitamin D, and with enough exposure to the sun, food sources may not be necessary.

What about calcium supplements?
Some people with lactose intolerance may think they are not getting enough calcium and vitamin D in their diet. Talk with your doctor or dietitian may be helpful in deciding whether any dietary supplements are needed. Taking vitamins or minerals of the wrong kind or in the wrong amounts can be harmful. A dietitian can help in planning meals that will provide the most nutrients with the least chance of causing discomfort.

Watch for Hidden Lactose
Although milk and foods made from milk are the only natural sources, lactose is often added to prepared foods. People with very low tolerance for lactose should know about the many food products that may contain even small amounts of lactose, such as:

• bread and other baked goods
• processed breakfast cereals
• instant potatoes, soups, and breakfast drinks
• margarine
• lunch meats (other than kosher)
• salad dressings
• candies and other snacks
• mixes for pancakes, biscuits, and cookies
• powdered meal-replacement supplements

Some products labeled non-dairy, such as powdered coffee creamer and whipped toppings, may also include ingredients that are derived from milk and therefore contain lactose.

Smart shoppers learn to read food labels with care, looking not only for milk and lactose among the contents, but also for such words as:

• butter
• cheese
• cream
• dried/powdered milk
• lactose
• whey
• curds
• milk by-product

If any of these are listed on a label, the product contains lactose.

In addition, lactose is used as the base for more than 20 percent of prescription drugs and about 6 percent of over-the-counter medicines. Many types of birth control pills, for example, contain lactose, as do some tablets for stomach acid and gas. However, these products typically affect only people with severe lactose intolerance.

Points to Remember

• Eat fewer foods with lactose in them, like milk, cheese, and ice cream.
• Find out if you can eat small amounts of food with lactose.
• Read food labels to find out if a food has lactose in it.
• Ask your doctor if you can use a special pill or liquid to help you digest foods with lactose.
• Eat enough foods with calcium, like broccoli.
• Ask your doctor if you need to take a calcium supplement.

For more information
To learn more about this topic, visit these web sites:

WebMD
www.webmd.com

Cleveland Clinic
www.clevelandclinic.org