What do you know about lactose-free diets? Lactose is a type of sugar that you’ll find in milk and other dairy products. You need to have an enzyme in your small intestine called lactase to comfortably digest lactose.
Many people produce little or no lactase. If you lack this enzyme, you may experience unpleasant gastrointestinal (GI) symptoms when you consume foods that are high in lactose. By making some changes to your diet, you can avoid this GI distress.
Are you ready to get the scoop on living the lactose-free lifestyle? Here are the questions that I’ll answer in today’s article:
- What are the different reasons you might have lactose intolerance?
- Which evidence-based tests are used to confirm that you are lactose intolerant?
- Do you know the biggest misconception surrounding the lactose-free diet?
- What is the lactose content of some common dairy foods?
- What are some calcium sources that are alternatives to dairy products?
If you think you might be lactose intolerant, we’ll wrap things up with some tips on the next steps to take. Do you already have a diagnosis of lactose intolerance? This article may help you to determine whether there are additional foods you should add or eliminate.
Knowing why you are lactose intolerant can help determine how to treat it
Most people associate lactose intolerance with the description of lactose “non-persistence” below. However, other types of lactose intolerance may occur in an individual. The reasons that a person may be intolerant to lactose include (more information available in this text):
- Lactase non-persistence: another name for this is hypolactasia. This refers to a reduction in the production of lactase that commonly occurs after weaning.
- Secondary lactose intolerance: is also known as acquired intolerance or secondary lactase deficiency. This type of lactose intolerance is the consequence of another condition. This can include bacterial infections, viral infections, antibiotic use, intestinal trauma, and certain gastrointestinal disorders such as irritable bowel syndrome (IBS).
- Congenital lactose intolerance: is also called primary or genetic lactose intolerance. This is a rare condition that is present at birth. It has a low incidence in children.
The information in this article is for those with lactase non-persistence since it is a common type of lactose intolerance. After weaning, about 75% of the human population experiences a decline in lactase production. Certain populations of adults are more likely to experience hypolactasia than others.
Lactose intolerance is highly prevalent in those of Native American, East Asian, West African, and Latino descent. (Certain groups within these larger populations have much higher rates of lactose tolerance than others.) Denmark and Sweden have the highest frequency of persons who are tolerant of lactose, at 97%.
Getting an evidence-based test for lactose intolerance is a smart move
If you think that you may be lactose intolerant, it is important to consult with your physician about getting tested. Trying to diagnose yourself with this condition may lead you to cut health-promoting foods out of your diet unnecessarily. Additionally, you might miss underlying medical conditions that may be the root of your gastrointestinal symptoms.
Two tests that are common to diagnose lactose malabsorption are the hydrogen breath test and the lactose tolerance test. Simple descriptions of each of these tests follow so that you know what to expect.
With the hydrogen breath test, you will fast and then consume a dose of lactose. If you cannot properly digest the lactose, it will ferment in your colon.
You will exhale some of the hydrogens that is produced in this fermentation process. The hydrogen breath test can detect this increased level of hydrogen 1-1.5 hours after you ingest the lactose. A significant increase in breath hydrogen is associated with lactose malabsorption.
The hydrogen breath test is not right for every situation. If you are taking certain antibiotics, you may have false-negative results. On the other hand, bacterial overgrowth may result in a false-positive.
With the lactose tolerance test, you are given a dose of lactose. If you are making enough lactase, your blood sugar will increase. This reflects the breakdown of lactose into glucose and galactose. If you are deficient in lactase, your blood sugar will not rise because your body did not absorb the lactose.
The limitation of the lactose tolerance test is that it is not specific or sensitive. This means that it produces many false positives and false negatives.
It is possible to be lactase deficient without outward symptoms if you already consume a diet with little lactose. Also, people experience different degrees of lactose tolerance, as I will cover below.
Avoiding this major misconception concerning lactose intolerance may mean more delicious foods for you
One of the biggest misconceptions surrounding the lactose-free diet is that you must give up all dairy foods. Lactose intolerance is not the same thing as a milk allergy. Food intolerances do not involve the immune system, unlike food allergies.
Those with a milk allergy must give up all products that contain milk or milk derivatives to avoid an adverse reaction. If you are allergic to milk, you must adhere to this dietary restriction. In cases of severe allergy, exposure to the food may result in a life-threatening reaction.
In contrast to milk allergy, many with lactose intolerance may be more correctly considered to have limited lactose tolerance. Most people who maldigest lactose can include some lactose in their diet without adverse effects. A lactose-free diet is not necessarily a dairy-free diet.
When introduced gradually, the person may be able to tolerate and adapt to 12 grams or more of lactose daily. This is the amount of lactose in one cup of full-lactose cow’s milk. It is thought that this improved tolerance is due to changes in the gut microbiome, not increased lactase production.
Consuming other foods with the foods containing lactose is a strategy that may help you to have more comfortable digestion. The other foods help to slow the transit time of the lactose-containing foods in your system.
Lactose-free milk is widely available so that those with limited lactose tolerance do not have to give up dairy milk. One popular brand of lactose-free dairy products is Lactaid.
In addition to calcium, dairy products contain riboflavin, iodine, vitamin K2, and other nutrients that are often not added to alternative products. Choosing lactose-free dairy milk is one of the simplest ways to ensure you are getting a wide range of nutrients.
If you are on a low-carb diet, know that lactose-free milk has about the same amount of carbs as regular milk. To make lactose-free milk, producers add lactase to full-lactose milk. The lactose is broken down into glucose and galactose in this process, making it easier to digest.
Your taste buds may perceive lactose-free milk as a tasting sweeter than the full-lactose varieties. This is due to differences in types of sugar, not differences in the amount of sugar present. Lactose-free and full-lactose milk contains about the same amount of natural sugars, as long as there are no added sweeteners.
There are skim, low-fat, and whole milk varieties of lactose-free milk available to meet your needs. Flavored lactose-free milk is another option for those looking for a treat that contains protein and calcium.
Lactase supplements are also available for those with limited lactose tolerance who do not wish to make dietary modifications. Taking a lactase supplement before consuming dairy products may help a person to digest lactose more comfortably.
Some dairy foods may be nicer to your gastrointestinal tract than others
The lactose content of the most common dairy foods varies widely. In addition to paying heed to the lactose content, consider whether it is a fermented dairy product. You may be able to comfortably digest cultured yogurt, even though the lactose content is higher than some other options.
Here is a list of the lactose content of some common dairy foods. If you have limited lactose tolerance and are trying to introduce dairy, start with items with lower lactose first. (A more comprehensive list of lactose-containing foods is available in this text.)
- Cow’s milk (includes whole, 2%, 1%, skim, and sweetened varieties): 1 cup contains 10-12 grams of lactose
- Yogurt (cultured, low-fat): 1 cup offers 5-10 grams of lactose (In comparison, this text says that whole milk yogurt provides 10-12 grams of lactose per cup.)
- Buttermilk: 1 cup provides 10 grams of lactose
- Butter and margarine: 1 teaspoon has a trace amount of lactose
- Cheese: 1 ounce offers 0-2 grams of lactose (hard, aged cheeses tend to be the best choice for those with limited lactose tolerance)
- Cottage cheese: ½ cup provides 2-3 grams of lactose
- Heavy whipping cream: ½ cup offers 3-4 grams of lactose
- Cream cheese: 1 ounce offers 1 gram of lactose
- Evaporated milk: 1 cup contains 24 grams of lactose
- Ice cream: ½ cup provides 6 grams of lactose
- Nonfat dry milk powder (un-reconstituted): 1 cup offers 62 grams of lactose
- Sour cream: ½ cup provides 4 grams of lactose
- Sweetened condensed milk: 1 cup contains 40 grams of lactose
As you can see, some of these dairy products are much better choices for those with limited lactose tolerance than others. While hard, aged cheese may fit into your diet, you should steer clear of evaporated milk and sweetened condensed milk.
Try substituting lactose-free milk or soymilk for evaporated milk in recipes. Adding one tablespoon of lemon juice or vinegar to lactose-free milk or soymilk can serve as a buttermilk alternative. There are many non-dairy alternatives available to dairy-based whipped creams.
Don’t forget that products such as store-bought bread, cookies, cakes, cereals, soups, and candies may contain hidden sources of lactose. Reading the labels of the products you are planning to purchase can help you maintain this diet. Heating milk, such as in a soup, does not change its lactose content.
Don’t miss out on this tasty calcium-packed and dairy-free options
If dairy products don’t fit with your dietary preferences, there are other non-dairy sources of calcium that are available. Consider adding some of these foods to your diet to get more of this bone health-supporting nutrient:
- Sardines or salmon (canned with the bones)
- Calcium-fortified tofu
- Turnip greens
- Calcium-fortified orange juice
- Calcium-fortified soymilk
If you depend on fortified products as a source of calcium, checking the food labels is essential. There are substantial differences in calcium content between brands of soymilk, orange juice, tofu, and other products. If you do not confirm that the product contains calcium, you may fall short on this micronutrient in your diet.
I maintain a list of dairy alternatives that are comparable to cow’s milk products in calcium and protein content. You may access the list here. This list is not exhaustive; there are most likely other calcium and protein-packed products available in your location.
Please keep in mind that these products are probably not entirely nutritionally equivalent to dairy products. By eating a wide variety of nutrient-rich foods, you can help ensure you are getting the essential nutrients you need. This general rule of thumb applies whether you are following a lactose-free diet or not.
High-risk groups who have limited lactose tolerance should receive nutritional counseling to help formulate a calcium-rich diet. These groups include children, teens, and pregnant women.
Failing to consume adequate calcium places an individual at risk for osteoporosis and bone fractures. Why take the risk?
If you think you might be one of the many adults with limited lactose tolerance, do not sweat it! The first step is to check in with your physician for a formal diagnosis.
If your testing comes back positive for this condition, following the tips above can help you to maintain a low-lactose diet. You have many choices available, such as using lactose-free milk or calcium-rich non-dairy options. A registered dietitian can help if you are struggling after a diagnosis of lactose intolerance.
There is no one food that we all must eat to maintain good health. Base your food choices on your essential nutrient needs, medical needs, personal preferences, and other individual factors. Accounting for these issues can help you build a meal plan that best supports your health.
Summer is a registered dietitian located in Avon, Connecticut where she specializes in weight management, special diets, general nutrition, and avoidant/restrictive food intake disorder (ARFID). She is the developer and content creator behind the Summer Yule Nutrition website, where she shares evidence-based information on hot topics in food and nutrition.