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Lactose Intolerance

Updated on February 18, 2018

The Basics

Lactose is a natural sugar found in milk and other dairy products. Intolerance to lactose can have some symptoms that mimic those of a milk allergy. In fact, these symptoms are not a true allergy. They are caused because the body does not posses adequate enzyme, lactase, to break down the sugar in the intestinal tract. When lactose is not properly digested, symptoms of abdominal bloating, cramping, and diarrhea can result.

Lactase deficiency is prevalent in adults worldwide, with estimates that as much as 70% are affected. It may be permanent or temporary. Primary lactase deficiency is the gradual lose of lactase that has been known to occur with age but also in racial groups. Primary lactase deficiency is thought to be permanent. Secondary lactase deficiency occurs as a result of another medical condition or illness that impairs the normal activity of the digestive system. This type of deficiency may only be temporary. The conditions most often associated with secondary lactase deficiency are celiac disease, irritable bowel, Crohn's disease, gastroenteritis, post gastrointestinal surgery, and irritation to the lining of the gastrointestinal tract by certain medications.

The lactose tolerance test is used to diagnose lactose intolerance. During this test, a person consumes a large dose of lactose, equivalent to four glasses of milk. Three parameters confirm a lactose intolerance. An inadequate rise in blood glucose, presence of physical symptoms, as well as a positive breath hydrogen test all indicate that lactose is not being digested.

Management of lactose intolerance includes avoidance or limitation of foods containing lactose. Some individuals may tolerate small amounts of foods containing lactose especially when consumed with other foods rather than on an empty stomach. Also, some may be able to tolerate foods that have been produced to be low lactose, such as milk treated to breakdown the lactose. Others may be successful using an oral lactase enzyme taken with all dairy products.

In addition to dairy products, foods that often contain lactose are beverage mixes, breads, cakes, candies, cereals, cookies, cream soups, desserts, diet foods, frostings, frozen entrees, high protein foods, pastries, prepared foods, processed meats, salad dressings, sauces and gravies, and sherbet. ยท Milk products with active cultures, such as yogurt, may be tolerated by some people with lactose intolerance. Active cultures help to breakdown lactose in these products. Similarly, heated milk products may be tolerated better than cold milk products.

Eliminating dairy products require careful menu planning. Decreasing your intake of dairy can result in reduction of important nutrients in the diet. If you are not able to tolerate milk products in your diet, discuss with your physician or dietitian your need to maintain adequate intake of protein, calcium, vitamin A, vitamin D, riboflavin, pantothenic acid, and phosphorous. If reintroducing lactose into your diet after secondary deficiency, increasing your lactose consumption slowly may help tolerance.

Reintroducing Lactose

  • Start with low lactose milk products, such as aged cheeses or low lactose milk
  • Go slowly, introducing foods in small quantities, one at a time
  • Eat lactose containing foods with other foods, not on an empty stomach

Label Reading

The amount of lactose in foods can vary from trace to large amounts. People experiencing lactose intolerance, therefore, may tolerate some milk products while not tolerating others. Moreover, even persons diagnosed with lactose intolerance have been shown to tolerate some amounts of lactose. This is especially true when eaten with other foods or active cultures, such as yogurt.

Even with familiar brands, it is very important to read all labels carefully prior to buying or eating a food. Food manufacturers frequently change suppliers and ingredients. It is equally important to read labels when changing brands. Different brands of the same type of food may contain different ingredients.

Review the list of common foods and milk ingredients and help take the guess work out of label reading. Keep this list handy, you never know when you will need to read a food label.

Lactose Content of Foods

High Lactose Foods
Low Lactose Foods
acidophilus milk
processed cheese
aged cheese
buttermilk solids
blue cheese
cultured milk
parmesan cheese
condensed milk
swiss cheese
dry milk solids
american chesse
evaporated milk
sharp cheddar cheese
fat free milk
artificial butter
low fat milk
artificial butter flavor
malted milk
milk powder
butter fat
milk solid
butter flavored oil
milk solid pastes
butter solids
nonfat dry milk
whipped butter
nonfat milk
nonfat milk solids
whey hydrolysate
powdered milk
whey protein hydrolysate
skim milk
whey protein concentrate
skim milk powder
cured whey
whole milk
delactosed whey
1% milk
demineralized whey
2% milk
hydrolyzed whey
whipped cream
powdered whey
heavy cream
sweet dairy whey
whey protein
acid whey
half & half
whey powder
sweetened condensed milk
whey solids
cream cheese
yogurt powder
processed cheese food
cheese spread
sour cream
imitation sour cream
cottage cheese
ricotta cheese
ice cream
ice milk
frozen yogurt


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