Lactose Intolerance

Treatment Overview

If you think you have lactose intolerance, it is a good idea to talk it over with your doctor. Your doctor can make sure that your symptoms are caused by lactose intolerance and not by another problem, such as irritable bowel syndrome, inflammatory bowel disease, overuse of laxatives, or problems digesting foods that contain fructose or sorbitol. Your doctor can also make sure that your lactose intolerance is not related to another health problem.

After being diagnosed with lactose intolerance, you may feel relieved to find out what has been causing your symptoms. You may also feel frustrated by having to deal with this condition for the rest of your life. You may find it reassuring to know that there are many people with lactose intolerance and most can avoid discomfort and still eat or drink some milk products throughout the day.

There are different ways to live with lactose intolerance. What works for one person may not work for another. Because there is no cure for lactose intolerance, controlling your symptoms is mostly up to you. The following tips can help you prevent symptoms of lactose intolerance.

Limit the amount of milk and milk products in your diet. Most people can drink 1 glass of milk each day. This can be a glass of whole, low-fat, or skim milk, because all milk contains the same amount of lactose. Other milk products contain different amounts of lactose:

Lactose and calcium in food

Food	Serving size	Lactose (g)	Calcium (mg)
Milk	240 mL (8 fl oz)	10–12	290–300
Yogourt	240 mL (8 fl oz)	10–15	300–400
Ice cream	240 mL (8 fl oz)	10	160
Hard cheese	30 g (1 oz)	0–1	150–275
Cottage cheese	240 mL (8 fl oz)	3	126–155
Cream cheese	30 g (1 oz)	0.8	23

Foods with less lactose, such as Swiss or cheddar cheese, may not cause problems. If you are not sure whether a milk product causes symptoms, try a small amount and wait to see how you feel before you eat or drink more.

Eat or drink milk and milk products along with other foods. For some people, combining a solid food (like cereal) with a dairy product (like milk) may reduce or eliminate symptoms.

Spread milk or milk products throughout the day. Many people who are lactose-intolerant find it helpful to eat small amounts of lactose-containing products throughout the day instead of larger amounts all at one time.

Eat or drink milk and milk products that have reduced lactose. In most grocery stores, you can buy milk with reduced lactose. Some people like buying this kind of milk and find that it helps control their symptoms. Others find that it tastes too sweet or is too expensive. People with diabetes may find that lactose-reduced milk raises their blood sugar levels higher than normal.

Eat or drink other foods instead of milk and milk products. You can substitute soy milk and soy cheese for milk and milk products. You can also use non-dairy creamers in your coffee. But keep in mind that non-dairy creamers do not contain the same vitamins and minerals as milk, and they may contain more fat than milk.

Use lactase products. Lactase products are dietary supplements that help you digest lactose. There are many different brands of lactase products. Some are pills that you chew (such as LactAid) before you eat or drink milk products. Others are liquids that you can add to milk 24 hours before you drink it. Because products and brands are different, you may want to try a few to see which ones work best for you.

Eat yogourt with live cultures (not pasteurized). Some people who are lactose-intolerant can eat yogourt without problems, especially yogourt with live cultures. Studies have shown that this type of yogourt can help people digest lactose.¹ All yogourts are made with live cultures but many yogourts go through a process called "heat treatment" that kills the bacteria. If you want to be sure you are buying yogourt that still contains live cultures, check the label for the words "active yogourt cultures," "living yogourt cultures," or "contains active cultures."

If you have severe lactose intolerance, you may need to avoid lactose completely. Some medicines and many prepared foods contain lactose. Examples of prepared foods with lactose include breads and baked goods; breakfast cereals and instant breakfast drinks; instant potatoes and instant soups; pancake, cookie, and biscuit mixes; margarine and salad dressings; candies, milk chocolate, and other snacks. Be sure to read labels for lactose and for lactose's "hidden" names, such as:

• Dry milk solids.
• Whey.
• Curds.
• Milk by-products.
• Non-fat dry milk powder.

One of the biggest concerns for people who are lactose-intolerant is making sure they get enough of the nutrients found in milk products, especially calcium. Calcium is especially important for women because it keeps bones strong and reduces the risk of osteoporosis. There are many non-dairy foods that contain calcium, including:

• Broccoli, okra, kale, collards, and turnip greens.
• Canned sardines, tuna, and salmon.
• Calcium-fortified juices and cereals.
• Calcium-fortified soy products such as soy milk, tofu, and soybeans.
• Almonds.

To absorb calcium, your body needs vitamin D. Most people get enough vitamin D by being out in the sun for short periods of time each day. Vitamin D is also found in fortified milk, fortified soy milk, butter, margarine, egg yolks, and liver.

If you don't know whether you are getting enough calcium, vitamin D, and other important nutrients found in milk products such as magnesium, potassium, protein, and riboflavin, talk to your doctor. He or she may recommend that you take a calcium supplement or meet with a registered dietitian to make sure you are getting enough of certain vitamins and minerals.

You should also talk with your doctor if your symptoms do not go away with treatment, if they get worse, or if you develop other symptoms, such as a fever, chills, or severe belly pain or vomiting.

What to think about

Lactose intolerance in newborns of normal birth weight and in babies is rare. But if your child has symptoms of lactose intolerance, see your doctor right away. Diarrhea is particularly dangerous because it can lead to dehydration, a serious problem that requires immediate attention.

Babies who are only fed breast milk do not develop lactose intolerance because breast milk contains lactase, the enzyme that helps digest milk sugar. If your baby is formula-fed and develops lactose intolerance, you can switch to a formula made without lactose. In rare cases, a baby may have a reaction to the proteins in milk, which is a different condition called sensitivity to milk protein.

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Author:	Shannon Erstad, MBA/MPH Ralph Poore	Last Updated: October 3, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
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