Understanding and Managing Lactose Intolerance

Lactose is a type of natural sugar found in milk. During digestion, lactose is normally broken down by lactase, an enzyme that is produced in the small intestine. However, some people are deficient in lactase, so they have difficulty digesting lactose, a condition referred to as “lactose intolerance,” or LI. LI can cause a variety of unpleasant symptoms, including abdominal pain, bloating, gas, nausea, and diarrhea, within 30 minutes to two hours after eating lactose-containing foods. It is estimated that as many as 25 percent of all American adults have some degree of LI, although certain ethnic groups, including Native Americans, African Americans, Asian Americans, and Hispanics/Latinos, have a much higher LI rate.


If you are lactose intolerant:

Keep a food journal; write down everything you eat and any symptoms you experience so you can pinpoint foods to avoid.

If you eat few or no dairy foods, ask your doctor about whether you may need to take a calcium supplement.

Have your bone mineral density checked; a diet low in calcium can cause bones to become fragile.

Simple Tests Can Confirm LI

If you suspect you may have LI, ask your doctor to test you. If test results confirm you are lactose intolerant, you will need to make adjustments in your diet. A registered dietitian can help you formulate a dietary plan that will prevent symptoms but ensure that you’re getting all of the essential nutrients you need.

Some people self-diagnose themselves with LI and avoid all dairy products; however, it’s a good idea to have this confirmed by a doctor, so you aren’t unnecessarily following a diet that may be lacking in important nutrients, such as calcium.

Varying Degrees of Intolerance

Lactose-rich foods include milk, cream, ice cream, yogurt, cheese, and butter. In addition, many packaged, prepared foods, such as breads, cookies, pastries, instant potatoes, nutrition bars, processed meats, snack chips, and salad dressings, are made with ingredients that contain lactose (see sidebar).

Not everyone with LI experiences the same symptoms or the same degree of severity. People have varying levels of lactase enzyme production, which causes varying levels of LI, and certain foods are better tolerated by some than others. Many people with LI are able to tolerate yogurt, especially Greek yogurt, since it contains about half the lactose of regular yogurt. Some people with LI also tolerate aged cheeses, such as Parmesan, Swiss, and cheddar. Some people even tolerate ice cream in small quantities.

Eating other foods along with the food that contains lactose also may help minimize symptoms. For example, you may be able to tolerate drinking a small amount of milk with your breakfast cereal or having cheese on a slice of pizza. If you are diagnosed with LI, you can do a trial and error with different types and amounts of dairy foods to determine exactly what you can eat without suffering from symptoms—and you may find you can eat more dairy than you think.

Coping Strategies

If you are lactose intolerant but you enjoy dairy foods, you can try taking lactase enzymes prior to eating foods that contain lactose. One popular brand name is Lactaid®, which is available in tablets and liquid form. These enzymes are available without a prescription and can be found in pharmacies and health food stores. In addition, most supermarkets carry lactose-free milk.

If your diet is dairy-free, be sure to consume a variety of other foods that contain calcium, such as sardines, shellfish, leafy greens such as kale, spinach, and collard greens, broccoli, black-eyed peas and other beans and peas, figs, tofu, and almonds. Some beverages, such as plant-based milks and orange juice, are often fortified with calcium.


When reading a product’s ingredient list to see if it contains lactose, obvious ingredients to look for include milk, butter, and cream, as well as dry milk solids, milk byproducts, and nonfat dry milk powder. Also be alert for whey and curds, which both contain lactose.

Take a closer look at products labeled “non-dairy” before putting them in your shopping cart: Some “non-dairy” coffee creamers and whipped toppings contain sodium caseinate, a product derived from milk. The U.S. Food and Drug Administration classifies sodium caseinate as a non-dairy product, because it is altered so much during processing that it is no longer regarded as a true dairy substance. However, some people with severe LI are unable to tolerate these products.

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