Lactose Intolerance

People who are lactose intolerant can still enjoy the goodness of dairy

Lactose intolerance is the inability to digest the natural sugar lactose, which is found primarily in dairy foods. Some people do not have enough of the enzyme lactase, which breaks down the sugar in their digestive system. Lactose sensitivity symptoms include abdominal pain, diarrhea, gas and uncomfortable bloating. This food sensitivity can be difficult to diagnose since symptoms can be attributed to a range of health issues.

Here are two common misconceptions about lactose intolerance:

People who are sensitive to lactose should avoid all dairy foods.

Truth: Most people who are lactose intolerant can enjoy many dairy foods, such as lactose-reduced or lactose-free milk, aged hard cheeses like Cheddar or Monterrey Jack, and yogurts with live, active cultures. Research shows most lactose-sensitive individuals can drink up to two glasses of regular milk a day with no symptoms if consumed in small quantities with food. Cooking with milk, yogurt or cheese is an easy way to get the health benefits of dairy and avoid uncomfortable symptoms. The key is to build slowly and know your limit.

Lactose intolerance means you are allergic to milk.

Truth: Many people confuse being intolerant with having a milk allergy. The truth is milk allergies are extremely rare. Only about 1 percent of adults and 3 percent of children are allergic to milk. The good news is most children typically grow out of a milk allergy in their first few years. Lactose intolerance is not a disease or allergy — it is simply the digestive system’s inability to break down the milk sugar lactose.

Managing Lactose Intolerance

Being lactose intolerant doesn’t require you to avoid dairy foods. Try these easy tips for enjoying milk, cheese, yogurt and other foods from the dairy aisle:

  • Include natural hard cheeses such as Cheddar, Monterey Jack, Gouda and Parmesan. When milk is made into cheese, most of the lactose is removed.
  • Choose yogurts with live, active cultures, which help to break down lactose.
  • Introduce small amounts of milk or milk products to help reduce symptoms.
  • Try chocolate milk. Sometimes it is easier to digest than white milk.
  • Try lactose-free products such as lactose-free milk and lactose-free ice cream.

Frequently Asked Questions

What are the symptoms of lactose intolerance?

People who are lactose intolerant may feel uncomfortable 30 minutes to two hours after consuming milk and milk products. Symptoms range from mild to severe, based on the amount of lactose consumed and the amount a person can tolerate. Common symptoms include abdominal pain, bloating, gas, diarrhea and nausea.

What are the causes?

This is best explained by describing how a person develops lactase deficiency. Primary lactase deficiency develops over time and begins after about age two when the body begins to produce less lactase. Most children who have lactase deficiency do not experience symptoms of lactose intolerance until late adolescence or adulthood.

How is it managed?

Symptoms can be managed with dietary changes. Many can tolerate some amount of lactose in their diet. Gradually introducing small amounts of milk or milk products may help some people adapt with fewer symptoms. Often, people can better tolerate milk with meals.

How is it diagnosed?

The doctor may first recommend eliminating all milk and milk products from the person’s diet for a short time to see if the symptoms resolve. Two tests measure the digestion of lactose. The Hydrogen Breath Test and the Stool Acidity Test help medical professionals determine the levels of undigested lactose in the patient’s diet.

Who is at risk?

Lactose intolerance is a common condition that is more likely to occur in adulthood, with a higher incidence in older adults. Some ethnic and racial populations are more affected than others, including African Americans, Hispanic Americans, Native Americans and Asian Americans. The condition is least common among Americans of northern European descent.

What products contain lactose?

Regular milk and milk products contain lactose, as well as some processed foods containing milk or milk products. Check the ingredients on food labels to find possible sources of lactose in food products. Lactose is sometimes used in prescription medicines and over-the-counter products to treat stomach acid and gas. Hard cheeses such as Cheddar, Monterey Jack, Gouda and Parmesan contain little or no lactose.

Why is chocolate milk better tolerated by people with lactose maldigestion than unflavored milk?

According to an article in the European Journal of Clinical Nutrition, “chocolate milk appears to be better tolerated than unflavored milk by lactose maldigesters, which can be explained by reduced breath hydrogen production when compared to skim milk.” Researchers agree that while the mechanism of action is not yet clear and further study is needed, the general hypothesis is: 1) cocoa might stimulate lactase activity, 2) cocoa might reduce the number of gas-producing bacteria in the colon, or 3) cocoa might slow gastric emptying. Learn more about chocolate milk for lactose intolerance.