Lactose is the main sugar present in milk and other dairy products. The enzyme lactase, found in the small intestine, is responsible for the breakdown of lactose into simpler substances until it is used by the body. Infants have an abundant lactase enzyme because they depend on milk for nourishment. Still, lactose intolerant patients cannot break down lactose, and therefore, face various gastrointestinal problems. These patients are advised to eat a lactose-free diet to reduce their symptoms.1
Nutritional Considerations for Lactose Intolerant Patients
Along with lactose, dairy products contain many important nutrients such as calcium, vitamin D, and riboflavin. Patients with lactose intolerance cannot digest dairy products, so they do not receive the benefits from these nutrients.2
Special Considerations3
Lactose tolerance
Lactose tolerance varies from person to person. Some can tolerate a minute amount of lactose, while others must avoid it completely.
Low lactose diet
This diet generally eliminates milk and milk products. However, some people can tolerate small amounts of milk, about 2oz throughout the day. Others may be able to digest small amounts of yogurt but no amount of milk. These patients must try different levels of lactose to find out how lactose intolerant they are and which foods are intolerable.
Lactose-free diet
These patients are completely intolerant to lactose and must eliminate all varieties of milk and dairy products from their diet. They can use lactose-free milk or soy milk with good success.
Food (Other Than Dairy Products) That Contain Lactose
These food groups must also be avoided:
- Salad dressings
- Biscuits
- Chocolates
- Cakes
- Some breakfast cereals
Lactase Digestive Aids and Products
Certain over the counter products are available that cause lactose to partially or completely break down into simpler substances. Consult your physician or dietitian before using enzyme products such as Lactaid and Dairy Ease.
Lactate Drops
Adding 5, 10, or 15 drops per quart of milk will reduce lactose content by 70%, 90%, or 99%, respectively, over 24 hours.
Lactate Capsules
You can chew 1–16 capsules after consuming lactose-containing foods to help relieve symptoms.
Lactaid Milk
- Non-fat or 1–2% low-fat is 70% lactose reduced
- Non-fat calcium-fortified is 70% lactose-reduced, and 500 mg of calcium per cup has been added
- Non-fat LACTAID 100 is completely lactose-free
Dairy Ease Milk
- Available in non-fat and 1%–2% low-fat – all are 70% lactose reduced
Dairy-Free Milk
- Calcium-fortified soy and almond milk has no lactose, is low in fat, and is an excellent source of Vitamin D.
Dairy-Free Cheese
If you are a cheese lover, but lactose intolerant, then you will be happy to know there are many cheese alternatives available on the market. Cheese made from soy, cashew nut, or coconut oil is the best alternative.
Dairy-Free Chocolates
Switch from dairy/milk chocolates to dark chocolates.
Dairy-Free Ice Cream
Ice cream made from coconut milk is an excellent alternative for lactose intolerant people.
Dairy-Free Yogurt
Yogurt made from plant-based ingredients such as soy, peas, coconut, cashew nut, and almonds are a few of the options available for those who are lactose intolerant.
| Food Groups | ||
|---|---|---|
| Food Group | Lactose-Free | Lactose-Containing |
| Milk & milk products | 100% lactose-free milk, soy milk | milk: whole, skim, 1%, 2%, buttermilk, sweet acidophilus milk, lactose-reduced milk, evaporated milk, acidophilus milk, sweetened condensed milk, instant hot chocolate and cocoa mixes, cheese |
| Vegetables | fresh, frozen, and canned vegetables without added milk or milk products, tomato paste and purée, tomato and spaghetti sauces without cheese | creamed or breaded vegetables, packaged dried potato mixes, tomato and spaghetti sauce with cheese |
| Fruits | fresh, frozen, canned, and dried fruits | none |
| Breads & grains | water-based breads (Italian, French, Jewish rye), rice and popcorn cakes, graham crackers, rusks, Pareve-Jewish bakery products, cooked and dry cereals without added milk solids, pasta, rice, oats, barley, cornmeal, bulgur, and other plain grains | the following made with milk or milk products, breads, rolls, biscuits, muffins, pancakes, sweet rolls, waffles, crackers, instant and dry cereals with added milk products, some packaged grain mixes, packaged macaroni mixes |
| Meat or meat substitutes | pure beef, lamb, veal, pork, wild game, poultry; fish, shellfish, eggs, kosher prepared meat products, peanut butter, peas, beans, or lentils (dried, canned or frozen), all nuts and seeds, tofu | eggs, fish, meat, or poultry (breaded or creamed), luncheon meats, sausage, frankfurters, some brands of egg substitutes and powdered eggs |
| Fats & oils | bacon, butter, margarine without milk derivatives (whey), salad dressing without cheese or milk, vegetable oils, olives, most non-dairy creamers, mayonnaise, gravy made without milk or milk products | cream, half & half, sour cream, cream cheese, chip dips, some types of margarine, salad dressing with cheese or milk, whipped toppings |
| Sweets & desserts | angel food cake, gelatin, fruit ice, fruit popsicles, fruit roll ups, hard candy, gum drops, jelly beans, licorice, fruit pie fillings | ice cream, ice milk, some brands of sherbet, soufflé, mousse, pudding, custard, packaged dessert mixes, milk chocolate, toffee, caramel, butterscotch |
| Beverages | Postum, lactose-free nutritional supplements (Sustacal, Ensure, Nutren), vegetable juice, fruit juices and drinks, tea, carbonated beverages, beer, wine, distilled spirits (gin, rum, etc.), cocoa powder, most coffee | instant iced tea, instant coffee, Ovaltine, chocolate drink mixes, cordials, liqueurs, milk-based nutritional supplements (Carnation Instant Breakfast) |
| Soups | bouillon, broth, meat, or vegetable stock soups; bisques and chowders made with water, soy milk, or 100% lactose-free milk | cream soup, canned and dehydrated soup mixes containing milk products |
| Miscellaneous | popcorn, plain pretzels, plain potato and corn tortilla chips, salsa, mustard, ketchup, pickles, uncreamed horseradish, relish, sauces made without milk or milk products, sugar, honey, jams and jellies, maple and corn syrup, molasses, herbs, spices, salt, pepper | cream or cheese sauces, ranch-style or cheese-flavored snack pretzels or chips, cheese curls, sugar substitutes with lactose added, medications and vitamin/mineral supplements with lactose added |
| Sample Menu Step 3 | ||
|---|---|---|
| Breakfast | Lunch | Dinner |
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| This sample diet provides the following: | |||
|---|---|---|---|
| Calories | 1,800 | Fat | 48 gm |
| Protein | 93 g | Sodium | 1,700 mg |
| Carbohydrates | 261 g | Potassium | 3,533 mg |
References
- Deng Y, Misselwitz B, Dai N, Fox M. Lactose Intolerance in Adults: Biological Mechanism and Dietary Management. Nutrients. 2015;7(9):8020. doi:10.3390/NU7095380
- Mattar R, Mazo DF de C, Carrilho FJ. Lactose intolerance: diagnosis, genetic, and clinical factors. Clin Exp Gastroenterol. 2012;5(1):113. doi:10.2147/CEG.S32368
- Facioni MS, Raspini B, Pivari F, Dogliotti E, Cena H. Nutritional management of lactose intolerance: the importance of diet and food labelling. J Transl Med. 2020;18(1):260. doi:10.1186/S12967-020-02429-2
