Most people with lactose intolerance can tolerate small or even moderate amounts of lactose. It’s generally thought that people with lactose intolerance can tolerate up to 18g of lactose spread throughout the day. Studies have even shown that some people with lactose intolerance can tolerate up to 12g of lactose in one sitting (the amount of lactose in 250ml of milk).
With some trial and error, it’s possible to figure out how much lactose you can ingest without experiencing discomfort.
If you don’t want to give up dairy, you should be able to reduce your lactose-intolerance symptoms as follows:
Small portion sizes
Choosing smaller servings of dairy will decrease the likelihood of experiencing gastrointestinal symptoms.
Consider taking enzymes that help to digest lactose. These are available in tablet form and as drops. Tablets are taken just before a meal and drops can be added to milk. Note that lactase enzyme supplements are very effective for some people, but that the effectiveness of these products varies from person to person.
Products that contain lactase (e.g. lactose-free milk) are also available. The lactose will be digested by the lactase in the product, thereby requiring no lactose digestion by the individual ingesting it.
Have dairy foods with meals
One way to reduce the symptoms of lactose intolerance is to have dairy foods with meals. Meals, especially those that contain protein and fat, move through the stomach and the small intestines at a slower pace, thereby allowing more time for the (limited) lactase to digest the lactose.
Probiotics are bacteria that provide health benefits to individuals. Certain bacteria, specifically Lactobacillus and Bifidobacteria, produce lactase and can help with the digestion of lactose. Probiotics have been shown to reduce the symptoms of lactose intolerance.
It may be possible to train your body to tolerate lactose. By slowly increasing the amount of dairy foods you consume, and regularly including them in your diet, your body might be able to tolerate more lactose without developing symptoms. Increasing the amount of lactose that enter the colon changes the environment, which may change the way the bacteria handle the lactose. Since lactase is produced by bacteria in the colon, one theory is that increasing amounts of lactose trains the bacteria to produce more lactase. However, more research is needed to define a protocol on how to increase milk intake to improve lactose tolerance.
Did you know? Yoghurt and amasi (or maas) are generally well tolerated by lactose-intolerant individuals. This is because the bacteria used to make these foods contain lactase, which partially digests the lactase during storage.
Treating severe lactose intolerance
For individuals who are sensitive to even very small amounts of lactose, dietary restrictions become stricter. All food products and dishes containing dairy must be avoided.
Dairy is highly nutritious and contains important nutrients such as protein, calcium, phosphorus, vitamins A, B12 and D, and riboflavin. Including dairy in the diet is linked to higher bone mineral density, which helps to reduce the risk of bone fractures as you get older. It has also been linked to a reduced risk of type 2 diabetes and obesity. Eating less dairy foods, or removing them completely from your diet, can therefore mean that you’ll miss out on important nutrients.
The good news is that, with the help of a registered dietitian, it is possible to remove dairy completely and still follow a healthy, balanced diet.
Complete elimination of dairy foods
Lactose is found in many foods and drinks. If your lactose intolerance is severe, it’s important to eliminate all foods and drinks containing even small amounts of lactose from your diet.
Take note of the following list of lactose-containing foods and products:
- Dairy foods, including cow’s milk, goat’s milk, sheep’s milk, yoghurt, cheese, cream, ice-cream and butter.
- Foods that contain some form of dairy as an ingredient. Examples include salad cream, salad dressing, mayonnaise, biscuits, chocolates, boiled sweets, cakes, foods made with milk (e.g. quiche or scrambled eggs), some breads, some breakfast cereals, some processed meats, instant soups and sauces, instant potatoes, ready-made meals, sauces and gravies, desserts, custard, and ready mixes for cakes, pancakes, scones etc.
- Some prescription, over-the-counter and complementary medicines contain small amounts of lactose. Always check in with your GP or pharmacist if you’re starting a new medication.
Always check the ingredient list of the foods and drinks that you want to consume to ensure that milk or lactose hasn’t been added. Other names for dairy, which may be used on food labels, include:
- Milk solids
- Milk powder
- Whey protein
- Milk casein
- Milk sugar
- Malted milk
- Dry milk solids
- Sour cream
- Whey protein concentrate
- Milk byproducts
Ingredients such as lactic acid, lactalbumin, lactate or casein are not lactose and do not need to be avoided.
There are several alternative foods and drinks available that don’t contain lactose. These include:
- Soya milk and yoghurt
- Any milk made from rice, oats, almond or coconut (note that these milks are very low in protein and often processed, which means they may contain other ingredients)
- Foods that are labelled “dairy-free” or “suitable for vegans”
- Lactose-free dairy products
Calcium deficiency is common among people with lactose intolerance. Although dairy is one of the best sources of calcium, eliminating dairy from your diet doesn’t mean that you can’t get enough calcium.
Calcium is found in many other foods. For example, many plant foods contain good amounts of calcium. Note, however, that this calcium is often poorly absorbed because of anti-nutrients such as phytates and oxalates that are present in the foods.
It’s important to get enough calcium through your diet as this mineral has a few very important functions:
- It helps to build strong bones and teeth
- It regulates muscle contractions (including contractions of the heart)
- It plays a role in blood clotting
If you can’t have dairy, try to regularly include these foods in your diet:
- Canned fish with bones (e.g. salmon, pilchards, sardines). It’s important to eat the bones of the fish. Crush them into the fish meat if you don’t like the texture of them.
- Milk substitutes (e.g. soy milk) that have been fortified.
- Legumes (e.g. beans, chickpeas, lentils)
- Dried figs
- Green, leafy vegetables such as broccoli, rhubarb, spinach, kale
- Nuts and nut butter, specifically almonds
- Sesame seeds and tahini (sesame seed paste)
It’s also possible to get the calcium you need by taking a supplement. Check with your GP or dietitian whether this would make sense for you.
Treating lactose intolerance in infants and children. In general, lactose intolerance in children is dealt with in the same way as lactose intolerance in adults. However, in children, the lactose intolerance is mostly secondary, i.e. temporary, which means that it will improve after a couple of days or weeks. Dairy should be gradually reintroduced into the child’s diet.
In infants, lactose intolerance can be developmental (temporary) or congenital (permanent). Both types of lactose intolerance are treated with a commercial formula that’s lactose free. Breast milk contains lactose and generally isn’t an option. However, some babies may be able to benefit from lactase drops added to breast milk.
If you’re a breastfeeding woman who is lactose intolerant, it’s safe to breastfeed your child. Breastfeeding has important health benefits for your baby and doesn’t put your child at risk of becoming lactose intolerant.
Reviewed by Kim Hofmann, registered dietitian, BSc Medical (Honours) Nutrition and Dietetics, BSc (Honours) Psychology. August 2018.