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Lactose intolerance is very common.
In fact, it’s thought to affect around 75% of the world’s population.
People with lactose intolerance experience digestive problems when they eat dairy, which can have a negative effect on quality of life.
Lactose intolerance is an impaired ability to digest lactose, a sugar found in milk and other dairy products. Lactose is normally broken down by an enzyme called lactase, which is produced by cells in the lining of the small intestine.
Congenital lactase deficiency, also called congenital alactasia, is a disorder in which infants are unable to break down lactose in breast milk or formula. This form of lactose intolerance results in severe diarrhoea. If affected infants are not given a lactose-free infant formula, they may develop severe dehydration and weight loss, however, it’s a rare condition.
Lactose intolerance in adulthood is caused by reduced production of lactase after infancy (lactase non-persistence). If individuals with lactose intolerance consume lactose-containing dairy products, they may experience abdominal pain, bloating, flatulence, nausea, and diarrhea beginning 30 minutes to 2 hours later.
Most people with lactose intolerance retain some lactase activity and can include varying amounts of lactose in their diets without experiencing symptoms. Often, affected individuals have difficulty digesting fresh milk but can eat certain dairy products such as cheese or yogurt without discomfort. These foods are made using fermentation processes that break down much of the lactose in milk.
Lactose intolerance in infants (congenital lactase deficiency) is caused by mutations in the LCT gene. The LCT gene provides instructions for making the lactase enzyme. Mutations that cause congenital lactase deficiency are believed to interfere with the function of lactase, causing affected infants to have a severely impaired ability to digest lactose in breast milk or formula.
Lactose intolerance in adulthood is caused by gradually decreasing activity (expression) of the LCT gene after infancy, which occurs in most humans. LCT gene expression is controlled by a DNA sequence called a regulatory element, which is located within a nearby gene called MCM6. Some individuals have inherited changes in this element that lead to sustained lactase production in the small intestine and the ability to digest lactose throughout life. People without these changes have a reduced ability to digest lactose as they get older, resulting in the signs and symptoms of lactose intolerance.
Avoiding Lactose Means Avoiding Dairy, Which Is High in Nutrients
Dairy is the term used to describe milk or products made from milk.
Dairy products are highly nutritious and important sources of protein calcium and vitamins like A, B12, and D.
This nutrient combination is good for your bones
Including dairy in your diet is linked to higher bone mineral density, which may help reduce the risk of bone fractures as you get older.
Dairy products have also been linked with a reduced risk of type 2 diabetes and obesity.
However, people with lactose intolerance may need to cut back or remove dairy products from their diets, potentially missing out on some nutrients.
Which Foods Contain Lactose?
Lactose is found in dairy foods and products that contain dairy.
Dairy Foods That Contain Lactose
The following dairy products contain lactose:
Cow’s milk (all types)
Cheese (including hard and soft cheeses)
Foods That Sometimes Contain Lactose Foods that have some form of dairy as an ingredient may also contain lactose, including:
Foods made with a milky sauce, like quiche
Biscuits and cookies
Chocolates and confectionary, like boiled sweets and candies
Bread and baked goods
Instant soups and sauces
Processed meat, such as pre-sliced ham or sausages
Sauces and Gravies
Potato chips, nuts, and flavored tortillas
Desserts and custards
Other Names for Added Dairy
You can check if a product contains dairy by looking at the labels. On ingredients lists, added milk or dairy products can be described as:
Dry milk solids
Whey protein concentrate
Don’t be confused if a product contains lactic acid, lactalbumin, lactate or casein. These ingredients aren’t lactose.
People With Lactose Intolerance May Be Able to Eat Some Dairy
All dairy foods contain lactose, but this doesn’t mean they are totally off limits for people with lactose intolerance.
Most people with lactose intolerance can tolerate small amounts of lactose. For example, some people can tolerate the small amount of milk in tea but not the amount you would get from a bowl of cereal.
It’s thought that people with lactose intolerance can tolerate up to 18 grams of lactose, spread throughout the day.
In fact, research has shown that many people with lactose intolerance can tolerate up to 12 grams of lactose in one sitting, which is approximately the amount in 1 cup (230 ml) of milk.
Some types of dairy are also naturally low in lactose when eaten in their usual portions. Butter, for example only contains 0.1 grams of lactose per 20-gram portion.
Certain types of cheese also have less than 1 gram of lactose per serving. This includes cheddar, Swiss, Colby, and mozzarella.
Interestingly, yogurt tends to cause fewer symptoms in people with lactose intolerance than other types of dairy.
Good Non-Dairy Sources of Calcium
Dairy foods are excellent sources of calcium, but eating dairy isn’t essential.
It’s still possible to have a very healthy diet without dairy foods. You just need to include other foods that are high in calcium.
The recommended intake for calcium is 1,000 mg per day.
Some good non-dairy source of calcium include:
Calcium-fortified foods: There are many calcium-fortified foods, including juices, bread and non-dairy milk such as almond, soy or oat milk. Shake the carton before use, since the calcium can settle on the bottom.
Boned fish: Canned fish with bones, such as sardines or whitebait, are high in calcium.
High-calcium plants foods: Many plant foods contain reasonable amounts of calcium. However, this calcium is often poorly absorbed due to the presence of anti-nutrient like phytate and oxalate.
Here’s a list of lactose-free foods that are high in bioavailable calcium:
Fortified non-dairy milk: 300 mg calcium in (240 ml) serving
Fortified fruit or vegetable juice: 300 mg calcium in (240 ml) serving
Fortified tofu: 200 mg calcium in a 1/2 cup serving
Cooked collard greens: 200 mg of calcium in a 1/2 cup serving
Dried figs: 100 mg calcium in five figs
Kale: 100 mg calcium in a 1/2 cup serving
Broccoli: 100 mg calcium in a 1/2 cup serving
Soybeans: 100 mg calcium in a 1/2 cup serving
mustard greens: 75 mg calcium in a 1/2 cup serving
Almond butter: 75 mg calcium in 2 Tablespoons
Treatments for Lactose Intolerance
If you don’t want to give up dairy, then there are a few natural treatments that can help.
It’s possible to buy enzymes to help digest lactose. These are tablets you swallow or drops you add to foods and drinks.
However, the effectiveness of these products seems to vary from person to person.
Nevertheless, lactase enzyme supplements may be very effective for some people.
One study examined the effects of three different types of lactase supplements in lactose-intolerant people who took 20 or 50 grams of lactose.
Compared to placebo, all three lactase supplements improved overall symptoms when taken with 20 grams of lactose.
However, they weren’t effective at a higher dose of 50 grams of lactose.
If you are lactose intolerant, regularly including lactose in your diet could help your body adapt to it.
So far, studies on this are few and far between, but initial studies have shown some positive results.
In one small study, nine lactose-intolerant people experienced a threefold increase in their lactase production after 16 days of eating lactose.
More rigorous trials are needed before definite recommendations can be made, but it may be possible to train your gut to tolerate lactose.
Probiotics and Prebiotics
Probiotics are microorganisms that provide health benefits when consumed.
Prebiotics are types of fiber that function as food for these bacteria. They feed the beneficial bacteria you already have in your gut, so that they thrive.
Both probiotics and prebiotics have been shown to reduce symptoms of lactose intolerance, although most studies so far have been small.
Some types of probiotics and prebiotics may be more effective than others for people with lactose intolerance.
One of the most beneficial probiotics is thought to be Bifidobacteria, often found in probiotic yogurts and supplements.