Healthy Eating Guidelines for Managing Lactose Intolerance

Posted: Feb 8, 2013

Lactose is a sugar found in milk and milk products. It is also added to some processed and prepared foods like salad dressings. An enzyme called lactase is needed for your body to break down (digest) lactose.

Lactose intolerance happens when your body does not have enough lactase.  Without this enzyme, or enough of this enzyme, your body does not break down all the lactose into smaller parts for digestion and absorption. The undigested lactose goes into your large intestine where it is fermented by bacteria causing symptoms such as:

  • bloating
  • gas
  • cramping
  • nausea
  • diarrhea
  • weight loss (in children).

If you are lactose intolerant you may benefit from reducing the amount of lactose in your diet.  Your symptoms depend on the amount of lactose you eat at one time and the amount of lactase enzyme in your body.
 
Lactose intolerance is not an allergy to milk.
 

Steps You can Take

 
Most people with lactose intolerance can tolerate some lactose in their diet. If you do get symptoms, you can manage them using the following information. Refer to Additional Resources at the end of this handout for more information.

  • Limit your intake of foods that cause you discomfort. You may be able to tolerate certain lactose-containing foods while other people with lactose intolerance cannot.

  • Eat small amounts of foods or beverages that have lactose with your meals.

  • Lower lactose-containing foods eaten in small amounts (60-125mL or 14-1/2 cup) can include:

    • cheese cottage
    • hard, aged cheese (cheddar, Swiss, Parmesan)
    • yogurt              
    • chocolate milk
    • pudding                      
    • sour cream.
  • If these amounts cause you discomfort, eat less.

  • Choose lactose-free or foods low in lactose, preferably fortified with calcium, such as:

    • lactose-hydrolyzed milk (e.g. Lactaid®, Lacteeze®)
    • soy beverage
    • rice beverage
    • casein or soy-based products in place of cheese
    • yogurts with live bacterial cultures or lactose-reduced yogurts
    • Note: According to the CFIA “lactose-free” means that there is no detectable lactose in the food.  “Lactose-reduced” means that at least 25% of the lactose in the product has been removed.
  • Carefully read food labels and ingredient lists for sources of lactose.

  • The following words on the ingredient list means the product contains lactose:
    • milk              
    • milk solids                  
    • whey
    • lactose          
    • curds          
    • cheese flavour 
    • malted milk  
    • non-fat milk solids 
    • buttermilk     
    • cream      
    • non-fat milk powder
  • Note: Products that contain lactic acid, lactalbumin, lactate and casein do not contain lactose.

  • Ask your Pharmacist about lactose in your medications; it may not be listed on the label. Your Pharmacist should be able to provide a lactose-free substitute.

  • Try lactase enzyme drops, tablets or other products made with these preparations to reduce the lactose in milk or dairy products. Tablets are taken before eating foods that have lactose. Enzyme drops can be added to milk before drinking. For the best results, follow the instructions included with the product or ask your Pharmacist for advice.

Special Considerations:

 
Many foods that contain lactose are also important sources of calcium and vitamin D. If you avoid lactose-containing foods, you will need to find other sources of these nutrients. The following information will help you to make healthy choices while managing your symptoms.
 
Calcium
Choose canned salmon (with the bones) and sardines, fortified soy and rice beverages, and calcium-fortified fruit juices. Many products are now fortified with calcium carbonate, which can settle to the bottom of the container. Shake these liquids well before use.
 
Talk to a Registered Dietitian if you are concerned that you are not getting enough calcium from food and if you should take a calcium supplement.
 
Vitamin D
Lactose-free sources of vitamin D include fish, liver and egg yolks. For foods that have been fortified with Vitamin D, choose lactose-free soy and rice beverages and non-hydrogenated margarine.
 

Additional Resources

 
For more information on lactase enzyme drops or lactase-treated products contact:

Lactaid

Lacteeze

Lactose-Free Milk

These resources are provided as sources of additional information believed to be reliable and accurate at the time of publication and should not be considered an endorsement of any information, service, product or company.