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Managing Lactose Intolerance

Writer's picture: Amanda Turner, RDAmanda Turner, RD

Amanda Turner, RD

Lactose intolerance is very common. Chances are you know at least a few people who have difficulty digesting dairy. Ever wonder why that is?


What is Lactose?


Lactose is a sugar found in milk and other dairy products. It is a disaccharide, consisting of two simpler sugars: glucose and galactose. To digest lactose, the body produces an enzyme called lactase in the small intestine. This enzyme breaks down lactose into its two components, allowing for absorption into the bloodstream.


Most infants produce high levels of lactase, which helps them thrive on their mother's milk. However, an average of roughly 65% of adults worldwide experience decreased lactase production as they age, resulting in various degrees of lactose intolerance.



The Science Behind Lactose Intolerance


Lactose intolerance occurs when the body does not produce enough lactase. When undigested lactose reaches the colon, it can lead to gastrointestinal symptoms such as bloating, gas, diarrhea, nausea and abdominal pain. These symptoms occur because the lactose ferments in the large intestine, generating gas and drawing water into the colon and generally present 30 minutes to 2 hours after consuming lactose-containing foods or drinks.


Among those with decreased lactase production, the degree of lactose intolerance varies. Some are able to tolerate dairy products that are well-cultured, like yogurt or kefir. Some can tolerate hard and aged cheeses, which are naturally lower in lactose compared to soft cheeses. There are even those that are able to tolerate a small amount of ice cream or cow's milk. Others are sensitive to even trace amounts of lactose and avoid it all together.



Strategies for Managing Lactose Intolerance


Living with lactose intolerance doesn't have to mean giving up dairy entirely. Here are some strategies to manage the condition while still enjoying dairy:



  1. Lactose-Free Products: Many grocery stores offer lactose-free milk, cheese, and yogurt that taste similar to regular dairy without causing discomfort.



  1. Naturally Better Tolerated Dairy Products: As mentioned above, many people with lactose intolerance are able to tolerate well-cultured products such as yogurt and kefir, as well as hard and aged cheeses that have low levels of lactose. These include parmesan, cheddar and Swiss.



  1. Easy Does It: Some individuals tolerate small amounts of lactose, especially when eaten with other foods that slow digestion.




  2. Lactase Supplements: Over-the-counter lactase enzyme supplements (e.g. Lactaid) can help digest lactose more efficiently when taken before meals containing dairy.


  1. Dairy Alternatives: Plant-based alternatives such as soy, almond, oat, rice and cashew milks, yogurts, cheeses and ice creams are great naturally lactose-free options.



Lactose Intolerance vs. Dairy Intolerance vs. Milk Allergy


While lactose intolerance can certainly be unpleasant and, if undiagnosed, even debilitating, it is not life threatening. Milk allergy on the other hand can cause life-threatening reactions. Lactose intolerance is a digestive reaction to lactose, while milk allergy is an immune system reaction to milk proteins (including casein and whey). Symptoms of a milk allergy reaction can include hives, shortness of breath, swelling of lips, tongue or throat and even anaphylaxis.


To further complicate things, some people have difficulty digesting milk proteins in large volumes but do not have an immune system response. For example, some people experience gas and bloating with whey-based protein powders.


Lactose-free dairy products are not suitable for individuals with a milk allergy or dairy intolerance as the allergens (milk proteins) are still present. Similarly, lactase supplements will be of no benefit. As with lactose intolerance, those with dairy intolerance may be able to tolerate a small amount of milk protein. However, individuals with a milk allergy will likely have to completely eliminate dairy from their diet. In both cases, plant-based dairy alternatives are the way to go as they are not only lactose-free, but also milk protein free.



Nutritional Considerations


Calcium and Vitamin D

Dairy products provide a significant amount of calcium and vitamin D. Those avoiding dairy will have to rely on other foods to meet their calcium and vitamin D needs. Consider these sources:



  • Fortified Alternatives: Many non-dairy milk options are fortified with calcium and vitamin D. Read the ingredient list and/or the nutrition facts label to make sure that the products you choose are fortified.


  • Leafy Greens: Kale, broccoli, and Bok choy are great sources of calcium.


  • Canned Fish: Canned salmon and sardines with bones are rich in both calcium and healthy omega-3 fatty acids.


  • Tofu: Most tofu products are prepared with calcium sulphate. Read the ingredient list and/or nutrition facts label and choose tofu products that contain calcium.


Protein

It is also important to consider protein as most non-dairy alternatives contain significantly less protein compared to cow's milk. 1 cup of 2% cow's milk contains 9 g of protein, compared to:


  • 1 g of protein per 1 cup of almond milk

  • 4 g of protein per 1 cup of oat milk

  • 1 g of protein per 1 cup of rice milk

  • 1 g of protein per 1 cup cashew milk


The only non-dairy milk alternative that provides adequate protein is soy milk, with 8 g per cup.


Sugar

Without the natural sweetness from lactose, non-dairy alternatives rely on processed sugars to add flavour. Many "Original" and flavoured (e.g. vanilla, chocolate, etc.) non-dairy milk alternatives contain a lot of added sugar. Your best bet is the "Unsweetened" versions but if you must have some sweetness, look for products that contain 5% or less added sugar per serving.



Final Thoughts


Lactose intolerance is common and can progress with age. Understanding the science behind lactose intolerance and being aware of which foods contain lactose are key to minimizing, even eliminating, unpleasant symptoms. Limiting, or avoiding, dairy doesn't have to mean compromising your nutrition or your health. You can continue to eat a well-balanced, nutritious diet by making a few simple dietary adjustments to account for the nutrients you may be missing out on.


If you suspect you may be lactose intolerant, or are having difficulty managing your pre-existing lactose-intolerance, I can help.





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Amanda Turner, RD Navigateyourplate@proton.me 

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