Lactose intolerance is a prevalent and distressing condition that affects a surprisingly high percentage of adults. The U.S. Department of Health & Human Services approximates that about 65 percent of the human population has a reduced ability to digest lactose after infancy.
Lactose intolerance is not the same as a milk allergy and is more of a discomfort than a real over-reaction by the immune system, according to the FDA. Many people with lactose intolerance can even have small amounts of the offending foods/drinks without having symptoms.
What sort of signs of lactose intolerance may indicate that you have this common problem? Lactose intolerance symptoms typically include bloating, gas, diarrhea and other GI issues. Fortunately, by following a lactose intolerance diet and treatment plan, it’s possible to reduce (and in some cases even eliminate) the symptoms of lactose intolerance.
What Is Lactose Intolerance?
The definition of lactose intolerance, according to The National Institute of Diabetes and Digestive and Kidney Diseases, is “a condition in which you have digestive symptoms — such as bloating, diarrhea and gas — after you consume foods or drinks that contain lactose.”
Lactose is a sugar that is found in milk and dairy products. In order to digest this sugar properly, the small intestine must produce adequate amounts of the enzyme called lactase.
Lactose is found in:
- Milk by-products
- Dry milk solids
- Non-fat dry milk powder
Lactase is responsible for breaking down the lactose into glucose and galactose, so the body can absorb it. When the body’s ability to make lactase diminishes, the result is lactose intolerance.
It is important to note that not all dairy products cause these unpleasant symptoms of lactose intolerance. In fact, yogurt or kefir with live active cultures typically do not produce these symptoms, as the active cultures help to break down lactose prior to consumption. Also, the longer the food is fermented, the less the lactose content will be, as the healthy probiotics survive by eating the lactose sugar.
Lactose Intolerance Causes
What triggers lactose intolerance? As described above, lactose intolerance is caused by the body’s inability to effectively digest lactose due to malabsorption or low levels of lactase produced in the digestive tract. This seems to occur for several main reasons:
1. Genetics/Family History
While it has been documented only rarely, the inability to produce lactase can sometimes be congenital. Researchers believe there are genetic links to lactose intolerance causing symptoms to appear during the teenage years. However, just because you made it through your teen years without affliction doesn’t mean you are immune for life. Lactose intolerance is not very common in children under two years of age, although it’s still possible.
In addition, lactose intolerance seems to run in families, and certain ethnic groups have greater occurrences of lactose intolerance than others. Native Americans, Hispanics, Asians and those from African descent often experience intolerance more often than those of European descent.
As we age lactase production decreases, leading to intolerance in individuals who otherwise never had overt signs of lactose intolerance.
3. Illness and Stress
In some cases, lactose intolerance can also result from surgery, injury, illness and even certain treatments. Common conditions that can contribute include gastroenteritis, IBS, Crohn’s Disease, ulcerative colitis, celiac disease and other conditions of the digestive tract, including candida overgrowth and leaky gut. Even cases of the flu can cause intolerance (however, often the symptoms will fade over time). Additionally, taking medications including some antibiotics for extended periods of time may disrupt gut health and contribute to lactose intolerance.
How do doctors test for lactose intolerance? To test for lactose intolerance in patients who are experiencing symptoms like bloating and diarrhea, doctors rely on a number of different tests, including:
- A hydrogen breath test, since undigested lactose causes you to have high levels of hydrogen in your breath
- Reactions to an elimination diet, in which you stop eating and drinking milk and milk products to test the effects.
- A test using a stethoscope to listen to sounds within your abdomen
- Discussion of symptoms, family history, medical history and eating habits
- A physical exam to check for any underlying health problems that may be the real cause of symptoms
Keep in mind that a number of other conditions aside from lactose intolerance can cause similar symptoms. These include: irritable bowel syndrome, celiac disease, inflammatory bowel disease or SIBO (small bowel bacterial overgrowth). This is why doctors must rule out these causes before confirming a diagnosis of lactose intolerance.
Symptoms of Lactose Intolerance
What are symptoms of being lactose intolerant? The most common symptoms of lactose intolerance include:
- Stomach bloating/swelling in the abdomen
- Stomach pain/cramping
- Nausea, vomiting
- Headaches or migraines
When do lactose intolerance symptoms start? These warning signs of lactose intolerance can arise anywhere from 30 minutes to two hours after the consumption of dairy products and can range from mild to severe. Most immediate reactions are caused by the body not having the enzymes to digest the lactose sugar, which causes the intestines to contract.
If you have had an ongoing intolerance, you might also experience issues besides digestive upset, such as more extreme headaches, migraines or bloating that can occur over the course of up to two days from these undigested particles entering your body, especially if you have leaky gut syndrome.
Can you become lactose intolerant all of a sudden? This is more common among older adults, but usually lactose intolerance is obvious from an earlier age.
How long do lactose intolerance symptoms last? The severity of lactose intolerance symptoms depends upon personal tolerations and the amount consumed. If you’re intolerant and continue consuming lactose without making any other changes, your symptoms will likely persist.
Lactose Intolerance Treatment & Diet
There is currently no permanent cure for lactose intolerance because no treatment can increase the amount of lactase your small intestine makes. However, there are steps to take to manage symptoms and avoid complications. One major concern for people who have lactose intolerance is they may not get enough of the essential nutrients found in milk products, including calcium, magnesium, vitamin D and vitamin K, for example.
While it’s an option to take dietary supplements called lactase products that help digest lactose, this will not solve the underlying problem and may not be a good long-term solution.
What foods should you avoid if you are lactose intolerant? Do you necessarily need to give up all dairy?
Depending on the severity of your intolerance, it may be necessary to take a break from dairy while you heal; however, by following a healthy lactose intolerance diet, it may not have to be a permanent sacrifice.
Some people with severe lactose intolerance will need to avoid having most or all dairy products. Others can tolerate certain kinds without experiencing a flare-up of lactose intolerance symptoms. For example, some research suggests that many people with lactose intolerance can have up to 12 grams of lactose, the amount in about 1 cup of milk, without triggering any strong symptoms. Some experts also believe that one key to consuming dairy products while eating a lactose intolerance diet is to choose raw and unpasteurized products made from raw cow, goat and sheep milk.
A study published in the Journal of the Dietetic Association indicates that consuming kefir improves lactose digestion and tolerance. Participants in the study perceived a reduction in the severity of gas by 54 to 71 percent. While kefir is a dairy product, the fermentation process breaks down the naturally occurring lactose, making it easier for the body to digest and absorb it. The result is that the majority of individuals with lactose intolerance can still enjoy some types of dairy, while reaping the health benefits.
If you need to avoid all lactose, keep a careful eye out for dairy derivatives that hide in common foods — including bread, pastries, crackers, cereals, soups, processed meats, protein bars and candy. Look at ingredient labels and avoid these foods as much as necessary to control your symptoms:
- Evaporated milk
- Condensed milk
- Dried milk
- Powdered milk
- Milk solids
There is no FDA definition for the terms “lactose-free” or “lactose-reduced.” Even products advertised as “non-dairy” could contain trace amounts of dairy products that can lead to the disrupting symptoms of lactose intolerance. Additionally, healthy natural foods that you have eaten for years may be at the root of your lactose intolerance. When transitioning to a lactose intolerance diet, it is important to carefully read the labels of all processed foods to ensure dairy products aren’t lurking.
Ideally, the best dairy products to consume if you have lactose intolerance are the types made from raw cow or goat’s milk that have been fermented for a minimum of 24 hours.
- Raw milk myths continue to cause controversy; however, many of the claims of illness are greatly exaggerated. It is estimated that raw milk is responsible for less than 50 cases of food-borne illnesses each year, while nearly 10 million Americans regularly consume raw milk.
- Raw milk benefits include immune system support, healthy skin, hair and nails, increased bone density, weight loss, muscle development and neurological support.
- Raw milk is beneficial because the pasteurization process dramatically reduces essential nutrients, including vitamins A, C, E and B as well as minerals such as iron, zinc and, of course, calcium. The natural enzymes that help our bodies digest dairy products are destroyed while the protein and immunoglobulin’s are damaged.
Below are additional steps to take to help manage lactose intolerance:
1. Use Organic Fermented Dairy
Fermented dairy improves the digestibility of the lactose, fats and protein in dairy, but also helps to spur healthy digestion of other foods. While the idea of drinking fermented dairy may be off-putting to some, high-quality, organic kefir is slightly tangy, creamy and ultimately satisfying.
It is similar to yogurt, just thinner and drinkable. Probiotic foods are rich in vitamins, minerals and essential amino acids. Kefir contains high levels of thiamin, B12, folate and the secret bone-builder, vitamin K.
Vitamin K2 specifically helps calcium to metabolize, creating stronger bones, which is essential to people on a lactose intolerance diet. Organic fermented dairy also helps to increase magnesium levels. Magnesium deficiency is common in people with digestive tract disorders, including celiac and Crohn’s disease and IBS … as well as lactose intolerance.
You may choose to eliminate all dairy products for a time to help reduce symptoms and help your body heal, but ideally you can begin to swap out regular dairy for fermented dairy, which can help to restore the health of the digestive tract and has enzymes that will actually aid in digestion.
2. Try Goat Milk
For many people, goat milk may be easier on the digestive system than cow milk. Goat milk is high in fatty acids, and it is more easily absorbed and assimilated in the body. The actual fat particles in goat milk are smaller and contain lower concentrations of lactose.
It takes significantly shorter time to digest goat milk products than it does cow milk products. And yet, goat milk is richer in calcium, phosphorus, iodine, potassium, biotin and pantothenic acid. In addition, its casein levels are reduced, making it friendly to those with casein sensitivity.
3. Take Digestive Enzymes That Contain Lactase
Lactase is the enzyme that is lacking in the digestive tract for individuals suffering from lactose intolerance. According to a study published in the Alternative Medicine Review, digestive enzyme supplementation can aid in the breakdown of fats, carbs and proteins, assisting in efficient digestive function
Taking specially formulated digestive supplements provide a safe treatment for digestive malabsorption disorders, including lactose intolerance.
- Genius Digestive Enzymes
- NOW Supplements, Super Enzymes
- Zenwise Health Digestive Enzymes Plus Prebiotics & Probiotics
Take a digestive enzyme at the beginning of each meal, to ensure that foods are fully digested. This also helps to decrease the probability that partially digested foods including proteins, fats and carbohydrates will sit in the gut.
4. Supplement with Probiotics
This is an essential part of a lactose intolerance diet. The live or active cultures in yogurt, kefir, fermented vegetables and supplements help to maintain a healthy digestive tract. Increasing healthy bacteria in your gut may help to spur greater lactase production, or at the very least, aid in digestion.
By adding probiotic supplements and probiotic-rich foods to your diet, you can change the balance in the gut, leading to greater nutrient absorption. Managing lactose intolerance with yogurt and probiotics is possible, according to a study published in the Journal of Applied Microbiology.
- Culturelle Daily Probiotic
- Zenwise Health Digestive Enzymes Plus Prebiotics & Probiotics
- NOW Supplements, Probiotic-10™
- Vitamin Bounty Pro 50 Probiotic with Prebiotics
However, probiotic supplements can do significantly more for overall health and wellness than just gut health. In fact, according to a study published in Science Daily lead by Dr. Collin Hill from the University of College Cork in Ireland, probiotics may be used in the future to help control disease, without relying on antibiotics.
It is important to look for a supplement that contain probiotics plus prebiotics derived from heat resistant soil-based organisms.
5. Incorporate Calcium-Rich Foods
While calcium is often considered a powerful mineral in the fight against osteoporosis, it is much more vital to our health than just our bones. In fact, calcium-rich foods help promote heart health and manage body weight. Calcium rich foods, which everyone should incorporate in their lactose intolerance diet include raw milk, yogurt, kefir, dark greens like cooked kale, raw cheese, sardines and broccoli.
6. Add Foods Rich in Vitamin K
As mentioned above, vitamin K plays a major role in calcium absorption and bone health, but its benefits do not end there. It also helps promote brain functioning and improve insulin sensitivity. This fat-soluble vitamin is stored in the liver, and proper levels can be disrupted by antibiotic use, certain prescription cholesterol medications and IBS and leaky gut. Many people who are lactose intolerant are also vitamin K deficient, so it is important to make sure you are getting enough in your daily food routine.
Foods rich in vitamin K to add to your lactose intolerance diet include green leafy vegetables, scallions, Brussels sprouts, cabbage, broccoli, cucumbers and dried basil. In addition, fermented, organic dairy is also rich with this essential vitamin.
7. Add Bone Broth to Your Diet
Central to helping restore the gut is bone broth. This simple and tasty broth helps the body overcome food intolerances, sensitivities and even allergies, while improving joint health, boosting the immune system and reducing cellulite.
Long simmering of grass-fed beef bones or organic free-range chicken transforms the calcium, magnesium, phosphorus, sulfur and other minerals, making them easier to absorb. In addition, the natural collagen and gelatin found in the bones help to support the GI tract. Aim to consume 8 ounces to 12 ounces each day.
8. Jumpstart Your Gut Health with the GAPS Diet
The GAPS diet plan was designed by Dr. Campbell to help reduce inflammation, treat autoimmune diseases, support healthy neurological function and minimize digestive disorders. If you have experienced the symptoms of lactose intolerance for months, or years, you can jumpstart your transition by following this eating plan.
The foods consumed include many of those mentioned above, like raw fermented dairy, fruits and vegetables rich in vitamins and minerals, healthy nuts and beans, wild fish, grass-fed beef and free-range chicken.
9. Add Non-Dairy, Probiotic-Rich Foods to Your Diet
Probiotic-rich foods increase the overall health of the digestive system and can help ease common digestive upset symptoms (including poor nutrient absorption), strengthen the immune system, support weight loss and increase energy due to more vitamin B12 in the body.
Sauerkraut and kimchi are both made from fermented cabbage and other vegetables that are nutrient rich, and rich with enzymes that help digest foods. Probiotic drinks, including kvass and kombucha, are rich with healthy bacteria, which help with liver detoxification, along with coconut kefir.
Coconut kefir is easy to make at home with the same types of kefir grains used in dairy kefirs and is rich with the healthy bacteria found in organic fermented dairy products.
10. Use Coconut Oil for Cooking
Coconut oil is one of the most amazing foods on the planet, and is easily converted to energy in the body. In addition, it helps to improve digestion, burn fat, kill bad bacteria and fungus and regulate candida in the body. Coconut oil can be used for high-heat cooking, it can replace dairy in coffee and tea and it is easy to bake with. It helps to fight inflammation throughout the body, boost the immune system and even prevent bone loss. For individuals that are limiting their traditional dairy intake, coconut oil should be included in their diet.
11. Substitute Ghee for Butter
Ghee has been used for thousands of years to improve digestion function, reduce inflammation, support weight loss, strengthen bones and so much more. But the most important factor for individuals with lactose intolerance — ghee contains only trace amounts of lactose that most aren’t likely to react to. The long simmering process and skimming of the butter removes most lactose and casein, so individuals with sensitivity or allergies to dairy products should try ghee. In addition, when created from milk from grass-fed cows, levels of conjugated linoleic acid or CLA, are double or triple that of traditional grain-fed cows.