Lactose Intolerance: What It Is and How To Cope

When you’re lactose intolerant, eating dairy products can bring on a whole host of unpleasant symptoms.

What is lactose?

Lactose is the naturally-occurring sugar found in milk and most dairy products (just like fructose is the sugar found in fruit). Lactose and fructose are different from added sugar, which is added during cooking or processing.

What does it mean to be “lactose intolerant?” 

Most people have an enzyme in their gut called lactase, which helps to digest lactose. People with lactose intolerance don’t have enough lactase to fully digest lactose, so they get stomach aches, bloating, gas or diarrhea after eating dairy products.

Is lactose intolerance the same as a milk allergy?

No. These two conditions are completely different. A milk allergy is an allergy to the protein component in milk, whereas lactose intolerance is an inability to digest the sugar component of milk. Here’s more on the difference between an intolerance and allergy.

What can you do if you’re lactose intolerant?

Different people have different levels of sensitivity to lactose. Some people may react severely and decide to avoid dairy altogether, whereas others can tolerate dairy in small amounts. Here are a few options for how to deal:

1. Buy lactose-free milk, cream, ice cream, etc.
2. Eat dairy products in small amounts.
3. Choose low-lactose dairy products, like yogurt, kefir and aged cheeses.
4. Take a lactase pill, like Lactaid, before eating dairy.
5. Avoid processed foods that contain whey protein concentrate and other dairy derivatives.
6. Avoid dairy products altogether.

It may take some trial and error to see which of these options will work best for you. Writing down exactly what you eat and when you experience symptoms for a few weeks can help you determine what most triggers your symptoms.

What can you eat if you’re lactose intolerant?

1. Yogurt.  Most people with lactose intolerance can eat yogurt. The good bacteria (live, active cultures) found in yogurt will help digest the lactose for you. Choose a high quality yogurt  or Greek yogurt (here’s a guide to help) with very few ingredients.
2. Kefir.  Kefir is like a drinkable yogurt, but with even more probiotics for even better digestion.
3. Aged cheeses.  The harder a cheese, the less lactose it has. Lactose is found in the watery part of milk, and since harder cheeses have less liquid, they naturally contain less lactose.  Extra sharp cheddar, Parmesan, Pecorino, aged gouda and other very hard cheeses are nearly lactose-free.
4. Lactase-fortified dairy products.  Lactaid is the most well-known lactose-free milk, but many brands now offer similar products, which makes lactose-free life a lot easier. If you like to buy organic, Organic Valley (pictured above) has some great lactose-free organic dairy products.
5. Low-fat dairy products in small amounts.  Low-fat dairy products can be easier on the system when eaten in small amounts and/or combined with other foods at a meal. (These foods are also higher in protein and calcium than high-fat dairy). Start with small portions so you can see what works for you.
6. Dairy products eaten with a lactase pill.  Not everyone finds lactase pills helpful, but they’re worth a try.  Pop a lactase pill 30-60 minutes before consuming dairy to see if this method works for you. (Note: don’t expect lactase to be a miracle pill…in other words avoid downing a huge milkshake after taking a pill).

What foods should be avoided?

1. Large serving sizes of dairy. Even if you’ve found a food that doesn’t cause bad symptoms, small portions are still best. Your body is more likely to tolerate dairy if you eat only a little at a time.
2. Very high fat dairy products like ice cream, soft creamy cheeses and cream (or foods made with cream). These actually have less lactose than low-fat products, but tend to be more irritating to those with lactose intolerance or who are sensitive to rich foods. The one exception here is aged cheese, which is high-fat but low-lactose.
3. Whey protein concentrate. This is a doozy, because it’s added to a lot of processed foods to make them richer and creamier.  But it can wreak havoc on a lactose intolerant person’s system (and on a normal person’s system), because it often contains concentrated lactose.
4. Soft-serve ice cream/frozen yogurt. This is mostly because of reason #3.  Many soft-serve desserts, smoothies and protein shakes have significant amounts of whey protein concentrate, and can cause bigtime symptoms. If you love ice cream-style desserts, buy real frozen yogurt from the grocery store (Stonyfield, Julie’s Organic, and Straus Family Creamery all contain live active cultures that will help you digest) or make it yourself.

What milk alternatives are best, if I’m going to avoid dairy?

Here’s a chart of milk alternatives so you can decide which give you the best nutritional bang for your buck.

Disclaimer: This advice should not replace the advice of your doctor or medical provider. These are general recommendations and may or may not be appropriate for you or your health conditions.