Guide to Lactose Intolerance Diet
Advice About Eating and Food For Lactase Deficiency
Lactose Intolerance Diet
People who suffer from lactose intolerance are unable to digest (break down in the gut) significant amounts of lactose, which is the principal sugar in milk and milk products. This digestive inability is caused by a lack of the digestive enzyme lactase.
Symptoms of Lactase Deficiency
Normally, in order to break down lactose, we rely on a digestive enzyme called lactase which is produced by the cells that line the small intestine. If a lactase-deficient individual eats a food containing lactose, the sugar passes through into the intestine where it provides a bonanza for waiting bacteria. The bacteria consume the sugar, emitting gas and toxic products (eg. lactic acid) as they grow and multiply. These toxins then cause unpleasant symptoms such as pain, bloating, gas, diarrhea and abdominal cramps.
Treatment
There is no “special treatment” for lactose intolerance. The only way to control symptoms is by diet modification. This means that if you suffer from lactose intolerance you need to follow a low-lactose or lactose-free diet. This should be planned in consultation with your dietitian or nutritionist.
Coping With Lactase Deficiency
The main strategy for people who are lactase-deficient and who have trouble digesting lactose is to adapt their eating habits according to which dairy products they can (and can’t) consume without discomfort. This largely involves a process of trial and error. Many sufferers are able to enjoy milk, ice cream, and other dairy products provided they eat them in small amounts or combine them with other foods. Other sufferers find it helpful to take supplements like lactase liquid or tablets to help digest the lactose.
Health Management
Groups with special calcium needs, such as women at risk from osteoporosis or growing children, who are unable to digest milk products, can satisfy most of their nutritional requirements by eating greens, fish, and other calcium-rich foods that do not contain lactose.
Special Causes of Lactase Deficiency
Lactase enzyme activity is reduced in people with certain intestinal conditions such as Crohn’s disease, ulcerative colitis, and celiac disease. In addition, patients taking certain drugs and alcoholic patients may also be lactase deficient. Lastly,patients who have undergone gastric bypass surgery may be lactose intolerant and may therefore need to reduce lactose in the diet.
Lactose Intolerance: Summary
For those people who are deficient in lactase and thus unable to tolerate milk foods, a lactose-free diet, combined if necessary with calcium supplements, is an effective way to reduce symptoms and protect health. Between 30 and 50 million Americans are lactose intolerant, but despite its prevalence, lactose intolerance does not pose a serious threat to good health. For example, even though it sometimes causes quite uncomfortable symptoms, it does not cause damage to the intestine.
Guide to Lactose Intolerance Diet
Advice About Eating and Food For Lactase Deficiency
Lactose Intolerance Diet
People who suffer from lactose intolerance are unable to digest (break down in the gut) significant amounts of lactose, which is the principal sugar in milk and milk products. This digestive inability is caused by a lack of the digestive enzyme lactase.
Symptoms of Lactase Deficiency
Normally, in order to break down lactose, we rely on a digestive enzyme called lactase which is produced by the cells that line the small intestine. If a lactase-deficient individual eats a food containing lactose, the sugar passes through into the intestine where it provides a bonanza for waiting bacteria. The bacteria consume the sugar, emitting gas and toxic products (eg. lactic acid) as they grow and multiply. These toxins then cause unpleasant symptoms such as pain, bloating, gas, diarrhea and abdominal cramps.
Treatment
There is no “special treatment” for lactose intolerance. The only way to control symptoms is by diet modification. This means that if you suffer from lactose intolerance you need to follow a low-lactose or lactose-free diet. This should be planned in consultation with your dietitian or nutritionist.
Coping With Lactase Deficiency
The main strategy for people who are lactase-deficient and who have trouble digesting lactose is to adapt their eating habits according to which dairy products they can (and can’t) consume without discomfort. This largely involves a process of trial and error. Many sufferers are able to enjoy milk, ice cream, and other dairy products provided they eat them in small amounts or combine them with other foods. Other sufferers find it helpful to take supplements like lactase liquid or tablets to help digest the lactose.
Health Management
Groups with special calcium needs, such as women at risk from osteoporosis or growing children, who are unable to digest milk products, can satisfy most of their nutritional requirements by eating greens, fish, and other calcium-rich foods that do not contain lactose.
Special Causes of Lactase Deficiency
Lactase enzyme activity is reduced in people with certain intestinal conditions such as Crohn’s disease, ulcerative colitis, and celiac disease. In addition, patients taking certain drugs and alcoholic patients may also be lactase deficient. Lastly,patients who have undergone gastric bypass surgery may be lactose intolerant and may therefore need to reduce lactose in the diet.
Lactose Intolerance: Summary
For those people who are deficient in lactase and thus unable to tolerate milk foods, a lactose-free diet, combined if necessary with calcium supplements, is an effective way to reduce symptoms and protect health. Between 30 and 50 million Americans are lactose intolerant, but despite its prevalence, lactose intolerance does not pose a serious threat to good health. For example, even though it sometimes causes quite uncomfortable symptoms, it does not cause damage to the intestine.
Lactose-Free Eating Plan
Factors to Consider When Starting a Lactose Free Diet
Starting a Lactose-Free Eating Plan
Lactose Tolerance Levels Can Vary
Younger children who are lactose intolerant should not eat any foods containing lactose. Most older children and adults need not eliminate lactose from their daily diet completely, although tolerance levels tend to vary. Some people develop symptoms after drinking a cup of milk, while others may be able to eat ice cream and some cheeses, but not other dairy products. Successful dietary management of lactose intolerance is largely based on trial and error. Sufferers need to experiment and discover for themselves how much lactose they can tolerate.
Lactose Reduced Foods
Lactose-reduced milk and other milk-based products are available in many food and health stores. Lactose-reduced milk contains all of the nutrients found in regular milk and remains fresh for about the same length of time, or longer if it is super-pasteurized.
Lactase Enzyme Supplements
For sufferers who can only tolerate the smallest amounts of lactose, non-prescription lactase enzyme supplements are available and often help to make dairy foods more digestible. They are available in liquid or tablet form.
Problems of Nutritional Deficiency
Dairy food is a major source of nutrition in the average American diet. Its most important nutrient is calcium, which is essential for the growth and repair of bones. Calcium deficiency can lead in later life to fragile bones and a higher risk of fracture – a condition known as osteoporosis. Thus any serious inability to consume milk and other dairy products raises concerns about how best to obtain adequate calcium.
How Much Calcium Do We Need
In general, daily calcium requirements vary according to age group, as follows:
Age Group – Daily Calcium (mg)
0-6 months – 210 mg
7-12 months – 270 mg
1-3 years – 500 mg
4-8 years – 800 mg
9-18 years – 1,300 mg
19-50 years – 1,000 mg
51-70+ years – 1,200 mg
Note: Pregnant and nursing women under 19 need 1,300 mg daily, while pregnant and nursing women over 19 need 1,000 mg.
Lactose-Free Calcium Sources
Non-Dairy Foods Containing the Mineral Calcium
Sources of Calcium For Lactose Intolerant
Non-Dairy Sources of Calcium
Many non-dairy foods are high in calcium. Green vegetables like broccoli and kale, and fish with edible bones like sardines and salmon, are excellent sources of calcium. Also, some cultured yogurts, despite containing lactose may be manageable sources of calcium.
See the following table for a sample list of common foods that are good sources of dietary calcium. If you are lactase-deficient and have difficulty tolerating dairy foods, include regular amounts of these foods in your daily diet.
able 1. Calcium and Lactose in Common Foods
| Food | Calcium Content | Lactose Content |
| Calcium-fortified orange juice (1 cup) | 308-344mg | 0mg |
| Sardines with edible bones (3oz) | 270mg | 0mg |
| Salmon, canned, w/ edible bones (3oz) | 205mg | 0mg |
| Soymilk, fortified (1 cup) | 200mg | 0mg |
| Broccoli, raw (1 cup) | 90mg | 0mg |
| Orange, (medium) | 50mg | 0mg |
| Pinto beans (1/2 cup) | 40mg | 0mg |
| Tuna, canned (3oz) | 10mg | 0mg |
| Lettuce greens (1/2 cup) | 10mg | 0mg |
| Yogurt, plain low-fat (1 cup) | 415mg | 5g |
| Milk, reduced fat, (1 cup) | 295mg | 11g |
| Swiss cheese (1 oz) | 270mg | 1g |
| Ice cream (1/2 cup) | 85mg | 6g |
| Cottage cheese (1/2 cup) | 75mg | 2-3g |
Source: Adapted from Manual of Clinical Dietetics. 6th ed. American Dietetic Association, 2000; and Soy Dairy Alternatives.
Need For Balanced Diet
As you can see from the above sample list, there are quite a few low-lactose foods that can provide the calcium you need, even if your intake of milk and dairy products is limited. However, calcium-content is only one factor. You need to be able to absorb the calcium you eat, which requires the presence or absence of other nutrients and ingredients.
Oxalates Inhibit Calcium Absorption
Some calcium-containing vegetables (Swiss chard, spinach, and rhubarb) are not useful sources as they contain substances called oxalates, which prevent calcium absorption.
Importance of Vitamin D
Calcium is absorbed only when there is a sufficient supply of vitamin D in the body. Sources of vitamin D include eggs and liver. Alternatively, since sunlight also helps the body obtain vitamin D, anyone with regular exposure to the sun needs less vitamin D in their diet.
Planning a Healthy Balanced Diet
For optimum nutrition, I recommend anyone with lactose intolerance to consult their dietitian or nutritionist in order to plan a healthy balanced eating plan, and determine what (if any) supplements are needed.
Lactose in Processed Food
Diet Advice For Lactase-Deficient – Hidden Lactose in Processed Foods
How to Avoid Hidden Lactose
Check Food Labels For Lactose
Lactose is sometimes added to prepared foods/meals, so if you can tolerate only very small amounts of lactose, it’s important to check food labels and lists of ingredients. Look not only for milk and lactose among the contents, but also for such words as “whey”, “curds”, “milk by-products”, “dry milk solids”, and “non-fat dry milk powder.” These words denote that the food contains lactose
Sample Foods That May Contain Lactose
– Bread and other bakery foods
– Candies
– Pancake, biscuit, or cookie mixes
– Breakfast cereals
– Breakfast drinks, instant potatoes, soups
– Non-dairy powdered coffee creamers
– Non-dairy whipped toppings
– Margarine
– Lunch meats
– Salad dressings
Drugs That May Contain Lactose
More than 20 percent of prescription drugs and about 6 percent of over-the-counter medicines contain lactose. For example, some types of birth pills, as well as tablets for stomach acid and gas may contain lactose.
Lactose-Free Diet Menu
Sample Food Plan For Lactase Deficient
Lactose-Free Menu
Breakfast
Orange juice, calcium fortified 1/2 cup
Oatmeal 1 cup
Italian bread 2 slices w.jelly and margarine
Tea or Coffee w.non-dairy
Lunch
Turkey 2 oz
Italian bread 2 slices
Mayonnaise 1/2 tbsp
Tossed green salad 1 cup
Oil & vinegar 2 tsp
Tomato 2 slices
Chopped carrot 1
Celery 1 stalk
Banana
Lactose-free milk 1 cup
Dinner
Roast beef 4 oz
Noodles 1/2 cup
Broccoli 1 cup
Italian bread 1 slice w.margarine
Fresh or frozen fruit
Tea or Coffee w.non-dairy creamer
List of Lactose-Free Foods
Diet For Lactase Deficient: Non-Lactose Food
List of Lactose-Free Foods
Milk & Milk Products
Lactose-Free
100 percent lactose-free milk, soy milk
Lactose-Containing
Milk – whole, skim, 1 percent. 2 percent; buttermilk; sweet acidophilus milk; lactose-reduced milk; evaporated milk; acidophilus milk; sweetened condensed milk; instant hot chocolate and cocoa mixes; cheese
Vegetables
Lactose-Free
Fresh, frozen, and canned vegetables without added milk or milk products; tomato paste and purée; tomato and spaghetti sauces without cheese
Lactose-Containing
Creamed or breaded vegetables, packaged dried potato mixes, tomato and spaghetti sauce with cheese
Fruits
Lactose-Free
Fresh, frozen, canned, and dried fruits
Lactose-Containing
None
Breads & Grains
Lactose-Free
Water-based breads (Italian, French, Jewish rye), rice and popcorn cakes, graham crackers, rusks, Pareve-Jewish bakery products, cooked and dry cereals without added milk solids, pasta, rice, oats, barley, cornmeal, bulgar, and other plain grains
Lactose-Containing
the following made with milk or milk products, breads, rolls, biscuits, muffins, pancakes, sweet rolls, waffles, crackers, instant and dry cereals with added milk products, some packaged grain mixes, packaged macaroni mixes
Meat and Meat Substitutes
Lactose-Free
Plain beef; lamb; veal; pork; wild game; poultry; fish; shellfish; eggs; kosher prepared meat products; peanut butter; peas, beans, or lentils (dried, canned or frozen); all nuts and seeds; tofu
Lactose-Containing
Eggs, fish, meat, or poultry (breaded or creamed); luncheon meats; sausage; frankfurters; some brands of egg substitutes and powdered eggs
Fats & Oils
Lactose-Free
Bacon, butter, margarine without milk derivatives (whey), salad dressing without cheese or milk, vegetable oils, olives, most non-dairy creamers, mayonnaise, gravy made without milk or milk products
Lactose-Containing
Cream, half & half, sour cream, cream cheese, chip dips, some types of margarine, salad dressing with cheese or milk, whipped toppings
Sweets & Desserts
Lactose-Free
Angel food cake, gelatin, fruit ice, fruit popsicles, fruit roll ups, hard candy, gum drops, jelly beans, licorice, fruit pie fillings
Lactose-Containing
Ice cream, ice milk, some brands of sherbet, soufflé, mousse, pudding, custard, packaged dessert mixes, milk chocolate, toffee, caramel, butterscotch
Beverages
Lactose-Free
Postum, lactose-free nutritional supplements (Sustacal, Ensure, Nutren), vegetable juice, fruit juices and drinks, tea, carbonated beverages, beer, wine, distilled spirits (gin, rum, etc.), cocoa powder, most coffee
Lactose-Containing
Instant iced tea, instant coffee, Ovaltine, chocolate drink mixes, cordials, liqueurs, milk-based nutritional supplements (Carnation Instant Breakfast)
Soups
Lactose-Free
Bouillon, broth, meat, or vegetable stock soups; bisques and chowders made with water, soy milk, or 100% lactose-free milk
Lactose-Containing
Cream soup, canned and dehydrated soup mixes containing milk products
Miscellaneous Foods
Lactose-Free
Popcorn, plain pretzels, plain potato and corn tortilla chips, salsa, mustard, ketchup, pickles, uncreamed horseradish, relish, sauces made without milk or milk products, sugar, honey, jams and jellies, maple and corn syrup, molasses, herbs, spices, salt, pepper
Lactose-Containing
Cream or cheese sauces, ranch-style or cheese-flavored snack pretzels or chips, cheese curls, sug
substitutes with lactose added, medications and vitamin/mineral supplements with lactose added
