Lactose Intolerance

What is lactose intolerance?

Lactose intolerance means you have trouble digesting milk and milk products. The condition is most common among Asians, American Indians, Mexican Americans, and African Americans. It is also a more common problem as people get older.

How does it occur?

You have trouble digesting milk because your body does not make enough lactase. Lactase is the enzyme that breaks down the natural sugar found in milk. This milk sugar is called lactose.

What are the symptoms?

Symptoms of lactose intolerance in adults include:

• rumbling abdominal sounds
• abdominal cramps
• abdominal bloating and gas
• diarrhea.

The severity of the intolerance varies from one person to another. Symptoms typically start 30 minutes to 2 hours after eating or drinking foods containing lactose. Many people with this problem are able to drink small amounts of milk, especially if they eat other foods with it. Others cannot drink any milk without having symptoms. The body naturally starts making less lactase around the age of 3 years. However, the symptoms often do not begin until early adulthood or later.

What changes should I make in my diet?

Milk and milk products are an important source of calcium. It can be hard to get enough calcium when dairy products are removed from your diet. You should be especially concerned about getting enough calcium if you are in one of the following groups:

• children
• teenagers
• women who are pregnant, are breast-feeding, or have gone through menopause.

The daily calcium requirement ranges from 500 mg to 1,500 mg a day for children through adulthood. The more dairy products you can tolerate, the less calcium you will need to take as a supplement.

To help you get enough calcium, you can make changes in your diet that will help you better digest milk and milk products. Or you can make sure that you get enough calcium from other foods. If possible, it is always best to get your nutrients from food.

Getting enough vitamin D (found mainly in milk and a few other vitamin D fortified products) is also a concern, especially if you are over 50 years old or don’t get out in the sun much. Most calcium supplements also contain vitamin D. If you cannot get enough calcium and vitamin D from the foods you drink or eat, you may want to talk with your healthcare provider about taking a supplement.

Here are some changes you can make in your diet to help reduce symptoms caused by lactose intolerance.

• Drink or eat smaller but more frequent servings of milk products. The smaller the serving, the less likely it is you will have symptoms.
• Eat other foods when you drink milk. This slows the digestive process and lessens symptoms of lactose intolerance. Most people with lactose intolerance can tolerate 1/2 to 1 cup of milk with meals.
• Look for lactose-reduced or lactose-free milk, such as Dairy Ease, in your grocery store.
• Try adding the lactase enzyme to ordinary milk. Lactase products, such as Lactaid, are available in drug and grocery stores. Some people prefer the flavor of milk with added lactase because it tastes a little sweeter.
• Eat yogurt that includes an active culture. The active cultures in yogurt make the enzyme (lactase) that breaks down lactose. Check yogurt container labels to see if active culture is included.
• Hard cheeses, such as cheddar, should not cause much of a problem because they don’t have a lot of lactose. But be cautious about how much cheese you eat. Cheese is usually high in fat and cholesterol.
• Eat other foods that are rich in calcium, such as leafy greens (collard, kale, and mustard), canned salmon and sardines (if the bones are included), broccoli, and Brussels sprouts. Also consider eating food that has been fortified with calcium, such soy milk, orange juice, breads, and breakfast cereals.

Lactose intolerance may get better during pregnancy. Pregnant women who have had lactose intolerance might want to try to slowly add milk products back to their diet and see if the symptoms return. Try small servings of milk several times a day because small servings may be better tolerated than larger ones. If you are unable to eat or drink any milk or dairy products, your healthcare provider may decide to recommend calcium tablets to make sure that you are getting enough calcium during your pregnancy.

What should I check for on food labels?

If you are very sensitive to lactose, check for the following ingredients on food labels.

• milk
• lactose
• whey
• curds
• milk by-products
• dry milk solids
• non-fat dry milk powder

Avoid any foods that include these ingredients.

How do I choose a calcium supplement?

There are many calcium preparations and strengths. Choosing one can be confusing. The most common products are calcium carbonate and calcium citrate.

Calcium carbonate is best absorbed with a meal. Calcium citrate can be taken on a full or empty stomach. Calcium citrate may be a better choice for older adults or younger people who have low levels of stomach acid.

Look at how much elemental calcium is in the supplement. The less elemental calcium per pill, the more pills you will have to take to meet your needs. If you want to take just 2 calcium pills a day, you need to choose a product that contains 500 to 600 mg of elemental calcium. Calcium, whether in food or supplements, is best absorbed if taken several times a day, in amounts of 500 mg or less.

Calcium phosphate, lactate, and gluconate are also well absorbed. However, the calcium content of these supplements is low per pill, so you need several pills a day to meet your needs.

It is a good idea to choose a calcium supplement that contains vitamin D (most do). Vitamin D helps your body absorb the calcium.