Lactose Intolerance

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KEY POINTS

• Lactose intolerance means you have trouble digesting milk and milk products. You may have bloating, nausea, cramps, or diarrhea after you have milk products.
• Treatment may include avoiding milk products, taking lactase supplements when you eat or drink dairy products, or having smaller servings. The smaller the serving, the less likely it is you will have symptoms.

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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 more common as people get older.

Lactose intolerance is not common in children, but may affect teens and adults.

What is the cause?

You have trouble digesting milk because your body cannot break down the natural sugar found in milk, called lactose. This normally happens as people get older.

Lactose intolerance is not the same as being allergic to milk. A milk allergy is a reaction by your immune system to cow's milk. Your body’s immune system treats dairy products as though they are harmful. Your immune system tries to protect you by making chemicals that can cause a rash, itching, swelling, irritation, and tight muscles in your airways that make it hard for you to breathe.

What are the symptoms?

Symptoms may include:

• Stomach cramps
• Bloating and gas
• Nausea and vomiting
• Diarrhea

Symptoms may start 30 minutes to 2 hours after you eat or drink foods that contain lactose.

You may be able to drink small amounts of milk, especially if you eat other foods with it. Or you may not be able to drink any milk without having symptoms.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. You may have tests to check for other problems.

How is it treated?

If you are very sensitive to lactose, check for ingredients on food labels and avoid any foods that include these ingredients:

• Milk, milk by-products, or dry milk solids or powder
• Ingredients that begin with "lact" such as lactose, lactate, lactoferrin, lactulose, lactalbumin, and lactic acid
• Whey
• Curds

Other changes you can make in your diet to help include:

• Try nondairy milk, such as soy milk, almond milk, or rice milk.
• 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 eat food that has been fortified with calcium, such orange juice, breads, and breakfast cereals.
• Drink or eat smaller 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. Most people can have 1/2 to 1 cup of milk with meals without having symptoms.
• Look for lactose-reduced or lactose-free milk, such as Dairy Ease or Lactaid products, in your grocery store.
• Try lactase supplements, such as Lactaid, that you can take when you eat or drink dairy products. The lactase in these products helps your body break down milk sugars. You can buy these supplements in drug or grocery stores.
• Eat yogurt that says on the label that it contains an active culture. The active cultures in yogurt help your body break down lactose.
• 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 because it is high in calories and fat.

Lactose intolerance may get better during pregnancy. If you are pregnant, try small servings of milk several times a day. Starting with small servings may keep you from having symptoms. If you are unable to eat or drink any milk or dairy products, your healthcare provider may prescribe calcium tablets to make sure that you are getting enough calcium during your pregnancy.

How do I choose a calcium supplement?

Milk and milk products are an important source of calcium and vitamin D. It can be hard to get enough of these nutrients without dairy products in your diet. If you don’t think you get enough calcium and vitamin D from the foods you drink or eat, ask your healthcare provider if you should take a supplement. There are many kinds of calcium supplements:

• Calcium carbonate is best absorbed with a meal.
• Calcium citrate can be taken on a full or empty stomach. This kind of calcium may be a better choice for older adults or people who have low levels of stomach acid.
• Calcium phosphate, lactate, and gluconate are well absorbed, but you need to take several pills a day to meet your needs.

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