People with real or perceived lactose intolerance often cut dairy foods out of their diet. First, it’s important to obtain a proper medical diagnosis. While restricting lactose may improve digestive symptoms in those who have lactose intolerance, avoiding dairy foods can have concerning long-term health consequences.1 Limiting milk product consumption deprives people of reliable sources of calcium, vitamin D and other key essential nutrients important for good health. That’s why health authorities recommend much better ways to manage lactose intolerance.1-3
Understanding lactose intolerance
There’s a lot of misunderstanding regarding lactose intolerance. It’s not an allergy, but rather a decreased ability to digest lactose, a sugar naturally found in milk and some milk products. People with lactose intolerance don’t produce enough of the enzyme lactase in their small intestine to break down large amounts of lactose all at once. These individuals are referred to as lactose maldigesters. As a result, undigested lactose can make its way into the large intestine where it is fermented by the gut flora. This can lead to digestive symptoms such as gas, bloating and cramps when those with lactose intolerance consume larger amounts of lactose at once than their digestive capacity is able to handle. However, the amount of lactose people can tolerate before experiencing uncomfortable digestive symptoms varies. So does the amount of lactose found in different milk products. With proper education and guidance, most people who are lactose maldigesters can continue to enjoy milk products.
In practice
Health authorities suggest several practical strategies to encourage those who are lactose maldigesters and experience symptoms of lactose intolerance to keep eating dairy foods.1-3
- Drink milk in smaller portions throughout the day, instead of drinking a large glass all at once, to improve tolerance.
- Start with small amounts of milk (less than 125 mL), then gradually increase intakes over the course of a few weeks.
- Consume milk along with other foods during meals, snacks and in recipes, to help slow down and facilitate digestion.
- Choose cheeses that contain very little lactose, such as Cheddar, Swiss, Mozzarella, Parmesan, Blue and Brie.
- Eat fermented milk products like yogurt and kefir that contain good bacteria that help break down lactose.
- Use lactase enzyme drops or tablets available before consuming dairy products, to help with lactose digestion.
- Try lactose-free milk products like milk, cheeses and yogurts that are now widely available in grocery stores.
Why a proper diagnosis is important
People with digestive symptoms often self-diagnose and are told by friends, family or social media to avoid milk products. However, their symptoms may not be due to lactose intolerance. So, it’s important that people consult their doctor to obtain a proper diagnosis and medical advice. If it turns out that lactose intolerance is the cause of the digestive symptoms, the good news is that most people diagnosed with lactose intolerance can tolerate small amounts of lactose.
Living with lactose intolerance
Research suggests that it is possible for those living with lactose intolerance to improve their tolerance. A 2021 systematic review of seven good quality randomized controlled trials indicates that consuming yogurt or kefir with live, active cultures can enhance lactose digestion and reduce symptoms of lactose intolerance in people diagnosed as lactose maldigesters.4 Yogurt consumption improved lactose digestion, which was demonstrated by a reduction in breath hydrogen, and improved lactose tolerance based on self-reported symptoms. A 2015 study also found that people with actual or perceived lactose intolerance can adapt to drinking milk.5 When milk intake was gradually increased over a 3-week period, digestive symptoms decreased.
Simple menu ideas to spread milk products throughout the day
| Meals | Menu ideas | Suggested amounts of milk products |
| Breakfast | Milk with homemade apple cinnamon oatmeal | 125 mL (1/2 cup) |
| Lunch | Cheese sliced on a sandwich or sprinkled on salad or soup | 50 g (1.5 oz) |
| Snack | Yogurt with berries | 175 mL (3/4 cup) |
| Dinner | Small glass of milk with grilled salmon, vegetables and whole-grain brown rice | 125 mL (1/2 cup) |
Why milk products matter
It’s important for people to understand the potential health consequences of avoiding dairy foods. Calcium, vitamin D and other nutrients in milk products work together to support bone health throughout life. Children and teens who don’t consume enough milk products often fail to meet their calcium needs. This in turn can prevent them from reaching their optimal peak bone mass, which is critical for preventing osteoporosis later in life. Adults need to continue to consume enough bone-building nutrients throughout life to avoid problems later in life. Young adulthood is also a critical time to ensure peak bone mass is optimized by about 30 years of age. This helps to lay a solid foundation that can then be maintained to help protect against bone loss in midlife and later years for lifelong bone health. Older adults who do not consume enough milk products are at increased risk of osteoporosis and a higher risk of fractures.1,6
To learn more about lactose intolerance, watch this webinar for health professionals.
References
- Suchy FJ et al. NIH consensus development conference statement: Lactose intolerance and health. NIH Consens State Sci Statements 2010;27:1-27.
- Bailey RK et al. Lactose intolerance and health disparities among African Americans and Hispanic Americans: an updated consensus statement. J Natl Med Assoc 2013;105:112-127.
- Heyman MB. Lactose intolerance in infants, children, and adolescents. Pediatrics 2006;118:1279-1286.
- Savaiano DA and Hutkins RW. Yogurt, cultured fermented milk, and health: a systematic review. Nutr Rev 2021;79:599–614.
- O’Conner LE et al. Improving milk intake in milk-averse lactose digesters and maldigesters. J Nutr Educ Behav 2015;47:325-230.
- Misselwitz B et al. Lactose malabsorption and intolerance: pathogenesis, diagnosis and treatment. United European Gastroenterol J 2013;1:151-159.
