Digestive Health Center Nutrition Services

Nutrition Guidelines for Lactose Intolerance

If you repeatedly have symptoms of gas, bloating, cramping and/or diarrhea after eating dairy, there is a chance you could be intolerant to lactose, the milk sugar in dairy. It is important that you talk to your doctor about your symptoms.

The most common cause of lactose intolerance is a gradual decrease over time in lactase levels, which is the intestinal enzyme needed to digest lactose well. It may also result from intestinal surgery or from conditions such as celiac disease and Crohn's disease.

Lactose intolerance is not a milk allergy. A milk allergy is an immune reaction to a milk protein in dairy, where one may develop rashes, itchiness, difficulty in breathing, etc after eating dairy. With a milk allergy, all dairy needs to be removed from the diet.

There is no need to avoid dairy with lactose intolerance as the amount of lactose can vary among dairy products. Your tolerance level to lactose is determined by the type and amount of dairy you eat, which may improve over time as you continue to eat dairy.

Including dairy in your diet will provide you a rich source of calcium and vitamin D, which is important for bone health.

To Build Tolerance with Dairy  Start with eating low lactose and lactose free dairy such as hard cheeses and lactose free cow’s milk  Experiment with different dairy products one at a time to determine your tolerance level  Eat small amounts of dairy (one small yogurt container, one slice of cheese etc). Include at least three servings of dairy daily.  Avoid eating multiple sources of dairy at the same meal. Spread out your dairy throughout the day.  Eat dairy with a meal. This may allow your body more time to digest the lactose.  Talk to your doctor about taking lactase enzyme pills before you eat dairy

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Dairy is also used as an ingredient in many foods...  Experiment with these foods as well  The food has lactose if the food label lists ingredients such as: butter, buttermilk, cheese, chocolate, cream, curd, margarine, whey, curd, milk (any), milk solids, sherbet and yogurt.  Ingredients such as casein, lactalbumin, lactate, lactic acid are made from milk, but do not have lactose  Hidden sources of lactose could be found in foods such as: o Baked goods such as cookies, cupcakes, donuts, pastries o Candies o Canned soup and soup powders o Instant mashed potatoes o Luncheon meats and hot dogs o Salad dressings o Pancake, cake and waffle mixes

Tips to Enjoy Dairy:  Mix a small amount of milk into your foods, such as oatmeal, soups, etc  Blend a small container of yogurt with a fruit such as a banana. Yogurt (but not frozen yogurt) has live bacterial cultures that help to digest lactose.  Spread cream cheese on your bagel  Sprinkle a small handful of shredded mozzarella cheese onto your pasta  Add a slice of cheddar or swiss cheese to sandwiches, crackers etc  Use lactose free cow’s milk instead of milk in your recipes

Lactose Content of Foods and Beverages Dairy Product Serving Size Lactose (gm) Sweetened condensed milk 1 cup 30 Evaporated milk 1 cup 24 Milk: whole, 2%, 1%, skim 1 cup 11 Acidophilus milk 1 cup 11 Buttermilk 1 cup 10 Carnation Instant Breakfast 1 packet (w/o milk) 8 Ice cream ½ cup 6 Low-fat yogurt 1 cup 5 Sour cream ½ cup 4 Whipped cream ½ cup 3 Cottage cheese ½ cup 3 Sherbet ½ cup 2 American cheese 1 oz 2 Cream cheese 2 TBSP 1 Half and half cream 2 TBSP 1 Soft cheeses; feta, mozzarella, ricotta 1 oz 1 Hard cheeses: cheddar, colby, parmesan, swiss 1 oz 0.2-0.5 Butter, margarine 1 TBSP trace Nutritional supplements: Ensure, Boost 1 bottle 0 2

Enjoy Dairy Alternatives As Well  Dairy alternatives (dairy substitutes) are available and are naturally lactose free  Look for dairy alternatives that are fortified with calcium and vitamin D (calcium and vitamin D has been added) o Almond milk o Coconut milk o Rice milk o Rice ice cream o Soy milk o Soy cheese o Soy ice cream o Soy yogurt

Calcium from Non Dairy Sources  Add other calcium rich foods and calcium fortified foods into your diet: o Almonds o Cooked green leafy vegetables (turnip greens, kale, collards, spinach, etc) o Canned salmon with soft bones o Calcium fortified tofu o Calcium fortified dry cereals o Calcium fortified orange juice  Talk to your doctor about taking a calcium and vitamin D supplement

Resources "Lactose Intolerance and Health" National Institute of Health Consensus Development Conference Statement Volume 27, Number 2, February 2010

"Lactose Intolerance: Considerations for the Clinician" Nutrition Issues in Gastroenterology (in Journal of Practical Gastroenterology) February 2003

National Dairy Council www.NationalDairyCouncil.org

Not for reproduction or publication without permission Direct inquiries to Digestive Health Center at Stanford Hospital and Clinics NS 4/2012

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