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Lactose intolerance is fairly common. Despite the fact that more than 75% of adults worldwide are unable to properly digest milk and dairy products, only 30% actually consider themselves to be lactose intolerant (1).
If you feel fine and dandy after consuming milk or dairy products, that is fantastic! If you enjoy those foods, keep on keepin’ on. For people who maybe don’t feel their best after consuming dairy or are just a bit confused about terminology, read on as we clarify some common questions and clear up a few things related to lactose intolerance.
We include a bonus “Am I Lactose Intolerant Quiz” at the end to help get you thinking about if you would like to discuss how lactose affects you with a Registered Dietitian and/or your physician.
Lactose Intolerance Symptoms
Let’s start with symptoms. Although you might be familiar with some of the symptoms associated with lactose intolerance, there are some that may be a sign of something more serious. It is imperative that we don’t confuse milk allergy or other GI conditions with lactose intolerance. Common symptoms of lactose intolerance include (2):
- Abdominal bloating
- Diarrhea
- Gas
- Nausea
- Cramps
- Overall feeling ill after lactose consumption
Symptoms NOT associated with Lactose Intolerance
Common symptoms that are NOT associated with lactose intolerance, but may indicate a milk allergy or other GI conditions (3)
- Skin rash or hives
- Blood in stool
- Difficulty breathing
- Vomiting
- Low blood pressure
- Fainting
Milk Allergy vs Lactose Intolerance
Some symptoms like diarrhea and abdominal pain might be present in both a milk allergy and lactose intolerance. So, what’s the difference between these two?
Milk Allergy
Having a milk allergy can be a life threatening condition and should be taken very seriously. A milk allergy requires medical testing for proper diagnosis and complete avoidance of milk and milk products. A milk allergy is commonly diagnosed early in childhood and may include a reaction to any dairy products from cow, sheep, goat, and other milk producing animals. Symptoms of milk allergy range from difficulty breathing, hives, skin irritation around lips and mouth to an anaphylactic reaction (4).
Lactose Intolerance
Lactose intolerance occurs when the body is unable to break down a type of sugar present in dairy products called lactose. This occurs when the body no longer is able to produce the enzyme responsible for breaking down lactose. This enzyme is called lactase. The small intestine fails to break down lactose into glucose and galactose, which are necessary for energy (5). Therefore, lactose from dairy products travels through the GI tract into the colon where gut bacteria ferments lactose causing abdominal discomfort (5).
Lactose intolerance may develop overtime as we age (6), or it may be caused by other conditions like Irritable Bowel Syndrome, Celiac Disease, HIV, malnutrition, or intestinal infection (7). These are usually differentiated as primary or secondary lactose intolerance. There are also risk factors associated with lactose intolerance like: ethnicity, age, premature birth, GI-related conditions, and some cancer treatments that target the GI tract.
Symptoms related to lactose intolerance vary depending on the amount of lactose consumed (8).
How Do You Know If You’re Lactose Intolerant?
Although the best and most accurate way of testing for lactose intolerance is by medical testing, some people opt for doing home tests that involve eliminating lactose. In order to try this process, one must stop eating all dairy products for about three days (a few more if you’ve been consuming more than usual). After this time, the individual must record how they feel when they consume dairy products. This will indicate what foods may be causing unpleasant symptoms. This process can help guide any underlying cause of lactose intolerance, if there are any other signs or symptoms present during this experiment. The most accurate way to determine whether someone is lactose intolerant would be through biological testing, such as blood, hydrogen, or stool sample tests.
Do you feel concerned about eating out and the choices that will be available to you?
Does anyone in your family have issues with dairy?
Do you experience GI discomfort after eating things like pizza, lasagna, ice cream or milkshakes?
Do you regularly eat foods that may contain lactose like milk, milk products, cheese, and ice cream?
After eating foods high in lactose (whole milk, milk shakes, heavy cream, sweet condensed milk), do you experience bloating, abdominal pain, diarrhea, or cramps?
Lactose Intolerance Test
Blood Test
There is a blood test called Lactose Intolerance Test which measures the amount of lactose in your blood to assess whether your body is able to break down lactose or not. This test is performed after the patient consumes a liquid that contains high levels of lactose.
Hydrogen Breath Test
The hydrogen breath test is one way to find out if you’re lactose intolerant. It’s also known as the Lactose Malabsorption Test or the HBT. The test is done by taking a deep breath, then swallowing 100 ml of glucose that contains 50 grams of lactose. If you’ve been drinking milk, cheese, or other foods with lactose for two hours before the test, you may need to stop for eight hours before the test to make sure your system is clear of any dairy products.
Stool Acidity Test
The clearest way to tell if someone is lactose intolerant is with a stool acidity test. This involves collecting samples of your stools before and after you eat or drink something that contains milk products. It’s important to note that this test doesn’t always work well in people who take antacids or have irritable bowel syndrome.
Other Possible Causes of Similar Symptoms
Other possible causes for overall GI discomfort include Irritable Bowel Syndrome (IBS), Crohn’s disease, Celiac disease, Ulcerative Colitis and gluten intolerance. If you suspect your GI symptoms relate to any of the conditions above, it’s highly recommended that you should talk with your family doctor who may refer you to a gastroenterologist for further tests.
Lactose Intolerance Treatment
Once a person has been diagnosed with lactose intolerance, reducing or avoiding foods rich in lactose is typically recommended (9). Symptoms associated with lactose intake vary per person (8,9). Although some people may be able to tolerate milk or milk products in smaller amounts, some people cannot tolerate any dairy products without experiencing GI discomfort. It can get a bit complicated! That is why we highly recommend partnering with a Registered Dietitian and/or your physician to help you feel your best.
If you are lactose intolerant, you may need to monitor your symptoms and assess if you can tolerate some cheeses or milk products. Some low-fat dairy products contain less lactose compared to the full-fat ones, so this may also be an important factor to consider (10).
Foods That Contain Lactose
- Milk (Cow + Goat)
- Yogurt
- Cheese
- Ice cream
- Butter
These dairy products are also rich sources of Calcium. Doctors typically advise people with lactose intolerance to consume food high in calcium to make up for the lack of calcium consumption due to avoidance of dairy products (11).
What is Lactaid?
Lactaid pills help to break down the lactose in dairy products. These pills are designed to help lactose intolerant individuals to digest and absorb the milk sugar (lactose) properly (12).
The tablets come either as chewable or as a liquid form you mix with water or other liquids like juice, coffee, tea, or carbonated drinks (13). It is recommended to take these tablets before eating any food that contains dairy products such as cheese, butter, ice cream and yogurt (13).
Every person with lactose intolerance is different so it’s important to see what works for you. With the aid of these pills, most people can live a normal life where they are able to consume dairy products again. However, not everyone sees equal benefit from taking Lactaid pills. Seeking medical advice is important to assure that all pertinent evaluations are made and your gut stays happy and healthy!
Lactose Intolerance vs Dairy Intolerance
There is a bit of confusion related to these two terms, however they are referring to the same thing: lactose intolerance. Dairy intolerance refers to the lactose present in dairy products and therefore, it is referring to the same condition. A milk allergy differs from lactose intolerance, which we discuss in detail above.
Dairy Products with High and Low Lactose Concentrations
Are there dairy products that contain more lactose compared to other dairy products? YES. This is why some lactose intolerant people have NO trouble eating parmesan cheese but cannot tolerate brie cheese.
Dairy products that contain high levels of lactose (grams of lactose)*:
- Sweet condensed milk (31-50 grams per 1 cup)
- Whole milk (12-13 grams per 1 cup)
- Milkshake (12 grams per 12 oz cup)
- Buttermilk (9-12 grams per 1 cup)
- Skim milk (5-10 grams per 1 cup)
Dairy products that contain low levels of lactose (grams of lactose):
- Cottage cheese (0.7-4 grams per ½ cup)
- Camembert cheese (0.1-1.8 grams per ½ cup)
- Sherbert (0.6-2 grams per ½ cup)
- Cream cheese (0.1-0.8 grams per 1 oz)
- Parmesan cheese (0 grams per ⅓ cup)
*Retrieved from USDA Database
The severity of the symptoms depend on how much lactose a person consumes at one time. Monitoring your symptoms after consuming lactose could help guide what amount or variety your body can actually tolerate. In addition, there may be some products that contain lactose that may not be as obvious as milk and cheese. These products include: baking mixes, salad dressings, sauces, cereals, and soup mixes.
Quick Tips for those who may be Lactose Intolerant
- If you think you might be lactose intolerant, talk to your doctor about having a test done to find out for sure.You can get gas and other symptoms from any food with lactose in it, not just dairy products. Some foods that may have added lactose are baking mixes, cereal and salad dressing. The ingredient list can be helpful in identifying if there is added lactose. If you think you might be lactose intolerant, but have not yet been tested for it, one strategy is to avoid whole milk and creams because they have the highest amount of lactose. Instead, go for low fat dairy products and hard cheeses like Parmesan cheese.
- Some symptoms of lactose intolerance may be confused with symptoms of other medical conditions. For instance, the bloating and cramps that some people get after they eat dairy may just be gas caused by indigestion or constipation.
- If you think you might have an allergy to milk, talk to your doctor about getting tested for milk allergies.
- If you have a milk allergy, you may need to avoid milk and milk products. There is a difference between being lactose intolerant and having a milk allergy. If an individual with this allergy consumes foods containing dairy on accident, they will experience more severe symptoms than those who are just lactose intolerant. Those with true allergies to milk may have swelling in their mouth, face, hands or feet. They may also experience other symptoms such as hives and breathing problems.
Before jumping to conclusions and cutting things out of your diet, it’s important to seek information about what could be going on. Here at Nutriving, we encourage people to include as many foods in their diet as possible to get a variety of nutrients and feel satisfied. That being said, there are cases where people may need to limit certain foods to feel their best.
Our “Am I Lactose Intolerant Quiz” may help get you thinking about if you have any issues with dairy and want to work with a Registered Dietitian and/or speak with your doctor. You 100% deserve to feel your best, so if you don’t currently, reach out to us. We can take some steps together to get you there!
If you liked this informational post, be sure to check out some of our other informational posts:
- Is Fruit Sugar Bad For You?
- Coconut Oil: What’s the Deal?
- Monk Fruit vs Stevia: The Lowdown on These 2
DISCLAIMER: The information provided on this website is for educational purposes only and should NOT be used as individual medical or nutritional advice. The “Am I Lactose Intolerant Quiz” is NOT intended as a diagnosis, treatment, prescription or cure for any disease, and is NOT intended as a substitute for regular medical care.
References.
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- Deng Y, Misselwitz B, Dai N, Fox M. Lactose Intolerance in Adults: Biological Mechanism and Dietary Management. Nutrients. 2015 Sep 18;7(9):8020-35. doi: 10.3390/nu7095380. PMID: 26393648; PMCID: PMC4586575.
- Boyce JA, Assa’a A, Burks AW, NIAID-sponsored Expert Panel. Guidelines for the diagnosis and management of food allergy in the United States: summary of the NIAID-Sponsored Expert Panel Report. Nutrition. 2011 Feb;27(2):253-67. doi: 10.1016/j.nut.2010.12.001.
- Milk & Dairy – ACAAI Patient. (2021). Retrieved 2021, from https://acaai.org/allergies/allergic-conditions/food/milk-dairy/
- Deng Y, Misselwitz B, Dai N, Fox M. Lactose Intolerance in Adults: Biological Mechanism and Dietary Management. Nutrients. 2015 Sep 18;7(9):8020-35. doi: 10.3390/nu7095380. PMID: 26393648; PMCID: PMC4586575.
- Szilagyi A. Adult lactose digestion status and effects on disease. Can J Gastroenterol Hepatol. 2015 Apr;29(3):149-56. doi: 10.1155/2015/904686. PMID: 25855879; PMCID: PMC4399375.
- Farnetti S, Zocco MA, Garcovich M, Gasbarrini A, Capristo E. Functional and metabolic disorders in celiac disease: new implications for nutritional treatment. J Med Food. 2014 Nov;17(11):1159-64. doi: 10.1089/jmf.2014.0025. Epub 2014 Jul 29. PMID: 25072743.
- Shaukat A, Levitt MD, Taylor BC, MacDonald R, Shamliyan TA, Kane RL, Wilt TJ. Systematic review: effective management strategies for lactose intolerance. Ann Intern Med. 2010 Jun 15;152(12):797-803. doi: 10.7326/0003-4819-152-12-201006150-00241. Epub 2010 Apr 19. PMID: 20404262.
- Di Rienzo, T., D’Angelo, G., D’Aversa, F., Campanale, M. C., Cesario, V., Montalto, M., Gasbarrini, A., & Ojetti, V. (2013). Lactose intolerance: from diagnosis to correct management. European review for medical and pharmacological sciences, 17 Suppl 2, 18–25.
- Wilt, T. J., Shaukat, A., Shamliyan, T., Taylor, B. C., MacDonald, R., Tacklind, J., Rutks, I., Schwarzenberg, S. J., Kane, R. L., & Levitt, M. (2010). Lactose intolerance and health. Evidence report/technology assessment, (192), 1–410
- Tai, V., Leung, W., Grey, A., Reid, I. R., & Bolland, M. J. (2015). Calcium intake and bone mineral density: systematic review and meta-analysis. BMJ (Clinical research ed.), 351, h4183. https://doi.org/10.1136/bmj.h4183
- Information, H. (2021). Treatment for Lactose Intolerance | NIDDK. 2021, from https://www.niddk.nih.gov/health-information/digestive-diseases/lactose-intolerance/treatment
- Lactose Intolerance? Try Lactase. (2021). 2021, from https://www.verywellhealth.com/the-benefits-of-lactase-supplements-89470
About the Author: Catalina Ruz Gatica, MS, RDN, LDN
