Deal With Lactose Intolerance

If you are lactose intolerant, drinking milk or eating dairy products might cause diarrhea, gas, or bloating – uncomfortable but generally harmless symptoms. This is because your body does not digest the sugar in dairy (lactose) properly. You can probably manage your condition without having to give up all dairy, which is ideal because dairy products are great sources of calcium and vitamin D. Once you’ve confirmed you are lactose intolerant, manage the condition by knowing what foods to limit and how to approach dairy to minimize your symptoms.

Steps

Minimizing Symptoms When Eating Dairy

1. Test your tolerance to specific products. Start by going dairy-free for several days. Then choose a day to attempt consuming one specific dairy product (for instance, eat cheese that day but no other dairy). Keep track of your symptoms. This way you can determine if there are certain products that do not upset your stomach. Very few people have such severe intolerance that they cannot eat dairy at all.
   • Swiss, cheddar, and other hard cheeses have lower lactose and might cause fewer symptoms than soft cheese like ricotta and brie.
   • Some people who are lactose intolerant can eat yogurt without a problem because of the bacteria cultures in it.
   • Low-fat and fat-free ice cream, hard cheese, cottage cheese, and yogurt contain less lactose per serving than milk. Some people who cannot drink milk can tolerate these other products in moderation.
2. Stick to small servings of dairy. Do not overwhelm your body with lactose. Try to limit drinking milk to 4 ounces at a time (118 ml) or less. Drink low-fat or fat-free milk instead of whole milk.
   • It’s likely that you can have some amount of dairy, and just have to discover your limit. Start with a very small serving of one dairy product, and if you do not have any symptoms, then try a larger serving the next day. With trial and error, you can determine what you can eat, and how much of it, without symptoms.
3. Increase dairy consumption gradually. There’s no “cure” for lactose intolerance, but you may be able to make symptoms tolerable or even non-existent. Eliminate dairy products from your diet, and then begin to introduce them slowly. You may be able to help your body acclimate to increasing levels of dairy.
4. Consume dairy with meals. You’re less likely to get symptoms if you have dairy with other food. Taking dairy with meals makes it easier for your body to digest everything, and will likely cause fewer symptoms for you than just having dairy on its own.
5. Get products that are lactose-reduced. Because lactose intolerance is so prevalent, many grocery stores carry lactose-reduced or lactose-free products. These generally do not taste any different than regular dairy products. Lactose-free products shouldn’t cause you any stomach upset; whether or not you get symptoms from lactose-reduced products depends on your body and how much lactose is still in the product.
   • Lactaid is a lactose-free milk product, for instance.
6. Include the lactose enzyme in your meal. Lactase is the enzyme that breaks down lactose in your body (most people are lactose intolerant because their body doesn’t have enough lactase). You can get tablets or drops from your drug store, usually over-the-counter, which contain lactase. These products come in different forms. Some you take as a tablet before eating lactose; others are liquids or powders that you add to dairy products.
   • Dairy Ease and Lactaid are some examples, but there are more. Some brands of milk even contain the lactase enzyme to minimize the lactose in the milk; look for this on the label.
   • Using these products can be helpful if you’re unsure of the lactose content of a meal, like if you’re eating at a restaurant.
   • These products don’t help everyone who is lactose intolerant. Some people are lactose intolerant for a different reason than lactase deficiency.
7. Try taking probiotics. In their natural state, probiotics are tiny organisms that live in your gut and help you digest food and keep your intestines healthy. You can also get probiotics in capsule form from your pharmacy (usually over-the-counter). Taking probiotics may help ease diarrhea and symptoms of lactose intolerance, and can be tried if other treatments don’t work.
   • Probiotics are considered generally safe, but you should still check with your doctor before taking them to make sure they won’t interfere with any other health conditions or medications you take.

Recognizing Dairy Products

1. Read product labels. Items that you might not expect to contain milk might actually have dairy, lactose, whey or other ingredients that can cause symptoms for the lactose intolerant. Be sure to read the Ingredients list on food items so you know what you’re consuming.
   • Avoid or limit anything that directly states “lactose” in the ingredients. Be sure to check products like margarine, salad dressing, non-dairy creamer, baked products and pastries, and shortening.
2. Replace milk with non-dairy options. There are many products on the market that you can use to substitute for milk. Soy milk, rice milk, and almond milk are the most common, and often come in plain and flavored varieties. You can usually also use non-dairy creamer (though be sure to check the label for lactose).
   • Stay away from other milk products like cream, buttermilk, malted milk, evaporated and condensed milk, and Kefir cultured milk.
   • To avoid all lactose, also exclude the following from your diet: cheese (including ricotta), cottage cheese, ice cream, whipped cream, sherbert, butter, cream cheese, hot cocoa mix, sour cream, yogurt, pudding, custard, and whey.
3. Know what goes in to your starches. Breads and starches on their own don’t always contain lactose if they’re made fresh and without additives. However, avoid pre-made products like instant mashed potato mixes and frozen pre-made meals – or at least carefully read the ingredients.
   • Baked goods (cookies, cakes, pies, etc.) and breads may or may not be made with milk, so use caution.
4. Watch out for hidden dairy ingredients. Milk, cheese, and other products that contain lactose can sometimes show up in meals and snacks that you wouldn’t expect. Be on the lookout for items that might contain hidden lactose:
   • Dips, for instance spinach and artichoke dip. These often contain cheese. Opt for salsa or hummus instead.
   • Creamed vegetables (creamed peas, creamed corn) and cream-based soups (white chowders, for instance).
   • Smoothies that contain yogurt
   • Vegetables and meats that are coated in batter, i.e. fried.
   • Cheese in things like pizza, burritos, casseroles, and in salads
   • Confections such as toffee, caramel, and butterscotch
   • Processed snacks like potato chips
5. Ask your doctor about the medications you take. Even some medications contain lactose. The birth control pill might, as well as over-the-counter medicines to treat gas and acid reflux. If you have severe lactose intolerance and are taking these medications, talk to your doctor about possibly switching to another option.

Diagnosing and Discussing Your Condition

1. Keep a food diary. Create a record of your dairy consumption and symptoms from day to day. Keep track of what dairy foods you eat (milk, yogurt, ice cream, cheese, cottage cheese), the serving size, what time you eat them, and what you eat with them. In another column, keep track of when you have symptoms, what the symptoms are, and how long they last. This can help you and your doctor make a diagnosis, and figure out which foods are most likely to give you symptoms.
   • Use a notebook, journal, online tool like excel or Google Docs, or wall chart – whatever helps you stay organized. If you want to keep your symptoms private, use something hand-held that only you can access.
2. Experiment with dairy deprivation. If you think you may be lactose intolerant, try to avoid eating dairy for a couple days or even 1-2 weeks. Make note of whether or not your symptoms subside or go away. Inform your doctor if your symptoms improve when you don’t have dairy.
3. See your doctor to get tested. Bloating, cramps, gas, diarrhea, or stomach noise after eating might be caused by lactose intolerance. However, you want to be sure you know what is causing your symptoms, and rule out any other possible reasons for your stomach upset. Make a doctor’s appointment to get tested, and discuss the possible cause of your lactose intolerance. There are a few different kinds of tests that your doctor can do:
   • For a lactose tolerance test, you drink a liquid containing lots of lactose and have a blood test done two hours later.
   • For the hydrogen breath test you also drink a high-lactose liquid, and then your doctor measures how much hydrogen is in your breath at set intervals.
   • A stool acidity test simply checks a stool sample; it is used for infants or children who can’t do the other tests.
4. Explain lactose intolerance to others. It might feel stressful if you have to change your diet, and you might be worried about what others will think. Fortunately, many people eat specific diets and you can explain your condition to others however you want to. Be vague, offer a simple explanation, or – if you want – wow others with your scientific knowledge!
   • It’s okay to say simply, “Dairy upsets my stomach so I try to stay away from it,” or, “If I have too much milk, I feel sick.”
   • You can also be specific, if you want to educate others. Say something like, “I’m lactose intolerant because I don’t have enough of the enzyme in my body that breaks down the sugar in milk, lactose.”
5. Address myths and misunderstandings. Some people might think that if you drink a sip of milk or can eat yogurt, you’re lying about being lactose intolerant. Many people simply don’t understand the condition. Explain that most people who are lactose intolerant can eat some dairy products and not others, or dairy in small amounts.
   • You can try to explain to people using an example, such as, “It probably wouldn’t affect you very much if you drink half a cup of coffee, but if you drink four espressos you might feel jittery, right? That’s how I am with dairy – a little is okay, a lot makes me feel sick.”
   • You can also explain that you’re not allergic to milk, so drinking it isn't unsafe. Explain that it’s the sugar in dairy that upsets your stomach, and there’s more milk sugar in some things (like whole milk) than others (like dairy and hard cheeses).

Tips

• Eat other calcium-rich foods if you have to minimize your dairy. Broccoli, oranges, pinto beans, spinach, rhubarb, soy and rice milk, canned salmon, and calcium-fortified products like bread and juice are great choices.
• Be sure to get enough vitamin D, as well. Eggs, liver, and yogurt contain lots of vitamin D. Be sure to get some sun, too – your body makes vitamin D when your skin is exposed to sunlight. Talk to your doctor if you are concerned you’re not getting enough calcium or vitamin D.

Warnings

• Ask a doctor before taking any medications.
• See your doctor if you have severe symptoms after eating dairy, especially if you are concerned you aren’t getting enough calcium.
• Watch out for and avoid “sweet whey powder” or “whey powder” in processed products.

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