The Ultimate Guide to Lactose Intolerance

Welcome to the ultimate guide to lactose intolerance.

As a Registered Dietitian, I have a responsibility to provide informed evidence based advice to my patients.

I frequently see people who have introduced various restrictions within their diet and completely understand why they are looking for a solution.

The concern I have is when people exclude foods with very little knowledge of why!

More recently I had a middle aged guy tell me, “ I stopped all milk because a work colleague mentioned it causes bloating”.

When we discussed this a little further it turns out this gentleman had not only excluded milk for 2 months, he had been avoiding cheese, yogurts too!

When asked if he had any improvements in his symptoms, he couldn’t recall.

Here was a guy who had completely eliminated dairy without trying any dairy alternatives.

Not only did he have a miserable time doing this, he had no improvements in his symptoms and was inadequate of dietary Calcium.

This is not the first time nor the last that uninformed choices can have a negative outcome.

The Ultimate Guide to Lactose Intolerance will help you get it right.

As you know milk plays a big part in the western diet.

And it provides a good source of protein as well as micro-nutrients including calcium and phosphorus.

Which is essential for your bone health.

And it isn’t in short supply nor is it expensive.

But there is a reason why your local supermarkets shelves are saturated with alternatives.

Alternatives that are often double the price of regular cow’s milk.

You’ve probably seen these yourself…

Coconut milk, soy milk, almond milk and more.

And all of them more expensive than regular cows milk.

So what’s the deal:

Previous marketing campaigns have told us to drink cows milk, it’s good for us right?

So why quit drinking the white stuff?

Its natural, it must be healthy right?

Well it CAN be but not always depending on your tolerance to it.

As it turns out 70% of the world population are lactose intolerant.

Which means they have issues with dairy products causing symptoms including IBS.

And if you’re reading this then you probably suspect you do too.

Which is we you see so many milk alternatives on the supermarket shelves.

So here’s what I will do:

In this Ultimate Guide to Lactose Intolerance I will address every question you have about lactose intolerance.

And provide answers to the questions you haven’t yet thought of.

The aim of this article is to help you make educated choices with diet and health.

And help you understand lactose intolerance better .

So if you do have an intolerance you can seek to minimize the discomfort it causes you.

Or so you can rule out lactose intolerance completely.

Let’s do this…

What Is Lactose Intolerance?

Here’s the science part before we get to the plain English part:

Lactose is a disaccharide sugar found in milk.

Which basically means two sugar molecules that are joined together.

These two sugar molecules Glucose and Galactose are absorbed in the small intestine pretty easily on their own but not as a disaccharide.

So in order to break the disaccharide into simple monosaccharide’s for absorption, we need an enzyme.

The enzyme needed to “chop” the double sugar into two simple sugars is Lactase.

And this is where the problem occurs.

Mammals including Humans need milk initially as a sole source of nutrition,

But then after 6 months we begin weaning and trying out solids for the first time.

Lactase production in babies is normally high as milk is the primary source of nutrition.

Until after the age of 2 where we are consuming more solid food.

This trend continues as we age, meaning we become less tolerant of lactose as we get older.

So we begin to produce less of the Lactase enzyme.

If we continue to consume large amounts of lactose without enough Lactase, we are unable to break Lactose in half.

The double sugar molecule travels down the small intestine into the large intestine where gut bacteria ferment on the sugar producing symptoms.

Just so you know:

Lactose intolerance is not the same as a milk allergy and will not promote an immune response.

But symptoms of lactose malabsorbtion can be very uncomfortable still.

We will discuss these symptoms in more detail below.

That’s the science.

Here’s what this means in plan English:

  • The small intestine does not absorb the natural sugar found in milk and dairy.
  • The milk sugar (Lactose) travels through the small intestine and into the large intestine whilst retaining water.
  • Bacteria within the large intestine ferments on the milk sugar and produces gas.
  • Extra water retention and additional gas causes bloating and discomfort.

Why You Might Be Intolerant

Believe it or not:

Your ethnicity or race can play a major factor in your intolerance to lactose.

People of African, Asian, and Hispanic origin have a greater prevalence of lactose intolerance of 50-100%.

Whereas those of north European origin can be as little as 2%.

Lactose Intolerance In Terms Of Population Group

  • South American, African 50%
  • White American) 15%
  • Black American 80%
  • Scandinavian 2%
  • Sicilian 70%
  • Source: (BDA, 2015).

And here’s why this happens:

It is thought that milk and dairy remained a larger part of the northern European diet long past infancy.

As a result the small intestine has evolved over centuries to continue to provide Lactase.

The theory being Europeans have been consuming milk for a longer period of time that they have developed the capability to absorb Lactose.

So something as simple as your race can determine how likely you are to be intolerant.

Other reasons for intolerance include:

  • Coeliac Disease
  • Crohns Disease
  • Gastroenteritis
  • Chemotherapy
  • Long use of antibiotics
  • Source: NHS,2016

And let’s look at what that means in terms of symptoms…

The Symptoms of Lactose Intolerance

Now if you suffer from lactose intolerance you’ll like be familiar with these symptoms.

But here’s a basic overview of the science before we cover the basic symptoms.

So you understand WHY these symptoms occur.

The science:

The bacteria ferment on the sugar and similar to brewing, produce a lot of gas.

The gas then causes your abdomen to stretch and distend.

This stretching can cause pain as well as flatulence in you.

Lactose also has an osmotic affect.

This basically means it draws fluid from your small intestine into the large bowel.

Too much water in your large bowel can cause further stretching of the bowel as well as diarrhea / liquid stool.

Now combine this extra fluid with the gas produced and it can be very messy indeed.

At a glance symptoms of lactose intolerance include:

  • Bloating
  • Flatulence
  • Abdominal pain
  • Explosive diarrhea

These will be the symptoms you recognize, right?

And none of them are pleasant.

As a registered dietitian I deal with patients suffering from these symptoms day in day out.

And for some of them it controls their life.

The good news is there are solutions which I will cover below…

How Lactose Intolerance Affects Your Health

Other than discomfort, flatulence, diarrhea and making you feel generally miserable, lactose intolerance itself won’t cause any harm to health.

However dietary restrictions imposed on you if you’re thought to have intolerance to lactose may have health implications.

Calcium is essential for your growth and maintenance.

Dairy is a rich source of calcium.

So excluding milk based products from your diet that is may lead to thinning of your bone, fractures and osteoporosis.

I will share below some alternatives to milk and lactose based products for you.

But first let’s look at how to figure out if you are lactose intolerant or not…

How To Find Out If You Are Lactose Intolerance

If you suspect that you may be intolerant to lactose, try excluding lactose from your diet for a couple weeks and take a note of your symptoms.

Do your symptoms lessen or disappear completely?

I have seen huge improvement in patients who suffer from lactose intolerance from trying this.

Milk exclusion is the simplest way of diagnosing whether you have lactose intolerance.

Switch up the milk in your cornflakes, tea and coffee for a cows milk alternative like Soy, Almond or Coconut milk.

Honestly I can say from personal experience they are delicious.

I will cover that in more detail below.

You can also speak to your health care provider and ask for a hydrogen breath test

Here’s the deal:

You would be asked to drink a lactose containing solution before breathing into an apparatus.

A health care provider then asks you to breathe into a balloon-type container that measures breath hydrogen level.

The test measures the amount of hydrogen you exhale when breathing.

Poor lactose absorption results in bacterial fermentation which produces hydrogen, an increase in hydrogen.

Hydrogen can then be calculated.

A high hydrogen output may suggest lactose intolerance.

A lactose tolerance test is similar to a blood sugar test.

Regular blood samples are taken following ingestion of lactose based drink.

Blood sugars can identify the absorption of lactose.

So if you suspect that you are lactose intolerant I suggest you speak to your health care provider.

Let’s look at how you can manage your intolerance…

How To Manage Your Lactose Intolerance

An estimated 75% of the world population are lactose intolerant although much fewer have any symptoms.

Simple changes to your diet to minimize consumption of lactose can help you manage it.

The severity and sensitivity of symptoms dictate how restrictive your diet should be.

You may wish to exclude lactose altogether, opting for lactose alternative products

I cover alternatives to lactose products below so keep reading.

Some people can have milk in cereal, cheese on their pizza and strawberries with cream, however a glass of milk may cause them problems.

It’s important to bear in mind that the amount of lactose consumed will have an effect on symptoms.

Smaller quantities likely won’t cause any symptoms in most people.

How To Know When You’re Consuming Too Much Lactose

This varies between individuals and depends on tolerance.

For example, you may have severe symptoms after drinking a small amount of milk, while another person can drink a large amount without having symptoms.

Other people can easily eat yogurt and hard cheeses such as cheddar and Swiss, while they are not able to eat or drink other milk products without having digestive symptoms.

The good news:

Most people with lactose intolerance can tolerate some amount of lactose in their diet and do not need to avoid milk or milk products completely.

As avoiding milk and milk products altogether may cause people to take in less calcium and vitamin D than they need.

Lactose-free and lactose-reduced milk and milk products are available at most supermarkets.

And they are identical nutritionally to regular milk and milk products.

You’re wondering if they taste as good as regular milk, right?

From my personal experience many of them do.

Soy, almond or coconut milk are all delicious in my opinion.

And many of the clients I see as a dietitian after switching have said they wouldn’t go back to cows milk.

There’s also another option:

Lactase Enyzmes.

Lactase enzymes come in the form of tablets or drops.

Enzymes can be taken when eating or drinking a lactose rich meal.

Lactase enzymes are synthetic enzymes that do exactly the same as our natural enzymes would do.  

Remember: Your symptoms are a result of not producing enough Lactase in the presence of a  lactose rich meal or drink. 

Lactose supplementation helps by breaking the disacharride into glucose and galactose.   

Improving Lactose absorption and minimizing symptoms.  

Some milks such as the one below is regular cows milk that has synthetic Lactase enzymes added to help with absorption.

This tastes just like cows milk and has the same nutritional values including Calcium and Protein.

How To Get Enough Lactose If You Are Intolerant

Although dairy produce is rich in calcium, those who who are lactose intolerant don’t necessarily have to consume milk and dairy products to get the calcium they need to maintain proper nutrition.

The following non-dairy foods are good sources of calcium and don’t contain lactose:

  • Broccoli
  • Beans
  • Spinach
  • Sardines, with edible bones
  • Salmon, canned with edible bones
  • Calcium-enriched fruit juice
  • Soy milk
  • Tofu (calcium-enriched)

Where Else To Find Lactose

Lactose is found mostly in dairy products including milk, yogurts cheese and ice cream.

However Lactase can also be found in cakes, biscuits and ready meals which is why I would suggest checking the labeling.

  • Lactose Free
  • Milk Free
  • Dairy Free

Are a good give away that a product is Lactose free!

Another tip is using a little commonsense.

If a product does contain dairy, a good way of judging the concentration is the positioning on the label.

The higher the ingredient is on the list= the greater the concentration.

The same in reverse, the lower an ingredient is on the  list =the lower the concentration.

The label above from a sponge cake has “milk emulsifier” and “whole milk powder”half way down the ingredients list.

If this was a label for ice cream, milk would likely be the first ingredient and therefore you may wish to choose a slice of cake over a serving of ice cream.

Depending on your level of sensitivity, you may want to pay extra attention to food labeling or reduce your portion sizes of certain foods.

A spot of milk in your tea or coffee is unlikely to cause any problems whereas a large glass of milk will.

Some medications can also contain lactose although very small amounts that are unlikely to cause issues.  However if you have a severe intolerance to Lactose,  you wish to discuss your medications with your  Doctor.

Some medications that contain lactose:

  • Anti anxiety medication
  • Antihistamines,
  • Muscle relaxants,
  • Pain relief,
  • Anti inflammatoy drugs
  • Source:

Wrapping This Up

Now you should have a good understanding of lactose intolerance, right?

If you takeaway anything from this article I hope it’s this:

Lactose intolerance doesn’t have to control your life.

You can manage your symptoms by reducing intake of milk and other dairy products.

Or replacing them with tasty and healthy alternatives.

Your options are still plentiful even if dairy is no longer a good option for you.

And remember:

Lactose intolerance other than the discomfort it causes (which is not to be overlooked as it’s a real problem) isn’t likely to affect your health in any major way.

So please try not to get stressed about it.

As a registered Dietitian I’ve seen many of my clients who have been diagnosed as lactose intolerant manage their symptoms and live happy lives.

It’s about making a few small changes in your life that will make your life less stressful and happier.

So now you know just about everything there is to know about lactose intolerance.

Feel free to ask questions in the comments section below…