Lactose Free Diet

Lactose IntoleranceAccording to the National Institutes of Health, between 30 and 50 million Americans suffer from lactose intolerance. Lactose intolerance affects people differently; some people can tolerate lactose in smaller servings, while others cannot digest any lactose.

Finding just the right diet after a diagnosis of lactose intolerance, therefore, will be different for each person. People who have trouble digesting lactose will have to learn which dairy products and other foods they can eat without discomfort and which they should avoid.

Why is changing my diet important?

It is very difficult to completely avoid lactose in your diet, because it is found in many foods. In addition to dairy products, which contain a great deal of lactose, there are many other foods (e.g. canned goods, delicatessen meats) that contain lactose.

You’ll also need to be careful when removing lactose from your diet because milk and milk products such as yogurt, ice cream and cheese contribute 73 percent of the calcium in the average American’s diet. Excluding these foods can leave you without enough calcium in your diet. Calcium is essential for the growth and repair of bones throughout life. In your early years, you need calcium to build strong bones as you grow. In the middle and later years, a shortage of calcium may lead to thin, fragile bones that break easily – a condition called osteoporosis. A concern, then, for both children and adults with lactose intolerance, is getting enough calcium in a diet that includes little or no milk.

What changes can I make?

If you are highly lactose intolerant and not able to digest any lactose, you’ll likely have to make some major changes in your eating habits, to remove all dairy and dairy-derivative ingredients from the foods you eat. Most people, however, are not completely lactose intolerant and can live quite comfortably by making a few modifications to the foods they choose.

Other options:

How much calcium do I need?

The amount of calcium a person needs to maintain good health varies by age group:

Age Group Amount of calcium to consume daily, in miligrams (mg)
0-6 months 210mg
7-12 months 270 mg
1-3 years 500 mg
4-8 years 800 mg
9-18 years 1300 mg
19-50 years 1000 mg
51-70+ years 1200 mg

Also, pregnant and nursing women under 19 need 1,300 mg daily, while pregnant and nursing women over 19 need 1,000 mg.

Good sources of calcium

When planning meals, make sure that each day's menu includes enough calcium, even if you’re not eating any dairy products. Many nondairy foods are high in calcium. Green vegetables, such as broccoli and kale, and fish with soft, edible bones, such as salmon and sardines, are excellent sources of calcium. To help in planning a high-calcium and low-lactose diet, the table below lists some common foods that are good sources of dietary calcium and shows how much lactose they contain.

Recent research shows that yogurt with active cultures may be a good source of calcium for many people with lactose intolerance, even though it is fairly high in lactose. Evidence shows that the bacterial cultures used to make yogurt produce some of the lactase enzyme required for

Vegetables Calcium Content Lactose C
Calcium-fortified orange juice, 1 cup 308-344mg
Sardines, with edible bones, 3 oz. 270 mg 0
Salmon, canned, with edible bones, 3 oz. 205 mg 0
Soymilk, fortified, 1 cup 200 mg 0
Broccoli (raw), 1 cup 90 mg 0
Orange, 1 medium 50 mg 0
Pinto beans, 1/2 cup 40 mg 0
Tuna, canned, 3 oz. 10 mg 0
Lettuce greens, 1/2 cup 10 mg 0

Dairy Products Calcium Content Lactose C
Yogurt, plain, low-fat, 1 cup 415 mg 5 g
Milk, reduced fat, 1 cup 295 mg 11 g
Swiss cheese, 1 oz. 270 mg 1 g
Ice cream, 1/2 cup 85 mg 6 g
Cottage cheese, 1/2 cup 75 mg 2-3 g
Adapted from Manual of Clinical Dietetics. 6th ed. American Dietetic Association, 2000; and Soy Dairy Alternatives. Available at: www.soyfoods.org. Accessed March 5, 2002.

Clearly, many foods can provide the calcium and other nutrients the body needs, even when intake of milk and dairy products is limited. However, factors other than calcium and lactose content should be kept in mind when planning a diet. Some vegetables that are high in calcium (Swiss chard, spinach, and rhubarb, for instance) are not listed in the chart because the body cannot use the calcium they contain. They contain substances called oxalates, which stop calcium absorption.

Calcium is absorbed and used only when there is enough vitamin D in the body. A balanced diet should provide an adequate supply of vitamin D. Sources of vitamin D include eggs and liver. However, sunlight helps the body naturally absorb or synthesize vitamin D, and with enough exposure to the sun, food sources may not be necessary.

What about calcium supplements?

Some people with lactose intolerance may think they are not getting enough calcium and vitamin D in their diet. It may be helpful to speak to your doctor or dietician to help decide whether any dietary supplements are needed. If you take vitamins or minerals of the wrong kind or amounts it could be harmful to you. A dietician can help you plan meals that will provide the most nutrients and at the same time will minimize abdominal discomfort.

Watch for Hidden Lactose

Although milk and foods made from milk are the only natural sources, lactose is often added to prepared foods. People with very low tolerance for lactose should know about the many food products that may contain even small amounts of lactose, such as:

Some products labeled non-dairy, such as powdered coffee creamer and whipped toppings, may also include ingredients that are derived from milk and therefore contain lactose.

Smart shoppers learn to read food labels with care, looking not only for milk and lactose among the contents, but also for such words as:

If any of these are listed on a label, the product contains lactose.

In addition, lactose is used as the base for more than 20 percent of prescription drugs and about 6 percent of over-the-counter medicines. Many types of birth control pills, for example, contain lactose, as do some tablets for stomach acid and gas. However, these products typically affect only people with severe lactose intolerance.

Points to Remember