By: Courtney Morrissey MS, RDN, LD
Lactose intolerance is a common digestive condition that causes gastrointestinal (GI) discomfort after consuming foods or beverages containing lactose. Lactose is the natural sugar found in milk and dairy products, and it requires the enzyme lactase, produced in the small intestine to be properly digested. When the body does not produce enough lactase, lactose is not fully broken down, leading to symptoms.
As we age, lactase production naturally declines. This decrease is more pronounced in certain populations and can result in symptoms such as abdominal pain, cramping, bloating, gas, diarrhea, and nausea after consuming dairy products.
It is important to note that lactose intolerance is not the same as a milk allergy. Lactose intolerance affects digestion and typically causes discomfort, whereas a milk allergy involves the immune system and can lead to more serious reactions, such as hives, swelling, or difficulty breathing.
In North America, approximately 35% of the population is affected by lactose intolerance. Globally, an estimated 65–70% of individuals experience some degree of lactose malabsorption. The condition is more prevalent among East Asian, Native American, African, and Hispanic/Latino populations, and is slightly more common in males.
How Is Lactose Intolerance Diagnosed?
Lactose intolerance is often identified based on symptoms and dietary patterns. A healthcare provider may recommend temporarily eliminating lactose-containing foods to see if symptoms improve, followed by a gradual reintroduction to assess tolerance.
In some cases, more formal testing may be used. The most common test is the hydrogen breath test, which measures hydrogen levels in the breath after consuming lactose. Elevated levels can indicate that lactose is not being properly digested. Other methods, such as stool acidity tests (more common in infants and young children), may also be used.
If you suspect lactose intolerance, it is important to consult with a healthcare provider to confirm the diagnosis and rule out other gastrointestinal conditions.
Can You Still Eat Dairy? Absolutely!
Most individuals with lactose intolerance can tolerate small amounts of lactose without significant symptoms. Rather than eliminating dairy entirely, many people can manage symptoms by reducing portion sizes or spreading lactose intake throughout the day.
Some dairy products naturally contain lower amounts of lactose and are often better tolerated. These include aged cheeses (such as cheddar, Swiss, and mozzarella), as well as butter, sour cream, and yogurt. Fermented dairy products like yogurt may be easier to digest because they contain beneficial bacteria that help break down lactose.
Alternatives and Nutritional Considerations
For those who prefer to avoid lactose altogether, there are many alternatives available. Lactose-free milk and plant-based products such as oat, soy, almond, rice, or coconut milk, yogurt, and cheese can serve as suitable substitutes.
However, these alternatives may be lower in key nutrients commonly found in dairy, including calcium, vitamin D, and vitamin B12. Choosing fortified products can help bridge this gap. If dietary intake is insufficient, supplementation may be necessary but this should always be discussed with a healthcare provider to ensure safety and appropriate dosing.
Key Nutrient Dietary Intake Recommendations (DRI)
Calcium
- Infants (0–6 months): 200 mg/day
- Infants (7–12 months): 260 mg/day
- Children (1–3 years): 700 mg/day
- Children (4–8 years): 1,000 mg/day
- Adolescents (9–18 years): 1,300 mg/day
- Adults (19–50 years): 1,000 mg/day
- Older adults (51+ years): 1,200 mg/day
Vitamin D
- Infants (0–12 months): 400 IU (10 mcg)/day
- Children and adults (1–70 years): 600 IU (15 mcg)/day
- Older adults (70+ years): 800 IU (20 mcg)/day
Vitamin B12
- Infants (0–6 months): 0.4 mcg/day
- Toddlers (1–3 years): 0.9 mcg/day
- Children (4–8 years): 1.2 mcg/day
- Children (9–13 years): 1.8 mcg/day
- Teens and adults (14+ years): 2.4 mcg/day
Conclusion
Lactose intolerance is common, but it doesn’t have to limit your diet as much as many people think. With the right approach whether that’s adjusting portion sizes, choosing lower-lactose foods, or using lactose-free or fortified alternatives, you can still maintain a balanced and nutrient-rich diet. Understanding your personal tolerance level and making informed choices can help you manage symptoms while supporting your overall health.
