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Diet for Lactose Intolerance

Lactose intolerance occurs when your body can't digest lactose, a sugar found in milk and milk products. Lactose intolerance happens when your small intestine does not make enough of a digestive enzyme called lactase. People who are lactose intolerant experience unpleasant symptoms (e.g., bloating, diarrhea, nausea and gas) after eating or drinking dairy products. While there is no treatment that can help your body make more lactase, you can manage the symptoms of lactose intolerance by changing your diet and/or taking supplements. It’s vital to maintain balanced nutrition while managing your diet for lactose intolerance.

What is the best diet for lactose intolerance?

The ideal diet for lactose intolerance has evolved over the years. Health experts used to recommend that people with lactose intolerance should remove all dairy products from their diet. Today, experts suggest trying different dairy foods to see which ones cause fewer symptoms. Incorporating a small amount of dairy in your diet helps ensure that you get a sufficient amount of calcium and other important nutrients.

The following tips will help you manage lactose in your diet:

  • Try small amounts. You may be able to eat or drink small amounts of dairy products without having any symptoms. Slowly add small amounts of milk or milk products and see how your body reacts. Using trial and error, your goal should be to predict your body's response to different dairy foods and figure out how much you can consume without experiencing issues.

  • Monitor and track your symptoms. Symptoms of lactose intolerance often begin about 30 minutes to 2 hours after you consume dairy foods. It can be helpful to use a food diary to keep track of what you eat and drink as well as any symptoms you experience. This information may be shared with your health care provider or dietician to assist in your dietary planning.

  • Consume milk and milk products with other foods. You may find that you experience fewer symptoms if you take milk or milk products with your meals. Try eating cheese with crackers or having milk with cereal.

  • Eat dairy products with naturally lower levels of lactose. These include hard cheeses and yogurt.

  • Choose full-fat dairy products. Some people with lactose intolerance are able to tolerate full-fat dairy products (e.g., whole milk and cheese) better than fat-free or reduced-fat dairy products.

  • Try lactose-free and low-lactose products. There are many lactose-free and low-lactose dairy products available, including milk, ice cream and cheeses. These can allow you to still enjoy dairy products. Ask your health care provider or dietitian about these products.

  • Take lactase enzyme supplements. These supplements are available over the counter. Taking the advised dose with your first drink or bite of a dairy product can help prevent symptoms. Talk with your provider about these supplements.

Fortunately, very few people with lactose intolerance have to cut out all milk products or be wary of medications that contain lactose. However, if you have trouble finding dairy products that don’t cause symptoms, talk to your health care provider. He or she can suggest other calcium-rich foods or calcium supplements.

Children with lactose intolerance should be seen by a health care provider for a comprehensive health and nutrition assessment. Children and teenagers require dairy products and other calcium-rich foods for bone growth and health.

Which foods contain lactose?

If you are lactose intolerant, it’s important to be aware of the foods that contain lactose so that you can manage your diet closely. Lactose is found in a variety of dairy products, including the following:

  • Milk

  • Cheese

  • Yogurt

  • Ice cream

  • Sherbet

  • Milk chocolate

  • Sour cream

Unfortunately, lactose can be hidden in some little-known ingredients on food labels. When checking food labels, look for the following items that contain lactose:

  • Milk

  • Milk solids

  • Skim milk powder

  • Cream

  • Buttermilk

  • Malted milk

  • Whey lactose

  • Curds

  • Margarine

In addition, some boxed, canned, frozen or prepared foods may have hidden sources of lactose. Be sure to read the labels of the following processed foods:

  • Breads

  • Candy

  • Cookies

  • Cold cuts

  • Hot dogs

  • Bologna

  • Sauces and gravies

  • Dessert mixes

  • Cream soup

  • Frostings

  • Chocolate drink mixes and candies

  • Salad dressing

  • Potato chips

The following food additives are considered lactose free and are safe to use by those following a diet for lactose intolerance:

  • Casein

  • Caseinate

  • Lactalbumin

  • Lactate

  • Lactic acid

  • Lactylate

What are some sources of calcium for a lactose-intolerant diet?

Calcium and vitamin D are needed for strong bones and teeth. If you are not using milk or milk products because you are following a lactose-intolerant diet, you may not be getting enough calcium and vitamin D from your food. Ask your health care provider or dietitian for more information about your body's specific calcium and vitamin D needs.

If you’ve had to reduce or eliminate dairy due to lactose intolerance, consider increasing your intake of other calcium-rich foods. The following foods are good sources of calcium:

300 mg calcium

  • 4 ounces canned salmon

  • 1 cup calcium-fortified orange juice

  • 1/4 cup almonds

  • 1 cup yogurt

150 mg calcium

  • 2 ounces canned sardines

  • 1/2 cup turnip greens, kale or collards

  • 1/2 cup tofu

  • 1 1/2 cups dried beans

100 mg calcium

  • 2/3 cup broccoli

  • 1/2 cup okra

  • 5 ounces shrimp

  • 2 cups cabbage

What are substitutes for dairy products?

If you are following a diet for lactose intolerance, there are several dietary substitutions that can be made to replace dairy products with more easily digestible foods. Consider the following examples:

 

Swap This

 

 

For That

 

Butter

Coconut, canola or olive oil

Milk

Soy, rice, cashew or almond milk

Coffee creamer

Almond milk

Cream cheese

Goat cheese

Pizza

Soy cheese pizza

Milk chocolate

Dark or semi-sweet chocolate

Ice cream

Soy/coconut ice cream, sorbet or blended frozen bananas

Whipped cream

Whipped coconut cream

Before choosing a dairy substitute, health experts recommend analyzing the food label and considering the nutritional content. You should be aware of any added sugars, fillers (to improve texture) or micronutrients. Also, check for the food’s protein content and any potential allergen/intolerance triggers (e.g., nuts). It’s important to balance the nutrition of your dairy substitutes with your regular diet. Since many nondairy options are expensive, you may want to try making your own nondairy substitutes.

Do lactase enzymes work?

If you are lactose intolerant, you may try to take a lactase enzyme with your first bite or drink of a dairy product to help your body break down the lactose. Several types (e.g., drops and capsules) and brands (e.g., Dairy Ease and Lactaid) of lactase enzyme supplements are available. According to a 2016 study published by Current Drug Metabolism journal, lactose-intolerant patients reported a significant improvement in symptoms with the use of lactase enzyme soft gel capsules, caplets and chewable tablets. However, not everyone with lactose intolerance will experience relief by using lactase enzymes. Side effects are rarely reported from the use of these supplements.

Can probiotics help with lactose intolerance?

Probiotics are live microorganisms that can improve your digestive health. Several studies and clinical trials have been conducted to determine if probiotics can help those with lactose intolerance. According to Critical Reviews in Food Science and Nutrition, accumulating evidence shows that probiotics can help reduce the symptoms caused by lactose intolerance. However, not all lactose-intolerant patients will respond favorably to probiotics. To see if probiotics alleviate your symptoms, your doctor may recommended probiotic supplements or fermented dairy products.

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