Lactose intolerance is a condition that affects many people, but it can be managed and even reversed with the right kind of regimen and diet.
Lactose is a disaccharide, or sugar, composed of glucose and galactose, found in milk from mammals such as cows, goats, sheep, buffalo, camels, and humans. Lactose content ranges from 2% to 8% in liquid dairy milk, depending on the source. According to the US Department of Agriculture’s food database, whole-fat cow’s milk contains between 11.3g and 12g of lactose per single-cup serving (up to 5%), with slightly higher amounts in lower fat milks. In comparison, goat’s milk contains less lactose, ranging from 10g to 11.5g per cup (up to 4.6%). Camel’s milk, not widely available but gaining in popularity, contains the least lactose per cup – about 10g (4%).
What is lactose intolerance?
Lactose intolerance is the reduced ability to break down lactose properly in the digestive tract, due to a deficiency of the enzyme lactase. If you eat or drink lactose but have too little lactase available in your small intestine, the partially undigested lactose travels to your colon, where it is fermented by bacteria. Symptoms such as abdominal pain, bloating, gas, cramping and/or diarrhea follow from 30 minutes to two hours after ingestion. Symptom severity and lactose tolerance threshold are highly variable from person to person.
There are three main types of lactose intolerance: congenital, primary and secondary. Rarely, lactase deficiency may exist at birth (congenital), but more often it gradually develops over time during the aging process (primary), or spontaneously after illness or infection (secondary). Lactase deficiency and/or lactose intolerance may be a temporary state as the body heals, or may persist indefinitely.
Lactose intolerance is different from a milk allergy. Lactose intolerance is malabsorption of one or more sugars, whereas an allergy involves immune reactions to one or more ingested antigens or proteins. A milk allergy is a dangerous medical condition that can result in anaphylaxis and even death after exposure. Lactose intolerance, while uncomfortable and even painful at times, does not carry the same immediate risks to health.
How common is lactose intolerance?
Lactose is the most common intolerance worldwide, affecting more than 65% of the global population, or over five billion people. Those of East Asian, African, Jewish, Greek, Arab and Italian descent have significantly higher rates of lactose intolerance.
What makes people more susceptible?
Risk factors for developing lactose intolerance include ethnicity, older age, immediate family history, damage to the small intestine through injury or disease, certain cancer treatments, and long-term dairy avoidance.
Lactose intolerance is most commonly diagnosed at your doctor’s office by one of two primary methods: a lactose tolerance test, or a hydrogen breath test.
The tolerance test measures blood glucose levels two hours after you’ve consumed a specific amount of lactose. An insufficient rise in glucose means you are poorly digesting and therefore not absorbing lactose.
The hydrogen test measures levels of gasses in your breath over a 2-3 hour period. Too much hydrogen means you aren’t properly digesting and absorbing lactose.
Recommended treatments of lactose intolerance include dietary changes, supplements and/or addressing any underlying health conditions.
Foods to reduce
To preserve your intestinal health, and avoid chronic inflammation and/or the development of leaky gut syndrome, lactose intolerance must be managed. Foods containing high levels of lactose will need to be reduced, or even avoided, depending on your severity of symptoms.
Foods high in lactose include:
- Liquid dairy milk from cows, sheep, and buffalo.
- Non-fat dry milk powder.
- Evaporated and condensed milk.
- Soft cheeses like ricotta, cream and cottage cheeses.
- Ice cream.
- Heavy cream.
- Sour cream.
Foods you may tolerate
Some foods are lower in lactose, or contain bacteria that help pre-digest the lactose for you. These often-tolerated foods include:
- Hard cheeses like Parmesan, Cheddar and Swiss.
- Feta cheese.
- Camel’s milk (due to low lactose levels, camel milk may be an advantageous milk alternative, carrying less possibility of digestive symptoms, and may even be a safe alternative for those with milk allergies).
You can bolster your ability to tolerate lactose by supplementing your diet with lactase-containing supplements before meals. These supplements come in powder, capsule, tablet, or liquid form. Lactose-free milk is also widely available.
Lactose intolerance – or something else?
If you've been diagnosed with lactose intolerance and have reduced your lactose intake, but are experiencing limited relief, you may need further medical assessment to rule out other digestive conditions. Celiac disease, small intestinal bacterial overgrowth (SIBO), irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD) often coexist with lactase deficiency and lactose intolerance, and may require medical intervention to help you feel your best.
Other tips to manage intolerance
In addition to reducing your lactose intake and taking lactase supplements, other strategies may also help you manage and/or reverse your lactose intolerance.
- Consider taking a probiotic containing the healthy lactase-producing gut bacteria Lactobacillus and Bifidobacterium, and continue to include the lactose-containing foods you do tolerate to boost their presence in your diet.
- Eat small portions of lactose-containing foods spread throughout the day, rather than a large quantity at once.
- Build up your dairy intake gradually over several weeks or months, to attempt to increase your lactase production and tolerance.
- Improve chronic inflammation by consistently exercising, prioritizing quality sleep, eating vegetables as well as foods rich in omega-3, and managing any diseases or conditions you may have.
Lactose intolerance is highly prevalent worldwide. Eating and drinking lower lactose-containing foods, and/or supplementing with lactase enzymes, among other strategies, can help significantly improve symptoms.